Survivors Of Acute Myocardial Infarction Research Articles

Smartwatch-derived heart rate variability: a head-to-head comparison with the gold standard in cardiovascular disease.

We aimed to investigate the concordance between heart rate variability (HRV) derived from the photoplethysmographic (PPG) signal of a commercially available smartwatch compared with the gold-standard high-resolution electrocardiogram (ECG)-derived HRV in patients with cardiovascular disease. We prospectively enrolled 104 survivors of acute ST-elevation myocardial infarction, 129 patients after an ischaemic stroke, and 30 controls. All subjects underwent simultaneous recording of a smartwatch (Garmin vivoactive 4; Garmin Ltd, Olathe, KS, USA)-derived PPG signal and a high-resolution (1000 Hz) ECG for 30 min under standardized conditions. HRV measures in time and frequency domain, non-linear measures, as well as deceleration capacity (DC) were calculated according to previously published technologies from both signals. Lin's concordance correlation coefficient (ρc) between smartwatch-derived and ECG-based HRV markers was used as a measure of diagnostic accuracy. A very high concordance within the whole study cohort was observed for the mean heart rate (ρc = 0.9998), standard deviation of the averages of normal-to-normal (NN) intervals in all 5min segments (SDANN; ρc = 0.9617), and very low frequency power (VLF power; ρc = 0.9613). In contrast, detrended fluctuation analysis (DF-α1; ρc = 0.5919) and the square mean root of the sum of squares of adjacent NN-interval differences (rMSSD; ρc = 0.6617) showed only moderate concordance. Smartwatch-derived HRV provides a practical alternative with excellent accuracy compared with ECG-based HRV for global markers and those characterizing lower frequency components. However, caution is warranted with HRV markers that predominantly assess short-term variability.

Abstract P405: Low Social Support Mediates the Effect of Marital Stress on 12-month Cardiac-Specific Quality of Life in Young Adults With Acute Myocardial Infarction

Background: Marital stress is associated with worse cardiac outcomes in young adults (≤55 years) with acute myocardial infarction (AMI), but whether psychosocial factors mediate this association remains largely unknown. We conducted a mediation analysis to investigate whether marital stress worsened quality of life (QoL) after AMI by increasing the likelihood of depression or low social support. Methods: There were 1,037 married/partnered AMI survivors aged 18-55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study (2008-2012) (67% women, mean age 47 years). Marital stress was measured by the Stockholm Marital Stress Scale at 1 month post-AMI; categorized as absent/moderate or severe. Depression (Patient Health Questionnaire-9 score ≥10), low social support (ENRICHD Social Support Instrument score ≤3 on ≥2 items and total score ≤18), and cardiac-specific QoL (Seattle Angina Questionnaire) were assessed at 1 year post-AMI. Natural direct and indirect effects of marital stress, depression, and low social support on QoL were estimated by causal mediation analysis with bias-corrected bootstrapped confidence intervals. Baseline QoL, sex, age, race, and socioeconomic factors (education, income, employment, and insurance status) were entered as covariates in all models. Results: There was a statistically significant direct effect from severe marital stress to lower 1-year cardiac-specific QoL after adjusting for covariates ( Figure ). Low social support and depression mediated 14.7% and 11.1% of the total relationship between marital stress and QoL, respectively; however, only the mediating effect through low social support was statistically significant. Conclusion: Marital stress was significantly associated with worse 1-year cardiac-specific QoL, and this effect was partially mediated by low social support. Interventions to decrease marital stress that also screen and provide resources for social support may help to improve AMI outcomes.

The long-term benefit of a cardiac rehabilitation program after myocardial infarction in patients under the Managed Care for Acute Myocardial Infarction Survivors (MACAMIS) program in Poland: A single-center study.

The Managed Care for Acute Myocardial Infarction Survivors (MACAMIS) program introduced for patients after myocardial infarction (MI) consists of 4 modules including early cardiac rehabilitation (CR). We compared the impact of CR on survival of patients after MI included in the MACAMIS program. Patients in MACAMIS were divided into subgroups based on being qualified or not qual-ified for CR and on whether they completed or failed to complete CR. We evaluated one-, two-, and three-year mortality. Of 244 patients in MACAMIS, 174 patients were qualified for CR. They were younger, had less advanced coronary artery disease (CAD), higher ejection fraction (EF), and fewer comorbidities. Finally, 102 (58.6%) patients completed CR. These patients were younger and more likely to have STEMI; they were more often treated invasively, with no differences in comorbidity burden. The survival rates at one, two, and three years were 93.6%, 87.8%, and 65.0%, respectively. Patients who qualified for CR had a better prognosis. The mortality rates at one, two, and three years were 2.38% vs. 16.18% (P = 0.0003), 6.71% vs. 25.4% (P = 0.002), and 26.87% vs. 51.35% (P = 0.01), respectively. Patients who completed CR, again, had a significantly better prognosis. The mortality rate was 1% vs. 10.29% (P = 0.009), 4.17% vs. 17.56% (P = 0.002), and 23.33% vs. 40.54% (P = 0.09) in analyzed periods. The only independent factors related to survival were completion of CR and number of comorbidities. Patients with MI in the MACAMIS program had better prognosis when participating in CR. After completing the MACAMIS program, increased mortality was observed in the following years. Despite the flexibility of the CR program, the proportion of patients who qualified and completed CR remained low.

