Changing patterns and mortality of acute myocardial infarction in a coronary care unit.

Hunt, David; Sloman, Graeme; Christie, David; Penington, C

doi:10.1136/bmj.1.6064.795

Cited by 34 publications

(7 citation statements)

References 7 publications

(3 reference statements)

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“…Although many patients spent longer in the unit than necessary because of a shortage of medical beds for transferring them, some 21 % of deaths occurred from late arrhythmias in the general ward, an observation previously made from this unit by Spracklen et al (1968) who argued the case for an intermediate care area. A similar study to this one, using similar severity indices is that of Hunt et al (1977) in Melbourne where a decline of fatality rates within groups stratified for severity was observed over the period 1969-1975, from an overall rate which was higher than this one to one that was lower despite a larger proportion of cases classified as severe. The authors postulated a change in the natural history of the disease in Australia; something that has not so far been witnessed in England.…”

Section: Discussionsupporting

confidence: 66%

“…Additional data were extracted from the case notes by a research assistant. Cases were graded as mild or severe using an index similar to that described by Hunt et al (1977), the severe cases being those who on admission or within 24 hr had a systolic BP < 100 mmHg, clinical heart failure, or ventricular tachy-0032-5473/81/0100-0004 $02.00 (© 1981 The Fellowship of Postgraduate Medicine cardia, ventricular fibrillation, asystole or complete heart block, or who needed electric cardioversion or pacing.…”

Section: Methodsmentioning

confidence: 99%

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Audit of an inner city coronary unit

Pedoe

Besterman

Kidner

1981

Postgraduate Medical Journal

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Section: Discussionsupporting

confidence: 66%

Section: Methodsmentioning

confidence: 99%

Audit of an inner city coronary unit

Pedoe

Besterman

Kidner

1981

Postgraduate Medical Journal

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“…Patients with atrial fibrillation tended to be in an older age group; 64 per cent of our patients with atrial fibrillation were over 60 years and they had a mean age of 62-3 years compared with 63 to 67 years in other reports (Klass and Haywood, 1970;Cristal et al, 1976;Liberthson et al, 1976). The mortality of patients with myocardial infarction either with or without atrial fibrillation is clearly related to age (Norris et al, 1969;Hunt et al, 1977). Within each age group, however, our patients with atrial fibrillation had a similar mortality rate to those without atrial fibrillation.…”

Section: Discussionmentioning

confidence: 51%

Effects of atrial fibrillation on prognosis of acute myocardial infarction.

Hunt¹,

Sloman²,

Penington³

1978

Heart

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suMMARY Nine hundred and sixty-nine coronary care patients with acute myocardial infarction were followed for one year. Atrial fibrillation was documented in 107 patients. Compared with patients without atrial fibrillation, those with this arrhythmia were older, had clinically more severe infarction, and had a higher frequency of ventricular fibrillation or tachycardia, and right bundle-branch block. They had similar past histories of ischaemic heart disease and coronary risk factors. Patients with atrial fibrillation had a higher total mortality at 3 months and 12 months. The presence of atrial fibrillation was not associated with any significant increase in mortality within any decade of age or within any subgroup of clinical severity of infarction. The frequency of atrial fibrillation was similar in anterior and inferior infarction. Multiple episodes of atrial fibrillation occurred in 52 patients and episodes usually lasted for over 1 hour. In 50 per cent of patients with single episodes of atrial fibrillation the initial ventricular rate was greater than 120 beats per minute.The association of atrial fibrillation with acute myocardial infarction is known to carry a high mortality (Stannard and Sloman, 1967;Klass and Haywood, 1970;Helmers et al., 1973;Cristal et al., 1976;Liberthson et al., 1976). It is unlikely that this high mortality is the result of the arrhythmia itself but is more likely the result of the clinical situation in which atrial fibrillation develops. Thus atrial fibrillation is usually associated with older patients and with clinically more severe infarction (Stannard and Sloman, 1967;Klass and Haywood, 1970;Helmers et al., 1973;Cristal et al., 1976;Liberthson et al., 1976 as necessary and intranasal oxygen given at a rate of 2 1/min for the first 12 hours. The patients' rhythms were displayed on multichannel oscilloscopes in a central nurses' station. Ten-second electrocardiograph strips were recorded every hour for the first 2 days and more often if arrhythmias were detected. A 4-channel tape recorder was available for part of the period under study. Blood was taken and measurements made of creatine kinase and aspartate transaminase on admission and then daily for at least 2 days. Routine 12-lead electrocardiograms and 2 metre posteroanterior chest radiographs with the patient sitting on the side of the bed were made on admission, daily for the first 2 days, and then according to need.

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“…20 The hospital mortality may also have decreased during the study period because the length of admission fell from about 19 days to about 11 days. The lower mortality in hospital due to the shorter stay would, however, tend to increase mortality later during the follow up period.…”

Section: Discussionmentioning

confidence: 97%

Declining trend in mortality after myocardial infarction.

Åberg¹,

Bergstrand²,

Johansson³

et al. 1984

Heart

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SUMMARY All patients under 60 years of age who were discharged from hospital after a first myocardial infarction between 1968 and 1977 in GCteborg were followed for a minimum of 24 months. The patients were unselected, and treatment was standardised. The patients were divided into five two yearly cohorts, and the prognostic comparability and mortality of these cohorts were assessed. There was a reduction in the two year mortality rate after discharge during the 10 year period. Small baseline differences between the cohorts were controlled by multivariate methods, and a subsequent analysis showed that there was a declining trend in mortality between 1968 and 1977. A higher tendency among smokers to give up smoking and a lower prevalence of angina pectoris could explain only part of the reduction in mortality. A small number of patients underwent a coronary bypass operation; the slight increase in the number of operations during the period cannot, however, account for the reduced mortality. Most of the patients in the later cohorts were treated with beta blockers, and this is the most likely explanation for the majority of the decline in mortality.During the past decade the mortality due to coronary heart disease has declined in some Western countries.' -3 Changes in cardiovascular risk factors and improved medical care in the community have been proposed as explanations for this trend,<-3 as has improved care during admission to hospital.4The mortality after myocardial infarction accounts for about a third of the total coronary heart disease mortality. During the past decade there have been several studies of the effects of different secondary preventive measures such as cessation of smoking and long term beta blockade.5 6 Despite growing interest in secondary prevention it has been difficult to show any reduction in mortality after discharge from hospital among larger groups of patients.7-'0 In Goteborg, all patients in the middle-aged groups have been routinely followed up after myocardial infarction since 1968.We undertook this study, firstly, to investigate whether there was a change in mortality after myocardial infarction over the 10 year period and, secondly, to find explanations for any such change.

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Changing patterns and mortality of acute myocardial infarction in a coronary care unit.

Cited by 34 publications

References 7 publications

Audit of an inner city coronary unit

Audit of an inner city coronary unit

Effects of atrial fibrillation on prognosis of acute myocardial infarction.

Declining trend in mortality after myocardial infarction.

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