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Andrzej Pajak

Publications and source records attributed to Andrzej Pajak.

At least 19 recordsLinked to original sources
PubMed2006

Determinants of cardiovascular disease and other non-communicable diseases in Central and Eastern Europe: rationale and design of the HAPIEE study.

BACKGROUND: Over the last five decades, a wide gap in mortality opened between western and eastern Europe; this gap increased further after the dramatic fluctuations in mortality in the former Soviet Union (FSU) in the 1990s. Recent rapid increases in mortality among lower socioeconomic groups in eastern Europe suggests that socioeconomic factors are powerful determinants of mortality in these populations but the more proximal factors linking the social conditions with health remain unclear. The HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study is a prospective cohort study designed to investigate the effect of classical and non-conventional risk factors and social and psychosocial factors on cardiovascular and other non-communicable diseases in eastern Europe and the FSU. The main hypotheses of the HAPIEE study relate to the role of alcohol, nutrition and psychosocial factors. METHODS AND DESIGN: The HAPIEE study comprises four cohorts in Russia, Poland, the Czech Republic and Lithuania; each consists of a random sample of men and women aged 45-69 years old at baseline, stratified by gender and 5 year age groups, and selected from population registers. The total planned sample size is 36,500 individuals. Baseline information from the Czech Republic, Russia and Poland was collected in 2002-2005 and includes data on health, lifestyle, diet (food frequency), socioeconomic circumstances and psychosocial factors. A short examination included measurement of anthropometric parameters, blood pressure, lung function and cognitive function, and a fasting venous blood sample. Re-examination of the cohorts in 2006-2008 focuses on healthy ageing and economic well-being using face-to-face computer assisted personal interviews. Recruitment of the Lithuanian cohort is ongoing, with baseline and re-examination data being collected simultaneously. All cohorts are being followed up for mortality and non-fatal cardiovascular events. DISCUSSION: The HAPIEE study will provide important new insights into social, behavioural and biological factors influencing mortality and cardiovascular risk in the region.

Aged↗
PubMed2006

Cerebral changes on MRI and cognitive function: the CASCADE study.

The aging, non-demented brain undergoes several physiological changes, some of which may affect cognitive function. The goal of the present study was to examine the associations between subcortical and periventricular white matter hyperintensities (WMHs), cortical and subcortical atrophy, and cognitive function (episodic memory, word fluency, attention, and perceptual, cognitive, and motor speed). This was done within a European collaborative study, Cardiovascular Determinants of Dementia (CASCADE), in which magnetic resonance imaging (MRI) was performed on community-dwelling individuals. The study includes 1254 persons from eight European study centers, ranging between 64 and 76 years of age (M 69.4+/-3.3; 55% men). When demographics (age, education, and sex), study center, and concurrent brain changes had been adjusted for, periventricular WMHS predicted lower performance in word fluency and the Stroop test (time), and subcortical atrophy predicted lower performance in motor speed and the Stroop test (errors). The findings are consistent with findings from lesion and functional neuroimaging studies.

Age Distribution↗
PubMed2006

Depressive symptoms in urban population samples in Russia, Poland and the Czech Republic.

BACKGROUND: Relatively little is known about depression in countries that were formerly part of the Soviet Union, especially Russia. AIMS: To investigate the rates and distribution of depressive symptoms in urban population samples in Russia, Poland and the Czech Republic. METHOD: A cross-sectional study was conducted in randomly selected men and women aged 45-64 years (n=2151 in total, response rate 69%) in Novosibirsk (Russia), Krakow (Poland) and Karvina (Czech Republic). The point prevalence of depressive symptoms in the past week was defined as a score of at least 16 on the Center for Epidemiological Studies Depression scale. RESULTS: In men the prevalence of depressive symptoms was 23% in Russia, 21% in Poland and 19% in the Czech Republic; in women the rates were 44%, 40% and 34% respectively. Depressive symptoms were positively associated with material deprivation, being unmarried and binge drinking. The association between education and depression was inverse in Poland and the Czech Republic but positive in Russia. CONCLUSIONS: The prevalence of depressive symptoms in these eastern European urban populations was relatively high; as in other countries, it was associated with alcohol and several sociodemographic factors.

Alcohol Drinking↗
PubMed2005

Do lipids contribute to the lack of cardio-protective effect of binge drinking: alcohol consumption and lipids in three eastern European countries.