Beta-blockers in post-acute myocardial infarction patients: Drug prescription patterns from 2018 to Italy's first wave of the COVID-19 pandemic.

Background: Major guidelines recommend the initiation of a beta-blocker therapy after an acute myocardial infarction (AMI). We aimed to map the treatment pathway of beta-blockers for AMI survivors during the first wave of COVID-19 pandemic in Italy and to investigate predictors for treatment non-initiation. Methods: Healthcare utilization databases of Lombardy Region were investigated. Subjects aged ≥18 years who were hospitalised with AMI in the period February-March-April of 2018, 2019, and 2020 were included, and followed for 30 days from the discharge date, to investigate whether they presented a first prescription of beta-blockers. A multivariate logistic model was performed to evaluate the effect of several covariates on the probability of not receiving a post-AMI beta-blocker therapy. Results: The cohorts comprised 2259, 2383, and 1932 individuals who were hospitalised with AMI in the 3-month period in 2018, 2019, and 2020, respectively. Overall in 2020, about 58-60% of individuals with AMI received a prescription of beta-blockers within 1month after the discharge. A continuous decreasing trend over time was observed. Men were 30% more likely to start the treatment than women, increasing age was associated with significant increasing probability of not receiving a post-infarction beta-blocker therapy, while having received an antihypertensive or lipid-lowering treatment, or having been hospitalized for heart failure prior to the AMI hospitalization reduced the likelihood of not being treated with beta-blockers. Conclusion: The initiation of beta-blocker treatment after AMI remains an under-prescribed practice, that does not seem to have been further affected by the first wave of the COVID-19 pandemic.

Clinical benefit of long-term use of dual antiplatelet therapy for acute myocardial infarction patients with the PEGASUS-TIMI 54 criteria.

We evaluated the effectiveness of extended dual antiplatelet therapy (DAPT) usage after 2nd-generation drug elution stent implantation in acute myocardial infarction (AMI) survivors with high ischemic risk characteristics who had no major bleeding for 24 months under at least 1 year of DAPT maintenance. The primary ischemic and bleeding endpoints were the risk of mortality and the risk of BARC 3 or 5 (major) bleeding. We investigated the event rates for 2-5 years after the index procedure. Of 3382 post-AMI survivors who met the PEGASUS-TIMI 54 (PEGASUS) criteria and without major bleeding until 2 years, 2281 (67.4%) maintained DAPT over 24 months, and 1101 (32.5%) switched DAPT to a single antiplatelet agent. The >24 M DAPT group showed a lower risk of mortality than the 12-24 M DAPT group (7.2 vs. 9.2%; adjusted hazard ratio: 0.648; 95% confidence interval: 0.595-0.976; p < 0.001). The mortality risk was significantly greater as the number of PEGASUS criteria increased (p < 0.001). DAPT > 24 months was not significantly associated with a decreased risk for major bleeding in the population meeting the PEGASUS criteria (2.0 vs. 1.1%; p = 0.093). The results were consistent after propensity-score matching and inverse probability weighting to adjust for baseline differences. Extended DAPT over 24 months was associated with a lower risk of mortality without increasing the risk of major bleeding among 2 years survivors after AMI who met the PEGASUS criteria and had no major bleeding events before 24 months.

Abstract 14359: Impact of Marital Stress on 12-month Health Outcomes Among Young Adults With Acute Myocardial Infarction

