Medicine and Health Sciences Commons^™

Body Mass Index, Treatment Practices, And Mortality In Patients With Acute Heart Failure, Timothy Fitzgibbons, Olga Hardy, Darleen Lessard, Joel Gore, Jorge Yarzebski, Robert Goldberg

Jorge L. Yarzebski

OBJECTIVES: Obesity is associated with an increased risk of heart failure (HF). Among patients presenting with acute HF, however, differences in clinical characteristics, treatment regimens, and short-term prognosis of varying weights are largely unknown, particularly from a broader population-based perspective. METHODS: A total of 3722 patients admitted with acute HF to 11 greater Worcester (Massachusetts, USA) hospitals during 1995 and 2000 were categorized as being lean (n = 216), normal weight (n = 1465), overweight (n = 1007), or obese (n = 1034) at the time of hospitalization. RESULTS: Obese patients with decompensated HF were significantly younger (mean age = …

Prognosis Of Acute Myocardial Infarction Complicated By Complete Heart Block (The Worcester Heart Attack Study), Robert Goldberg, Juan Zevallos, Jorge Yarzebski, Joseph Alpert, Joel Gore, Z. Chen, James Dalen

Jorge L. Yarzebski

As part of a community-based study of patients hospitalized with acute myocardial infarction (AMI) in the Worcester, Massachusetts, metropolitan area, changes over time in the incidence rates of complete heart block (CHB) complicating AMI, and the prognostic impact of CHB on the in-hospital and long-term survival of these patients were examined. In all, 4,762 patients with validated AMI hospitalized at 16 hospitals in the Worcester metropolitan area during 1975, 1978, 1981, 1984, 1986 and 1988 constituted the study sample. The incidence rates of CHB complicating AMI remained relatively stable at 5.8% over the 13-year (1975 to 1988) period studied. The …

Temporal Trends (1975 Through 1990) In The Incidence And Case-Fatality Rates Of Primary Ventricular Fibrillation Complicating Acute Myocardial Infarction. A Communitywide Perspective, David Chiriboga, Jorge Yarzebski, Robert Goldberg, Joel Gore, Joseph Alpert

Jorge L. Yarzebski

BACKGROUND: As part of a population-based study of acute myocardial infarction, we examined changes over time in the incidence and in-hospital case-fatality rates of primary ventricular fibrillation complicating acute myocardial infarction. METHODS AND RESULTS: Patients with validated acute myocardial infarction hospitalized at 16 hospitals in the Worcester, Mass, metropolitan area between 1975 and 1990 comprised the study sample. During the 15-year study period, 5.1% of patients developed primary ventricular fibrillation in the setting of uncomplicated acute myocardial infarction, with this rate remaining relatively constant over time. Both age- and multivariable-adjusted analyses showed no significant trend in the incidence rates of …

A Community-Wide Perspective Of Gender Differences And Temporal Trends In The Use Of Diagnostic And Revascularization Procedures For Acute Myocardial Infarction, David Chiriboga, Jorge Yarzebski, Robert Goldberg, Z. Chen, Jerry Gurwitz, Joel Gore, Joseph Alpert, James Dalen

Jorge L. Yarzebski

This study compares the overall use, as well as temporal trends, of various diagnostic and revascularization procedures for acute myocardial infarction (AMI) in men and women. The study sample comprised a total of 2,924 men and 1,838 women with validated AMI admitted to any of the 16 teaching and community hospitals in the Worcester, Massachusetts, metropolitan area during 1975, 1978, 1981, 1984, 1986 and 1988. During the period under study there was a significant increase in use of each of the examined procedures during hospitalization for AMI in both men and women. Increasing use of multiple procedures was also seen …

Decade-Long Trends And Factors Associated With Time To Hospital Presentation In Patients With Acute Myocardial Infarction: The Worcester Heart Attack Study, Robert Goldberg, Jorge Yarzebski, Darleen Lessard, Joel Gore

