EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2015440438
Authors
Je H.G. Shuman D.J. Ad N.
Institution
(Je, Shuman, Ad) Inova Heart and Vascular Institute, Falls Church, VA,
United States
Title
A systematic review of minimally invasive surgical treatment for atrial
fibrillation: A comparison of the Cox-Maze procedure, beating-heart
epicardial ablation, and the hybrid procedure on safety and efficacy.
Source
European Journal of Cardio-thoracic Surgery. 48 (4) (pp 531-541), 2015.
Article Number: ezu536. Date of Publication: October 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
There is a growing trend to perform off-bypass surgical ablation for
atrial fibrillation (AF) because it is perceived to be safer and more
effective than the Cox-Maze procedure with cardiopulmonary bypass (CPB)
support. In this systematic review, we compared three minimally invasive
stand-alone surgical ablation procedures for AF: the endocardial Cox-Maze
procedure, epicardial surgical ablation and a hybrid epicardial surgical
and catheter-based endocardial ablation procedure (hybrid procedure).
Relevant studies were identified in MEDLINE and the Cochrane Database of
Systematic Reviews according to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From 565 initial
studies, 37 were included in this review. The total number of patients
across all studies was 1877 (range 10-139). Two studies reported on
endocardial Cox-Maze procedures (n = 145), 26 reported on epicardial
surgical ablation (n = 1382) and 9 reported on hybrid surgical ablation (n
= 350). For minimally invasive Cox-Maze, epicardial and hybrid groups,
operative mortality rates were 0, 0.5 and 0.9%, perioperative permanent
pacemaker insertion rates were 3.5, 2.7 and 1.5%, incidence of conversion
to median sternotomy was 0, 2.4 and 2.5%, and reoperation for bleeding was
1.0, 1.5 and 2.2%, with mean length of stay (days) of 5.4, 6.0 and 4.6,
respectively. At 12 months, rates of sinus rhythm restoration were 93, 80
and 70%, and sinus restoration without anti-arrhythmic medications was 87,
72 and 71%, for Cox-Maze, epicardial and hybrid procedures, respectively.
Of the three procedures, the minimally invasive Cox-Maze procedure with
CPB support was most effective for the treatment of stand-alone AF and had
important safety advantages in conversion to sternotomy and major
bleeding. The minimally invasive Cox-Maze procedure with CPB support also
demonstrated the potential for a higher success rate 12 months following
the procedure.

<2>
Accession Number
2015438419
Authors
Wan Q. Ye Q. Huang F.
Institution
(Wan, Ye) Department of Transplant Surgery, Third Xiangya Hospital,
Central South University, Changsha, Hunan, China
(Ye) Department of Transplant Surgery, Zhongnan Hospital, Wuhan
University, Wuhan, China
(Huang) Department of General Surgery, Third Xiangya Hospital, Central
South University, No 138 Tongzipo Rd., Changsha 410013, China
Title
The Bacteremia Caused by Non-Lactose Fermenting Gram-Negative Bacilli in
Solid Organ Transplant Recipients.
Source
Surgical Infections. 16 (5) (pp 479-489), 2015. Date of Publication: 01
Oct 2015.
Publisher
Mary Ann Liebert Inc.
Abstract
Background: Blood stream infections (BSIs) remain as a serious
life-threatening condition after solid organ transplant (SOT). In recent
years, a progressive growth in the incidence of bacteremia caused by
non-lactose fermenting gram-negative bacilli (NLF GNB) has been observed.
NLF GNB led to high mortality among SOT recipients with bacteremia and
were difficult to treat because of their high drug resistance to commonly
used antibiotics. Methods: Two electronic databases, PUBMED and EMBASE,
were searched for relevant literature published up to January 2015, to
better understand the characteristics of bacteremia because of NLF GNB.
Results: The morbidity and mortality rates of bacteremia because of NLF
GNB depend on the types of organisms and transplantation. Multi-drug
resistant NLF GNB ranged from 9.8% to 12.5% of all NLF GNB causing BSIs
among SOT recipients. Certain factors can predispose SOT recipients to NLF
GNB bacteremia, which included previous transplantation, hospital-acquired
BSIs, and prior intensive care unit admission. Combination therapy may be
beneficial in the treatment of NLF GNB bacteremia to enhance antimicrobial
activity, provide synergistic interactions, relieve side effects, and
minimize superinfections. Conclusions: Prevention is pivotal in minimizing
the morbidity and mortality associated with NLF GNB bacteremia after SOT.
To improve the outcomes of SOT recipients with NLF GNB bacteremia,
prevention is pivotal, and combination therapy of antibiotics may be
beneficial.

<3>
Accession Number
2015539292
Authors
Steenen S.A. van Wijk A.J. van Westrhenen R. de Lange J. de Jongh A.
Institution
(Steenen, de Lange) Academic Medical Center of the University of
Amsterdam, Department of Oral and Maxillofacial Surgery, Meibergdreef 9,
Amsterdam, AZ 1105, Netherlands
(van Wijk, de Jongh) Academic Centre for Dentistry Amsterdam, Department
of Social Dentistry and Behavioral Sciences, Gustav Mahlerlaan 3004,
Amsterdam, LA 1081, Netherlands
(van Westrhenen) Erasmus University Medical Center, Department of
Psychiatry, 's-Gravendijkwal 230, Rotterdam, CE 3015, Netherlands
(de Jongh) School of Health Sciences, Salford University, Salford, United
Kingdom
Title
Effects of propranolol on fear of dental extraction: Study protocol for a
randomized controlled trial.
Source
Trials. 16 (1) , 2015. Article Number: 536. Date of Publication: November
25, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Undergoing an extraction has been shown to pose a
significantly increased risk for the development of chronic apprehension
for dental surgical procedures, disproportionate forms of dental anxiety
(that is, dental phobia), and symptoms of post-traumatic stress. Evidence
suggests that intrusive emotional memories of these events both induce and
maintain these forms of anxiety. Addressing these problems effectively
requires an intervention that durably reduces both the intrusiveness of
key fear-related memories and state anxiety during surgery. Moreover,
evidence suggests that propranolol is capable of inhibiting "memory
reconsolidation" (that is, it blocks the process of storing a recently
retrieved fear memory). Hence, the purpose of this trial is to determine
the anxiolytic and fear memory reconsolidation inhibiting effects of the
s-adrenoreceptor antagonist propranolol on patients with high levels of
fear in anticipation of a dental extraction. Methods/Design: This trial is
designed as a multicenter, randomized, placebo-controlled, two-group,
parallel, double-blind trial of 34 participants. Consecutive patients who
have been referred by their dentist to the departments of oral and
maxillofacial surgery of a University hospital or a secondary referral
hospital in the Netherlands for at least two tooth and/or molar removals
and with self-reported high to extreme fear in anticipation of a dental
extraction will be recruited. The intervention is the administration of
two 40 mg propranolol capsules 1 hour prior to a dental extraction,
followed by one 40 mg capsule directly postoperatively. Placebo capsules
will be used as a comparator. The primary outcome will be dental trait
anxiety score reduction from baseline to 4-weeks follow-up. The secondary
outcomes will be self-reported anxiety during surgery, physiological
parameters (heart rate and blood pressure) during recall of the crucial
fear-related memory, self-reported vividness, and emotional charge of the
crucial fear-related memory. Discussion: This randomized trial is the
first to test the efficacy of 120 mg of perioperative propranolol versus
placebo in reducing short-term ("state") anxiety during dental extraction,
fear memory reconsolidation, and lasting dental ("trait") anxiety in a
clinical population. If the results show a reduction in anxiety, this
would offer support for routinely prescribing propranolol in patients who
are fearful of undergoing dental extractions. Trial registration:
ClinicalTrials.gov identifier: NCT02268357 , registered on 7 October 2014.
The Netherlands National Trial Register identifier: NTR5364 , registered
on 16 August 2015.

