Coronary Heart Disease Care Research Articles

Effect of continuous nursing on treatment compliance and side effect management of coronary heart disease.

There are relatively few studies on continuing care of coronary heart disease (CHD), and its research value needs to be further clarified. To investigate the effect of continuous nursing on treatment compliance and side effect management in patients with CHD. This is a retrospective study with patients from January 2021 to 2023. The study was divided into two groups with 30 participants in each group. Self-rating anxiety scale (SAS) and Self-rating depression scale (SDS) were used to assess patients' anxiety and depression, and medical coping questionnaire was used to assess patients' coping styles. The pelvic floor dysfunction questionnaire (PFDI-20) was used to assess the status of pelvic floor function, including bladder symptoms, intestinal symptoms, and pelvic symptoms. SAS score decreased from 57.33 ± 3.01before treatment to 41.33 ± 3.42 after treatment, SDS score decreased from 50.40 ± 1.45 to 39.47 ± 1.57. The decrease of these two indexes was statistically significant (P < 0.05). PFDI-20 scores decreased from the mean 16.83 ± 1.72 before treatment to 10.47 ± 1.3the mean after treatment, which was statistically significant (P < 0.05). The results of this study indicate that pioneering research in continuous care of CHD has a positive impact on improving patients' treatment compliance, reducing anxiety and depression levels, and improving coping styles and pelvic floor functional status.

Causes of Death in Patients Asking for Polyclinic Care for Coronary Heart Disease.

Retrospective analysis of the underlying causes for death of patients who did and did not seek outpatient medical care (OPMC) for ischemic heart disease (IHD), and discussion of a possibility for using administrative anonymized but individualized databases for analysis. The electronic database of the Central Administration of the Civil Registry Office of the Moscow Region (Unified State Register of the Civil Registry Office of the Moscow Region), including medical death certificates (MDC) for 2021, was used to select all cases of fatal outcomes with the disease codes of the International Classification of Diseases, Tenth Revision (ICD-10) (codes of external causes, injuries, poisonings excluded) that were indicated as the primary cause of death (PCD). Personalized data of the deceased were combined with data from electronic medical records of patients who sought OPMC at institutions of the Moscow Region within up to 2 years before death. In addition to IHD, the following PCD codes were taken into account: malignant tumors, COVID-19, diabetes mellitus, cerebrovascular diseases, hypertension, chronic obstructive pulmonary disease, alcohol-associated diseases, and, as examples of unspecified PCD, old age and unspecified encephalopathy.Results In total, among those who died from diseases, the proportion of those who died from IHD was 18.9%; for another 8.4%, IHD was indicated as a comorbid disease in Part II of the MDC. Among those who sought OPMC for IHD, the IHD proportion indicated as PCD was 27.5%, and among those who did not seek OPMC 17.4% (p &lt;0.0001). Those who died from IHD and who had sought OPMC were older (mean age, 75.59 ± 10.94 years) than those who died from IHD and had not sought OMPM (mean age, 73.96 ± 10.94 years; p &lt; 0.0001). The frequency of myocardial infarction as PCD among those who had and had not sought OPMC was the same (12%), chronic forms of IHD were 83.9% and 79.7%, the frequencies of "unspecified" acute forms of IHD (codes I24.8-9) were 4.1% and 8.3%, respectively. The proportion of deaths from COVID-19 was the highest (21.7% and 24.3%, respectively), from malignant neoplasms 11.6% and 12.7%, respectively, and from unspecified encephalopathy 10.6% and 10.7%, respectively. Only 25% of patients who had sought OPMC for IHD died from IHD, otherwise the causes of death were the same as for patients who had not sought OPMC for IHD. Analysis of administrative databases allows identifying disparities in the PCD structure and to direct the efforts of specialists to reconciling the criteria for death from various forms of IHD.

The Use of Precision Epigenetic Methods for the Diagnosis and Care of Stable Coronary Heart Disease Reduces Healthcare Costs.

