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This study investigates social support type and long-term mortality following AMI. Demographic and clinical data were collected retrospectively from a tertiary hospital for all patients with AMI (2011–2017). Study groups based on support type were defined: (1) employed partner (served as the reference group); (2) unemployed partner; (3) no partner, family support; (4) institutional or benefit-dependent; and (5) non-kin support (caregiver). Ten-year all-cause mortality risk was assessed and compared between the groups. We identified 2652 AMI patients with recorded support type: mean age 67.6 (SD = 14) years, 66% male; 40% had no partner, followed by those with an unemployed partner (31%). Over the follow-up of (median) 7.6 years, 1471 patients died; significantly higher mortality rates were observed in patients without family support (67.9%) or receiving non-kin support (94.9%). Those with non-kin support were at the highest mortality risk, AdjHR = 2.20, 95% CI: 1.67–2.91, p < 0.001, as compared with the reference group. Subgroup analyses found women below age 75 years, Arab women, and those with higher functional status to be most vulnerable to mortality in the absence of family support. Lack of family support was associated with increased long-term mortality among AMI patients. Assessment of support status among AMI patients is integral for secondary prevention.

Background: Chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) are common comorbidities in patients with acute myocardial infarction (AMI) and are associated with adverse cardiovascular outcomes. However, the impact of their coexistence on long-term post-AMI outcomes remains unclear. This study aimed to investigate the long-term effects of COPD and AF on AMI survivors. Methods: This retrospective cohort study analyzed data from consecutive AMI hospitalizations between 1 January 2002 and 31 October 2017. Patients were categorized into four groups based on the presence or absence of COPD and AF. The primary outcome was all-cause mortality up to 10 years post-discharge. Multivariate survival models were used to assess independent associations. Results: A total of 15,449 AMI survivors (mean age 66 ± 14 years, 30% female) were included, of whom 1386 (8.9%) had COPD, 2547 (16.5%) had AF, and 376 (2.4%) had both conditions. Over a median follow-up of 7.7 (IQR 3.3–10) years, 44.7% of the patients died. COPD (AdjHR = 1.89, 95% CI: 1.74–2.05), AF (AdjHR = 1.39, 95% CI: 1.31–1.48), and coexistence of both conditions (AdjHR = 1.82, 95% CI: 1.61–2.04) were associated with an increased risk for mortality (p < 0.001 for each). However, in patients with both conditions, the mortality risk was comparable to that of COPD alone. Conclusions: While both COPD and AF are associated with increased long-term mortality after AMI, COPD appears to be the primary independent driver of this risk. These findings underscore the need for proactive screening and individualized management in this high-risk population.

Background The use of medical cannabis has been increasing significantly worldwide, including in Israel, a country characterized by substantial religious diversity. This study examines the influence of religion on physicians’ and nurses’ attitudes toward medical cannabis use, focusing on four primary religions in Northern Israel: Judaism, Islam, Christianity, and the Druze faith. Methods A descriptive cross-sectional study was conducted at the Ziv Medical Center in Northern Israel, involving 395 physicians and nurses. Participants completed a structured questionnaire based on a modified version of the Medical Marijuana Questionnaire (MMQ), assessing their attitudes toward the medical benefits and risks of cannabis. Data were analyzed using ANCOVA and mixed-design ANCOVA models, controlling for covariates including age, gender, religiosity, profession, educational level, and exposure to cannabis use among acquaintances. Results Statistical analyses revealed significant differences in attitudes toward medical cannabis across religious groups. After adjusting for demographic and background variables, Jewish and Christian participants reported significantly more favorable attitudes regarding the medical benefits of cannabis, while Muslim and Druze participants emphasized its associated risks. A significant interaction was also found between religious affiliation and attitude type (benefits vs. risks), indicating that religious affiliation moderated the relative evaluation of cannabis’s therapeutic potential versus its harms. These findings suggest that each religion’s unique cultural and ethical frameworks shaped participants’ attitudes. The more permissive attitudes observed among Jewish and Christian participants reflect religious principles that emphasize alleviating suffering, while the cautious attitudes of Muslim and Druze participants align with stricter interpretations of religious guidelines. Conclusions This study identified significant differences in attitudes toward medical cannabis among physicians and nurses from different religious backgrounds in Northern Israel. Jewish and Christian participants expressed more favorable views regarding its medical use, while Muslim and Druze participants exhibited more cautious attitudes. These findings underscore the need for culturally and religiously tailored education and policies to facilitate the integration of medical cannabis into clinical practice.

