Results Generated From:
Embase <1980 to 2015 Week 05>
Embase (updates since 2015-01-23)
<1>
Accession Number
23485658
Authors
Erdogan A.
Institution
(Kol) Department of Nursing, Akdeniz University, School of Medicine,
Antalya, Turkey. Electronic address: ekol@akdeniz.edu.tr
(Alpar) Department of Nursing, Marmara University, Faculty of Health
Sciences, Istanbul, Turkey
(Erdogan) Department of Thoracic Surgery, Akdeniz University, School of
Medicine, Antalya, Turkey
Title
Preoperative education and use of analgesic before onset of pain routinely
for post-thoracotomy pain control can reduce pain effect and total amount
of analgesics administered postoperatively.
Source
Pain management nursing : official journal of the American Society of Pain
Management Nurses. 15 (1) (pp 331-339), 2014. Date of Publication: 01 Mar
2014.
Abstract
The purpose of this study was to investigate the efficiency of
preoperative pain management education and the role of analgesics
administration before the onset of pain postoperatively. The study was a
prospective, randomized, and single-blind clinical trial, which was
conducted January 1, 2008 through October 1, 2008 in the Thoracic Surgery
Unit of Akdeniz University Hospital. A total of 70 patients who underwent
thoracotomy (35 in the control group and 35 in the study group) were
included in the study. Of the patients, 70% (n = 49) were male and 30% (n
= 21) were female. Mean age was 51 +/- 10 years (range = 25-65). The same
analgesia method was used for all patients; the same surgical team
performed each operation. Methods, including preemptive analgesia and
placement of pleural or thoracic catheter for using analgesics, that were
likely to affect pain level, were not used. The same analgesia medication
was used for both patient groups. But the study group, additionally, was
educated on how to deal with pain preoperatively and on the
pharmacological methods to be used after surgery. An intramuscular
diclofenac Na 75 mg was administered to the study group regardless of
whether or not they reported pain in the first two postoperative hours.
The control group did not receive preoperative education, and analgesics
were not administered to them unless they reported pain in the
postoperative period. The routine analgesics protocol was as follows:
diclofenac Na 75 mg (once a day) intramuscular administered upon the
complaint of pain following extubation in the postoperative period and 20
mg mepederin intravenously (maximum dose, 100 mg/day), in addition, when
the patient expressed pain. Pain severity was assessed during the second,
fourth, eighth, 16th, 24th, and 48th hours, and marked using the Verbal
Category Scale and the Behavioral Pain Assessment Scale. Additionally, the
total dose of daily analgesics was calculated. The demographic
characteristics showed a homogeneous distribution in both patient groups.
The rate of pain, which was defined as sharp, stabbing, and exhausting,
was higher in the control group than in the study group, and the
difference between the two groups was statistically significant (p < .05).
As the doses of analgesics used for pain management in both groups were
compared, it was determined that analgesic consumption was lower in the
study group than in the control group, and the difference was
statistically significant (p < .05). As a result, it was determined that
preoperative thoracic pain management education and analgesics
administered postoperatively, before the onset of pain, reduced the amount
of analgesics used in the first postoperative 48 hours.
<2>
Accession Number
24619042
Authors
Luger T.J. Kammerlander C. Luger M.F. Kammerlander-Knauer U. Gosch M.
Institution
(Luger, Kammerlander, Luger, Kammerlander-Knauer, Gosch) Department of
Anaesthesiology and Critical Care Medicine, Innsbruck Medical University,
Anichstr. 25, 6020, Innsbruck, Austria, thomas.luger@i-med.ac.at
Title
Mode of anesthesia, mortality and outcome in geriatric patients.
Source
Zeitschrift fur Gerontologie und Geriatrie. 47 (2) (pp 110-124), 2014.
Date of Publication: 01 Feb 2014.
Abstract
BACKGROUND: In older non-cardiac surgery patients, the influence of the
mode of anesthesia on late-term outcome (rehabilitation, mobility,
independence) is a controversial issue in the medical literature. In light
of an aging society, this review assessed the association between regional
(RA), local (LA) and general anesthesia (GA) and mortality and morbidity.
