Keywords
real-world evidence
heart disease risk factors
odds ratio
statin therapy
beta-blockers
calcium channel blockers
heart disease risk factors
odds ratio
statin therapy
beta-blockers
calcium channel blockers
Categories
How to Cite
Davari, M., Mensa Sorato, M., Fatemi, B., Rezaei, S., Sadeghipour, P. ., Kebriaeezadeh, A. ., & Soleymani, F. . (2022). Factors Associated with Re-hospitalization and Status of Risk Factors among Patients with Stable Coronary Artery Disease Referring for Medical Therapy: An Unmatched Cohort Study. Iranian Red Crescent Medical Journal, 24(1). https://doi.org/10.32592/ircmj.2022.24.1.1257
Abstract
Background: All patients with stable coronary artery diseases (CADs) require medical therapy (MT) to prevent disease progression and recurrent cardiovascular events, alleviate symptoms, and reduce mortality. Nonetheless, little is known about the clinical outcomes of unrevascularized patients taking MT for stable CAD and the status of CAD risk factor control in Iran.
Objectives: This study aimed to evaluate the impact of MT in unrevascularized CAD patients on risk factor modification and re-hospitalization among patients referring to the Rajaie Cardiovascular Medical and Research Center, Tehran, Iran.
Methods: This unmatched cohort study was conducted to collect demographic, risk factors, comorbidity, and re-hospitalization data about stable CAD patients in 2014 and followed until 2021. A multivariate regression analysis was applied to explore the relationship between re-hospitalization as the dependent variable and independent variables.
Results: A total of 290 stable CAD patients were included in our cohort. More than 60% of the subjects were male. The mean age of the participants was obtained at 55.9±5.4 years. It was revealed that being male (adjusted odds ratio [AOR]=0.513, 95% confidence interval [CI], 0.24-0.85, P=0.048), having hypercholesterolemia (AOR=4.10, 95% CI, 1.07-15.62, P=0.040), having an ejection fraction of below 40% (AOR=4.05, 95% CI, 1.50-10.97, P=0.006), being a current smoker (AOR=2.18, 95% CI, 1.03-4.62, P=0.042), and involving three vessels (AOR=10.39, 95% CI, 2.37-45.77, P=0.002) were independently associated with re-hospitalization.
Conclusion: Gaps were identified concerning CAD risk factor control. Higher re-hospitalization was associated with female gender, smoking, hypercholesterolemia, and reduced ejection fraction. Therefore, it is essential to improve healthy lifestyle modification interventions tailored to individual patients with a particular focus on females.
References
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29. White HD, Stewart RAH, Dalby AJ, Stebbins A, Cannon CP, Budaj A, et al. In patients with stable coronary heart disease, low-density lipoprotein-cholesterol levels< 70 mg/dL and glycosylated hemoglobin A1c< 7% are associated with lower major cardiovascular events. Am Heart J. 2020;225:97–107.
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31. Natsuaki M, Furukawa Y, Morimoto T, Nakagawa Y, Ono K, Kaburagi S, et al. Intensity of Statin Therapy, Achieved Low-Density Lipoprotein Cholesterol Levels and Cardiovascular Outcomes in Japanese Patients After Coronary Revascularization–Perspectives From the CREDO-Kyoto Registry Cohort-2–. Circ J. 2012;76(6):1369–79.
32. Alizadehasl A, Sohrabi B, Panjavi L, Sadeghpour A, Azarfarin R, Ghadrdoost B, et al. Comparison of the effects of coronary artery bypass grafting versus medical therapy on short and long term outcomes in Octogenarian patients with multi-vessel coronary artery disease. Res Cardiovasc Med. 2016;5(1).
33. Ferrari R, Abergel H, Ford I, Fox KM, Greenlaw N, Steg PG, et al. Gender-and age-related differences in clinical presentation and management of outpatients with stable coronary artery disease. Int J Cardiol. 2013;167(6):2938–43.
34. Norris CM, Spertus JA, Jensen L, Johnson J, Hegadoren KM, Ghali WA. Sex and gender discrepancies in health-related quality of life outcomes among patients with established coronary artery disease. Circ Cardiovasc Qual Outcomes. 2008;1(2):123–30.
