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Relevant bibliographies by topics / Type 2 myocardial infarction

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Academic literature on the topic 'Type 2 myocardial infarction'

Author: Grafiati

Published: 28 September 2022

Last updated: 20 April 2024

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Journal articles on the topic "Type 2 myocardial infarction"

1

Smer, Aiman, Ray W. Squires, Ahmed Aboeata, et al. "Type 2 Myocardial Infarction." Journal of Cardiopulmonary Rehabilitation and Prevention 41, no. 3 (2021): 147–52. http://dx.doi.org/10.1097/hcr.0000000000000550.

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Radovanovic, Dragana, Thomas Pilgrim, Burkhardt Seifert, Philip Urban, Giovanni Pedrazzini, and Paul Erne. "Type 2 myocardial infarction." Journal of Cardiovascular Medicine 18, no. 5 (2017): 341–47. http://dx.doi.org/10.2459/jcm.0000000000000504.

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Dahhan, Ali. "Type 2 myocardial infarction." Journal of Cardiovascular Medicine 20, no. 8 (2019): 510–17. http://dx.doi.org/10.2459/jcm.0000000000000813.

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Nestelberger, Thomas, Jasper Boeddinghaus, and Christian Mueller. "Type 2 myocardial infarction." European Heart Journal 39, no. 42 (2018): 3825. http://dx.doi.org/10.1093/eurheartj/ehy535.

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Collinson, P. O. "Type 2 myocardial infarction." Heart 101, no. 2 (2014): 89–90. http://dx.doi.org/10.1136/heartjnl-2014-306865.

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Sandoval, Yader, and Allan S. Jaffe. "Type 2 Myocardial Infarction." Journal of the American College of Cardiology 73, no. 14 (2019): 1846–60. http://dx.doi.org/10.1016/j.jacc.2019.02.018.

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Sandoval, Yader, and Allan S. Jaffe. "Type 2 Myocardial Infarction." Journal of the American College of Cardiology 81, no. 2 (2023): 169–71. http://dx.doi.org/10.1016/j.jacc.2022.11.010.

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Strömbäck, Ulrica, Åsa Engström, Robert Lundqvist, Dan Lundblad, and Irene Vikman. "The second myocardial infarction: Is there any difference in symptoms and prehospital delay compared to the first myocardial infarction?" European Journal of Cardiovascular Nursing 17, no. 7 (2018): 652–59. http://dx.doi.org/10.1177/1474515118777391.

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Background: Knowledge is limited concerning the type of symptoms and the time from onset of symptoms to first medical contact at first and second myocardial infarction in the same patient. Aim: This study aimed to describe the type of symptoms and the time from onset of symptoms to first medical contact in first and second myocardial infarctions in men and women affected by two myocardial infarctions. Furthermore, the aim was to identify factors associated with prehospital delays ≥2 h at second myocardial infarction. Methods: A retrospective cohort study with 820 patients aged 31–74 years with a first and a second myocardial infarction from 1986 through 2009 registered in the Northern Sweden MONICA registry. Results: The most common symptoms reported among patients affected by two myocardial infarctions are typical symptoms at both myocardial infarction events. Significantly more women reported atypical symptoms at the second myocardial infarction compared to the first. Ten per cent of the men did not report the same type of symptoms at the first and second myocardial infarctions; the corresponding figure for women was 16.2%. The time from onset of symptoms to first medical contact was shorter at the second myocardial infarction compared to the first myocardial infarction. Patients with prehospital delay ≥2 h at the first myocardial infarction were more likely to have a prehospital delay ≥2 h at the second myocardial infarction. Conclusions: Symptoms of second myocardial infarctions are not necessarily the same as those of first myocardial infarctions. A patient’s behaviour at the first myocardial infarction could predict how he or she would behave at a second myocardial infarction.

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London, Martin J. "Type 2 Perioperative Myocardial Infarction." Anesthesiology 128, no. 6 (2018): 1055–59. http://dx.doi.org/10.1097/aln.0000000000002153.

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Sandoval, Yader, and Kristian Thygesen. "Myocardial Infarction Type 2 and Myocardial Injury." Clinical Chemistry 63, no. 1 (2017): 101–7. http://dx.doi.org/10.1373/clinchem.2016.255521.

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Abstract BACKGROUND The development and implementation of sensitive and high-sensitivity cardiac troponin assays has not only expedited the early ruling in and ruling out of acute myocardial infarction, but has also contributed to the identification of patients at risk for myocardial injury with necrosis, as confirmed by the presence of cardiac troponin concentrations above the 99th percentile. Myocardial injury with necrosis may occur either in the presence of overt ischemia from myocardial infarction, or in the absence of overt ischemia from myocardial injury accompanying other conditions. Myocardial infarction type 2 (T2MI) has been a focus of attention; conceptually T2MI occurs in a clinical setting with overt myocardial ischemia where a condition other than an acute atherothrombotic event is the major contributor to a significant imbalance between myocardial oxygen supply and/or demand. Much debate has surrounded T2MI and its interrelationship with myocardial injury. CONTENT We provide a detailed overview of the current concepts and challenges regarding the definition, diagnosis, management, and outcomes of T2MI, as well as the interrelationship to myocardial injury, and emphasize several critical clinical concepts for both clinicians and researchers moving forward. SUMMARY T2MI and myocardial injury are frequently encountered in clinical practice and are associated with poor outcomes in both the short term and long term. Diagnostic strategies to facilitate the clinical distinction between ischemic myocardial injury with or without an acute atheroma-thrombotic event vs non–ischemic-mediated myocardial injury conditions are urgently needed, as well as evidence-based therapies tailored toward improving outcomes for patients with T2MI.

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Dissertations / Theses on the topic "Type 2 myocardial infarction"

1

Adachi, Yuichiro. "Angiotensin 2 type 2 receptor deficiency exacerbates heart failure and reduces survival after acute myocardial infarction in mice." Kyoto University, 2006. http://hdl.handle.net/2433/144310.

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Putot, Alain. "Approche épidémiologique des infarctus du myocarde de type 2 : Etiologies, caractéristiques, traitements et pronostic." Thesis, Bourgogne Franche-Comté, 2020. http://www.theses.fr/2020UBFCI001.

