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Angina at Low heart rate And Risk of imminent Myocardial infarction (the ALARM study): a prospective, observational proof-of-concept study

Overview of attention for article published in BMC Cardiovascular Disorders, November 2015
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Title
Angina at Low heart rate And Risk of imminent Myocardial infarction (the ALARM study): a prospective, observational proof-of-concept study
Published in
BMC Cardiovascular Disorders, November 2015
DOI 10.1186/s12872-015-0140-z
Pubmed ID
Authors

Yuk-ki Wong, Shelley Stearn, Sally Moore, Beverley Hale

Abstract

Myocardial infarction (MI) is often preceded by unstable angina. Helping patients identify the onset of unstable angina rather than MI may result in earlier treatment and improve outcomes. Unstable angina is angina occurring at a lower-than-usual workload. Since heart rate (HR) is correlated with degree of exertion, we hypothesised that angina occurring at low HR is a warning signal for unstable angina and MI. In this prospective study, 111 patients with acute coronary syndrome (ACS) or prognostically significant coronary disease were recruited. Each patient's HR was measured using a portable electrocardiogram (ECG) recorder after regular class III exercise on the Canadian Cardiovascular Society Angina Grading Scale and the cumulative moving average and three-sigma (standard deviation) range were calculated for each new measurement. The HR was subsequently measured at the beginning of angina; a HR lower than the preceding three-sigma ranges for class III or anginal HR was regarded as a 'warning signal'. The proportion of warning signals associated with ACS occurring in the following 2 weeks was compared with that for non-warning signals. Nine cases of ACS occurred in eight patients. Two cases were preceded by warning signals; a signal marked the onset of ACS in a third patient, and four patients failed to make anginal ECG recordings. There were 591 documented episodes of angina during the study and ECGs were available for 383 (64.8 %) of these of which 55 were warning signals. Of these warning signals, 4 occurred in the 2 weeks preceding ACS, compared with 4 of 328 non-warning signals (odds ratio, 6.4; 95 % confidence interval, 1.5-26.2; p = 0.01; positive predictive value, 7.3 %; negative predictive value, 98.8 %). Low HR angina may identify unstable angina and serve as an early warning for MI. In addition, angina that does not occur at a low heart rate indicates that ACS is very unlikely.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 25 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 25 100%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 6 24%
Student > Master 3 12%
Student > Ph. D. Student 2 8%
Student > Doctoral Student 1 4%
Other 1 4%
Other 3 12%
Unknown 9 36%
Readers by discipline Count As %
Nursing and Health Professions 8 32%
Medicine and Dentistry 5 20%
Engineering 2 8%
Unknown 10 40%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 22 August 2016.
All research outputs
#20,742,895
of 23,342,092 outputs
Outputs from BMC Cardiovascular Disorders
#1,383
of 1,681 outputs
Outputs of similar age
#237,276
of 282,817 outputs
Outputs of similar age from BMC Cardiovascular Disorders
#29
of 37 outputs
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