Serum albumin and body mass index (BMI, kg/m2) have been associated with outcomes following acute myocardial infarction (AMI). Aiming to assess whether the mortality risk inflicted by hypoalbuminemia (<3.5 g/dL) in this context is influenced by BMI, we conducted a retrospective analysis of AMI survivors hospitalized during 2004–2017. Stratified by admission-time albumin level and BMI, eligible cases were evaluated for all-cause mortality up to 10 years after discharge. A total of 6283 individuals (74.1% males, mean age 64.1 ± 13.1 years, 44.3% with ST-elevation MI) were included. Of them, 22.7% had hypoalbuminemia and 1.2%, 41.0%, and 28.6% were underweight (BMI < 18.5), overweight (BMI 25–30), and obese (BMI ≥ 30), respectively. Over a median of 7.9 (IQR, 4.8–10.0) years of follow-up, 42.5% of patients died. Hypoalbuminemia was independently associated with a heightened mortality risk overall (AdjHR = 1.54, 95%CI 1.42–1.67, p < 0.001), accounted for by the normal weight (AdjHR = 1.73, 95%CI 1.50–1.99, p < 0.001), overweight (AdjHR = 1.55, 95%CI 1.35–1.79, p < 0.001), and class 1 obesity (BMI 30–35) (AdjHR = 1.37, 95%CI 1.12–1.68, p = 0.002) subgroups. Upon interaction analysis, the mortality risk imposed by hypoalbuminemia was most pronounced among individuals with normal BMI. In conclusion, hypoalbuminemia constituted a negative prognostic marker for long-term survival in AMI patients with normal or mildly elevated but not reduced or severely increased BMI. Pending further research, addressing hypoalbuminemia based on BMI range may prove beneficial.

We investigated the recovery pattern from acute kidney injury (AKI) following acute myocardial infarction (AMI) and its association with long-term mortality. The retrospective study included AMI patients (2002–2027), who developed AKI during hospitalization. Creatinine (Cr) measurements were collected and categorized into 24 h timeframes up to 7 days from AKI diagnosis. The following groups of recovery patterns were defined: rapid (24–48 h)/no rapid and early (72–144 h)/no early recovery. Specific cut-off points for recovery at each AKI stage and timeframe were determined through receiver operating characteristic (ROC) curves. The probability of long-term (up to 10 years) mortality as a post-AKI recovery was investigated using a survival approach. Out of 17,610 AMI patients, 1069 developed AKI. For stage 1 AKI, patients with a Cr ratio <1.5 at 24 h and/or <1.45 at 48 h were defined as ‘rapid recovery’; for stages 2–3 AKI, a Cr ratio <2.5 at 96 h was defined as ‘early recovery’. Mortality risk in stage 1 AKI was higher among the non-rapidly recovered: AdjHR = 1.407; 95% CI: 1.086–1.824; p = 0.010. Among stages 2–3 AKI patients, the risk for long-term mortality was higher among patients who did not recover in the early period: AdjHR = 1.742; 95% CI: 1.085–2.797; p = 0.022. The absence of rapid recovery in stage 1 AKI and lack of early recovery in stages 2–3 AKI are associated with higher long-term mortality.

Objectives: We aimed to investigate the association between acute kidney injury (AKI) and the risk for long-term (up to 10 years) all-cause mortality among elderly compared with younger patients following an acute myocardial infarction (AMI). Methods: This study was a retrospective analysis of the Soroka Acute Myocardial Infarction registry and covered the years 2002 to 2017. It included patients diagnosed with an AMI who had a baseline estimated glomerular filtration rate (eGFR) greater than 60 mL/min/1.73 m2 and serum creatinine measurements available during hospitalization. The patients were stratified by age: elderly (aged 65 years or older at admission) and younger. In each stratum, two groups were defined based on the presence of an AKI. The survival approach (Kaplan–Meier survival curves, log-rank test and Cox regressions) was utilized to estimate and compare the probability of long-term (up to 10 years) all-cause mortality in each group. Results: Among the 10,511 eligible patients, which consisted of 6132 younger patients (58.3%) and 4379 elderly (41.7%), an AKI occurred in 15.2% of cases, where the elderly patients experienced a higher incidence than the younger patients (20.9% vs. 11.2%, p < 0.001). The presence of an AKI significantly increased the risk of death in both age groups, with the association being stronger among the younger patients (AdjHR = 1.634, 95% CI: 1.363–1.959, p < 0.001) than among the elderly (AdjHR = 1.278, 95% CI: 1.154–1.415, p < 0.001, p-for-interaction = 0.020). Conclusions: An AKI following an AMI was associated with a high risk for long-term all-cause mortality in both age groups, with a stronger association among younger patients.

Acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM) share common risk factors. To evaluate the long-term incidence and predictors of new-onset T2DM (NODM) among post-AMI adults, we conducted a retrospective analysis of AMI survivors hospitalized between 2002 and 2017. Eligible patients were followed for up to 16 years to identify NODM, stratified by demographic and clinical characteristics. Among 5147 individuals (74.2% males, mean age 64.6 ± 14.9 years) without pre-existing T2DM, 23.4% developed NODM (cumulative incidence: 0.541). Key risk factors included an age of 50–60 years, a minority ethnicity (Arabs), smoking, metabolic syndrome (MetS), hemoglobin A1C (HbA1C) ≥ 5.7%, and cardiovascular comorbidities. A total score (TS), integrating these factors, revealed a linear association with the NODM risk: each 1-point increase corresponded to a 1.2-fold rise (95% CI 1.191–1.276, p < 0.001). HbA1C ≥ 6% on the “Pre-DM sub-scale” conferred a 2.8-fold risk (p < 0.001), while other risk factors also independently predicted NODM. In conclusion, post-AMI patients with multiple cardiovascular risk factors, particularly middle-aged individuals, Arab individuals, and those with HbA1C ≥ 6% or MetS, are at a heightened risk of NODM. Early identification and targeted interventions may mitigate this risk.

