Cholesterol goal attainment in patients with coronary heart disease and elevated coronary risk: results of the Hong Kong hospital audit study.

OBJECTIVE: We sought to determine 1) long-term lipid-lowering treatment patterns; 2) cholesterol goal attainment rates and possible determinants of goal achievement; and 3) effects of cholesterol goal attainment on coronary events in hospitalized Hong Kong patients. METHODS: In this retrospective cohort analysis, records of two public Hong Kong hospitals were reviewed for 196 adults (69% with coronary heart disease (CHD) or CHD-risk equivalent) who received at least one lipid-lowering therapy during hospitalization. Low-density lipoprotein cholesterol (LDL-C) targets were <2.6 mmol/l (<100 mg/dL) for patients with CHD or CHD risk equivalents and <3.37 mmol/l (<130 mg/dL) for those without. RESULTS: Most participants were initiated on regimens of low to midequipotency doses and never had their regimens adjusted to higher potency. Approximately 44% of patients not at LDL-C at baseline failed to achieve goal during a median follow-up of 1.9 years. Patients with higher coronary risk and/or LDL-C levels at baseline were less likely than their lower-risk counterparts to achieve goal; for each 1-mmol/l (38.7-mg/dL) increase in LDL-C at baseline, the likelihood of attaining goal declined by 64%. Patients achieving cholesterol goal had significantly longer cardiovascular event-free times. CONCLUSIONS: A total of 44% of Hong Kong patients not at LDL-C goals at baseline did not achieve them over 1.9 years. More effective and well-tolerated therapies, including adjunctive regimens (e.g., ezetimibe-statin, niacin-statin), may be necessary to enhance LDL-C goal achievement and increase event-free time.

Effect of severe acute respiratory syndrome on bystander willingness to perform cardiopulmonary resuscitation (CPR)--is compression-only preferred to standard CPR?

OBJECTIVE: The effect of the severe acute respiratory syndrome (SARS) outbreak on the willingness of laypersons to provide bystander cardiopulmonary resuscitation (CPR) using standard CPR (SCPR) or compression-only CPR (CCPR) was evaluated. The preferred type of SCPR in the post-SARS era was assessed. METHODS: A descriptive study was conducted through telephone interviews. Persons who attended a CPR course from January 2000 through February 2003 answered a structured questionnaire. The respondents' willingness to perform SCPR or CCPR during a witnessed cardiac arrest of an average adult stranger or that of a family member in the pre-SARS and the post-SARS era was surveyed. RESULTS: Data for 305 respondents were processed. For the scenario of cardiac arrest of an average stranger, more respondents would perform CCPR than SCPR in the pre-SARS era (83.6% vs. 61.3%, p <0.001) and in the post-SARS era (77.4% vs. 28.9%, p <0.001). In the scenario of the cardiac arrest of a family member, more would perform CCPR than SCPR in the pre-SARS era (92.8% vs. 87.2%, p <0.001) and in the post-SARS era (92.8% vs. 84.9%, p <0.001). After SARS, more respondents were unwilling to perform SCPR (p <0.001) and CCPR (p <0.001) on strangers. After SARS, more respondents were unwilling to perform SCPR on a family member (p = 0.039), but there was no difference in the preference to perform CCPR (p = 1.000). CONCLUSIONS: Concerns about SARS adversely affected the willingness of respondents to perform SCPR or CCPR on strangers and to perform SCPR on family members. Compression-only CPR was preferred to SCPR to resuscitate strangers experiencing cardiac arrest after the emergence of SARS.

A cost analysis in patients with acute coronary syndrome using clopidogrel in addition to aspirin in a Hong Kong public hospital.

