جستجوی مقالات مرتبط با کلیدواژه « ischemic heart disease » در نشریات گروه « پزشکی »

Little is known about the impact of sex-related differences on clinical presentation, treatment adherence, and outcomes in patients with acute coronary syndrome (ACS) in developing countries, such as Iran.
 
This observational cross-sectional study used the Coronary Angiography and Angioplasty Registry (CAAR) data. We included all adults who underwent coronary angiography or angioplasty within 1 year, analyzing data from 1548 cases.
 
A total of 1548 patients were included in the analysis. Women were older than men when experiencing ACS and had a higher prevalence of atypical symptoms. Women were also more likely to have comorbid conditions such as hypertension, diabetes, obesity, dyslipidemia, and depression. Still, men were more likely to have a history of smoking and previous myocardial infarction (MI). Investigation of differences regarding invasive therapeutic procedures, culprit arteries, and numbers of diseased vessels showed no significant differences between women and men in the ST-elevation myocardial infarction (STEMI) and non-STEMI groups. However, there was a significant difference between women and men in these factors in patients with unstable angina and stable angina. Men in these groups were more likely to have the involvement of 2 or 3 coronary arteries and were more likely to be recommended for percutaneous coronary intervention and coronary artery bypass graft surgery. Nonetheless, there was no significant difference in acceptance rates of recommended treatment in these groups between men and women.
 
The study findings provide insight into the differences between male and female ACS patients in the Iranian population, highlighting the need for sex-specific approaches in treatment. (Iranian Heart Journal 2024; 25(3): 58-71)

A major clinical challenge in ischemic heart disease is the prevention of myocardial injury following ischemia/reperfusion (I/R). Application of natural pharmaceuticals seems to be clinically interesting due to their multiplex activities. Protective effects of troxerutin (TXR) in myocardial I/R injury have been ever demonstrated, nevertheless, the purpose of this study is to explore the role of mitochondrial adenosine triphosphate -sensitive potassium (mitoKATP) channels and toll-like receptor 4 (TLR4)-nuclear factor kappa B (NF-κB) pathway in cardioprotective effects of TXR against I/R injury in rats. Male Wistarrats (n=72, 250–300 g, 12 weeks old) were randomized into groups with/without I/R and/or TXR and 5-hydroxydecanoate(5-HD), alone or in combination. To induce I/Rmodel, the langendorff-perfused hearts were subjected to left anterior descending coronary artery (LAD) ligation and re-opening. TXR (150mg/kg/day) was administered for 4 weeks before I/R. Moreover, 5-HD (100 μM) was added to the perfusion solution before the ischemia. Finally, myocardial infarct size, LDH release, protein expression levels of TLR4 and NF-κB, and the levels of pro-inflammatory cytokines (TNF-α and IL-1β) were assessed. TXR preconditioning significantly reduced IS and LDH release (P<0.05). Furthermore, it decreased the expression of TLR4 and NF-κB and the levelof pro-inflammatory cytokines (P<0.05 to P<0.01). Inhibition of mitoKATPchannels by 5-HD significantly reversed the cardioprotective effects of TXR. This work shed some light on the knowledge about the mechanisms involved in the anti-inflammatory effect of TXR preconditioning in myocardial I/R injury. This effect may be partly mediated through mitoKATPchannels opening and subsequent suppression of the TLR4/NF-κB pathway.

 Little is known about the predictors of left ventricular ejection fraction (LVEF) —an important predictor of mortality— after primary percutaneous coronary intervention (PCI) in low- and middle-income countries.

 In a prospective cohort study at Imam Ali hospital, Kermanshah, Iran, we enrolled consecutive ST-elevation myocardial infarction (STEMI) patients treated with primary PCI (2016-2018) and followed them up to one year. LVEF levels were measured by echocardiography, at baseline and one-year follow-up. Determinants of preserved/improved LVEF were assessed using multi-variable logistic regression models.