AIMS: The cardio-protective effect of moderate alcohol consumption is partly mediated by HDL cholesterol. However, epidemiological studies suggest that binge drinking may not be associated with reduced risk of heart disease; a possible explanation is that the relationship of blood lipids with binge drinking is different from that with moderate intake. We investigated this hypothesis in a population study in three eastern European countries. METHODS: We conducted a cross-sectional study in random population samples in Novosibirsk (Russia), Krakow (Poland) and Karvina (Czech Republic). A sub-sample of 282 men aged 45-64 years who provided a fasting blood sample were analysed. Annual alcohol intake and the frequency of heavy binge drinking (> or =140 g of ethanol per session) were estimated from a graduated frequency questionnaire. RESULTS: Annual intake of alcohol was positively associated with total and HDL cholesterol. After controlling for annual intake, the frequency of heavy binge drinking was associated with increased concentrations of total and HDL cholesterol. By combining annual intake and drinking pattern, we found that men consuming >8 l of alcohol per year who had a heavy binge at least once a month had the mean total, HDL and LDL cholesterol 1.69 (SE 0.35), 0.61 (0.11) and 0.97 (0.34) mmol/l, respectively, higher than non-drinkers; this resulted in more favourable ratios of total and LDL cholesterol relative to HDL cholesterol in frequent heavy bingers. Triglycerides were not related to alcohol intake or binge drinking. CONCLUSIONS: Blood lipids do not seem to explain the apparent lack of the cardio-protective effect of binge drinking reported in epidemiological studies.

Alcoholic Intoxication↗
PubMed2005

Determinants of poor hypertension management in patients with ischaemic heart disease.

UNLABELLED: Not much is known about factors influencing hypertension management in patients with ischaemic heart disease (IHD). Therefore, the aim of the study was to assess factors influencing hypertension management in patients hospitalized due to IHD. We reviewed hospital records of 1051 consecutive patients with a discharge diagnosis of myocardial infarction (MI; n = 290), unstable angina (n = 247), percutaneous coronary intervention (PCI; n = 259) or coronary artery bypass grafting (CABG; n = 255) who were hospitalized at three university (n = 533) or three community (n = 518) cardiac departments. During the follow-up interview (6-18 months after discharge) 70.2% of study participants fulfilled the criteria for a diagnosis of hypertension. Hypertension had not been diagnosed during index hospitalization in 17.5% of hypertensive participants. Overall, 7.1% of hypertensives were not treated with any blood pressure lowering agent. Irregular health checks (odds ratio, OR, 16.3, 95% confidence interval, CI, 4.1-64.0), alcohol drinking (OR 3.3, 95% CI 1.5-7.0), unstable angina (OR 2.7, 95% CI 1.3-5.8), hypertension awareness (OR 0.2, 95% CI 0.1-0.5) and blood pressure lowering drugs prescribed at discharge (OR 0.08, 95% CI 0.03-0.19) were significantly related to the probability of not being on antihypertensive medication. High blood pressure (>or=140/90 mmHg) was found in 68.9% of hypertensives; older age (OR 1.3, 95% CI 1.0-1.6) and hypertension awareness (OR 0.6, 95% 0.3-1.0) were the only significant predictors of uncontrolled hypertension. Among treated participants with uncontrolled hypertension, 33.4% were on monotherapy, 66.6% were on combination therapy, 25.5% were on three or more drugs and 14.7% were on combination of three or more drugs with diuretic. CONCLUSIONS: Hypertension management in the secondary prevention of IHD is not satisfactory. Age and hypertension awareness are the main factors related to the quality of blood pressure control in the post-discharge period.

Aged↗
PubMed2005

Body mass index and risk of death in middle-aged men and women in Poland. Results of POL-MONICA cohort study.