METHODS: A literature search within the PubMed and Cochrane databases
yielded 47 clinical trials and 35 reviews/meta-analyses published between
1965 and 2013. Potential outcome-influencing factors such as mortality,
risk factors, early complications (e.g. postoperative confusion,
aspiration, vomiting), adverse events (e.g. deep vein thrombosis,
pulmonary embolism), discharge, rehabilitation and mobilization were
evaluated in relation to the mode of anesthesia (RA, LA or GA).
RESULTS: The current literature contains 82 references covering 74,476
non-cardiac surgery patients. Analysis shows that the particular mode of
anesthesia influences mortality and morbidity. RA is associated with
reduced early mortality and morbidity, e.g. fewer incidents of deep vein
thrombosis and less acute postoperative confusion, as well as a tendency
toward fewer myocardial infarctions and fatal pulmonary embolisms. GA has
the advantages of a lower incidence of hypotension and reduced surgery
time.
CONCLUSION: Strictly speaking, true anesthesia-related complications
appear to be rare and many adverse outcomes may be multifactorial.
Postoperative complications are largely related to the perioperative
procedure and not to the anesthesia itself. GA and RA are both useful for
older non-cardiac patients, but for some procedures, e.g. hip fracture
surgery, RA seems to be the technique of choice. The mode of anesthesia
may only play a secondary role in mobility, rehabilitation and discharge
destination. In general, due to the many different possible
outcomes--which are often very difficult or impossible to compare--no
other specific recommendations can be made with regard to the type of
anesthesia to be preferred for older non-cardiac patients.
<3>
Accession Number
24621972
Authors
Velazquez E.J.
Institution
(Carson) Washington DC VA Medical Center, Washington DC. Electronic
address:
(Wertheimer) Pennsylvania Heart and Vascular Group, Philadelphia,
Pennsylvania
(Miller) University of Florida-Shands Jacksonville, Jacksonville, Florida
(O'Connor) Duke University Medical Center/Duke Clinical Research
Institute, Durham, North Carolina
(Pina) Montefiore Medical Center, Bronx, New York
(Selzman) University of Utah School of Medicine, Salt Lake City, Utah
(Sueta) University of North Carolina, Chapel Hill, North Carolina
(She) Duke University Medical Center/Duke Clinical Research Institute,
Durham, North Carolina
(Greene) Duke University Medical Center/Duke Clinical Research Institute,
Durham, North Carolina
(Lee) Duke University Medical Center/Duke Clinical Research Institute,
Durham, North Carolina
(Jones) Duke University Medical Center/Duke Clinical Research Institute,
Durham, North Carolina
(Velazquez) Duke University Medical Center/Duke Clinical Research
Institute, Durham, North Carolina
Title
The STICH trial (Surgical Treatment for Ischemic Heart Failure):
mode-of-death results.
Source
JACC. Heart failure. 1 (5) (pp 400-408), 2013. Date of Publication: 01 Oct
2013.
Abstract
OBJECTIVES: This study sought to assess the effect of the addition of
coronary artery bypass grafting (CABG) to medical therapy on mode of death
in heart failure.
BACKGROUND: Although CABG therapy is widely used in ischemic
cardiomyopathy patients, there are no prospective clinical trial data on
mode of death.
METHODS: The STICH (Surgical Treatment for Ischemic Heart Failure ) trial
compared the strategy of CABG plus medical therapy to medical therapy
alone in 1,212 ischemic cardiomyopathy patients with reduced ejection
fraction. A clinical events committee adjudicated deaths using
pre-specified definitions for mode of death.
RESULTS: In the STICH trial, there were 462 deaths over a median follow-up
of 56 months. The addition of CABG therapy tended to reduce cardiovascular
deaths (hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.68 to
1.03; p = 0.09) and significantly reduced the most common modes of death:
sudden death (HR: 0.73; 95% CI: 0.54 to 0.99; p = 0.041) and fatal pump
failure events (HR: 0.64; 95% CI: 0.41 to 1.00; p = 0.05). Time-dependent
estimates indicate that the protective effect of CABG principally occurred
after 24 months in both categories. Deaths post-cardiovascular procedures
were increased in CABG patients (HR: 3.11; 95% CI: 1.47 to 6.60), but
fatal myocardial infarction deaths were lower (HR: 0.07; 95% CI: 0.01 to
0.57). Noncardiovascular deaths were infrequent and did not differ between
groups.