<4>
[Use Link to view the full text]
Accession Number
2015448078
Authors
Garg P. Malhotra A. Desai M. Sharma P. Bishnoi A.K. Tripathi P. Rodricks
D. Pandya H.
Institution
(Garg, Malhotra, Desai, Sharma, Bishnoi) Department of Cardiovascular and
Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center,
Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016, India
(Tripathi) Department of Pathology, U. N. Mehta Institute of Cardiology
and Research Center (Affiliated to B. J. Medical College), Civil Hospital
Campus, Asarwa, Ahmedabad, India
(Rodricks) Department of Perfusion, U. N. Mehta Institute of Cardiology
and Research Center (Affiliated to B. J. Medical College), Civil Hospital
Campus, Asarwa, Ahmedabad, India
(Pandya) Department of Medical Research, U. N. Mehta Institute of
Cardiology and Research Center (Affiliated to B. J. Medical College),
Civil Hospital Campus, Asarwa, Ahmedabad, India
Title
Pretransfusion comparison of dialyser-based hemoconcentrator with cell
saver system for perioperative cell salvage.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 10 (5) (pp 334-341), 2015. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Cell Saver system is the method of choice for red blood cell
salvage from the surgical field; however, cost is a limiting factor. We at
our institute have devised a cost-effective version of dialyser-based
autotransfusion system. We performed pretransfusion comparison of our
autotransfusion system with conventional cell saver system. Methods:
Aprospective randomized observational studywas performed in 104
consecutive patients with coronary artery disease undergoing by off-pump
coronary artery bypass grafting. Patients were divided into two groups. In
the dialyser group (53 patients), blood from surgical field was salvaged
by our dialyser-based system. In the cell saver group (51 patients), blood
was salvaged by cell saver. In both groups, 20-mL sample from the salvaged
blood was analyzed for hemoglobin, platelets, protein, albumin, free
hemoglobin, osmotic fragility, and peripheral blood smear examination.
Results: Total hemoglobin salvaged was comparable in both groups (85% vs
76%). On peripheral smear, red blood cells were swollen, but morphologywas
preserved.Moreover, normal osmotic fragility suggested absence of any
lethal damage to red blood cells in either group. Dialyserbased system was
more efficient in salvaging platelets (42.9% vs 6%), proteins (79.2% vs
0%), and albumin (65% vs 0%). Total free hemoglobin was three times more
in dialyser group but was well below recommended limits. Conclusions:
Dialyser-based system is economical, is equally efficacious in salvaging
red blood cells, is more effective in salvaging platelets and proteins,
and does not contain significant amount of free hemoglobin. Therefore,
this salvaged blood can be safely transfused.

<5>
Accession Number
2015251309
Authors
Ho J. Tangri N. Komenda P. Kaushal A. Sood M. Brar R. Gill K. Walker S.
Macdonald K. Hiebert B.M. Arora R.C. Rigatto C.
Institution
(Ho, Tangri, Komenda, Kaushal, Rigatto) Section of Nephrology, Department
of Internal Medicine, University of Manitoba, Winnipeg, MT, Canada
(Ho) Department of Immunology, University of Manitoba, Winnipeg, MT,
Canada
(Tangri, Komenda, Kaushal, Brar, Gill, Walker, Rigatto) Seven Oaks
Hospital Research Centre, Winnipeg, MT, Canada
(Tangri) Department of Community Health Sciences, University of Manitoba,
Winnipeg, MT, Canada
(Sood) Division of Nephrology, Department of Internal Medicine, University
of Ottawa, Winnipeg, MT, Canada
(Macdonald) Seven Oaks Hospital Library, University of Manitoba, Winnipeg,
MT, Canada
(Hiebert, Arora) Institute of Cardiac Sciences, St. Boniface General
Hospital, Winnipeg, MT, Canada
(Arora) Department of Surgery, University of Manitoba, Winnipeg, MT,
Canada
Title
Urinary, plasma, and serum biomarkers' utility for predicting acute kidney
injury associated with cardiac surgery in adults: A meta-analysis.
Source
American Journal of Kidney Diseases. 66 (6) (pp 993-1005), 2015. Date of
Publication: December 2015.
Publisher
W.B. Saunders
Abstract
Background Early accurate detection of acute kidney injury (AKI) occurring
after cardiac surgery may improve morbidity and mortality. Although
several novel biomarkers have been developed for the early detection of
AKI, their clinical utility in the critical intraoperative and immediate
postoperative period remains unclear. Study Design Systematic review and
meta-analysis. Setting & Population Adult patients having cardiac surgery.
Selection Criteria for Studies EMBASE, CINAHL, Cochrane Library, Scopus,
and PubMed from January 1990 until January 2015 were systematically
searched for cohort studies reporting the utility of novel biomarkers for
the early diagnosis of AKI after adult cardiac surgery. Reviewers
extracted data for study design, population, timing of biomarker
measurement and AKI occurrence, biomarker performance (area under the
receiver operating characteristic curve [AUROC]), and risk of bias. Index
Tests Novel urine, plasma, and serum AKI biomarkers, measured
intraoperatively and in the early postoperative period (<24 hours).
Reference Tests AKI was defined according to the RIFLE, AKIN, or 2012
KDIGO criteria. Results We found 28 studies reporting intraoperative
and/or early postoperative measurement of urine (n = 23 studies) or plasma
or serum (n = 12 studies) biomarkers. Only 4 of these studies measured
biomarkers intraoperatively. Overall, intraoperative discrimination by the
urine biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and
kidney injury marker 1 (KIM-1) demonstrated AUROCs < 0.70, whereas
N-acetyl-beta-d-glucosaminidase (NAG) and cystatin C had AUROCs < 0.75. In
the immediate 24-hour postoperative period, the urine biomarkers NGAL (16
studies), KIM-1 (6 studies), and liver-type fatty acid binding protein (6
studies) exhibited composite AUROCs of 0.69 to 0.72. The composite AUROCs
for postoperative urine cystatin C, NAG, and interleukin 18 were <0.70.
Similarly, the composite AUROCs for postoperative plasma NGAL (6 studies)
and cystatin-C (5 studies) were <0.70. Limitations Heterogeneous AKI
definitions. Conclusions In adults, known urinary, plasma, and serum
biomarkers of AKI possess modest discrimination at best when measured
within 24 hours of cardiac surgery.

<6>
Accession Number
2015082424
Authors
MacDonald M.R. She L. Doenst T. Binkley P.F. Rouleau J.L. Tan R.-S. Lee
K.L. Miller A.B. Sopko G. Szalewska D. Waclawiw M.A. Dabrowski R.
Castelvecchio S. Adlbrecht C. Michler R.E. Oh J.K. Velazquez E.J. Petrie
M.C.
Institution
(MacDonald) Department of Cardiology, Changi General Hospital, 2 Simei
Street 3, Singapore 529889, Singapore
(She) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, United States
(Doenst) Department of Cardiothoracic Surgery, Jena University Hospital,
Friedrich Schiller University, Jena, Germany
(Binkley) Ohio State University Wexner Medical Center, Columbus, OH,
United States
(Rouleau) Montreal Heart Institute, Universite de Montreal, Canada
(Tan) National Heart Centre, Singapore, Singapore
(Lee) Department of Biostatistics and Bioinformatics, Duke University
School of Medicine, Durham, NC, United States
(Miller) Department of Cardiology, University of Florida, Jacksonville,
FL, United States
(Sopko, Waclawiw) National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, MD, United States
(Szalewska) Department of Rehabilitation, Medical University of Gdansk,
Gdansk, Poland
(Dabrowski) Institute of Cardiology, Warsaw, Poland
(Castelvecchio) IRCCS Policlinico San Donato, Milan, Italy
(Adlbrecht) Department of Medicine II, Division of Cardiology, Medical
University of Vienna, Austria
(Michler) Department of Surgery, Montefiore Medical Center, Albert
Einstein College of Medicine, New York City, NY, United States
(Oh) Department of Medicine, Mayo Clinic, Rochester, MN, United States
(Velazquez) Department of Medicine-Cardiology, Duke University School of
Medicine, Durham, NC, United States
(Petrie) Scottish National Advanced Heart Failure Service, Golden Jubilee
National Hospital, University of Glasgow, Glasgow, United Kingdom
Title
Clinical characteristics and outcomes of patients with and without
diabetes in the Surgical Treatment for Ischemic Heart Failure (STICH)
trial.
Source
European Journal of Heart Failure. 17 (7) (pp 725-734), 2015. Date of
Publication: 01 Jul 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Aims Hypothesis 1 of the Surgical Treatment for Ischemic Heart Failure
(STICH) trial enrolled 1212 patients with an LVEF of <35% and CAD amenable
to coronary artery bypass grafting (CABG). Patients were randomized to
CABG and optimal medical therapy (MED) or MED alone. The objective was to
assess whether or not patients with diabetes mellitus (DM) enrolled in the
STICH trial would have greater benefit from CABG than patients without DM.
Methods and results The characteristics and clinical outcomes of patients
with and without DM randomized to CABG and MED or MED alone were compared.
DM was present in 40%. At baseline, patients with DM had more triple
vessel CAD, higher LVEF, and smaller left ventricular volumes. In patients
with DM, the primary outcome of all-cause mortality occurred in 39% of
patients in the MED group and 39% in the CABG group [hazard ratio (HR)
with CABG 0.96, 95% confidence interval (CI) 0.73-1.26]. In patients
without DM, the primary outcome occurred in 41% of patients in the MED
group and 32% in the CABG group (HR with CABG 0.80, 95% CI 0.63-1.02).
While numerically it would appear that the treatment effect of CABG is
blunted in patients with DM, there was no significant interaction between
DM and treatment group on formal statistical testing. Conclusions Patients
with DM enrolled in the STICH trial had more triple vessel disease,
smaller hearts, and higher LVEF than those without DM. CABG did not exert
greater benefit in patients with DM.