Jorge L. Yarzebski

BACKGROUND: Duration of prehospital delay in patients with acute myocardial infarction (AMI) is receiving increasing attention given the time-dependent benefits associated with prompt use of coronary reperfusion strategies. OBJECTIVE: To examine trends (1986-1997) in time to hospital presentation and factors associated with prolonged delay in a community-wide study of patients with AMI. METHODS: Longitudinal study of 3837 residents of the Worcester, Mass, metropolitan area hospitalized with AMI in 7 one-year periods between 1986 and 1997 in whom information about prehospital delay was available. RESULTS: The mean, median, and distribution of delay times exhibited either inconsistent or no changes over time. …

Multidecade-Long Trends (1986-2005) In The Utilization Of Coronary Reperfusion And Revascularization Treatment Strategies In Patients Hospitalized With Acute Myocardial Infarction: A Community-Wide Perspective, Jared Wasser, Robert Goldberg, Frederick Spencer, Jorge Yarzebski, Joel Gore

Jorge L. Yarzebski

OBJECTIVES: The objectives of our community-wide investigation were to describe multidecade-long trends (1986-2005) in the utilization of thrombolytic therapy, percutaneous coronary interventions, and coronary artery bypass graft surgery in patients hospitalized with acute myocardial infarction (AMI). METHODS: The study sample consisted of 9422 greater Worcester (MA) residents hospitalized with confirmed AMI at all metropolitan Worcester medical centers in 11 annual periods between 1986 and 2005. RESULTS: Increases in the utilization of percutaneous coronary interventions were observed between 1986 (2.0%) and 2005 (50.7%) with the most rapid increases beginning in the late 1990s. Utilization of coronary artery bypass graft surgery during …

Use Of Aspirin, Beta-Blockers, And Lipid-Lowering Medications Before Recurrent Acute Myocardial Infarction: Missed Opportunities For Prevention, Danny Mccormick, Jerry Gurwitz, Darleen Lessard, Jorge Yarzebski, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: For patients who have had a previous myocardial infarction (MI), the use of aspirin, beta-blockers, and lipid-lowering agents reduces the risk of recurrent MI and death. OBJECTIVE: To examine trends in and determinants of receipt of these 3 medications before hospitalization for recurrent acute MI (AMI). METHODS: The study population consisted of 1710 patients with a previous history of MI hospitalized with a validated recurrent AMI in all hospitals in Worcester, Mass, during 1986, 1988, 1990, 1991, 1993, and 1995. Logistic regression analyses were used to assess the effect of demographic, clinical, and temporal factors on the receipt of …

Temporal Trends And Factors Associated With Extent Of Delay To Hospital Arrival In Patients With Acute Myocardial Infarction: The Worcester Heart Attack Study, Jorge Yarzebski, Robert Goldberg, Joel Gore, Joseph Alpert

Jorge L. Yarzebski

Factors associated with delay to hospital arrival after the onset of symptoms suggestive of acute myocardial infarction (AMI) were examined in the late 1960s and 1970s, but recent data concerning these characteristics are limited. The purpose of the present study was to examine overall and temporal distributions of the extent of patients' delay from the time of onset of AMI symptoms to hospital arrival and factors associated with delay in seeking medical care from a multihospital, population-based perspective. Review of medical records was undertaken of patients hospitalized with a discharge diagnosis of AMI in 16 teaching and community hospitals in …

Trends In Prehospital Delay In Patients With Acute Myocardial Infarction (From The Worcester Heart Attack Study)., Jane Saczynski, Jorge Yarzebski, Darleen Lessard, Frederick Spencer, Jerry Gurwitz, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

