Lower incidence of myocardial infarction after smoke-free legislation enforcement in Chile

Objective To evaluate the impact of a complete smoking ban in enclosed spaces on the incidence of acute myocardial infarction in Chile. Methods The population-based study involved residents of urban areas, where 80% of the Chilean population live, aged 20 years or older who had a myocardial infarction. Monthly myocardial infarction incidence and mortality rates at health-care facilities between January 2011 and December 2014 were derived from admission and mortality databases. Regression discontinuity methods were used to estimate the near-immediate impact on disease incidence of enforcing smoke-free legislation in March 2013. The same analysis was performed for ischaemic stroke, degenerative disc disease and colon cancer. Data on the concentration of fine respirable particulates were included in an additional analysis of myocardial infarction incidence in the Santiago metropolitan area. Results The enforcement of smoke-free legislation was associated with an abrupt, near-immediate decline of 0.639 cases of myocardial infarction per 100 000 adults per month (95% confidence interval, CI: 0.242 to 1.036; relative decline: 7.8%). Similar declines were observed in men and women and in people aged over and under 70 years. However, enforcement of the legislation was not associated with a significant change in the rate of ischaemic stroke, degenerative disc disease or colon cancer. The abrupt decline in myocardial infarction incidence was also observed when data on fine respirable particulates were included in an analysis for Santiago. Conclusion The enforcement of extensive smoke-free legislation in Chile was associated with an abrupt, near-immediate decline in the incidence of myocardial infarction

Incidence and hospital mortality due to heart failure. Are there any differences by sex?

Background: Gender may influence the incidence, severity and hospital mortality due to heart failure (HF). Aim: To evaluate the influence of sex on the proportion of patients hospitalized due to heart failure, its incidence and hospital mortality. Methods: Analysis of the hospital discharge database of the Chilean Ministry of Health during 2014. All hospital admissions for HF were considered according to ICD-10 codes, including the discharge diagnosis of congestive HF (7500), left ventricular HF (1501) and non-specified HF (1509). Incidence rates, proportion of discharges due to HF and hospital mortality were calculated according to age and sex. Results: During 2014, there were 1,306,431 discharges from Chilean hospitals. Of these, 125,484 were for cardiovascular disease and 10% of these corresponded to HF (12,825). The incidence rate was slightly higher in men than in women (0.71 and 0.70 per 1,000 admissions respectively). Among patients aged 80 years or more, the prevalence of admissions for HF was higher in women (19.1 and 15.9% respectively, p < 0.01). Hospital mortality was also higher in women (9.7 and 8.6% respectively, p = 0.03). The factors associated with a higher hospital mortality were an age over 80 years (Odds Ratio (OR) 2.11; 95% confidence intervals (CI): 1.87-2.40; p < 0.01), a length of stay over seven days (OR 1.13; 95%CI: 1.01-1.29; p = 0.04), being admitted to high complexity facilities (OR 1.29; 95%CI: 1.12-1.50; p = 0.01) and being insured by the public national health fund (OR 1.94; 95%CI: 1.54-2.43; p < 0.01). Conclusions: The incidence of hospital admissions due to HF is similar in men and women. There is high hospital mortality, especially in women

Association between socioeconomic status and survival after a first episode of myocardial infarction

Background: A low socioeconomic status is associated with higher overall mortality rates. Aim: To assess the effect of socioeconomic inequalities on survival of patients hospitalized with a first myocardial infarction. Material and Methods: Analysis of hospital discharge and mortality databases of the Ministry of Health. Patients aged over 15 years discharged between 2002 and 2011 with a first myocardial infarction (code I-21, ICD-10) were identified. Their survival was verified with the mortality registry. Survival from 0 to 28 and from 29 to 365 days was analyzed. Socioeconomic status was determined using the type of health insurance, stratified as public insurance (low and medium status) and private insurance (high status). Prais-Winsten trend (P-W) and Cox survival analyses were done. Results: We analyzed 59,557 patients (69% males). Sixty three percent were of low socioeconomic status, 19% medium and 18% high. Between 2002 and 2011 the increase in survival was higher among patients of low socioeconomic status, mainly in women (P-W coefficients 0.58:0.31-0.86 in men and 1.12:0.84-1.41 in women for 0-28 days survival and 0.24:0.09-0.39 in men and 0.48:0.37-0.60 in women for 29-365 days survival, respectively). However, age and year of hospitalization adjusted analysis showed a higher mortality risk among patients of low socioeconomic status at 0-28 days ( HR 1.67:1.53-1.83 for men and 1.49:1.34-1.66 for women) and at 29-365 days (HR 2.30: 1.75-2.71 for men and 1.90:1.56-1.85 for women). Conclusions: Survival after a myocardial infarction improved in the last decade especially in patients of low socioeconomic status. However, subjects of this stratum continue to have a higher mortality.Fondo concursable para el apoyo a la investigación, Insituto de Salud Poblacional - Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile

Influence of childhood socioeconomic disadvantage in the incidence of cardiovascular disease in adults in Chile

Artículo de publicación ISISin acceso a texto complet

Mediation of the effect of childhood socioeconomic position by educational attainment on adult chronic disease in Chile