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Introduction : L’infarctus du myocarde (IDM) de type 2 a été récemment défini par un déséquilibre entre apports et besoins du myocarde en oxygène, en l’absence de processus athérothrombotique. L’objectif de ce travail était d’en décrire les principales étiologies, ainsi que les caractéristiques épidémiologiques, cliniques et pronostiques.Méthode : Les données des patients présentant un IDM de type 2 ont été recueillies à partir de l’observatoire des infarctus de Cote d’Or (RICO). Un travail complémentaire a analysé les données rétrospectives du service des urgences du Centre Hospitalier Universitaire (CHU) de Dijon BourgogneRésultats : Parmi 4436 patients consécutifs hospitalisés aux urgences du CHU pour IDM sur 3 ans, 947 (21%) présentaient un IDM de type 2 (âge médian : 81 ans). Dans l’observatoire RICO, 4572 patients consécutifs dont 862 (19%) IDM de type 2 ont été inclus sur 5 ans (âge médian : 77 ans). La mortalité intra-hospitalière des IDM de type 2 était de 14% parmi les patients des urgences et de 11% pour les patients du RICO. Les pathologies chroniques prédisposant à l’IDM de type 2 les plus fréquemment retrouvés étaient l’anémie sévère et le rétrécissement aortique serré. Une infection aigue, dans deux tiers des cas respiratoire, était retrouvée dans 10% de l’ensemble des IDM de la base RICO, représentant de loin le facteur précipitant le plus fréquent dans la genèse des IDM de type 2. Sur le plan thérapeutique, après ajustements sur scores de propension, la transfusion globulaire était associée à une réduction de la mortalité à un an pour les patients >80 ans avec un nadir d’hémoglobine ≤ 8 g/dL. L’angioplastie après IDM post-infectieux n’était pas associée à un meilleur pronostic qu’un traitement médicamenteux seul (mortalité à un an de 24% vs 19%, p = 0.5).Conclusion :L’IDM de type 2 est une pathologie sous-diagnostiquée, représentant 20% des IDM, et fréquente chez le sujet âgé. Elle est associée à un sur-risque de mortalité par rapport aux IDM de type 1. Les infections aigues, en particulier respiratoires, représentent le facteur déclenchant le plus fréquent. Sur la base de données observationnelles, l’angioplastie coronaire ne semble pas associée à une amélioration du pronostic<br>Introduction: Type 2 Myocardial infarction (MI)has been recently defined as an imbalance between oxygen supply and demand, in the absence of atherothromthrombosis. This work aimed to describe the main etiolgies as well as epidemiological, clinical and prognostic characteristics.Method: Data from patients with type 2 MI were collected from the RICO cohort (Observatoire des Infarctus de Cote d'Or). In a complementary work, we analyzed the retrospective data of the emergency department of Dijon University Hospital.Results: Among 4,436 consecutive patients hospitalized for MI in Dijon emergency department over 3 years, 947 (21%) had type 2 MI (median age: 81 years). In the RICO cohort, 4,572 consecutive patients, including 862 (19%) type 2 MI were included over 5 years (median age: 77 years). Intra-hospital mortality after type 2 MI was 14% among ED patients and 11% for RICO patients. The most common chronic conditions predisposing to type 2 MDI were severe anemia and severe aortic stenosis. An acute infection, from the respiratory tract for rougly 2/3 of them, was found in 10% of all MI in the RICO database, and was by far the most common precipitating factor in the pathogenesis of type 2 MI. Concerning therapeutics, after adjustments on propensity scores, red blood cell transfusion was associated with a one-year mortality reduction for patients >80 years of age with a hemoglobin nadir ≤ 8 g/dL. In Post-infectious PI, percutaneous coronary intervention was not associated with a better prognosis than drug treatment alone (one-year mortality of 24% vs 19%, p = 0.5).Conclusion:Type 2 MI is an underdiagnosed condition, representing 20% of all MI, and is common in the elderly. It is associated with an over-risk of mortality compared with type 1 MI. Acute infections, particularly from the respiratory tract, are the most common triggering factor. Based on observational data, invasive procedures do not appear to be associated with improved prognosis

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Reed, Grant William. "Associations Between Cardiac Troponin, Mechanism of Myocardial Injury, and Long-Term Mortality After Non-Cardiac Vascular Surgery." Case Western Reserve University School of Graduate Studies / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=case1491571890479287.

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Grzesiak, Aleksandra [Verfasser]. "Angiotensin II type 2 receptor stimulation : a novel options of therapeutic interference with the renin-angiotensin system in myocardial infarction? / Aleksandra Grzesiak." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2014. http://d-nb.info/1052529879/34.

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Yao, Coffy-Akpolet. "Nouvelles approches épidémiologiques des infarctus du myocarde de type 2 : vers une prise en charge personnalisée." Electronic Thesis or Diss., Bourgogne Franche-Comté, 2023. http://www.theses.fr/2023UBFCI011.