<7>
[Use Link to view the full text]
Accession Number
2015540821
Authors
Fan M.-K. Su Y.-M. Cai X.-X. Gu Z.-S. Geng H.-H. Pan H.-Y. Zhu J.-H. Pan
M.
Institution
(Fan, Su, Cai, Gu, Geng, Pan, Zhu, Pan) Department of Cardiology,
Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, China
Title
Clinical outcomes of revascularization strategies for patients with
MVD/LMCA disease.
Source
Medicine (United States). 94 (42) (pp e1745), 2015. Date of Publication:
01 Oct 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Hybrid coronary revascularization (HCR), a new minimally invasive
procedure for patients requiring revascularization for multivessel
coronary lesions, combines coronary artery bypass grafting (CABG) for left
anterior descending (LAD) lesions and percutaneous coronary intervention
(PCI) for non-LAD coronary lesions. However, available data related to
outcomes comparing the 3 revascularization therapies is limited to small
studies. We conducted a search in MEDLINE, EMBASE, and the Cochrane
Library of Controlled Trials up to December 31, 2014, without language
restriction. A total of 16 randomized trials (n=4858 patients) comparing
HCR versus PCI or off-pump CABG (OPCAB) were included in this
meta-Analysis. The primary outcomes were major adverse cardiac and
cerebrovascular events (MACCE), all-cause death, myocardial infarction
(MI), cerebrovascular events (CVE), and target vessel revascularization
(TVR). Odds ratios (OR) and 95% confidence intervals (CI) were calculated
using random-effect and fixed-effect models. Ranking probabilities were
used to calculate a summary numerical value: the surface under the
cumulative ranking (SUCRA) curve. No significant differences were seen
between the HCR and PCI in short term (in hospital and 30 days) with
regard to MACCE (odds ratio [OR] = 0.51, 95% confidence interval [CI]
0.00-2.35), all-cause death (OR = 2.09, 95% CI 0.34-7.66), MI (OR = 1.02,
95% CI 0.19-2.95), CVE (OR = 4.45, 95% CI 0.39-19.16), and TVR (OR = 6.99,
95% CI 0.17-39.39). However, OPCAB had lower MACCE than HCR (OR = 0.19,
95% CI 0.00-0.95). In midterm (1 year and 3 year), in comparison with HCR,
PCI had higher all-cause death (OR = 5.66, 95% CI 0.00- 13.88) and CVE (OR
= 4.40, 95% CI 0.01-5.68), and lower MI (OR = 0.51, 95%CI 0.00-2.86), TVR
(OR=0.53, 95%CI 0.05-2.26), and thus theMACCE(OR=0.51, 95%CI 0.00-2.35).
Off-pumpCABGpresented a better outcome than HCR with significant lower
MACCE (OR = 0.17, 95% CI 0.01-0.68). Surface under the cumulative ranking
probabilities showed that HCR may be the superior strategy for MVD and
LMCA disease when regarded to MACCE (SUCRA=0.84), MI (SUCRA= 0.76) in
short term, and regarded to MACCE (SUCRA=0.99), MI (SUCRA=0.94), and CVE
(SUCRA=0.92) in midterm. Hybrid coronary revascularization seemed to be a
feasible and acceptable option for treatment of LMCA disease and MVD. More
powerful evidences are required to precisely evaluate risks and benefits
of the 3 therapies for patients who have different clinical
characteristics.

<8>
Accession Number
2015526946
Authors
Yang C. Mo L. Ma Y. Peng G. Ren Y. Wang W. Liu Y. He J.
Institution
(Yang, Ma, Ren, Liu) Department of Thoracic Surgery, Liaoning Cancer
Hospital and Institute, Shenyang 110042, China
(Yang, Ma, Ren, Liu) Dalian Medical University, Clinical Oncology College,
Shenyang 110042, China
(Mo, Peng, Wang, He) Department of Cardiothoracic Surgery, The First
Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, China
(Mo, Peng, Wang, He) State Key Laboratory of Respiratory Disease, The
First Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436,
China
(He) Key cite of National Clinical Research Center for Respiratory
Disease, Guangzhou 510120, China
Title
A comparative analysis of lung cancer patients treated with lobectomy via
three-dimensional video-assisted thoracoscopic surgery versus
two-dimensional resection.
Source
Journal of Thoracic Disease. 7 (10) (pp 1798-1805), 2015. Date of
Publication: 2015.
Publisher
Pioneer Bioscience Publishing
Abstract
Background: Three-dimensional (3D) vision systems are now available for
thoracic surgery. It is unclear whether 3D video-assisted thoracic surgery
(VATS) is superior to 2D VATS systems. This study aimed to compare the
operative and perioperative data between 2D and 3D VATS lobectomy (VTL)
and to identify the actual role of 3D VTL in thoracic surgery. Methods: A
two-institutional comparative study was conducted from November 2013 to
November 2014 at Liaoning Cancer Hospital & Institute and the First
Affiliated Hospital of Guangzhou Medical University, China, of 300
patients with resectable non-small cell lung cancer (NSCLC). Patients were
assigned to receive either the 3D VATS (n=150) or 2D VATS (n=150)
lobectomy. The operative and perioperative data between 2D VATS and 3D
VATS were compared. Results: Although there was no significant difference
between the two groups regarding the incidence of each single
complication, a significantly less operative time was found in the 3D VATS
group (145 min) than in the 2D VATS group (176 min) (P=0.006).
Postoperative mortality rates in 3D VATS and 2D VATS groups were both
0%.No significant difference was found between groups for estimated blood
loss (P=0.893), chest drainage tube placement time (P=0.397), length of
hospital stay (P=0.199), number of lymph nodes resected (P=0.397),
postoperative complications (P=0.882) and cost of care (P=0.913).
Conclusions: Early results of this study demonstrate that the 3D VATS
lobectomy procedure can be performed with less operative time. 3D VATS and
2D VATS lobectomy are both safe procedures in first-line surgical
treatment of NSCLC.

<9>
Accession Number
2015537592
Authors
Rothnie K.J. Yan R. Smeeth L. Quint J.K.
Institution
(Rothnie, Quint) Respiratory Epidemiology, Occupational Medicine and
Public Health, National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Rothnie, Smeeth, Quint) Faculty of Epidemiology and Population Health,
London School of Hygiene and Tropical Medicine, London, United Kingdom
(Yan) Medical School, Faculty of Medical Sciences, University College
London, London, United Kingdom
Title
Risk of myocardial infarction (MI) and death following MI in people with
chronic obstructive pulmonary disease (COPD): A systematic review and
meta-analysis.
Source
BMJ Open. 5 (9) , 2015. Article Number: e007824. Date of Publication:
2015.
Publisher
BMJ Publishing Group
Abstract
Objectives: Cardiovascular disease is an important comorbidity in patients
with chronic obstructive pulmonary disease (COPD). We aimed to
systematically review the evidence for: (1) risk of myocardial infarction
(MI) in people with COPD; (2) risk of MI associated with acute
exacerbation of COPD (AECOPD); (3) risk of death after MI in people with
COPD. Design: Systematic review and meta-analysis. Methods: MEDLINE,
EMBASE and SCI were searched up to January 2015. Two reviewers screened
abstracts and full text records, extracted data and assessed studies for
risk of bias. We used the generic inverse variance method to pool effect
estimates, where possible. Evidence was synthesised in a narrative review
where meta-analysis was not possible. Results: Searches yielded 8362
records, and 24 observational studies were included. Meta-analysis showed
increased risk of MI associated with COPD (HR 1.72, 95% CI 1.22 to 2.42)
for cohort analyses, but not in case-control studies: OR 1.18 (0.80 to
1.76). Both included studies that investigated the risk of MI associated
with AECOPD found an increased risk of MI after AECOPD (incidence rate
ratios, IRR 2.27, 1.10 to 4.70, and IRR 13.04, 1.71 to 99.7).
Meta-analysis showed weak evidence for increased risk of death for
patients with COPD in hospital after MI (OR 1.13, 0.97 to 1.31). However,
meta-analysis showed an increased risk of death after MI for patients with
COPD during follow-up (HR 1.26, 1.13 to 1.40). Conclusions: There is good
evidence that COPD is associated with increased risk of MI; however, it is
unclear to what extent this association is due to smoking status. There is
some evidence that the risk of MI is higher during AECOPD than stable
periods. There is poor evidence that COPD is associated with increased in
hospital mortality after an MI, and good evidence that longer term
mortality is higher for patients with COPD after an MI.

