Background: The trend in the incidence of hospitalized acute myocardial infarction (AMI) and the difference between regions has not been reported in Korea since 2010. Thus, we aimed to inspect recent trends and regional differences in the incidence of AMI and casefatality between 2007 and 2016. Methods: Data from the medical utilization cohort from 2002 to 2016 were analyzed. New incidence of AMI was identified by checking the diagnosis code, duration of admission, type of test, treatment, and medication. Age-standardized incidence rate by gender, age group, and resident region was calculated from 2007 to 2016. Cumulative case-fatality rate was calculated until 3 years. Results: Age-standardized incidence of hospitalized AMI decreased from 53.6 cases per 100,000 person-years in 2007 to 38.9 cases in 2011. Thereafter, the incidence gradually increased to 43.2 cases in 2016. The trend by gender and age groups was also similar to the total trend. The regional age-standardized incidence was the highest in Daegu (50.3 cases per 100,000 person-years) and the lowest in Sejong (30.2 cases), which were similar to the ischemic heart disease mortality in these regions. The 7-, 30-, and 90-days and 1-and 3-years average case-fatality over 10 years were 3.2%, 6.9%, 9.9%, 14.7%, and 22.4%, respectively.
Purpose: Recently, obstetric massive transfusion protocols have shifted toward early intervention. This study aimed to develop a prediction model for transfusion of ≥5 units of packed red blood cells (PRBCs) during cesarean section in women with placenta previa. Materials and Methods: We conducted a cohort study including 287 women with placenta previa who delivered between September 2011 and April 2018. Univariate and multivariate logistic regression analyses were used to test the association between clinical factors, ultrasound factors, and massive transfusion. For the external validation set, we obtained data (n=50) from another hospital. Results: We formulated a scoring model for predicting transfusion of ≥5 units of PRBCs, including maternal age, degree of previa, grade of lacunae, presence of a hypoechoic layer, and anterior placentation. For example, total score of 223/260 had a probability of 0.7 for massive transfusion. Hosmer-Lemeshow goodness-of-fit test indicated that the model was suitable (p>0.05). The area under the receiver operating characteristics curve (AUC) was 0.922 [95% confidence interval (CI) 0.89-0.95]. In external validation, the discrimination was good, with an AUC value of 0.833 (95% CI 0.70-0.92) for this model. Nomogram calibration plots indicated good agreement between the predicted and observed outcomes, exhibiting close approximation between the predicted and observed probability. Conclusion: We constructed a scoring model for predicting massive transfusion during cesarean section in women with placenta previa. This model may help in determining the need to prepare an appropriate amount of blood products and the optimal timing of blood transfusion.
ObjectivesThis study evaluated the relationship between guideline adherence for recommended therapy on discharge and relevant 60-day and 1-year clinical outcomes in patients with acute heart failure (HF) with reduced ejection fraction and atrial fibrillation (AF).MethodsOf 5625 acute patients with HF in the Korean Acute Heart Failure registry, 986 patients with HF and documented AF were analysed. Guideline adherence scores were calculated for the prescription of ACE inhibitors, angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists and anticoagulants.ResultsIn patients with HF with AF, there was a significant trend of reduced 60-day and 1-year mortality rates and the composite end point with guideline adherence. According to the Cox proportion hazard model, poor adherence was associated with a significantly higher risk of 60-day mortality (HR 4.75; 95% CI 1.77 to 12.74) and the composite end point (HR 2.36; 95% CI 1.33 to 4.18) compared with good adherence. Furthermore, poor adherence was associated with a significantly higher risk of 1-year mortality compared with moderate (HR 1.64; 95% CI 1.15 to 2.33) and good adherence (HR 2.34; 95% CI 1.39 to 3.97) and with a higher risk of the 1-year composite end point compared with good adherence (HR 1.58; 95% CI 1.07 to 2.33).ConclusionBetter adherence to guidelines was associated with better 60-day and 1-year prognoses in patients with HF with AF.
ObjectivesThis study investigated the risk associated with interhospital transfer of patients with acute myocardial infarction (AMI) and clinical outcomes according to the location of the patient’ residence.DesignA nationwide longitudinal cohort.SettingNational Health Insurance Service database of South Korea.ParticipantsThis study included 69 899 patients with AMI who visited an emergency centre from 2013 to 2015, as per the Korea National Health Insurance Service database.Primary outcome measureThe clinical outcome of a patient with AMI was defined as mortality within 7 days, 30 days and 1 year.ResultsClinical outcomes were analysed and compared with respect to the location of the patient’s residence and occurrence of interhospital transfer. We concluded that the HR of mortality within 7 days was 1.49 times higher (95% CI 1.18 to 1.87) in rural patients than in urban patients not subjected to interhospital transfer and 1.90 times higher (95% CI 1.13 to 3.19) in transferred rural patients than in non-transferred urban patients.ConclusionsTo reduce health inequality in rural areas, a healthcare policy considering regional characteristics, rather than a central government-led, catch-all approach to healthcare policy, must be formulated. Additionally, a local medical emergency delivery system, based on allocation of roles between different medical facilities in the region, must be established.
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