Background: Psychosocial stress is associated with worse cardiac outcomes, but little is known about the prognostic impact of marital stress in young adults (≤55 years) with acute myocardial infarction (AMI). We investigated the association between marital stress and 1-year health outcomes in young AMI survivors. Methods: We used data from the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients), which enrolled people aged 18-55 years with AMI (2008-2012). Marital stress was assessed among married/partnered participants at 1 month post-AMI using the Stockholm Marital Stress Scale, categorized as absent/mild, moderate, and severe. Main outcomes were physical/mental health status, generic/disease-specific quality of life, angina, depressive symptoms, and all-cause readmission at 1 year post-AMI. Linear and logistic regression models were sequentially adjusted for baseline health status, demographics, and socioeconomic factors (including education level, income level, employment status, and insurance status). Results: Among the 1593 married/partnered participants in our study, more women reported severe marital stress than men (39.4% vs 30.4%, p=0.001). Having severe marital stress was associated with worse physical and mental health, lower generic and cardiovascular-specific quality of life, more angina and depressive symptoms, and 1.48 times higher all-cause readmission at 1 year post-AMI. These associations remained significant after adjusting for baseline health score and patient demographics ( Table Model 1 ), but they attenuated and became non-significant when further adjusting for socioeconomic factors ( Model 2 ). Conclusion: Marital stress was associated with worse health outcomes in young AMI patients, which can be partially mediated by socioeconomic factors. Further research is needed to understand this complex relationship and potential causal pathway associated with these findings.

Telemedical cardiac risk assessment by implantable cardiac monitors in post-infarction patients with autonomic dysfunction (SMART-MI-DZHK9): gender differences and outcomes

Abstract Background Cardiac autonomic dysfunction identifies high-risk patients after myocardial infarction (MI). Telemedical cardiac risk assessment by implantable cardiac monitors (ICM) after MI was recently identified as an effective method to early detect subclinical, but prognostically relevant serious arrhythmic events (SArE). Clinical complications in female patients after MI usually present with atypical symptoms. Therefore, early detection of prognostically relevant SArE in females would be of great clinical interest. Purpose In this pre-specified analysis of the SMART-MI trial we aimed to assess the impact of gender on detection of SArE and subsequent clinical complications. Methods SMART-MI was a prospective, randomised trial. Survivors of acute MI with preserved left-ventricular ejection fraction (LVEF 36–50%) and abnormal periodic repolarization dynamics (≥5.75deg2) and/or deceleration capacity (≤2.5ms) were randomly assigned to ICM-based telemedical monitoring or conventional follow-up. Primary endpoint was time to detection of SArE defined as the composite of atrial fibrillation ≥6 minutes, atrioventricular block ≥IIb, or fast non-sustained (&amp;gt;187 bpm;≥40 beats)/sustained ventricular tachycardia/fibrillation. Clinical complications were defined as the composite of mortality, stroke, systemic arterial thromboembolism, and hospitalization for decompensated heart failure. The effect of intervention on the primary endpoint was tested using Cox-regression analysis. The effect of SArE on clinical complications was evaluated by introducing SArE as time-dependent covariate. Results Between May 12, 2016, and July 20, 2020, 1305 individuals were screened and 400 patients were randomly assigned to ICM-implantation (N=201; 49 females) or conventional follow-up (control group; N=199; 29 females). During a median follow-up of 21±23 months, SArE were detected in 60 (30%; 12 females) patients in the ICM and 12 (6%; 1 female) patients in the control group. In both males and females ICM-implantation was associated with a higher detection rate of SArE (HR 6.33; 3.28–12.23; p&amp;lt;0.001 in males and HR 8.49; 1.10–65.66; p=0.040 in females; p-interaction = 0.790; Figure 1). In both male and female patients, detection of SArE was prognostic for subsequent clinical complications (HR 3.64; 1.89–7.02; p&amp;lt;0.001 in males and HR 16.19; 4.76–55.11 in females; p&amp;lt;0.001). The association between SArE and clinical complications was significantly higher in females than males. Among the 13 females with detected SArE, 6 developed clinical complications within a median period of 25±18 months, compared to 12 complications out of 59 SArE within 18±13 months among males (Figure 2; p-interaction = 0.030). Conclusion Telemedical monitoring with ICM was highly effective in early detection of subclinical, prognostically relevant SArE in both female and male patients. However, the association of a detected SArE with a subsequent clinical complication was significantly higher among females. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsches Zentrum für Herz und Kreislaufforschung (DZHK) and Medtronic Bakken Research Center

Sodium-glucose co-transporter-2 inhibitors after acute myocardial infarction in type 2 diabetes patients: a population-based investigation from South Korea