 Of 803 patients (mean age 58.53±11.7 years, 20.5% women), baseline LVEF levels of ≤35% were reported in 44%, 35- 50% in 40%, and ≥50% in 16% of patients. The mean ± SD of LVEF increased from 38.13%±9.2% at baseline to 41.49%±9.5% at follow-up. LVEF was preserved/improved in 629 (78.3%) patients. Adjusted ORs (95% CIs) for predictors of preserved/improved LVEF showed positive associations with creatinine clearance, 1.01 (1.00-1.02) and adherence to clopidogrel, 2.01 (1.33-3.02); and inverse associations with history of myocardial infarction (MI), 0.44 (0.25-0.78); creatine kinase MB (CK-MB), 0.997 (0.996- 0.999); door-balloon time (3rd vs. 1st tertile), 0.62 (0.39-0.98); number of diseased vessels (2 and 3 vs. 1: 0.63 (0.41-0.99) and 0.58 (0.36-0.93), respectively); and baseline LVEF (35-50% and ≥50% vs. ≤35%: 0.45 (0.28-0.71) and 0.19 (0.11-0.34), respectively).

 Adherence to clopidogrel, short door-balloon time, high creatinine clearance, and lower baseline LVEF were associated with preserved/improved LVEF, while history of MI, high CK-MB, and multi-vessel disease were predictors of reduced LVEF. Long-term drug adherence should be considered for LVEF improvement in low- and middle-income countries.

 Stress often happens in acute coronary syndrome (ACS) patients, especially during hospitalization.

 The current study intended to identify the prevalence of stress and its associated factors among ACS patients in two selected hospitals in the east coast region of Malaysia.

 A total of 400 ACS patients in both hospitals participated in this cross-sectional study. Acute coronary syndrome patients above 18 who can read, speak and understand in Malay and obtained informed consent were included in the study. The study excluded those patients who were intubated, had any altered mental status, were mentally retarded, and had psychological problems. Stress among ACS patients was measured using the validated questionnaire of the Malay version of the Depression Anxiety Stress Scale 21. Logistic regression was used for analysis.

 Of these ACS patients, 58.5% had stress symptoms. A higher frequency of stress was found in patients of male (63.7%), Malay (82.1%), and married (67.1%). Acute coronary syndrome patients with a history of ischemic heart disease were a strong and independent factor associated with stress (adjusted odds ratio: 1.73, 95% confidence interval: 1.14 - 2.63, P = 0.010).

 The prevalence of stress in the study population was high and significantly associated with a history of ischemic heart disease. Creating awareness regarding the risk factors of stress is recommended. In addition, policies should be implemented to reduce the risk of stress among patients.

Ischemic heart disease (IHD) is a common cardiovascular disease. One of the main concerns of health system staff is the non-compliance of these patients in adherence to treatment after discharge from the hospital. Designing and implementing a program to follow up patients after discharge can positively affect their rehabilitation and treatment adherence. This study was performed with aim to investigate the effect of discharge planning on adherence to treatment in patients with ischemic heart disease. This quasi-experimental study was performed with the participation of 70 ischemic heart disease patients hospitalized in Hamadan Cardiovascular Hospital in 2018. Participants were selected by simple random sampling and divided into experimental (n = 35) and control (n = 35) groups using permutation blocks. In the first 24 hours of admission, a researcher-made questionnaire of adherence to treatment was completed by all participants to assess the educational needs. The discharge planning consisted of two stages: before discharge and after discharge from the hospital with telephone follow-up for 2 months. Then adherence to treatment was re-assessed after discharge. Data was analyzed using SPSS software (version 22) by chi-square, Fisher's exact test, independent t-test and paired t-test. P<0.05 was considered statistically significant. Before the intervention, there was no statistically significant difference between the control and experimental groups in adherence to treatment (p> 0.05); however, after the discharge planning, adherence to treatment significantly increased in all areas in the experimental group (P <0.001).Implications for Practice: Implementation of discharge planning improves and promotes adherence to treatment in IHD patients.

