An analysis of blood pressure screening of 21 112 participants in Armenia: May Measurement Month 2018.

Elevated blood pressure (BP) is a growing burden worldwide and is the leading cause of mortality and disability-adjusted life years all over the world. May Measurement Month (MMM) is a global initiative aimed to raise awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May to July 2018. Blood pressure measurement, the definition of hypertension (HTN) and statistical analysis followed the standard MMM protocol. The study was conducted in public areas (17 sites in Yerevan and 22 in regions), both indoor and outdoor, as well as in 78 primary care centres. A total of 21 112 individuals were screened during MMM18, of which 20 732 had three BP measurements available. The mean age of screened individuals was 46.2 ± 17.3 years, 57.8% were female. At the time of screening, 26.1% were on antihypertensive medication. After imputation, the percentage of participants with HTN was 38.7%, and 76.7% of them were aware of their high BP. Of participants receiving treatment, 47.1% had a controlled BP. MMM18 was the largest BP screening campaign undertaken in Armenia. We found that the proportion of HTN is substantial in Armenia, which may be a vital contributor to the growing burden of non-communicable diseases. Our results also suggest that untreated HTN is common and when treated still not adequately controlled in Armenia. The current situation, with an insufficient control rate of HTN, must be changed as soon as possible

Left atrial strain as a predictor of atrial fibrillation in patients with asymptomatic severe aortic stenosis and preserved left ventricular systolic function

Aim. To study the structural and functional left heart parameters in patients with severe aortic stenosis (AS) and preserved ejection fraction (EF) in order to determine the risk of atrial fibrillation (AF).Material and methods. The study included 84 patients (men, 37; mean age, 68±8 years) with severe AS and EF >55%. All patients had sinus rhythm and were asymptomatic. Echocardiography was performed to assess longitudinal strain of the left ventricle (LVLS), right ventricle, left atrium (LALS) and the left atrial stiffness (LAS) using the speckle tracking method. Left ventricular mass index (LVMI) and maximum left atrium volume index (LAVI) were also determined. Patients were followed up for 1 year.Results. AF was reported in 27 (32%) patients, of which 9 (33%) had asymptomatic AF episodes detected by 48-hour electrocardiography. Eighteen (67%) patients with AF felt palpitations. Patients with and without episodes of atrial fibrillation had non-significant differences in LVMI, LAVI, and LVLS. Patients with atrial fibrillation had a lower LALS and a higher LAS compared with patients without atrial fibrillation. Regression analysis revealed that LALS and LAS were independent predictors of AF.Conclusion. AF develops in about one third of asymptomatic patients with severe AS and normal EF. The development of AF predisposes to the onset of AS symptoms in most patients. LALS and LAS were predictors of AF in these patients. Identification of patients at risk of AF will allow for earlier aortic valve replacement

May Measurement Month 2019: an analysis of blood pressure screening results from Armenia.

Elevated blood pressure (BP) is an enormous public health problem and a growing burden worldwide and the biggest single risk factor for cardiovascular death. May Measurement Month (MMM) is a global initiative aimed to raise awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May to July 2019. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. The study was conducted in public areas (23 sites in the capital city Yerevan and 13 in other regions), both indoor and outdoor, as well as in primary and secondary healthcare centres. In total, 9818 individuals (11.3% participated in either MMM2017/2018 or both) were screened of which 9786 had three BP measurements available, 1.6% of them reported never having had their BP measured. The mean age of screened participants was 47.6 (SD ± 16.5) years, 61.9% were female. After multiple imputation, 41.6% of participants had hypertension and 72.8% of them were aware of their high BP, 65.4% were on treatment, and of those treated, 46.5% had controlled BP (<140/90 mmHg). Of 4088 participants with hypertension, 30.4% had controlled BP. Of all risk factors analysed, reported use of anti-hypertensive medication and a previous diagnosis of hypertension were the strongest predictors of higher levels of BP. We found that the prevalence of hypertension, untreated and treated, but uncontrolled hypertension is still substantial in Armenia, which maybe a vital contributor to the growing burden of non-communicable diseases

Reperfusion therapies and in-hospital outcomes for ST-elevation myocardial infarction in Europe: The ACVC-EAPCI EORP STEMI Registry of the European Society of Cardiology

Aims: The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results: Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0-100%), fibrinolysis (18.8%; 0-100%), and no reperfusion therapy (9.0%; 0-75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5-5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8-97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1-70.1%) for timely reperfusion. Conclusions: The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

Aims The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. Methods and results Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (inhospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, prehospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. Conclusion The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims: The Acute Cardiac Care Association (ACCA)-European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI. Methods and results: Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients' outcomes. Patients will be followed for 1 year after admission. Conclusion: The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI