The objective of the dissertation is analysis of costs that are connected with acute myocardial infarction in the Znojmo Hospital. It is about the bill of costs of this diagnosis with the use of analysis "Cost of Illness". Cost of Illness is one of many kinds of analysis examining the costs of illnesses. At work, I have tried to capture all relevant costs of this diagnosis, especially the cost of diagnosis, therapy and hospitalization of patients with the diagnosis of acute myocardial infarction.

Myocardial Infarction: A Study of the Effects On Patient Compliance of Structured Education and Participation of the Significant Other This study was designed to explore the effects of the independent variables of patient education and the significant other on compliance. The purpose of the study was to test three hypotheses predicting that subjects who receive structured education with their significant other would have higher compliance rates with health care recommendations than would subjects who receive structured and unstructured education without their significant other. The study was conducted with a convenience sample of 12 male patients who had a significant other and had not experienced a previous myocardial infarction within five years. The convenience sample was then randomly and equally allocated into three groups. The control group received unstructured education as currently practiced by nursing staff. One experimental group received structured education from the investigator and the other experimental group of subjects and their significant other received structured education from the investigator. Using a semi-structured interview guide, the investigator interviewed each subject at one month and at three to four months postdischarge from hospital to determine compliance rates with physical activity, dietary, and medication health care recommendations as prescribed by the subject's physician. Open-ended questions were used to determine recommendations and difficulties encountered by noncompliers. More specific questions were used to allow subjects to rate their compliance. Results were subjected to the Kruskal-Wallis rank-sum test with one-way analysis of variance. Statistically significant differences (p < .05) were not found suggesting that method of patient education was not a valid prediction of compliant behaviour. The insignificant findings of this study need to be interpreted with caution because of the small sample size and between group differences of the demographic variables of age and employment. From general observations of the total sample, personal definitions of health, simultaneous demands and the extent of behavioural changes required, and the demographic variables of education and employment appear to influence compliance. These findings suggest that individual differences have an impact on compliant behaviour. Findings also suggest that the significant others of patients with myocardial infarctions are actively involved with the therapeutic regimen prescribed for their mates. The study discusses implications and recommendations for nurse practitioners and researchers who wish to improve their care of myocardial infarction patients and their significant others. / Applied Science, Faculty of / Nursing, School of / Graduate

This study involves an investigation of the relationship between dependency and work resumption of patients with myocardial infarction. In the process of studying this problem, information concerning the different levels of dependency during the convalescence through employment continuum v/as gathered. The purposes of the study are to add to the body of knowledge concerning the concept of dependency and to make nurses and other members of the health team aware of the implications of dependency behaviour in the process of resuming normal function of patients with myocardial infarction. Its long range purpose is to increase the sense of well-being and achieving of the patient with myocardial infarction by helping him resume his productive role, both through the help of members of the health team and members of his family. The study was planned to test the following hypotheses: 1. The employed patients with myocardial infarction will show lower dependency ratings than the unemployed patients in the Navran Dy Scale. 2. The employed patients with myocardial infarction will show progressive decrease in the D-I Scale dependency ratings along the convalescence to employment period continuum, while the unemployed patients with myocardial infarction will maintain a constant level of dependency ratings in the D-I Scale along the convalescence to employment period continuum. 3. Low trait dependents with myocardial infarction will show progressive decrease in the D-I Scale dependency ratings along the convalescence to employment period continuum, while high trait dependent patients with myocardial infarction will continue to show steady dependency ratings in the D-I Scale along the convalescence to employment period continuum. Two structured questionnaires were constructed following a review of the literature to obtain information regarding the research problem. The Navran Dy and the dependency portion of the D-I Scale were also administered. The study population consisted of 21 men. The study population was restricted to men who were confined in the hospital for their first myocardial infarction, who were 64 years of age or younger, who could read and write English, and who had been employed for the 6 months immediately prior to the confinement. Analysis of the data included Frequency tables, T test and the Two-Factor Analysis of Variance. The findings of the study showed that patients with myocardial infarction showed different degrees of dependency, both trait and state. The findings failed to support the three hypotheses even though during the data analysis of the individual hypothesis, the group means showed leaning towards the direction of the hypothesis. The study suggests that steps should be taken to make nurses and family more aware of the varying degrees of dependency in patients. / Applied Science, Faculty of / Nursing, School of / Graduate

