ABSTRACT
Introduction: European guidelines recommend the implementation of lipid-lowering therapies (LLTs) in adults (≥ 65 years) with established atherosclerotic cardiovascular disease (ASCVD) and for risk-based primary prevention in older adults (≤ 75 years), yet their use in very-old adults (> 75 years) is controversial, discretionary, and oriented on the presence of risk factors. The aim of this retrospective study is to assess guideline-directed LLT implementation and low-density lipoprotein cholesterol (LDL-C) target achievement in high-/very-high-risk older/very-old adults (65-74 and ≥ 75 years) at presentation for ST-segment elevation myocardial infarction (STEMI) and also to assess evidence-based care delivery to older adults in our region. Methods: All STEMI patients with available LDL-C and total cholesterol presenting for treatment at a large tertiary center in Salzburg, Austria, 2018-2020, were screened (n = 910). High-risk/very-high-risk patients (n = 369) were classified according to European guidelines criteria and divided into cohorts by age: < 65 years (n = 152), 65-74 years (n = 104), and ≥ 75 years (n = 113). Results: Despite being at high-/very-high-risk, prior LLT use was < 40% in the total cohort, with no significant difference by age. Statin monotherapy predominated; 20%-23% of older/very-old adults in the entire cohort were using low-/moderate-intensity stains, 11%-13% were using high-intensity statins, 4% were on ezetimibe therapy, and none were taking proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. In the secondary prevention cohort, 53% of older/very-old patients used prior LLTs. Significantly higher percentages of older/oldest ASCVD patients (43% and 49%) met LDL-C targets < 70 mg/dL compared to patients < 65 years (29%; p = 0.033), although just 22% and 30% of these older groups attained stricter LDL-C targets of < 55 mg/dL. Low LLT uptake (16%) among older adults aged 64-74 years for primary prevention resulted in 17% and 10% attainment of risk-based LDL-C targets < 70 mg/dL and < 55 mg/dL, respectively. Oldest adults (≥ 75 years) in both primary and secondary prevention groups more often met risk-based targets than older and younger adults, despite predominantly receiving low-/moderate-intensity statin monotherapy. Conclusion: Secondary prevention was sub-optimal in our region. Less than half of older/very-old adults with established ASCVD met LDL-C targets at the time of STEMI, suggesting severe care-delivery deficits in LLT implementation. Shortcomings in initiation of risk-based LLTs were also observed among high-/very-high-risk primary prevention patients < 75 years, with the achievement of risk-based LDL-C targets in 10%-48% of these patients.
ABSTRACT
Background: Pathological Altruism and the concept of Helper Syndrome are comparable. We focused on Schmidbauer's description because it provides a comprehensive and testable definition. Nevertheless, this concept of Helper Syndrome has not yet been empirically investigated in a sample of helping professionals. Aim: To investigate whether nurses working with covid-19 patients are more likely to have Helper Syndrome compared with individuals from non-helper professions. Methods: The online survey took place between April 2021 and February 2022, in urban and rural regions of Salzburg, during the time of the COVID-19 pandemic. Nurses (n = 447) and controls (n = 295) were compared regarding Helper Syndrome characteristics. To measure characteristics of Helper Syndrome the following questionnaires were used: WHO-Five (WHO-5), selected scales of the Personality, Style and Disorder Inventory (PSSI) and the Freiburg Personality Inventory-Revised (FPI-R), the Alcohol Use Disorders Identification Test (AUDIT). Insecure gender identity and self-assessment of having a Helper Syndrome was measured by a Likert scale. Results: In both groups, Helper Syndrome was detected (nurses 29.5%, controls 30.5%). Participants with Helper Syndrome showed significant differences in personality styles and traits, namely significantly higher scores for Foreboding-Schizotypical Personality Style, Spontaneous-Borderline Personality Style, Amiable-Histrionic Personality Style, Ambitious-Narcissistic Personality Style, Loyal-Dependent Personality Style, Helpful-Selfless Personality Style, Carefully-Obsessive Personality Style, Optimistic-Rhapsodic Personality Style, Social Orientation, Strain, Emotionality and lower well-being. The only difference between nurses and controls was that nurses were significantly less open aggressive. Conclusion: For the first time, we were able to demonstrate Schmidbauer's concept of Helper Syndrome. According to our data, we found a subgroup of individuals similar to Schmidbauer's description of Helper Syndrome, but this sample was independent of helping or non-helping profession. These individuals seem to be at higher risk for psychiatric disorders.
ABSTRACT
The aim of this retrospective study was to provide real-world data on lipid-lowering therapy (LLT) implementation and low-density lipoprotein cholesterol (LDL-C) target achievement in an ST-segment elevation myocardial infarction (STEMI) population, with a focus on very-high-risk patients according to European guidelines criteria. METHODS: Included were all STEMI patients with available LDL-C and total cholesterol treated at a large tertiary center in Salzburg, Austria, 2018-2020 (n = 910), with stratification into very-high-risk cohorts. Analysis was descriptive, with variables reported as number, percentages, median, and interquartile range. RESULTS: Among patients with prior LLT use, statin monotherapy predominated, 5.3% were using high-intensity statins, 1.2% were using combined ezetimibe therapy, and none were taking PCSK9 inhibitors at the time of STEMI. In very-high-risk secondary prevention cohorts, LLT optimization was alarmingly low: 8-22% of patients were taking high-intensity statins, just 0-6% combined with ezetimibe. Depending on the very-high-risk cohort, 27-45% of secondary prevention patients and 58-73% of primary prevention patients were not taking any LLTs, although 19-60% were actively taking/prescribed medications for hypertension and/or diabetes mellitus. Corresponding LDL-C target achievement in all very-high-risk cohorts was poor: <22% of patients had LDL-C values < 55 mg/dL at the time of STEMI. CONCLUSION: Severe shortcomings in LLT implementation and optimization, and LDL-C target achievement, were observed in the total STEMI population and across all very-high-risk cohorts, attributable in part to deficits in care delivery.
ABSTRACT
Background: According to literature, the COVID-19 pandemic caused stressful working conditions for nurses, which may have a negative impact on their Well-Being and mental health. Aim: To investigate whether nurses and non-helping professionals differ in their Well-Being. Furthermore, we analyzed, for the first time, which personality traits and styles are a risk factor for nurses' wellbeing during COVID-19 pandemic. Methods: In an online survey, the following psychological tests were used on nursing staff (n = 518) and non-helping professionals (n = 335): WHO-Five (WHO-5), the Personality, Style and Disorder Inventory (PSSI), and the Freiburg Personality Inventory-Revised (FPI-R). Results: Nurses and non-helping professionals did not differ significantly in terms of Well-Being. The Well-Being of nurses was correlated with the following personality traits and styles, namely Spontaneous-Borderline Personality Style, Silent-Depressive Personality Style, Strain, Emotionality, and Life Satisfaction. According to our results, 33% of participants suffered from clinically significant depressive symptoms. Discussion: According to our results, nurses are not more at risk for depression. However, it was shown that Well-Being during the pandemic is highly dependent on personality. Conclusion: Specific personality traits and styles are a greater predictor of depressive symptoms than profession. The stressful occupational environment during COVID-19 pandemic is not the only cause for depressive symptoms in nurses. Psychotherapeutic interventions are especially important for particular individuals and are necessary to prevent depressive symptoms during COVID-19 pandemic.