Abstract Background Whether the early use of sodium-glucose co-transporter-2 (SGLT2) inhibitors has cardioprotective effects following acute myocardial infarction (AMI) is unknown. Purpose We aimed to evaluate the association between the early initiation of SGLT2 inhibitors and cardiac event rates in diabetes patients with AMI undergoing percutaneous coronary intervention (PCI). Methods Based on the National Health Insurance claims data in South Korea, patients aged 18 years or older who had undergone PCI for the diagnosis of AMI between 2014 and 2018 were analyzed. Patients treated with SGLT2 inhibitors or other glucose-lowering drugs were matched based on a propensity score. The primary endpoint was a composite of all-cause mortality and hospitalizations for heart failure (HF). Major adverse cardiac events (MACE; a composite of all-cause death, non-fatal MI, and ischemic stroke) were compared as the secondary endpoint. Results After 1:2 propensity score matching, a total of 26,814 patients were assigned to the SGLT2 inhibitors group (938 patients) and the no use of SGLT2 inhibitors group (1,876 patients), respectively. During a median follow-up of 2.1 years, compared to no use of SGLT2 inhibitors, the early use of SGLT2 inhibitors was associated with lower risks of both the primary endpoint (9.8% vs. 13.9%, adjusted hazard ratio [HR] = 0.68, 95% confidence interval [CI]: 0.54 to 0.87, p=0.002) and secondary endpoint (9.1% vs. 11.6%, adjusted HR = 0.77, 95% CI: 0.60 to 0.99, p=0.04) (Figure 1). All-cause mortality and hospitalizations for HF were significantly lower in the early use of SLGT2 inhibitors group (adjusted HR = 0.55; 95% CI: 0.37 to 0.80; p=0.002; and HR = 0.74; 95% CI: 0.56 to 0.98; p=0.03, respectively). The incidence of non-fatal MI and ischemic stroke were not statistically different (Figure 2). Conclusions The early use of SGLT2 inhibitors in diabetes patients treated with PCI for AMI was associated with a significantly lower risk of cardiovascular events including all-cause mortality, hospitalizations for HF, and MACE. Our results suggest that the use of SGLT2 inhibitors could expand to the acute phase of AMI survivors with diabetes to reduce mortality and the subsequent development of congestive HF and ischemic events. Funding Acknowledgement Type of funding sources: Private hospital(s). Main funding source(s): This work was partly supported by the Research Institute of Medical Science, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea.

Prognostic impact of incident left ventricular systolic dysfunction after myocardial infarction.

IntroductionWe sought to investigate the prognostic impact of incident left ventricular (LV) systolic dysfunction at the chronic phase of acute myocardial infarction (AMI).Materials and methodsAmong 2,266 consecutive patients admitted for AMI, 1,330 patients with LV ejection fraction (LVEF) ≥ 40% during hospitalization who had LVEF data at 6 months after AMI were analyzed. Patients were divided into three subgroups based on LVEF at 6 months: reduced-LVEF (<40%), mid-range-LVEF (≥ 40% and < 50%) and preserved-LVEF (≥ 50%). Occurrence of a composite of hospitalization for heart failure or cardiovascular death after 6 months of AMI was the primary endpoint. The prognostic impact of LVEF at 6 months was assessed with a multivariate-adjusted Cox model.ResultsOverall, the mean patient age was 67.5 ± 11.9 years, and LVEF during initial hospitalization was 59.4 ± 9.1%. The median (interquartile range) duration of follow-up was 3.0 (1.5–4.8) years, and the primary endpoint occurred in 35/1330 (2.6%) patients (13/69 [18.8%] in the reduced-LVEF, 9/265 [3.4%] in the mid-range-LVEF, and 13/996 [1.3%] in the preserved-LVEF category). The adjusted hazard ratio for the primary endpoint in the reduced-LVEF vs. mid-range-LVEF category and in the reduced-LVEF vs. preserved-LVEF category was 4.71 (95% confidence interval [CI], 1.83 to 12.13; p < 0.001) and 14.37 (95% CI, 5.38 to 38.36; p < 0.001), respectively.ConclusionIncident LV systolic dysfunction at the chronic phase after AMI was significantly associated with long-term adverse outcomes. Even in AMI survivors without LV systolic dysfunction at the time of AMI, post-AMI reassessment and careful monitoring of LVEF are required to identify patients at risk.

PREDICTORS OF LOW FUNCTIONAL RESERVES IN REHABILITATION OF PATIENTS WITH MYOCARDIAL INFARCTION COMPLICATED BY COMORBID PATHOLOGY

Background. Myocardial infarction (MI) is one of the leading causes of death in working age population; the risk of cardiovascular complications for survivors of acute MI complicated by comorbid pathology (CP) is very high. Objective. The study is aimed to search for reliable prognostic markers for risk of reducing the functional reserves of the cardiovascular system in myocardial infarction with comorbid pathology. Methods. The prospective study involved 371 patients with MI, who received non-invasive therapy and were observed for a 90-day period after admission to the hospital. All patients were examined and treated according to current protocols. Results. It was found that 6-minute walk test (6MWT) is a specific and highly sensitive prognostic marker of functional reserves for patients with MI with CP (specificity – 100%, sensitivity – 63%, prognostic value of a positive result – 100%) with the Charlson comorbidity index (CCI) ≥2. The correlation of 6MWT performed on the 10th, 30th and 90th day of rehabilitation was revealed with the age of patients, SpO2, respiratory rate, systolic blood pressure, heart rate, left ventricular ejection fraction, levels of troponin T, creatinine, the number of lymphocytes in the peripheral blood, CCI (p&lt;0.05). Conclusions. During the 90-day rehabilitation period of a patient with MI complicated by CP, the markers of reduced exercise tolerance to be monitored are: blood pressure levels, respiratory rate, troponin T, creatinine, cholesterol, low-density lipoprotein, SpO2, the number of lymphocytes in the peripheral blood. To improve control over the process of rehabilitation in patients with MI complicated by CP the 6MWT and CCI should be used.

