Ajakirjas European Heart Journal aasta jooksul ilmunud olulisematest kardioloogiaartiklitest

Eesti Arst 2015; 94(7):393–39

Äge müokardiinfarkt Eestis: muutused kliinilistes tunnustes, ravikäsitluses ja -tulemustes

Väitekirja elektrooniline versioon ei sisalda publikatsioone.Eestis on suremus südame veresoonte ateroskleroosi tõttu viimasel aastakümnel oluliselt langenud, ometi paikneme Euroopas edetabelis endiselt esikolmikus. Probleemiks on just kõrge suremus töövõimelise elanikkonna seas. Üks tõsisemaid südame veresoonte ateroskleroosi avaldusvorme on südamelihase infarkt ehk kärbumine, mis võib lõppeda surmaga. Siiski saab kaasaegsete tõenduspõhiste ravivõtete viivitamatul rakendamisel patsientide ravitulemusi, sh elulemust, oluliselt parandada. Aastal 2001. tehtud uuring näitas Eestis suuri lahknevusi südamelihase infarktiga patsientide ravikäsitluses ja -tulemustes erineva ravitasemega haiglates. Seetõttu on viimase kümnendi jooksul palju panustatud ravikäsitluse parandamisele ja ühtlustamisele. Lisaks tõenduspõhiste raviskeemide kasutamise rõhutamisele on üheks prioriteediks olnud võimaldada suuremale osakaalule patsientidest väheinvasiivset ravimeetodit, kus südame veresoontes taastatakse verevool mehhaaniliselt. Antud uuring näitas, et ajavahemikul 2001 ja 2007 oli südamelihase infarktiga patsientide ravikäsitlus Eestis paranenud nii kõrgema kui madalama etapi haiglates. Siiski kõrgema etapi haiglates oli areng rohkem väljendunud, mis tõi kaasa ka paremad ravitulemused võrreldes madalama etapi haiglatega. Ometigi ei väljendunud parem ravikäsitlus oluliselt paremates ravitulemustes haigla etapi piires. Probleemiks on eelkõige patsientide kõrgem vanus ja kaasuvate haiguste sagedam esinemine. Muuhulgas näitasid töö tulemused, et just suhkurtõvega naissoost patsientidel on risk halvematele ravitulemustele. Kokkuvõtteks võib uuringutulemustest järeldada, et nii kõrgema kui madalama etapi haiglates on võimalusi ravikäsitluse ja -tulemuste parandamiseks, seejuures võtmeküsimuseks oleks erineva ravitasemega haiglate koostöö. Eestis on vaja jätkata südamelihase infarktiga patsientide ravikäsitluse ja -tulemuste seiret.Mortality due to coronary heart diseases has decreased in Estonia during the last decade, still being among the highest in Europe. One of the most serious manifestations of coronary heart disease is acute myocardial infarction, also known as heart attack, which is accompanied by a high risk of death. The prompt use of modern evidence-based strategies makes it possible to considerably improve the outcomes, including survival. A study conducted in 2001 showed important differences in the management and outcomes of patients with myocardial infarction in hospitals providing different levels of care. Therefore much effort has been put into improving and harmonizing the quality of management. In addition to emphasizing the use of evidence-based medications, one of the main priorities has been to enable more patients to receive a minimally invasive management method, in which the blood flow in the vessels of the heart is restored mechanically. Our study demonstrated that in Estonia between 2001 and 2007 the management of patients with myocardial infarction improved considerably both in hospitals of higher and lower level of care. However, the developments were more pronounced in the higher level of care setting, which translated also into better outcomes compared to those seen in lower care hospitals. Nevertheless, the better management did not result in significantly better outcomes within a level of care setting. Higher age and higher rates of co-morbidities pose a challenge for the management of myocardial infarction. In particular, we found that women with diabetes have a high risk for worse outcomes. In conclusion, the study suggests possibilities of improving the management and outcomes of patients with myocardial infarction in both the higher and the lower level of care hospitals in Estonia. The key issue would be the cooperation between hospitals of different levels of care. Further surveillance of the management and outcomes of patients with myocardial infarction in Estonia is crucial

Kroonilise koronaarsündroomiga patsiendi ravikäsitlus aastal 2020

Eesti Arst 2020; 99(7):439–44

Kardioloogia

Eesti Arst 2011; 90(5):23

Müokardiinfarkti diagnoosimise kriteeriumid 2007

Müokardiinfarkt (MI) on üks sagedasemaid surma ja töövõimetuse põhjuseid maailmas ning seega on diagnoosi kriteeriumite täpne määratlemine ja rahvusvaheline ühtlustamine oluline nii haige kui ka ühiskonna seisukohast. Müokardiinfarkt on epidemioloogiliselt ühe peamise terviseprobleemi indikaator ning laialdaselt kasutusel kliinilistesse uuringutesse kaasamise kriteeriumi ja tulemusnäitajana. Ühtne arusaam diagnoosist võimaldab teadusuuringuid paremini omavahel võrrelda ja teha erinevate uuringute tulemuste analüüse. Eesti Arst 2008; 87(6):411−41

