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Piotr Jankowski

Publications and source records attributed to Piotr Jankowski.

29 records · Page 2Linked to original sources
PubMed2003

Determinants of appropriate lipid management in patients with ischaemic heart disease. Cracovian Program for Secondary Prevention of Ischaemic Heart Disease.

UNLABELLED: Although several randomised clinical trials have documented the efficacy of lipid-lowering therapy in improving clinical outcomes in hyperlipidemic subjects with ischaemic heart disease (IHD), such therapy is underutilized worldwide. Not much is known about the effects of the hospital setting (university vs. community) on lipid management in patients after hospitalization due to ischaemic heart disease. The combined effect of age, sex, education, risk factors, hospital as well as practice setting in the post-discharge period on lipid management in IHD patients is also unknown. Therefore the aim of this study was to evaluate factors influencing lipid management during and after hospitalization due to IHD. The primary outcome measure was "appropriate lipid management", defined as: (a) being discharged on lipid-lowering medication or having a documented LDL cholesterol level <3.4 microM/l within the first 24 h of hospitalization, and (b) (for patients with hypercholesterolemia) being prescribed a lipid-lowering drug at the time of the interview 6-18 months after discharge. METHODS AND RESULTS: We reviewed the hospital records of 1051 consecutive patients with a discharge diagnosis of acute myocardial infarction (N=290), unstable angina (N=247), percutaneous coronary intervention (N=259) or coronary artery bypass surgery (N=255) who were hospitalized at three university (N=533) or three community (N=518) cardiac departments. Overall, 42.2% of the study population met the criteria for appropriate lipid management during hospitalization. Admission to the university hospital, percutaneous coronary intervention, a history of myocardial infarction, the presence of hypertension, the absence of diabetes mellitus, and younger age were all associated with an increased probability of receiving proper treatment during hospitalization. During the follow-up interview (6-18 months after discharge), 10.4% patients had a LDL cholesterol level of <2.6 microM/l. The use of lipid-lowering agents in the group with hypercholesterolemia was 40.8%. Patients who met the criteria for appropriate lipid management during hospitalization were more often prescribed a lipid-lowering drug at the time of interview compared with persons who did not meet those criteria (62.5% vs. 23.5%; P<0.0001). Patients undergoing percutaneous coronary interventions, treated in hospital outpatient clinics, obese patients as well as those better educated were more likely to be treated appropriately than the other groups. CONCLUSIONS: Proper lipid management during hospitalization is the most important factor related to lipid management in the post-discharge period. There is the potential for a further reduction of coronary risk, especially in patients hospitalized in community hospitals, not undergoing coronary interventions and those being under the care of general practitioners.

Comorbidity↗
PubMed2003

[Cracovian program for secondary prevention of ischemic heart disease. Methods of intervention].

The Cracovian Program for Secondary Prevention of Ischaemic Heart Disease carried out in cooperation with the Cracow Branch of Polish Cardiac Society is the first and so far the only attempt in Poland to extensively assess the quality of care in terms of secondary prevention of ischaemic heart disease, at the same time trying to influence both the physicians and patients. The results of the 1st stage of the Cracovian Program conducted in 1997-98 indicate that the recommendations for secondary prevention of ischaemic heart disease are not implemented to a satisfactory degree during hospitalization in cardiology departments of university and general hospitals in Cracow, as well as in the post-discharge period. Because of this, measures were undertaken to improve the quality of secondary prevention. Current recommendations for secondary prevention of ischaemic heart disease were presented and discussed during trainings for physicians from the participating centres and primary care physicians. At the same time the results of the 1st stage of the Cracovian Program were presented and the discrepancies between recommendations and everyday practice were identified. Two types of leaflets concerning secondary prevention were also given to patients discharged from the participating departments. In the 2nd stage of the Cracovian Program for Secondary Prevention of Ischaemic Heart Disease carried out in 1999-2000, the implementation of recommendations on secondary prevention was reassessed. The analysis of data obtained in the 2nd stage shows to what extent progress in research dealing with patients with ischaemic heart disease is reflected in everyday practice. It also allows for the evaluation of the impact of the above described intervention on the frequency of achieving the goals defined in the guidelines of cardiac societies. In this paper the genesis, outline and objectives of the project are discussed as well as the methods of intervention applied. The implementation of secondary prevention guidelines both during hospitalization and after discharge will be discussed in separate publications.