BACKGROUND: Overweight and obesity have been considered to be the causes of serious health consequences. So far, there have been no studies in Poland to analyse the relationship between Body Mass Index (BMI) and mortality. AIM: To determine the relationship between BMI and the mortality risk due to all causes and due to cardiovascular diseases (CVD) in the middle-aged population of Poland. METHODS: The study group consisted of men and women aged 35-64, residents of two districts of Warsaw (Praga Północ and Praga Południe) and the former Tarnobrzeg Voivodship who were selected at random for POL-MONICA Project cross-sectional studies in 1983-1994. Risk assessment of death due to all causes and due to CVD was performed using the Cox proportional hazards method. Persons with BMI of 22-23.9 were adopted as reference group. RESULTS: Sample size consisted of 5,281 men and 5,691 women. Prospective observation was carried out from 5 to 15 years, mean duration 10.7 years. Overall, the observation comprised 117,839 person-years. During the study, 914 men died (including 448 due to CVD) as well as 430 women (including 160 due to CVD). After adjusting for age, place of residence (Warsaw vs. the Tarnobrzeg Voivodship), risk factors (hypercholesterolemia, arterial hypertension and smoking) and self-assessment of health, increased risk of all cause death was found in men with BMI lower than 20 kg/m(2) (relative risk 2.27), with BMI of 32-34.9 kg/m(2) (relative risk 1.41), with BMI > or =35 kg/m(2) (relative risk 1.73), and in women whose BMI was lower than 20 kg/m(2) (relative risk 1.66). Increased risk of CVD death was found in men with BMI lower than 20 kg/m(2) (relative risk 1.97), with BMI of 32-34.9 kg/m(2) (relative risk 1.66), with BMI > or =35 kg/m(2) (relative risk 2.06), and in women with BMI > or =35.0 kg/m(2) (relative risk 2.02). CONCLUSIONS: The POL-MONICA study carried out in the middle-aged Polish population did not confirm a relationship between overweight (BMI from 25 to 29.9 kg/m(2)) and risk of death due to all causes or due to CVD.

Adult↗
PubMed2005

The challenge of blood pressure control in patients with ischaemic heart disease in Europe.

The goal of the paper is to summarize the current status of blood pressure management in patients with ischaemic heart disease. Recently published results from Europe and North America showed that about half of ischaemic heart disease patients have their blood pressure over 140/90 mmHg. Moreover, these data provide further evidence that poor hypertension management is common in a variety of healthcare settings. Although most ischaemic heart disease patients receive blood pressure-lowering drugs, still a large proportion of them does not reach the recommended treatment goals. During recent years, several attempts were made to improve the control of risk factors (among them blood pressure) in patients with ischaemic heart disease; however, none of them was definitively successful.

Antihypertensive Agents↗
PubMed2005

Lifestyle characteristics and hypertension in the middle-aged population of Kraków.

Hypertension affects nearly one-third of total Polish adult population. Poor control of hypertension largely contributes to high cardiovascular disease (CVD) mortality in Poland. However, satisfactory hypertension control at the national level could be beyond economical conditions. Prevention of hypertension by lifestyle modification may be one of the ways to decrease CVD population risk attributed to hypertension. The goal was to assess the relation between the chance of having hypertension and lifestyle characteristics, i.e. education, smoking, physical activity, salt consumption, ethanol consumption and body mass index (BMI) in the middle-aged population of the urban population of Kraków. A cross-sectional study of a random sample of 1157 women and 1153 men, permanent inhabitants of Kraków at age 45-64 years, was carried out by home interview followed by a visit in the clinic. There were 66% men and 56% women who had hypertension. After adjustment for age, BMI over 27.5 kg/m2 in men and over 25.0 kg/m2 in women was strongly related to hypertension. In men, odds ratio (OR) increased from 1.96 in the group with overweight (27.5 kg/m2 < or = BMI < 30.0 kg/m2) to 5.33 in the group with obesity (BMI > or = 35.0 kg/m2). In women, OR increased from 1.6 in the group with overweight (25.0 kg/m2 < or = BMI < 27.5 kg/m2) to 13.42 in the group with obesity (BMI > or = 35.0 kg/m2). In men, after adjustment for age and BMI, a higher chance of hypertension was found for binge drinkers but the result was of borderline significance (p = 0.057). In women, moderate alcohol consumption was related to lower chance of hypertension (OR = 0.72). Women who were current smokers had lower chance of hypertension (OR = 0.67). No significant relation between smoking and hypertension was found in men. After adjustment for age and BMI, there was no significant relation between hypertension and physical activity. However, both in men and in women, there was a dose effect of leisure time physical activity on the average estimate of the chance of hypertension. Education, estimate of sodium consumption and blood total cholesterol (TC) were not related to hypertension. The findings confirmed that weight control may be a strong tool for preventing hypertension and increasing physical activity and refraining from binge drinking may have a protective effect.

