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At least 253 records · Page 14Linked to original sources
PubMed1998

Management of patients with diabetes after heart attack: a population-based study of 1982 patients from a heart disease register.

BACKGROUND: Previous studies examining the management of patients with diabetes after acute myocardial infarction (AMI) have been based on clinical studies under experimental conditions. We used data from a population-based heart disease register to document differences in the management after AMI between patients with and without diabetes. HYPOTHESIS: There were no differences in the prescription rates of aspirin, beta blockers, streptokinase, ACE inhibitors and calcium channel blockers between patients with and without diabetes admitted to hospital with AMI. METHODS: A retrospective study of 268 patients with, and 1714 patients without, diabetes discharged from hospital with 'definite' AMI between August 1988 and March 1994. RESULTS: The prescription rates of all five drug classes increased between 1988 and 1994 both for patients with and without diabetes. Patients with diabetes were significantly less likely to have been prescribed aspirin (76% vs 85%), beta blockers (41% vs 53%) and streptokinase (25% vs 43%) but more likely to have been prescribed ACE inhibitors (47% vs 29%) and calcium channel blockers (50% vs 40%). The differences in prescription rates were statistically significant after controlling for age, sex, history of ischaemic heart disease, smoking status, educational level and disease severity. CONCLUSION: Patients with diabetes were less likely to have been prescribed three of the five drug classes where evidence points to a beneficial effect after AMI. Further work is needed to identify the reasons for the disparity between management of patients with and without diabetes, and to develop effective strategies to increase the implementation of best practice guidelines in the management of patients with diabetes after AMI.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Recent changes in attack and survival rates of acute myocardial infarction (1975 through 1981). The Worcester Heart Attack Study.

A communitywide study was conducted in all 16 acute general hospitals in the metropolitan Worcester, Mass, area during the calendar years 1975, 1978, and 1981 to examine time trends in the attack and case-fatality rates of patients hospitalized with validated acute myocardial infarction as well as of the occurrence of out-of-hospital coronary heart disease (CHD) deaths. Between 1975 and 1981, there was an increase in the age-adjusted attack rates of initial events of acute myocardial infarction (1975, 254/100,000; 1981, 280/100,000) as well as recurrent events (1975, 133/100,000; 1981, 156/100,000). These overall increases were due to an increase among those 65 years of age and older, with no significant changes observed in those less than 65 years old. The age-adjusted in-hospital case-fatality rates declined from 22.1% in 1975 to 20.3% in 1978 and 17.4% in 1981. In examining long-term prognosis, no significant differences were seen over an eight-year follow-up period between patients discharged in 1975, 1978, and 1981. The age-adjusted mortality rates of out-of-hospital CHD deaths significantly declined between 1975 (229/100,000) and 1981 (147/100,000). The results of this population-based survey suggest that recently observed declines in the mortality rates of CHD may reflect decreases in out-of-hospital coronary deaths and improving trends in the in-hospital survival of patients with acute myocardial infarction.

Adult↗
PubMedDate not supplied

Heart attack.

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Heart Failure↗
PubMed1992

Reduction of ischemic heart disease risk markers in the teenage children of heart attack patients.

BACKGROUND: Families of people with ischemic heart disease (IHD) are likely to share high levels of risk markers and to have similar lifestyle patterns. Teenage children in such families were the focus of a behavioral intervention program. METHODS: Families were randomly allocated to either an "early" or a "late" advice group. The late group and a third "control" group (consisting of families with no cardiovascular disease) received the intervention only after baseline measurements were repeated in all three groups at the end of 12 months. Pedigree analysis was used to compare changes across groups. RESULTS: The decrease in self-reported total fat intake was greater among teenagers in the early group (mean = -3.38, SE = 1.00) than among those in the late group (mean = -0.58, SE = 1.06), as was the decrease in saturated fat intake (mean = -2.46, SE = 0.56; mean = -0.54, SE = 0.60, respectively). These differences were statistically significant (P < 0.05). There were no differences between these groups for changes in total or high-density lipoprotein cholesterol levels. There was a statistically significant difference between the change in total cholesterol levels in the control group (mean = +0.08, SE = 0.07) and that in the late group (mean = -0.14, SE = 0.11). CONCLUSIONS: The intervention program appears to have made the teenagers aware of high-fat foods, as stated fat intake was significantly lowered, but it was not successful in decreasing blood cholesterol levels. Having a parent with IHD did, however, influence the teenagers' risk-related behavior, leading to a significant reduction in blood cholesterol levels.

Adolescent↗
PubMed2001

Ask the doctor. A few years ago, I had a heart attack. My doctor treated me with angioplasty, and I haven't had any symptoms of heart disease since. I do carry a bottle nitroglycerin with me, but haven't taken any in years. I renew my prescription every six months because I know the pills go bad. My problem is that I also need Viagra to have sexual intercourse. Whenever I refill my prescription for Viagra, the pharmacist gives me a hard time because he knows I also have a prescription for nitroglycerin. Just how dangerous is Viagra?

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3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed1985

Enhancement of visit adherence in the national beta-blocker heart attack trial.

Efforts were made in the Beta Blocker Heart Trial (BHAT), a double-blind study of 3837 post-MI patients, to enhance visit adherence, a measure of compliance that is not subjective and can be easily monitored. Of the required visits, 93.9% were completed in the window, 3.9% of the patients were classified as dropouts and 12 persons were lost to follow-up. Methods used to enhance compliance varied with circumstances but included appointment reminders, assistance with transportation, minimal waiting times, newsletters, continuity of care, involvement of family members, and close contact with private physicians. Comparisons of the BHAT visit adherence rates to those from other clinical trials are difficult to make because there are few reports in the literature regarding follow-up in large multicenter clinical trials. However, data obtained through personal communications, as well as published reports, indicate that adherence in primary prevention trials was generally less than that of secondary prevention trials. Adherence rates in the BHAT tended to be slightly higher than those of comparable trials.

Adult↗