Orientador: Orlando Petrucci Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T16:20:22Z (GMT). No. of bitstreams: 1 Lima_FanySilva_M.pdf: 1729080 bytes, checksum: a3d4e3c77bc179cf859c845d5e3bac06 (MD5) Previous issue date: 2015 / Resumo: O infarto agudo do miocárdio (IAM) ainda permanece como umas das principais causas de morbimortalidade em indivíduos adultos, ocasionando lesões miocárdicas pela isquemia seguida da reperfusão. No presente trabalho estudamos a cardioproteção por meio de três diferentes estratégias: a utilização de um fármaco denominado - Piracar (Piracetam, L-carnitiva, glutamato e aspartato), a utilização de uma solução contendo eritropoietina, glicose, insulina e potássio (EG); e por meio da modulação humoral/neurológica denominada isquemia de pré-condicionamento remoto (IPCR). Para esta análise utilizou-se de modelo agudo de isquemia e reperfusão miocárdica em suínos onde foram avaliadas variáveis hemodinâmicas, quantificação da área de infarto, quantidade de troponina I liberada (TnI-C) e de adenosina trifosfato no músculo cardíaco (ATP). Também foram estudadas proteínas relacionadas a isquemia e reperfusão miocárdicas de duas vias conhecidas como a Survivor Activating Factor Enhancement (SAFE) e a Reperfusion Injury Salvage Kinase Pathway (RISK) utilizando Western Blotting. Foi observado maior ativação das proteínas ERK (p?0,05) e STAT (p?0,05) no grupo EG e IPCR comparados ao controle, quando comparados entre si o grupo que se apresentou melhor foi o EG, também com a quantidade de ATP significativamente maior. No grupo Piracar e IPCR a AKT (p?0,05) apresentou-se ativada comparada aos demais grupos. Não encontramos diferença nas análises hemodinâmicas e na porcentagem de área de infarto. Entretanto, a TnI-C apresentou-se elevada na fase de reperfusão nos grupo IPCR e EG; e reduzida no grupo Piracar. Dos tratamentos estudados, o grupo EG foi o que mais se destacou pelo aumento significativo das proteínas ERK e STAT, e aparente melhora na reserva metabólica pela quantidade elevada de ATP disponível, enquanto os demais grupos e nas demais formas de análises foram semelhantes ou com resultados inferiores / Abstract: Acute myocardial infarction (AMI) still the major cause of morbidity and mortality in adults, causing myocardial ischemia followed by lesions of reperfusion. In the present study, we studied cardioprotection by 3 different strategies: the use of a so-called drug - Piracar ( Piracetam, L- carnitiva, glutamate and aspartate) using a solution containing erythropoietin, glucose, insulin and potassium (EG); by humoral and/modulation neurological called remote ischemic preconditioning (IPCR) . For this analysis we used the model of acute myocardial ischemia and reperfusion in pigs where hemodynamic variables were evaluated, quantification of infarct area, amount of troponin I released (cTnI) and adenosine triphosphate in the heart muscle (ATP). Were also studied proteins related to myocardial ischemia and reperfusion two-way known as the Survivor Activating Factor Enhancement (SAFE) Reperfusion Injury and Salvage Kinase Pathway (RISK) using Western blotting. We found greater activation of ERK proteins (p= 0,05) and STAT (p= 0,05) in the EG group and IPCR compared to the control, when comparing between the group that performed best was the EG, also with the amount significantly higher ATP. In group Piracar AKT (p= 0,05) was significantly activated compared to the other groups. No differences in hemodynamic analysis and the percentage of infarcted area. However, cTnI showed up high in the reperfusion phase in IPCR and EG group; and reduced in Piracar group. Of the treatments, the EG group was the one that stood out the significant increase in ERK and STAT proteins, and apparent improvement in metabolic reserve by the high amount of ATP available, while the other groups and other forms of analysis were similar or results below / Mestrado / Fisiopatologia Cirúrgica / Mestra em Ciências