Integrated Photothermal-Pyroelectric Biosensor for Rapid and Point-of-Care Diagnosis of Acute Myocardial Infarction: A Convergence of Theoretical Research and Commercialization.

Acute myocardial infarction (AMI) survivors face a high risk of mortality as a result of increasing heart failure and irreparable myocardial injury. New portable methods for immediate diagnosis must be developed to provide patients with daily warnings. Herein, the development of a dual-mode photothermal-pyroelectric output system based on a point-of-care platform for rapid AMI detection is reported. Termed as Integrated Photothermal-Pyroelectric Biosensor for AMI (IPPBA), the method leverages cascade enzymatic amplification to convert the target signal into a thermal and pyrooelectric conversion of the testing process by delicate pyroelectric pervokite NaNbO3 nanocubes modified microelectrodes for sensitive detection of cTnI protein in whole blood. In addition, the mechanism of the proposed pyroelectric bioassay model is explored in depth based on in situ variable temperature X-ray diffraction (XRD) lattice change statistics and density function theory (DFT) calculations. With standard samples and under optimized experimental conditions, the proposed IPPBA platform exhibits excellent signal stability and ultra-low detection limit (0.05ng mL-1 ) for the target cTn I. With further developments in digital technology (e.g., 5G signaling protocols, fully automated systems), the integrated digital bio-testing platform IPPBA is fully capable of accomplishing positive and timely diagnosis of AMI.

Development of a Laboratory Risk-Score Model to Predict One-Year Mortality in Acute Myocardial Infarction Survivors.

The high post-discharge mortality rate of acute myocardial infarction (AMI) survivors is concerning, indicating a need for reliable, easy-to-use risk prediction tools. We aimed to examine if a combined pre-procedural blood testing risk model predicts one-year mortality in AMI survivors. Overall, 1355 consecutive AMI patients who received primary coronary revascularization were divided into derivation (n = 949) and validation (n = 406) cohorts. A risk-score model of parameters from pre-procedural routine blood testing on admission was generated. In the derivation cohort, multivariable analysis demonstrated that hemoglobin < 11 g/dL (odds ratio (OR) 4.01), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (OR 3.75), albumin < 3.8 mg/dL (OR 3.37), and high-sensitivity troponin I > 2560 ng/L (OR 3.78) were significantly associated with one-year mortality after discharge. An increased risk score, assigned from 0 to 4 points according to the counts of selected variables, was significantly associated with higher one-year mortality in both cohorts (p < 0.001). Receiver-operating characteristics curve analyses of risk models demonstrated adequate discrimination between patients with and without one-year death (area under the curve (95% confidence interval) 0.850 (0.756–0.912) in the derivation cohort; 0.820 (0.664–0.913) in the validation cohort). Our laboratory risk-score model can be useful for predicting one-year mortality in AMI survivors.

Impact of myocardial revascularization on long-term outcomes in a nationwide cohort of first acute myocardial infarction survivors.

The long-term clinical benefits of myocardial revascularization in a contemporary, nationwide cohort of acute myocardial infarction (AMI) survivors are unclear. We aimed to compare the mortality rates and clinical outcomes at 8 years of patients admitted in Italy for a first AMI managed with or without myocardial revascularization during the index event. This is a national retrospective cohort study that enrolled patients admitted for a first AMI in 2012 in all Italian hospitals who survived at 30 days. The outcomes of interest were all-cause mortality, major cardio-cerebrovascular events (MACCE), and re-hospitalization for heart failure (HF) at 8 years. Time to events was analysed using a Cox and Fine and Gray multivariate regression model. A total of 127 431 patients with AMI were admitted to Italian hospitals in 2012. The study cohort consisted of 62 336 AMI events, of whom 63.8% underwent percutaneous or surgical revascularization ≤30 days of the index hospital admission. At 8 years, the cumulative incidence of all-cause death was 36.5% (24.6% in revascularized and 57.6% in not revascularized patients). After multiple corrections, the hazard ratio (HR) for all-cause mortality in revascularized vs. not revascularized patients was 0.61 (P < 0.0001). The rate of MACCE was 45.7% and 65.8% (adjusted HR 0.83; P < 0.0001), while re-hospitalizations for HF occurred in 17.6% and 29.8% (adjusted HR 0.97; P = 0.16) in AMI survivors revascularized and not revascularized, respectively. In our contemporary nationwide cohort of patients at their first AMI episode, those who underwent myocardial revascularization within 1 month from the index event compared to those not revascularized presented an adjusted 39% risk reduction in all-cause mortality and 17% in MACCE at 8-year follow-up.

