Relationship of depression, anxiety, and social isolation to chronic heart failure outpatient mortality

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• 作者：Erika Friedmann ; Sue A. Thomas ; Fang Liu ; Patricia G. Morton ; Deborah Chapa ; Stephen S. Gottlieb
• 关键词：Alzheimer’ ; s disease ; Dementia ; Education ; Occupation ; Cognitive activities ; Exercise ; Cholesterol ; Statins ; Head trauma ; Prevention
• 刊名：American Heart Journal
• 出版年：2006
• 出版时间：November 2006
• 年：2006
• 卷：152
• 期：5
• 页码：940.e1-940.e8
• 全文大小：132 K

文摘

Percutaneous coronary intervention (PCI) in nonemergent patients with coronary artery disease in hospitals without on-site cardiac surgery backup is still controversial. To prospectively evaluate a set of low procedural risk criteria for PCI, patients with stable or unstable angina were randomized to treatment in either a community hospital, which had all supportive services except for on-site cardiac surgery, or a regional surgical hospital 213 km away.

Methods and results

During a 4-year period, 609 (57 % ) of 1064 consecutive patients with stable or unstable angina who underwent coronary angiography at a teaching community hospital in Norway fulfilled the predefined low-risk criteria for PCI. The patients were randomized to treatment at either the community hospital (n = 305) or at the regional hospital (n = 304). The angiographic success rate (96 % at both hospitals) and number of major periprocedural complications (overall 0.3 % ) were equal at the 2 hospitals. In particular, there were no deaths or need for urgent transfer to cardiac surgery. At 6 months of clinical follow-up, there was a significant higher major adverse cardiac event rate rate at the community hospital, compared with the regional hospital (6.9 % vs 2.3 % , respectively, P = .03) because of more repeat target vessel revascularizations. Improvement in angina functional class and exercise capacity was similar in both groups. The excluded high-risk PCI patients had higher 6-month major adverse cardiac event compared with all low-risk patients (8.4 % vs 4.3 % , respectively, P = .01).

Conclusion

Selected nonemergent patients can, based on angiography, safely undergo PCI at hospitals without cardiac surgery backup. The angiographic selection criteria identified high-risk patients, which had worsened outcome at 6 months of follow-up.