CONCLUSIONS: In the STICH trial, the addition of CABG to medical therapy
reduced the most common modes of death: sudden death and fatal pump
failure events. The beneficial effects were principally seen after 2
years. Post-procedure deaths were increased in patients randomized to
CABG, whereas myocardial infarction deaths were decreased.
<4>
Accession Number
24621971
Authors
Nicholls S.J.
Institution
(Kobashigawa) Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center,
Los Angeles, California. Electronic address: Kobashigawaj@cshs.org
(Pauly) Division of Cardiovascular Medicine, University of Florida College
of Medicine, Gainesville, Florida
(Starling) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, Ohio
(Eisen) Division of Cardiology, Drexel University College of Medicine,
Philadelphia, Pennsylvania
(Ross) Division of Experimental Therapeautics, Toronto Medical Hospital,
Toronto, Ontario, Canada
(Wang) Department of Cardiovascular Surgery, National Taiwan University
Hospital, Taipei, Taiwan
(Cantin) Lipid Research Center, Laval University Medical Center, Quebec,
Canada
(Hill) Division of Cardiovascular Medicine, University of Florida College
of Medicine, Gainesville, Florida
(Lopez) Novartis Pharma AG, Basel, Switzerland
(Dong) Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
(Nicholls) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, Ohio
Title
Cardiac allograft vasculopathy by intravascular ultrasound in heart
transplant patients: substudy from the Everolimus versus mycophenolate
mofetil randomized, multicenter trial.
Source
JACC. Heart failure. 1 (5) (pp 389-399), 2013. Date of Publication: 01 Oct
2013.
Abstract
METHODS: Study patients were a pre-specified subgroup of the 553-patient
Everolimus versus mycophenolate mofetil in heart transplantation: a
randomized, multicenter trial who underwent heart transplantation and were
randomized to everolimus 1.5 mg or MMF 3 g/day. IVUS was performed at
baseline and at 12 months. Evaluable IVUS data were available in 189
patients (34.6%).
RESULTS: Increase in average maximal intimal thickness (MIT) from baseline
to month 12 was significantly smaller in the everolimus 1.5 mg group
compared with the MMF group (0.03 mm vs. 0.07 mm, p < 0.001). The
incidence of CAV, defined as an increase in MIT from baseline to month 12
of greater than 0.5 mm, was 12.5% with everolimus versus 26.7% with MMF (p
= 0.018). These findings remained irrespective of sex, age, diabetic
status, donor disease, and across lipid categories.
CONCLUSIONS: Everolimus was significantly more efficacious than MMF in
preventing CAV as measured by IVUS among heart-transplant recipients after
1 year, a finding, which was maintained in a range of patient
subpopulations. CV surgery: transplantation, ventricular assistance,
cardiomyopathy.
OBJECTIVES: A pre-planned substudy of a larger multicenter randomized
trial was undertaken to compare the efficacy of everolimus with
reduced-dose cyclosporine in the prevention of cardiac allograft
vasculopathy (CAV) after heart transplantation to that of mycophenolate
mofetil (MMF) with standard-dose cyclosporine.
BACKGROUND: CAV is a major cause of long-term mortality following heart
transplantation. Everolimus has been shown to reduce the severity and
incidence of CAV as measured by first year intravascular ultrasound
(IVUS). MMF, in combination with cyclosporine, has also been shown to have
a beneficial effect in slowing the progression of CAV.
<5>
Accession Number
2015681351
Authors
Verdoia M. Schaffer A. Suryapranata H. De Luca G.
Institution
(Verdoia, Schaffer, De Luca) Division of Cardiology, Azienda
Ospedaliera-Universitaria Maggiore della Carita, Eastern Piedmont
University, Novara, Italy
(Suryapranata) Department of Cardiology, UMC St Radboud, Nijmegen,
Netherlands
Title
Effects of HDL-modifiers on cardiovascular outcomes: A meta-analysis of
randomized trials.
Source
Nutrition, Metabolism and Cardiovascular Diseases. 25 (1) (pp 9-23), 2015.
Date of Publication: 01 Jan 2015.
Publisher
Elsevier
Abstract
Background and aim: High density lipoproteins (HDL) have been addressed as
a potential strategy for cardiovascular prevention, with great
controversies on pharmacological approaches for HDL-elevation. Our aim was
to compare HDL-rising treatment with niacin or CETP-inhibitors with
optimal medical therapy in cardiovascular outcome. Methods and results:
Randomized trials were searched. Primary endpoint was cardiovascular
death, secondary were: non fatal myocardial infarction; coronary
revascularization; cerebrovascular accidents and safety endpoints. As many
as 18 randomized trials, for a total of 69,515 patients, were included.