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Introduction : l’infarctus du myocarde (IDM) de type 2, qui résulte d’un déséquilibre entre les apports et les besoins en oxygène du myocarde en l’absence d’événement athéro-thrombotique, est une entité mal connue. L’objectif de ce travail était de préciser certains aspects épidémiologiques et diagnostiques de l’IDM de type 2, notamment la place de la maladie coronaire, et d’évaluer la pertinence clinique et pronostique d’une nouvelle classification des IDM proposée par de LemosMéthodes : A partir de la base de données de l’Observatoire des Infarctus de la Côte d’Or (RICO), nous avons analysé les données des patients hospitalisés pour un IDM entre 2012 et 2017, après adjudication des IDM de type 1, de type 2 et des sous types identifiés selon la nouvelle classification distinguant les IDM de type 2 avec (IDM de type 2A) et sans maladie coronaire sous-jacente (IDM de type 2B). Nous avons également réalisé une revue systématique de la littérature sur la maladie coronaire obstructive (MCO) dans l’IDM de type 2 à partir de la base de données PubMed®. Enfin, nous avons travaillé sur le REgistre des InfArctus de CôTe d’IVoire (REACTIV) hospitalisés pour un IDM entre 2018 et 2022 à l’Institut de cardiologie d’Abidjan, afin d’identifier les spécificités des IDM de type 2 dans cette population Sub-Saharienne.Résultats : Parmi les 4573 patients inclus dans l’observatoire RICO sur une période de 5 ans, 3806 (81,1%) patients et 767 (18,9%) présentaient respectivement un IDM de type 1 et un IDM de type 2 après reclassification. Une coronaropathie obstructive était retrouvée chez 68,6 % des patients atteints d’IDM de type 2. L’IDM de type 2A concernait des patients plus âgés (âge médian 78 ans), avec davantage de comorbidités, et il était associée à un plus mauvais pronostic à 1 an, comparativement aux IDM de type 2B et aux IDM de type 1 de nature athéro-thrombotique (type 1A). Nos données retrouvent un surrisque, d’environ 40%, pour la mortalité toutes causes (RR 1,362; IC95% 1,029-1,802) de l’IDM de type 2A par rapport à l’IDM de type 1A. La revue systématique nous a permis de monter une prévalence particulièrement variable de la MCO dans l’IDM de type 2 (entre 30 et 92%), dépendante des définitions, du mode diagnostique de la coronaropathie et de l’origine des populations étudiées. Chez des patients admis aux urgences, un antécédent de MCO était un facteur prédictif indépendant de présenter un IDM de type 2 par rapport à un IDM de type 1, avec une augmentation de cette probabilité de près de 40%. (RR 1,38; IC95% 1,08-1,77). Enfin, parmi les patients inclus dans le programme REACTIV, 62 (14,1%) ont présenté un IDM de type 2. Comparativement aux IDM de type 1, les IDM de type 2 avaient une tendance à être plus jeunes (54 vs 58 ans, p = 0,09), avec une plus faible fréquence de facteurs de risque cardiovasculaires. Les IDM de type 2 présentaient une MCO moins sévère, avec une atteinte tritronculaire moins fréquente (p < 0,001). Dans cette population sub-saharienne, l'embolie coronaire (24,2 %), l'hypertension sévère ± hypertrophie ventriculaire gauche (22,6 %) et la tachyarythmie (16,1 %) constituaient les principaux facteurs déclenchants.Conclusion : Nos travaux soutiennent l’hypothèse que l’IDM de type 2, souvent considérée comme une pathologie gériatrique, semble en réalité présenter une grande hétérogénéité épidémiologique et physiopathologique. De plus, nous suggérons que l’identification de la maladie coronaire, dont la prévalence est élevée, pourrait permettre d’améliorer la caractérisation et la stratification du risque des IDM de type 2 et ainsi guider le développement d’études interventionnelles pour améliorer leur prise en charge<br>Introduction : Type 2 myocardial infarction (MI) resulting from an imbalance between oxygen supply and demand, in the absence of atherothrombosic phenomenom, remains an enigmatic clinical entity. This work aimed to precise type 2 MI epidemiological and prognostic features, especially the key role of coronary artery disease (CAD), and to appraise the clinical and prognostic relevance of a new classification of MI proposed by de Lemos.Method : Using the Observatoire des Infarctus de la Côte d'Or (RICO), we collected data from patients hospitalized for MI, including differentiation between type 1 (T1MI) and type 2 MI (T2MI), after adjudication of type 1 MI and type 2 MI, and sub-groups according to the new classification, with categorization of T2MI into those with (T2AMI) or without (T2BMI) obstructive coronary artery disease (CAD). We also conducted a systematic review of the literature on the role of obstructive CAD in T2MI using the PubMed® database. Finally, we analyzed data from the REgistre des InfArctus de CôTe d'IVoire (REACTIV) at the Abidjan Heart Institute, in order to identify the specific features of type 2 MI in this Sub-Saharan Africa population.Results : Among the 4573 patients included in RICO over a 5-year period, 3806 (81.1%) and 767 (18.9%) had T1MI and T2MI after reclassification, respectively. Obstructive CAD was identified in 68.6% of patients with T2MI. T2AMI affected older patients (median age 78 yo), with more comorbidities, and is associated with poorer outcomes after 1-year follow-up, compared with T2BMI and even T1MI due to atherothrombosis (T1AMI). Our data show a 40% excess all-cause mortality at 1-year (HR 1.362; IC95% 1.029-1.802) in T2AMI versus T1AMI. Based on the systematic review of the literature, we found a wide range of CAD prevalence in type 2 MI (between 30% and 92%), depending on definition criteria, diagnostic tools and populations studied. In patients admitted to the emergency department, history of obstructive CAD was an independent predictor of T2MI versus T1MI, increasing this probability by 40% (OR 1.38; 95%CI 1.08-1.77). Finally, of the MI patients included in REACTIV registry over 4 years, 62 (14.1%) met the definition of T2MI. Patients with T2MI were slightly younger (54 vs. 58 years, p = 0.09) with fewer conventional CV risk factors. Patients with T2MI had less severe CAD, with less 3-vessel CAD (p < 0.001). The main triggering factors for T2MI in this Sub-Saharan population were coronary embolism (24.2%), severe hypertension ± left ventricular hypertrophy (22.6%) and tachyarrhythmia (16.1%).Conclusion : Our work support the hypothesis of epidemiological and pathophysiological heterogeneity of T2MI, despite it is increasingly considered as a geriatric condition. Furthermore, we suggest that the identification of CAD, which is highly prevalent, could improve the characterization and risk stratification of type 2 MI, and help target interventional studies to improve its management and outcomes

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Lauer, Dilyara [Verfasser]. "Prevention of cardiac remodeling after experimental myocardial infarction. Role of the angiotensin II type 2 receptor stimulation and modulation of MMP/TIMP axis / Dilyara Lauer." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2016. http://d-nb.info/1119803527/34.

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Davidson, Melissa Anne. "A Pharmacovigilance Approach for Assessing Cardiovascular, Osteological, and Carcinogenic Risk Associated with Thiazolidinedione Drugs Used in the Treatment of Type 2 Diabetes Mellitus." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/38062.

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Diabetes is a chronic and debilitating disease that affects nearly half a billion people worldwide with the vast majority of diabetics suffering from Type 2 diabetes mellitus (T2DM), a disease characterized by insulin insensitivity that often requires pharmacotherapy to effectively maintain target blood sugar levels. The thiazolidinedione (TZD) class of drugs consists of oral hypoglycaemic agents used alone or in combination with other antidiabetic drugs to treat T2DM. The drugs within this class, which include rosiglitazone and pioglitazone, were originally heralded as providing novel first and second-line treatment of T2DM with glycaemic control and physiological effects comparable to, and in some cases, better than, first-line treatments such as metformin. However, over time they have also been associated with adverse cardiovascular, osteological, and carcinogenic effects in some, but not all clinical trials, observational studies, and meta-analyses. Given the conflicting evidence to date on the safety of TZD drugs, their role in the treatment of T2DM continues to be debated and epidemiological gaps remain. The objectives of this doctoral research are fourfold: 1) to conduct an in-depth review of the epidemiology of TZD pharmacotherapy including pharmacokinetics and modes of action, the results of previous studies investigating health risks and benefits associated with TZD treatment, and new and future uses for this class of drugs; 2) to determine whether diabetic patients treated with TZDs are at increased risk of adverse cardiovascular outcomes; 3) to assess whether TZD pharmacotherapy is associated with an increased risk of bone fractures and whether risks differ depending on fracture site and patient sex; and, 4) to investigate associations between TZD use and risk of bladder cancer. Specific research questions were investigated using nested case-control analyses designed to capture incident users of antidiabetic drugs and electronic health data from Cerner Health Facts®, an electronic medical record database that stores time-stamped patient records from more than 480 contributing hospitals throughout the United States. Findings from this work are reported in a series of manuscripts, including a published review paper. Key findings include: 1) TZD use was associated with an increased risk of incident myocardial infarction and congestive heart failure compared to never use of TZD drugs with a trend towards a potential early treatment effect within the first year of exposure to pioglitazone; 2) TZD use was associated with an increased risk of closed bone fractures among Type 2 diabetics with use of pioglitazone or rosiglitazone associated with an increased risk across multiple fracture sites in women, but only rosiglitazone use in men and only at peripheral fracture sites; 3) use of either pioglitazone or rosiglitazone were associated with an increased risk of incident bladder cancer compared to never users, however, a low number of bladder cancer cases resulted in underpowered analyses; and, 4) insulin use in a hospital setting may replace a patient's normal course of antidiabetic therapy which, when combined with other potential sources of bias in traditional nested case-control studies using hospital-based data, may lead to overestimation or underestimation of adverse health risks associated with non-insulin antidiabetic therapies. Although these findings warrant replication, the results of the research contained within this dissertation suggest that caution should be exercised when prescribing diabetic patients TZD drugs if they have cardiovascular, osteological, or carcinogenic risk factors. Additional pharmacovigilance studies should also continue to strive to better understand the health risks related to TZD therapy, especially as new therapeutic roles for TZDs in the prevention and treatment of some cancers, inflammatory diseases, and other conditions in non-diabetic populations are being explored.

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Wu, Chiung-Jung. "Promoting self-management for patients with type 2 diabetes following a critical cardiac event." Thesis, Queensland University of Technology, 2007. https://eprints.qut.edu.au/16465/1/Chiung-Jung_Wu_Thesis.pdf.

