Early statin therapy in elderly patients presenting with acute coronary syndrome causing less heart failure.

Objectives: Elderly patients are less likely to receive statin therapy because of concerns about their side-effects. However, 80% of deaths related to coronary heart disease occur in patients above the age of 65 years. This study evaluated the potential benefit of early administration of statins in elderly patients presenting with an acute coronary syndrome.

Smoking cessation in patients with acute coronary syndrome.

BACKGROUND, In patients with acute coronary syndrome, smoking cessation rates, demographics, and management strategies havenot been well described. We hypothesized that hospitalized patients with acute coronary syndrome would have higher smoking cessation rates than other currently available therapies. In-hospital counseling and referral to cardiac rehabilitation may further improve cessation rates.

Electrocardiographic abnormalities and sudden death in myotonic dystrophy type 1.

Background: Sudden death can occur as a consequence of cardiac-conduction abnormalities in the neuromuscular disease myotonic dystrophy type 1. The determinants of the risk of sudden death remain imprecise.

Methods: We assessed whether the electrocardiogram (ECG) was useful in predicting sudden death in 406 adult patients with genetically confirmed myotonic dystrophy type 1.

Brugada syndrome in the presence of coronary artery disease and parasympathomimetic drug therapy.

Brugada pattern ECG changes have been described in various disease states and drug therapies, including electrolyte abnormalities, myocardial pathology, medications, and mechanical abnormalities. Therefore, the diagnosis of Brugada syndrome cannot be made in the presence of confounding variables according to prevailing guidelines. We present a case report which illustrates two important principles regarding Brugada syndrome, the dynamic ECG manifestations and the elimination of confounding variables (in this case significant coronary artery disease and cholinergic pharmacotherapy) prior to definitive diagnosis.

Prognostic value of transient and sustained increase in in-hospital creatinine on outcomes of patients admitted with acute coronary syndrome.

A history of renal insufficiency or increased creatinine level on admission is associated with poor outcomes in patients with acute coronary syndrome (ACS). This study sought to determine whether in-hospital worsening of renal function, either transient or sustained, is an independent risk factor for 6-month mortality in patients admitted with ACS. A total of 1,417 patients admitted with ACS from June 2000 to May 2003 were reviewed.

A quality guarantee in acute coronary syndromes: the American College of Cardiology's Guidelines Applied in Practice program taken real-time.

Background: Wide variation exists in the management of acute coronary syndromes (ACSs), which includes an apparent underutilization of evidence-based therapies. We have previously demonstrated that application of the American College of Cardiology Guidelines Applied in Practice (GAP) tools can improve quality indicator rates and outcomes of patients hospitalized with ACS.

Objective: To determine whether a real-time system for monitoring key quality-of-care indicators using GAP would improve both process indicators and outcomes beyond those of the initial implementation of GAP.

Adherence to medications by patients after acute coronary syndromes.

Background: Nonadherence to medication may lead to poor medical outcomes.

Objective: To describe medication-taking behavior of patients with a history of acute coronary syndromes (ACS) for 4 classes of drugs and determine the relationship between self-reported adherence and patient characteristics.

Methods: Consenting patients with the diagnosis of ACS were interviewed by telephone approximately 10 months after discharge.

Comparison of outcomes in acute coronary syndrome in patients receiving statins within 24 hours of onset versus at later times.

The clinical benefits of statins in acute coronary syndromes are well established, but the optimal time for administration in this setting has not been well studied. In this study, patients who had acute coronary syndrome and received statins <24 hours of presentation had lower incidences of death, stroke, reinfarction, heart failure, and pulmonary edema compared with delayed administration. Prompt administration of statins appears to be significantly beneficial in patients who present with an acute coronary syndrome.