Mailikezhati Maimaitiming

Background Cardiogenic shock (CS) is a serious complication of acute myocardial infarction (AMI), which could lead to severe health loss. This systematic review aimed to analyze the risk factors related to the incidence and poor outcomes of cardiogenic shock after acute myocardial infarction (AMI-CS), including in-hospital death, 30-day death and 1-year death. Methods Original studies were systematically searched in PubMed and Embase up to November 2022. The summary odds ratio (OR) and 95% confidence interval (CI) of all studies were acquired based on a random effect model or fixed effect model. Subgroup analyses were conducted according to the study design, followed by sensitive analyses. The protocol was registered on PROSPERO (registration number: CRD42023466123). Results There are 25 studies enrolled, including 12 cross-sectional studies, ten retrospective cohort studies, and three case-control studies. The pooled results reveal that female sex (OR, 1.10; 95% CI, 1.09-1.11), advanced age (OR, 1.06; 95% CI, 1.03-1.09), smoking (OR, 1.36; 95% CI, 1.26-1.45), diabetes (OR, 1.45; 95% CI, 1.08-1.82), and ST-segment elevation myocardial infarction (STEMI; OR, 1.99; 95% CI, 1.34-2.63) are significantly associated with the development of AMI-CS. Among these factors, all except smoking increase the risk of in-hospital death among AMI-CS patients. Advanced age (OR, 1.08; 95% CI, 1.04-1.12) and diabetes (OR, 1.77; 95% CI, 1.25-2.29) have negative impacts on 30-day death, while advanced age (OR, 2.10; 95% CI, 1.70-2.50) and STEMI (OR, 1.55; 95% CI, 1.15-1.95) are associated with 1-year death. Conclusions Our findings highlight the significance of risk factors in predicting the incidence and prognosis of AMI-CS. Early identification and targeted interventions for individuals with these risk factors could potentially help prevent the occurrence of AMI-CS and improve patient outcomes.

Malaria is a major public health challenge worldwide, especially in sub-Saharan Africa (SSA), where the malaria disease burden remains the highest globally. In 2022, the SSA region accounted for 95% of total malaria cases; the deaths in this region reached 580 000, and four SSA countries accounted for approximately half of the global mortality [1]. At […]

Background and purpose: Disease burden of non-communicable diseases (NCDs) has been increasing in low- and middle-income countries, especially in African countries. Cardiovascular disease (CVD) is a common NCDs and the leading cause of death in Africa. Yet, evidence on the contribution of CVD to the total NCDs burden is scarce. This study aimed to investigate the contribution of CVD to the total disease burden caused by NCDs in Africa between 1990 and 2019. Methods: Data on NCDs, including CVD, were extracted from the Global Burden of Disease (GBD) database. Disease burden was measured by disability-adjusted life years (DALYs) and deaths. Results: From 1990 to 2019, the share of CVD in the total NCDs burden increased and remained as the first contributor. In 2019, NCDs caused 204 million DALYs and over 2.18 million deaths in the Africa Union, among which 49.1% of the total DALYs and 66.0% of deaths were caused by the traditional five NCDs, including CVD that accounted for the largest burden of NCDs (20.5% of DALYs and 35.2% of deaths). The proportion of CVD to the total NCDs burden was most considerable, reaching up to 32.4% and 52.4% in Northern Africa for DALYs and deaths, respectively. CVD were important contributors to NCDs burden in Africa, including ischemic heart disease (1334 DALYs per 100,000 and 27.79 deaths per 100,000) and intracerebral hemorrhage (632 DALYs per 100,000 and 13.53 deaths per 100,000) that were the top two causes of NCDs in 2019. Conclusions: CVD has been the biggest contributor to NCDs burden in the Africa Union over the thirty years. Given the increase in the share of NCDs burden attributable to CVD, it demands a close attention to implementing cost-effective policies and interventions for CVD to achieve an improvement in population health and reduction of health loss from NCDs.

Background: Acute coronary syndrome (ACS) is the most time-sensitive acute cardiac event that requires rapid dispatching and response. The medical priority dispatch system (MPDS), one of the most extensively used types of emergency dispatch systems, is hypothesized to provide better-quality prehospital emergency treatment. However, few studies have revealed the impact of MPDS use on the process of ACS care. Objective: This study aimed to investigate whether the use of MPDS was associated with higher prehospital diagnosis accuracy and shorter prehospital delay for patients with ACS transferred by an emergency medical service (EMS), using a national database in China. Methods: This retrospective analysis was based on an integrated database of China’s MPDS and hospital registry. From January 1, 2016, to December 31, 2020, EMS-treated ACS cases were divided into before MPDS and after MPDS groups in accordance with the MPDS launch time at each EMS center. The primary outcomes included diagnosis consistency between hospital admission and discharge, and prehospital delay. Multivariable logistic regression and propensity score–matching analysis were performed to compare outcomes between the 2 groups for total ACS and subtypes. Results: A total of 9806 ACS cases (3561 before MPDS and 6245 after MPDS) treated by 43 EMS centers were included. The overall diagnosis consistency of the after MPDS group (Cohen κ=0.918, P<.001) was higher than that of the before MPDS group (Cohen κ=0.889, P<.001). After the use of the MPDS, the call-to-EMS arrival time was shortened in the matched ACS cases (20.0 vs 16.0 min, P<.001; adjusted difference: –1.67, 95% CI –2.33 to –1.02; P<.001) and in the subtype of ST-elevation myocardial infarction (adjusted difference: –3.81, 95% CI –4.63 to –2.98, P<.001), while the EMS arrival-to-door time (20.0 vs 20.0 min, P=.31) was not significantly different in all ACS cases and subtypes. Conclusions: The optimized use of MPDS in China was associated with increased diagnosis consistency and a reduced call-to-EMS arrival time among EMS-treated patients with ACS. An emergency medical dispatch system should be designed specifically to fit into different prehospital modes in the EMS system on a regional basis.

Objective To evaluate changes in admission rates for and quality of healthcare of ST-segment-elevation myocardial infarction (STEMI) during the period of the COVID-19 outbreak and postoutbreak. Methods We conducted a retrospective study among patients with STEMI in the outbreak time and the postoutbreak time. Design To examine the changes in the admission rates and in quality of healthcare, by comparison between periods of the postoutbreak and the outbreak, and between the postoutbreak and the corresponding periods. Setting Data for this analysis were included from patients discharge diagnosed with STEMI from all the hospitals of Suzhou in each month of the year until the end of July 2020. Participants 1965 STEMI admissions. Primary and secondary outcome measures The primary outcome was the number of moecondary outcomnthly STEMI admissions, and the secondary outcomes were the quality metrics of STEMI healthcare. Results There were a 53% and 38% fall in daily admissions at the phase of outbreak and postoutbreak, compared with the 2019 corresponding. There remained a gap in actual number of postoutbreak admissions at 306 and the predicted number at 497, an estimated 26 deaths due to STEMI would have been caused by not seeking healthcare. Postoutbreak period of 2020 compared with corresponding period of 2019, the percentage of cases transferred by ambulance decreased from 9.3% to 4.2% (p=0.013), the door-to-balloon median time increased from 17.5 to 34.0 min (p=0.001) and the rate of percutaneous coronary intervention (PCI) therapy declined from 71.3% to 60.1% (p=0.002). Conclusions The impact of public health restrictions may lead to unexpected out-of-hospital deaths and compromised quality of healthcare for acute cardiac events. Delay or absence in patients should be continuously considered avoiding the secondary disaster of the pandemic. System delay should be modifiable for reversing the worst clinical outcomes from the COVID-19 outbreak, by coordination measures with focus on the balance between timely PCI procedure and minimising contamination of cardiac catheterisation rooms.