Müokardiinfarktiga haige käsitlus Eesti haiglates 2007. aastal. Eksperdihinnang

Eesti Kardioloogide Seltsi ja Eesti Haigekassa koostöös valminud eksperdihinnang ägeda müokardiinfarkti ravikäsitluse kohta Eesti haiglates 2007. a näitab, et võrreldes 2001. a on toimunud positiivne areng. Paranenud on koronarograafia kättesaadavus ning tõenduspõhiste ravimite kasutamine, mõnes haiglas on kasutusele võetud ägeda koronaarhaige haigusloo vorme ning koostatud tegevusjuhendeid. Tänapäevast ravikäsitlust negatiivselt mõjutavatest teguritest on esiplaanil nii sisulised kui ka vormilised haiguslugude täitmise probleemid, esmase EKG teostamise ja interpreteerimise kiirus, samuti varieeruvad reperfusioonravi rakendamise aluseks olevad otsused. Vajakajäämiste kõrvaldamiseks on oluline luua tingimused ravijuhendite koostamise ja uuendamise ning koolituse kulude katteks riiklikul tasemel. Eesti Arst 2009; 88(9):552−55

Sex-specific outcomes of diabetic patients with acute myocardial infarction who have undergone percutaneous coronary intervention: a register linkage study

BACKGROUND: The presence of diabetes mellitus poses a challenge in the treatment of patients with acute myocardial infarction (AMI). We aimed to evaluate the sex-specific outcomes of diabetic and non-diabetic patients with AMI who have undergone percutaneous coronary intervention (PCI). METHODS: Data of the Estonian Myocardial Infarction Registry for years 2006–2009 were linked with the Health Insurance Fund database and the Population Registry. Hazard ratios (HRs) with the 95% confidence intervals (CIs) for the primary composite outcome (non-fatal AMI, revascularization, or death whichever occurred first) and for the secondary outcome (all cause mortality) were calculated comparing diabetic with non-diabetic patients by sex. RESULTS: In the final study population (n = 1652), 14.6% of the men and 24.0% of the women had diabetes. Overall, the diabetics had higher rates of cardiovascular risk factors, co-morbidities, and 3–4 vessel disease among both men and women (p < 0.01). Among women, the diabetic patients were younger, they presented later and less often with typical symptoms of chest pain than the non-diabetics (p < 0.01). Women with diabetes received aspirin and reperfusion for ST-segment elevation AMI less often than those without diabetes (p < 0.01). During a follow-up of over two years, in multivariate analysis, diabetes was associated with worse outcomes only in women: the adjusted HR for the primary outcome 1.44 (95% CI 1.05 − 1.96) and for the secondary outcome 1.83 (95% CI 1.17 − 2.89). These results were largely driven by a high (12.0%) mortality during hospitalization of diabetic women. CONCLUSIONS: Diabetic women with AMI who have undergone PCI are a high-risk group warranting special attention in treatment strategies, especially during hospitalization. There is a need to improve the expertise to detect AMI earlier, decrease disparities in management, and find targeted PCI strategies with adjunctive antithrombotic regimes in women with diabetes

"What's in a Lunchbox?": A Story About New Zealand Ideals of Health, Social Class and Ethnicity Told Through Sandwiches and the Children Who Eat Them

Through an ethnographic investigation of school lunchboxes, this thesis explores if and how difference and Otherness is understood by children. In three urban New Zealand primary schools I examine how children construct, affirm and/or challenge social inequalities and issues of inclusion by looking at the contents, concepts, narratives and activities related to the consumption and sharing of their lunch food. Literature dedicated to social class (Bourdieu, 1984) and identity (Rikoon, 1982; Stern, 1977) has documented the way in which food is creatively used to reaffirm unity and belonging within minority groups (Camp, 1979; Abrahams & Kalcik, 1978). In contrast to this approach, I review the role of food as a ‘safe space’ (Mercon, 2008: 5) where diversity may be allowed to symbolically exist for the purpose of affirming the unity of the nation state, while ultimately muffling deeper social differences. The thesis thus questions the assumption that food, identity and social cohesion are conceptually linked. My overall argument centres on the “humble” sandwich, which I claim is constructed as the core, dominant component of the lunchbox, mutually constituting nutritional, social class and ethnic tropes, practices and values. I assess the discourses, behaviours and symbolism that historically situates the sandwich as iconicaly or emblematically “Kiwi”, contending that via the creation of a dychotomized system (i.e. healthy, good, skinny, well-behaved, energetic, Kiwi versus junk-food, bad, fat, naughty, sick, Other) children are enculturated into the logics of work and socialized to be compliant with structures of inequality. Thus, while the sandwich appears equally accessible to all, the differences in its production can result in practices of class based distinction (Bourdieu, 1984) and ethnic exclusion (Hage, 2003). However, my analysis also reveals that children are not mere subjects of structure, but that they reproduce, challenge, mediate, and re-shape these discourses and behaviours

Eesti perekondliku hüperkolesteroleemia käsitlusjuhend

Eesti Arst 2023; 102(4):237–24

Müokardiinfarktihaige käsitlus esimesel aastal pärast haigestumist

Eesti Arst 2022; 101(5):324–32