András Jánosi

Nagy rizikójú egyének és cardiovascularis betegek gondozása egy családorvosi praxisban

The aim of this investigation was to study, how high-risk subjects and cardiovascular (CV) patients are receiving care in a general medical (GP) practice. There are 1296 individuals belonging to this GP outpatient ward. Taking into consideration of available data, it was considered that because of high-risk level or some CV diseases, 883 subjects (68%) should have been taken care. The number of definitely cared subjects was 831 (94%), which means that just 6% of the whole group remained out of proper CV care activity. High risk subjects were as follows: 56.2% overweight, 26.0% obese, and 19.4% were active smokers. Every fourth of patients with angiological disease (24.2%) were actively smoking. The majority of high-risk subjects (83.5%) have had a physically inactive life. In the very high-risk group, just 31.5% of subjects, in the high-risk group 23.0% could reach the lipid target values, fixed by the III. Hungarian Consensus Conference. These target values were, however, achieved by 61.1% of patients treated because of arterial hypertension, and 64.6% of diabetics. According to these data, in this very GP practice two third of all individuals do need CV care. Majority of these subjects were properly drawn into this activity. At present, the possibilities of GP care are not enough for properly influencing lifestyle, shown by the high ratio of smokers, people with overweight and those who are living without regular physical exercise. In the same time, the ratio of optimal care of patients with diabetes and hypertension was significantly higher than those in the data published in the literature. The results of treating hyperlipidaemia were similar to other studies published in the medical literature.

[Data on secondary prevention of coronary artery disease in Hungary and some changes in the last ten years (EUROASPIRE 1995-2005)].

In year 1995 the European Society of Cardiology started an epidemiological study EUROASPIRE to evaluate the results of secondary prevention in some European countries. The first study period was in 1995, the second in 1999-2000 and the third in 2007. From Hungary the same study centers participated in EUROASPIRE I-II-III investigation. Authors present the Hungarian data and changes occurring the last ten years. During the three studies, 1627 coronary patients- younger than 70 years - were evaluated, using standardized methods. In the two Hungarian study centers, the proportion of women and patients older than 60 years increased. The hospital documentation of risk factors improved, at the time of EUROASPIRE III necessary data were found in 89%-99% of patients records. Mean systolic and diastolic blood pressure continuously decreased between the first and second study period, but at the time of the third study 44% of the patients had elevated blood pressure (>140/90 mmHg). Prevalence of smoking decreased by 8% between second and third study period, however, at the time of the last study, 18% of coronary patients were smokers. The mean of total cholesterol was lower in the last study period comparing to the first investigation (5.6 vs. 5.2 mmol/l). HDL cholesterol level was unchanged and increasing triglyceride values were observed. During the study period the prevalence of obesity continuously increased from 23% to 49%. Prevalence of patients with total cholesterol level 5.5 mmol/l or higher has decreased from 60% to 24%, however 57% of patients did not reach the target level (4.5 mmol/l) although 80% of patients were treated with lipid lowering drugs: 76% of them received statins. Authors say that some part of secondary prevention improved during the last ten years, but many patients did not reach the target blood pressure and cholesterol level and it is embarrassing the prevalence of obesity and diabetes. The published data are not representative for whole Hungary; most probably the general situation is worse. Authors emphasize the importance of secondary prevention in the graduate and postgraduate education. For improving the secondary prevention, better cooperation is needed between hospital staff and patients and general practitioners as well.

Cardiovascular care of high-risk subjects and cardiovascular patients in a general medical practice

