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<1>
Accession Number
2014982705
Authors
Lopes-Conceicao L. Pereira M. Araujo C. Laszczynska O. Lunet N. Azevedo A.
Institution
(Lopes-Conceicao, Pereira, Araujo, Laszczynska, Lunet, Azevedo) Department
of Clinical Epidemiology, Predictive Medicine and Public Health,
University of Porto, Medical School, Porto, Portugal
(Lopes-Conceicao, Pereira, Araujo, Laszczynska, Lunet, Azevedo) EPIUnit,
Institute of Public Health, University of Porto, Porto, Portugal
(Araujo) Centro Hospitalar de Tras-Os-Montes e Alto Douro EPe, Vila Real,
Portugal
Title
The use of reperfusion and revascularization procedures in acute coronary
syndrome in Portugal: A systematic review.
Source
Revista Portuguesa de Cardiologia. 33 (11) (pp 707-715), 2014. Date of
Publication: 01 Nov 2014.
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Introduction and Objectives Reperfusion and revascularization therapies
play an important role in the management of coronary heart disease and
have contributed to decreases in case fatality rates. We aimed to describe
the use of these therapies for the treatment of acute coronary syndrome
(ACS) patients over time in Portugal.
Methods PubMed was searched in July 2012. The proportion of patients
treated with fibrinolysis, primary percutaneous coronary intervention
(PCI), any PCI and coronary artery bypass grafting (CABG) was described
according to type of ACS: STEMI (>90% patients with ST-segment elevation
or Q-wave myocardial infarction), NSTE-ACS (>90% patients with
non-ST-segment elevation ACS) and mixed ACS (all others).
Results We identified 41 eligible studies, published between 1989 and
2011. Twenty-eight reported on samples considered representative of ACS
patients treated in Portugal. The small number of estimates of the use of
each treatment in STEMI and NSTE-ACS patients precluded identification of
any time trend. In the last 20 years, the proportion of mixed ACS patients
treated with fibrinolysis decreased and the use of PCI increased, while
the use of CABG did not change.
Conclusions The general pattern of the use of reperfusion and
revascularization is in accordance with that reported in other developed
countries, reflecting a favorable trend in the quality of care of ACS
patients. The relatively small number of estimates on the same procedure
in comparable patients limits the generalizability of the conclusions, and
highlights the need for systematic approaches to monitor the use of
treatments over time.
<2>
Accession Number
2014982484
Authors
Van Meenen L.C.C. Van Meenen D.M.P. De Rooij S.E. Ter Riet G.
Institution
(Van Meenen, Van Meenen) University of Amsterdam, Amsterdam, Netherlands
(De Rooij) Geriatrics Section, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Ter Riet) Department of General Practice, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
Title
Risk prediction models for postoperative delirium: A systematic review and
meta-analysis.
Source
Journal of the American Geriatrics Society. 62 (12) (pp 2383-2390), 2014.
Date of Publication: 01 Dec 2014.
Publisher
Blackwell Publishing Inc.
Abstract
Postoperative delirium (POD) is a common neuropsychiatric disorder
characterized by inattention, fluctuating levels of consciousness, and
disorganized thinking. POD can have serious consequences, including
institutionalization and death. Risk stratification may target prevention
to individuals at greater risk of POD. The objective of this study was to
identify all published POD risk prediction models (RPMs) and to compare
them with regard to their clinical practicability and predictive and
discriminative performance. PubMed and EMBASE were searched from inception
to January 1, 2013, for articles describing POD RPMs. Studies were
included if they presented data from a cohort study, examined one or more
RPMs, examined POD as an outcome, and assessed the performance of the
RPM(s). Thirty of 2,246 articles were included, and 37 RPMs were found.
Sixteen and six studies described individuals who had undergone
cardiovascular and orthopedic surgery, respectively. The Confusion
Assessment Method (CAM) for the intensive care unit checklist was the most
often used diagnostic method (65%), followed by the Diagnostic and
Statistical Manual of Mental Disorders (DSM), Fourth Edition criteria
(16%). Predictors most often used in RPMs were age (20), preoperative
Mini-Mental State Examination score (10), and preoperative increased
alcohol use (7). Thirty RPMs were not validated, three were validated
internally, and four were validated externally. Size of the models was not
associated with their discriminatory performance. Instead of creating
steadily new RPMs, existing RPMs should be further tested, improved, and
meta-analytically integrated. It may be too early to implement a
particular PODRPM in clinical practice with confidence.