The Polyscore of autonomic parameters predicts mortality and identifies low-risk individuals among diabetic survivors of acute myocardial infarction

Survivors of an acute myocardial infarction with diabetes mellitus retain an increased mortality risk. Reliable assessment of individual risk is required for effective and cost-efficient medical care in these patients. The Polyscore is a previously established risk predictor consisting of seven autonomic tests derived from electrocardiogram, blood pressure, and respiration. The Polyscore allows classification of survivors of myocardial infarction in groups at low, intermediate and high mortality risk. The aim of this study was to investigate the prognostic value of the Polyscore in diabetic survivors of acute myocardial infarction, which may be impaired by the presence of diabetic autonomic neuropathy. Survivors of an acute myocardial infarction were included in a prospective cohort study during hospitalisation due to the index event at two university hospitals in Munich, Germany. The Polyscore was determined from simultaneous non-invasive 30-min recordings of electrocardiogram, continuous arterial blood pressure, and respiration which were performed in all participants. Patients were followed for 5 years. The primary and secondary outcomes were all-cause mortality and cardiac mortality. 184 of 941 enrolled patients (19.6%) suffered from diabetes mellitus. 5-year-mortality was higher in diabetic patients (15.2%) compared to non-diabetic patients (5.8%). A multivariable Cox regression model confirmed the Polyscore as a strong predictor of mortality in diabetic post-MI patients (intermediate risk: HR 6.56, 95% CI 1.61–26.78, p = 0.004, mortality 22.8%; high risk: HR 18.76, 95% CI 4.35–80.98, p < 0.001, mortality 68.8%). There was no interaction between diabetes mellitus and the Polyscore regarding mortality prediction (p = 0.775). Interestingly, in contrast to the groups at intermediate and high risk (73 patients, 39.7%), the Polyscore identified a majority of diabetic patients (111, 60.3%) with a low mortality risk, comparable to that of low-risk non-diabetic patients (3.6% and 2.1%, respectively, p = 0.339). Consistent results were observed for cardiac mortality. This analysis shows that the Polyscore predicts all-cause and cardiac mortality in diabetic survivors of acute myocardial infarction. Within these patients it identifies a large population not affected by the excess mortality associated with diabetes in this setting. Thus, the Polyscore may facilitate risk-adapted follow-up strategies in diabetic survivors of myocardial infarction.

Managed Care after Acute Myocardial Infarction (MC-AMI) improves prognosis in AMI survivors with pre-existing heart failure: A propensity score matching analysis of Polish nationwide program of comprehensive post-MI care.

Despite improvement in acute myocardial infarction (AMI) treatment, post-discharge mortality remains high. The outcomes are supposed to be even worse in patients with post-MI heart failure (HF), as only a half of patients with newly diagnosed HF survive four years. The study aimed to analyze whether managed care after acute myocardial infarction (MC-AMI) is associated with better survival in AMI survivors with a pre-existing diagnosis of HF. The study included 7228 patients with a pre-existing diagnosis of HF who survived the hospitalization for AMI in Poland between November 2017 and December 2020, of whom 2268 (31.4%) were referred for the MC-AMI program. The median follow-up was 1.5 (0.7-2.3) years. In the unmatched analysis, patients without MC-AMI had more than twice higher 12-month mortality (21.8% vs. 9.9%; P <0.01) than MC-AMI participants. The difference remained significant after propensity score matching (16,8% vs. 10.0%; P <0.01). In multivariable analysis, participation in MC-AMI was an independent factor of 12-month survival. MC-AMI participants had a lower stroke rate (1.5% vs. 3.0%; P <0.01) and fewer hospital admissions due to HF (22.9% vs. 27.6%; P <0.01). After propensity score matching, participation in MC-AMI was associated with lower rates of stroke, HF hospitalizations, and all-cause mortality in the 12-month follow-up and was an independent factor of 12-month survival in AMI survivors with pre-existing HF.

One-Year Outcomes and Factors Associated With Mortality Following Acute Myocardial Infarction in Northern Tanzania.

