Patient after cardiac infarction: risk factors that can cause new cardiovascular disasters

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UDC: 
616.127-005.8-059-06-092.12
Authors: 

I.A. Novikova, L.A. Nekrutenko, T.M. Lebedeva, O.V. Kchlynova, E.A. Shishkina

Organization: 

E.A. Vagner's Perm State Medical University of the RF Public Healthcare Ministry, 26 Petropavlovsjaya Str., Perm, 614000, Russian Federation

Abstract: 

Over recent years there has been a trend for a decrease in lethality during an acute cardiac infarction period; but at the same time there is a growth in a number of patients who run high risks of recurrent adverse cardiovascular events. Despite secondary prevention measures having been introduced, frequency of recurrent cardiac infarctions is still high, and most of them occur during the first year. Our research goal was to reveal basic risk factors that cause recurrent adverse cardiovascular events in patients during the first year after a cardiac infarction. We questioned 40 patients living in Perm who had had cardiac infractions from September 2017 to July 2018 and who were undergoing polyclinic rehabilitation. To perform this questioning, we applied an original questionnaire.

We revealed that men prevailed among patients with cardiac infarction. The first infarction usually occurs in early 60ties. Ischemic heart disease starts with cardiac infarction in 45% patients. We detected that at least one risk factor occurred for all the patients; the most widely spread risk factors in the given population were burdened heredity, low physical activity, overweight, uncontrolled arterial hypertension, and hypercholesterolemia. We also revealed in our research that less than 50 % patients were committed to treatment and it was primarily due to low awareness about the necessity to take medications and also due to these medications being hardly affordable for patients. Therefore, patients who suffered from cardiac infarction and are undergoing polyclinic rehabilitation run an elevated risk of recurrent cardiovascular events during the first year and it means that secondary prevention measures are not efficient. When treating patients with cardiac infarction, we should optimize interaction between a physician and a patient and pay greater attention to a patient being committed to treatment.