<10>
Accession Number
2015529594
Authors
Nelson S. Muzyk A.J. Bucklin M.H. Brudney S. Gagliardi J.P.
Institution
(Nelson) Critical Care, Hospital Pharmacy Services, Mayo Clinic,
Rochester, MN 55905, United States
(Muzyk) Department of Pharmacy Practice, Campbell University, School of
Pharmacy and Health Sciences, Buies Creek, NC 27506, United States
(Muzyk, Gagliardi) Department of Psychiatry and Behavioral Sciences, Duke
University, Durham, NC 27710, United States
(Bucklin) Department of Clinical Pharmacy, University of Tennessee Medical
Center, Knoxville, TN 37920, United States
(Brudney) Departments of Anesthesiology and Medicine, Duke University
Medical Center, Durham VAMC, Durham, NC 27710, United States
(Gagliardi) Department of Medicine, Duke University, Durham, NC 27710,
United States
Title
Defining the role of dexmedetomidine in the prevention of delirium in the
intensive care unit.
Source
BioMed Research International. 2015 , 2015. Article Number: 635737. Date
of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Dexmedetomidine is a highly selective alpha 2 agonist used as a sedative
agent. It also provides anxiolysis and sympatholysis without significant
respiratory compromise or delirium. We conducted a systematic review to
examine whether sedation of patients in the intensive care unit (ICU) with
dexmedetomidine was associated with a lower incidence of delirium as
compared to other nondexmedetomidine sedation strategies. A search of
PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews yielded
only three trials from 1966 through April 2015 that met our predefined
inclusion criteria and assessed dexmedetomidine and outcomes of delirium
as their primary endpoint. The studies varied in regard to population,
comparator sedation regimen, delirium outcome measure, and dexmedetomidine
dosing. All trials are limited by design issues that limit our ability
definitively to conclude that dexmedetomidine prevents delirium. Evidence
does suggest that dexmedetomidine may allow for avoidance of deep sedation
and use of benzodiazepines, factors both observed to increase the risk for
developing delirium. Our assessment of currently published literature
highlights the need for ongoing research to better delineate the role of
dexmedetomidine for delirium prevention.

<11>
Accession Number
2015501587
Authors
Song F. Brown T.J. Blyth A. Maskrey V. McNamara I. Donell S.
Institution
(Song, Brown, Blyth, Maskrey, McNamara, Donell) University of East Anglia,
Norwich Medical School, Faculty of Medicine and Health Science, Norwich,
Norfolk, United Kingdom
(McNamara, Donell) Norfolk and Norwich University Hospital, Orthopaedic
Department, Norwich, Norfolk, United Kingdom
Title
Identifying and recruiting smokers for preoperative smoking cessation-a
systematic review of methods reported in published studies.
Source
Systematic Reviews. 4 (1) , 2015. Article Number: 157. Date of
Publication: November 11, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Smoking cessation before surgery reduces postoperative
complications, and the benefit is positively associated with the duration
of being abstinent before a surgical procedure. A key issue in providing
preoperative smoking cessation support is to identify people who smoke as
early as possible before elective surgery. This review aims to summarise
methods used to identify and recruit smokers awaiting elective surgery.
Methods: We searched MEDLINE, EMBASE, CINAHL, and PsycINFO, and references
of relevant reviews (up to May 2014) to identify prospective studies that
evaluated preoperative smoking cessation programmes. One reviewer
extracted and a second reviewer checked data from the included studies.
Data extracted from included studies were presented in tables and
narratively described. Results: We included 32 relevant studies, including
18 randomised controlled trials (RCTs) and 14 non-randomised studies
(NRS). Smokers were recruited at preoperative clinics (n = 18), from
surgery waiting lists (n = 6), or by general practitioners (n = 1), and
the recruitment methods were not explicitly described in seven studies.
Time points of preoperative recruitment of smokers was unclear in four
studies, less than 4 weeks before surgery in 17 studies, and at least 4
weeks before surgery in only 11 studies. The recruitment rate tended to be
lower in RCTs (median 58.2 %, range 9.1 to 90.9 %) than that in NRS
(median 99.1 %, range 12.3 to 100 %) and lower in preoperative
clinic-based RCTs (median 54.4 %, range 9.1 to 82.4 %) than that in
waiting list-based RCTs (median 70.1 %, range 36.8 to 85.0 %). Smokers
were recruited at least 4 weeks before surgery in four of the six waiting
list-based studies and in only three of the 18 preoperative clinic-based
studies. Conclusions: Published studies often inadequately described the
methods for recruiting smokers into preoperative smoking cessation
programmes. Although smoking cessation at any time is beneficial, many
programmes recruited smokers at times very close to scheduled surgery so
that the benefit of preoperative smoking cessation may have not been fully
effected. Optimal delivery of preoperative smoking cessation remains
challenging, and further research is required to develop effective
preoperative cessation programmes for smokers awaiting elective
operations.

<12>
Accession Number
2015476984
Authors
Rusinaru D. Vrolix M. Verheye S. Chowdhary S. Schoors D. Di Mario C.
Desmet W. Donohoe D.J. Ormiston J.A. Knape C. Bezerra H. Lansky A. Wijns
W.
Institution
(Rusinaru, Wijns) Cardiovascular Research Center Aalst, OLV Clinic, Aalst,
Belgium
(Vrolix) Ziekenhuis Oost-Limburg, Genk, Belgium
(Verheye) Antwerp Hospital, Antwerp, Belgium
(Chowdhary) South Manchester University Hospital, Manchester, United
Kingdom
(Schoors) Brussels University Hospital, Brussels, Belgium
(Di Mario) NIHR Cardiovascular Research Unit, Royal Brompton Hospital and
Imperial College, London, United Kingdom
(Desmet) Department of Cardiovascular Diseases, UZ Leuven, Belgium
(Donohoe, Knape) Micell Technologies, Durham, NC, United States
(Ormiston) Auckland City Hospital, Auckland, New Zealand
(Bezerra) Case Medical Center, Cleveland, OH, United States
(Lansky) Yale University, School of Medicine, New Haven, CT, United States
Title
Bioabsorbable polymer-coated sirolimus-eluting stent implantation
preserves coronary vasomotion: A DESSOLVE II trial sub-study.
Source
Catheterization and Cardiovascular Interventions. 86 (7) (pp 1141-1150),
2015. Date of Publication: December 1, 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives We studied coronary vasomotion in patients treated with the
Mistent absorbable polymer sirolimus-eluting stent (APSES) and in patients
implanted with the Endeavor zotarolimus-eluting stent (ZES). Background
First generation (1st-gen) drug-eluting stents (DES) induce persistent
vasomotor dysfunction in the treated coronary artery. It is unknown
whether and to what extent the implantation of an absorbable polymer DES
impairs coronary vasomotion. Methods This sub-study of the DESSOLVE II
trial included 19 APSES Mistent and 10 ZES Endeavor patients. Incremental
atrial pacing and quantitative coronary angiography were used to assess
vasomotion proximal and distal to the stent and in a reference segment at
9 months after implantation. Percent changes in vessel diameter with
pacing versus baseline were calculated and compared. Vasomotor response of
the APSES group was also compared with changes observed in a historical
group of 17 patients implanted with a 1st-gen sirolimus-eluting stent
(SES). Results Normal vasomotion (vasodilatation) was preserved and of
comparable magnitude in the APSES and in the ZES group both proximally (P
= 0.34) and distally (P = 0.38) to the stent. This finding was not
observed in the 1st-gen SES group showing marked pacing-induced
vasoconstriction at both stent edges (P < 0.05 vs. APSES). The results
were practically unchanged after excluding patients with absolute changes
in vessel diameter <3% between baseline and maximal pacing. Conclusions
The implantation of an absorbable polymer sirolimus-eluting stent is
associated with preserved coronary vasomotion, comparable to that observed
after implantation of the Endeavor ZES, and distinct from 1st-gen SES
which induce coronary vasomotor dysfunction.