The cost of secondary prevention of coronary heart disease (CHD) is continuing to increase, with a substantial portion of this acceleration being driven by the expense of confirmatory diagnostic testing. Conceivably, newly developed precision epigenetic technologies could drive down these costs. However, at the current time, their impact on overall expense for CHD care is poorly understood. We hypothesized that the use of a newly developed, highly sensitive, and specific epigenetic test, PrecisionCHD, could decrease the costs of secondary prevention. To test this hypothesis, we constructed a budget impact analysis using a cost calculation model that examined the effects of substituting PrecisionCHD for conventional CHD diagnostic tests on the expenses of the initial evaluation and first year of care of stable CHD using a 1-year time horizon with no discounting. The model projected that for a commercial insurer with onemillion members, full adoption of PrecisionCHD as the primary method of initial CHD assessment would save approximately $113.6million dollars in the initial year. These analyses support the use of precision epigenetic methods as part of the initial diagnosis and care of stable CHD and can meaningfully reduce cost. Real-world pilots to test the reliability of these analyses are indicated.

Self-Efficacy in Self-Care and Its Related Factors Among Patients with Coronary Heart Disease in Indonesia: A Rasch Analysis.

Low self-efficacy (SE) can impact decreasing health status, poor self-care, and quality of life among patients with Coronary Heart Disease (CHD). Many factors can affect SE. However, studies on SE in CHD patients with Rasch Model analysis have not been carried out widely. This study aims to identify the SE in self-care and its related factors that correlate SE among CHD patients. Cross-sectional study was conducted on 104 adult patients (≥18 years) diagnosed with CHD. Selection of the sample using convenience sampling technique with several predetermined criteria. SE was measured using the SEQ-CHDM questionnaire, with high validity and reliability results. Data were analyzed using the Rasch model and chi-square test. The results showed that most respondents had a moderate SE (51.5%). Care units (p=0.003) and duration of illness (p=0.049) were significantly correlated to SE among patients with CHD. "Maintaining an ideal body weight" is the most challenging thing. On the other hand, stop smoking is the most confident thing to be performed by the respondents. We conclude that CHD patients in the acute care unit and patients with a duration of illness >6 months have a lower tendency for SE. Health interventions such as raising awareness about the disease, modifying health behavior, and immediately screening can improve patients' SE. Besides that, proper diagnosis and ongoing treatment are crucial to improving SE and CHD care outcomes.

The Effect of Phase I of Cardiac Rehabilitation on Length of Stay for Coronary Heart Disease Patients at Mardi Waluyo Hospital, Blitar City

Coronary Heart Disease (CHD) is a specific term for a cardiovascular disease characterized by narrowing coronary artery tissue mainly due to atherosclerosis that causes microangiopathy. CHD patients in the treatment, in addition to receiving treatment, also receive rehabilitation to help speed up the recovery from physical, psychological, and social conditions. The rehabilitation program should be given since admission to the hospital, known as phase I of Cardiac Rehabilitation. One of the components of phase I of Cardiac Rehabilitation is a physical activity aimed at speeding up the recovery of the patient's condition to return to regular activities. This study aims to determine the relationship between cardiac phase I rehabilitation for the length of patient care for CHD in Mardi Waluyo Hospital Blitar City. This study used a quasi-experimental design with the post-test only non-equivalent group. The sample in this study consisted of 14 respondents from the intervention group and 14 patients for the control group respondents who were diagnosed with CHD in Mardi Waluyo Hospital, Blitar City, matching the specified inclusion criteria. The results showed a significant correlation between heart phase I rehabilitation on the duration of care (p-value = 0.007). The statistical test used a bivariate correlation test with the Mann-Whitney Test. This result yielded that it needs to be given early on to CHD patients as it can help the healing process and shorten hospitalization. Furthermore, the shorter length of care will further save the operational costs of CHD patient care.