Catchment Area, Health↗
PubMed2003

[Cracovian program for secondary prevention of ischemic heart disease. Secondary prevention of ischemic heart disease during hospitalization in 1996-97 and 1998-99].

INTRODUCTION: Hospitalization for ischaemic heart disease is a convenient moment to initiate pharmacological and non-pharmacological treatment as well as education of patients. The aim of the study was to assess the quality of medical care in the field of secondary prevention in patients hospitalized for ischaemic heart disease in cardiac departments of university and general hospitals in 1998/99 as compared with 1996/97. MATERIAL: Consecutive patients were recruited on the basis of hospital records review of six cardiac departments (three in the university and three in general hospitals) in 1998/99. Inclusion criteria were: age < or = 70 years, inhabitance in the city of Cracow and its province and hospitalization due to: myocardial infarction, unstable angina, coronary angioplasty or coronary-aortic bypass grafting. METHODS: Hospital records of the included patients were reviewed. Data on previous history of ischaemic heart disease, on risk factors (including smoking, hypertension, diabetes, dyslipidemia, obesity) and drugs prescribed at discharge were obtained based on a predefined questionnaire. RESULTS: The frequency of blood pressure measurement in the first 24 hours of hospitalization was 88.8% in 1996/97 vs 95.7% in 1998/99 (p < 0.001). In the first 24 hours after admission total cholesterol concentration was measured in 32.8% and 45.0% of patients (p < 0.001), HDL cholesterol in 30.2% and 41.9% (p < 0.001) and triglycerides in 32.3% and 44.5% (p < 0.001), respectively. Both height and body mass were documented in 54.3% and 61.7% (p < 0.05) of the reviewed charts. Antiplatelet drugs were prescribed at discharge in 86.7% and 90.7% of patients (p < 0.05), beta-blockers in 66.4% and 61.9%, ACE inhibitors in 50.2% and 52.8%, while lipid lowering drugs in 27.1% and 41.6% (p < 0.001), respectively. CONCLUSION: In 1998/99 compared with 1996/97 the quality of care in the field of secondary prevention of ischaemic heart disease was improved in cardiac departments of university and general hospitals in Cracow.

Adrenergic beta-Antagonists↗
PubMed2003

[Cracovian program for secondary prevention of ischemic heart disease. Secondary prevention of ischemic heart disease after discharge in 1997-98 and 1999-2000].

INTRODUCTION: Although most actions undertaken within the scope of the secondary prevention of ischaemic heart disease should be initiated during hospitalization, obtaining maximal effects (quantified by cardiovascular risk reduction) depends largely on continuation and appropriate adjustment of these measures in the post-discharge period. The aim of this paper is to assess the implementation of guidelines on secondary prevention of ischaemic heart disease in the period after discharge from the hospital in the years 1999/2000 as compared with 1997/98. MATERIAL AND METHODS: In the first phase 515 subjects hospitalized in cardiac departments of university and general hospitals in Cracow were included. Out of them, 427 patients attended the control visit 6-18 months after index hospitalization. Based on a standardized questionnaire a structured medical history was obtained including the presence of risk factors and medication. At the same time body height and mass and blood pressure were measured and blood samples were obtained for lipid profile and fasting glucose level. RESULTS: Elevated cholesterol levels (> or = 5.2 mmol/l) were observed in 65.8% of patients in 1998/99 and 66.3% in 1999/2000, high blood pressure (> or = 140/90 mmHg) in 46.2% and 50.4%, obesity (BMI > or = 30 kg/m2) in 24.6% and 27.2%, fasting hyperglycemia (> or = 6.0 mmol/l) in 17.7% and 27.4% (p < 0.05) and smoking in 16.3% and 15.9%, respectively. An increase was observed in the rate of antiplatelet (76.1% in 1998/99 vs 86.7% in 1999/2000, p < 0.001) and lipid lowering drug use (34.0% vs 41.9%, p < 0.05). The rate of beta-blockers and ACE inhibitors use did not change significantly. CONCLUSIONS: In the years 1999/2000 the control of main risk factors of ischaemic heart disease did not improve when compared with 1997/98. There was only an increase in the percentage of patients on antiplatelet and lipid lowering drugs. These results indicate that the dissemination of the guidelines for secondary prevention of ischaemic heart disease among physicians and patients remains one of the top priorities of cardiology in Poland.

Adrenergic beta-Antagonists↗
PubMed2003

[Is homocysteine a new factor in the pathogenesis of restenosis after percutaneous coronary angioplasty?].