<13>
Accession Number
2015459943
Authors
Steingrimsson S. Thimour-Bergstrom L. Roman-Emanuel C. Schersten H.
Friberg O. Gudbjartsson T. Jeppsson A.
Institution
(Steingrimsson, Thimour-Bergstrom, Roman-Emanuel, Schersten, Jeppsson)
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital,
Gothenburg 413 45, Sweden
(Steingrimsson, Gudbjartsson) Landspitali University Hospital, University
of Iceland, Reykjavik, Iceland
(Friberg) Department of Cardiothoracic Surgery, University Hospital,
Orebro, Sweden
(Jeppsson) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
Title
Triclosan-coated sutures and sternal wound infections: a prospective
randomized clinical trial.
Source
European Journal of Clinical Microbiology and Infectious Diseases. 34 (12)
(pp 2331-2338), 2015. Date of Publication: 01 Dec 2015.
Publisher
Springer Verlag
Abstract
Surgical site infection is a common complication following cardiac
surgery. Triclosan-coated sutures have been shown to reduce the rate of
infections in various surgical wounds, including wounds after vein
harvesting in coronary artery bypass grafting patients. Our purpose was to
compare the rate of infections in sternotomy wounds closed with
triclosan-coated or conventional sutures. A total of 357 patients that
underwent coronary artery bypass grafting were included in a prospective
randomized double-blind single-center study. The patients were randomized
to closure of the sternal wound with either triclosan-coated sutures
(Vicryl Plus and Monocryl Plus, Ethicon, Inc., Somerville, NJ, USA) (n =
179) or identical sutures without triclosan (n = 178). Patients were
followed up after 30 days (clinical visit) and 60 days (telephone
interview). The primary endpoint was the prevalence of sternal wound
infection according to the Centers for Disease Control and Prevention
(CDC) criteria. The demographics in both groups were comparable, including
age, gender, body mass index, and rate of diabetes and smoking. Sternal
wound infection was diagnosed in 43 patients; 23 (12.8 %) sutured with
triclosan-coated sutures compared to 20 (11.2 %) sutured without triclosan
(p = 0.640). Most infections were superficial (n = 36, 10.1 %), while 7
(2.0 %) were deep sternal wound infections. There were 16 positive
cultures in the triclosan group and 17 in the non-coated suture group (p =
0.842). The most commonly identified main pathogens were Staphylococcus
aureus (45.4 %) and coagulase-negative staphylococci (36.4 %). Skin
closure with triclosan-coated sutures did not reduce the rate of sternal
wound infection after coronary artery bypass grafting.
(clinicaltrials.gov: NCT01212315)

<14>
Accession Number
2015025100
Authors
Maeng M. Baranauskas A. Christiansen E.Ho. Kaltoft A. Holm N.R. Krusell
L.R. Ravkilde J. Tilsted H.-H. Thayssen P. Jensen L.O.
Institution
(Maeng, Baranauskas, Christiansen, Kaltoft, Holm, Krusell) Department of
Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens
Boulevard 99, Aarhus N 8200, Denmark
(Baranauskas) Department of Cardiology, Center of Cardiology and
Angiology, Vilnius University Hospital, Vilnius, Lithuania
(Ravkilde, Tilsted) Department of Cardiology, Aarhus University Hospital,
Aalborg Hospital, Aalborg, Denmark
(Thayssen, Jensen) Department of Cardiology, Odense University Hospital,
Odense, Denmark
Title
A 10-month angiographic and 4-year clinical outcome of everolimus-eluting
versus sirolimus-eluting coronary stents in patients with diabetes
mellitus (the diabedES IV randomized angiography trial).
Source
Catheterization and Cardiovascular Interventions. 86 (7) (pp 1161-1167),
2015. Date of Publication: December 1, 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective We aimed to compare angiographic and clinical outcomes after the
implantation of everolimus-eluting (EES) and sirolimus-eluting (SES)
stents in patients with diabetes. Background There are limited data on
long-term outcome after EES vs SES implantation in diabetic patients.
Methods We randomized 213 patients with diabetes and coronary artery
disease to EES (n = 108) or SES (n = 105) implantation. Angiographic
follow-up was performed 10 months after the index procedure and all
patients were followed clinically for 4 years. The primary endpoint was
angiographic in-stent late luminal loss at 10-month follow-up. Secondary
endpoints included angiographic restenosis rate, the need for target
lesion revascularization (TLR) and major adverse cardiac events (MACE;
defined as cardiac death, myocardial infarction, definite stent
thrombosis, or TLR) at 4-year follow-up. Results At 10-month angiographic
follow-up, in-stent late lumen loss was 0.20 +/- 0.53 mm and 0.11 +/- 0.49
mm (P = 0.28), and angiographic restenosis rate was 3.8% and 5.2% (P =
0.72) in the EES and SES groups, respectively. At 4-year clinical
follow-up, MACE had occurred in 22 (20.4%) patients in the EES group and
25 (23.8%) patients in SES group (HR 0.84, 95% CI 0.47-1.49; P = 0.55),
with TLR performed in 6 (5.6%) and 10 (9.5%) patients in the two groups
(HR 0.57, 95% CI 0.21-1-58; P = 0.28). Conclusion EES and SES had
comparable 10-month angiographic and 4-year clinical outcomes in patients
with diabetes mellitus and coronary artery disease.

<15>
[Use Link to view the full text]
Accession Number
2015535542
Authors
Sethi A. Malhotra G. Singh S. Singh P.P. Khosla S.
Institution
(Sethi, Malhotra, Singh, Singh, Khosla) Department of Cardiology, Chicago
Medical School, Rosalind Franklin University of Medicine, 3333 Green bay
Rd, North Chicago, IL 60064, United States
(Sethi, Malhotra, Singh, Singh, Khosla) Division of Cardiology, Mount
Sinai Hospital Medical Center, Chicago, IL, United States
Title
Efficacy of Various Percutaneous Interventions for In-Stent Restenosis:
Comprehensive Network Meta-Analysis of Randomized Controlled Trials.
Source
Circulation: Cardiovascular Interventions. 8 (11) , 2015. Date of
Publication: 01 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-In-stent restenosis (ISR) remains a difficult problem in
interventional cardiology. The relative efficacy and safety of available
interventions is not clear. We aimed to perform a network meta-analysis
using both direct evidence and indirect evidence to compare all available
interventions. Methods and Results-We systematically searched electronic
databases for randomized trials comparing >2 treatments for ISR. A network
meta-analysis was performed using a Bayesian approach. Eleven treatments
were compared in 31 studies with 8157 patient-years follow-up. Compared
with balloon angioplasty, everolimus-eluting stent (hazard ratio [95%
credibility interval], 0.13 [0.048-0.35]), paclitaxel-eluting balloon
(0.32 [0.20-0.49]), paclitaxel-eluting cutting balloon (0.054
[0.0017-0.5]), paclitaxel-eluting stent (0.39 [0.24-0.62]), and
sirolimus-eluting stent (0.32 [0.18-0.50]) are associated with lower
target vessel revascularization. Balloon angioplasty is not different from
cutting balloon (0.73 [0.31-1.5]), excimer laser (0.89 [0.29-2.7]),
rotational atherectomy (0.96 [0.53-1.7]), and vascular brachytherapy (0.60
[0.35-1.0]). In drug-eluting stent ISR, balloon angioplasty was inferior
to everolimus-eluting stent (0.19 [0.049-0.76]), paclitaxel-eluting
balloon (0.43 [0.18-0.80]), paclitaxel-eluting stent (0.35 [0.13-0.76]),
and sirolimus-eluting stent (0.36 [0.11-0.86]) for target vessel
revascularization. There was no difference between treatments in probable
or definitive stent thrombosis. The results of binary restenosis and
target lesion revascularization were similar. Paclitaxel-eluting cutting
balloon, everolimus-eluting stent, and paclitaxel-eluting balloon have the
highest probability of being in the top 3 treatments based on low target
lesion revascularization, but there was no statistical significant
difference between them. Conclusions-Balloon angioplasty is inferior to
all drug-eluting treatments for ISR, including drug-eluting stent ISR.
Drug-eluting stent, particularly everolimus-eluting stent, or
paclitaxel-eluting cutting balloon and paclitaxel-eluting balloon should
be preferred for treating ISR.

