Hospital Admissions For Acute Myocardial Infarction Research Articles

Vulnerabilities to Temperature Effects on Acute Myocardial Infarction Hospital Admissions in South Korea.

Most previous studies have focused on the association between acute myocardial function (AMI) and temperature by gender and age. Recently, however, concern has also arisen about those most susceptible to the effects of temperature according to socioeconomic status (SES). The objective of this study was to determine the effect of heat and cold on hospital admissions for AMI by subpopulations (gender, age, living area, and individual SES) in South Korea. The Korea National Health Insurance (KNHI) database was used to examine the effect of heat and cold on hospital admissions for AMI during 2004–2012. We analyzed the increase in AMI hospital admissions both above and below a threshold temperature using Poisson generalized additive models (GAMs) for hot, cold, and warm weather. The Medicaid group, the lowest SES group, had a significantly higher RR of 1.37 (95% CI: 1.07–1.76) for heat and 1.11 (95% CI: 1.04–1.20) for cold among subgroups, while also showing distinctly higher risk curves than NHI for both hot and cold weather. In additions, females, older age group, and those living in urban areas had higher risks from hot and cold temperatures than males, younger age group, and those living in rural areas.

Air Pollution and Acute Myocardial Infarction Hospital Admission in Alberta, Canada: A Three-Step Procedure Case-Crossover Study.

Adverse associations between air pollution and myocardial infarction (MI) are widely reported in medical literature. However, inconsistency and sensitivity of the findings are still big concerns. An exploratory investigation was undertaken to examine associations between air pollutants and risk of acute MI (AMI) hospitalization in Alberta, Canada. A time stratified case-crossover design was used to assess the transient effect of five air pollutants (carbon monoxide (CO), nitrogen dioxide (NO2), nitric oxide (NO), ozone (O3) and particulate matter with an aerodynamic diameter ≤2.5 (PM2.5)) on the risk of AMI hospitalization over the period 1999–2009. Subgroups were predefined to see if any susceptible group of individuals existed. A three-step procedure, including univariate analysis, multivariate analysis, and bootstrap model averaging, was used. The multivariate analysis was used in an effort to address adjustment uncertainty; whereas the bootstrap technique was used as a way to account for regression model uncertainty. There were 25,894 AMI hospital admissions during the 11-year period. Estimating health effects that are properly adjusted for all possible confounding factors and accounting for model uncertainty are important for making interpretations of air pollution–health effect associations. The most robust findings included: (1) only 1-day lag NO2 concentrations (6-, 12- or 24-hour average), but not those of CO, NO, O3 or PM2.5, were associated with an elevated risk of AMI hospitalization; (2) evidence was suggested for an effect of elevated risk of hospitalization for NSTEMI (Non-ST Segment Elevation Myocardial Infarction), but not for STEMI (ST segment elevation myocardial infarction); and (3) susceptible subgroups included elders (age ≥65) and elders with hypertension. As this was only an exploratory study there is a need to replicate these findings with other methodologies and datasets.

Influence of Asian dust storms on daily acute myocardial infarction hospital admissions.

This study was the first to explore the relationship between Asian dust storm events (ADS) and acute myocardial infarction (AMI) hospital admissions by applying time series models. Nationwide population-based hospitalization claims data in Taiwan were used. There were 143,063 AMI admissions during 2000-2009. An autoregressive with exogenous variables (ARX) time series model was used to investigate the dynamic connection between AMI hospital admissions and ADS events. AMI hospitalizations significantly spiked on post-ADS day three. Among the total population, 3.2 more cases of AMI admissions occurred on post-ADS day three. When the data were stratified by age and gender, the same delayed effect was present in the male population, especially those aged 45-64 and over 74. Our study shows that although an ADS event does not cause an immediate incidence of AMI, storms may increase AMI incidence through a delayed effect. Hence, AMI prevention is not only important during a dust storm, but particularly so in subsequent days. During the days after an ADS, exposure to dust should be minimized by staying indoors as much as possible and by wearing a mask when exposure to dust is unavoidable. This is especially true for working and older adults. Nurses at local public health centers can increase awareness and promote public safety by providing health information to local communities regarding the link between dust storms and AMI.