 Many biological and cultural factors are involved in the physical resilience of older adults, but these factors are not fully known and the results of studies are contradictory in this field. 
 The present study was conducted to determine the level of physical resilience and its associated factors in Iranian older adults with ischemic heart disease (IHD). 
 A cross-sectional study was conducted on 350 older adults with IHD admitted to Shahid Beheshti Hospital in Kashan, Iran, in 2018. Sampling was done consecutively. Eligible older adults completed a demographic form and the Resnick physical resilience questionnaire in the presence of the researcher. Data were analyzed using Pearson's correlation coefficient, t-test, analysis of variance, and multivariate regression. 
 A majority of the participants were female (50.6%) and mostly resided in urban areas (67.4%). The overall mean score of physical resilience was 9.57 ± 3.00 out of 15. Women, those with an unmarried child at home, those who were literate and lived in urban areas, those without comorbidities, and those who did not receive financial support from family members had significantly higher resilience scores (P < 0.05). Multiple linear regression analysis showed that younger age (P < 0.001), better cognitive function (P = 0.006), and employment (P = 0.01) significantly predicted physical resilience. 
 The average score of the participants was above 50% of the score of the physical resilience questionnaire. Our findings encourage authorities to develop comprehensive care plans including community education and more diverse care for patients with noncommunicable diseases, to increase resilience in older adults with IHD.

Despite steps in lifestyle changes and preventive measures, the incidence of heart disease is still rising. Coronary artery disease (CAD) is the world’s leading cause of death; thus, the early detection of this disease can significantly reduce its mortality rate. We evaluated the diagnostic value and prognostic role of positive exercise stress echocardiography in CAD.

The present retrospective study was performed on 350 patients with symptoms of IHD referred for exercise stress echocardiography between 2004 and 2017. The obtained data were analyzed using the SPSS software.

Ischemic electrocardiographic (ECG) changes, the regional wall motion abnormality (RWMA) score index, the metabolic equivalent, and the peak left ventricular ejection fraction were associated with CAD (P=0.004, P=0.000, P=0.02, and P=0.000, respectively). The incidence of ventricular arrhythmias was associated with sudden cardiac death and myocardial infarction (P=0.00). Ischemic ECG changes were significantly associated with myocardial infarction and the need for percutaneous coronary interventions in the future (P=0.04 and P=0.03). The relationship between left ventricular dilation and sudden cardiac death was significant (P=0.01), and RWMAs were significantly associated with myocardial infarction (P=0.03). However, dyspnea and chest pain had no association with cardiac events.

Positive exercise stress echocardiography was associated with sudden cardiac death, myocardial infarction, and the need for future coronary revascularization, and its diagnostic and predictive role was observed in ischemic heart disease and predicting future cardiac events. 

Carbon monoxide (CO) poisoning is the leading cause of poisoning-related deaths in theUnited States. In addition, myocardial infarction (MI) due to CO poisoning in a young, healthy adult is rare.On the other hand, smokeless tobacco, processed in various forms, is a controversial coronary heart disease(CHD) risk factor.

CASE REPORT: 

In this study, we describe a 29-year-old man who presented with acute chest pain followinga night of smoking tobacco and using smokeless tobacco in the presence of carbon monoxide poisoning.ST-segment elevation was observed on an electrocardiogram, and echocardiography revealed akinesia. Inaddition, cardiac markers were elevated. In this particular instance, thrombolytic therapy demonstratedsuccessful outcomes.

We believe the case and discussion could shed light on the emergency departmentmanagement of such individuals. We advise clinicians to consider the possibility of coronary heart diseasein carbon monoxide poisoning patients and to obtain a baseline electrocardiogram and cardiac markers.

In patients with cardiac disease, it’s always a challenge for the anaesthetist to administer general anaesthesia as well as central neuraxial blockade. The major perioperative task in these patients with low cardiac output is maintaining hemodynamic stability. Here, we are discussing a case of successful management of a geriatric patient having ischemic heart disease with ejection fraction of 25% posted for bilateral total knee replacement under graded epidural anaesthesia.