<16>
Accession Number
2015525323
Authors
Zhang Y. Ma X.-J. Shi D.-Z.
Institution
(Zhang) Graduate School, Beijing University of Chinese Medicine, Beijing,
China
(Zhang, Ma, Shi) China Heart Institute of Chinese Medicine, China Academy
of Chinese Medical Sciences, Beijing, China
(Zhang, Ma, Shi) Cardiovascular Diseases Center, Xiyuan Hospital, China
Academy of Chinese Medical Sciences, Beijing, China
Title
Effect of trimetazidine in patients undergoing percutaneous coronary
intervention: A meta-analysis.
Source
PLoS ONE. 10 (9) , 2015. Article Number: e0137775. Date of Publication: 14
Sep 2015.
Publisher
Public Library of Science
Abstract
Optimizing the metabolism of the myocardium is a new strategy for patients
with ischemic heart disease. Many studies have reported beneficial effects
of trimetazidine (TMZ) on the clinical prognosis of patients with ischemic
heart disease, but whether these beneficial effects are extended to
patients undergoing percutaneous coronary intervention (PCI) remains
uncertain. A meta-analysis was performed to evaluate the effect of TMZ on
patients undergoing PCI. We conducted an electronic search of PubMed,
Cochrane databases, the China National Knowledge Infrastructure, and
Chinese Biological Medicine Database to identify randomized controlled
trials. Methodological quality was assessed according to the Jadad scale
score, and the meta-analysis was performed using Cochrane Collaboration
RevMan 5.2 and Comprehensive Meta-Analysis. Dichotomous data were analyzed
using relative risk (RR) or odds ratio (OR) with effect size indicated by
the 95% confidence interval (CI), and continuous variables were analyzed
using weighted mean differences (WMD) with effect size indicated by the
95% CI. Sensitivity analysis was performed by changing the statistical
methods and effect model. Nine studies involving a total of 778 patients
were included in this meta-analysis. Additional use of TMZ significantly
improved the left ventricular ejection fraction (WMD: 3.11, 95% CI: [2.26,
3.96]) and reduced elevated cardiac troponin Ic level (RR: 0.69, 95% CI:
[0.48, 0.99]), angina attacks during PCI (OR: 0.16, 95% CI: [0.07, 0.38]),
and ischemic ST-T changes on the echocardiogram during PCI (RR: 0.76, 95%
CI: [0.59, 0.98]). However, no significant difference was observed in
serum BNP level 30 days after PCI between the experimental and control
group. Additional use of TMZ for patients undergoing PCI may reduce
myocardial injury during the procedure and improve cardiac function.

<17>
Accession Number
2015524795
Authors
Donato A.
Institution
(Donato) Reading Health System, Reading, PA, United States
Title
In AF requiring warfarin interruption, no anticoagulation bridging was
noninferior to bridging for thromboembolism.
Source
Annals of Internal Medicine. 163 (10) (pp JC5), 2015. Date of Publication:
17 Nov 2015.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<18>
Accession Number
2015524233
Authors
Andraos C. Arthur H.M. Oh P. Chessex C. Brister S. Grace S.L.
Institution
(Andraos, Grace) School of Kinesiology and Health Science, York
University, 368 Bethune College, 4700 Keele Street, Toronto, ON M3J 1P3,
Canada
(Arthur) Hamilton Health Sciences Centre, Hamilton, ON, Canada
(Oh, Chessex, Brister, Grace) University Health Network, Toronto, ON,
Canada
Title
Women's preferences for cardiac rehabilitation program model: A randomized
controlled trial.
Source
European Journal of Preventive Cardiology. 22 (12) (pp 1513-1522), 2015.
Date of Publication: 01 Dec 2015.
Publisher
SAGE Publications Inc.
Abstract
Background Although cardiac rehabilitation (CR) is effective, women often
report programs do not meet their needs. Innovative models have been
developed that may better suit women. The objectives of the study were to
describe: (1) adherence to CR model allocation; (2) satisfaction by model
attended; and (3) CR preferences. Design and methods Tertiary objectives
from a randomized controlled trial of female patients randomized to
mixed-sex, women-only, or home-based CR were tested. Patients were
recruited from six hospitals. Consenting participants were asked to
complete a survey and undertook a CR intake assessment. Eligible patients
were randomized. Participants were mailed a follow-up survey six months
later. Adherence to model allocation was ascertained from CR charts.
Results Overall 169 (18.6%) patients were randomized, of which 116 (68.6%)
completed the post-test survey. Forty-five (26.6%) participants did not
receive the allocated model, with those referred to home-based CR least
likely to attend the allocated model (n = 25; 45.4%). Semi-structured
interviews revealed participants also often switched from women-only to
mixed-sex CR due to time conflicts. Satisfaction was high across all
models (mean = 4.23 +/- 1.16/5; p = 0.85) but participants in the
women-only program felt significantly more comfortable in their workout
attire (p = 0.003) and perceived the environment as less competitive (p =
0.02). Patients equally preferred mixed-sex (n = 44, 41.9%) and women-only
(n = 44, 41.9%) CR, over home-based (n = 17, 16.2%), with patients
preferring the model they attended. Conclusion Females were highly
satisfied regardless of CR model attended but preferred supervised
programs most. Patient preference and session timing should be considered
in program model allocation decisions.

<19>
Accession Number
2015524224
Authors
Ostovaneh M.R. Poustchi H. Hemming K. Marjani H. Pourshams A. Nateghi A.
Majed M. Navabakhsh B. Khoshnia M. Jaafari E. Mohammadifard N. Malekzadeh
F. Merat S. Sadeghi M. Naemi M. Etemadi A. Thomas G.N. Sarrafzadegan N.
Cheng K.K. Marshall T. Malekzadeh R.
Institution
(Ostovaneh, Poustchi, Pourshams, Nateghi, Majed, Navabakhsh, Jaafari,
Malekzadeh, Merat, Etemadi, Malekzadeh) Digestive Disease Research
Institute, Tehran University of Medical Sciences, Shariati Hospital,
Tehran 1411713135, Iran, Islamic Republic of
(Ostovaneh) Division of Gastroenterology and Hepatology, Department of
Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States
(Hemming, Thomas, Cheng, Marshall) School of Health and Population
Sciences, University of Birmingham, United Kingdom
(Marjani, Khoshnia, Naemi) Golestan Research Center of Gastroenterology
and Herpetology, Golestan University of Medical Sciences, Gorgan, Iran,
Islamic Republic of
(Mohammadifard, Sarrafzadegan) Isfahan Cardiovascular Research Center,
Cardiovascular Research Institute, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Sadeghi) Cardiac Rehabilitation Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
(Etemadi) Division of Cancer Epidemiology and Genetics, National Cancer
Institute, Bethesda, MD, United States
Title
Polypill for the prevention of cardiovascular disease (PolyIran): Study
design and rationale for a pragmatic cluster randomized controlled trial.
Source
European Journal of Preventive Cardiology. 22 (12) (pp 1609-1617), 2015.
Date of Publication: 01 Dec 2015.
Publisher
SAGE Publications Inc.
Abstract
Background The complexity of treatment regimens, costs and pill burden
decrease the medication adherence and contribute to shortfall in
cardiovascular preventive drug coverage. The polypill, a fixed dose
combination pill of established drugs, is expected to increase adherence
and reduce the costs whilst preventing major cardiovascular events (MCVE).
Design and methods The PolyIran trial is a pragmatic cluster randomized
trial nested within the Golestan Cohort Study (GCS). Subjects were
randomized to either non-pharmacological preventive interventions alone
(minimal care arm) or together with a polypill (polypill arm) comprising
hydrochlorothiazide, aspirin, atorvastatin and either enalapril or
valsartan. This study benefits from the infrastructure of the primary
health care system in Iran and the interventions are delivered by the
local auxiliary health workers (Behvarz) to the participants. The primary
outcome of the study is the occurrence of first MCVE within five years
defined as non-fatal and fatal myocardial infarction, unstable angina,
sudden death, heart failure, coronary artery revascularization procedures,
and non-fatal and fatal stroke. Trial status From February 2011 to April
2013, 8410 individuals (236 clusters) attended the eligibility assessment.
Of those, 3421 in the polypill arm and 3417 in the minimal care arm were
eligible. The study is ongoing. Conclusion The infrastructure of GCS and
the primary health care system in Iran enabled the conduct of this
pragmatic large-scale trial. If the polypill strategy proves effective, it
may be implemented to prevent cardiovascular disease in developing
countries.