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Type 2 diabetes is a global health problem. Evidence indicates that type 2 diabetes can lead to serious complications, such as a cardiac event, which usually require critical nursing care. Patients with type 2 diabetes and with a history of cardiac disease are at greater risk of a further cardiac event requiring readmission to hospital. Evidence indicates that improved diabetes management assists patients with type 2 diabetes to manage their condition efficiently, reduces risks of a further cardiac event, and therefore reduces hospitalisations. However, there is limited information found regarding a diabetes management program specifically for patients who have already had cardiac complications. Difficulties in developing patients' skills in managing and modifying their daily lives also present a challenge to coronary care staff. Therefore, there is a real need to develop a special diabetes management program for patients with diabetes who have experienced a critical cardiac event, which will be commenced in the Coronary Care Unit (CCU). The aim of this research is to gain a greater understanding of the characteristics, secondly to obtain in-depth understanding of needs and experiences of patients with type 2 diabetes hospitalised for a critical cardiac event. A further aim is to develop and pilot test a diabetes management program, specific to the patients with diabetes in the context of the CCU. The design of this research employed three studies: Study I was an exploratory study, which obtained patients' demographic and disease characteristics from the hospital records of all patients with diabetes admitted to the CCU of one public hospital between 1 January 2000 to 31 December 2003. Study II used a qualitative interpretative approach and aimed to gain an in-depth understanding of the perspectives of patients with type 2 diabetes who have experienced a critical cardiac event in managing their everyday lives with both diabetes and cardiac conditions. Study III included two parts. The first utilised the information from the first two studies and the literature (self-efficacy theory) to develop a diabetes self-management program specifically for patients with diabetes who have had a critical cardiac event. The second part pilot tested the newly-developed diabetes self-management program for patients with diabetes admitted to CCU following a critical cardiac event. The pilot study used a randomised controlled trial research design to evaluate the efficacy of the program. Study I collected data from one hospital's records retrospectively from 2000 to 2003. The results of Study I showed there were 233 (14.7%) patients admitted to CCU that had diabetes out of the total 1589 CCU admissions during the study period. More than 22% of CCU patients with diabetes were readmitted to hospital within 28 days, compared to 6% of CCU patients without diabetes. Patients with diabetes who had a longer CCU stay were more likely to be readmitted. These results indicate that a significant proportion of a CCU population had type 2 diabetes and is more likely to be readmitted to hospital. Study II used an interpretive approach comprising open-ended interviews to collect data from patients with type 2 diabetes experiencing a cardiac event who had a CCU admission in 2000-2003. The findings revealed that patients with diabetes who had a critical cardiac event experienced considerable feelings of hopelessness and fatigue. Patients also had concerns in the areas of self-confidence and confidence in health professionals. Patients indicated that greater self-confidence and confidence in health professionals would help their ability to manage their daily lives. Therefore, it is very important that intervention programs for these at-risk patients need to improve patients' confidence levels, and reduce their feelings of hopelessness and fatigue. The information gathered from Study I and Study II provided important insight into the development of an effective diabetes self-management specifically designed for patients with type 2 diabetes following a critical cardiac event, which is presented in Study III in this thesis. Study III also provided a preliminary evaluation of the newly developed program. The evaluation used a randomised controlled trial research design for the new program and the current educational program provided in the CCU. The results of the program indicate the feasibility of commencing the new diabetes self-management program in the CCU, and to be continued in wards or at home. The results also showed significant improvements in patients' knowledge in the experimental group, but not in other outcome variables (self-efficacy, vitality and mental health levels). However, as a small sample size was used in this pilot study, a larger study is needed to ensure adequate testing of the intervention. Future research is also recommended to incorporate the new diabetes self-management program into the current cardiac education program. Staff's further professional development in providing such a program also needs to be examined. Improvements in quality of care, and patients' quality of life are expected in the future.

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Wu, Chiung-Jung. "Promoting self-management for patients with type 2 diabetes following a critical cardiac event." Queensland University of Technology, 2007. http://eprints.qut.edu.au/16465/.

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Type 2 diabetes is a global health problem. Evidence indicates that type 2 diabetes can lead to serious complications, such as a cardiac event, which usually require critical nursing care. Patients with type 2 diabetes and with a history of cardiac disease are at greater risk of a further cardiac event requiring readmission to hospital. Evidence indicates that improved diabetes management assists patients with type 2 diabetes to manage their condition efficiently, reduces risks of a further cardiac event, and therefore reduces hospitalisations. However, there is limited information found regarding a diabetes management program specifically for patients who have already had cardiac complications. Difficulties in developing patients' skills in managing and modifying their daily lives also present a challenge to coronary care staff. Therefore, there is a real need to develop a special diabetes management program for patients with diabetes who have experienced a critical cardiac event, which will be commenced in the Coronary Care Unit (CCU). The aim of this research is to gain a greater understanding of the characteristics, secondly to obtain in-depth understanding of needs and experiences of patients with type 2 diabetes hospitalised for a critical cardiac event. A further aim is to develop and pilot test a diabetes management program, specific to the patients with diabetes in the context of the CCU. The design of this research employed three studies: Study I was an exploratory study, which obtained patients' demographic and disease characteristics from the hospital records of all patients with diabetes admitted to the CCU of one public hospital between 1 January 2000 to 31 December 2003. Study II used a qualitative interpretative approach and aimed to gain an in-depth understanding of the perspectives of patients with type 2 diabetes who have experienced a critical cardiac event in managing their everyday lives with both diabetes and cardiac conditions. Study III included two parts. The first utilised the information from the first two studies and the literature (self-efficacy theory) to develop a diabetes self-management program specifically for patients with diabetes who have had a critical cardiac event. The second part pilot tested the newly-developed diabetes self-management program for patients with diabetes admitted to CCU following a critical cardiac event. The pilot study used a randomised controlled trial research design to evaluate the efficacy of the program. Study I collected data from one hospital's records retrospectively from 2000 to 2003. The results of Study I showed there were 233 (14.7%) patients admitted to CCU that had diabetes out of the total 1589 CCU admissions during the study period. More than 22% of CCU patients with diabetes were readmitted to hospital within 28 days, compared to 6% of CCU patients without diabetes. Patients with diabetes who had a longer CCU stay were more likely to be readmitted. These results indicate that a significant proportion of a CCU population had type 2 diabetes and is more likely to be readmitted to hospital. Study II used an interpretive approach comprising open-ended interviews to collect data from patients with type 2 diabetes experiencing a cardiac event who had a CCU admission in 2000-2003. The findings revealed that patients with diabetes who had a critical cardiac event experienced considerable feelings of hopelessness and fatigue. Patients also had concerns in the areas of self-confidence and confidence in health professionals. Patients indicated that greater self-confidence and confidence in health professionals would help their ability to manage their daily lives. Therefore, it is very important that intervention programs for these at-risk patients need to improve patients' confidence levels, and reduce their feelings of hopelessness and fatigue. The information gathered from Study I and Study II provided important insight into the development of an effective diabetes self-management specifically designed for patients with type 2 diabetes following a critical cardiac event, which is presented in Study III in this thesis. Study III also provided a preliminary evaluation of the newly developed program. The evaluation used a randomised controlled trial research design for the new program and the current educational program provided in the CCU. The results of the program indicate the feasibility of commencing the new diabetes self-management program in the CCU, and to be continued in wards or at home. The results also showed significant improvements in patients' knowledge in the experimental group, but not in other outcome variables (self-efficacy, vitality and mental health levels). However, as a small sample size was used in this pilot study, a larger study is needed to ensure adequate testing of the intervention. Future research is also recommended to incorporate the new diabetes self-management program into the current cardiac education program. Staff's further professional development in providing such a program also needs to be examined. Improvements in quality of care, and patients' quality of life are expected in the future.