HDL-modifiers did not reduce cardiovascular mortality (2.3%vs3.4%; OR
[95%CI]=0.96 [0.87-1.05], p=0.37, phet=0.58), with no benefit from
niacin/CETP inhibitors according to patients' risk profile (beta
[95%CI]=-0.14 [-0.29 to 0.02], p=0.09) or the amount of HDL increase (beta
[95%CI]=0.014 [-0.008 to 0.04], p=0.21). Niacin but not CETP-I reduced
myocardial infarction and coronary revascularization, but higher rate of
SAE occurred with HDL-modifiers (OR [95%CI]=1.24 [1.18-1.31], p<0.00001,
phet=0.02), in particular new onset of diabetes with niacin and worsening
of hypertension with CETP-inhibitors. Conclusions: Niacin and CETP
inhibitors do not influence cardiovascular mortality. Significant benefits
in MI and coronary revascularization were observed with niacin, despite
the higher occurrence of diabetes.
<6>
Accession Number
2015671981
Authors
Zhu H.-C. Li Y. Guan S.-Y. Li J. Wang X.-Z. Jing Q.-M. Wang Z.-L. Han
Y.-L.
Institution
(Zhu) Second Affiliated Hospital of Dalian Medical University, Dalian,
Shandong Province 116023, China
(Zhu, Li, Guan, Li, Wang, Jing, Wang, Han) Cardiovascular Institute,
General Hospital of Shenyang Military Region, Department of Cardiology,
Shenyang, Liaoning Province 110016, China
Title
Efficacy and safety of individually tailored antiplatelet therapy in
patients with acute coronary syndrome after coronary stenting: A single
center, randomized, feasibility study.
Source
Journal of Geriatric Cardiology. 12 (1) (pp 23-29), 2015. Date of
Publication: 2015.
Publisher
Science Press
Abstract
Background: Low responsiveness to clopidogrel (LRC) is associated with
increased risk of ischemic events. This study was aimed to explore the
feasibility of tailored antiplatelet therapy according to the
responsiveness to clopidogrel. Methods A total of 305 clopidogrel naive
patients with acute coronary syndromes (ACS) undergoing coronary stenting
were randomly assigned to receive standard (n = 151) or tailored (n = 154)
antiplatelet therapy. The ADP-induced platelet aggregation tests by light
transmission aggregometry were performed to identify LRC patients assigned
to the tailored group. The standard antiplatelet regimen was dual
antiplatelet therapy with aspirin and clopidogrel. The tailored
antiplatelet therapy was standard regimen for non-LRC patients and an
additional 6-month cilostazol treatment for LRC patients. The primary
efficacy outcome was the composite of cardiovascular death, myocardial
infarction or stroke at one year. Results: LCR was present in 26.6%
(41/154) of patients in the tailored group. The percentage platelet
aggregation for LCR patients was significantly decreased at three days
after adjunctive cilostazol treatment (77.5% +/- 12.1% vs. 64.5% +/-
12.1%, P < 0.001). At one year follow-up, a non-significant 37% relative
risk reduction of primary events were observed in the tailored group as
compared to the standard group (5.8% vs. 9.3%, P = 0.257). There were no
differences in the rates of stent thrombosis and hemorrhagic events
between the two groups. Conclusions: Tailored antiplatelet therapy for ACS
patients after coronary stenting according to responsiveness to
clopidogrel is feasible. However, its efficacy and safety need further
confirmation by clinical trials with larger sample sizes.
<7>
Accession Number
2014825028
Authors
Suehiro K. Tanaka K. Yamada T. Matsuura T. Funao T. Mori T. Nishikawa K.
Institution
(Suehiro, Tanaka, Yamada, Matsuura, Funao, Mori, Nishikawa) Department of
Anaesthesiology, Osaka City University, Graduate School of Medicine,
Osaka, Japan
Title
The utility of intra-operative three-dimensional transoesophageal
echocardiography for dynamic measurement of stroke volume.