<20>
[Use Link to view the full text]
Accession Number
2015448785
Authors
Bohula E.A. Aylward P.E. Bonaca M.P. Corbalan R.L. Kiss R.G. Murphy S.A.
Scirica B.M. White H. Braunwald E. Morrow D.A.
Institution
(Bohula, Bonaca, Murphy, Scirica, Braunwald, Morrow) TIMI Study Group,
Cardiovascular Division, Brigham and Women's Hospital, 350 Longwood Ave,
Boston, MA 02115, United States
(Aylward) Department of Cardiovascular Medicine, Flinders Cardiovascular
Center, Adelaide, Australia
(Corbalan) Cardiovascular Division, Pontificia Universidad Catolica de
Chile, Santiago, Chile
(Kiss) Department of Cardiology, Military Hospital, Budapest, Hungary
(White) Green Lane Cardiovascular Research Unit, Auckland City Hospital,
Auckland, New Zealand
Title
Efficacy and safety of vorapaxar with and without a thienopyridine for
secondary prevention in patients with previous myocardial infarction and
no history of stroke or transient ischemic attack: Results from TRA
2degreeP-TIMI 50.
Source
Circulation. 132 (20) (pp 1871-1879), 2015. Date of Publication: 17 Nov
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Vorapaxar antagonizes protease-activated receptor 1, the
primary receptor for thrombin on human platelets, and reduces recurrent
thrombotic events in stable patients with a previous myocardial infarction
(MI). We wished to determine whether the efficacy and safety of
antiplatelet therapy with vorapaxar was modified by concurrent
thienopyridine use. Methods and Results - The Thrombin Receptor Antagonist
in Secondary Prevention of Atherothrombotic Ischemic Events-Thrombolysis
in Myocardial Infarction 50 (TRA 2degreeP-TIMI 50) was a randomized,
double-blind, placebo-controlled trial of vorapaxar in 26 449 patients
with previous atherothrombosis. This prespecified analysis included 16 897
patients who qualified with a MI in the preceding 2 weeks to 12 months and
was restricted to patients without a history of stroke or transient
ischemic attack given its contraindication in that population.
Randomization was stratified on the basis of planned thienopyridine use.
Thienopyridine was planned at randomization in 12 410 (73%). Vorapaxar
significantly reduced the composite of cardiovascular death, MI, and
stroke in comparison with placebo regardless of planned thienopyridine
therapy (planned thienopyridine, hazard ratio, 0.80, 0.70-0.91, P<0.001;
no planned thienopyridine, hazard ratio, 0.75; 0.60-0.94, P=0.011;
P-interaction=0.67). Findings were similar when patients were stratified
by actual thienopyridine use at baseline (P-interaction=0.82) and through
18 months (P-interaction=0.44). Global Use of Strategies to Open Occluded
Coronary Arteries (GUSTO) moderate or severe bleeding risk was increased
with vorapaxar and was not significantly altered by planned thienopyridine
(planned, hazard ratio, 1.50; 1.18-1.89, P<0.001; no planned, hazard
ratio, 1.90, 1.17-3.07, P=0.009; P-interaction=0.37) or actual
thienopyridine use (P-interaction=0.24). Conclusions - Vorapaxar reduced
cardiovascular death, MI, or stroke in stable patients with a history of
previous MI, whether treated concomitantly with a thienopyridine or not.
The relative risk of moderate or severe bleeding was similarly increased
irrespective of thienopyridine use.

<21>
Accession Number
2015837383
Authors
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, The First Hospital of Putian,
Teaching Hospital, Fujian Medical University, 389 Longdejing Street,
Chengxiang District, Putian, Fujian Province 351100, China
Title
Acquired left ventricle-to-right atrium shunt: clinical implications and
diagnostic dilemmas.
Source
Wiener Klinische Wochenschrift. 127 (21-22) (pp 884-892), 2015. Date of
Publication: 01 Nov 2015.
Publisher
Springer-Verlag Wien
Abstract
Background: The acquired left ventricle-to-right atrium (LV-RA) shunt
(Gerbode defect) is rare but it can sometimes be a critical condition. The
diagnosis is quite challenging largely due to its exotic anatomic features
and diagnostic difficulties. This study aims to present the clinical
features and diagnostic solutions of this rare lesion. Methods: Data
source was based on a comprehensive literature retrieval of acquired LV-RA
shunts of 1990-2014. Results: Most of the acquired LV-RA shunts are of
either a postoperative or an infective etiology. Transthoracic
echocardiography showed a 62.2 % accurate diagnosis, 13.4 % inclusive
diagnosis, 9.8 % missed diagnosis, and 14.5 % misdiagnosis rate. The
accurate diagnostic rate of transthoracic echocardiography was
significantly lower than that of the transesophageal echocardiography or
cardiac catheterization. The LV-RA shunts are often misinterpreted as
mitral regurgitation, pulmonary hypertension, tricuspid regurgitation,
Valsalva aneurysm rupture, and subaortic/high perimembrane/residual
ventricular septal defect. Surgical, interventional, and conservative
treatments were applied in 57.8, 24.4, and 17.8 % patients, respectively.
Prognosis showed an event-free survival of 85 %, a comorbidity of 9.1 %,
and a mortality of 13.6 %. Conclusions: A high jet detected in the right
atrium with uncertain origin and course has to appeal to additional
diagnostic techniques including transesophageal echocardiography, cardiac
catheterization, or cardiac magnetic resonance imaging for differential
diagnoses. Small restrictive shunts are preferred with conservative
treatments, high-risk patients are candidates of interventional therapy,
and the patients with unstable hemodynamics warrant an open heart surgery.
Careful operative maneuver, good control of intracardiac infection,
preservation of heart function, etc., are mandatory for the prevention of
the development of an acquired LV-RA shunt.

<22>
Accession Number
2015524131
Authors
Tang E.Y.H. Harrison S.L. Errington L. Gordon M.F. Visser P.J. Novak G.
Dufouil C. Brayne C. Robinson L. Launer L.J. Stephan B.C.M.
Institution
(Tang, Harrison, Robinson, Stephan) Institute of Health and Society,
Newcastle University Institute of Ageing, Newcastle University, Newcastle
upon Tyne NE2 4AX, United Kingdom
(Errington) Medical School, Newcastle University, Newcastle upon Tyne NE2
4HH, United Kingdom
(Gordon) Boehringer Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Road,
Ridgefield, Connecticut 06877, United States
(Visser) Maastricht University, Department of Psychiatry and
Neuropsychology, School for Mental Health and Neuroscience, Maastricht,
Netherlands
(Visser) VU University Medical Centre, Department of Neurology, Alzheimer
Centre, Neuroscience Campus, Amsterdam, Netherlands
(Novak) Janssen Pharmaceutical Research and Development, 1125
Trenton-Harbourton Road, Titusville, New Jersey 08560, United States
(Dufouil) Inserm Research Centre (U897), Team Neuroepidemiology, Bordeaux
F-33000, France
(Brayne) Department of Public Health and Primary Care, Cambridge
University, Cambridge CB2 0SR, United Kingdom
(Launer) Laboratory of Epidemiology, Demography and Biometry, National
Institute on Aging, National Institutes of Health (NIH), Bethesda,
Maryland, United States
Title
Current developments in dementia risk prediction modelling: An updated
systematic review.
Source
PLoS ONE. 10 (9) , 2015. Article Number: e0136181. Date of Publication: 03
Sep 2015.
Publisher
Public Library of Science
Abstract
Background: Accurate identification of individuals at high risk of
dementia influences clinical care, inclusion criteria for clinical trials
and development of preventative strategies. Numerous models have been
developed for predicting dementia. To evaluate these models we undertook a
systematic review in 2010 and updated this in 2014 due to the increase in
research published in this area. Here we include a critique of the
variables selected for inclusion and an assessment of model prognostic
performance. Methods: Our previous systematic review was updated with a
search from January 2009 to March 2014 in electronic databases (MEDLINE,
Embase, Scopus, Web of Science). Articles examining risk of dementia in
non-demented individuals and including measures of sensitivity,
specificity or the area under the curve (AUC) or c-statistic were
included. Findings: In total, 1,234 articles were identified from the
search; 21 articles met inclusion criteria. New developments in dementia
risk prediction include the testing of non-APOE genes, use of
non-traditional dementia risk factors, incorporation of diet, physical
function and ethnicity, and model development in specific subgroups of the
population including individuals with diabetes and those with different
educational levels. Four models have been externally validated. Three
studies considered time or cost implications of computing the model.
Interpretation: There is no one model that is recommended for dementia
risk prediction in populationbased settings. Further, it is unlikely that
one model will fit all. Consideration of the optimal features of new
models should focus on methodology (setting/sample, model development and
testing in a replication cohort) and the acceptability and cost of
attaining the risk variables included in the prediction score. Further
work is required to validate existing models or develop new ones in
different populations as well as determine the ethical implications of
dementia risk prediction, before applying the particular models in
population or clinical settings.