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Curato, Caterina. "Identification of a non-cytotoxic and IL-10- producing CD8+AT2R+ T lymphocyte population in response to ischemic heart injury." Doctoral thesis, Humboldt-Universität zu Berlin, Mathematisch-Naturwissenschaftliche Fakultät I, 2011. http://dx.doi.org/10.18452/16362.

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Neuere Untersuchungen legen eine kardioprotektive Rolle für den Angiotensin AT2-Rezeptor nahe, welcher die Postinfarkt-Entzündungsreaktion vermindert, wobei der zelluläre Mechanismus noch wenig verstanden ist. Das Ziel dieser Arbeit war es deshalb, die potentielle Rolle des AT2-Rezeptors in der zellulären Immunantwort auf ischemische Herzverletzungen zu ergründen. Sieben Tage nach myokardialem Infarkt in Ratten wurde der AT2-Rezeptor mittels Immunfluoreszenzfärbung von Gewebeschnitten in einer CD8 T-Zellfraktion detektiert, die das Peri-Infarkt-Myokard infiltiert hatte. Wir haben eine Methode entwickelt, die es mittels kombinierter MACS und FACS Technilogie ermöglicht, CD8+AT2R+ T-Zellen aus dem Myokard zu isolieren und zu analysieren. Im Gegensatz zu den CD8+AT2R- T-Zellen, die in Kultur sowohl auf adulte als auch auf fötale Kardiomyozyten stark zytotoxisch wirkten, zeigten die CD8+AT2R+ T-Zellen keinerlei Zytotoxizität. Die CD8+AT2R+ T-Zellen zeigten eine erhöhte Expression von IL-10 und eine geringere mRNA Expression von IL-2 und IFN-gamma im Vergleich zu CD8+AT2R-T-Zellen. Weiterhin konnten wir zeigen, dass in vitro Stimulation des AT2-Rezeptors zur Hochregulation der IL-10-Expression von CD8+ T-Zellen führt. Entsprechend führt die in vivo Aktivierung des AT2-Rezeptors zur Vergrößerung der CD8+AT2R+ T-Zellpopulation und erhöhter IL-10-Produktion im ischemischen Myokard. Diese CD8+AT2R+ T-Zellen konnten auch in humanem periphärem Blut detektiert werden. Wir haben eine CD8+AT2+T-Zellpopulation definiert, welche sich während ischemischer Herzverletzung vergrößert und das Kardiomyocytenüberleben mittels kardioprotektivem IL-10 aufrechterhält. Somit konnten wir einen neuartigen AT2-Rezeptorvermittelten zellulären Mechanismus aufdecken, welcher die adaptive Immunantwort im Herzen moduliert.<br>One important aspect of cardiac remodeling after myocardial infarction is the activation of an immune response, which removes death cardiomyocytes and initiates scar formation. On the other hand, activation and infiltration of immunocompetent cells are responsible for augmenting damage in non-infarcted areas. Emerging evidence suggests a cardioprotective role of the angiotensin AT2R by attenuating this post-infarct inflammatory reaction, albeit the underlying cellular mechanisms are not well understood. We aimed here at elucidating a potential role of the cardiac angiotensin AT2R in regulating the cellular immune response to ischemic heart injury. Seven days after myocardial infarction in rats, immunofluorescence staining of tissue sections showed that AT2R was detected in a fraction of CD8+ T cells infiltrating the peri-infarct myocardium. We developed a method that allowed the isolation and characterization of CD8+AT2R+ T cells infiltrating the myocardium via combined MACS and FACS technology. While the CD8+AT2R- T cells exhibited potent cytotoxicity to both adult and fetal cardiomyocytes in vitro, the CD8+AT2R+ T cells were non-cytotoxic to these cardiomyocytes. The CD8+AT2R+ T cells were characterized by upregulated IL-10 and downregulated IL-2 and INF-gamma gene expression when compared to CD8+AT2R- T cells. We further showed that IL-10 gene expression was enhanced in CD8+ T cells upon in vitro AT2R stimulation. In addition, in vivo AT2R activation leads to an increment of the CD8+AT2R+ T cells and IL-10 production in the ischemic myocardium. Moreover, the CD8+AT2R+ T cell population was also detected in human peripheral blood. We have defined a CD8+ T cell population that expresses AT2R and increases during ischemic heart injury. This population sustains cardiomyocyte viability by providing cardioprotective IL-1 via a novel AT2R-mediated cellular mechanism for modulating adaptive immune response in the heart.

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Books on the topic "Type 2 myocardial infarction"

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A, Raineri, Leachman Robert D, Kellermann Jan J, and International School of Cardiology (4th : 1986 : Ettore Majorana Centre for Scientific Culture), eds. The State and future directions of acute myocardial infarction: Proceedings of a course held at the International School of Medical Sciences, Ettore Majorana Centre for Scientific Culture, Italy, 2-7 April 1986. Harwood Academic Publishers, 1988.

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Müller-Schreiber, Sabine Christine. Myokardinfarkt und Leistungsmotivation. P. Lang, 1988.

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Inoue, Michitoshi. Kokuritsu byōin, ryōyōjo ni okeru konpyūta nettowāku o mochiita shinkin kōsoku no 1-ji, 2-ji yobō to kosuto benefitto ni kansuru tashisetsu maemuki kenkyū: Heisei 12-nendo sōkatsu kenkyū hōkokusho. s.n.], 2001.

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Gross, Dawn H. Progressive muscular relaxation and rational-emotive therapy during the rehabilitation of survivors of first episode myocardial infarction classified as type A. UMIST, 1997.

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The behavioral management of the cardiac patient. Ablex Pub. Corp., 1987.

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A fatal chapter. Thorndike Press, 2015.

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King, Stephen. El umbral de la noche. Plaza y Janés, 2001.

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King, Stephen. Night Shift. Knopf Doubleday Publishing Group, 2008.

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King, Stephen. Night shift. Anchor Books, 2012.

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Danse macabre. J'ai lu, 2002.

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Book chapters on the topic "Type 2 myocardial infarction"

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Hanefeld, M., S. Fischer, J. Schulze, U. Julius, U. Schwanebeck, and H. Schmechel. "Hypertriglyceridaemia (HTG) as independent risk factor for myocardial infarction in type 2 diabetes: The Diabetes Intervention Study." In Diätetik und Arteriosklerose. Vieweg+Teubner Verlag, 1993. http://dx.doi.org/10.1007/978-3-663-01942-8_18.