Decisions on dual antiplatelet therapy (DAPT) duration should balance the opposing risks of ischaemia and bleeding. Our aim was to develop a risk score to identify stable coronary artery disease (SCAD) patients undergoing PCI who would benefit or suffer from extending DAPT beyond 6 months. Retrospective analysis of a cohort of patients who completed 6 months of DAPT following PCI. Predictors of ischaemic and bleeding events for the 6-12 month period post-PCI were identified and a risk score was developed to estimate the likelihood of benefiting from extending DAPT beyond 6 months. Incidence of mortality, ischaemic and bleeding events for patients treated with DAPT for 6 vs. 6-12 months, was compared, stratified by strata of the risk score. The study included 2,699 patients. Over 6 months' follow up, there were 78 (2.9%) ischaemic and 43 (1.6%) bleeding events. Four variables (heart failure, left ventricular ejection fraction ≤30%, left main or three vessel CAD, status post (s/p) PCI and s/p stroke) predicted ischemic events, two variables (age>75, haemoglobin <10 g/dL) predicted bleeding. In the lower stratum of the risk score, 6-12 months of treatment with DAPT resulted in increased bleeding (p = 0.045) with no decrease in ischaemic events. In the upper stratum, 6-12 months DAPT was associated with reduced ischaemic events (p = 0.029), with no increase in bleeding. In a population of SCAD patients who completed 6 months of DAPT, a risk score for subsequent ischaemic and bleeding events identified patients likely to benefit from continuing or stopping DAPT.

Background Acute myocardial infarction (AMI) is associated with greater utilization of healthcare resources and financial expenditure. Objectives To evaluate temporal trends in healthcare resource utilization and costs following AMI throughout 2003–2015. Methods AMI patients who survived the first year following hospitalization in a tertiary medical center (Soroka University Medical Center) throughout 2002–2012 were included and followed until 2015. Length of the in-hospital stay (LOS), emergency department (ED), primary care, outpatient consulting clinic visits and other ambulatory services, and their costs, were evaluated and compared annually over time. Results Overall 8047 patients qualified for the current study; mean age 65.0 (SD = 13.6) years, 30.3% women. During follow-up, LOS and the number of primary care visits has decreased significantly. However, ED and consultant visits as well as ambulatory-services utilization has increased. Total costs have decreased throughout this period. Multivariate analysis, adjusted for potential confounders, showed as significant trend of decrease in LOS and ambulatory-services utilization, yet an increase in ED visits with no change in total costs. Conclusions Despite a decline in utilization of most healthcare services throughout the investigated decade, healthcare expenditure has not changed. Further evaluation of the cost-effectiveness of long-term resource allocation following AMI is warranted. Nevertheless, we believe more intense ambulatory follow-up focusing on secondary prevention and early detection, as well as high-quality outpatient chest pain unit are warranted.

BackgroundAnemia and chronic kidney disease (CKD) adversely affect prognosis following acute myocardial infarction (AMI). We aimed to assess their interaction regarding long-term survival post-AMI.MethodsThis is a single-center, retrospective analysis of consecutive AMI survivors. Stratified by admission-time anemia status and CKD grade, as determined by hemoglobin and creatinine levels, the cohort was evaluated for all-cause mortality at 10 years after hospital discharge.ResultsA total of 11,395 patients (69.1% males, mean age 65.8 ± 13.9 years, 49.6% with ST elevation MI) were included, of whom 29.9% had anemia and 15.9% - grade 3b or higher CKD. CKD was more advanced among anemic patients and the prevalence of anemia rose as CKD grade increased (p for trend < 0.001). At 10 years, 47.8% of patients died. Notwithstanding differences in baseline characteristics, presentation, and treatment between those with various anemia status and CKD grades, anemia presence (HR 1.40, 95% CI 1.32–1.49, p < 0.001) and increasing CKD grade (HR 1.10, 95% CI 1.02–1.20, p for trend < 0.001) were independently associated with a higher mortality risk. The incremental hazard imposed by either anemia or more advanced CKD was limited to patients with normal renal function and up to grade 3a (in the total cohort and the conservative treatment subgroup) or 4 (in the invasive revascularization subgroup) CKD. The added risk associated with increasing CKD grade also affected non-anemic individuals irrespective of the specific CKD grade.ConclusionAnemia and more advanced CKD are associated with reduced long-term survival post-AMI, inflicting higher risk when conjoined in lower-grade CKD.