The aim of this investigation was to study, how high-risk subjects and cardiovascular (CV) patients are receiving care in a general medical (GP) practice. There are 1296 individuals belonging to this GP outpatient ward. Taking into consideration of available data, it was considered that because of high-risk level or some CV diseases, 883 subjects (68%) should have been taken care. The number of definitely cared subjects was 831 (94%), which means that just 6% of the whole group remained out of proper CV care activity. High risk subjects were as follows: 56.2% overweight, 26.0% obese, and 19.4% were active smokers. Every fourth of patients with angiological disease (24.2%) were actively smoking. The majority of high-risk subjects (83.5%) have had a physically inactive life. In the very high-risk group, just 31.5% of subjects, in the high-risk group 23.0% could reach the lipid target values, fixed by the III. Hungarian Consensus Conference. These target values were, however, achieved by 61.1% of patients treated because of arterial hypertension, and 64.6% of diabetics. According to these data, in this very GP practice two third of all individuals do need CV care. Majority of these subjects were properly drawn into this activity. At present, the possibilities of GP care are not enough for properly influencing lifestyle, shown by the high ratio of smokers, people with overweight and those who are living without regular physical exercise. In the same time, the ratio of optimal care of patients with diabetes and hypertension was significantly higher than those in the data published in the literature. The results of treating hyperlipidaemia were similar to other studies published in the medical literature.

[Hospital and long-term prognosis of patients with non-ST-segment elevation myocardial infarction].

The authors analyze some clinical data, hospital and long-term prognosis of 139 consecutive patients with non-ST-segment elevation myocardial infarction. A three-quarter-year long follow-up of patients was performed, and data were recorded by use of postal questionnaire. The follow-up was complete in 98% of the patients. The mean age was 78.6 and 71.4 years in the case of female and male patients, respectively. High percent of patients had comorbidity (diabetes mellitus, hypertension and previous ischemic heart disease). Coronary angiography was performed in 30 patients (22%) and revascularization in 29 of them. Hospital mortality was found in 15% and during follow-up 17% of the patients died. The patients who died during hospital stay and during the follow-up period were significantly older than patients who stayed alive. Some echocardiographic parameters were also found prognostically important: ejection fraction, end systolic diameter, segmental wall motion abnormality and severity of mitral regurgitation were found significantly different in patients alive and who died. The authors investigated the hospital discharge medications according to guideline recommendations. The authors emphasize that this quality indicator was much better in this patient population than the earlier published data. By the end of follow-up, similar percent of patients used these drugs as at the time of hospital discharge.

[Arrhytmogenic right ventricle--prognostic significance of exercise test].

UNLABELLED The authors summarize the present knowledge on arrhythmogenic right ventricular cardiomyopathy/dysplasia. Limited data are available about natural history of asymptomatic patients with arrhythmogenic right ventricle cardiomyopathy/dysplasia, who have a ventricular tachycardia during exercise test. A 25-year old female patient was treated with osteosynthesis because of ankle injury. Cardiology consultation was performed because of an abnormal ECG. Physical examination was normal. ECG showed a normal sinus rhythm, left axis deviation, negative T waves in leads II, III, aVF and V2-V6. Chest X-ray and laboratory findings were normal. Echocardiography showed normal left ventricular ejection fraction along with inferior akinesis and dilated right ventricle. Bicycle exercise test revealed a good exercise tolerability (9 MET), and after sporadic ventricular extra systoles ventricular tachycardia developed lasting for 3 minutes, which spontaneously stopped after aborting the test and performed abdominal strain. MRI was performed which has shown normal left ventricular size, wall motion and ejection fraction and depressed right ventricle function (ejection fraction 31.6%) enlarged right ventricular end-systolic and diastolic volumes, hypo-akinetic regions without aneurysm and bulging. No contrast enhancement was seen in the thin right ventricular wall. According to abnormal ECG and MRI findings arrhythmogenic right ventricle cardiomyopathy/dysplasia was diagnosed. No ICD implantation was indicated because the patient was asymptomatic, and no sudden cardiac death occurred in the family. Three month later the patient was found dead. At autopsy the right ventricular chamber was markedly enlarged, with multiple translucent areas of fatty accumulation accompanied with extended myocytes loss. There was a characteristic triangle dysplasia: the inflow, outflow tracts and apical areas. The coronaries were free of atherosclerosis. Mallorys phosphotungstic acid-hematoxilin stain demonstrated the presence of fibrosis within the scattered myocardium. CONCLUSION malignant ventricular arrhythmia provoked by exercise test in an asymptomatic arrhythmogenic right ventricle cardiomyopathy/dysplasia patient with negative family history should be an indication for ICD implantation.