Source
Anaesthesia. 70 (2) (pp 150-159), 2015. Date of Publication: 01 Feb 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Summary Measurement of left ventricular stroke volume and cardiac output
is very important for managing haemodynamically unstable or critically ill
patients. The aims of this study were to compare stroke volume measured by
three-dimensional transoesophageal echocardiography with stroke volume
measured using a pulmonary artery catheter, and to examine the ability of
three-dimensional transoesophageal echocardiography to track stroke volume
changes induced by haemodynamic interventions. This study included 40
cardiac surgery patients. Haemodynamic variables were measured before and
2 min after haemodynamic interventions, which consisted of phenylephrine
100 mug or ephedrine 5 mg. We used Bland-Altman analysis to assess the
agreement between the stroke volume measured by three-dimensional
transoesophageal echocardiography and by the pulmonary artery catheter.
Polar-plot and 4-quadrant plot analyses were used to assess the trending
ability of three-dimensional transoesophageal echocardiography compared
with the pulmonary artery catheter. Bias and percentage error were -1.2 ml
and 20%, respectively. The concordance rate in the 4-quadrant analysis
after phenylephrine and ephedrine administration was 75% and 84%,
respectively. In the polar-plot analysis, the angular concordance rate was
66% and 73% after phenylephrine and ephedrine administration,
respectively. Three-dimensional transoesophageal echocardiography was
clinically acceptable for measuring stroke volume; however, it was not
sufficiently reliable for tracking stroke volume changes after
haemodynamic interventions.
<8>
Accession Number
2015672891
Authors
Haddadzadeh M. Motavaselian M. Rahimianfar A.A. Forouzannia S.K. Emami M.
Barzegar K.
Institution
(Haddadzadeh, Motavaselian, Rahimianfar, Forouzannia, Emami, Barzegar)
Department of Surgery, Cardiovascular Research Center, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
Title
The effect of posterior pericardiotomy on pericardial effusion and atrial
fibrillation after off-pump coronary artery bypass graft.
Source
Acta Medica Iranica. 53 (1) (pp 57-61), 2015. Date of Publication: 2015.
Publisher
Medical Sciences University of Teheran
Abstract
The most common type of arrhythmia following coronary artery bypass graft
(CABG) is atrial fibrillation (AF) with an incidence rate of 20-30%.
Pericardial effusion is one of the etiologic factors of atrial
fibrillation occurring after CABG. Posterior pericardiotomy (PP) causes
the drainage of blood and fluids from the pericardial space into the
pleural space leading to a decreased pericardial effusion. Most of the
studies dealing with the occurrence of AF in the surgical operation of
CABG have focused on patients undergoing on-pump CABG. The purpose of the
present study was to determine the effect of posterior pericardiotomy on
pericardial effusion and atrial fibrillation following the off-pump CABG.
This study was a clinical trial conducted on 207 patients. The patients
were randomly assigned to groups A, and B. Posterior pericardiotomy was
performed on the patients in Group A. This was not done on patients in
Group B. Following general anesthesia and median sternotomy, the left
internal mammary artery (LIMA) and saphenous vein were harvested
simultaneously. Following the injection of heparin, distal and proximal
anastomosis was performed and at the end of surgery, a longitudinal
incision with a length of 4 cm was performed parallel and posterior to the
left phrenic nerve from the left vein to diaphragm for patients in the
pericardiotomy group. 105 patients in the pericardiotomy group and 102
patients in the control group were examined regarding demographic
variables, AF incidence, and pericardial effusion. There was no
statistically significant correlation between two groups. There was no
statistically significant difference between the two groups regarding the
rate of AF incidence (P=0.719) and the rate of pericardial effusion (P=1).
Posterior pericardiotomy has no effect on postoperative AF incidence and
pericardial effusion in patients undergoing the off-pump CABG.
<9>
Accession Number
2015667879
Authors
Candilio L. Malik A. Ariti C. Barnard M. Di Salvo C. Lawrence D. Hayward
M. Yap J. Roberts N. Sheikh A. Kolvekar S. Hausenloy D.J. Yellon D.M.
Institution
(Candilio, Malik, Hausenloy, Yellon) Hatter Cardiovascular Institute,
University College London, 67 Chenies Mews, London WC1E 6HX, United
Kingdom
(Ariti) Nuffield Trust, London, United Kingdom
(Barnard, Di Salvo, Lawrence, Hayward, Yap, Roberts, Sheikh, Kolvekar)
Heart Hospital, University College London Hospital, London, United Kingdom
Title
Effect of remote ischaemic preconditioning on clinical outcomes in
patients undergoing cardiac bypass surgery: A randomised controlled
clinical trial.