Keywords: 
cardiac infarction, recurrent cardiac infarction, risk factors, revascularization, rehabilitation, commitment to treatment, secondary prevention
Novikova I.A., Nekrutenko L.A., Lebedeva T.M., Kchlynova O.V., Shishkina E.A. PATIENT After cardiac infarction: risk factors that can cause new cardiovascular disasters. Health Risk Analysis, 2019, no. 1, pp. 135–143. DOI: 10.21668/health.risk/2019.1.15.eng
References: 
  1. Sulo E., Vollset S.E., Nygard O., Sulo G., Igland J.[et al.]. Trends in 28-day and 1-year mortality rates in patients hospitalized for a first acute myocardial infarction in Norway during 2001-2009: a “Cardiovascular disease in Norway” (CVDNOR) project. Journal of Internal Medicine, 2015, no. 277, pp. 353–361.
  2. Koopman C., Bots M.L., van Oeffelen A.A., van Dis I., Verschuren W.M., Engelfriet P.M. [et al.]. Population trends and inequalities in incidence and short-term outcome of acute myocardial infarction between 1998 and 2007. International Journal of Cardiology, 2013, no. 168, pp. 993–998.
  3. Schmidt M., Jacobsen J.B., Lash T.L., Botker H.E., Sorensen H.T. 25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study. BMJ, 2012, vol. 344, pp. 356–364.
  4. Dudas K., Lappas G., Rosengren A. Long-term prognosis after hospital admission for acute myocardial infarction from 1987 to 2006. International Journal of Cardiology, 2012, no. 155, pp. 400–405.
  5. Strelchenko O.V. Osnovnye pokazateli zdorov'ya naseleniya i zdravookhraneniya Sibirskogo federal'nogo okruga v 2012 godu. Sbornik statisticheskikh i analiticheskikh materialov. [The main indicators of public health and health care of the Siberian Federal District in 2012. Digest of statistical and analytical materials. Release 12]. Novosibirsk: Ofset, 2013, pp. 332 (in Russian).
  6. Wagner S., Burczyk U., Schiele R. [et al.]. The 60 minutes myocardial infarction project: characteristics on admission and clinical outcome in patients with reinfarction compared to patients with a first infarction. European Heart Journal, 1998, no. 19, pp. 879–884.
  7. Natali A., Vichi S., Landi P. [et al.]. Mortality from coronary heart disease in subjects with type 2 diabetes and in non-diabetic subjects with and without prior myocardial infarction. The New England Journal of Medicine, 1998, no. 339, pp. 229–234.
  8. Motivala A.A., Tamhane U., Ramanath V.S. [et al.]. A prior myocardial infarction: how does it affect management and outcomes in recurrent acute coronary syndromes? Clinical Cardiology, 2008, no. 31, pp. 590–596.
  9. Volkova E.G., Malykhina O.P., Levashov S.Yu. Povtornye infarkty miokarda: osobennosti izmeneniya soderzhaniya biomarkerov i remodelirovaniya miokarda (issledovanie sluchai-kontrol'). Kardiologiya, 2007, no.7, pp. 26–28 (in Russian).
  10. Shiraishi J., Kohno Y., Sawada T. [et al.]. Predictors of in-hospital outcome after primary percutaneous coronary intervention for recurrent myocardial infarction. Circulation Journal, 2008, no. 72, pp. 1225–1229.
  11. Shotan A., Blondheim D.S., Gottlieb S. [et al.]. Comparison of outcome of recurrent versus first ST-segment elevation myocardial infarction (from National Israel Surveys 1998 to 2006). American Journal of Cardiology, 2011, no. 107, pp. 1730–1737.
  12. Antman E.M., Cohen M., Bernink P.J. [et al.]. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. The Journal of the American Medical Association, 2000, vol. 284, no. 7, pp. 835–842.
  13. Boersma E., Pieper K.S., Steyerberg E.W. [et al.]. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation. Results from an international trial of 9461 patients. The PURSUIT Investigators. Circulation, 2000, vol. 101, no. 22, pp. 2557–2567.
  14. Fox K.A., Dabbous O.H., Goldberg R.J. [et al.]. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ, 2006, vol. 333, no. 7578, pp. 1091–1094.
  15. Eagle K.A., Lim M.J., Dabbous O.H. [et al.]. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. The Journal of the American Medical Association, 2004, vol. 291, no. 22, pp. 2727–2733.
  16. Barbarash O.L., Sedykh D.Yu., Gorbunova E.V. Osnovnye faktory, opredelyayushchie risk razvitiya povtornogo infarkta miokarda // Serdtse: zhurnal dlya praktikuyushchikh vrachei, 201, vol. 16, no. 1, pp. 10–50 (in Russian).
  17. Negmadzhonov U.U., Kuimov A.D. Povtornye infarkty miokarda: faktory riska, klinika, lechenie [Recurrent myocardial infarction: risk factors, clinic, treatment]. Meditsina i obrazovanie v Sibiri: elektronnyi nauchnyi zhurnal, 2011, no. 6. Available at: http://www.ngmu.ru/cozo/mos/article/text_full.php?id=548 (23.12.2018) (in Russian).
  18. Kylbanova E.S., Gur'eva E.V., Pavlova A.V. Chastota vstrechaemosti faktorov riska i priverzhennost' k medikamentoznoi terapii u yakutov, perenesshikh Q-pozitivnyi infarkt miokarda [The frequency of occurrence of risk factors and adherence to drug therapy in Yakuts who had Q-positive myocardial infarction]. Arhiv vnutrennei meditsiny, 2018, vol. 8, no. 4, pp. 291–299 (in Russian).
  19. Myftiu S., Sulo E., Burazeri G. [et al.]. Clinical profile and management of patients with incident and recurrent acute myocardial infarction in Albania – a call for more focus on prevention strategies. Slovenian Journal of Public Health, 2017, vol. 56, no. 4, pp. 236–243.