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Alpert, Joseph S., and Allan S. Jaffe. "What Is a Type 2 Myocardial Infarction: How Is It Recognized and What Should One Do to Establish That Diagnosis?" In Cardiac Biomarkers. Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-42982-3_6.

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Roth, Elliot J. "Myocardial Infarction." In Encyclopedia of Clinical Neuropsychology. Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-56782-2_2192-2.

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Ye, Siqin. "Acute Myocardial Infarction." In Encyclopedia of Behavioral Medicine. Springer New York, 2018. http://dx.doi.org/10.1007/978-1-4614-6439-6_1243-2.

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Neskovic, Aleksandar N., Leonardo Bolognese, and Michael H. Picard. "Echocardiography in acute myocardial infarction." In Emergency Echocardiography, 3rd ed. CRC Press, 2023. http://dx.doi.org/10.1201/9781003245407-2.

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Neuhaus, K. L. "Recombinant Tissue-Type Plasminogen Activator in the Treatment of Myocardial Infarction." In Reperfusion and Revascularization in Acute Myocardial Infarction. Springer Berlin Heidelberg, 1988. http://dx.doi.org/10.1007/978-3-642-83544-5_15.

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Stump, David. "Pro-urokinase and tissue-type plasminogen activator." In Facts and Hopes in Thrombolysis in Acute Myocardial Infarction. Steinkopff, 1986. http://dx.doi.org/10.1007/978-3-662-07174-8_3.

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Collen, Désiré, and H. Roger Lijnen. "Tissue-type plasminogen activator: helping patients with acute myocardial infarction." In Recombinant Protein Drugs. Birkhäuser Basel, 2001. http://dx.doi.org/10.1007/978-3-0348-8346-7_5.

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Powell, Lynda H., C. E. Thoresen, and M. Friedman. "Modification of the Type A Behavior Pattern After Myocardial Infarction." In Primary and Secondary Prevention of Coronary Heart Disease. Springer Berlin Heidelberg, 1985. http://dx.doi.org/10.1007/978-3-642-70296-9_10.

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Xuguo, L., X. Yuzhong, Z. Shilin, and Y. Lijun. "Association of Interleukin-2 Receptor with Acute Myocardial Infarction." In Advances in Critical Care Testing. Springer Berlin Heidelberg, 1997. http://dx.doi.org/10.1007/978-3-642-60735-6_17.

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Conference papers on the topic "Type 2 myocardial infarction"

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Hung, John, Andreas Roos, Erik Kadesjo, et al. "23 Performance of the grace 2.0 score in patients with type 1 and type 2 myocardial infarction." In Abstracts from the British Cardiovascular Society Annual Conference 2020. BMJ Publishing Group Ltd and British Cardiovascular Society, 2020. http://dx.doi.org/10.1136/heartjnl-2020-bcs.23.

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Taggart, Caelan, Anton Gard, Anda Bularga, et al. "48 Outcomes following acute myocardial injury and type 2 myocardial infarction in patients with and without coronary artery disease." In British Cardiovascular Society Annual Conference, ‘100 years of Cardiology’, 6–8 June 2022. BMJ Publishing Group Ltd and British Cardiovascular Society, 2022. http://dx.doi.org/10.1136/heartjnl-2022-bcs.48.

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Wereski, Ryan, John Hung, Anoop SV Shah, et al. "28 Probability of coronary disease and clinical outcomes in patients with type 2 myocardial infarction." In Abstracts from the British Cardiovascular Society Annual Conference 2020. BMJ Publishing Group Ltd and British Cardiovascular Society, 2020. http://dx.doi.org/10.1136/heartjnl-2020-bcs.28.

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Koteliukh, Mariia. "CONTENTS OF ENERGY HOMEOSTASY INDICATORS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH CONCOMITANT TYPE 2 DIABETES MELLITUS." In SCIENTIFIC PRACTICE: MODERN AND CLASSICAL RESEARCH METHODS, chair Pavlo Kravchun. European Scientific Platform, 2021. http://dx.doi.org/10.36074/logos-26.02.2021.v3.13.

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Bularga, Anda, Atul Anand, Fiona E. Strachan, et al. "19 The mechanism of supply-demand imbalance and clinical outcomes in patients with type 2 myocardial infarction." In Abstracts from the British Cardiovascular Society Annual Conference 2020. BMJ Publishing Group Ltd and British Cardiovascular Society, 2020. http://dx.doi.org/10.1136/heartjnl-2020-bcs.19.

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Taggart, Caelan, Amy Ferry, Bertil Lindahl, et al. "60 Consensus on the diagnosis and management of patients with type 2 myocardial infarction: an international delphi study." In British Cardiovascular Society Annual Conference, ‘Future-proofing Cardiology for the next 10 years’, 5–7 June 2023. BMJ Publishing Group Ltd and British Cardiovascular Society, 2023. http://dx.doi.org/10.1136/heartjnl-2023-bcs.60.

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Bode, C., F. Schwarz, G. Schuler, R. Zimmermann, and W. Kubler. "INTRAVENOUS THROMBOLYTIC THERAPY WITH SINGLE-CHAIN UROKINASE-TYPE PLASMINOGEN ACTIVATOR IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643574.

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Seventeen patients with acute myocardial infarction were treated with heparin combined with intravenous single-chain urokinase-type plasminogen activator (scu-PA),obtained from transformed human kidney cells. 4 patients in group I and 13 patients in group II received a bolus of 4 mg and 7-5 mg followed by an infusion of 11 mg and 40.5 mg over 60 minutes, respectively. Thrombolysis was achieved in no patient of group I during intravenous infusion of scu-PA, however, upon subsequent intracoronary infusion of 250000 IE streptokinase, reperfusion could be established in two out of three patients. In group II seven patients were successfully treated with intravenous infusion of scu-PA. In 2 of the 6 patients unsuccessfully treated with intravenous scu-PA,intracoronary streptokinase was subsequently administered. In both cases recanalization could not be achieved. The effects on the hemostatic system are summarized below. In all patients a severe residual stenosis persisted after thrombolytic treatment and 13 patients underwent PTCA.Group Reperfusion Fibrinogen Plasminogen AntiplasminThere was no difference between sucessfully and unsuccessfully treated patients in group II with respect to the effect of treatment on serum parameters.It is concluded that intravenous infusion of scu-PA at a dose of 15 mg over 60 minutes is ineffective treatment for patients with acute myocardial infarction. However,at a dose of 48 mg over 60 minutes this form therapy is effective, save and specific.

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Stump, D. C., E. J. Topol, R. Califf, A. B. Chen, A. Hopkins, and A. D. Collen. "RESULTS OF COAGULATION - FIBRINOLYSIS ANALYSES IN 386 PATIENTS WITH ACUTE MYOCARDIAL INFARCTION TREATED WITH RECOMBINANT TISSUE-TYPE PLASMINOGEN ACTIVATOR (rt-PA) (TAMI TRIAL)." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643746.

