检索结果-南通市图书馆

Acute coronary syndromes： an old age problem

Journal of Geriatric Cardiology 2012年第2期9卷 192-196页

作者： alexander D simms Philip D Batin John Kurian Nigel Durham Christopher P Gale Centre for Epidemiology and Biostatistics Level 8 Worsley Building University of Leeds Clarendon Way West Yorkshire Leeds LS2 9JT UK Hull and York Medical School York Teaching Hospital NHS Foundation Trust York Y031 8HE UK Department of Cardiology York Teaching Hospital NHS Foundation Trust York Y031 8HE UK Department of Cardiology Mid Yorkshire NHS Trust Wakefield WF1 4DG UK Department of Cardiology Bradford Teaching Hospital NHS Foundation Trust Bradford UK

The increasing population in older age will lead to greater numbers of them presenting with acute coronary syndromes （ACS）. This has implications on global healthcare resources and necessitates better management and selection for evidenced-based therapies. The elderly are a high risk group with more significant treatment benefits than younger ACS. Nevertheless, age related inequalities in ACS care are recognised and persist. This discrepancy in care, to some extent, is explained by the higher frequency of atypical and delayed presentations in the elderly, and less diagnostic electrocardiograms at presentation, potentiating a delay in ACS diagnosis. Under estimation of mortality risk in the elderly due to limited consideration for physiological tiailty, co-morbidity, cognitive/psychological impairment and physical disability, less input by cardiology specialists and lack of randomised, controlled trials data to guide management in the elderly may further confound the inequality of care. While these inequalities exist, there remains a substantial opportunity to improve age related ACS outcomes. The selection of elderly patients for specific therapies and medication regimens are unanswered. There is a growing need for randomised, controlled trial data to be more representative of the population and enroll those of advanced age with co-morbidity. A lack of reporting of adverse events, such as renal impairment post coronary angiography, in the elderly further limit risk benefit decisions. Substantial improvements in care of elderly ACS patients are required and should be advocated. Ultimately, these improvements are likely to lead to better outcomes post ACS. However, the improvement in outcome is not infinite and will be limited by non-modifiable factors of age-related risk.

关键词： Acute coronary syndromes Elderly patients Inequalities of care Evidenced-based treatments

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Inequalities in care in patients with acute myocardial infarction

引用

World Journal of Cardiology 2015年第12期7卷 895-901页

作者： Shabnam Rashid alexander simms Phillip Batin John Kurian Chris P Gale Department of Cardiology Leeds General Infirmary Department of Cardiology Pinderfields General Hospital Department of Cardiology Bradford Royal Infir-mary Department of Cardiology University of Leeds

Coronary heart disease is the single largest cause of death in developed countries. Guidelines exist for the management of acute myocardial infarction(AMI),yet despite these,significant inequalities exist in the care of these patients. The elderly,deprived socioeconomic groups,females and non-caucasians are the patient populations where practice tends to deviate more frequently from the evidence base. Elderly patients often had higher mortality rates after having an AMI compared to younger patients. They also tended to present with symptoms that were not entirely consistent with an AMI,thus partially contributing to the inequalities in care that is seen between younger and older patients. Furthermore the lack of guidelines in the elderly age group presenting with AMI can often make decision making challenging and may account for the discrepancies in care that are prevalent between younger and older patients. Other patients such as those from a lower socioeconomic group,i.e.,low income and less than high school education often had poorer health and reduced life expectancy compared to patients from a higher socioeconomic group after an AMI. Lower socioeconomic status was also seen to be contributing to racial and geographical variation is the care in AMI patients. Females with an AMI were treated less aggressively and had poorer outcomes when compared to males. However even when females were treated in the same way they continued to have higher in hospital mortality which suggests that gender may well account for differences in outcomes. The purpose of this review is to identify the inequalities in care for patients who present with an AMI and explore potential reasons for why these occur. Greater attention to the management and a better understanding of the root causes of these inequalities in care may help to reduce morbidity and mortality rates associated with AMI.

关键词： Coronary artery disease Dual antiplatelet therapy Inequalities Guidelines Myocardial infarction

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

引用

World Journal of Cardiology 2014年第8期6卷 865-872页

作者： Richard A Brogan Christopher J Malkin Philip D Batin alexander D simms James M McLenachan Christopher P Gale Leeds Institute of Cardiovascular and Metabolic Medicine Division of Epidemiology and BiostatisticsUniversity of LeedsLeeds LS2 9JTUnited Kingdom York and Hull Medical School University of YorkYorkYO10 5DDUnited Kingdom Department of Cardiology Leeds Teaching Hospital NHS TrustLeeds LS2 9JTUnited Kingdom Department of Cardiology Pinderfields General HospitalMid Yorkshire NHS TrustWakefield WF5 9LZUnited Kingdom Department of Cardiology York Teaching Hospital NHS Foundation TrustYork YO10 5DDUnited Kingdom

Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.

关键词： ST segment elevation myocardial infarction Risk stratification Primary percutaneous coronary intervention Harm Risk scores

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

欢迎您,

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

请选择保存的检索档案：

请选择收藏分类：

通借通还

欢迎您,

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：