Cardiologia Croatica. 2024;19(5-6)

Zrinka Biloglav, Petar Medaković, Dominic Vidović, Diana Kovač, Dea Barać, Ivana Škrlec, Ivan Padjen, Matea Turudić, Domagoj Andrić, Antun Tonko Jakobović, Blanka Glavaš, Filip Relković, Stipe Radoš, Josip Ćurić, Nino Tićinović, Tatjana Ružić, Slavica Kovačić

Peripheral artery disease (PAD) is, along with ischemic heart disease and stroke, one of the three most significant diagnostic subgroups of cardiovascular diseases. According to prevalence estimates, the prevalence of PAD is 65. Analysis of the dynamics of PAD in the population has indicated a reduction of its incidence in EU15+ countries in the last 27 years, but with increasing mortality. The Republic of Croatia stands out among other Mediterranean countries due to its high cardiovascular burden, but there have been no systematic epidemiological studies on the dynamics of mortality from PAD. In the present study, regression analysis of age-standardized mortality rates due to PAD were used to show trends and timepoints with changes over time by region for the period from 2011 to 2020. The hospital information systems of two institutions were searched for diagnoses that are applied for coding PAD and related interventional and diagnostic procedures, supplemented by diagnoses used in previous studies. Data were obtained from the Croatian Institute of Public Health Mortality Database and were categorized five-year-interval age groups, by sex, and by county. The National Classification of Statistical Regions from 2019 was used for regional classification, and age-standardized rates were calculated based on the Revised European Standard Population from 2013. Mortality increased in both men (3.09%) and women (2.94%), and there were significant regional differences in this trend for men in Adriatic Croatia and for both sexes in Northern Croatia. In men, the greatest increase was observed in the City of Zagreb, namely 3.71%, whereas the lowest and also the only negative value was found in Northern Croatia, namely -0.24%. In women, the greatest increase was in the City of Zagreb, i.e. 3.57%, and the lowest in Northern Croatia at 1.67%. In addition to raising awareness, this study on mortality trends facilitates improving our understanding of the epidemiological dynamics of this insufficiently diagnosed and treated, complex, and chronic disease. Improving clinical care for patients with PAD can be achieved by systemic screening of individual and clinically relevant data at medical institutions and merging this data in regional and national registries.

Karla Savić, Mira Stipčević, Jogen Patrk, Dražen Zekanović, Marin Bištirlić

To emphasize the severe adverse effects of capecitabine and prevent misdiagnosis in patients with acute coronary syndrome. We present the case of a 74-year-old woman with pancreatic adenocarcinoma who presented to the hospital with capecitabine-induced acute coronary syndrome. She was admitted to the Emergency Department (ED) because of a squeezing chest pain episode. Treatment with oral capecitabine (2500 mg daily) was initiated 72 hours before admission. The patient had electrocardiographic (ECG) changes and positive biochemical markers for myocardial ischemia (including HS-troponin T) and was transferred to the coronary intensive care unit. Urgent cardiac catheterization was performed and showed no coronary artery disease (CAD). Thirty hours after discharge, the patient presented to the ED with the same symptoms arising two hours after taking 1000 mg of capecitabine. The resolution of chest pain after using nitrates, normalization of ECG, and HS troponin T levels combined with the proven absence of CAD ruled out acute coronary syndrome in our patient. Our patient had capecitabine-induced coronary vasospasm in the absence of pre-existing CAD. Further use of capecitabine had to be discontinued to avoid the risk of cardiotoxicity.

Drago Rakić, Leo Luetić, Zrinka Jurišić, Nina Berović, Ivana Cvitković, Zvonko Rumboldt

Sudden cardiac death or sudden cardiac arrest (SCD/SCA) is a major public health problem, responsible for several million victims worldwide every year. SCA survival rates are still low, around 5-10%, mostly due to delayed cardiopulmonary resuscitation and defibrillation. The advent of automated external defibrillators (AED) has allowed for quick and effective lay resuscitation. To achieve the goals of Public Access Defibrillation (PAD) project, ensuring a large number of easily available AEDs (in the US there are one million AED per 350 million people) with a large, nation-wide pool of educated and motivated lay persons/bystanders is essential. Unfortunately, over the last three decades, the AED implementation rate has remained low, with only a marginal impact on survival, since the traditional PAD concept was focused on public places, where only a fifth of SCA/SCD happens, while the majority, some 70-80%, takes place in residential environments, which are currently almost excluded from such programs. This review makes the case for PAD extension to residential areas with prompt defibrillation even with no basic life support interventions. Indeed, recent technological advances may substantially shorten the accident-defibrillation time lag, e.g. using the smartphone of a victim-bystander/rescuer – the closest AED – or drone delivery of an AED to the victim’s location. The Croatian “Restart a Heart – Save a Life” program is still an underused tool for the emergency response by individuals, organizations, and institutions, and should be reinforced and aligned with the best current evidence.

Zrinka Biloglav, Petar Medaković, Dominic Vidović, Diana Kovač, Dea Barać, Ivana Škrlec, Ivan Padjen, Matea Turudić, Domagoj Andrić, Antun Tonko Jakobović, Blanka Glavaš, Filip Relković, Nikolina Jupek, Stipe Radoš, Josip Ćurić, Nino Tićinović, Tatjana Ružić, Melita Kukuljan, Dimitrij Kuhelj, Miljenko Kovačević, Slavica Kovačić

Peripheral artery disease (PAD) is, along with ischemic heart disease and stroke, among the most significant diagnostic subgroups of cardiovascular diseases and one of the leading public health issues. Approximately 17 million people are affected by this disease in the European Union. Its real incidence and prevalence are several times higher than the estimates for this disease, and it is insufficiently diagnosed. The Republic of Croatia has a high burden and mortality from cardiovascular diseases. The goal of this analysis was to calculate and compare the age-standardized mortality rates for PAD based on sex and on 2nd level statistical regions in Croatia in the period from 2011 to 2020. Hospital information systems were searched for diagnoses that are applied for coding death from PAD in clinical practice and for coding interventional and diagnostic procedures, which were also supplemented by diagnoses from other studies. Based on data from the Croatian Institute of Public Health Mortality Database from 2011 to 2020, we calculated proportional mortality, percentage change for 2020 in comparison with 2011, and age-specific rates per 100 000 inhabitants. Statistical analysis used descriptive and analytic statistical methods. Among the 16 799 people who died, 10 352 were women and 6447 were men. Diagnosis I70.9, Generalized and non-specific atherosclerosis, was the most common at 43.2%. The highest age-standardize mortality rates in men and women were found in Northern Croatia, and the lowest in Adriatic Croatia. There were significant differences between regions in age-standardized mortality rates in both sexes. This study also showed an increase in the trend since 2018. In order to reduce mortality from PAD, efforts should be invested in prevention and early diagnostics and implementing systematic data collection on clinical outcomes for patient treatment.