Source
Heart. 101 (3) (pp 185-192), 2015. Date of Publication: 01 Jan 2015.
Publisher
BMJ Publishing Group
Abstract
Objectives Remote ischaemic preconditioning (RIPC), using brief cycles of
limb ischaemia/reperfusion, is a non-invasive, low-cost intervention that
may reduce perioperative myocardial injury (PMI) in patients undergoing
cardiac surgery. We investigated whether RIPC can also improve short-term
clinical outcomes. Methods One hundred and eighty patients undergoing
elective coronary artery bypass graft (CABG) surgery and/ or valve surgery
were randomised to receive either RIPC (2-5 min cycles of simultaneous
upper arm and thigh cuff inflation/deflation; N=90) or control (uninflated
cuffs placed on the upper arm and thigh; N=90). The study primary end
point was PMI, measured by 72 h area under the curve (AUC) serum
high-sensitive troponin-T (hsTnT); secondary end point included short-term
clinical outcomes. Results RIPC reduced PMI magnitude by 26% (-9.303
difference (CI - 15.618 to - 2.987) 72 h hsTnT-AUC; p=0.003) compared with
control. There was also evidence that RIPC reduced the incidence of
postoperative atrial fibrillation by 54% (11% RIPC vs 24% control;
p=0.031) and decreased the incidence of acute kidney injury by 48% (10.0%
RIPC vs 21.0% control; p=0.063), and intensive care unit stay by 1 day
(2.0 days RIPC (CI 1.0 to 4.0) vs 3.0 days control (CI 2.0 to 4.5);
p=0.043). In a post hoc analysis, we found that control patients
administered intravenous glyceryl trinitrate (GTN) intraoperatively
sustained 39% less PMI compared with those not receiving GTN, and RIPC did
not appear to reduce PMI in patients given GTN. Conclusions RIPC reduced
the extent of PMI in patients undergoing CABG and/or valve surgery. RIPC
may also have beneficial effects on short-term clinical outcomes, although
this will need to be confirmed in future studies. Trial registration
number ClinicalTrials.gov ID: NCT00397163.
<10>
Accession Number
2015672755
Authors
Ranjbaran S. Dehdari T. Sadeghniiat-Haghighi K. Majdabadi M.M.
Institution
(Ranjbaran) Department of Health Education and Health Promotion, School of
Health, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Dehdari) Department of Health Education and Health Promotion, School of
Health, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Sadeghniiat-Haghighi) Occupational Sleep Research Center, Baharloo
Hospital, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Majdabadi) Department of Biostatistics, School of Health, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Poor sleep quality in patients after coronary artery bypass graft surgery:
An intervention study using the PRECEDE-PROCEED model.
Source
Journal of Tehran University Heart Center. 10 (1) (pp 1-8), 2015. Date of
Publication: 2015.
Publisher
Tehran Heart Center
Abstract
Background: Poor sleep quality (SQ) is common among patients after
coronary artery bypass graft surgery (CABG). This study attempted to
determine the status of SQ following an intervention based on the
PRECEDE-PROCEED model in patients with poor SQ after CABG.
Methods: This study was a randomized clinical trial. The study sample,
including 100 patients referred to the Cardiac Rehabilitation Clinic of
Tehran Heart Center, was assigned either to the intervention (recipient of
exercise and lifestyle training plus designed intervention based on the
PRECEDE-PROCEED model) or to the control group (recipient of exercise and
lifestyle training). Eight training sessions over 8 weeks were conducted
for the intervention group. Predisposing, enabling, and reinforcing
factors as well as social support and SQ were measured in the intervention
group before and one month after the intervention and compared to those in
the control group at the same time points.
Results: The mean age of the patients in the intervention (24% women) and
control (24% women) groups was 59.3 +/- 7.3 and 59.5 +/- 9.3 years,
respectively. The results showed that the mean scores of SQ (p value <
0.001), knowledge (p value < 0.001), beliefs (p value < 0.001), sleep
self-efficacy (p value < 0.001), enabling factors (p value < 0.001),
reinforcing factors (p value < 0.001), and social support (p value <
0.001) were significantly different between the intervention and control
groups after the intervention.