Adult↗
PubMed2005

[Intake of selected nutrients by perceived control over life, over health and general control in men and women aged 45-64, residents of Kraków].

The aim of this study was to compare mean intake of energy and selected nutrients in groups with high perceived control over life, over health, general control and the remaining part of population. The study sample was 3544 men and women aged 45-4, residents of Kraków, randomly selected by sex, age and districts. Data on perceived control was collected by using 9-items questionaire. Nutrient intake was assessed by 24-hour recall. After adjustment to age and education, in men with high perceived control over life mean intake of witamin C was higher (56.3 mg) than in the remaining men (49.0 mg). Compared with other women, women with high perceived control over health had lower mean intake of total energy (6403.9 kJ vs 6831.9 kJ), proteins (56.3 g vs 60.1 g), carbohydrates (217.4 g vs 229.6 g), fat (55.1 g vs 59.8 g) and sodium (1347.5 mg vs 1446.6 mg). In women with high general control, there was lower mean energy intake (6403.9 kJ vs 6773,9 kJ) and SFA intake (18.3 g vs 20.1 g) than in the remaining women. P/S ratio was higher in women with high general control (0.55) then in other women (0.49). In men with high general control mean intake of carbohydrates was lower (292.3 g vs 310.3 g) then in the remaining men. There was no difference in nutrient intake in men with high perceived control over health and in women with high perceived control over life than in remaining part of the sample. In the study sample, high perceived control was related to more favourable diet in women, less effect was observed in men.

Attitude to Health↗
PubMed2005

[Homocysteine level, relationship with cardiovascular risk factors in selected Polish population].

The aim of the study was to evaluate the concentration and distribution of homocysteine in random samples of men and women aged 20-74 from two populations: urban (Warsaw) and industrial-rural (former Tarnobrzeg Province), and the estimation of relationship between selected cardiovascular risk factors and homocysteine concentration. In 2001 in 617 men and 657 women homocysteine level, lipids profile, glucose, folic acid, vitamin B12 concentration, blood pressure and alcohol intake were determined. The mean (geometric) homocysteine concentration was 10.9 micro mol/L in men and 9.6 micro mol/L in women. There were no differences in the homocysteine concentration and distribution between regions according to sex. The homocysteine level was connected with folic acid and vitamin B12 concentration in both genders. Moreover, in men was recorded relationship between homocysteine and body mass index, cholesterol level, alcohol intake, and in women between homocysteine and daily number of cigarettes smoked.

Adult↗
PubMed2004

The association between blood pressure, hypertension, and cerebral white matter lesions: cardiovascular determinants of dementia study.

Cerebral white matter lesions are frequently observed on magnetic resonance imaging (MRI) scans in elderly people and are associated with stroke and dementia. Elevated blood pressure is presumed one of the main risk factors, although data are almost exclusively derived from cross-sectional studies. We assessed in 10 European cohorts the relation between concurrently and previously measured blood pressure levels, hypertension, its treatment, and severe cerebral white matter lesions. In total, 1805 nondemented subjects aged 65 to 75 years were sampled from ongoing community-based studies that were initiated 5 to 20 years before the MRI. White matter lesions in the periventricular and subcortical region were rated separately using semiquantitative measures. We performed logistic regression analyses adjusted for potential confounders in 1625 people with complete data. Concurrently and formerly assessed diastolic and systolic blood pressure levels were positively associated with severe white matter lesions. Both increases and decreases in diastolic blood pressure were associated with more severe periventricular white matter lesions. Increase in systolic blood pressure levels was associated with more severe periventricular and subcortical white matter lesions. People with poorly controlled hypertension had a higher risk of severe white matter lesions than those without hypertension, or those with controlled or untreated hypertension. Higher blood pressure was associated with an increased risk of severe white matter lesions. Successful treatment of hypertension may reduce this risk; however, a potential negative effect of decreasing diastolic blood pressure level on the occurrence of severe periventricular white matter lesions should be taken into account.

Aged↗
PubMed2004

Total cholesterol and mortality in China, Poland, Russia, and the US.