Delay in seeking medical care after symptom onset in patients with an acute myocardial infarction (AMI) is related to increased morbidity and mortality. Duration of prehospital delay in patients hospitalized with AMI has not been well characterized over time, and potentially changing patient characteristics associated with prolonged delay are not well understood. The study sample consisted of 5,967 residents (mean age 76 years; 39% women) of the Worcester, Massachusetts, metropolitan area hospitalized with AMI in 11 annual periods from 1986 to 2005. Mean and median delay times have remained essentially unchanged during the past 2 decades. Mean and median prehospital …

Patient Delay And Receipt Of Thrombolytic Therapy Among Patients With Acute Myocardial Infarction From A Community-Wide Perspective, Robert Goldberg, Jerry Gurwitz, Jorge Yarzebski, J. Landon, Joel Gore, Joseph Alpert, P. Dalen, James Dalen

Jorge L. Yarzebski

The duration of patient delay from the time of onset of symptoms of acute myocardial infarction (AMI) to hospital presentation, and the relation of delay time and various patient characteristics to receipt of thrombolytic therapy were examined as part of a community-based study of patients hospitalized with AMI in the Worcester, Massachusetts, metropolitan area. In all, 800 patients with validated AMI hospitalized at 16 hospitals in the Worcester metropolitan area in 1986 and 1988 constituted the study sample. Patients delayed on average 4 hours between noting symptoms suggestive of AMI and presenting to area-wide emergency departments with no significant change …

Decade-Long Changes In The Use Of Combination Evidence-Based Medical Therapy At Discharge For Patients Surviving Acute Myocardial Infarction, Frederick Spencer, Darleen Lessard, Jorge Yarzebski, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: Current practice guidelines suggest routine use of several effective cardiac medications in hospital survivors of acute myocardial infarction (AMI). The objectives of our population-based study were to describe decade-long trends (1990-2001) in the use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, lipid-lowering agents, and combinations thereof, in patients discharged from all metropolitan Worcester (Mass) hospitals after AMI. METHODS: The study sample consisted of 5965 adult men and women of all ages discharged after AMI from all greater Worcester hospitals in 7 annual periods between 1990 and 2001. RESULTS: Although consistent increases in the use of each of the effective cardiac …

Changes Over Time In The Incidence And Case-Fatality Rates Of Primary Ventricular Fibrillation Complicating Acute Myocardial Infarction: Perspectives From The Worcester Heart Attack Study, Craig Thompson, Jorge Yarzebski, Robert Goldberg, Darleen Lessard, Joel Gore, James Dalen

Jorge L. Yarzebski

BACKGROUND: Limited population-based data are available that describe temporal and recent trends in the incidence and case-fatality rates in patients with primary ventricular fibrillation (VF) complicating acute myocardial infarction (AMI). The purpose of this study was to describe changes over a 22-year period (1975 through 1997) in the incidence and hospital case-fatality rates of primary VF complicating AMI from a multihospital, community-wide perspective. METHODS AND RESULTS: This was an observational study of metropolitan Worcester residents hospitalized with a validated uncomplicated AMI (n = 5020) in all hospitals in the Worcester, Massachusetts, metropolitan area (1990 census population = 437,000) during 11 …

Twenty-Two Year (1975 To 1997) Trends In The Incidence, In-Hospital And Long-Term Case Fatality Rates From Initial Q-Wave And Non-Q-Wave Myocardial Infarction: A Multi-Hospital, Community-Wide Perspective, Mark Furman, Harold Dauerman, Robert Goldberg, Jorge Yarzebski, Darleen Lessard, Joel Gore

Jorge L. Yarzebski

OBJECTIVES: The goal of this study was to examine long-term trends in the incidence, in-hospital and long-term mortality patterns in patients with an initial non-Q-wave myocardial infarction (NQWMI) as compared with those with an initial Q-wave myocardial infarction (QWMI). BACKGROUND: Limited data are available describing trends in the incidence and mortality from an initial QWMI and NQWMI from a multi-hospital community-wide perspective. METHODS: Our study was an observational study of 5,832 metropolitan Worcester, Massachusetts residents (1990 census = 437,000) hospitalized with validated initial acute MI in all greater Worcester hospitals during 11 annual periods between 1975 and 1997. RESULTS: The …