Hospital and emergency department factors associated with variations in missed diagnosis and costs for patients age 65 years and older with acute myocardial infarction who present to emergency departments.

The objective was to measure the variation in missed diagnosis and costs of care for older acute myocardial infarction (AMI) patients presenting to emergency departments (EDs) and to identify the hospital and ED characteristics associated with this variation. Using 2004-2005 Medicare inpatient and outpatient records, the authors identified a cohort of AMI patients age 65 years and older who presented to the ED for initial care. The primary outcome was missed diagnosis of AMI, i.e., AMI hospital admission within 7 days of an ED discharge for a condition suggestive of cardiac ischemia. Costs were defined as Medicare hospital payments for all services associated with and immediately resulting from the ED evaluation. The effect of ED and hospital characteristics on quality and costs were estimated using multilevel models with hospital random effects. There were 371,638 AMI patients age 65 and older included in the study, of whom 4,707 were discharged home from their initial ED visits and subsequently admitted to the hospital. The median unadjusted hospital-level missed diagnosis percentage was 0.52% (interquartile range [IQR] = 0 to 3.45%). ED characteristics protective of adverse outcomes include higher ED chest pain acuity (adjusted odds ratio [aOR] = 0.23, 99% confidence interval [CI] = 0.19 to 0.27) and American Board of Emergency Medicine (ABEM) certification (aOR = 0.60, 99% CI = 0.50 to 0.73). Protective hospital characteristics include larger hospital size (aOR = 0.46, 99% CI = 0.37 to 0.57) and academic status (aOR = 0.74, 99% CI = 0.58 to 0.94). All of these characteristics were associated with higher costs as well. The proportion of missed AMI diagnoses and cost of care for patients age 65 years and older presenting to EDs with AMI varies across hospitals. Hospitals with more board-certified emergency physicians (EPs) and higher average acuity are associated with significantly higher quality. All hospital characteristics associated with better ED outcomes are associated with higher costs.

Successful surgery for lateral left ventricular wall rupture with severe mitral insufficiency resulting in cardiogenic shock

A 68-year-old female was admitted to the intensive cardiac care unit with acute (6 h from pain onset) lateral myocardial infarction (MI) with ST elevation and cardiogenic shock, treated with successful circumflex stenting. On day 5, she developed pulmonary oedema and new systolic murmur 4/6 over apex. Transthoracic echocardiography (TTE) revealed a wide rupture of the left ventricular (LV) lateral wall with pseudoaneurysm entry of 46 mm (Fig. 1). A severe mitral regurgitation due to extreme mitral leaflets restriction was the predominant haemodynamic disorder (Fig. 2). The patient was supported with an intraaortic balloon and immediately transferred by air to the cardiosurgical unit, where successful reconstruction of the left ventricle with Dor’s method and mitral annuloplasty with a 28 mm ring was performed. Control contrast TTE and magnetic resonance imaging two weeks later showed a small pericardial patch leak with residual pseudoaneurysm of 18 mm diameter with LV ejection fraction of 34% and insignificant mitral regurgitation (Figs. 3, 4). This case illustrates the successful treatment of a severe mechanical complication with unusual pathophysiology resulting in functional NYHA class II eight months after surgery. A delay in hospital admission for acute MI is often associated with higher mortality, severe complications such as heart rupture (HR) with an incidence as high as 6% in the prereperfusion era, 1–4 accounting for up to 30% of hospital mortality. A free wall HR occurs in 0.45% of patients with MI treated with percutaneous coronary intervention (PCI), although primary PCI is not independently related to HR. The main risk factors for HR are: ST-segment elevation/left bundle branch block; ST-segment deviation; female sex; previous stroke; positive initial cardiac biomarkers; and older age. TTE is the first line tool for a suspected myocardial rupture, and intravenous echocardiographic contrast agent may be useful for the evaluation of the development of an LV pseudoaneurysm (LVP). However, contrast-enhanced myocardial resonance imaging helps to delineate the location and extent of the myocardial rupture, providing valuable structural and functional information in the assessment of LVP. Prompt diagnosis and early surgical intervention is essential for patients with a large or expanding LVP due to the high propensity for fatal rupture.