PURPOSE: To examine the relationships of total and cause-specific mortality to serum cholesterol in four diverse populations. METHODS: Chinese, Polish, Russian, and US population-based samples were studied. The relationship between cholesterol levels and mortality was assessed by Cox proportional hazard regression with restricted piecewise cubic splines. RESULTS: The cholesterol and total mortality relationship was statistically significantly J-shaped for all men combined. In country-specific relationships, cholesterol was significantly, linearly, and positively related to total mortality in Russian and US men. For women, the relationship was non-linear, but not statistically significant, and became statistically significant upon adjustment for other risk factors. For Polish women, a statistically significant inverse relationship existed. CHD mortality and cardiovascular disease (CVD) mortality increased linearly with cholesterol in Polish, Russian, and US men and the aggregate of men, but there was no relationship for women. Cancer mortality was not related to cholesterol except for the Polish cohort and Russian women, where there was an inverse relationship. CONCLUSIONS: Serum cholesterol was a strong, consistent predictor of CHD and CVD mortality in Polish, Russian, and US men despite their social diversity. In contrast to CHD mortality, the relation of cholesterol to total mortality and non-CVD mortality varied by country and gender.

Adult↗
PubMed2004

Psychosocial factors at work and depression in three countries of Central and Eastern Europe.

Psychosocial factors at work have been found to predict a range of health outcomes but their effect on mental health outcomes has not been extensively studied. This paper explores the relationship between psychosocial factors at work and depression in three countries of Central and Eastern Europe. The data come from a cross-sectional study of working men (n = 645) and women (n = 523) aged 45-64 years, randomly selected from population registers in Novosibirsk (Russia), Krakow (Poland) and Karvina-Havirov (Czech Republic). The questionnaire included questions on the effort and reward at work, job control, the full CES-D scale of depression, and a range of other characteristics. Linear regression was used to estimate the association between depression score and work characteristics: the logarithm of the effort-reward ratio, and continuous job control score. The means of the depression score were 10.5 for men and 14.2 for women. After controlling for age, sex and country, effort-reward ratio (logarithmically transformed) was strongly related to depression score; a 1 SD increase in the log transformed effort-reward ratio was associated with an increase in the depression of 2.0 points (95% CI 1.5; 2.4), and further adjustment did not materially change the effect. Job control was inversely associated with depression score in Poland and the Czech Republic (not in Russia) but the association was largely eliminated by controlling for socioeconomic characteristics. This study suggests that the effort-reward imbalance at work is related to prevalence of depression in these central and eastern European populations.

Aged↗
PubMed2004

Magnetic resonance imaging of the brain in diabetes: the Cardiovascular Determinants of Dementia (CASCADE) Study.

Diabetic patients are at increased risk for stroke, but little is known about the presence of other brain lesions. We studied the association of magnetic resonance imaging-detected brain lesions to diabetes in 1,252 individuals aged 65-75 years who were randomly selected from eight European population registries or defined working populations. All scans were centrally read for brain abnormalities, including infarcts, white matter lesions, and atrophy. We used a three-point scale to rate periventricular white matter lesions, and the volume of subcortical lesions was calculated according to their number and size. Subjective grading of cortical atrophy by lobe and summation of the lobar grades resulted in a total cortical atrophy score. The mean of three linear measurements of the ventricular diameter relative to the intracranial cavity defined the severity of subcortical atrophy. After adjustment for possible confounders, diabetes was associated with cortical brain atrophy but not with any focal brain lesions or subcortical atrophy. There was a strong interaction of diabetes and hypertension, such that the association between diabetes and cortical atrophy existed only in hypertensive but not in normotensive participants. Cognitive and pathological data are needed to determine the clinical significance of these findings as well as to understand the mechanisms underlying these associations.

Aged↗
PubMed2004

[Secondary prevention of ischemic heart disease in diabetics in clinical practice].