<3>
Accession Number
2014985593
Authors
Smith P.K. Puskas J.D. Ascheim D.D. Voisine P. Gelijns A.C. Moskowitz A.J.
Hung J.W. Parides M.K. Ailawadi G. Perrault L.P. Acker M.A. Argenziano M.
Thourani V. Gammie J.S. Miller M.A. Page P. Overbey J.R. Bagiella E.
Dagenais F. Blackstone E.H. Kron I.L. Goldstein D.J. Rose E.A. Moquete
E.G. Jeffries N. Gardner T.J. O'Gara P.T. Alexander J.H. Michler R.E.
Institution
(Smith) Division of Cardiovascular and Thoracic Surgery, Department of
Surgery, United States
(Alexander) Division of Cardiology, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Puskas, Rose) Department of Cardiac Surgery, Mount Sinai Health System,
United States
(Ascheim, Gelijns, Moskowitz, Parides, Overbey, Bagiella, Moquete)
International Center for Health Outcomes and Innovation Research,
Department of Population Health Science and Policy, Icahn School of
Medicine at Mount Sinai, Box 1077, New York, NY 10029, United States
(Miller) Division of Cardiothoracic Surgery, Department of Surgery,
Columbia University, United States
(Goldstein, Michler) Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center-Albert Einstein College of Medicine, New York,
United States
(Voisine, Dagenais) Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Hopital Laval, Quebec, QC, Canada
(Perrault) Montreal Heart Institute, University of Montreal, Canada
(Page) Department of Surgery, Hopital du Sacre-Coeur de Montreal,
Montreal, Canada
(Hung) Echocardiography Core Lab, Massachusetts General Hospital, Boston,
United States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Boston,
United States
(Ailawadi, Kron) Division of Thoracic and Cardiovascular Surgery,
University of Virginia School of Medicine, Charlottesville, United States
(Acker) Department of Surgery, Division of Cardiovascular Surgery,
University of Pennsylvania School of Medicine, Philadelphia, United States
(Thourani) Clinical Research Unit, Division of Cardiothoracic Surgery,
Emory University School of Medicine, Atlanta, United States
(Gammie) University of Maryland, Baltimore, National Heart, Lung, and
Blood Institute, Bethesda, MD, United States
(Argenziano) Division of Cardiovascular Sciences, National Heart, Lung,
and Blood Institute, Bethesda, MD, United States
(Jeffries) Office of Biostatistics Research, National Heart, Lung, and
Blood Institute, Bethesda, MD, United States
(Blackstone) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, United States
(Gardner) Center for Heart and Vascular Health, Christiana Care Health
System, Newark, DE, United States
Title
Surgical treatment of moderate ischemic mitral regurgitation.
Source
New England Journal of Medicine. 371 (23) (pp 2178-2188), 2014. Date of
Publication: 04 Dec 2014.
Publisher
Massachussetts Medical Society
Abstract
Background Ischemic mitral regurgitation is associated with increased
mortality and morbidity. For surgical patients with moderate
regurgitation, the benefits of adding mitralvalve repair to
coronary-artery bypass grafting (CABG) are uncertain.
Methods We randomly assigned 301 patients with moderate ischemic mitral
regurgitation to CABG alone or CABG plus mitral-valve repair (combined
procedure). The primary end point was the left ventricular end-systolic
volume index (LVESVI), a measure of left ventricular remodeling, at 1
year. This end point was assessed with the use of a Wilcoxon rank-sum test
in which deaths were categorized as the lowest LVESVI rank.
Results At 1 year, the mean LVESVI among surviving patients was 46.1+22.4
ml per square meter of body-surface area in the CABG-alone group and
49.6+31.5 ml per square meter in the combined-procedure group (mean change
from baseline, -9.4 and -9.3 ml per square meter, respectively). The rate
of death was 6.7% in the combined-procedure group and 7.3% in the
CABG-alone group (hazard ratio with mitral-valve repair, 0.90; 95%
confidence interval, 0.38 to 2.12; P = 0.81). The rank-based assessment of
LVESVI at 1 year (incorporating deaths) showed no significant
between-group difference (z score, 0.50; P = 0.61). The addition of
mitral-valve repair was associated with a longer bypass time (P<0.001), a
longer hospital stay after surgery (P = 0.002), and more neurologic events
(P = 0.03). Moderate or severe mitral regurgitation was less common in the
combined-procedure group than in the CABG-alone group (11.2% vs. 31.0%,
P<0.001). There were no significant between-group differences in major
adverse cardiac or cerebrovascular events, deaths, readmissions,
functional status, or quality of life at 1 year.
