Risk for major adverse cardiovascular events in hospitalized emergency department

Kessler, J. (Joanne) (2015) Risk for major adverse cardiovascular events in hospitalized emergency department. thesis, Medicine.

Text KesslerJ.pdf Restricted to Registered users only Download (422kB)

Abstract

Infections have been associated with a higher risk of major adverse cardiovascular events (MACE), but the relevance for the emergency department (ED) setting is unclear. Clinical policy might have to be adjusted if hospitalization with an infection results in a higher chance for MACE. Therefore, we investigated if hospitalized ED patients with a suspected infection have an increased risk for MACE and the time between the onset of the symptoms of the infection or ED admission and the onset of MACE. This was a quasi-experimental study using an existing database in which consecutive hospitalized ED patients with a suspected infection were prospectively enrolled. In all included patients, the incidences of MACE in the 90-day period before and the 90-day period after hospital admission were retrospectively compared. The primary outcome MACE was defined as acute coronary syndrome, sudden cardiac death, resuscitation with ventricular tachycardia or fibrillation as first rhythm, ischemic stroke, transient ischemic attack and acute peripheral ischemia. The incidence ratio was calculated by dividing the percentage of MACE before and after hospital admission, and p-value using the McNemar test. Secondarily, we determined the duration till the onset of MACE, with T=0 as the start of symptoms of the infection and T=0 at ED admission. 1728 patients were included. The incidence of MACE increased from 15 of 1728 patients (0.08% 95%-CI 0.4-1.3) in the 90-day period before hospital admission, to 36 of 1728 patients (2.1% CI 1.4-2.8) in the 90-day period after hospital admission (P=0.005). Incidence ratio was 2.4 (95% CI 1.3-4.3). The median time to onset of MACE was 5 days after onset of the infection episode (IQR 1.7-11.3), and 1 day after ED admission (IQR 0- 4.8). The present study shows that hospitalized ED patients with a suspected infection have an increased incidence of a MACE. MACE occurs mostly 5 days after the start of an infection episode, and 1 day after ED admission. Future studies should investigate whether MACE after hospital admission with an infection can be predicted at the time of ED presentation.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Majoor, Drs. J.W.M. MD
Supervisor name:	Second supervisor: and Groot, Dr. B. de MD and Location: Leiden University Medical Centre (LUMC) and Emergency Department (ED)
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:56
Last Modified:	25 Jun 2020 10:56
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1664

Actions (login required)

View Item