Delays In Seeking Medical Care In Hospitalized Patients With Decompensated Heart Failure, Robert Goldberg, Jordan Goldberg, Sean Pruell, Jorge Yarzebski, Darleen Lessard, Frederick Spencer, Joel Gore

Jorge L. Yarzebski

PURPOSE: The magnitude of, and factors associated with, prolonged delay in seeking medical care in patients with acute myocardial infarction has been well described. It is unknown, however, what the extent of, and factors associated with, prehospital delay are in patients hospitalized with acute heart failure. The purpose of this study was to examine patterns of prehospital delay, and factors associated with delay in seeking medical care, in patients hospitalized with acute heart failure at all 11 medical centers in the Worcester, Massachusetts metropolitan area. METHODS: The medical records of 2587 greater Worcester residents with decompensated heart failure who were …

Gender Differences And Factors Associated With The Receipt Of Thrombolytic Therapy In Patients With Acute Myocardial Infarction: A Community-Wide Perspective, Jorge Yarzebski, Nananda Col, Paul Pagley, Judith Savageau, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

In spite of national interest in gender differences in the presentation and management of chronic disease, limited information is available about possible gender differences in the receipt of thrombolytic therapy after acute myocardial infarction (AMI). As part of an ongoing community-based study of AMI, we examined gender differences in the receipt of thrombolytic therapy among 2885 patients with confirmed AMI. The study sample consisted of 1680 males and 1205 females with validated AMI who were admitted to 16 hospitals in the Worcester, Massachusetts, metropolitan area in four study periods between 1986 and 1991. During the years under study, 24.4% of …

Changing Trends In The Long-Term Prognosis Of Patients With Acute Myocardial Infarction: A Population-Based Perspective, Naomi Botkin, Frederick Spencer, Robert Goldberg, Darleen Lessard, Jorge Yarzebski, Joel Gore

Jorge L. Yarzebski

BACKGROUND: Little contemporary data exist describing changes over time in the postdischarge prognosis of hospital survivors of acute myocardial infarction (AMI). The purpose of our study was to examine recent and multidecade-long (1975-2001) trends in the long-term prognosis of greater Worcester (MA) residents discharged from all metropolitan Worcester hospitals after confirmed AMI.

METHODS: A total of 9827 greater Worcester residents with independently validated AMI discharged from all metropolitan Worcester hospitals during 13 annual periods between 1975 and 2001 comprised the study population. A variety of follow-up approaches were used to ascertain the survival status of discharged patients through the end …

A Communitywide Perspective Of Sex Differences And Temporal Trends In The Incidence And Survival Rates After Acute Myocardial Infarction And Out-Of-Hospital Deaths Caused By Coronary Heart Disease, Robert Goldberg, Edward Gorak, Jorge Yarzebski, David Hosmer, Priscilla Dalen, Joel Gore, Joseph Alpert, James Dalen

Jorge L. Yarzebski

BACKGROUND: The purpose of the study was to examine overall differences and temporal trends therein between men and women regarding the incidence rates, in-hospital and long-term survival after initial acute myocardial infarction (AMI), and out-of-hospital deaths caused by coronary disease.