Conclusion: Adding an intervention based on the PRECEDE-PROCEED model to
the cardiac rehabilitation program may further improve the SQ of patients.
<11>
Accession Number
2015668179
Authors
Cramariuc D. Rogge B.P. Lonnebakken M.T. Boman K. Bahlmann E.
Gohlke-Barwolf C. Chambers J.B. Pedersen T.R. Gerdts E.
Institution
(Cramariuc, Rogge) Department of Heart Disease, Haukeland University
Hospital, Bergen, Norway
(Rogge, Lonnebakken, Gerdts) Department of Clinical Science, University of
Bergen, Bergen, Norway
(Boman) Research Unit, Medicine, Umeaa University, Skellefteaa, Sweden
(Bahlmann) Asklepios Clinic St. Georg, Hamburg, Germany
(Gohlke-Barwolf) Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
(Chambers) Guy's and St Thomas Hospitals, London, United Kingdom
(Pedersen) Department of Preventive Cardiology, Ulleval University
Hopital, Oslo, Norway
Title
Sex differences in cardiovascular outcome during progression of aortic
valve stenosis.
Source
Heart. 101 (3) (pp 209-214), 2015. Date of Publication: 01 Jan 2015.
Publisher
BMJ Publishing Group
Abstract
Objective Women with severe aortic valve stenosis (AS) have better LV
systolic function and more concentric LV geometry than their male
counterparts. However, sex differences in cardiovascular (CV) outcome
during progression of AS have not been reported from a longitudinal
prospective study. Methods Doppler echocardiography and CV events were
recorded during a median of 4.0 years in 979 men and 632 women aged 28-86
(mean 67+/-10) years in the Simvastatin Ezetimibe in Aortic Stenosis
(SEAS) study. LV systolic function was assessed by EF and midwall
shortening (MWS). Study outcomes were ASrelated events, ischaemic CV
events and total mortality. Results The annular cumulative incidence of AS
events, ischaemic CV events and death was 8.1%, 3.4% and 2.8% in women,
and 8.9%, 4.4% and 2.4% in men, respectively. Women and men had similar AS
progression rate whether measured by peak jet velocity, mean gradient or
valve area. In multivariate analyses, female sex independently predicted
less reduction in LV MWS and EF during follow-up (both p<0.05). In
time-varying Cox analyses, women had a 40% lower rate of ischaemic CV
events (95% CI 21% to 54%), in particular, more than 50% lower rate of
stroke and coronary artery bypass grafting, and a 31% lower allcause
mortality (95% CI 1% to 51%), independent of active study treatment, age
and hypertension, as well as time-varying valve area, low systolic
function and abnormal LV geometry. AS event rate did not differ by sex.
Conclusions In the SEAS study, women and men had similar rates of AS
progression and AS-related events. However, women had lower total
mortality and ischaemic CV event rate than men independent of confounders.
Trial registration number ClinicalTrials.gov identi fier: NCT00092677.
Funding The SEAS (Simvastatin Ezetimibe in Aortic Stenosis)
Echocardiography Core Laboratory was supported by MSP Singapore Company,
LLC, Singapore, a partnership between Merck Co, and the Schering-Plough
Corporation.
<12>
Accession Number
2015663117
Authors
Lenarczyk R. Jedrzejczyk-Patej E. Mazurek M. Szulik M. Kowalski O.
Pruszkowska P. Sokal A. redniawa B. Boidol J. Kowalczyk J. Podolecki T.
Mencel G. Kalarus Z.
Institution
(Lenarczyk, Jedrzejczyk-Patej, Mazurek, Szulik, Kowalski, Pruszkowska,
Sokal, redniawa, Boidol, Kowalczyk, Podolecki, Mencel, Kalarus) Department
of Cardiology Congenital Heart Disease and Electrotherapy, Silesian
Medical University, Silesian Centre for Heart Diseases, Sklodowskiej-Curie
9, Zabrze 41-800, Poland
Title
Quality of life in cardiac resynchronization recipients: Association with
response and impact on outcome.