Objectives We estimated the roles of childhood socioeconomic position (ChSEP) and education attainment on chronic diseases in Chilean adults, mediated through structural determinants and health behaviors, to identify potential pro-equity interventions. Methods We analyzed Chile’s longitudinal Social Protection Surveys, a national sample of 14,788 adults with follow- up to 2009. Controlled direct effects (CDE) and natural effects (NDE and NIE) of ChSEP and education on number of chronic diseases were estimated with negative binomial models. Results CDE of low ChSEP with education fixed at 12 years showed a 12% increase with 4% indirect effects. CDEs at favorable levels of BMI, smoking, alcohol use, and physical activity were similar. CDE estimates for education adjusted for ChSEP were larger with negligible mediation. CDEs for women were generally larger. Conclusions Low ChSEP exerts a primarily direct effect on later chronic disease, modestly mediated by education. Education attainment showed larger direct effects with minimal mediation by behaviors. Strengthening current– early child development and education policies, particularly gender aspects, may reduce social inequalities and key pathways for reducing chronic disease inequalities in Chile.Chile’s National Fund for Health Research and Development (Fondo Nacional de Investigacio´n y Desarrollo en Salud, FONIS. Grant no. SA13|20138

Effects of early decrease in oxidative stress after medical therapy in patients with class IV congestive heart failure

It has been reported that patients with congestive heart failure (CHF) have increased breath pentane content, conjugated diene levels, and plasma malondialdehyde (MDA) levels, an indirect marker of lipid peroxidation.(1-3) Ghatak et al(4) found that patients with chronic CHF had increased MDA and superoxide levels, which correlated with the severity of the CHF. Low glutathione levels and superoxide dismutase (SOD) activity have also been reported.(5,6) There have been no studies in human refractory CHF to evaluate the impact of acute intensive medical therapy on oxidative stress status and antioxidant enzyme activity. We determined the plasma levels of MDA, SOD, catalase (CAT), and glutathione peroxidase (GSH-Px) activities before and after therapeutic intervention in patients with chronic advanced CHF and refractory symptoms (New York Heart Association functional class IV)

Valor pronóstico de marcadores no invasivos de reperfusión coronaria frente a flujo TIMI 3 en pacientes tratados con angioplastia primaria

Introducción y objetivos. La angioplastia primaria ha resultado ser el tratamiento más eficaz para pacientes con infarto agudo de miocardio (IAM). Tanto la obtención de un flujo coronario óptimo, grado TIMI 3, como la asociación de indicadores no invasivos de reperfusión coronaria han demostrado ser métodos útiles para predecir el pronóstico inmediato y a medio plazo de pacientes con IAM tratados con trombólisis o angioplastia primaria. El objetivo es comparar el valor pronóstico del flujo TIMI 3 con la asociación de indicadores no invasivos de reperfusión coronaria (disminución del supradesnivel del segmento ST > 50% a los 90 min, inversión de la onda T dentro de las 24 h y elevación máxima de la creatincinasa [CK] 70%, valor máximo de CK) demostró que tanto la reperfusión exitosa como el flujo TIMI 3 resultaron ser protectores frente a la mortalidad intrahospitalaria (odds ratio [OR] = 0,028; intervalo de confianza [IC] del 95%, 0,003-0,268, y OR = 0,104; IC del 95%, 0,019-0,563, respectivamente). Sin embargo, sólo la reperfusión exitosa resultó ser protectora frente a la insuficiencia cardíaca y las arritmias complejas en la evolución intrahospitalaria y en la mortalidad a medio plazo al ajustar por ambos criterios en el análisis multivariado. Conclusión. Se confirma que tanto el flujo TIMI 3 como la reperfusión coronaria exitosa evaluada a través de indicadores no invasivos tienen un valor pronóstico independiente en pacientes con IAM tratados con angioplastia primaria. Sin embargo, la reperfusión coronaria exitosa resultó ser un indicador de pronóstico independiente para la mortalidad intrahospitalaria y a medio plazo, el desarrollo de insuficiencia cardíaca y arritmias complejas. Los indicadores no invasivos de reperfusión coronaria debieran emplearse en forma complementaria a la angiografía en estos pacientes

Frailty in patients admitted to hospital with acute decompensated heart failure Factores asociados a fragilidad en pacientes hospitalizados con insuficiencia cardiaca descompensada

© 2017 Rev Med Chile. All right reserved. Background: Frailty is a geriatric syndrome characterized by a progressive impairment in the subjects’ ability to respond to environmental stress. Frailty is more commonly found in heart failure (HF) patients than in general population and it is an independent predictor of rehospitalization, emergency room visits and death. Aim: To estimate the prevalence of frailty in patients with decompensated HF admitted to four hospitals in Santiago, Chile. Material and Methods: Cross-sectional study. Subjects aged 60 or older consecutively admitted for decompensated HF to the study centers between August 2014 and March 2015 were included. Frailty was defined as the presence of three or more of the following criteria: unintended weight loss, muscular weakness, depression symptoms (exhaustion), reduced gait speed and low physical activity. Independent variables were tested for association using simple logistic regression. Variables associated with frailty