The Effect of Phase I of Cardiac Rehabilitation on Length of Stay for Coronary Heart Disease Patients at Mardi Waluyo Hospital, Blitar City

Coronary Heart Disease (CHD) is a specific term for a cardiovascular disease characterized by narrowing coronary artery tissue mainly due to atherosclerosis that causes microangiopathy. CHD patients in the treatment, in addition to receiving treatment, also receive rehabilitation to help speed up the recovery from physical, psychological, and social conditions. The rehabilitation program should be given since admission to the hospital, known as phase I of Cardiac Rehabilitation. One of the components of phase I of Cardiac Rehabilitation is a physical activity aimed at speeding up the recovery of the patient's condition to return to regular activities. This study aims to determine the relationship between cardiac phase I rehabilitation for the length of patient care for CHD in Mardi Waluyo Hospital Blitar City. This study used a quasi-experimental design with the post-test only non-equivalent group. The sample in this study consisted of 14 respondents from the intervention group and 14 patients for the control group respondents who were diagnosed with CHD in Mardi Waluyo Hospital, Blitar City, matching the specified inclusion criteria. The results showed a significant correlation between heart phase I rehabilitation on the duration of care (p-value = 0.007). The statistical test used a bivariate correlation test with the Mann-Whitney Test. This result yielded that it needs to be given early on to CHD patients as it can help the healing process and shorten hospitalization. Furthermore, the shorter length of care will further save the operational costs of CHD patient care.

Identifying and comparing low-value care recommendations for coronary heart disease prevention, diagnosis, and treatment in the US and China

BackgroundLow-value care provides little or no benefit, causes harm and incurs unnecessary costs. Low-value care for coronary heart disease (CHD) is particularly prevalent in the US and China. Identifying low-value care services is the first step in reducing these services. There is currently limited data on identifying a comprehensive CHD low-value care list in the US and China. We aimed to identify and compare low-value care recommendations for CHD prevention, diagnosis, and treatment in the US and China. MethodsClinical practice guidelines (CPGs) related to CHD in the US and China were screened for do-not-do recommendations stating that specific services should be avoided. The similarities and discrepancies of low-value care recommendations for CHD between the two countries were then compared. ResultsWe found a total of 38 low-value care recommendations in 6 Chinese CPGs and 98 recommendations in 11 US CPGs. In the US, the most common types of low-value care recommendations were therapeutic medications (44, 44.9%), followed by therapeutic procedures (27, 27.6%), diagnostic imaging (16, 16.3%), diagnostic testing (9, 9.2%) and primary prevention (2, 2.0%). In China, the most common types were therapeutic medications (18, 47.4%), followed by therapeutic procedures (13, 34.2%), diagnostic testing (4, 10.5%), and diagnostic imaging (3, 7.9%). ConclusionIn this study, a comprehensive list of low-value care for CHD in the US and China was established and potentially become the important targets for de-implementation for both countries. The findings may have important implications for other countries, especially low-and middle-income countries, to reduce low-value care for CHD.

Recurrence risk prediction of acute coronary syndrome per patient as a personalized ACS recurrence risk: a retrospective study.

Acute coronary syndrome (ACS) has been one of the most important issues in global public health. The high recurrence risk of patients with coronary heart disease (CHD) has led to the importance of post-discharge care and secondary prevention of CHD. Previous studies provided binary results of ACS recurrence risk; however, studies providing the recurrence risk of an individual patient are rare. In this study, we conducted a model which provides the recurrence risk probability for each patient, along with the binary result, with two datasets from the Korea Health Insurance Review and Assessment Service and Chungbuk National University Hospital. The total data of 6,535 patients who had been diagnosed with ACS were used to build a machine learning model by using logistic regression. Data including age, gender, procedure codes, procedure reason, prescription drug codes, and condition codes were used as the model predictors. The model performance showed 0.893, 0.894, 0.851, 0.869, and 0.921 for accuracy, precision, recall, F1-score, and AUC, respectively. Our model provides the ACS recurrence probability of each patient as a personalized ACS recurrence risk, which may help motivate the patient to reduce their own ACS recurrence risk. The model also shows that acute transmural myocardial infarction of an unspecified site, and other sites and acute transmural myocardial infarction of an unspecified site contributed most significantly to ACS recurrence with an odds ratio of 97.908 as a procedure reason code and with an odds ratio of 58.215 as a condition code, respectively.

Gender differences in lifestyle management among coronary patients and the association with education and age: results from the ESC EORP EUROASPIRE V registry.