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Three hundred eighty-six patients with acute myocardial infarction received up to 150 mg rt-PA (single chain) IV either over 8 h (60mg over 1 h, 20 mg/h for 2 h,10 mg/h for 5 h)(173 pts) or over"5h(1 mg/kg over 1 h, remainder over 4 h) (213 pts),before randomization to early or late angioplasty. Blood was collected on a lyophilized mixture of citrate and the t-PA inhibitor D-Phe-Pro-Arg-CH2C1 (PPACK), to maximally prevent in vitro fibrinolytic activation and concomitant fibrinogen degradation. The plasma rt-PA level increased to 2.4±2.0 /μg/ml(mean +SD)and 1.7 ±1.3 /μg/ml after 3h and to 1.0 ±1.8 and 1.0 ±0.9 /μg/ml at the end of the infusion.Fibrinogen levels (coagulation rate assay) fell to 5 ± 28 and 52 ± 27% at 3 h and to53 ± 28 and 47 μ 26% at the endof infusion.Fibrinogen degradation productsincreased to 32 /μg/ml (median, with 10 and 90 percentile values of 2 and 512 /μg/ml) after 3h and to3 2 /μg/1 (median, with 10 and 90 percentile values of 2and 512 ug/ml) at the end of infusion. The fibrinogen decreased to below 1 g/1 in 23% of patients and b e low 0-5 g/1 in 11% after 3 h infusion with corresponding values of 33% and 12%at the end of infusion.Thus, at the infusion rates required for rapid coronary artery reperfusion in man, rt-PA remains relatively fibrin-specific. The cause of the extensive fibrinogen depletion occurring in some patients remains to be further investigated.

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Altunina, N. V. "Effect of alpha-lipoic acid combined with zinc sulfate on daily profile of blood pressure in patients with type 2 diabetes mellitus who have had non-Q-myocardial infarction." In NEW TRENDS AND UNRESOLVED ISSUES OF PREVENTIVE AND CLINICAL MEDICINE. Baltija Publishing, 2020. http://dx.doi.org/10.30525/978-9934-588-81-5-1.1.

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Fleetwood, K., S. Wild, D. Smith, et al. "OP73 The impact of major mental illness on risk of stroke and myocardial infarction in people with type 2 diabetes in scotland: an analysis of routinely collected health data." In Society for Social Medicine 62nd Annual Scientific Meeting, Hosted by the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 5–7 September 2018. BMJ Publishing Group Ltd, 2018. http://dx.doi.org/10.1136/jech-2018-ssmabstracts.72.

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Reports on the topic "Type 2 myocardial infarction"

1

Deo, Salil, David McAllister, Naveed Sattar, and Jill Pell. The time-varying cardiovascular benefits of glucagon like peptide-1 agonist (GLP-RA)therapy in patients with type 2 diabetes mellitus: A meta-analysis of multinational randomized trials. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, 2021. http://dx.doi.org/10.37766/inplasy2021.7.0097.

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Review question / Objective: P - patients with type 2 diabetes melllitus already receiving routine medical therapy; I - patients receiving glucagon like peptide 1 receptor agonist (GLP1 receptor agonist) therapy (semaglutide, dulaglutide, liraglutide, exenatide, lixisenatide, efpeglenatide, abiglutide); C - patients receiving standard therapy for diabetes mellitus but not receiving GLP1 agonist therapy; O - composite end point as per invididual trial, cardiovascular mortality, all-cause mortality, myocardial infarction, stoke. Condition being studied: Type 2 diabetes mellitus. Study designs to be included: Randomised controlled trials which enroll a large number of patients (defined as > 500) and are multinational in origin. Studies included will need to have published Kaplan and Meier curves for the end-points presented in the manuscript.

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Li, Peng, Na jia, Bing Liu, and Qing He. Effect of cardiac shock wave therapy on adverse cardiovascular event for patients with coronary artery disease: an updated systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, 2022. http://dx.doi.org/10.37766/inplasy2022.1.0103.

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Review question / Objective: We have previously demonstrated that cardiac shock wave therapy (CSWT) effectively improves myocardial perfusion in patients with coronary artery disease (CAD). In this study, we want to address whether CSWT could decrease the risk of adverse cardiovascular events in CAD patients unsuitable for revascularization. Eligibility criteria: Trials are considered eligible if they meet these criteria: (1) patients included are diagnosed as refractory angina or ischemic heart failure; (2) the study i a randomized controlled trial (RCT) or a prospective cohort study; (3) intervention consisted of CSWT; (4) patients in the control group are treated with optimal medical therapy, (5)the primary outcome of interest Is rate of MACE. Exclusion criteria were (1) patients with acute myocardial infarction, (2) repeated CSWT, (3) with coronary artery revascularization, (4) without primary outcome, (5) retrospective study, and (6)duplicated data.

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liao, xiaoqian, xingyu fan, ziyi wang, shumin huang, and zhixi hu. Prognostic value of heart-type fatty acid binding protein in heart failure: a systematic review protocol. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, 2022. http://dx.doi.org/10.37766/inplasy2022.3.0126.

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Review question / Objective: (1)Can heart type fatty acid binding protein effectively predict the prognosis of patients with heart failure? (2)Is high expression of ear type fat acid binding protein associated with poor clinical outcomes in patients with heart failure? Condition being studied: Heart-type fatty acid binding protein (H-FABP) mainly exists in cardiomyocytes and is a potential biomarker of myocardial injury.However, the adverse consequences of heart failure have not been fully analyzed.Therefore, the purpose of this study was to comprehensively evaluate the correlation between H-FABP and the prognosis of heart failure through meta-analysis.

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Sosa Munguía, Paulina del Carmen, Verónica Ajelet Vargaz Guadarrama, Marcial Sánchez Tecuatl, Mario Garcia Carrasco, Francesco Moccia, and Roberto Berra-Romani. Diabetes mellitus alters intracellular calcium homeostasis in vascular endothelial cells: a systematic review. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, 2022. http://dx.doi.org/10.37766/inplasy2022.5.0104.

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Review question / Objective: What are the effects of diabetes mellitus on the calcium homeostasis in vascular endothelial cells? -To describe the effects of diabetes on the mechanisms that regulate intracellular calcium; -To describe other molecules/mechanisms that alters intracellular Ca2+ homeostasis. Condition being studied: Diabetes mellitus is a pathology with a high incidence in the population, characterized by an increase in blood glucose. People with diabetes are 2-4 times more likely to suffer from a cardiovascular complication, such as total or partial loss of sight, myocardial infarction, kidney failure, among others. Cardiovascular complications have been reported to derive from dysfunction of endothelial cells, which have important functions in blood vessels. In order to understand the etiology of this poor function of endothelial cells, it is necessary to study the molecular mechanisms involved in these functions, to identify the effects of diabetes and thus, develop new research that will mitigate the effects of this pathology.

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Newman-Toker, David E., Susan M. Peterson, Shervin Badihian, et al. Diagnostic Errors in the Emergency Department: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), 2022. http://dx.doi.org/10.23970/ahrqepccer258.

