Background Acute myocardial infarction (AMI) infrequently occurs after acute stroke. The Heart‐brain team approach has a potential to appropriately manage this poststroke cardiovascular complication. However, clinical outcomes of AMI complicating acute stroke (AMI‐CAS) with the heart‐brain team approach have not been characterized. The current study investigated cardiovascular outcomes in patients with AMI‐CAS managed by a heart‐brain team. Methods and Results We retrospectively analyzed 2390 patients with AMI at our institute (January 1, 2007–September 30, 2020). AMI‐CAS was defined as the occurrence of AMI within 14 days after acute stroke. Major adverse cerebral/cardiovascular events (cardiac‐cause death, nonfatal myocardial infarction, and nonfatal stroke) and major bleeding events were compared in subjects with AMI‐CAS and those without acute stroke. AMI‐CAS was identified in 1.6% of the subjects. Most AMI‐CASs (37/39=94.9%) presented ischemic stroke. Median duration of AMI from the onset of acute stroke was 2 days. Patients with AMI‐CAS less frequently received primary percutaneous coronary intervention (43.6% versus 84.7%; P <0.001) and dual‐antiplatelet therapy (38.5% versus 85.7%; P <0.001), and 33.3% of them did not receive any antithrombotic agents (versus 1.3%; P <0.001). During the observational period (median, 2.4 years [interquartile range, 1.1–4.4 years]), patients with AMI‐CAS exhibited a greater likelihood of experiencing major adverse cerebral/cardiovascular events (hazard ratio [HR], 3.47 [95% CI, 1.99–6.05]; P <0.001) and major bleeding events (HR, 3.30 [95% CI, 1.34–8.10]; P =0.009). These relationships still existed even after adjusting for clinical characteristics and medication use (major adverse cerebral/cardiovascular event: HR, 1.87 [95% CI, 1.02–3.42]; P =0.04; major bleeding: HR, 2.67 [95% CI, 1.03–6.93]; P =0.04). Conclusions Under the heart‐brain team approach, AMI‐CAS was still a challenging disease, reflected by less adoption of primary percutaneous coronary intervention and antithrombotic therapies, with substantially elevated cardiovascular and major bleeding risks. Our findings underscore the need for a further refined approach to mitigate their ischemic/bleeding risks.
The use of social network service (SNS) applications for health communication has revolutionized communication between physicians in recent years. We performed an unrestricted retrospective study focusing on emergency physicians (EPs) in Kyoto University Hospital (KUHP) since timely communication is important during emergencies. EPs used LINE, a popular SNS application in Japan. EPs (n = 22) sent 1752 messages from April 2017 to March 2018. Most messages sent contained text data (82.1%), the remaining contained media (17.9%); media included images (72.6%), LINE stamps (22.9%), LINE albums (2.3%) and les (1.6%). Content analysis by two coders produced 13 categories (n = 1438); these were miscellaneous , patient , team , treatment , event , situation , reference , announcement , schedule , resource , policy , transport and unknown. The top ve message categories were related to miscellaneous chat (22.5%), patient (19.1%), team (14.3%), treatment (11.8%) and event (6.6%). The largest number of messages among EPs were sent on Monday and Friday. The numbers of messages sent among EPs during day-shift and night-shift were similar. The categories identi ed in uenced our proposal of medical oriented SNS platform features: structured tagging system for messages related to relevant categories (F1); inquiry broadcast system for speci c inquiries using structured tagging (F2); image tagging system for images shared within groups (F3) and summarized noti cations (F4). Features that need consideration are (1) an opt-in location sharing system between physicians and (2) physicians access to patient records from the SNS application. In this study, messages discussed by EPs were categorized and the resulting categories in uenced our proposal of a physician-centered SNS platform customized to EPs roles. Since physicians prefer using SNS applications compared to traditional mobile phones, their information needs should be considered. Designing a medical oriented SNS platform that is physician-centered should rst include an understanding of topics discussed by physicians. Based on the categories classi ed, the proposal of physician-centered features for designing a medical oriented SNS platform is also discussed in this paper.
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