Lifestyle management is essential in the secondary care of coronary heart disease (CHD) patients. Little evidence is available about gender differences in lifestyle counselling and lifestyle compliance. This study aimed to provide an overview on potential gender differences in lifestyle advice provided by a healthcare professional and patients' lifestyle compliance. Analyses were based on the cross-sectional ESC EORP EUROASPIRE V survey including data on CHD patients across 27 European countries. Consecutive patients &lt;80 years, hospitalized for a first or recurrent coronary event, were included in the study. Information on lifestyle management was collected from medical records, medical examination, and structured questionnaires during patient interviews (≥6 months to &lt;2 years after hospitalization). Data were available for 8261 patients of whom 25.8% women. Overall, no gender differences were observed in lifestyle advice provided by a healthcare professional for smoking cessation advice, dietary advice, advice on losing weight, and physical activity advice (P &gt; 0.05). However, a closer look at the particular actions to adopt a healthy diet revealed that women reported more frequently a reduction of their salt (68.6% vs. 73.7%; P = 0.002), fat (70.8% vs. 74.7%; P = 0.003), and calorie intake (56.8% vs. 60.5%; P = 0.004) compared to men. In contrast, women were less likely to increase their physical activity levels (55.5% vs. 48.0%; P &lt; 0.001). Despite little gender differences in lifestyle advice provided by a healthcare professional, lifestyle compliance for physical activity is worse in CHD women. Further actions are needed to increase physical activity levels in female CHD patients.

Clinician Perspectives of Barriers and Enablers to Implementing the Mediterranean Dietary Pattern in Routine Care for Coronary Heart Disease and Type 2 Diabetes: A Qualitative Interview Study

BackgroundPractice guidelines for coronary heart disease and type 2 diabetes recommend promoting the Mediterranean dietary pattern (MDP), which improves cardiometabolic risk markers and may prevent disease progression and complications. It is unknown to what extent the MDP is recommended in routine care for patients with these conditions, particularly in multiethnic settings. ObjectiveThe study aim was to explore multidisciplinary health care professionals’ perspectives on recommending the MDP in routine care for patients with coronary heart disease or type 2 diabetes and barriers and enablers to its implementation. DesignA qualitative description design was employed, utilizing semistructured individual interviews to collect data. Participants and settingFifty-seven clinicians (21 nurses, 19 doctors, 13 dietitians, and 4 physiotherapists) routinely managing relevant patients across hospital and community settings in a metropolitan health service in Australia participated in interviews between November 2019 and March 2020. Statistical analysis performedInterviews were audiorecorded, transcribed verbatim, and analyzed using thematic analysis. ResultsFour overarching themes were identified highlighting that the MDP was not routinely recommended: current dietary practices (all clinicians perceived they had a role in dietary care but prioritization varied. There was a legacy of single nutrient-based strategies and disease silos); clinician-centered barriers to recommending MDP (limited MDP knowledge and practice skills and variable understanding and acceptance of evidence supporting its use. This was related to lack of education and training about the diet and personal interest/experience); organizational culture and resources influence dietary care (MDP not embedded in service culture or current clinic tools and resources, with limited dietary knowledge exchange within and across multidisciplinary teams); and perceived patient-centered barriers to implementation of MDP (socioeconomic challenges in a multicultural setting, and a lack of belief in patient capabilities to improve diet adherence). ConclusionsClinician and organizational factors, compounded by perceptions about patient acceptance, influence recommendations of the MDP for patients with coronary heart disease or type 2 diabetes. These factors should be addressed to improve translation of MDP evidence into practice.

Soziale Ungleichheiten in der gesundheitlichen Versorgung der koronaren Herzkrankheit. Ergebnisse der GEDA-Studie 2014/2015