Results from the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) study showed that clopidogrel plus aspirin, compared to aspirin alone, reduced cardiovascular events (death, myocardial infarction, and stroke) in patients with acute coronary syndromes (ACS). Yet the acquisition cost of clopidogrel is much higher. It would therefore be worthwhile to compare the long-term cost impact of these 2 regimens. Until recently, only very few patients with ACS received clopidogrel-aspirin combination therapy in Hong Kong. Therefore, a hypothetical cohort was formed and compared to a real group of patients treated with aspirin alone. For the aspirin group, medical history was reviewed and cardiovascular and gastrointestinal events occurring in a period of 12 months after initiation of therapy were recorded. The target cost items included hospitalisation, emergency room visits, outpatient clinic visits, related medications, diagnostic tests, procedures, and surgery. For the hypothetical cohort, the probabilities/relative risks for clinical events were adopted from the CURE study. Fifty-four consecutive patients with ACS receiving aspirin therapy were identified and studied between January 1, 2001 and December 31, 2001 from a major public hospital in Hong Kong. The average cost of management per patient over the 12 month period for the aspirin group was HK$85,324 (US$10,940, HK$7.8 = 1 US$) versus the hypothetical cohort HK$83,903 (US$10,757). Hospitalisation represented the major cost item (64.6%), followed by the cost of investigational tests (14.5%) and procedural cost (11.6%). According to our analytical model, the overall cost impact between clopidogrel plus aspirin versus aspirin alone in the 2 groups of patients was similar.

An evaluation of two behavioral rehabilitation programs, qigong versus progressive relaxation, in improving the quality of life in cardiac patients.

OBJECTIVES: The aim of the current study was to evaluate and compare two different behavioral rehabilitation programs in improving the quality of life in cardiac patients in Hong Kong. DESIGN AND SETTING: The current study was carried out in the outpatient unit of Occupational Therapy Department in the United Christian Hospital, Hong Kong. Convenience sampling with referral from the cardiac specialty was used in the present study. SUBJECTS: A total of 65 subjects, with a mean age 65 (range, 42 to 76), were recruited in the study. The cardiac diseases included myocardial infarct, postcoronary intervention, valve replacement, and also ischemic heart disease. INTERVENTIONS: Patients were alternately allocated to the two groups. The first group of patients received instructions and practiced on progressive relaxation. The second group of patients underwent training in qigong. A total of eight sessions were conducted and each session lasted 20 minutes. OUTCOME MEASURES: Demographic and clinical data such as gender, age, and systolic and diastolic blood pressure were recorded. The psychological and Quality of Life assessment was performed using the Chinese versions of Short Form 36 (C-SF36), State-Trait Anxiety Inventory (C-STAI), and General Health Questionnaire (C-GHQ-12). RESULTS: Fifty-nine (59) subjects (44 men and 15 women) completed all eight rehabilitation sessions in the study. Patients allocated to the two treatment groups had comparable baseline characteristics. Progressive relaxation was more effective in reducing blood pressures compared to qigong. Relaxation appeared to be particularly beneficial in somatic domains. qigong group demonstrated greater improvement in psychologic measures in addition to reduction in systolic blood pressure. CONCLUSIONS: Progressive relaxation and qigong exercise improved the quality of life for cardiac patients with reference to certain physiologic and psychologic measures. The result was supported by previous studies and literature reviews on qigong in terms of its effect on the psychologic dimension.

Low dose amiodarone-induced lung injury.

Amiodarone-induced lung injury is a potentially lethal side-effect of amiodarone. In an attempt to assess its risk, we studied the incidence and clinical profile of Chinese patients prescribed with low dose amiodarone.

Behçet's aortitis and aortic regurgitation: a report of two cases.

Behçet's disease is a rare systemic vasculitis that may lead to neurologic complications and rare manifestations of aortitis and aortic regurgitation. We report 2 cases of Behçet's aortitis and aortic regurgitation. The first patient presented with acute stroke. Recognition of acute aortitis on echocardiography led to the diagnosis of vasculitis as the cause of the cerebral event. This case highlights the echocardiographic features of aortic root pathology from acute aortitis to subsequent aortic valve perforation. In both cases, severe aortic regurgitation necessitated aortic valve replacement. Both were complicated by valve dehiscence requiring reoperation, illustrating the postoperative morbidity in this inflammatory condition.

Doctor-based basic cardiopulmonary resuscitation course: an alternative to the conventional approach.

United Christian Hospital initiated a doctor-based cardiopulmonary resuscitation (CPR) Program. It is a two-hour, focused, adult CPR course, suitable for adults of different age groups and of different educational levels. The course was rated highly by the participants. Most trainees acquired CPR knowledge and skills, and had confidence to perform CPR. This type of training could improve the rate of bystander CPR for out-of-hospital cardiac arrest patients in this region. Avoiding the complexity and pass-fail psychology that is used in the traditional CPR training curriculum, it can be an alternative to the traditional four-hour instructor-based Basic Life Support (BLS) course.