Conclusions In patients with moderate ischemic mitral regurgitation, the
addition of mitral-valve repair to CABG did not result in a higher degree
of left ventricular reverse remodeling. Mitral-valve repair was associated
with a reduced prevalence of moderate or severe mitral regurgitation but
an increased number of untoward events. Thus, at 1 year, this trial did
not show a clinically meaningful advantage of adding mitral-valve repair
to CABG. Longer-term follow-up may determine whether the lower prevalence
of mitral regurgitation translates into a net clinical benefit. (Funded by
the National Institutes of Health and the Canadian Institutes of Health
Research; ClinicalTrials.gov number, NCT00806988.).
<4>
Accession Number
2014980872
Authors
Cui Y. Ma C. Long D. Wang L. Cao X. Zhang G.
Institution
(Cui, Ma, Long) Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing Institute of Heart, Lung and Blood Vessel
Diseases, Chao Yang, Beijing 100029, China
(Wang, Cao, Zhang) Department of Cardiology, Geriatric Cardiovascular
Disease Center of Chinese PLA, No. 252 Hospital of PLA, Baoding, Hubei
071000, China
Title
Effect of valsartan on atrial fibrillation recurrence following pulmonary
vein isolation in patients.
Source
Experimental and Therapeutic Medicine. 9 (2) (pp 631-635), 2015. Date of
Publication: 2015.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece)
Abstract
Pulmonary venous isolation has emerged as an effective therapy for atrial
fibrillation (AF); however, AF recurrence is common. The aim of the
present study was to investigate the effect of angiotensin receptor
blockers (ARBs) on the recurrence rate of AF following ablation therapy.
In total, 120 patients, who were scheduled for ablation, were randomly
selected. The patients were randomly divided into three groups, which
received treatment with a placebo (n=40), 80 mg valsartan daily (n=40) or
with 160 mg valsartan daily (n=40). The demographic characteristics,
comorbidities, AF type and information regarding treatment with ARBs were
recorded and analyzed. Following a mean follow-up period of 13.8+8.6
months, 66.7% of patients were found to be free of AF. Kaplan-Meier
analysis of the time until the first recurrence during the follow-up
period revealed that patients treated with 160 mg/day valsartan presented
a higher probability of remaining free of AF (88%, vs. 47% for the control
and 65% for the 80 mg/day valsartan groups). In addition, multivariate
analysis demonstrated that treatment with ARB was associated with lower AF
recurrence rates (hazard ratio, 0.46; 95% confidence interval, 0.20-0.93]
P=0.01). In conclusion, treatment with 160 mg/day valsartan markedly
reduced the risk of recurrence of AF in a dose-dependent manner in AF
patients following ablation.
<5>
Accession Number
2014980690
Authors
Iliou M.-C. Pavy B. Martinez J. Corone S. Meurin P. Tuppin P.
Institution
(Iliou, Martinez) Cardiac Rehabilitation Department, Hopital Corentin
Celton, 4 parvis Corentin Celton, Issy les Mx Cedex 92130, France
(Pavy) Centre Hospitalier Loire Vendee Ocean, Machecoul, France
(Corone) Centre Hospitalier Bligny, Briis Sous Forges, France
(Meurin) Cardiac Rehabilitation Center, Villeneuve Saint Denis, France
(Tuppin) Caisse Nationale Asuurance Maladie des Travailleurs Salaries,
Paris, France
Title
Exercise training is safe after coronary stenting: A prospective
multicentre study.
Source
European Journal of Preventive Cardiology. 22 (1) (pp 27-34), 2015. Date
of Publication: 19 Jan 2015.
Publisher
SAGE Publications Inc.