Restenosis after coronary angioplasty is still a significant problem despite the dynamic development of intervention cardiology. Homocysteine causes endothelial dysfunction and disorders of the coagulation system, increases in platelets aggregation and stimulates the proliferation of the vascular smooth cell. These were the reasons for investigating the relation between homocysteine level and the risk of restenosis. Some studies indicate that higher homocysteine levels increase the risk of restenosis after coronary angioplasty, while it has not been proven in other studies. The results of the only one randomized trial demonstrated that pharmacological lowering of the homocysteine level decreased the risk of restenosis after coronary angioplasty. At this time there are some studies which started focusing on the role of lowering homocysteine level in cardiovascular risk. These investigations may explain the importance of homocysteine level in the development of cardiovascular diseases. There is a need of a large prospective multicenter trial assessing the relationship between increased homocysteine level and the frequency of restenosis after coronary angioplasty. Using intravascular ultrasonography could be especially helpful in assessing the role of decreasing homocysteine level on neo-intima formation and arterial remodeling after intervention.

Angioplasty, Balloon, Coronary↗
PubMed2002

[The influence of percutaneous coronary recanalization of total coronary occlusions on the heart rate variability ].

In patients following a myocardial infarction, heart rate variability is an important prognostic factor. Decreased heart rate variability is associated with a higher mortality rate. This study evaluated the influence of recanalisation by percutaneous coronary intervention (PCI) in totally occluded coronary arteries on the heart rate variability in patients with myocardial akinesis in the recanalised artery area. The study group included 22 men (average age 52.8 +/- 7.7) after successful PCI recanalization of the totally occluded artery. All patients had akinesis in the recanalised artery area. All patients underwent 24-hour continuous electrocardiographic Holter monitoring with HRV analysis and echocardiographic dobutamine tests both before the PCI and 6 months afterwards. The population was divided into two groups: group A (10 patients) had contractility adjustments in echocardiographic tests that were performed 6 months after the PCI. Group B (12 patients) did not have contractility adjustments. Before the PCI, there were no differences in the wall motion score index (WMI) or the time-domain HRV parameters between the two groups. After 6 months, there was a significant increase in the WMI value in group A, whereas this index remained unchanged in group B. In group A the time-domain HRV parameters had improved 6 months after the PCI, whereas they remained unchanged in group B. Successful percutaneous revascularization of the totally occluded coronary artery in patients with myocardial akinesis in the occluded artery area leads to an increase in HRV parameters. This improvement occurred only in patients that had a contractility adjustment after the PCI in previous akinetic segments of myocardium.

Adult↗
PubMedDate not supplied

INTERHEART.

Explore the source record for details and available documents.

Depression↗
PubMedDate not supplied

[Comprehensive treatment of nicotine dependence in patients with cardiovascular diseases--personal experience].

AIM: To evaluate psychological factors influencing the effectiveness of smoking cessation using bupropion and psychological intervention in patients with cardiovascular diseases. METHOD: A group of 59 patients (26 M, 33 F; mean age 44.2 +/- 10.2 years) identified among smokers admitted to the 1st Cardiac Department between 2000 and 2001 with hypertension (n = 46) and coronary artery disease (n = 13). Entry criteria to participate in a 7-week programme included nicotine dependence and no contraindications to bupropion. Pharmacotherapy was used in parallel with psychological interventions based upon cognitive and behavioural methods. The type and degree of nicotine dependence was measured using Fragerstrom tolerance questionnaire whereas motivation was scored according to the Schneider questionnaire. The severity of depression symptoms was measured by the Beck Depression Inventory. RESULTS: At 2 months and at one year after discontinuation of treatment 74.6% and 40% of the patients respectively maintained abstinence from smoking. Among patients with good therapeutic effects the level of motivation to quit smoking was higher (p < 0.001 vs. p < 0.007). The level of motivation was correlated with the severity of depression symptoms (p < 0.005) but not with nicotine dependence, age and sex. Motivation to stop smoking is related to the depression symptoms (beta = -0.32; p = -.01). CONCLUSION: Patients with initially higher motivation benefit more from treatment of nicotine dependence. The level of motivation is adversely affected by the depressive mode of functioning (negative cognitive patterns, learned helplessness). It appears necessary to take into account the assessment of depressive disorders when planning treatment of nicotine dependence in patients with cardiovascular diseases.

Adult↗