scholarly journals Non-ST elevation myocardial infarction (NSTEMI) in three hospital settings in South Africa : does geography influence management and outcome? A retrospective cohort study : cardiovascular topics

2013 ◽  
Vol 24 (4) ◽  
pp. 110-116
Author(s):  
Jane Moses ◽  
Anton F Doubell ◽  
Philip G Herbst ◽  
Karl J.C Klusmann ◽  
Hellmuth S.V.H. Weich
Keyword(s):  
Myocardial Infarction ◽  
South Africa ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
St Elevation Myocardial Infarction ◽  
St Elevation

scholarly journals Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study

BMJ ◽  
2019 ◽  
pp. l1927 ◽  
Author(s):  
Thomas S Valley ◽  
Theodore J Iwashyna ◽  
Colin R Cooke ◽  
Shashank S Sinha ◽  
Andrew M Ryan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
St Elevation Myocardial Infarction ◽  
Icu Admission ◽  
Admission Rates ◽  
Percentage Points ◽  
St Elevation

AbstractObjectiveTo evaluate the effect of intensive care unit (ICU) admission on mortality among patients with ST elevation myocardial infarction (STEMI).DesignRetrospective cohort study.Setting1727 acute care hospitals in the United States.ParticipantsMedicare beneficiaries (aged 65 years or older) admitted with STEMI to either an ICU or a non-ICU unit (general/telemetry ward or intermediate care) between January 2014 and October 2015.Main outcome measure30 day mortality. An instrumental variable analysis was done to account for confounding, using as an instrument the additional distance that a patient with STEMI would need to travel beyond the closest hospital to arrive at a hospital in the top quarter of ICU admission rates for STEMI.ResultsThe analysis included 109 375 patients admitted to hospital with STEMI. Hospitals in the top quarter of ICU admission rates admitted 85% or more of STEMI patients to an ICU. Among patients who received ICU care dependent on their proximity to a hospital in the top quarter of ICU admission rates, ICU admission was associated with lower 30 day mortality than non-ICU admission (absolute decrease 6.1 (95% confidence interval −11.9 to −0.3) percentage points). In a separate analysis among patients with non-STEMI, a group for whom evidence suggests that routine ICU care does not improve outcomes, ICU admission was not associated with differences in mortality (absolute increase 1.3 (−0.9 to 3.4) percentage points).ConclusionsICU care for STEMI is associated with improved mortality among patients who could be treated in an ICU or non-ICU unit. An urgent need exists to identify which patients with STEMI benefit from ICU admission and what about ICU care is beneficial.

scholarly journals CODE STEMI Program Improves Clinical Outcome in ST Elevation Myocardial Infarction Patients: A Retrospective Cohort Study

2020 ◽  
Vol Volume 12 ◽  
pp. 315-321
Author(s):  
Eka Ginanjar ◽  
Amal C Sjaaf ◽  
Idrus Alwi ◽  
Wahyu Sulistiadi ◽  
Ede Suryadarmawan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cohort Study ◽  
Clinical Outcome ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
St Elevation Myocardial Infarction ◽  
St Elevation

scholarly journals CODE STEMI Improves Clinical Outcomes and Cost Efficiency in ST Elevation Myocardial Infarction Patients : A Retrospective Cohort Study

2020 ◽  
Author(s):  
Eka Ginanjar ◽  
Amal Chalik Sjaaf ◽  
Idrus Alwi ◽  
Wahyu Sulistyadi ◽  
Ede Suryadarmawan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cohort Study ◽  
Length Of Stay ◽  
Clinical Outcome ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Cost Efficiency ◽  
Retrospective Cohort ◽  
Quality Care ◽  
St Elevation

Abstract Background One of the highest causes of cardiac mortality is ST Elevation Myocardial Infarction (STEMI). Delay in the management of STEMI patients resulted high mortality, morbidity, and economic burden. CODE STEMI is a protocol to reduce door to balloon time and improve patient’s quality care and clinical outcome. This study aims to determine the effect of the implementation of CODE STEMI on clinical outcome and cost efficiency of a quality care of STEMI patients at Dr. Cipto Mangunkusumo General Hospital.Method This is a retrospective cohort study that reviewed 207 medical records of STEMI patients who underwent primary percutaneous coronary intervention (PPCI) in 2015–2018. The patients were divided into two groups. The first group was treated prior to establishing the CODE STEMI program. The other group was treated according to the program, which was implemented in January 2017. The primary outcome was to measure in-hospital mortality and morbidity and total hospital cost between both groups. Secondary end-points included length of stay (LOS) and Cost Efficient Analysis. Data analysis was done using Mann Whitney and Chi square test.Results There were 72 and 135 patients in Pre-CODE STEMI and CODE STEMI groups respectively. In CODE STEMI group, median D2BT was significantly reduced by 130 min (P < 0.001), median LOS was reduced by 1 day (P = 0.009) and there was cost reduction by approximately USD 1,000. There were declining trend of in-hospital mortality rates (8.3% vs 4.4%) and MACE at 30 days (48.61% vs 37.78%).Conclusion Implementation of CODE STEMI can improve clinical outcome, reduce length of stay and cost efficiency of STEMI patients in general hospitals.

scholarly journals Glucose variability and the risks of stroke, myocardial infarction, and all-cause mortality in individuals with diabetes: retrospective cohort study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Da Young Lee ◽  
Kyungdo Han ◽  
Sanghyun Park ◽  
Ji Hee Yu ◽  
Ji A. Seo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
The Elderly ◽  
Glucose Variability ◽  
All Cause Mortality ◽  
Nationwide Observational Study ◽  
The Impact

Abstract Background Previous research regarding long-term glucose variability over several years which is an emerging indicator of glycemic control in diabetes showed several limitations. We investigated whether variability in long-term fasting plasma glucose (FG) can predict the development of stroke, myocardial infarction (MI), and all-cause mortality in patients with diabetes. Methods This is a retrospective cohort study using the data provided by the Korean National Health Insurance Corporation. A total of 624,237 Koreans ≥ 20 years old with diabetes who had undergone health examinations at least twice from 2005 to 2008 and simultaneously more than once from 2009 to 2010 (baseline) without previous histories of stroke or MI. As a parameter of variability of FG, variability independent of mean (VIM) was calculated using FG levels measured at least three times during the 5 years until the baseline. Study endpoints were incident stroke, MI, and all-cause mortality through December 31, 2017. Results During follow-up, 25,038 cases of stroke, 15,832 cases of MI, and 44,716 deaths were identified. As the quartile of FG VIM increased, the risk of clinical outcomes serially increased after adjustment for confounding factors including duration and medications of diabetes and the mean FG. Adjusted hazard ratios (95% confidence intervals) of FG VIM quartile 4 compared with quartile 1 were 1.20 (1.16–1.24), 1.20 (1.15–1.25), and 1.32 (1.29–1.36) for stroke, MI and all-cause mortality, respectively. The impact of FG variability was higher in the elderly and those with a longer duration of diabetes and lower FG levels. Conclusions In diabetes, long-term glucose variability showed a dose–response relationship with the risk of stroke, MI, and all-cause mortality in this nationwide observational study.

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