Kardioloogia

Eesti Arst 2012; 91(3):152–15

Use of evidence-based pharmacotherapy after myocardial infarction in Estonia

<p>Abstract</p> <p>Background</p> <p>Mortality from cardiovascular disease in Estonia is among the highest in Europe. The reasons for this have not been clearly explained. Also, there are no studies available examining outpatient drug utilization patterns in patients who suffered from acute myocardial infarction (AMI) in Estonia. The objective of the present study was to examine drug utilization in different age and gender groups following AMI in Estonia.</p> <p>Methods</p> <p>Patients admitted to hospital with AMI (ICD code I21-I22) during the period of 01.01.2004-31.12.2005 and who survived more than 30 days were followed 365 days from the index episode. Data about reimbursed prescriptions of beta-blockers (BBs), angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACE/ARBs) and statins for these patients was obtained from the database of the Estonian Health Insurance Fund. Data were mainly analysed using frequency tables and, where appropriate, the Pearson's χ2 test, the Mann-Whitney U-test and the t-test were used. A logistic regression method was used to investigate the relationship between drug allocation and age and gender. We presented drug utilization data as defined daily dosages (DDD) per life day in four age groups and described proportions of different combinations used in men and women.</p> <p>Results</p> <p>Four thousand nine hundred patients were hospitalized due to AMI and 3854 of them (78.7%) were treated by BBs, ACE/ARBs and/or statins. Of the 4025 inpatients who survived more than 30 days, 3799 (94.4%) were treated at least by the one of drug groups studied. Median daily dosages differed significantly between men and women in the age group 60-79 years for BBs and ACE/ARBs, respectively. Various combinations of the drugs studied were not allocated in equal proportions for men and women, although the same combinations were the most frequently used for both genders. The logistic regression analysis adjusted to gender and age revealed that some combinations of drugs were not allocated similarly in different age and gender groups.</p> <p>Conclusions</p> <p>Most of the patients were prescribed at least one of commonly recommended drugs. Only 40% of them were treated by combinations of beta-blockers, ACE inhibitors/angiotensin II receptor blockers and statins, which is inconsistent with guideline recommendations in Estonia. Standards of training and quality programs in Estonia should be reviewed and updated aiming to improve an adherence to guidelines of management of acute myocardial infarction in all age and gender groups.</p

Statiinide kasutamine müokardiinfarktijärgsel perioodil

Statiine ordineeritakse järjest sagedamini südame-veresoonkonnahaigustega patsientidel. Nad on efektiivsed nii haiguse primaarseks preventsiooniks kui ka müokardiinfarkti ravis. Uurimuses on hinnatud statiinravi kasutamist müokardiinfarkti põdenud haigetel. Eesti Arst 2005; 84 (10): 710–71

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

Müokardiinfarkti neljas universaalne definitsioon

Euroopa Kardioloogide Seltsi juhendmaterjal, tunnustanud ja kohandanud Eesti Kardioloogide Selts, Eesti Laborimeditsiini Ühing ja Eesti Radioloogia Ühing

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

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

Südame isheemiatõve riski ennustamine geneetiliste markerite abil

Südame isheemiatõbi on komplekshaigus, mille avaldumises on roll keskkonnal, eluviisil, pärilikkusel ja nende koosmõjudel. Haiguse tekkeriski võimalikult varajane ja täpne hindamine on ennetava ravi määramise nurgakiviks. Kasutusel olevates riskiskoorides ei ole võetud arvesse pärilikkust, kuigi selle osakaalu südame isheemiatõve kujunemisel hinnatakse 40–60%-ni.Uute meetodite jõudmine geneetiliste uuringute paletti on toonud kaasa enam kui 50 südame isheemiatõve avaldumise riskiga soetud geneetilise markeri tuvastamise. Leitud markerite kombineerimine võimaldab koostada polügeense riskiskoori, mis aitab seni klassikalistel riskiteguritel põhinenud riski hindamist ja ravi määramist oluliselt täpsemaks muuta. On ootuspärane, et lähitulevikus kuulub südame isheemiatõve tervikliku käsitluse hulka lisaks klassikalistele riskiteguritele ka geneetiliste markerite hindamine.Eesti Arst 2015; 94(9):522–52

"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

Kodade virvendusarütmiaga patsientide elupäevade kaetus suukaudsete antikoagulantidega ja ühe aasta suhteline elulemus: rahvastikupõhine uuring Eestis

Eesti Arst 2023; 102(12):68