BACKGROUND: Diabetes is an indication for particularly careful risk factors management in ischaemic heart disease patients. AIM: The aim of the study was to assess the implementation of guidelines on secondary prevention of ischaemic heart disease in diabetics. METHODS: We reviewed hospital records of 1051 consecutive patients at age < or = 70 years with discharge diagnosis of acute myocardial infarction, unstable angina, percutaneous coronary intervention or coronary artery bypass surgery who were hospitalized in three university and in three community cardiac departments serving the area of the city. The follow-up interview took place 6-18 months after discharge. RESULTS: Out of 1051 (754 men and 297 women; mean age 57.1 +/- 8.4 years) study participants 160 (15.2%) were diagnosed as having diabetes. ACE inhibitors were prescribed at discharge more often (73.1% vs 47.6%; p < 0.0001) whereas beta-blockers (54.4% vs 66,0%; p < 0.01) and lipid-lowering drugs (25.0% vs 35.9%; p < 0.01) less often in diabetics compared to non-diabetics. One year after discharge diabetics smoked less frequently compared to non-diabetics (9.8% vs 17.2%; p < 0.05). No significant difference was found in the prevalence of high blood pressure, high total and LDL cholesterol levels, low HDL cholesterol level and high triglycerides level in diabetic and non-diabetic patients. The prevalence of obesity increased after hospitalization in both groups. ACE inhibitors were used more often (61.5% vs 44.3%; p < 0.001) whereas lipid-lowering drugs less often (27.1% vs 39.8%; p < 0.01) in diabetics compared to non-diabetics. Diabetes was not independently related to the frequency of lipid-lowering drug use in patients with hypercholesterolemia. CONCLUSIONS: Insufficient control of risk factors and too low prescription rate of secondary prevention drugs were found both in diabetic and non-diabetic patients. There is a need to intensify secondary prevention, especially in patients with diabetes.

Adrenergic beta-Antagonists↗
PubMed2003

Case definitions for acute coronary heart disease in epidemiology and clinical research studies: a statement from the AHA Council on Epidemiology and Prevention; AHA Statistics Committee; World Heart Federation Council on Epidemiology and Prevention; the European Society of Cardiology Working Group on Epidemiology and Prevention; Centers for Disease Control and Prevention; and the National Heart, Lung, and Blood Institute.

Explore the source record for details and available documents.

Acute Disease↗
PubMed2003

Determinants of appropriate lipid management in patients with ischaemic heart disease. Cracovian Program for Secondary Prevention of Ischaemic Heart Disease.

UNLABELLED: Although several randomised clinical trials have documented the efficacy of lipid-lowering therapy in improving clinical outcomes in hyperlipidemic subjects with ischaemic heart disease (IHD), such therapy is underutilized worldwide. Not much is known about the effects of the hospital setting (university vs. community) on lipid management in patients after hospitalization due to ischaemic heart disease. The combined effect of age, sex, education, risk factors, hospital as well as practice setting in the post-discharge period on lipid management in IHD patients is also unknown. Therefore the aim of this study was to evaluate factors influencing lipid management during and after hospitalization due to IHD. The primary outcome measure was "appropriate lipid management", defined as: (a) being discharged on lipid-lowering medication or having a documented LDL cholesterol level <3.4 microM/l within the first 24 h of hospitalization, and (b) (for patients with hypercholesterolemia) being prescribed a lipid-lowering drug at the time of the interview 6-18 months after discharge. METHODS AND RESULTS: We reviewed the hospital records of 1051 consecutive patients with a discharge diagnosis of acute myocardial infarction (N=290), unstable angina (N=247), percutaneous coronary intervention (N=259) or coronary artery bypass surgery (N=255) who were hospitalized at three university (N=533) or three community (N=518) cardiac departments. Overall, 42.2% of the study population met the criteria for appropriate lipid management during hospitalization. Admission to the university hospital, percutaneous coronary intervention, a history of myocardial infarction, the presence of hypertension, the absence of diabetes mellitus, and younger age were all associated with an increased probability of receiving proper treatment during hospitalization. During the follow-up interview (6-18 months after discharge), 10.4% patients had a LDL cholesterol level of <2.6 microM/l. The use of lipid-lowering agents in the group with hypercholesterolemia was 40.8%. Patients who met the criteria for appropriate lipid management during hospitalization were more often prescribed a lipid-lowering drug at the time of interview compared with persons who did not meet those criteria (62.5% vs. 23.5%; P<0.0001). Patients undergoing percutaneous coronary interventions, treated in hospital outpatient clinics, obese patients as well as those better educated were more likely to be treated appropriately than the other groups. CONCLUSIONS: Proper lipid management during hospitalization is the most important factor related to lipid management in the post-discharge period. There is the potential for a further reduction of coronary risk, especially in patients hospitalized in community hospitals, not undergoing coronary interventions and those being under the care of general practitioners.

Comorbidity↗