The Northern and Central Vietnam Heart attack study

摘要 尽管越南是一个中低收入国家，但它一直在经历流行病的转变 与非传染性疾病日益流行的发展中国家的情况类似。根据 最新的国家报告显示，约27,000人死于冠心病 2010年越南成年人。没有当代的区域或国家数据来描述这一规模， 影响，或如何在越南男性或女性住院治疗有严重冠心病表现的冠心病。 尽管冠心病在发达国家的规模和影响相当大，但其发病率极其有限 现有的流行病学数据描述了这种发病率、死亡率和功能性功能丧失的不断增加的原因 在越南等发展中国家的地位，特别是从更普遍的角度来看 在社区范围内进行调查，并在最近几年。我们建议进行一项试验性研究，以发展一个人口- 越南北部和中部2个省(海防和清华；总计)的居民登记 人口：分别为180万和340万)因急性心肌梗死(AMI)在2岁时住院 2016年在这些地区设立省级医疗中心。拟议的观察性研究的总体目标是 描述急性心肌梗死的发病率、患者延迟就医的程度、频率 重要的住院临床并发症、住院和长期存活率以及再发的频率 医院治疗急性心肌梗死的住院情况和管理做法。纸质病历 这两个地区的居民因出院诊断为急性心肌梗死和相关的冠心病而住院 根据最新的信息，我们训练有素的研究人员将对药典进行个别审查和验证 对急性心肌梗死的普遍重新定义。这种模式将急性心肌梗死的发作分为几种类型，频率越高 1型心肌梗死(ST段抬高心肌梗死-STEMI或非ST段抬高心肌梗死-NSTEMI)和较少发生 2型心肌梗死(需求缺血)。我们预计将确认这两个省约1000名居民的身份 2016年因确诊的急性心肌梗死住院。关于患者的社会人口学特征的信息，医学 病史、临床体征和症状、就医行为、急性心肌梗死相关特征、医院治疗、 临床并发症，住院和出院后的生存和再入院状态将从 1型和2型急性心肌梗死患者的医院病历。符合条件的患者将通过 2017年底，用于确定死亡情况以及随后的心脏病住院和门诊就诊情况 以及与心脏无关的原因及其时机。死亡证明将在公社/地区办事处获得 和仔细审查，以记录出院病人的死亡日期和死因，并确定- 因冠心病导致的院内死亡。 鉴于在日益西化的人群中有关冠心病的数据极其有限，特别是来自 以人口为基础的调查的更普遍的观点，在当代时期， 对急性心肌梗死的临床流行病学、治疗和自然病史提供了重要的见解。 为更有效的二级预防划定要点。这项初步研究将是第一次 越南基于人群的冠心病监测项目是一项开创性的努力，将 提供数据，这些数据将用于创建必要的基础设施，以便开发并最终 持续对越南人群进行冠心病的长期监测。 这项研究将在越南河内公共卫生大学与Dr。 贝勒·斯科特和怀特健康公司的Hoa Nguyen和马萨诸塞大学的Robert Goldberg博士 医学院。美国国立卫生研究院资助心脏病社区监测基金(R01 HL 45434-26和R56HL45434)是一项以人口为基础的长期研究 马萨诸塞州伍斯特大都会地区住院居民冠心病监测项目 马萨诸塞州中部医疗中心有独立验证的急性心肌梗死。

ABSTRACT Although being a low-middle income country, Vietnam has been experiencing an epidemiologic transition to that of a developing country with an increasing prevalence of non-communicable diseases. According to the most recent national report, coronary heart disease (CHD) accounted for approximately 27,000 deaths among Vietnamese adults in 2010. No contemporary regional or national data are available describing the magnitude, impact, or how CHD is managed in Vietnamese men or women hospitalized with acute manifestations of CHD. Despite the considerable magnitude and impact of CHD in developed countries, there are extremely limited epidemiologic data available describing this increasing cause of morbidity, mortality, and loss of functional status in developing countries such as Vietnam, especially from the more generalizable perspective of a community-wide investigation and during recent years. We are proposing a pilot study to develop a population- based registry of residents from 2 provinces in northern and central Vietnam (Hai phong and Thanh hoa; total population: 1.8 and 3.4 million, respectively) hospitalized with acute myocardial infarction (AMI) at the 2 provincial medical centers in these areas during 2016. The overall aim of the proposed observational study is to describe the incidence rates of AMI, extent of patient's delay in seeking acute medical care, frequency of important in-hospital clinical complications, in-hospital and long-term survival rates and frequency of re- hospitalizations, and management practices used in the hospital treatment of AMI. The paper medical records of residents from these 2 areas hospitalized with a discharge diagnosis of AMI and related CHD diagnostic rubrics will be individually reviewed and validated by our trained research staff according to the updated Universal Redefinition of AMI. This schema classifies episodes of AMI into several types, the more frequent Type 1 MI (ST segment elevation AMI-STEMI or non-ST segment elevation AMI- NSTEMI) and less frequent Type 2 MI (demand ischemia). We anticipate identifying approximately 1,000 residents of these 2 provinces hospitalized with validated AMI in 2016. Information on patient's socio-demographic characteristics, medical history, clinical signs and symptoms, care seeking behavior, AMI associated characteristics, hospital therapies, clinical complications, and hospital and post-discharge survival and readmission status will be abstracted from hospital medical records for patients with Type 1 and Type 2 AMI. Eligible patients will be followed though the end of 2017 for purposes of identifying deaths as well as subsequent hospital and outpatient visits for cardiac and non-cardiac related reasons and their timing. Death certificates will be obtained at commune/district offices and carefully reviewed to record the date and cause of death for discharged patients as well as to identify out- of- hospital deaths due to CHD. Given the extremely limited data on CHD in this increasingly Westernized population, especially from the more generalizable perspective of a population-based investigation, and during a contemporary period, important insights would be provided into the clinical epidemiology of AMI, its management, and natural history to delineate points for more effective secondary prevention. This pilot study, which would be the first population-based surveillance project of CHD in Vietnam, represents a ground breaking endeavor that would provide data that would be used to create the necessary infrastructure for developing and eventually sustaining long-term surveillance of CHD in the Vietnamese population. This research will be carried out in Vietnam at the Hanoi University of Public Health in collaboration with Dr. Hoa Nguyen at Baylor Scott and White Health and Dr. Robert Goldberg from the University of Massachusetts Medical School. The companion NIH supported grant, Community Surveillance for Heart Disease (R01 HL 45434-26 and R56 HL45434) that the proposed study is modelled on, is a long-term population-based surveillance project of CHD among residents of the Worcester, MA, metropolitan area hospitalized at all central Massachusetts medical centers with independently validated AMI.