Enxhela Sulo

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

The aim of this study was to investigate the trends in 28‐day and 1‐year mortality rates in patients hospitalized for a first acute myocardial infarction (AMI) in Norway during the period 2001–2009. Potential age group and gender differences in these trends were also examined.

Educational inequalities in 28 day and 1-year mortality after hospitalisation for incident acute myocardial infarction — A nationwide cohort study

BACKGROUND There is little recent evidence on the impact of comorbidities and access to revascularisation procedures on educational inequalities in mortality after acute myocardial infarction (AMI). The aim of the study was to investigate educational inequalities in mortality among all patients hospitalised for an incident AMI during 2001-2009 in Norway. METHODS Data were obtained through the Cardiovascular Disease in Norway (CVDNOR) project. Incident AMI was defined as an AMI-hospitalisation without any AMI-events in the previous 7 years. Education was categorised as basic, upper secondary or tertiary (college/university). Cox regression was used to assess educational differences in 28-day and 29-365-day mortality after an incident AMI in terms of hazard ratios and relative index of inequality (RII). RII can be interpreted as the ratio in mortality between the 0 th and the 100th percentile of the education distribution. RESULTS 111 993 incident AMIs were included (39.4% women). Among patients aged 35-69, RIIs (95% CI) adjusted for age, sex and year were 1.86 (1.59-2.18) and 2.10 (1.69-2.59) for 28-day and 29-365-day mortality respectively. Among patients aged 70-94 the corresponding RIIs were 1.12 (1.06-1.30) and 1.28 (1.19-1.38). Educational inequalities in mortality were attenuated after adjustment for comorbidities and revascularisation, but were still significant. Educational inequalities did not decrease during 2001-2009. CONCLUSION Educational inequalities in both 28-day and 29-365 day mortality were strong and persistent during 2001-2009. Further research is needed to investigate if these disparities are driven by inequalities in the severity of the AMI or by inequitable access to treatment and rehabilitation.

Heart Failure Complicating Acute Myocardial Infarction; Burden and Timing of Occurrence: A Nation‐wide Analysis Including 86 771 Patients From the Cardiovascular Disease in Norway (CVDNOR) Project

Background Coronary heart disease (CHD) represents often the underlying conditions for the development of heart failure (HF). We aimed at exploring the burden and timing of HF complicating an acute myocardial infarction (AMI), using the total population of AMI patients hospitalized during 2001–2009 in Norway. Methods and Results A total of 86 771 patients with a first AMI during 2001–2009 and without previous HF were identified in the “Cardiovascular Disease in Norway” project and followed until HF development, death, or December 31, 2009. In 16 219 patients (18.7%), HF was present on admission or developed during hospitalization for the incident AMI. HF occurrence varied according to age (8.9%, 15.2%, and 25.6% among men and 10.2%, 16.8%, and 27.1% among women ages 25–54, 55–74, and 75–85 years). Among 63 853 patients discharged alive without HF, 8058 (12.6%) were hospitalized with or died because of HF during a median follow‐up time of 3.2 years. HF incidence rates (IRs) per 1000 person‐years during follow‐up were 31 (95% CI, 30–32) for men and 46 (95% CI, 44–47) for women (P<0.01). IRs of HF were highest during the first 6 months of follow‐up, after which they leveled off and remained stable until the end of follow‐up. Conclusions In this nation‐wide cohort study, we observed that HF remains a frequent complication of the first AMI; both during the acute phase and shortly after the discharge from the hospital.

Effect of the Lookback Period’s Length Used to Identify Incident Acute Myocardial Infarction on the Observed Trends on Incidence Rates and Survival Cardiovascular Disease in Norway Project

Background—In studies using patient administrative data, the identification of the first (incident) acute myocardial infarction (AMI) in an individual is based on retrospectively excluding previous hospitalizations for the same condition during a fixed time period (lookback period [LP]). Our aim was to investigate whether the length of the LP used to identify the first AMI had an effect on trends in AMI incidence and subsequent survival in a nationwide study. Methods and Results—All AMI events during 1994 to 2009 were retrieved from the Cardiovascular Disease in Norway project. Incident AMIs during 2004 to 2009 were identified using LPs of 10, 8, 7, 5, and 3 years. For each LP, we calculated time trends in incident AMI and subsequent 28-day and 1-year mortality rates. Results obtained from analyses using the LP of 10 years were compared with those obtained using shorter LPs. In men, AMI incidence rates declined by 4.2% during 2004 to 2009 (incidence rate ratio, 0.958; 95% confidence interval, 0.935–0.982). The use of other LPs produced similar results, not significantly different from the LP of 10 years. In women, AMI incidence rates declined by 7.3% (incidence rate ratio, 0.927; 95% confidence interval, 0.901–0.955) when an LP of 10 years was used. The decline was statistically significantly smaller for the LP of 5 years (6.2% versus 7.3%; P=0.02) and 3 years (5.9% versus 7.3%; P=0.03). The choice of LP did not influence trends in 28-day and 1-year mortality rates. Conclusions—The length of LP may influence the observed time trends in incident AMIs. This effect is more evident in older women.