The impact of "unseasonably" warm spring temperatures on acute myocardial infarction hospital admissions in Melbourne, Australia: a city with a temperate climate.

The effects of extreme temperatures on human health have been well described. However, the adverse health effects of warm weather that occurs outside the summer period have had little attention. We used daily anomalous AMI morbidity and daily anomalous temperature to determine the impact of “unseasonable” temperature on human health. The “unseasonably” warm weather was attributed to a slow moving high pressure system to the east of Melbourne. No morbidity displacement was noted during either of these periods suggesting that morbidity due to “unseasonable” temperatures is avoidable. An increase in warmer weather during the cooler months of spring may result in increased morbidity, and an alert system based on summer thresholds may not be appropriate for early season heat health warnings. A straightforward alert system based on calculating anomalous temperature from daily weather forecasts may reduce the public health impact of “unseasonably” warm weather.

2224 – Assessment of depression and anxiety following myocardial infarction

Introduction Studies indicate that about 20% of patients experience depression after acute Myocardial infarction (MI) and that the presence of depression is associated with increased risk for recurrent hospitalization and death. Anxiety seemed to be an independent risk factor for incident Coronary heart disease (CHD) and cardiac mortality. CHD death rates vary with age, gender and socio-economic status. Heart attack patients feel a wide range of emotions including depression, fear and anger, for about two to six months post-MI. Objectives Examine a level of depression and anxiety in patients after acute MI compared to outpatient control group according to age, gender and education. Methods Patients (n = 60) were assessed on demographic and clinical variables and completed the Beck Depression Inventory (BDI). The State - Trait Anxiety Inventory for Adults (STAI) within the first week of hospital admission for acute MI. The STAI has forty questions with a range of four possible responses to each. Patients with a positive depression score should be interviewed more extensively to confirm or rule out depression. Results Significant anxiety and depressive symptoms were present in patients with MI compared to the healthy controls. Significant differences between anxiety and depression were found according to gender and age. According to education there were no substantive differences in either sample. Conclusion It appears that anxiety after MI a universal phenomenon. In future trials the cause effect relationships between depression, anxiety and adverse health behaviors in patients with coronary artery disease need to be clarified.

Hospital admission time and acute myocardial infarction outcomes in elderly patients from Central Asia

Aim. To identify the specifics of acute myocardial infarction (AMI) clinical course and to study the association between clinical outcomes and hospital admission time among elderly patients from Central Asia. Material and methods. In total, 508 AMI patients were divided into the main group (MG), which included 298 men and women aged over 65 years, and the control group (CG; n=210). The analysed parameters included mean time between AMI onset and hospital admission; percentage of patients hospitalised within first 6 hours; percentage of patients administered streptokinase; streptokinase effectiveness; clinical course of AMI; and in-hospital outcomes. Results. Mean hospital admission time was significantly higher in the MG, compared to the CG: 1220±165 vs. 977±88 minutes (p<0,05). Out of 188 MG patients with ST segment elevation, thrombolytic therapy (TLT) was administered to 14,3 %; in the CG (149 patients with ST segment elevation), the respective percentage was 25,5 %. Clinical course of AMI was similar in both groups. However, the MG was characterised by a significantly higher risk of death (9,4 % vs. 2,86 %; F=0,001; OR 3,53, 95 % CI 1,43—8,67), acute heart failure (33,89 % vs. 21,9 %; F=0,001; OR 1,83, 95 % CI 1,22—2,74), or chronic heart failure (41,31 % vs. 24,76 %; F=0,000; OR 2,62, 95 % CI 1,78—3,86). Conclusion. Elderly patients faced a lower chance of myocardial reperfusion, due to later hospital admission and lower TLT effectiveness, and, as a result, had a higher risk of heart failure.