Background: Myocardial infarction (MI), also known as heart attack, is the leading cause of morbidity and mortality among the heart diseases spectrum. It results from an insufficient supply of blood to the heart muscles. According to the United States (U.S.) Centers for Disease Control and Prevention (CDC), about 610 000 people die of heart disease in the U.S. every year. Myocardial infarction contributes 370 000 of these deaths annually. Every 40 seconds, someone in the U.S. experience heart attack. This burden is disproportionately distributed within the U.S. population. The rate of heart disease in Central Appalachia is 249 per 100 000, 42% higher than the national rate. Exploring further within the region, rural areas experience higher heart disease mortality rates; 27% higher than the region’s metro counties. According to 2018 America Health Ranking, the prevalence of heart attack in Tennessee is 5.9%, compared to the 4.9% nationwide, with the majority of the burden seen among adults aged ≥65 years and with a 1:1.8 female to male ratio. Patients with heart disease often have other comorbid conditions such as peripheral arterial disease (PAD), hypertension, diabetes, dyslipidemias, which contribute immensely to this chronic condition. Therefore, the aim of this study is to explore the association between cardiovascular comorbidities such as diabetes mellitus, hypertension and dyslipidemia, and the prevalence of heart attack among patients with PAD in rural Central Appalachia. Methods: We used a cross-sectional data of patients diagnosed with PAD in the Central Appalachian region. A total of 13455 patients with PAD were recruited using ICD 9 and 10 search terms for PAD from the electronic medical records (EMR) system between January 1, 2008, and April 30, 2018. Descriptive statistics of the variables were extracted. The association between the comorbidities, including hypertension, diabetes, dyslipidemia, body mass index(BMI) and the prevalence of MI was determined using a binomial logistic regression model. All analysis was done using IBM SPSS statistics 25. Results: Of the total 13455 patients with PAD, 3045 had MI (37.7% female and 62.3% male) with a mean age of 69±10.5years. While 93% had hypertension, 56% had diabetes. For the lipids, the mean of HDL, Cholesterol, and LDL among participants with a history of MI is 40.99mg/dl±13, 156.32mg/dl±45, 82.08mg/dl±36.35 respectively. The results of binomial logistic regression with stratification based on gender shows that female patients with diabetes had 86% increased odds of MI [OR: 1.858, C.I: 1.308-2.638, p-value=0.001), and for female hypertensives, 4.51 times increased odds of MI was found (C.I: 1.576-12.895, p-value=0.005). The male diabetics and hypertensives showed a similarly increased odds of MI with (OR 1.138, C.I: 0.870-1.489 p-value=0.345) and (OR 3.697C.I: 1.559-8.736, p-value=0.003) respectively. No significant association was found among the various lipid profiles examined. Conclusion: The results showed that female PAD patients with hypertension and diabetes have a significantly increased likelihood of having MI. In contrast, male with PAD also showed increased likelihood (although to a lesser degree) of MI in those with hypertension, but not those with diabetes. These findings underscore the importance of a proactive approach to preventive care and adequate control among PAD patients with diabetes and hypertension in a bid to curbing the morbidity and mortality associated with myocardial infarction among residents in Central Appalachia.

Bakgrund: I sjuksköterskans profession ingår att främja hälsa, förebygga sjukdom, återställa hälsa och lindra lidande. En hjärtinfarkt är en omtumlande händelse och flera tusen drabbas varje år, för en sådan kris saknar ofta människor beredskap. En hjärtinfarkt kan ge plötslig, svår smärta samt ångest och orsakas av stopp i ett kranskärl, vilket leder till syrebrist i hjärtat. Anhöriga kände ett stort ansvar och saknade information från sjukvården. De kände även en oro att deras närstående skulle drabbas av ännu en hjärtinfarkt. Syfte: Att beskriva kvinnor och mäns erfarenheter efter en hjärtinfarkt.  Metod: Resultatet av denna litteraturstudie utgjordes av tio kvalitativa artiklar identifierade i databasen PubMed.     Huvudresultat: Det framkom att flera konsekvenser upplevdes efter hjärtinfarkten, såsom utmattning, ångest, oro och rädsla för att drabbas igen, vilket gav begränsningar i livet. Efter hjärtinfarkten kunde livet präglas av en rädsla att anstränga det sjuka hjärtat och minskad tro på hjärtats förmåga. Vidare framkom behovet av mer information från sjukvården. Närstående visade sig ha stor betydelse för tillfrisknandet samt möjligheten att få träffa andra i samma situation. Hjärtinfarkten var för många en väckarklocka som gav insikt om det viktiga i livet och kunde motivera till livsstilsförändringar. Slutsats: Hjärtinfarkten medförde många konsekvenser. Trots en rädsla att anstränga det sjuka hjärtat kunde händelsen motivera till livsstilsförändring. Anhöriga var ett stort stöd i tillfrisknandet, dock fanns en önskan om mer stöd och information från sjukvården. Denna litteraturstudie kan ge vårdpersonalen ökad förståelse för erfarenheter efter en hjärtinfarkt samt bidra med kunskap om hur eftervården kan utformas. / Background: The nursing profession includes promoting health, preventing disease, restoring health and relieving suffering. A heart attack is a dizzying event and several thousand are affected every year, because such a crisis often leaves people unprepared. A heart attack can cause sudden, severe pain and anxiety and is caused by a blockage in a coronary artery, which leads to a lack of oxygen in the heart. Relatives felt a great responsibility and lacked information from the health service. They also felt a concern that their loved ones would suffer another heart attack.Aim: To describe women's and men's experiences after a heart attack.Method: The results of this literature review consisted of ten qualitative articles identified in the PubMed database.Main results: It turned out that several consequences were experienced after the heart attack, such as fatigue, anxiety, worry and fear of being hit again, which gave limitations in life. After the heart attack, life could be marked by a fear of straining the diseased heart and diminished belief in the heart's ability. Furthermore, the need for more information from the health service emerged. Relatives proved to be of great importance for recovery and the opportunity to meet others in the same situation. For many, the heart attack was an alarm clock that provided insight into the important things in life and could motivate them to make lifestyle changes.Conclusion: The heart attack had many consequences. Despite a fear of straining the sick heart, the event could motivate a lifestyle change. Relatives were a great support in the recovery, however, there was a desire for more support and information from the health care. This literature study can give the care staff an increased understanding of experiences after a heart attack and contribute with knowledge of how aftercare can be designed.