IntroductionLittle is known about social inequalities in outpatient long-term care of coronary heart disease (CHD) in Germany. MethodsRegression analyses are based on the responses of women and men who participated in the national cross-sectional study “German Health update” (GEDA) 2014/2015 and had self-reported CHD (N=920). Outpatient healthcare of CHD was analysed on the basis of the self-reported administration of antihypertensive and cholesterol-lowering drugs, and the frequency of general practitioner (GP) contacts. ResultsOn average, respondents visited their GP 7.5 times a year (mean). 46 % did not receive guideline-consistent treatment, i. e. both antihypertensive and cholesterol-lowering drugs. Respondents of lower social status consulted their GP more frequently (approx. two visits per year) than those of higher social status (AME: 1.94; 95% CI 0.56 to 3.31). Regarding treatment with antihypertensive and cholesterol-lowering drugs, there were no significant differences for either gender or social status. Nevertheless, the probability that respondents with increased levels of blood lipids or cholesterol took only one or none of the two medications recommended for long-term treatment of CHD was reduced by 54 percentage points (AME: –0,54; 95% CI –0,61 to –0,48). DiscussionThere are no social inequalities in the treatment of CHD patients with antihypertensive and cholesterol-lowering drugs, but inequalities exist in the frequency of visits to the GP who is more often consulted by the more socially disadvantaged patients. ConclusionWith about 7.5 consultations per year, CHD patients visit their general practitioner more often than average, but in about half of these patients the medication supply is less than optimal. This may indicate a deficit in the medical treatment of CHD that cannot be explained by social inequalities. A possible starting point for improving healthcare, especially for patients without other risk factors, is to focus more strongly on a guideline-based approach to prescribing medication for CHD patients.

Application Effect of Predictive Nursing in the Nursing Process of Patients with Coronary Heart Disease and Angina Pectoris

To explore the measures and clinical effects of applying predictive nursing methods in the process of nursing care of patients with coronary heart disease and angina pectoris. The patients who were treated in our hospital from December 2019 to December 2020 were selected as the research objects. The patients were all with coronary heart disease and angina pectoris. Nursing care of the patients was carried out. 100 patients were randomly selected as the research objects. In the controlled experiment, patients were given conventional nursing intervention (control group) and predictive nursing intervention (experimental group), and the clinical intervention effects of the two nursing methods were compared and analyzed. The number and duration of angina pectoris in the experimental group were lower than those in the control group. The nursing satisfaction of the two groups was 96.00% and 82.00% respectively. The satisfaction of the patients in the experimental group was higher, and the blood pressure and blood sugar of the experimental group were normal. The number of normal blood lipids was higher than that of the control group. The SAS score and SDS score of the experimental group were relatively low compared with the control group, and the differences in the data were large, expressed as P&lt;0.05, which was statistically significant. The effect of the experimental group is better. Applying predictive nursing methods in the process of nursing care for coronary heart disease and angina pectoris has significant clinical effects, which can effectively stabilize various physical indicators of the patient community, improve patient care satisfaction, and have significant clinical application value.

Effects of a Web-Based Educational Support Intervention on Total Exercise and Cardiovascular Risk Markers in Adults With Coronary Heart Disease.

eHealth educational programs have proven to be an effective means for health promotion, yet limited studies have been conducted for coronary heart disease (CHD) patients to improve their total physical exercise, self-efficacy for exercise, and cardiovascular risk factor profile. A prospective randomized controlled trial (RCT) was conducted in two cardiac clinics in Hong Kong. Four hundred thirty-eight eligible CHD clients were randomly assigned to either the control or the intervention group. All of the participants received standard care, which consisted of regular medical and nursing care in the cardiac clinic. The intervention group received an additional web-based educational support intervention (eHES), which consisted of a 20-minute individual educational session on the use of the eHES web link. The eHES web link contains a health information platform related to CHD care and an individual member area with records of health measures and physical exercise data for six months. Data were collected at baseline, at three-month and six-month intervals at the cardiac clinic. The primary outcome was the total amount of physical exercise, measured by the Godin-Shephard Leisure-Time Physical Activity Questionnaire. The secondary outcomes were self-efficacy for exercise and cardiovascular disease (CVD) risk markers (body weight, blood pressure, lipid profile). The data were analyzed using a generalized estimating equations model. The intervention group reported a statistically higher amount of physical exercise and a higher HDL-C at 3 and 6months, respectively. There were no statistical differences between the groups in self-efficacy for exercise and other CVD risk markers. The study demonstrated the effectiveness of the eHES in meeting the challenge of boosting the amount of physical exercise and increase HDL-C among CHD patients who engaged for over three months. The results provide insight for eHealth development to support and promote exercise among CHD patients in the community.

