Preventable clinical and psychosocial factors predicted two out of three recurrent cardiovascular events in a coronary population.
Aged
Disease Progression
Female
Heart Failure
/ mortality
Humans
Ischemic Attack, Transient
/ mortality
Male
Middle Aged
Myocardial Infarction
/ mortality
Myocardial Revascularization
/ adverse effects
Norway
/ epidemiology
Patient Readmission
Prospective Studies
Recurrence
Risk Assessment
Risk Factors
Secondary Prevention
Stroke
/ mortality
Time Factors
Treatment Outcome
Coronary heart disease
Prognosis
Psychosocial factors
Recurrent cardiovascular events
Risk factors
Secondary prevention
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
05 02 2020
05 02 2020
Historique:
received:
06
08
2019
accepted:
30
01
2020
entrez:
7
2
2020
pubmed:
7
2
2020
medline:
30
9
2020
Statut:
epublish
Résumé
The relative importance of lifestyle, medical and psychosocial factors on the risk of recurrent major cardiovascular (CV) events (MACE) in coronary patients' needs to be identified. The main objective of this study is to estimate the association between potentially preventable factors on MACE in an outpatient coronary population from routine clinical practice. This prospective follow-up study of recurrent MACE, determine the predictive impact of risk factors and a wide range of relevant co-factors recorded at baseline. The baseline study included 1127 consecutive patients 2-36 months after myocardial infarction (MI) and/or revascularization procedure. The primary composite endpoint of recurrent MACE defined as CV death, hospitalization due to MI, revascularization, stroke/transitory ischemic attacks or heart failure was obtained from hospital records. Data were analysed using cox proportional hazard regression, stratified by prior coronary events before the index event. During a mean follow-up of 4.2 years from study inclusion (mean time from index event to end of study 5.7 years), 364 MACE occurred in 240 patients (21, 95% confidence interval: 19 to 24%), of which 39 were CV deaths. In multi-adjusted analyses, the strongest predictor of MACE was not taking statins (Relative risk [RR] 2.13), succeeded by physical inactivity (RR 1.73), peripheral artery disease (RR 1.73), chronic kidney failure (RR 1.52), former smoking (RR 1.46) and higher Hospital Anxiety and Depression Scale-Depression subscale score (RR 1.04 per unit increase). Preventable and potentially modifiable factors addressed accounted for 66% (95% confidence interval: 49 to 77%) of the risk for recurrent events. The major contributions were smoking, low physical activity, not taking statins, not participating in cardiac rehabilitation and diabetes. Coronary patients were at high risk of recurrent MACE. Potentially preventable clinical and psychosocial factors predicted two out of three MACE, which is why these factors should be targeted in coronary populations. Registered at ClinicalTrials.gov: NCT02309255. Registered at December 5th, 2014, registered retrospectively.
Sections du résumé
BACKGROUND
The relative importance of lifestyle, medical and psychosocial factors on the risk of recurrent major cardiovascular (CV) events (MACE) in coronary patients' needs to be identified. The main objective of this study is to estimate the association between potentially preventable factors on MACE in an outpatient coronary population from routine clinical practice.
METHODS
This prospective follow-up study of recurrent MACE, determine the predictive impact of risk factors and a wide range of relevant co-factors recorded at baseline. The baseline study included 1127 consecutive patients 2-36 months after myocardial infarction (MI) and/or revascularization procedure. The primary composite endpoint of recurrent MACE defined as CV death, hospitalization due to MI, revascularization, stroke/transitory ischemic attacks or heart failure was obtained from hospital records. Data were analysed using cox proportional hazard regression, stratified by prior coronary events before the index event.
RESULTS
During a mean follow-up of 4.2 years from study inclusion (mean time from index event to end of study 5.7 years), 364 MACE occurred in 240 patients (21, 95% confidence interval: 19 to 24%), of which 39 were CV deaths. In multi-adjusted analyses, the strongest predictor of MACE was not taking statins (Relative risk [RR] 2.13), succeeded by physical inactivity (RR 1.73), peripheral artery disease (RR 1.73), chronic kidney failure (RR 1.52), former smoking (RR 1.46) and higher Hospital Anxiety and Depression Scale-Depression subscale score (RR 1.04 per unit increase). Preventable and potentially modifiable factors addressed accounted for 66% (95% confidence interval: 49 to 77%) of the risk for recurrent events. The major contributions were smoking, low physical activity, not taking statins, not participating in cardiac rehabilitation and diabetes.
CONCLUSIONS
Coronary patients were at high risk of recurrent MACE. Potentially preventable clinical and psychosocial factors predicted two out of three MACE, which is why these factors should be targeted in coronary populations.
TRIAL REGISTRATION
Registered at ClinicalTrials.gov: NCT02309255. Registered at December 5th, 2014, registered retrospectively.
Identifiants
pubmed: 32024471
doi: 10.1186/s12872-020-01368-6
pii: 10.1186/s12872-020-01368-6
pmc: PMC7003324
doi:
Banques de données
ClinicalTrials.gov
['NCT02309255']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
61Subventions
Organisme : Vestre Viken Trust
ID : 1703001
Pays : International
Organisme : Vestfold Hospital Trust
ID : 703110
Pays : International
Organisme : EkstraStiftelsen Helse og Rehabilitering
ID : 2018/FO190774
Pays : International
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