METHODS AND RESULTS: This nonconcurrent prospective study was carried out in 16 teaching and community hospitals in Worcester, Mass., in six time periods between 1975 and 1988. A total of 3,148 patients hospitalized with validated initial AMI comprised the study sample. The age-adjusted incidence rates of initial AMI increased between 1975 and 1981 in the two sexes, with a marked …

The Opposite Effects Of Acute And Chronic Alcohol On Lipopolysaccharide-Induced Inflammation Are Linked To Irak-M In Human Monocytes, Pranoti Mandrekar, Shashi Bala, Donna Catalano, Karen Kodys, Gyongyi Szabo

Gyongyi Szabo

Impaired host defense after alcohol use is linked to altered cytokine production, however, acute and chronic alcohol differently modulate monocyte/macrophage activation. We hypothesized that in human monocytes, acute alcohol induces hyporesponsiveness to LPS, resulting in decreased TNF-alpha, whereas chronic alcohol increases TNF-alpha by sensitization to LPS. We found that acute alcohol increased IL-1R-associated kinase-monocyte (IRAK-M), a negative regulator of IRAK-1, in human monocytes. This was associated with decreased IkappaB alpha kinase activity, NFkappaB DNA binding, and NFkappaB-driven reporter activity after LPS stimulation. In contrast, chronic alcohol decreased IRAK-M expression but increased IRAK-1 and IKK kinase activities, NFkappaB DNA binding, and …

Mechanisms Of Altered Monocyte Prostaglandin E2 Production In Severely Injured Patients, Carol Miller-Graziano, Mitchell Fink, Jia-Yan Wu, Gyongyi Szabo, Karen Kodys

Gyongyi Szabo

Monocytes from immunosuppressed trauma (11 patients) and burn (12 patients) patients stimulated with muramyl dipeptide, a potent prostaglandin E2 (PGE2) secretagogue, showed twofold greater PGE2 production compared with normal controls or immunocompetent patients. Monocyte plasminogen activator production was markedly depressed and inversely correlated to patients' monocyte hyper PGE2 production. Levels of the PGE2-producing monocyte subset (selected as high-affinity Fc+ receptors) were progressively elevated after injury in immunosuppressed patients, reaching 65% to 80% of the total monocyte population (39% for normal controls). Although early T-suppressor (Ts) lymphocytes did not augment monocyte PGE2 secretion, Ts lymphocytes that appeared late (greater than 12 …

Induction Of Transforming Growth Factor-Beta And Prostaglandin E2 Production By Ethanol In Human Monocytes, Gyongyi Szabo, Bikash Verma, Miklos Fogarasi, Donna Catalano

Gyongyi Szabo

To test our hypothesis that monocytes (M phi) and their mediators are major contributors to ethanol-related immunodepression, the modulating capacity of acute ethanol treatment was assessed on the production of transforming growth factor-beta (TGF beta) and prostaglandin E2 (PGE2) by human peripheral blood M phi. We demonstrate that acute in vitro treatment of adherent M phi with either 50 or 150 mM ethanol induced a significant increase in the production of TGF beta (P < 0.045 and P < 0.001, respectively). Furthermore, M phi pretreatment with both 50 and 150 mM ethanol augmented TGF beta production in response to subsequent stimulation with …

Fcgammar Cross-Linking Mediates Nf-Kappab Activation, Reduced Antigen Presentation Capacity, And Decreased Il-12 Production In Monocytes Without Modulation Of Myeloid Dendritic Cell Development, Yvonne Drechsler, Sangeeta Chavan, Donna Catalano, Pranoti Mandrekar, Gyongyi Szabo

Gyongyi Szabo

Stimulation of monocytes (MO) through receptors for the Fc region of immunoglobulin G (FcgammaR) activates a variety of responses, including phagocytosis, antibody (Ab)-dependent cellular cytotoxicity, and production of cytokines. We previously reported that the MO subpopulation that expresses FcgammaR in high density produces high levels of tumor necrosis factor alpha (TNF-alpha) compared with FcgammaR-negative MO. Here, we show that cross-linking MO via FcgammaRI or FcgammaRII but not via FcgammaRIII activates nuclear regulatory factor-kappaB (NF-kappaB), a transcription factor involved in regulation of TNF-alpha. NF-kappaB activation peaked at 2.75 h after FcgammaRI cross-linking, involved p65 and p50 (heterodimer) and not c-rel-containing NF-kappaB …