Long-term trajectories of anxiety and depression in patients with stable coronary heart disease and risk of subsequent cardiovascular events.

Anxiety and depression seem to be under-recognized in their importance and are often not incorporated in subsequent prevention strategies in routine clinical care of coronary heart disease. The KAROLA cohort included coronary heart disease patients participating in an in-patient rehabilitation program (years 1999/2000) and followed after 1, 3, 6, 8, 10, 13, and 15 years. We identified anxiety and depression trajectories based on the hospital anxiety and depression scale subdomains using joint latent class mixture time-to-event models. We included cardiovascular (CV) events and non-CV mortality as competing endpoints. We included 1,109 patients (15.4% female; mean age, 59.4 (standard deviation [SD] = 8.0) years) with baseline covariate data. Over a median follow-up of 14.8 years, participants experienced 324 subsequent CV events. We identified four anxiety and depression trajectory classes, a low-stable class (52.2% and 69.6% of patients for anxiety and depression, respectively), moderate-stable class (37.6% and 23.8%), increasing class (2.3% and 3.3%), and high-stable/high-decreasing class (7.9% and 3.3%). The hazard ratio (HR) for subsequent CV events for the increasing anxiety class was 2.13 (95% confidence interval [CI], 0.61; 7.45) compared with the low-stable class after covariate adjustment. Patients following the high-decreasing anxiety trajectory showed an HR of 1.72 (95% CI, 1.11; 2.68) and patients following the high-stable depression trajectory an HR of 2.47 (95% CI, 1.35; 4.54). Chronic high anxiety and depression trajectory classes were associated with increased risk of subsequent CV events. Assessments of both symptoms of anxiety and depression during long-term routine medical care are recommended to identify patients who would benefit from appropriate interventions.

Factors associated with smoking cessation in patients with coronary heart disease: a cohort analysis of the German subset of EuroAspire IV survey

BackgroundTobacco smoking is one of the most important risk factors of coronary heart disease (CHD). Hence, smoking cessation is considered pivotal in the prevention of CHD. The current study aimed to evaluate smoking cessation patterns and determine factors associated with smoking cessation in patients with established CHD.MethodsThe fourth European Survey of Cardiovascular Disease Prevention and Diabetes investigated quality of CHD care in 24 countries across Europe in 2012/13. In the German subset, smoking cessation patterns and clinical characteristics were repetitively assessed a) during index event due to CHD by medical record abstraction, b) as part of a face-to-face interview 6 to 36 months after the index event (i.e. baseline visit), and c) by telephone-based follow-up interview two years after the baseline visit. Logistic regression analysis was performed to search for factors determining smoking status at the time of the telephone interview.ResultsOut of 469 participants available for follow-up, 104 (22.2%) had been classified as current smokers at the index event. Of those, 65 patients (62.5%) had quit smoking at the time of the telephone interview, i.e., after a median observation period of 3.5 years (quartiles 3.0, 4.1). Depressed mood at baseline visit and higher education level were less prevalent amongst quitters vs non-quitters (17.2% vs 35.9%, p = 0.03 and 15.4% vs 33.3%, p = 0.03), cardiac rehabilitation programs were more frequently attended by quitters (83.1% vs 48.7%, p < 0.001), and there was a trend for a higher prevalence of diabetes at baseline visit in quitters (37.5% vs 20.5%, p = 0.07). In the final multivariable model, cardiac rehabilitation was associated with smoking cessation (OR 5.19; 95%CI 1.87 to 14.46; p = 0.002).DiscussionAttending a cardiac rehabilitation program after a cardiovascular event was associated with smoking cessation supporting its use as a platform for smoking cessation counseling and relapse prevention.

Comparison of Patient and Proxy Assessment of Patient-Centeredness in the Care of Coronary Heart Disease: A Cross Sectional Survey Using the PACIC-S11.1.