35. Daly CA, De Stavola B, Sendon JLL, Tavazzi L, Boersma E, Clemens F, et al. Predicting prognosis in stable angina—results from the Euro heart survey of stable angina: prospective observational study. Bmj. 2006;332(7536):262–7.
36. Daly C, Norrie J, Murdoch DL, Ford I, Dargie HJ, Fox K, et al. The value of routine non-invasive tests to predict clinical outcome in stable angina. Eur Heart J. 2003;24(6):532–40.
37. Otgontuya D, Oum S, Buckley BS, Bonita R. Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia. BMC Public Health. 2013;13(1):1–12.
38. Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1· 25 million people. Lancet. 2014;383(9932):1899–911.
39. Members AF, Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34(39):3035–87.
2. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: the Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(3):407–77.
3. Ardati AK, Pitt B, Smith DE, Aronow HD, Share D, Moscucci M, et al. Current medical management of stable coronary artery disease before and after elective percutaneous coronary intervention. Am Heart J. 2013;165(5):778–84.
4. Ford TJ, Corcoran D, Berry C. Stable coronary syndromes: pathophysiology, diagnostic advances and therapeutic need. Heart. 2018;104(4):284–92.
5. Pflieger M, Winslow BT, Mills K, Dauber IM. Medical management of stable coronary artery disease. Am Fam Physician. 2011;83(7):819–26.
6. K. S, D.L. B, Stergiopoulos K, Brown DL. Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: Meta-analysis of randomized controlled trials. Arch Intern Med [Internet]. 2012 Feb;172(4):312–9. Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L364371668
7. Pursnani S, Korley F, Gopaul R, Kanade P, Chandra N, Shaw RE, et al. Percutaneous coronary intervention versus optimal medical therapy in stable coronary artery disease: a systematic review and meta-analysis of randomized clinical trials. Circ Cardiovasc Interv. 2012;5(4):476–90.
8. Jabbour S, Young-Xu Y, Graboys TB, Blatt CM, Goldberg RJ, Bedell SE, et al. Long-term outcomes of optimized medical management of outpatients with stable coronary artery disease. Am J Cardiol. 2004;93(3):294–9.
9. Group B 2D S. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360(24):2503–15.
10. Windecker S, Stortecky S, Stefanini GG, Rutjes AW, Di Nisio M, Siletta MG, et al. Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis. Bmj. 2014;348.
11. Bauters C, Tricot O, Meurice T, Lamblin N, Investigators C. Long-term risk and predictors of cardiovascular death in stable coronary artery disease: the CORONOR study. Coron Artery Dis. 2017;28(8):636–41.
12. Sawhney JPS, Kahali D, Desai B, Kumar SKP, Vishvanathan M, Rastogi V. The role of optimal medical therapy in patients with stable coronary artery disease. J Clin Prev Cardiol. 2018;7(2):60.
13. Brown TM, Voeks JH, Bittner V, Brenner DA, Cushman M, Goff DC, et al. Achievement of optimal medical therapy goals for US adults with coronary artery disease: results from the REGARDS Study (REasons for Geographic And Racial Differences in Stroke). J Am Coll Cardiol. 2014;63(16):1626–33.
14. Kotseva K, De Backer G, De Bacquer D, Rydén L, Hoes A, Grobbee D, et al. Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry. Eur J Prev Cardiol. 2019;26(8):824–35.
15. Freeman AM, Morris PB, Barnard N, Esselstyn CB, Ros E, Agatston A, et al. Trending cardiovascular nutrition controversies. J Am Coll Cardiol. 2017;69(9):1172–87.
16. Miller V, Mente A, Dehghan M, Rangarajan S, Zhang X, Swaminathan S, et al. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet. 2017;390(10107):2037–49.
17. Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–52.
18. Piano MR. Alcohol’s effects on the cardiovascular system. Alcohol Res Curr Rev. 2017;38(2):219.
19. Cai H, Dai H, Hu Y, Yan X, Xu H. Pharmacist care and the management of coronary heart disease: a systematic review of randomized controlled trials. BMC Health Serv Res. 2013;13(1):1–7.
20. Corlin L, Short MI, Vasan RS, Xanthakis V. Association of the duration of ideal cardiovascular health through adulthood with cardiometabolic outcomes and mortality in the Framingham Offspring study. JAMA Cardiol. 2020;5(5):549–56.