Abstract
Background: Data on the safety of exercise training after coronary
stenting are scarce. Design: This is a prospective cohort study of 3132
patients with coronary stenting within the last 12 months, recruited by 44
cardiac rehabilitation centres; patients were included in a cardiac
rehabilitation programme with training sessions 3-5 days a week. Cardiac
rehabilitation was defined as early rehabilitation when starting <1 month
after coronary stenting and as late rehabilitation when starting later.
Methods: Rate of acute coronary syndrome (ACS) after coronary stenting was
estimated according to time to training session. ACS was defined as
related to exercise when it occurs during or within the hour after an
exercise stress test or a training session. All ACS were documented by an
angiographic control. Results: Overall 5016 stents (41.4% drug-eluting
stents) were implanted in 3132 patients aged 56.5 + 12.9 years (84.7% men)
with a median of 1 stent (range 1-8) per patient. Indication of coronary
senting was ACS (86.4%), angina pectoris (8.6%), and silent ischaemia
(5%). Combined antiplatelet treatment was used in 97.2% of the patients.
Overall rate of ACS after coronary stenting was 2.9/1000 patients,
corresponding to 1.7 complications out of 10<sup>6</sup> patient-hours of
exercise. There were four stent thromboses related to exercise (1.2/1000
patients, 0.8/10<sup>6</sup> patient-hours of exercise): two in the early
rehabilitation group (days 9 and 11), and two in the late rehabilitation
group (days 77 and 228). Conclusions: Exercise training seems safe and
there is no justification to delay cardiac rehabilitation after coronary
stenting.
<6>
Accession Number
2014980681
Authors
Clark R.A. Conway A. Poulsen V. Keech W. Tirimacco R. Tideman P.
Institution
(Clark) School of Nursing and Midwifery, Flinders University, Sturt Road,
Bedford Park 5042, GPO Box 2100, Adelaide, SA 5001, Australia
(Conway) School of Nursing, Institute of Health and Biomedical Innovation,
Queensland University Technology, Australia
(Poulsen, Keech) National Heart Foundation of Australia, Australia
(Tirimacco, Tideman) Integrated Cardiovascular Clinical Network, SA,
Australia
Title
Alternative models of cardiac rehabilitation: A systematic review.
Source
European Journal of Preventive Cardiology. 22 (1) (pp 35-74), 2015. Date
of Publication: 19 Jan 2015.
Publisher
SAGE Publications Inc.
Abstract
The traditional hospital-based model of cardiac rehabilitation faces
substantial challenges, such as cost and accessibility. These challenges
have led to the development of alternative models of cardiac
rehabilitation in recent years. The aim of this study was to identify and
critique evidence for the effectiveness of these alternative models. A
total of 22 databases were searched to identify quantitative studies or
systematic reviews of quantitative studies regarding the effectiveness of
alternative models of cardiac rehabilitation. Included studies were
appraised using a Critical Appraisal Skills Programme tool and the
National Health and Medical Research Council's designations for Level of
Evidence. The 83 included articles described interventions in the
following broad categories of alternative models of care: multifactorial
individualized telehealth, internet based, telehealth focused on exercise,
telehealth focused on recovery, community- or homebased, and complementary
therapies. Multifactorial individualized telehealth and community- or
home-based cardiac rehabilitation are effective alternative models of
cardiac rehabilitation, as they have produced similar reductions in
cardiovascular disease risk factors compared with hospital-based
programmes. While further research is required to address the paucity of
data available regarding the effectiveness of alternative models of
cardiac rehabilitation in rural, remote, and culturally and linguistically
diverse populations, our review indicates there is no need to rely on
hospital-based strategies alone to deliver effective cardiac
rehabilitation. Local healthcare systems should strive to integrate
alternative models of cardiac rehabilitation, such as brief telehealth
interventions tailored to individual's risk factor profiles as well as
community- or home-based programmes, in order to ensure there are choices
available for patients that best fit their needs, risk factor profile, and
preferences.
<7>
Accession Number
2014982570
Authors
Mansoor E.
Institution
(Mansoor) Department of General Surgery, University of KwaZulu-Natal,
Durban, South Africa
Title
De novo atrial fibrillation post cardiac surgery: The Durban experience.
Source
Cardiovascular Journal of Africa. 25 (6) (pp 282-287), 2014. Date of
Publication: 01 Nov 2014.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Atrial fibrillation (AF) is the most common complication post cardiac
surgery and results in elevated morbidity and mortality rates and
healthcare costs. A pilot, retrospective study of the medical records of
all adult patients developing de novo AF post surgery was undertaken at
the cardiac surgical unit in Durban between 2009 and 2012. We aimed to
describe the local experience of AF with a view to suggesting an adapted
local treatment policy in relation to previously published data.