CLINICAL PROFILE AND MANAGEMENT OF PATIENTS WITH INCIDENT AND RECURRENT ACUTE MYOCARDIAL INFARCTION IN ALBANIA - A CALL FOR MORE FOCUS ON PREVENTION STRATEGIES : KLINIČNI PROFIL IN ZDRAVLJENJE PACIENTOV S PRVIM IN PONOVNIM POJAVOM AKUTNEGA MIOKARDNEGA INFARKTA V ALBANIJI – POZIV ZA VEČJO POZORNOST NA PODROČJU PREVENTIVNIH STRATEGIJ

Abstract Background The clinical profile of acute myocardial infarction (AMI) patients reflects the burden of risk factors in the general population. Differences between incident (first) and recurrent (repeated) events and their impact on treatment are poorly described. We studied potential differences in the clinical profile and in-hospital treatment between patients hospitalised with an incident and recurrent AMI. Methods A total of 324 patients admitted in the Coronary Care Unit of ‘Mother Teresa’ hospital, Tirana, Albania (2013-2014), were included in the study. Information on AMI type, complications and risk factors was obtained from patient’s medical file. Logistic regression analyses were used to explore differences between the incident and recurrent AMIs regarding clinical profile and in-hospital treatment. Results Of all patients, 50 (15.4%) had a prior AMI. Compared to incident cases, recurrent cases were older (P=0.01), more often women (P=0.01), less educated (P=0.01), and smoked less (P=0.03). Recurrent cases experienced more often heart failure (HF) (OR=2.48; 95% CI: 1.31–4.70), impaired left ventricular ejection fraction (OR=1.97; 95% CI:1.05–3.71), and multivessel disease (OR=6.32; 95% CI: 1.43–28.03) than incident cases. In-hospital use of beta-blockers was less frequent among recurrent compared to incident cases (OR=0.45; 95% CI: 0.24–0.85), while no statistically significant differences between groups were observed regarding angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, statin, aspirin or invasive procedures. Conclusion A more severe clinical expression of the disease and underutilisation of treatment among recurrent AMIs are likely to explain their poorer prognosis compared to incident AMIs.

Time trends and educational inequalities in out-of-hospital coronary deaths in Norway 1995-2009: A Cardiovascular Disease in Norway (CVDNOR) project

Background Recent time trends and educational gradients characterizing out‐of‐hospital coronary deaths (OHCD) are poorly described. Methods and Results We identified all deaths from coronary heart disease occurring outside the hospital in Norway during 1995 to 2009. Time trends were explored using Poisson regression analysis with year as the independent, continuous variable. Information on the highest achieved education was obtained from The National Education Database and classified as primary (up to 10 years of compulsory education), secondary (high school or vocational school), or tertiary (college/university). Educational gradients in OHCD were explored using Poisson regression, stratified by sex and age (<70 and ≥70 years), and results were expressed as incidence rate ratios (IRRs) and 95%CIs. Of 100 783 coronary heart disease deaths, 58.8% were OHCDs. From 1995 to 2009, age‐adjusted OHCD rates declined across all education categories (primary, secondary, and tertiary) in younger men (IRR=0.35; 95%CI 0.32‐0.38; IRR=0.38; 95%CI 0.35‐0.42; IRR=0.33; 95%CI 0.28‐0.40), younger women (IRR=0.47; 95% CI 0.40‐0.56; IRR=0.55; 95%CI 0.45‐0.67; IRR=0.28; 95% CI 0.16‐0.47), older men (IRR=0.20; 95%CI 0.19‐0.22; IRR=0.20; 95%CI 0.18‐0.22; IRR=0.20; 95%CI 0.17‐0.23), and older women (IRR=0.26; 95%CI 0.24‐0.28; IRR=0.25; 95%CI 0.23‐0.28; IRR=0.28; 95%CI 0.22‐0.34). Tertiary education was associated with lower risk of OHCD compared to primary education (IRR=0.37; 95%CI 0.35‐0.40 in younger men, IRR=0.26; 95%CI 0.22‐0.30 in younger women, IRR=0.52; 95%CI 0.49‐0.55 in older men, and IRR=0.61; 95%CI 0.57‐0.66 in older women). These gradients did not change over time (P interaction=0.25). Conclusions Although OHCD rates declined substantially during 1995 to 2009, they displayed educational gradients that remained constant over time.

Higher education is associated with reduced risk of heart failure among patients with acute myocardial infarction: A nationwide analysis using data from the CVDNOR project

Aims Coronary heart disease (CHD) outcomes are characterised by socioeconomic gradients. Although heart failure (HF) is a severe complication of CHD, sparse evidence exists on the association between socioeconomic status and HF among coronary patients. This study aimed to explore potential educational differences in the risk of HF among acute myocardial infarction (AMI) patients in Norway during 2001–2009. Methods and results A total of 70,506 patients hospitalised for an incident (first) AMI and without history of HF were included in the analyses. Information on education was obtained from the Norwegian Education Database and categorised into primary, secondary or tertiary. In 12,487 (17.7%) patients, HF was present at admission or developed during the AMI hospitalisation (early-onset HF). Compared to patients with primary education, patients with secondary or tertiary education had 9% [incidence rate ratio (IRR) = 0.91; 95% confidence interval (CI): 0.87–0.94] and 20% (IRR = 0.80; 95% CI: 0.75–0.86) lower risks of early-onset HF, respectively. Of the 54,095 AMI patients discharged alive without concurrent HF, 6375 (11.8%) were subsequently hospitalised with or died from late-onset HF during a median follow-up period of 3.4 years. Compared to patients with primary education, those with secondary or tertiary education had 14% [hazard ratio (HR = 0.86; 95% CI: 0.82–0.91] and 27% (HR = 0.73; 95% CI: 0.66–0.80) lower risks of HF, respectively. Educational differences in the risk of HF were not influenced by gender. Conclusions We observed an inverse association between educational level and risk of HF. More efforts in preventing this severe complication of AMI among less educated patients may help to reduce the socioeconomic gap in survival following coronary events.