Document Detail


Do patients with heart failure appropriately undergo invasive procedures post-myocardial infarction? Results from a prospective multicentre study.
MedLine Citation:
PMID:  18397275     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The degree of adherence to guideline recommendations that patients following myocardial infarction (MI) with congestive heart failure (CHF) undergo early angiography, and angioplasty if indicated, is unknown. METHODS: We prospectively evaluated the use of invasive procedures in patients with segment-elevation myocardial infarction (STEMI), non-STEMI and CHF, admitted in 1 month to 16 Australian hospitals. RESULTS: Of 475 post-MI patients (248 (52.2%) with STEMI), 112 (23.6%) had CHF, (57 (23.0%) with STEMI). Patients with CHF, compared with those without CHF, were older (67.8 vs 63.2 years; P = 0.002) and were more often women (34 vs 24%, P = 0.03), but had similar rates of other risk factors. Compared with post-MI patients without CHF, patients with CHF had fewer invasive procedures: angiography 72.3% versus 85.1% (P = 0.002) and angioplasty 33.9% versus 52.9% (P < 0.001) (12 (2.5%) patients underwent coronary surgery in-hospital); and among STEMI patients (angiography 72.3% CHF vs 89.5% no CHF [P < 0.001]; angioplasty 50.9% CHF vs 69.1% no CHF [P = 0.011]); these differences remained significant after adjustment for clinical covariates. Of the 121 (25.5%) post-MI patients aged > or =75 years, compared with those <75 years, the frequencies of angiography and angioplasty procedures were 66.1% versus 87.6% (P < 0.001) and 33.9% versus 53.4% (P < 0.001), respectively; 66% of the elderly with, and without, CHF had angiography. CONCLUSION: The presence of CHF post-MI resulted in lower rates of use of angiography and angioplasty, which was not explained by lower procedure rates in the elderly. As these guideline-recommended procedures may improve survival in patients with CHF post-MI, future strategies should aim to enhance their use.
Authors:
D Tobing; J French; J Varigos; A Meehan; B Billah; H Krum;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2008-04-04
Journal Detail:
Title:  Internal medicine journal     Volume:  38     ISSN:  1445-5994     ISO Abbreviation:  Intern Med J     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2009-01-05     Completed Date:  2009-11-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101092952     Medline TA:  Intern Med J     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  845-51     Citation Subset:  IM    
Affiliation:
Liverpool Hospital and South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon / utilization
Antifibrinolytic Agents / therapeutic use
Coronary Angiography / utilization
Female
Heart Failure / diagnosis*,  etiology,  therapy*
Humans
Male
Middle Aged
Myocardial Infarction / complications,  diagnosis*,  therapy*
Prospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antifibrinolytic Agents
Investigator
Investigator/Affiliation:
Roger Ku / ; Mark Horrigan / ; Louise Brown / ; Gishel New / ; Louise Roberts / ; John Counsell / ; Marianne Martin / ; Randall Hendricks / ; Gill Tullock / ; James Rogers / ; Bets Conway / ; John French / ; Elizabeth Newland / ; Richard Harper / ; Lisa Jenkins / ; Steven Coverdale / ; Sue Murray / ; Warren Walsh / ; Anne Russell / ; Paul Garrahy / ; Tom Christensen / ; Andrew Adjani / ; Michele Sallaberger / ; Greg Nelson / ; Annie Loxton / ; Peter Thompson / ; Patricia Taaffe / ; David Rees / ; Glenn Paull / ; Robert Whitbourn / ; Britt Christensen /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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