Adherence To Guidelines For Secondary Prevention In Patients With St Segment Elevation Myocardial Infarction
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Adherence to guidelines for secondary prevention in patients with ST-Segment elevation myocardial infarction
Several classes of medication improve survival in patients with ST-segment elevation myocardial infarction (STEMI). These classes have strong levels of recommendation in current guidelines; however, their efficacy when used according to the guidelines in the 'real world' setting and in a modem era with high levels of access to primary percutaneous coronary intervention is unclear. We sought to assess the effect of strict adherence to current international guidelines on 1-year ail-cause mortality in a prospective cohort of patients with STEMI. Using data from the French RESCUe Network, we studied all patients with STEMI admitted and discharged alive from hospital between 2009 and 2013. Class 1 and II level guidelines were used to define the 'optimal therapy'(OT) group. The 'undertreatment'(UT) group comprised patients in whom at least one drug with a class 1 recommendation was missing. Multivariable Cox regression analysis with propensity score for the prescription of OT was used. Of the 5161 patients discharged alive, 2991 (58%) were prescribed OT. The 1-year overall survival rate was 0.99 in the OT group (95% confidence interval [CI] 0.99- 1.00) and 0.90 (95% CI0.88-0.92) in the UT group. Patient characteristics in the UT group were worse than those in the OT group. After multivariable adjustment, the association between the OT group and survival remained significant, with a hazard ratio of0.12 (95% CI 0.07-0.22; P
Clinical Cardiology: Current Practice Guidelines
Author: Demosthenes G. Katritsis
language: en
Publisher: Oxford University Press
Release Date: 2016-07-21
Clinical Cardiology: Current Practice Guidelines Updated Edition is an essential tool for the busy clinician, offering succinct yet detailed access to the most recent trial and guideline data supporting practice and patient management in cardiology. ESC and ACC/AHA guidelines are continually updated and often overlap in their advice, making it difficult for the cardiologist to obtain a clear picture of the right way to diagnose and treat disease according to the latest evidence base. Written by leading authorities in the field, this book, together with its regularly-updated online version, provides a unique solution. The authors have scrutinized all available guidelines and research from both ACC/AHA and ESC on every clinical issue. The result is a rigorous examination of the implications of published guidance, illustrated by more than 600 easy-to-follow tables and 200 full-colour images, which reinforce key points and clarify difficult concepts. 87 comprehensive chapters explore the definition, epidemiology, pathophysiology, diagnosis and management of cardiac disease. Two new chapters examine the univentricular heart and venous thrombembolism. Each chapter encompasses the latest published research, followed by discussions of possible presentations and investigations, offering detailed insights for clinicians into best practice for diagnosis and treatment. Providing at-a-glance access to the best guidance in cardiology, this book offers a diagnosis and management toolkit which no practising cardiologist can afford to be without.
The ESC Textbook of Intensive and Acute Cardiovascular Care
Author: Marco Tubaro
language: en
Publisher: Oxford University Press, USA
Release Date: 2015
The ESC Textbook of Intensive and Acute Cardiovascular Care is the official textbook of the Acute Cardiovascular Care Association (ACCA). The new edition continues to approach issues on Intensive and Acute Cardiac Care for not only cardiologists, intensivists and critical care specialists, but emergency physicians and healthcare professionals too.