Little is known about long-term outcomes and uptake of secondary preventative therapies following acute myocardial infarction (AMI) in sub-Saharan Africa. Consecutive patients presenting with AMI (as defined by the Fourth Universal Definition of AMI Criteria) to a northern Tanzanian referral hospital were enrolled in this prospective observational study. Follow-up surveys assessing mortality, medication use, and rehospitalization were administered at 3, 6, 9, and 12 months following initial presentation, by telephone or in person. Multivariate logistic regression was performed to identify baseline clinical and sociodemographic factors associated with one-year mortality. Of 152 enrolled patients with AMI, 5 were lost to one-year follow-up (96.7% retention rate). Mortality rates were 34.9% (53 of 152 participants) during the initial hospitalization, 48.7% (73 of 150 patients) at 3 months, 52.7% (78 of 148 patients) at 6 months, 55.4% (82 of 148 patients) at 9 months, and 59.9% (88 of 147 patients) at one year. Of 59 patients surviving to one-year follow-up, 43 (72.9%) reported persistent anginal symptoms, 5 (8.5%) were taking an antiplatelet, 8 (13.6%) were taking an antihypertensive, 30 (50.8%) had been rehospitalized, and 7 (11.9%) had ever undergone cardiac catheterization. On multivariate analysis, one-year mortality was associated with lack of secondary education (odds ratio, 0.26 [95% CI, 0.11-0.58]; P=0.001), lower body mass index (odds ratio, 0.90 [95% CI, 0.82-0.98]; P=0.015), and higher initial troponin (odds ratio, 1.30 [95% CI, 1.05-1.80]; P=0.052). In northern Tanzania, AMI is associated with high all-cause one-year mortality and use of evidence-based secondary preventative therapies among AMI survivors is low. Interventions are needed to improve AMI care and outcomes.

Norton Scale Score and long-term healthcare services utilization after acute myocardial infarction.

Many patients admitted with acute myocardial infarction (AMI) have considerable multimorbidity, sometimes associated with functional limitations. The Norton Scale Score (NSS) evaluates clinical aspects of well-being and predicts numerous clinical outcomes. We evaluated the association between NSS and long-term healthcare utilization (HU) following a non-fatal AMI. A retrospective observational study including AMI survivors during 1 January 2004 to 31 December 2015 with a filled NSS report. Data were recouped from the electronic medical records of the hospital and two Health Maintenance Organizations. Norton Scale Score ≤16 or &gt;16 was defined as low or high respectively. The outcome was annual HU, encompassing length of hospital stay (LOS), emergency department (ED) visits, primary care, and other ambulatory service utilization during up to 10 years of follow-up. HU costs were compared between groups. Two-level models were built: unadjusted and adjusted for patients' baseline characteristics. The study included 4613 patients, 784 (17%) had low NSS. Patients with low NSS compared with patients with high NSS were older, had a higher rate of multimorbidity, and had significantly lower coronary angiography and revascularization rates. In addition, low NSS patients presented higher annual HU costs (4879 vs. 3634 Euro, P &lt;0.001), primarily due to LOS, ED visits, and less frequent ambulatory services usage. In patients after non-fatal AMI, low NSS is a signal for higher long-term costs reflecting the presence of expensive comorbidities. Management disparity and impaired mobility may offset the real need of these patients. Therefore, the specific proactive nursing intervention in that population is recommended.

Telemedical cardiac risk assessment by implantable cardiac monitors in patients after myocardial infarction with autonomic dysfunction (SMART-MI-DZHK9): a prospective investigator-initiated, randomised, multicentre, open-label, diagnostic trial

Cardiac autonomic dysfunction after myocardial infarction identifies patients at high risk despite only moderately reduced left ventricular ejection fraction. We aimed to show that telemedical monitoring with implantable cardiac monitors in these patients can improve early detection of subclinical but prognostically relevant arrhythmic events. We did a prospective investigator-initiated, randomised, multicentre, open-label, diagnostic trial at 33 centres in Germany and Austria. Survivors of acute myocardial infarction with left ventricular ejection fraction of 36-50% had biosignal analysis for assessment of cardiac autonomic function. Patients with abnormal periodic repolarisation dynamics (≥5·75 deg2) or abnormal deceleration capacity (≤2·5 ms) were randomly assigned (1:1) to telemedical monitoring with implantable cardiac monitors or conventional follow-up. Primary endpoint was time to detection of serious arrhythmic events defined by atrial fibrillation 6 min or longer, atrioventricular block class IIb or higher and fast non-sustained (>187 beats per min; ≥40 beats) or sustained ventricular tachycardia or fibrillation. This study is registered with ClinicalTrials.gov, NCT02594488. Between May 12, 2016, and July 20, 2020, 1305 individuals were screened and 400 patients at high risk were randomly assigned (median age 64 years [IQR 57-73]); left ventricular ejection fraction 45% [40-48]) to telemedical monitoring with implantable cardiac monitors (implantable cardiac monitor group; n=201) or conventional follow-up (control group; n=199). During median follow-up of 21 months, serious arrhythmic events were detected in 60 (30%) patients of the implantable cardiac monitor group and 12 (6%) patients of the control group (hazard ratio 6·33 [IQR 3·40-11·78]; p<0·001). An improved detection rate by implantable cardiac monitors was observed for all types of serious arrhythmic events: atrial fibrillation 6 min or longer (47 [23%] patients vs 11 [6%] patients; p<0·001), atrioventricular block class IIb or higher (14 [7%] vs 0; p<0·001) and ventricular tachycardia or ventricular fibrillation (nine [4%] patients vs two [1%] patients; p=0·054). In patients at high risk after myocardial infarction and cardiac autonomic dysfunction but only moderately reduced left ventricular ejection fraction, telemedical monitoring with implantable cardiac monitors was highly effective in early detection of subclinical, prognostically relevant serious arrhythmic events. German Centre for Cardiovascular Research (DZHK) and Medtronic Bakken Research Center.