The prevalence of non-alcoholic fatty liver disease (NAFLD) is about 30% in general population. Since conditions such as obesity, hyperlipidemia, diabetes mellitus, metabolic syndrome and insulin resistance have been named as some of the most important risk factors, as the prevalence of these conditions continues to rise, NAFLD becomes an increasingly significant problem. Endothelial dysfunction, increased pulse wave velocity, increased coronary artery calcification, and the development of atherosclerosis appear to be influenced by NAFLD. Considering this concern, this narrative review investigated the prevalence of CVD in NAFLD patients.

This narrative study evaluates the prevalence of CVD in NAFLD patients, as well as several variables that influence their association. In this study our search strategy engines include PubMed, Scopus, MEDLINE, and Google Scholar.

Previous research suggests that as nonalcoholic steatohepatitis (NASH) and liver fibrosis progress, there is an increased risk of CVD, most likely due to the hepato-cardiovascular axis’ effect. The correlation between NAFLD and metabolic disorders suggests that fatty liver disease may cause cardiovascular disorders (CVD).

As a result, the management of both NAFLD and the risk of CVD are aimed at the same target, which is to reduce insulin tolerance by lifestyle modifications. Moreover, monitoring for CVD and proper pharmacotherapy is essential in individuals with severe NAFLD and those who are at increased risk for ischemic heart disease.

We aimed to evaluate the impact of national health programs implemented in Kazakhstan from 2011 on CVD incidence and mortality.

Incidence and mortality rates from CVD were studied in Kazakhstan from 2004 to 2017. The official data obtained from “Medinform” company were analyzed based on the annual population statistics.

There was an increase in the incidence of cardiovascular disease among the population of Kazakhstan from 1845.4 per 100,000 in 2004 to 2597.5 per 100,000 in 2017. This might be attributed to the implementation of the national health programs, which improved early CVD identification. Incidence of ischemic heart disease (IHD) was grown almost in all provinces of Kazakhstan during the study period. The mortality from cardiovascular disease had a considerable decline over the study period, in particular after 2010, it might be influenced by early diagnosis and provision of timely treatment.

The experience of Kazakhstan national health programs shows improved identification of CVD and IHD and timely treatment for cardiovascular disease. A significant variation in incidence and mortality rates of cardiovascular disease was observed between the country provinces.

Patients with ischemic heart disease (IHD) gradually reduce their follow-up treatment due to the vulnerable physical condition and high involvement with the disease-related treatment process. The purpose of this research was to investigate the effect of intervention based on the protection motivation theory (PMT) on treatment adherence in patients with IHD.

This quasi-experimental research used a pretest-posttest design with a control group. The statistical population included all patients with IHD referred to the Payambar Azam hospital in Bandar Abbas, Iran for more than once between March 2019 and May 2020. A total of 16 patients were selected through the matched targeted sampling and randomly assigned into two equal groups of experimental and control (n = 8 each). The test group received an intervention based on the PMT in six 90-minute sessions within 45 days. We used the Modanloo Treatment Adherence Questionnaire (TAQ), and the data were analyzed using the analysis of covariance (ANCOVA) in the SPSS23 statistical software.

The results of ANCOVA showed that the intervention based on the PMT significantly increased the treatment adherence and its subscales in patients with IHD (P<0.001).

Intervention based on the PMT can be used as an effective intervention to increase treatment adherence in patients with IHD, depending on proper nutrition training, self-care skills, awareness-raising, and relaxation exercises.

Ischemic heart disease (IHD) is the leading cause of death and disability worldwide and in Iran, which imposes a heavy financial burden both on patient’s family and society.

This study aimed to analyze the direct medical costs of inpatients with IHD and its influencing factors in Iran in 2020.

The sample of this cross-sectional study included 41,357 patients with IHD selected from the hospital information system (HIS) of the Iran Health Insurance Organization from August 23, 2019, to June 20, 2020. The study used the claims data of these patients, which included their demographics, length of stay (LOS), intensive care unit (ICU) admission, hospital accreditation grade, hospital ownership type, and patient discharge status. The multiple linear regression model was employed to evaluate the relationship between hospitalization costs and the associated factors. All statistical tests were conducted at the significance level of P < 0.05 using the R 3.6.3 software.