Magyarországi adatok a koszorúér-betegség másodlagos megelozésének helyzetérol és a változás fobb jellemzoi (EUROASPIRE 1995-2005)

In year 1995 the European Society of Cardiology started an epidemiological study EUROASPIRE to evaluate the results of secondary prevention in some European countries. The first study period was in 1995, the second in 1999-2000 and the third in 2007. From Hungary the same study centers participated in EUROASPIRE I-II-III investigation. Authors present the Hungarian data and changes occurring the last ten years. During the three studies, 1627 coronary patients- younger than 70 years - were evaluated, using standardized methods. In the two Hungarian study centers, the proportion of women and patients older than 60 years increased. The hospital documentation of risk factors improved, at the time of EUROASPIRE III necessary data were found in 89%-99% of patients records. Mean systolic and diastolic blood pressure continuously decreased between the first and second study period, but at the time of the third study 44% of the patients had elevated blood pressure (>140/90 mmHg). Prevalence of smoking decreased by 8% between second and third study period, however, at the time of the last study, 18% of coronary patients were smokers. The mean of total cholesterol was lower in the last study period comparing to the first investigation (5.6 vs. 5.2 mmol/l). HDL cholesterol level was unchanged and increasing triglyceride values were observed. During the study period the prevalence of obesity continuously increased from 23% to 49%. Prevalence of patients with total cholesterol level 5.5 mmol/l or higher has decreased from 60% to 24%, however 57% of patients did not reach the target level (4.5 mmol/l) although 80% of patients were treated with lipid lowering drugs: 76% of them received statins. Authors say that some part of secondary prevention improved during the last ten years, but many patients did not reach the target blood pressure and cholesterol level and it is embarrassing the prevalence of obesity and diabetes. The published data are not representative for whole Hungary; most probably the general situation is worse. Authors emphasize the importance of secondary prevention in the graduate and postgraduate education. For improving the secondary prevention, better cooperation is needed between hospital staff and patients and general practitioners as well.

Magyarországi adatok a koszorúér-betegség másodlagos megelőzésének helyzetéről és a változás főbb jellemzői (EUROASPIRE 1995–2005) @@@Data on secondary prevention of coronary artery disease in Hungary and some changes in the last ten years (EUROASPIRE 1995–2005)

In year 1995 the European Society of Cardiology started an epidemiological study EUROASPIRE to evaluate the results of secondary prevention in some European countries. The first study period was in 1995, the second in 1999-2000 and the third in 2007. From Hungary the same study centers participated in EUROASPIRE I-II-III investigation. Authors present the Hungarian data and changes occurring the last ten years. During the three studies, 1627 coronary patients- younger than 70 years - were evaluated, using standardized methods. In the two Hungarian study centers, the proportion of women and patients older than 60 years increased. The hospital documentation of risk factors improved, at the time of EUROASPIRE III necessary data were found in 89%-99% of patients records. Mean systolic and diastolic blood pressure continuously decreased between the first and second study period, but at the time of the third study 44% of the patients had elevated blood pressure (>140/90 mmHg). Prevalence of smoking decreased by 8% between second and third study period, however, at the time of the last study, 18% of coronary patients were smokers. The mean of total cholesterol was lower in the last study period comparing to the first investigation (5.6 vs. 5.2 mmol/l). HDL cholesterol level was unchanged and increasing triglyceride values were observed. During the study period the prevalence of obesity continuously increased from 23% to 49%. Prevalence of patients with total cholesterol level 5.5 mmol/l or higher has decreased from 60% to 24%, however 57% of patients did not reach the target level (4.5 mmol/l) although 80% of patients were treated with lipid lowering drugs: 76% of them received statins. Authors say that some part of secondary prevention improved during the last ten years, but many patients did not reach the target blood pressure and cholesterol level and it is embarrassing the prevalence of obesity and diabetes. The published data are not representative for whole Hungary; most probably the general situation is worse. Authors emphasize the importance of secondary prevention in the graduate and postgraduate education. For improving the secondary prevention, better cooperation is needed between hospital staff and patients and general practitioners as well.