Wnt/β-catenin signaling is activated in the heart after myocardial infarction (MI). This study aims to investigate if β-catenin deletion affects post-MI ion channel gene alterations and ventricular tachycardias (VT). MI was induced by permanent ligation of left anterior descending artery in wild-type (WT) and cardiomyocyte-specific β-catenin knockout (KO) mice. KO mice showed reduced susceptibility to VT (18% vs. 77% in WT) at 8 weeks after MI, associated with reduced scar size and attenuated chamber dilation. qPCR analyses of both myocardial tissues and purified cardiomyocytes demonstrated upregulation of Wnt pathway genes in border and infarct regions after MI, including Wnt ligands (such as Wnt4) and receptors (such as Fzd1 and Fzd2). At 1 week after MI, cardiac sodium channel gene (Scn5a) transcript was reduced in WT but not in KO hearts, consistent with previous studies showing Scn5a inhibition by Wnt/β-catenin signaling. At 8 weeks after MI when Wnt genes have declined, Scn5a returned to near sham levels and K⁺ channel gene downregulations were not different between WT and KO mice. This study demonstrated that VT susceptibility in the chronic phase after MI is reduced in mice with cardiomyocyte-specific β-catenin deletion primarily through attenuated structural remodeling, but not ion channel gene alterations.

Unplanned readmissions to the hospital are a problem faced by most health care organizations in the United States; hospitals are penalized for such readmissions. The project site identified high readmission rates for patients who were discharged after acute myocardial infarction (AMI), making careful transition home a necessity for post-AMI patients. The focus of this quality improvement (QI) project was implementation of an early follow-up appointment of AMI patients following discharge. The purpose of this project was to evaluate the effectiveness of changing follow-up appointments for patients with an AMI from 14-30 days to 7-14 days post discharge to reduce unplanned readmission rates. Bandura’s self- efficacy theory provided the theoretical framework for this project. An evaluation of the QI project was completed by comparing patient readmission rates 6 months before and 6 months after implementation of the early follow-up appointments. Data analysis demonstrated that the readmission rate was not improved in the first 6 months post QI project implementation. Using the plan-do-check-act process, a multifactorial approach was recommended to refine the QI project and address the system-wide readmission rates. The implications of this project for positive social change include providing early analysis of the readmission QI project, which allowed the hospital to restructure the QI approach and improve the plan for preventing readmission.