The mean age of patients was 63.95 ± 12.63 years old, and most of them were male (54.4%). The mean hospitalization cost per patient and per day was 586.42 ± 472.51 USD and 103.64 ± 100.29 USD, respectively. Moreover, the mean LOS was 4.92 days. Drugs and consumable medical supplies, as well as nursing and hoteling services, had the highest shares of hospitalization costs (29.54% and 29.4%, respectively). The hospitalization costs of patients with IHD were higher among men (β = 1.24), age 61 - 70 years (β = 1.38), LOS ≥ 5 (β = 2.92), ICU admission (β = 1.62), Iranian health fund (β = 1.21), and private hospitals (β = 1.91). Top-grade and first-grade hospitals had higher costs compared to grade 2 (β = 0.67), grade 3 (β = 0.35), and grade 4 (β = 0.72) hospitals. Deceased patients had also higher costs than patients with complete recovery (β = 0.63), relative recovery (β = 0.59), follow-up (β = 0.51), transfer to other medical centers (β = 0.44), and discharge against medical advice (DAMA) (β = 0.62).

According to the results, shortening the LOS and controlling the high costs of drugs and consumable medical supplies are among the main strategies to reduce high hospitalization costs.

Ischemic Heart Diseases (IHDs) are the main causes of deaths all over the world. Since there is no comprehensive study on IHDs mortality rate in Iran, the present study aimed to estimate age-standardized IHDs mortality rate by sex, age, geography, and time trends at both national and sub-national levels in Iran.

We used the Death Registration System (DRS) data from 1990 to 2015 collected by the Iranian Ministry of Health and Medical Education across the country, Tehran, and Isfahan main cemetery, not included in the DRS. Utilized death distribution methods to overcome the incompleteness of data. Statistical models including Spatio-temporal and Gaussian-Process Regression models were used to extrapolate all-cause and cause-specific mortality rates.

Age-standardized IHDs mortality rate in Iran almost doubled from 1990 to 2015. Forty-nine deaths per 100.000 population in 1990, which increased to 91.6 deaths per 100.000 in 2015). Male to female age-standardized mortality rate increased from 1.07 to 1.32 during the studied period. Aging was associated with an increase in age-standardized IHDs mortality rate in both sexes, all provinces, and all of the years. The range of age-standardized IHDs mortality rate for both sexes was from 58 to 136.2 deaths per 100,000 across provinces in 2015.

Due to the increase in age-standardized IHDs mortality rate in Iran, it seems necessary to design and implement appropriate public health interventions by health authorities to prevent and control this group of diseases.

Investigators have identified sufficient self‑care as an important factor in reducing health‑care costs and improving health outcomes in cardiac patients. Therefore, the purpose of the present study was to determine the relationship between perceived social support (PSS) and self‑care behaviors (SCBs) in patients with ischemic heart disease.

The present work was a cross‑sectional study. Patients with ischemic heart disease were selected using the convenience sampling method. Data gathering tools used in this study were questionnaires of Zimet multidimensional social support and Miller self‑care. The data were analyzed in SPSS 18 software using Spearman’s correlation and Mann–Whitney tests by significant coefficient <0.05.

It was revealed that income, ethnicity, gender, and the type of employment had significant effects on the scores of PSS and SCBs. The mean score of PSS was 44.60 ± 14.30 and that of SCBs for all the patients was calculated at 67.12 ± 17.04. The majority of the patients had a high score of PSS, while, in case of SCBs, the score showed an undesirable condition. The results revealed a direct and significant relationship between PSS and SCBs in patients with ischemic heart disease (P < 0.05).

The score of PSS wasin a satisfactory range; the unsuitable score of SCBsshowed an urgent need of providing education for myocardial ischemia patients to improve the level of their self‑care affairs. In addition, the caretakers of the patient should be trained to pay attention to all the important aspects of PSS.