The marine economy of the United Kingdom

The marine and coastal environment is an important economic asset in the UK, and there is a need for greater information about marine economic activities for the purposes of marine management and policy. However, due to the difficulties of quantifying some marine sectors and separating them from terrestrial activities, the current size and structure of the marine economy is unknown. This paper defines a systematic approach to quantifying the UK marine economy, aiming to capture all activities in the market economy that occur within and depend upon UK marine and coastal environments, and estimates its contribution to the UK economy as a whole. The approach draws on previous research in this area and links sectors used in marine planning with the methodologies used in national accounts. The results suggest that the marine economy contributes double the amount of previous estimates to the UK economy. Changes in the structure of the marine economy, partly due to the expansion of offshore wind energy, may affect its economic contribution. The results also show that marine and coastal leisure and recreation sectors, which were previously thought to have a small economic contribution, are the second largest sector in the UK marine economy and account for the largest number of jobs. By disaggregating the economic sectors, the approach used here can underpin a marine natural capital approach, enabling economic activities to be linked with aspects of marine natural capital

Invasive and conservative treatment of spontaneous coronary artery dissection: a meta-analysis

This study aims to compare clinical outcomes of SCAD patients initially managed with medical therapy (conservative approach) versus intervention strategy.Цель работы – сравнить эффективность и безопасность консервативной и инвазивной стратегий лечения у пациентов со спонтанной диссекцией коронарных артерий (СДКА)

Prediction of Post-Discharge Bleeding in Elderly Patients with Acute Coronary Syndromes: Insights from the BleeMACS Registry

Background A poor ability of recommended risk scores for predicting in-hospital bleeding has been reported in elderly patients with acute coronary syndromes (ACS). No study assessed the prediction of post-discharge bleeding in the elderly. The new BleeMACS score (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome), was designed to predict post-discharge bleeding in ACS patients. We aimed to assess the predictive ability of the BleeMACS score in elderly patients. Methods We assessed the incidence and characteristics of severe bleeding after discharge in ACS patients aged ≥ 75 years. Bleeding was defined as any intracranial bleeding or bleeding leading to hospitalization and/or red blood transfusion, occurring within the first year after discharge. We assessed the predictive ability of the BleeMACS score according to age by Fine-Gray proportional hazards regression analysis, calculating receiver-operating characteristic (ROC) curves and the area under the ROC curves (AUC). Results The BleeMACS registry included 15,401 patients of whom 3,376/15,401 (21.9%) were aged ≥ 75 years. Elderly patients were more commonly treated with clopidogrel and less often treated with ticagrelor or prasugrel. Of 3,376 elderly patients, 190 (5.6%) experienced post-discharge bleeding. The incidence of bleeding was moderately higher in elderly patients (hazard ratio [HR], 2.31, 95% confidence interval [CI], 1.92-2.77). The predictive ability of the BleeMACS score was moderately lower in elderly patients (AUC, 0.652 vs. 0.691, p = 0.001). Conclusion Elderly patients with ACS had a significantly higher incidence of post-discharge bleeding. Despite a lower predictive ability in older patients, the BleeMACS score exhibited an acceptable performance in these patients

Octogenarian women with acute coronary syndrome present frailty and readmissions more frequently than men

Background: A worse prognosis has been reported among women with acute coronary syndrome compared to men. Our aim was to address the role of frailty and sex in the management and prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome. Methods: A prospective registry in 44 Spanish hospitals including patients aged 80 years and older with non-ST-segment elevation acute coronary syndrome. Frailty assessment was performed using the FRAIL scale. Results: Of a total of 535 patients, 207 (38.7%) were women. Mean age was 84.8±4.0 years, similar in men and women. A prior history of coronary artery disease was more common in men (146, 44.9%) than in women (46, 22.2%), P<0.001. Frailty was less frequent in men (65, 20.2%) than in women (77, 37.8%), P<0.001. Female sex was an independent predictor of death/hospitalisation (hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.1–2.4) and of hospitalisation at 6 months (HR 1.6, 95% CI 1.04–2.4). In men, compared to non-frail patients, both a prefrail status (HR 3.47, 95% CI 1.22–9.89) and frailty (HR 3.19, 95% CI 1.08–9.43) were independently associated with higher mortality. In women only frailty was independently associated with higher mortality (HR 5.68, 95% CI 1.91–16.18, compared to prefrailty or robustness). Frailty was associated with readmissions in men (HR 3.34, 95% CI 1.79–6.22) but not in women. Conclusions: In octogenarians with acute coronary syndrome female sex was independently associated with death/hospitalisation at 6 months. Frailty was more common in women and was a predictor of poor prognosis. In men prefrailty also predicted a poor prognosis.Sin financiación3.813 JCR (2019) Q2, 47/138 Cardiac & Cardiovascular Systems1.630 SJR (2019) Q1, 46/362 Cardiology and Cardiovascular Medicine, 9/91 Critical Care and Intensive Care Medicine, 208/2754 Medicine (miscellaneous)No data IDR 2019UE