Apparent temperature and acute myocardial infarction hospital admissions in Copenhagen, Denmark: a case-crossover study

BackgroundThe influence of temperature on acute myocardial infarction (AMI) has not been investigated as extensively as the effects of broader outcomes of morbidity and mortality. Sixteen studies reported inconsistent results and two considered confounding by air pollution. We addressed some of the methodological limitations of the previous studies in this study.MethodsThis is the first study of the association between the daily 3-hour maximum apparent temperature (Tappmax) and AMI hospital admissions in Copenhagen. The study period covered 1 January 1999-31 December 2006, stratified in warm (April - September) and cold (October - March) periods. A case-crossover epidemiology study design was applied. Models were adjusted for public holidays and influenza, confounding by PM10, NO2 and CO was investigated, the lag and non-linear effects of Tappmax was examined, effect modification by age, sex and SES was explored, and the results of the case-crossover models were compared to those of the generalised additive Poisson time-series and generalised estimating equation models.Results14 456 AMI hospital admissions (12 995 people) occurred during the study period. For an inter-quartile range (6 or 7°C) increase in the 5-day cumulative average of Tappmax, a 4% (95% CI:-2%; 10%) and 9% (95% CI: 3%; 14%) decrease in the AMI admission rate was observed in the warm and cold periods, respectively. The 19-65 year old group, men and highest SES group seemed to be more susceptible in the cold period.ConclusionAn increase in Tappmax is associated with a decrease in AMI admissions during the colder months.

Hospital admissions for acute myocardial infarction before and after implementation of a comprehensive smoke-free policy in Uruguay

BackgroundStimulated by the WHO Framework Convention on Tobacco Control, many countries in Latin America adopted comprehensive smoke-free policies. In March 2006, Uruguay became the first Latin American country to adopt...

Abstract P84: The Impact of a Potential Nationwide Comprehensive Smoking Ban on Acute Myocardial Infarction Hospitalizations

Introduction: Smoking is a well established risk factor for acute myocardial infarction (AMI). The potential impact of a nationwide comprehensive smoking ban (CSB) legislation on the incidence of AMI hospital admissions is not known. The aim of this analysis is to determine the impact of a nationwide CSB legislation on the incidence of AMI hospitalizations. Methods: We contacted the department of health at states with no CSB law for information on the total number of AMI discharges (ICD-9-CM 410), length of stay and charges in dollars for 2007. Expected decrease in the number of AMI in the year following a potential implementation of a nationwide CSB was calculated by multiplying the current number of AMI by the pooled relative risk reduction (RRR) obtained from a recent published meta analysis (RR 0.89). Results: In 2007, 37 States had CSB laws. There were 169,043 AMI hospitalizations in states without CSB. A nationwide smoking ban would result in 18,596 less AMI hospitalizations in the year following such a ban. This is associated with more than 92 million dollars in direct cost savings. Conclusion: A nationwide CSB legislation would result in significant reduction in the number of AMI hospitalizations. This is associated with significant cost saving. Further studies are needed to evaluate the impact of CSB on admission from other disease states.

Predictors of Omega-3 Index in Patients With Acute Myocardial Infarction

To identify the patient and dietary characteristics associated with low omega-3 levels in patients with acute myocardial infarction (AMI) and determine whether these characteristics are useful to identify patients who may benefit from omega-3 testing and treatment. Dietary habits of 1487 patients in the 24-center Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients' Health status (TRIUMPH) registry between April 11, 2005, and September 28, 2007, were assessed by asking about the frequency of fast food and nonfried fish consumption. All patients had erythrocyte omega-3 index measured at the time of hospital admission for AMI. We used multivariable linear regression to identify independent correlates of the omega-3 index and modified Poisson regression to predict risk of a low omega-3 index (<4%). The proportion of patients with a low omega-3 index increased with more frequent fast food intake (18.9% for <1 time monthly, 28.6% for 1-3 times monthly, 28.8% for 1-2 times weekly, and 37.6% for ≥ 3 times weekly; P<.001). In contrast, a low omega-3 index was less common among patients with more frequent fish intake (35.1% for <1 time monthly, 24.9% for 1-3 times monthly, 16.1% for 1-2 times weekly, and 21.1% for ≥ 3 times weekly; P<.001). Fish intake, older age, race other than white, and omega-3 supplementation were independently associated with a higher omega-3 index, whereas frequent fast food intake, smoking, and diabetes mellitus were associated with a lower omega-3 index. Potentially modifiable factors, such as patient-reported fast food intake, fish intake, and smoking, are independently associated with the omega-3 index in patients with AMI. These characteristics may be useful to identify patients who would benefit most from omega-3 supplementation and lifestyle modification.