Introduction:When making medical care more patient-centered, surveys on patients’ and their relatives’ experiences can be helpful in identifying opportunities for improvement. In cases where the targeted patients are unable to express their own perspective, for example, due to them being too young or suffering from severe impairments, proxies can serve as substitutes. Proxies are frequently used in care planning and consent. Nevertheless, it is unclear whether patients’ assessments of how patient-centered their medical care is are similar to those of their proxies. This study aims to assess the level of consistency between patients’ and their proxies’ assessments using an adapted version of the Patient Assessment of Chronic Illness Care (PACIC) short form questionnaire.Methods:In a cross-sectional study, patients with coronary heart disease were recruited at cardiologists’ offices, rehabilitation clinics and hospitals. Participants were surveyed with regard to the perceived level of patient-centeredness during their care using an adapted version of the German PACIC short form (PACIC-S11.1). Correlations in the assessments made by each patient and their respective proxy were analyzed. On the level of the patients group and the relatives group differences between mean ratings for each item were compared using paired t-tests.Results:In total, 74 pairs of patients and proxies submitted the completed questionnaire. On the level of the individual patient/proxy pairs, no correlation, or significant but low correlation, was found between the ratings. On the group level, patients’ and their proxies’ item ratings were similar in the interpretation of averages, but still demonstrated statistically significant differences. Overall, patients rated their care as more patient-centered than their proxies did.Conclusion:The study shows that, on the individual level, proxies’ ratings do not necessarily reflect the patients’ assessment of PCC. On the group level, the assessments of relatives regarding PCC are similar to those of the patients.Trial registrationGerman clinical trials register (Deutsches Register Klinischer Studien, DRKS) Registration Number: DRKS00012434 (URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012434)

Network Medicine: A Clinical Approach for Precision Medicine and Personalized Therapy in Coronary Heart Disease.

Early identification of coronary atherosclerotic pathogenic mechanisms is useful for predicting the risk of coronary heart disease (CHD) and future cardiac events. Epigenome changes may clarify a significant fraction of this “missing hereditability”, thus offering novel potential biomarkers for prevention and care of CHD. The rapidly growing disciplines of systems biology and network science are now poised to meet the fields of precision medicine and personalized therapy. Network medicine integrates standard clinical recording and non-invasive, advanced cardiac imaging tools with epigenetics into deep learning for in-depth CHD molecular phenotyping. This approach could potentially explore developing novel drugs from natural compounds (i.e. polyphenols, folic acid) and repurposing current drugs, such as statins and metformin. Several clinical trials have exploited epigenetic tags and epigenetic sensitive drugs both in primary and secondary prevention. Due to their stability in plasma and easiness of detection, many ongoing clinical trials are focused on the evaluation of circulating miRNAs (e.g. miR-8059 and miR-320a) in blood, in association with imaging parameters such as coronary calcifications and stenosis degree detected by coronary computed tomography angiography (CCTA), or functional parameters provided by FFR/CT and PET/CT. Although epigenetic modifications have also been prioritized through network based approaches, the whole set of molecular interactions (interactome) in CHD is still under investigation for primary prevention strategies.

P5489Old ladies paradox: trends in the inpatient care of coronary heart disease 2005–2016 in Germany