21. Wood DA, Kotseva K, Connolly S, Jennings C, Mead A, Jones J, et al. Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial. Lancet. 2008;371(9629):1999–2012.
22. Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract. 2017;23:1–87.
23. Arnold S V, Bhatt DL, Barsness GW, Beatty AL, Deedwania PC, Inzucchi SE, et al. Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association. Circulation. 2020;141(19):e779–806.
24. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108(17):2154–69.
25. Brosius III FC, Hostetter TH, Kelepouris E, Mitsnefes MM, Moe SM, Moore MA, et al. Detection of chronic kidney disease in patients with or at increased risk of cardiovascular disease: a science advisory from the American Heart Association Kidney And Cardiovascular Disease Council; the Councils on High Blood Pressure Research, Cardiovascular Disease in the Young, and Epidemiology and Prevention; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: developed in collaboration with the National Kidney Foundation. Circulation. 2006;114(10):1083–7.
26. Herzog CA. How to manage the renal patient with coronary heart disease: the agony and the ecstasy of opinion-based medicine. J Am Soc Nephrol. 2003;14(10):2556–72.
27. Best PJM, Lennon R, Ting HH, Bell MR, Rihal CS, Holmes DR, et al. The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions. J Am Coll Cardiol. 2002;39(7):1113–9.
28. Sedlis SP, Jurkovitz CT, Hartigan PM, Goldfarb DS, Lorin JD, Dada M, et al. Optimal medical therapy with or without percutaneous coronary intervention for patients with stable coronary artery disease and chronic kidney disease. Am J Cardiol. 2009;104(12):1647–53.
29. White HD, Stewart RAH, Dalby AJ, Stebbins A, Cannon CP, Budaj A, et al. In patients with stable coronary heart disease, low-density lipoprotein-cholesterol levels< 70 mg/dL and glycosylated hemoglobin A1c< 7% are associated with lower major cardiovascular events. Am Heart J. 2020;225:97–107.
30. Rosenblit PD. Lowering Targeted Atherogenic Lipoprotein Cholesterol Goals for Patients at “Extreme” ASCVD Risk. Curr Diab Rep [Internet]. 2019 Nov 21 [cited 2020 Jan 7];19(12):146. Available from: http://www.ncbi.nlm.nih.gov/pubmed/31754844
31. Natsuaki M, Furukawa Y, Morimoto T, Nakagawa Y, Ono K, Kaburagi S, et al. Intensity of Statin Therapy, Achieved Low-Density Lipoprotein Cholesterol Levels and Cardiovascular Outcomes in Japanese Patients After Coronary Revascularization–Perspectives From the CREDO-Kyoto Registry Cohort-2–. Circ J. 2012;76(6):1369–79.
32. Alizadehasl A, Sohrabi B, Panjavi L, Sadeghpour A, Azarfarin R, Ghadrdoost B, et al. Comparison of the effects of coronary artery bypass grafting versus medical therapy on short and long term outcomes in Octogenarian patients with multi-vessel coronary artery disease. Res Cardiovasc Med. 2016;5(1).
33. Ferrari R, Abergel H, Ford I, Fox KM, Greenlaw N, Steg PG, et al. Gender-and age-related differences in clinical presentation and management of outpatients with stable coronary artery disease. Int J Cardiol. 2013;167(6):2938–43.
34. Norris CM, Spertus JA, Jensen L, Johnson J, Hegadoren KM, Ghali WA. Sex and gender discrepancies in health-related quality of life outcomes among patients with established coronary artery disease. Circ Cardiovasc Qual Outcomes. 2008;1(2):123–30.
35. Daly CA, De Stavola B, Sendon JLL, Tavazzi L, Boersma E, Clemens F, et al. Predicting prognosis in stable angina—results from the Euro heart survey of stable angina: prospective observational study. Bmj. 2006;332(7536):262–7.
36. Daly C, Norrie J, Murdoch DL, Ford I, Dargie HJ, Fox K, et al. The value of routine non-invasive tests to predict clinical outcome in stable angina. Eur Heart J. 2003;24(6):532–40.
37. Otgontuya D, Oum S, Buckley BS, Bonita R. Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia. BMC Public Health. 2013;13(1):1–12.
38. Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1· 25 million people. Lancet. 2014;383(9932):1899–911.
39. Members AF, Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34(39):3035–87.