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Objectives. Diagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). We conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measure error and harm frequency, as well as assess causal factors. Methods. We searched PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL®), and Embase® from January 2000 through September 2021. We included research studies and targeted grey literature reporting diagnostic errors or misdiagnosis-related harms in EDs in the United States or other developed countries with ED care deemed comparable by a technical expert panel. We applied standard definitions for diagnostic errors, misdiagnosis-related harms (adverse events), and serious harms (permanent disability or death). Preventability was determined by original study authors or differences in harms across groups. Two reviewers independently screened search results for eligibility; serially extracted data regarding common diseases, error/harm rates, and causes/risk factors; and independently assessed risk of bias of included studies. We synthesized results for each question and extrapolated U.S. estimates. We present 95 percent confidence intervals (CIs) or plausible range (PR) bounds, as appropriate. Results. We identified 19,127 citations and included 279 studies. The top 15 clinical conditions associated with serious misdiagnosis-related harms (accounting for 68% [95% CI 66 to 71] of serious harms) were (1) stroke, (2) myocardial infarction, (3) aortic aneurysm and dissection, (4) spinal cord compression and injury, (5) venous thromboembolism, (6/7 – tie) meningitis and encephalitis, (6/7 – tie) sepsis, (8) lung cancer, (9) traumatic brain injury and traumatic intracranial hemorrhage, (10) arterial thromboembolism, (11) spinal and intracranial abscess, (12) cardiac arrhythmia, (13) pneumonia, (14) gastrointestinal perforation and rupture, and (15) intestinal obstruction. Average disease-specific error rates ranged from 1.5 percent (myocardial infarction) to 56 percent (spinal abscess), with additional variation by clinical presentation (e.g., missed stroke average 17%, but 4% for weakness and 40% for dizziness/vertigo). There was also wide, superimposed variation by hospital (e.g., missed myocardial infarction 0% to 29% across hospitals within a single study). An estimated 5.7 percent (95% CI 4.4 to 7.1) of all ED visits had at least one diagnostic error. Estimated preventable adverse event rates were as follows: any harm severity (2.0%, 95% CI 1.0 to 3.6), any serious harms (0.3%, PR 0.1 to 0.7), and deaths (0.2%, PR 0.1 to 0.4). While most disease-specific error rates derived from mainly U.S.-based studies, overall error and harm rates were derived from three prospective studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758). If overall rates are generalizable to all U.S. ED visits (130 million, 95% CI 116 to 144), this would translate to 7.4 million (PR 5.1 to 10.2) ED diagnostic errors annually; 2.6 million (PR 1.1 to 5.2) diagnostic adverse events with preventable harms; and 371,000 (PR 142,000 to 909,000) serious misdiagnosis-related harms, including more than 100,000 permanent, high-severity disabilities and 250,000 deaths. Although errors were often multifactorial, 89 percent (95% CI 88 to 90) of diagnostic error malpractice claims involved failures of clinical decision-making or judgment, regardless of the underlying disease present. Key process failures were errors in diagnostic assessment, test ordering, and test interpretation. Most often these were attributed to inadequate knowledge, skills, or reasoning, particularly in “atypical” or otherwise subtle case presentations. Limitations included use of malpractice claims and incident reports for distribution of diseases leading to serious harms, reliance on a small number of non-U.S. studies for overall (disease-agnostic) diagnostic error and harm rates, and methodologic variability across studies in measuring disease-specific rates, determining preventability, and assessing causal factors. Conclusions. Although estimated ED error rates are low (and comparable to those found in other clinical settings), the number of patients potentially impacted is large. Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible. With 130 million U.S. ED visits, estimated rates for diagnostic error (5.7%), misdiagnosis-related harms (2.0%), and serious misdiagnosis-related harms (0.3%) could translate to more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death. Over two-thirds of serious harms are attributable to just 15 diseases and linked to cognitive errors, particularly in cases with “atypical” manifestations. Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms. New studies should confirm overall rates are representative of current U.S.-based ED practice and focus on identified evidence gaps (errors among common diseases with lower-severity harms, pediatric ED errors and harms, dynamic systems factors such as overcrowding, and false positives). Policy changes to consider based on this review include: (1) standardizing measurement and research results reporting to maximize comparability of measures of diagnostic error and misdiagnosis-related harms; (2) creating a National Diagnostic Performance Dashboard to track performance; and (3) using multiple policy levers (e.g., research funding, public accountability, payment reforms) to facilitate the rapid development and deployment of solutions to address this critically important patient safety concern.

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McCausland, Rachel, Joann Fontanarosa, and Ravi Patel. Nonemergent Percutaneous Coronary Intervention Versus Optimal Medical Treatment for Stable Ischemic Heart Disease: A Rapid Response Literature Review. Agency for Healthcare Research and Quality (AHRQ), 2023. http://dx.doi.org/10.23970/ahrqepcrapidcoronary.

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Aims. There is uncertainty around the optimal role of percutaneous coronary intervention (PCI) for management of chronic coronary syndrome, specifically when patients have disease in multiple coronary vessels and disease in the proximal portion of the left anterior descending coronary artery. This uncertainty was reflected in 2021 guidance from the American College of Cardiology (ACC)/American Heart Association (AHA) on coronary artery revascularization. The Agency for Healthcare Research and Quality has commissioned this rapid response literature review to meet a Congressional request for a summary of recent evidence on the benefits of angioplasties conducted in nonemergency situations. Methods. This rapid response literature review on the comparative effectiveness of nonemergent PCI followed established best systematic review methods, modified to meet a shortened project timeframe. We searched PubMed®, Embase®, and the Trip© medical database from 2018 through April 2023 for systematic reviews (SRs), clinical practice guidelines, and randomized controlled trials, and summarized the evidence comparing PCI to optimal medical therapy (OMT) for stable ischemic heart disease (SIHD). Our primary outcomes of interest were major objective cardiovascular outcomes, including mortality, myocardial infarction, stroke, urgent revascularization, or composites of one or more of these hard clinical outcomes. Where available, we also abstracted patient reported outcomes (e.g., angina severity and quality of life [QoL]) from included studies. Findings. Key findings from nine SRs and one primary study include: • The body of evidence directly comparing PCI to OMT for SIHD has remained largely unchanged since the 2021 ACC/AHA guidance’s publication. • Most studies of revascularization for coronary artery disease do not focus on direct head-to-head comparisons of PCI versus OMT for SIHD but instead either (1) compare OMT to invasive revascularization (PCI and coronary artery bypass graft [CABG] combined cohort); (2) compare PCI to CABG; or (3) compare different PCI techniques. • Another factor that complicates comparison is that the meta-analyses often included data from CABG and PCI combined cohorts (e.g., the recent landmark ISCHEMIA trial) but reported the outcomes as PCI specific. • In the general SIHD population, our review did not find evidence to support survival benefit or effect on hard clinical outcomes when PCI is added to OMT. • Limited evidence indicates there may be a beneficial effect of PCI on angina symptoms and measures of QoL, but most systematic reviews focused on major objective cardiovascular outcomes and did not consider QoL or freedom from angina. • Both OMT and PCI have evolved significantly during the period of time in which the systematic reviews’ included studies were conducted. It is not clear how these changes may have affected the applicability of past studies to current practice. Conclusions. The evidence directly comparing PCI to OMT for SIHD has remained largely unchanged since publication of the 2021 ACC/AHA guidelines. More research is needed to verify the comparative effectiveness of nonemergent PCI compared to medical treatment for individuals with SIHD, and how the effectiveness varies by certain patient populations and clinical presentation.

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