It is just a game: lack of association between watching football matches and the risk of acute cardiovascular events

The role of trigger factors in acute cardiovascular events has been much studied in the past few years. A recent study analysed changes in the rates of cardiac emergencies in Bavaria (Germany) during the last Football World Cup. The authors reported a 2.7-fold increase in the incidence of cardiac emergencies in the 12 h before and after football matches involving the German team, which sparked the debate on the necessity of the introduction of ad hoc cardiovascular preventive measures. We studied 25,159 hospital admissions for acute myocardial infarction (AMI) among the Italian population during three international football competitions: the World Cup 2002, the European Championship 2004 and the World Cup 2006. Poisson regression was used to estimate the relative risk of hospital admission for AMI on the days when football matches involving the Italian team were disputed, compared with the other days of the three competitions. Furthermore, we reviewed the available published studies regarding the association between football matches and the risk of cardiovascular events. We did not find an increase in the rates of admission for AMI on the days of football matches involving Italy in either the single competitions or the three competitions combined (relative risk 1.01; 95% confidence interval 0.98-1.05). We identified 10 studies published on this topic. With the exception of the recently published German study and two small Swiss studies, all relative risk estimates were between 0.7 and 1.3. The cardiovascular effects of watching football matches are likely to be, if anything, very small.

Type D Personality Predicts Clinical Events After Myocardial Infarction, Above and Beyond Disease Severity and Depression

To investigate the effect of Type D personality (high negative affectivity and social inhibition) on cardiac death and/or recurrent myocardial infarction (MI) in patients with acute MI, after adjustment for disease severity and depression. To explore the differential effect of Type D on early (< or = 6 months) versus late (> 6 months) events separately. Patients hospitalized for acute MI (N = 473) were recruited between May 2003 and May 2006. Patients were assessed on demographic and clinical variables and completed the Type D Personality Scale within the first week of hospital admission for acute MI; depression severity was assessed with the 17-item Hamilton Depression Rating Scale. The mean follow-up period was 1.8 years. There were 44 events attributable to cardiac death (n = 16) or recurrent MI (n = 28), with 26 early and 18 late events. Type D patients were at cumulative increased risk of death/recurrent MI compared with non-Type D patients (16.3% vs 7.8%; P = .012). Cardiac history, left ventricular ejection fraction, and use of statins were predictors of total and late death/recurrent MI, with statins showing a substantial protective effect. In addition, cardiac history and use of statins were significantly associated with early death/recurrent MI. Type D patients had a 2-fold increased risk of total death/recurrent MI after adjustment for disease severity and depression (HR = 2.23; 95% CI, 1.14-4.35; P = .019) and a more than 3-fold increased risk of late death/recurrent MI (HR = 3.57; 95% CI, 1.23-10.30; P = .019). Type D was a strong predictor of adverse cardiac outcome after acute MI, above and beyond disease severity and depression severity, and the associated risk was similar to that of traditional cardiovascular risk factors. Type D may be an important psychosocial factor to assess in patients post-MI for risk stratification purposes.