  20. Cao C-F., Li S-F., Chen H., Song J-X. Predictors and in-hospital prognosis of recurrent acute myocardial infarction. Journal of Geriatric Cardiology, 2016, vol. 13, no. 10, pp. 836–839.
  21. Janzon M., Henriksson M., Hasvold P. [et al.]. Long-term resource use patterns and healthcare costs after myocardial infarction in a clinical practice setting: results from a contemporary nationwide registry study. European Heart Journal - Quality of Care and Clinical Outcomes, 2016, vol. 2, no. 4, pp. 291–298.
  22. Scandanavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet, 1994, vol. 344, pp. 1383–1389.
  23. Tonelli M., Moyé L. [et al.]. Effect of pravastatin on loss of renal function in people with moderate chronic renal insufficiency and cardiovascular disease. American Society of Nephrology, 2003, no. 14, pp. 1605–1613.
  24. The long-term intervention with pravastatin in ischaemic disease (LIPID) study group. Prevention of cardiovascular events and death with prevastatinin patients with coronary heart disease and a broad range of initial cholesterol levels. The New England Journal of Medicine, 1998, no. 339, pp. 1349–1357.
  25. ISIS-2 collaborative group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction. Lancet, 1988, vol. 332, no. 8607, pp. 349–360.
  26. Steinhubl S.R., Berger P.B., Mann J.T. [et al.]. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. The Journal of the American Medical Association, 2002, no. 288, pp. 2411–2420.
  27. Berger J.S. Aspirin, clopidogrel, and ticagrelorin acute coronary syndromes. American Journal of Cardiology, 2013, no.112, pp. 737–745.
  28. The acute infarction ramipril efficacy (AIRE) study investigators. Effect of ramipril on mortality and morbidity of sur-vivors of acute myocardial infarction with clinical evidence of heart failure. Lancet, vol. 342, no. 8875, pp. 821–828.
  29. HOPE (Heart Outcomes Prevention Evaluation) study investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The New England Journal of Medicine, 2000, no. 342, pp. 145–153.
  30. Teo K.K., Yusuf S. Furberg C.D. Effects of prophylactic antiarrhythmic drug therapy in acute myocardial infarction. An overview of results from randomized controlled trials. The Journal of the American Medical Association, 1993, no. 270, pp. 1589–1595.
  31. Spertus J.A., Masoudi F.A., Reid K.J. [et al.]. Impact of medication therapy discontinuation on mortality after myocardial infarction. Archives of Internal Medicine, 2006, vol. 166, no.17, pp. 1842–1847.
  32. Erlikh A. D. Dvoinaya antitrombotsitarnaya terapiya: neobkhodimost' priverzhennosti k lecheniyu i vozmozhnosti ee povysheniya [Dual antiplatelet therapy: the need for adherence to treatment and the possibility of its increase]. Aterotromboz, 2014, no. 2, pp. 25–33 (in Russian).
  33. Thygesen K., Alpert J.S., Jaffe A.S. [et al.]. Third Universal Definition of Myocardial Infarction. Circulation, 2012, no. 126, pp. 2020–2035.
  34. Nauchnaya platforma «profilakticheskaya sreda» [Scientific platform "Preventive environment], 2013. Available at: http://www.gnicpm.ru/UserFiles/prof_sreda_bazis_posl_variant.pdf (23.09.2018) (in Russian).
  35. Dultsev K.N., Lapin O.M., Oschepkova M.A., Syromyatnikova L.I., Yunusov E.M., Chizhova A.A. Puti optimizatsii okazaniya meditsinskoi pomoshchi bol'nym s ostrym koronarnym sindromom (po dannym gospital'nogo etapa registra “Rekord-3”) [Ways for optimization of rendering medical care to patients with acute coronary syndrome (by hospital register “Record-3” data)]. Sovremennye problemy nauki i obrazovaniya, 2015, no. 5, p. 196 (in Russian).
  36. Lapin O.M. Sravnitel'nyi analiz rezhimov reperfuzionnoi terapii v lechenii bol'nykh infarktom miokarda s pod"emom segmenta ST v usloviyakh real'noi klinicheskoi praktiki [Comparative analysis of reperfusion therapy regimes in management of patients with ST segment elevation myocardial infarction in conditions of real clinical practice]. Sovremennye problemy nauki i obrazovaniya, 2015, vol. 32, no. 5, pp. 37–43 (in Russian).
  37. Ibanez B. [et al.]. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force for the management of acute myocardial infarction in patients presenting with ST-seg¬ment elevation of the European Society of Cardiology (ESC). European Heart Journal, 2017, no. 00, pp. 1–66.
  38. Rymer J.A., Chen A.Y., Thomas L. [et al.]. Advanced practice provider versus physician-only outpatient follow-up after acute myocardial infarction. Journal of the American Heart Association, 2018, vol. 7, no. 17.
  39. Ciccone M.M., Aquilino A., Cortese F. [et al.]. Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo). Vascular health and risk management, 2010, no. 6, pp. 297–305.
  40. Munkhaugen J., Peersen K., Sverre E. [et al.]. The follow-up after myocardial infarction – is it good enough? Journal of the Norwegian Medical Association, 2018, vol. 138, no. 5.
  41. Tung Y.C., Chang G.M., Chang H.Y., Yu T.H. Relationship between early physician follow-up and 30-day readmission after acute myocardial infarction and heart failure. PLoS One, 2017, vol. 12, no. 1.
Received: 
06.11.2018
Accepted: 
24.02.2019
Published: 
30.03.2019

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