OBJECTIVES. Many developed countries have seen declining mortality rates for heart disease, together with an alleged decline in incidence and a seemingly paradoxical increase in health care demands. This paper presents a model for forecasting the plausible evolution of heart disease morbidity. METHODS. The simulation model combines data from different sources. It generates acute coronary event and mortality rates from published data on incidences, recurrences, and lethalities of different heart disease conditions and interventions. Forecasts are based on plausible scenarios for declining incidence and increasing survival. RESULTS. Mortality is postponed more than incidence. Prevalence rates of morbidity will decrease among the young and middle-aged but increase among the elderly. As the milder disease states act as risk factors for the more severe states, effects will culminate in the most severe disease states with a disproportionate increase in older people. CONCLUSIONS. Increasing health care needs in the face of declining mortality rates are no contradiction, but reflect a tradeoff of mortality for morbidity. The aging of the population will accentuate this morbidity increase.
Patients who continued to smoke after CABG had a greater risk of death than patients who stopped smoking. They also underwent repeat revascularization procedures more frequently. Cessation of smoking is therefore strongly recommended after CABG. Clinicians are encouraged to start or to continue smoking-cessation programs in order to help smokers to quit smoking, especially after CABG.
The renal side-effects are a major limitation of the use of cyclosporine A (CsA) following heart transplantation. In an effort to define the time course of the decline in renal function and to identify a group of patients especially prone to the nephrotoxic effects of CsA, we studied 187 orthotopic heart transplant recipients who had a follow-up of at least 1 month. All patients received oral CsA in a starting dose of 8 mg/kg and low-dose steroids. Renal function decreased steadily after transplantation. Serum creatinine was > 150 µmol/l in 52% of the patients after 2 years. After 4 years serum creatinine was > 250 µmol/l in 13% of the patients. No relation could be found between the decline in renal function (as defined by the slope of serum creatinine-1 versus time) and age, sex, creatinine levels before transplantation, blood pressure, CsA blood levels, the number of rejections or the use of calcium channel blocking drugs. We conclude that, despite reduction of CsA dosage, progressive renal insufficiency can be observed in an increasing percentage of heart tansplant recipients. We were not able to identify patients with a poor renal prognosis in an early phase after transplantation.
The authors investigated 40 heart transplant recipients and their partners to determine both the partner's quality of life upon transplantation and the experiences of both patient and partner with compliance with the medical regimen. Data on sleep disturbances, social isolation, emotional reactions, depression, anxiety, partner's apprehension, social support and compliance (regarding behaviour and emotional experience) were obtained approximately 21 months after transplantation. Compared to related study groups, partners did not experience more problems in sleep, social isolation, emotional reactions, depression and anxiety. Patients overestimated the apprehension of their partners significantly (p < 0.0001). Generally speaking, with the exception of three items relating to eating fish, canned food and forgetfulness in medicine intake, patients and partners agreed with respect to actual compliance behaviour. Lowest compliance concerned regular physical exercise: 28%. Both patient and partner insisted that they had scarcely any emotional problem with the regimen. Further systematic research is needed to bring to light factors that affect compliance as well as adequate methods to bring about an improvement therein.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.