Source
PACE - Pacing and Clinical Electrophysiology. 38 (1) (pp 8-17), 2015. Date
of Publication: 01 Jan 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background The prognostic impact of improvement in health-related quality
of life (QoL) and its relation to response in cardiac resynchronization
therapy (CRT) recipients remains unknown. Aim To assess the correspondence
between response to CRT and improvements in QoL and to verify if a change
in QoL after pacing influences outcome in CRT patients. Methods
Ninety-seven participants of the Triple-Site Versus Standard Cardiac
Resynchronization Therapy Trial (TRUST CRT) randomized trial, in New York
Heart Association class III-IV, QRS width > 120 ms, left ventricular
ejection fraction <35%, and significant mechanical dyssynchrony were
included. Subjects filled out the Minnesota-QoL questionnaire prior to and
6 months after CRT with defibrillator (CRT-D) implantation. Data on major
adverse cardiac events (MACEs: death, heart failure hospitalization, heart
transplant) collected within the next 2.5 years and adjudicated blindly
constituted the censoring variables. Results Within the first 6 months of
resynchronization QoL improved in 81%, while worsening in 19% of patients.
Clinical response, but not the echocardiographic one, was associated with
improved QoL. During subsequent 2.5 years MACEs occurred in 37% of
patients (23% died). Subjects without QoL improvement were significantly
(both P < 0.05) more prone to experience MACE (61% vs 32%) and die (44% vs
18%) within the follow-up. Unimproved QoL increased the probability of
future MACE by 2.7 times (95% confidence intervals [CI]: 1.26-5.83; P =
0.01) and death by 3.2 times (95% CI: 1.23-8.32; P = 0.02) independently
from clinical and echocardiographic response. Conclusions Clinical
response, but not the echocardiographic one, was associated with improved
QoL in CRT recipients. These preliminary data suggest that lack of
improvement in QoL after CRT was associated with a strongly unfavorable
prognosis, regardless of functional or echocardiographic response. Our
results merit further studies with a larger number of patients.
<13>
Accession Number
2014724502
Authors
Bowater R.J. Hartley L.C. Lilford R.J.
Institution
(Bowater) Faculty of Engineering, Universidad Autonoma de Queretaro, Cerro
de las Campanas s/n, Col. Las Campanas, C.P., Santiago-de Queretaro,
Queretaro 76010, Mexico
(Hartley) Statistics and Epidemiology, Division of Health Sciences,
University of Warwick, Coventry, United Kingdom
(Lilford) Department of Public Health, Epidemiology and Biostatistics,
University of Birmingham, Edgbaston, Birmingham, United Kingdom
Title
Are cardiovascular trial results systematically different between North
America and Europe? A study based on intra-meta-analysis comparisons.
Source
Archives of Cardiovascular Diseases. 108 (1) (pp 23-38), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France. E-mail: infos@masson.fr)
Abstract
Background. - It is often assumed that differences in the efficacy of
treatments between countries (or regions) will be neither negligible nor
minor and therefore cannot be overlooked when assessing the potential
benefit of treatments in one country (or region) on the basis of trials
conducted in another country (or region). Aim. - To assess differences in
the results of cardiovascular trials between Europe and North America on
the basis of data from an extensive collection of trials. Methods. - A
systematic search was conducted of Medline (from the year 2005 to 2008)
and the Cochrane Library (from 2000 to 2008) for all meta-analyses of
randomized controlled tri-als aimed at treating and preventing
cardiovascular disease. Within each meta-analysis that satisfied given
criteria, trial results were compared between Europe and North America
with respect to a fatal and/or non-fatal endpoint by forming separate
estimates of treatment efficacy for each of these continents. Results. -
The literature search found 59 meta-analyses that satisfied all the
inclusion criteria. For most meta-analyses, it was the case that relative
to the control, the intervention was more favoured in trials conducted in
Europe than in North America with regard to both fatal endpoints(28 out of
43 meta-analyses) and non-fatal endpoints (28 out of 40 meta-analyses).
However, it was only with regard to non-fatal endpoints that this
imbalance turned out to be statistically significant at the 5% level (P =
0.017). Also, the lack of statistically significant differences in trial
results between Europe and North America within individual meta-analyses
meant that it was not possible to determine for which types of
intervention these intercontinental differences are likely to be more
pronounced than others. Conclusion. - There is some evidence to support
the theory that, relative to controls, interventions are more favoured in
cardiovascular trials conducted in Europe than in North America, when
treatment efficacy is measured in terms of a non-fatal endpoint. However,
the overall support for systematic differences in cardiovascular trial
results between Europe and North America is weak, which may be surprising
given the amount of data collected.
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