Abstract Objectives Coronary heart disease (CHD) and subsequent illnesses are the most common cause of death in industrialized countries and they continue to lead the cause of death statistics. In Germany, 2015 from all registered deaths 7.1% (n=65,686) are due to chronic CHD and 5.3% (n=49,210) due to acute myocardial infarction (AMI), but the proportion has fallen: Compared to 2003, when 10.9% (n=92,637) of the deceased of CHD and 7.5% of AMI (n=64,229). It is established that there are sex-differences in prevalence and in the age of the persons concerned. E.g. 2015 AMI infarction is cause of death in 57% (n=27,835) men and 43% (n=21,375) women from 49% men (n=36,049) and 51% women (n=37,127) in 2003. Aim of the study was, whether these differences in prevalence and diagnostic and interventional measurements in the hospital sector have shifted in recent years with the various entities of the acute coronary disease. Methods G-DRG Report-Browser 2005–2016 of the German DRG-Institute (InEK) and Federal Statistical Office data were used. Analysis was carried out with Microsoft Excel and Access (version 2016). Results Inpatient cases of main diagnosis AMI increased from 2005 from 206,104 cases to 219,156 cases in 2016 (+6.3%). Share of male increased from 62.5% to 66.6%. The NSTEMI share increased from 39.7% in 2005 to 66.2% in 2016; a total 145.202 cases (+77.2% to 2005). The increase was smaller in older women: 60–70y: +33.7%; 70–80y: +44.5%; 80–90y: +61.9%The NSTEMI increase in men was slightly higher than in women; proportion of men 2005: 64.2%, 2016; 65.1%. The STEMIs number shrank from 104,082 in 2005 to 70,521 (−34.0%) in 2016. The relative reduction was very high in older women: 60–70y: −45.2%; 70–80y: −55.3%; 80–90y: −54.1%. Share of men 2005: 60.1%, 2015; 70.0%. In 2008: 220,595 diagnostic-only coronarographies were conducted from a total of 690,745 coronarography measurements. These numbers increased to 485.496 (+120.1%) and 869.002 (+25.8%) in 2016. Share of the male decreased from 73.0% in 2008 to 65.6% in 2015. The increase for all coronarographies was highest in older women: 50–60y: +60.7% 60–70y: +39.4%; 70–80y: +72.5%; 80–90y: +168,4% The total number of percutaneous transluminal vascular interventions (PCI) increased from 2008 with 488,542 to 661,693 in 2016 (+35.4%). The relative increase in PCI was high in older women: 60–70y: +18.6%; 70–80y: +42.7%; 80–90y: +126.1%; &gt;90y: +314.1% Conclusions The number of cases of ACS is declining since 2005. There is a significant shift from STEMI to NSTEMI events over the observation period. In all forms of the ACS, the proportion of men in is increasing. The rate of coronary diagnostic and coronary intervention in men is disproportionately high in relation to disease rate. Paradoxically the share of examinations older women without further action increases strongly, despite their share in the disease was small and is still decreasing.

Gender differences in symptom misattribution for coronary heart disease symptoms and intentions to seek health care

ABSTRACTWomen are more likely to delay seeking care for coronary heart disease (CHD) symptoms than men. We tested whether this was because they are more likely to misattribute CHD symptoms. Data were collected in December 2016. Participants were 714 Amazon’s Mechanical Turk (crowdsourcing marketplace) workers with US Internet Protocol (IP) addresses; 52% female (ages 35–77 years) made judgments about patients of their same gender described in vignettes. We used adjusted multivariable logistic, ordinal, and linear regression to test our hypotheses. Women had a higher odds of misattributing the symptoms of the target in the vignettes to non-cardiac causes than men (adjusted odds ratio [AOR] = 2.08, p < .001), despite having higher mean knowledge scores about CHD (4.49 vs. 4.03, p < .001) and rating their CHD risk as higher (25% more likely to get CHD vs. 19%, p = .025) than men. Women were also less likely than men to intend to seek care at an emergency department (b = −0.33, p = .024), and if they did intend to seek care, they were more likely to intend to wait to seek care (AOR = 2.37, p = .003). Symptom misattribution may partially account for women’s lower likelihood of intending to seek care from an emergency department, which would be especially critical in emergency situations.

Effects of meditation training on medication compliance and prognosis among coronary heart disease patients

Objective To explore the effects of the meditation training on medication compliance and prognosis among coronary heart disease patients. Methods From January to June 2017, we selected 120 coronary heart disease inpatients at Beijing Chaoyang Hospital Affiliated to Capital Medical University by convenience sampling. All of the patients were divided into observation group (n=60) and control group (n=60) with the method of random number table. The control group received routine nursing care for coronary heart disease. Apart from that, the observation group received meditation training. The medication compliance, re-hospitalization rate because of cardiovascular events and death were compared between two groups after intervention. Results The medication compliance of observation group was better than that of control group with a statistical difference (P<0.05) . The re-hospitalization rate because of cardiovascular events and cases of death in observation group were less than those in control group with statistical differences (P<0.05) . Conclusions Meditation training for coronary heart disease patients can improve their medication compliance and reduce the rate of re-admission because of cardiovascular events. Key words: Coronary heart disease; Meditation training; Medication adherence; Prognosis