L’objectif de ce travail est de présenter et évaluer une nouvelle méthode, PGRx,systématique cas-référents en pharmaco-épidémiologie avec son application à l’étudede l’infarctus du myocarde (IDM). Elle se distingue par la collecte systématique etcontinue de cas d’événements dans des centres spécialisés et d’un pool de référenceen médecine générale dont sont tirés les témoins appariés aux cas. L’évaluation durisque d’IDM associé au diclofénac (OR 1.5) et celle du bénéfice associé aux statines(OR 0.75) montrent des résultats similaires à ceux publiés (respectivement OR 1.4 etOR 0.74). Nous montrons que les référents sont un échantillon représentatif de lapopulation française en termes de motif de consultation et valide en termesd’évaluation de facteurs de risque. La concordance entre la mesure de l’exposition parla déclaration du patient et par les prescriptions médicales est excellente pour lesmédicaments cardiovasculaires (95%). Notre travail sur une série d’études montre quela collecte systématique de cas et d’un pool de référence, selon la méthode PGRx, estfaisable, reproductible et valide en termes de résultats et d’indicateurs de qualité. / The objective of this work is to present and assess PGRx, a new systematic case-referentsmethod in pharmacoepidemiology and its application on the study of themyocardial infarction (MI). The originality of PGRx is the systematic and on-goingcollect of cases of events in a network of specialized centres and of a pool of referentsin general practice (GP), from which controls are selected by matching to the cases.The assessment of the risk of MI associated with diclofenac (OR 1.5) and of thebenefit on MI associated with statins (OR 0.75) displays similar results than theliterature (respectively OR 1.4 and OR 0.74).We show that the pool of referents is arepresentative sample of the French population in terms of reasons of consulting a GPand valid in terms of risk factors’assessment. Agreement between the measure ofexposure from patients’ self-report and from physician’s report of their prescriptionsis excellent on cardiovascular drugs (95%). Our work, through several studies, showsthat the systematic collect of cases and of a reference pool by the PGRx method isfeasible, reproducible and valid in terms of results and quality indicators.

Le pronostic à long-terme actuel après un accident ischémique transitoire (AIT) ou un infarctus cérébral reste mal connu. Ainsi, j’ai déterminé les risques absolus à long-terme de récidive d’infarctus cérébral et d’évènement coronarien aigu après un AIT ou un infarctus cérébral et identifié les individus qui restent à haut risque absolu de récidive ischémique malgré la prévention secondaire actuelle.Dans une cohorte populationnelle contemporaine de patients ayant eu un AIT ou un infarctus cérébral (OXVASC study, 2002-2014), les risques absolus de récidive d’infarctus cérébral et d’infarctus du myocarde après un AIT/infarctus cérébral ont significativement diminué au cours de la période d’étude, très probablement du fait de l’amélioration de la prévention secondaire avec le temps. Cependant, malgré la prévention secondaire actuelle les sous-groupes de patients avec un antécédent de pathologie coronarienne et ceux sans antécédent coronaire mais avec un score Essen 4 sont exposés à un risque absolu de récidive d’évènement ischémique suffisamment élevé pour justifier d’une intensification du traitement. Néanmoins, les thérapeutiques de prévention secondaire futures nécessitent de permettre d’obtenir une réduction absolue du risque de récidive d’évènement ischémique importante pour compenser un risque augmenté d’effets indésirables ou de surcoût par rapport aux thérapeutiques actuelles. En effet, chez ces sous-groupes de patients à haut risque de récidive ischémique, une réduction plus intensive du taux de cholestérol avec les inhibiteurs des PCSK-9 parait tout à fait justifiée, cependant nous avons montré que le coût de ces traitements excède la limite du rapport coût-efficacité généralement accepté tandis que le bénéfice d’une majoration du traitement antithrombotique semble contrebalancé par l’augmentation du risque hémorragique extracrânien. / The current long-term prognosis after transient ischaemic attack (TIA) or ischaemic stroke is not well known. I aimed to determine the long-term absolute residual risks of recurrent stroke and coronary events after TIA or ischaemic stroke and identify individuals who remain at high absolute risk of recurrent ischaemic events despite current secondary prevention management.In a population-based cohort of consecutive TIA or ischaemic stroke patients (OXVASC study, 2002-2014), the overall absolute risks of recurrent ischaemic stroke and coronary events after TIA/ischaemic stroke have decreased over the study period, and are likely to be explained by the improvement of secondary prevention over time. However, despite current secondary prevention, the subgroups of patients with prior coronary artery disease and those without prior coronary artery disease but with an Essen score of 4 remain at sufficiently high absolute risk of recurrent ischaemic events to justify more intensive treatment. Nevertheless, future secondary prevention therapies would need to achieve a substantial absolute risk reduction to outweigh increased side effects or cost compared to current therapies. Indeed, in these high-risk subgroups, more intensive lipid-lowering therapies might be justified, but we showed that the total cost of PCSK-9 inhibitors seems to exceed the generally accepted cost-effectiveness threshold while benefit from increased antithrombotic treatment might be offset by the higher risk of extracranial bleeding.