Fifty-nine patients developed AF during the study period. AF occurred
predominantly three or more days post surgery. Thirty-five patients
required cardioversion and amiodarone to restore sinus rhythm. Return to
the general ward (RGW) was 4.6 days longer than the institutional norm.
Liberal peri-operative beta-blocker and statin use is currently preferred
to a formal prophylaxis strategy. Randomised, controlled trials are
required to evaluate measures curbing prolonged length of stay and
morbidity burdens imposed by AF on the local resource-constrained
environment.
<8>
Accession Number
2014750207
Authors
Marwali E.M. Boom C.E. Sakidjan I. Santoso A. Fakhri D. Kartini A. Kekalih
A. Schwartz S.M. Haas N.A.
Institution
(Marwali, Boom) Department of Pediatric Cardiac Intensive Care and
Anaesthesiology, National Cardiovascular Center Harapan Kita, Jakarta,
Indonesia
(Sakidjan, Santoso) Department of Cardiology and Vascular Medicine,
National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
(Fakhri) Department of Pediatric Cardiac Surgery, National Cardiovascular
Center Harapan Kita, Jakarta, Indonesia
(Kartini) Department of Clinical Pathology, National Cardiovascular Center
Harapan Kita, Jakarta, Indonesia
(Kekalih) Division of Epidemiology and Biostatistics, Department of
Community Medicine, University of Indonesia, Jakarta, Indonesia
(Schwartz) Department of Critical Care Medicine, Hospital for Sick
Children, University of Toronto School of Medicine, Toronto, ON, Canada
(Haas) Department of Congenital Heart Defects, Heart and Diabetes Centre,
North Rhein-Westfalia, Bad Oeynhausen, Germany
Title
Oral triiodothyronine normalizes triiodothyronine levels after surgery for
pediatric congenital heart disease.
Source
Pediatric Critical Care Medicine. 14 (7) (pp 701-708), 2013. Date of
Publication: 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: This study was conducted to determine if oral triiodothyronine
supplementation could prevent the decrease of serum triiodothyronine
levels that commonly occurs after cardiopulmonary bypass for pediatric
congenital heart surgery. Secondary objectives included identifying any
significant adverse effects of oral triiodothyronine supplementation,
including any effects on the thyroid/pituitary axis. Design: Randomized,
placebo-controlled, doubleblind clinical trial. Setting: Operating room
and ICU. Subjects: Infants and children younger than 2 years of age
undergoing congenital heart surgery using cardiopulmonary bypass (n = 43).
Interventions: Subjects were assigned to placebo (n = 15, group A) or one
of two treatment groups: a low-dose group (group B, n = 14, 0.5 mcg/kg
triiodothyronine orally every 24 hr for 3 d) or a high-dose group (group
C, n = 14, 0.5 mcg/kg triiodothyronine orally every 12 hr for 3 d).
Measurements and Main Results: Thyroid hormone, including total and free
triiodothyronine levels at predetermined time points, potential side
effects indicatinghyperthyroidism, indicators of the thyroid-pituitary
axis, and clinicalendpoints. Oral triiodothyronine supplementation
twice-daily maintainedserum triiodothyronine levels within normal limits
in groupC, whereas serum levels progressively declined in groups A and B.
A statistically significant difference in triiodothyronine levels between
the treatment groups occurred between 18 and 36 hourspost cross-clamp
release, with the largest difference in serum levelsbetween group C and
group A noted at 36 hours post cross-clamprelease (total triiodothyronine,
0.71 + 0.15 [0.34-1.08] ng/mL [p < 0.01]; free triiodothyronine, 2.56 +
0.49 [1.33-3.79] pg/mL [p < 0.01]). There was no evidence of
hyperthyroidism or suppressionof the pituitary-thyroid axis in either
treatment group. Conclusions: Oral triiodothyronine supplementation at a
dose of 0.5 mcg/kg every 12 hours for 3 days can maintain total and free
triiodothyronine levels within normal limits after open-heart surgery
using cardiopulmonary bypass for congenitalheart disease.
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