Impact of Acute and Chronic Kidney Disease on Heart Failure Hospitalizations After Acute Myocardial Infarction

Very few studies evaluated the impact of acute kidney injury (AKI) and chronic kidney disease (CKD) on heart failure (HF) hospitalization risk following an acute myocardial infarction (AMI). For this retrospective cohort analysis, we identified adult AMI survivors from January to June 2014 from the United States Nationwide Readmissions Database. Outcomes were a 6-month HF, fatal HF, composite of HF during the AMI or a 6-month HF, and a composite of 6-month HF or death during a non-HF-related admission. We analyzed differences in outcomes across categories of patients without renal injury, AKI without CKD, stable CKD, AKI on CKD, and end-stage renal disease (ESRD). Of 237,549 AMI survivors, AKI was present in 13.8%, CKD in 16.5%, ESRD in 3.4%, and AKI on CKD in 7.7%. Patients with renal failure had lower coronary revascularization rates and higher in-hospital HF. A 6-month HF hospitalization occurred in 12,934 patients (5.4%). Compared with patients without renal failure (3.3%), 6-month HF admission rate was higher in patients with AKI on CKD (14.6%; odds ratio [OR] 1.99; 95% confidence interval [CI] 1.81 to 2.19), ESRD (11.2%; OR 1.57; 95% CI 1.36 to 1.81), stable CKD (10.7%; OR 1.72; 95% CI 1.56 to 1.88), and AKI (8.6%; OR 1.52; 95% CI 1.36 to 1.70). Results were generally homogenous in prespecified subgroups and for the other outcomes. In conclusion, 1 in 4 AMI survivors had either acute or chronic renal failure. The presence of any form of renal failure was associated with a substantially increased risk of 6-month HF hospitalizations and associated mortality with the highest risk associated with AKI on CKD.

Influence of diabetes mellitus interactions with cardiovascular risk factors on post-myocardial infarction heart failure hospitalizations

ObjectiveThere is a paucity of information regarding how cardiovascular risk factors (RF) modulate the impact of diabetes mellitus (DM) on the heart failure hospitalization (HFH) risk following an acute myocardial infarction (AMI). MethodsAdult survivors of an AMI were retrospectively identified from the 2014 US Nationwide Readmissions Database. The impact of DM on the risk for a 6-month HFH was studied in subgroups of RFs using multivariable logistic regression to adjust for baseline risk differences. Individual interactions of DM with RFs were tested. ResultsOf 237,549 AMI survivors, 37.2% patients had DM. Primary outcome occurred in 12,934 patients (5.4%), at a 106% higher rate in DM patients (7.9% vs 4.0%, p < 0.001), which was attenuated to a 45% higher adjusted risk. Higher HFH risk in DM patients was consistent across subgroups and significant interactions were present between DM and other RFs. The increased HFH risk with DM was more pronounced in patients without certain HF RFs compared with those with these RFs [age < 65: OR for DM 1.84 (1.58–2.13) vs age ≥ 65: OR 1.34 (1.24–1.45); HF absent during index AMI: OR for DM 1.87 (1.66–2.10) vs HF present: OR 1.24 (1.14–1.34); atrial fibrillation absent: OR for DM 1.57 (1.46–1.68) vs present: OR 1.19 (1.06–1.33); Pinteraction < 0.001 for all]. Similar results were noted for hypertension and chronic kidney disease. ConclusionsAMI survivors with DM had a higher risk of 6-month HFHs. The impact of DM on the increased HFH risk was more pronounced in patients without certain RFs suggesting that more aggressive preventive strategies related to DM and HF are needed in these subgroups to prevent or delay the onset of HFHs.