Assessing the effects of the introduction of the New Zealand Smokefree Environment Act 2003 on Acute Myocardial Infarction hospital admissions in Christchurch, New Zealand

To examine trends in Acute Myocardial Infarction (AMI) hospital admissions in Christchurch, New Zealand before and after the implementation of the New Zealand Smokefree Environments Act 2003 in December 2004. Data on AMI hospital admissions to Christchurch Public Hospital were extracted for the period 2003 to 2006. Poisson regression was used to calculate rate ratios by comparing for AMI rates of hospital admissions before (2003/04) and after (2005/06) the introduction of the Smokefree legislation, and to assess whether there was a significant change over time. The introduction of the smokefree legislation was associated with a 5% reduction in AMI admissions. The 55-74 age group recorded the greatest decrease in admissions (9%) and this figure rose to 13% among never smokers in this group. Reductions were more marked for men. Adding the effects of area deprivation increased the reduction to 21% among 55-74 year olds living in more affluent (quintile 2) areas. Overall however, the statistical association of changing levels of AMI admissions with smoking status and with deprivation was not consistently significant. At this early stage following the smokefree legislation, there are hints emerging of a positive impact on AMI admissions but these suggestions cannot yet be treated with certainty. Further research could usefully evaluate the longer-term effects of smoking legislation on the prevalence of smoking and exposure to second hand smoke, especially in more deprived urban communities.

Declines in Acute Myocardial Infarction After Smoke-Free Laws and Individual Risk Attributable to Secondhand Smoke

The estimated effects of recent pubic and workplace smoking restriction laws suggest that they produce significant declines in community rates of heart attack. The consistency of these declines with existing estimates of the relative risk of heart attack in individuals attributable to passive smoking exposure is poorly understood. The objective is to determine the consistency of estimates of reductions in community rates of heart attacks resulting from smoking restriction laws with estimates of the relative risk of heart disease in individuals exposed to passive smoking. Meta-analyses of existing estimates of declines in community rates were compared with a mathematical model of the relationship between individual risk and community rates. The outcome measure is the ratio of community rates of acute myocardial infarction (after divided by before implementation of a smoking restriction law). There is a significant drop in the rate of acute myocardial infarction hospital admissions associated with the implementation of strong smoke-free legislation. The primary reason for heterogeneity in results of different studies is the duration of follow-up after adoption of the law. The pooled random-effects estimate of the rate of acute myocardial infarction hospitalization 12 months after implementation of the law is 0.83 (95% confidence interval, 0.80 to 0.87), and this benefit grows with time. This drop in admissions is consistent with a range of plausible individual risk and exposure scenarios. Passage of strong smoke-free legislation produces rapid and substantial benefits in terms of reduced acute myocardial infarctions, and these benefits grow with time.

Ivabradine

Ivabradine

POLICY: Smoking Bans Yield Long-Term Benefits

When it comes to linking cigarette smoke to heart attacks, one might assume that such a link would apply only as long as one is smoking or being exposed to secondhand smoke. That’s not necessarily true, however, at least according to a follow-up study of people living in and around Pueblo, Colorado. In the 2 January 2009 issue of Morbidity and Mortality Weekly Report (MMWR), researchers reported that hospitalizations in Pueblo for acute myocardial infarction (AMI) showed a steady, continuous decline three years after the city introduced a smoking ban in all public buildings. In November 2005, researchers first began to report that a smoking ban in all public buildings in Pueblo was associated with a significant reduction in the number of hospitalizations for AMI [see EHP 114:A154 (2006)]. In the 18 months after the ban came into force, the number of such hospitalizations fell 27%, from 257 to 187 per 100,000 person-years. Only a small reduction was seen for the population living outside the city limits, and no reduction was seen in neighboring El Paso County—areas unaffected by the ban. The new figures published in MMWR examine the three years since the smoking ban began and show that the number of hospitalizations for AMI has continued to decline to 152 per 100,000 person-years, says Robert Alsever, medical director for health information at the Parkview Medical Center in Pueblo and first author of the update report. That’s a 19% reduction over the figure for the first 18 months after the ban began and a total 41% reduction since the ban started, he says. The point at which these improvements will level off remains to be seen. In a review published in the February 2009 issue of Preventive Medicine, Lorenzo Richiardi and colleagues noted that at least 10 studies in the United States and Europe had reported a reduction in the number of hospital admissions for AMI in the months following the introduction of regulations banning smoking in public places. The decreases observed ranged from 8% in New York State to 40% in Helena, Montana. Specifically, the Helena study found a 40% decline in hospital admissions for AMI during a 6-month smoking ordinance within Helena city limits; however, this was a relatively small population study. An editorial note that accompanies the MMWR report observes that a meta-analysis of seven other studies and one unpublished study yielded a pooled estimate of a 19% reduction in AMI hospitalization rates after implementation of public smoking bans. Three studies suggested these reductions were more pronounced among non smokers than among smokers. The Pueblo study, however, did not assess what portion of the observed decrease in hospitalizations could be attributed to reduced secondhand smoke exposure among nonsmokers or to quitting among smokers. Even though the prevalence of smoking dropped in Pueblo County as a whole, the difference over time was not statistically significant. As the editorial note explains, “the ecologic nature of this study precludes definite conclusions about the extent to which the observed decline in AMI hospitalizations in the city of Pueblo was attributable to the smoke-free ordinance.” One concept that may begin making its way into tobacco control policies and programs is that of “thirdhand smoke,” which refers to the chemicals in cigarette smoke that settle on the surfaces inside a home. Jonathan Winickoff, a pediatrician at the Dana-Farber/Harvard Cancer Center, is one of a growing number who believe these deposited chemicals pose a hazard to occupants’ health days after a cigarette is stubbed out. “Children are particularly likely to come into contact with this third-hand smoke,’” explains Winickoff. “The chemicals in smoke may stick to objects for many days and are gradually released back into the air, so infants and children breathe in and ingest tobacco toxins as they crawl over, mouth, and play on contaminated surfaces.” In a survey published in the January 2009 issue of Pediatrics, Winickoff’s team asked U.S. adults to describe their beliefs about the health effects of second- and thirdhand cigarette smoke. Many people reported believing that thirdhand smoke is far less of a health concern for children than secondhand smoke. Those who did report believing thirdhand smoke poses a hazard to children were more likely to enact strict smoking bans inside their homes. Says Winickoff, “These findings suggest that if more people understood the dangers of thirdhand smoking, especially to their children, we might see more nonsmoking policies adopted in the home.”

Cardiovascular Safety of Celecoxib in Acute Myocardial Infarction Patients: A Nested Case-Control Study

The objective was to measure the impact of exposure to coxibs and non-steroidal antiinflammatory drugs (NSAID) on morbidity and mortality in older patients with acute myocardial infarction (AMI). A nested case-control study was carried out using an exhaustive population-based cohort of patients aged 66 years and older living in Quebec (Canada) who survived a hospitalization for AMI (ICD-9 410) between 1999 and 2002. The main variables were all-cause and cardiovascular (CV) death, subsequent hospital admission for AMI, and a composite end-point including recurrent AMI or CV death. Conditional logistic regressions were used to estimate the risk of mortality and morbidity. A total of 19,823 patients aged 66 years and older survived hospitalization for AMI in the province of Quebec between 1999 and 2002. After controlling for covariables, the risk of subsequent AMI and the risk of composite end-point were increased by the use of rofecoxib. The risk of subsequent AMI was particularly high for new rofecoxib users (HR 2.47, 95% CI 1.57–3.89). No increased risk was observed for celecoxib users. No increased risk of CV death was observed for patients exposed to coxibs or NSAIDs. Patients newly exposed to NSAIDs were at an increased risk of death (HR 2.22, 95% CI 1.30–3.77) and of composite end-point (HR 2.28, 95% CI 1.35–3.84). Users of rofecoxib and NSAIDs, but not celecoxib, were at an increased risk of recurrent AMI and of composite end-point. Surprisingly, no increased risk of CV death was observed. Further studies are needed to better understand these apparently contradictory results.

Monitoring trends in acute coronary syndromes: can we use hospital admission registries?

Mortality rates from coronary heart disease (CHD), and from acute myocardial infarction (AMI), in particular, have been declining steadily since the 1970s.1 2 Data from the MONICA study suggest that...