<23>
Accession Number
2015522202
Authors
Simonini M. Pozzoli S. Bignami E. Casamassima N. Messaggio E. Lanzani C.
Frati E. Botticelli I.M. Rotatori F. Alfieri O. Zangrillo A. Manunta P.
Institution
(Simonini, Pozzoli, Casamassima, Messaggio, Lanzani, Botticelli, Manunta)
Genomics of Renal Diseases and Hypertension Department, Vita-Salute San
Raffaele University, Dept. of Nephrology, IRCCS San Raffaele Scientific
Institute, Milan 20132, Italy
(Bignami, Frati, Zangrillo) Anesthesia and Intensive Care Department,
Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific
Institute, Milan 20132, Italy
(Rotatori) SUNY Downstate Medical Center, State University of New York,
Brooklyn, NY 11203, United States
(Alfieri) Cardiac Surgery Department, Vita-Salute San Raffaele University,
IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
Title
Endogenous Ouabain: An Old Cardiotonic Steroid as a New Biomarker of Heart
Failure and a Predictor of Mortality after Cardiac Surgery.
Source
BioMed Research International. 2015 , 2015. Article Number: 714793. Date
of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Cardiovascular diseases remain the main cause of mortality and morbidity
worldwide; primary prevention is a priority for physicians. Biomarkers are
useful tools able to identify high-risk individuals, guide treatments, and
determine prognosis. Our aim is to investigate Endogenous Ouabain (EO), an
adrenal stress hormone with hemodynamic effects, as a valuable biomarker
of heart failure. In a population of 845 patients undergoing elective
cardiac surgery, we have investigated the relationships between EO and
echocardiography parameters/plasmatic biomarker of cardiac function. EO
was found to be correlated negatively with left ventricular EF (p=0.001),
positively with Cardiac End-Diastolic Diameter (p=0.047), and positively
with plasmatic NT-proBNP level (p=0.02). Moreover, a different plasmatic
EO level (both preoperative and postoperative) was found according to NYHA
class (p=0.013). All these results have been replicated on an independent
cohort of patients (147 subjects from US). Finally, a higher EO level in
the immediate postoperative time was indicative of a more severe
cardiological condition and it was associated with increased perioperative
mortality risk (p=0.023 for 30-day morality). Our data suggest that
preoperative and postoperative plasmatic EO level identifies patients with
a more severe cardiovascular presentation at baseline. These patients have
a higher risk of morbidity and mortality after cardiac surgery.

<24>
Accession Number
2015521462
Authors
Meurin P. Lelay-Kubas S. Pierre B. Pereira H. Pavy B. Iliou M.C. Bussiere
J.L. Weber H. Beugin J.P. Farrokhi T. Bellemain-Appaix A. Briota L. Tabet
J.Y.
Institution
(Meurin, Weber, Tabet) Department of Cardiology, Les Grands Pres (CRCB),
27 rue Sainte Christine, Villeneuve Saint Denis 77174, France
(Lelay-Kubas) Centre de Readaptation Bois Gibert, Ballan Mire, France
(Pierre) IRIS, Marcy l'etoile, France
(Pereira) Assistance Publique, Hopitaux de Paris, Hopital Europeen
Georges-Pompidou, Unite D'epidemiologie et de Recherche Clinique, Paris,
France
(Pereira) INSERM, Centre D'Investigation Clinique 1418, Module
epidemiologie Clinique, Paris, France
(Pavy) Centre Hospitalier Loire Vendee Ocean, Machecoul, France
(Iliou) Corentin-Celton Hospital, Issy Les Moulineaux, France
(Bussiere) Clinique de Chatillon, Chatillon, France
(Beugin) Clinique de la Mitterie, 195 rue Adolphe Defrenne, Lomme, France
(Farrokhi) Bligny Hospital, Briis-sous-Forges, France
(Bellemain-Appaix) La Maison du Mineur, Vence, France
(Briota) Centre Dieuleufit Sante, Dieulefit, France
(Tabet) Private Hospital Jacques Cartier, Institut Cardiovasculaire Paris
Sud, Massy, France
Title
Colchicine for postoperative pericardial effusion: A multicentre,
double-blind, randomised controlled trial.
Source
Heart. 101 (21) (pp 1711-1716), 2015. Date of Publication: 01 Nov 2015.
Publisher
BMJ Publishing Group
Abstract
Objectives Pericardial effusion is common after cardiac surgery. Growing
evidence suggests that colchicine may be useful for acute pericarditis,
but its efficacy in reducing pericardial effusion volume postoperatively
has not been assessed. Methods This randomised, double-blind,
placebocontrolled study conducted in 10 centres in France included 197
patients at high risk of tamponade (ie, with moderate to large-sized
persistent effusion (echocardiography grades 2, 3 or 4 on a scale of 0-4))
at 7-30 days after cardiac surgery. Patients were randomly assigned to
receive colchicine, 1 mg daily (n=98), or a matching placebo (n=99). The
main end point was change in pericardial effusion grade after 14-day
treatment. Secondary end points included frequency of late cardiac
tamponade. Results The placebo and the colchicine groups showed a similar
mean baseline pericardial effusion grade (2.9 +/-0.8 vs 3.0+/-0.8) and
similar mean decrease from baseline after treatment (-1.1+/-1.3 vs
-1.3+/-1.3 grades). The mean difference in grade decrease between groups
was -0.19 (95% CI -0.55 to 0.16, p=0.23). In total, 13 cases of cardiac
tamponade occurred during the 14-day treatment (7 and 6 in the placebo and
colchicine groups, respectively; p=0.80). At 6-month follow-up, all
patients were alive and had undergone a total of 22 (11%) drainages: 14 in
the placebo group and 8 in the colchicine group ( p=0.20). Conclusions In
patients with pericardial effusion after cardiac surgery, colchicine
administration does not reduce the effusion volume or prevent late cardiac
tamponade.

<25>
Accession Number
2015237184
Authors
Wang N. Zhou J.J. Phan S. Yan T.D. Phan K.
Institution
(Wang, Phan, Phan) Sydney Medical School, University of Sydney, Sydney,
NSW, Australia
(Zhou, Phan) Faculty of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Yan, Phan) The Collaborative Research (CORE) Group, Macquarie University,
Sydney, NSW, Australia
Title
Robot-assisted Hybrid Coronary Revascularisation: Systematic Review.
Source
Heart Lung and Circulation. 24 (12) (pp 1171-1179), 2015. Date of
Publication: December 2015.
Publisher
Elsevier Ltd
Abstract
Background: Hybrid coronary revascularisation (HCR) for multi-vessel
coronary artery disease combines surgical bypass grafting for the left
anterior descending (LAD) coronary artery and percutaneous coronary
intervention (PCI) for non-LAD coronary arteries. The present systematic
review was conducted to assess the available evidence on robotic-assisted
HCR and explore the potential advantages and disadvantages it proposes.
Methods: A comprehensive search from six electronic databases was
performed for studies reporting outcomes for robotic-assisted hybrid
coronary revascularisation. Eight studies were identified from six
electronic databases amenable for qualitative assessment and pooled
quantitative analysis. Results: There were no in-hospital deaths reported.
Pooled myocardial infarction rates was 1.2% (range 0-3.7%), pooled strokes
was 0.8% (range: 0-1.7%), freedom from reintervention was 92.5% (range
70.4-100%), and freedom from angina was 92.9% (range 74.3-100%). LITA
patency ranged from 89-100%, while hospital stay ranged from 4-8.1 days.
Conclusions: The current data suggests potentially acceptable mortality
and complication rates, when patients are carefully selected and operated
on by expert cardiovascular teams. However, due to the heterogeneous
nature of the evidence and lack of long-term outcomes, this promising
technique warrants future comparative and randomised studies before
becoming a part of mainstay coronary interventions.

<26>
Accession Number
72092512
Authors
Skoloudik D. Hurtikova E. Brat R. Herzig R.
Institution
(Skoloudik, Hurtikova) Neurology, University Hospital Ostrava, Ostrava,
Czech Republic
(Brat) Cardiosurgery, University Hospital Ostrava, Ostrava, Czech Republic
(Herzig) Neurosurgery, Military University Hospital, Prague, Czech
Republic
Title
Sonolysis in prevention of brain infarction during cardiac surgery
(Sonorescue): A randomized, controlled trial.
Source
Journal of the Neurological Sciences. Conference: 22nd World Congress of
Neurology, WCN 2015 Santiago Chile. Conference Start: 20151031 Conference
End: 20151105. Conference Publication: (var.pagings). 357 (pp e411),
2015. Date of Publication: 15 Oct 2015.
Publisher
Elsevier
Abstract
Background: Previous studies detected silent brain infarctions in as many
as two-thirds of patients after coronary artery bypass graft (CABG) or
valve surgery. Sonolysis employs ultrasound to facilitate disruption of
thrombi. Objective: To determine if intraoperative sonolysis alters the
risk of new brain infarction in insonated brain artery territory during
CABG or valve surgery. Patients and methods: Functionally independent
patients indicated for CABG or valve surgery were assigned to the
sonolysis or control group. Sonolysis was performed as continuous
transcranial Doppler monitoring of right middle cerebral artery (MCA)
during cardiac surgery using 2-MHz diagnostic probe. Neurological
examination, cognitive functions tests, and brain magnetic resonance
imaging (MRI) were conducted before intervention, at 24-72 h and 30 days
post-surgery. The primary endpoints were the incidence and volume of new
brain infarctions and incidence of new brain infarctions >0.5 mL in the
right MCA territory on control MRI in sonolysis and control groups.
Results: Of 214 screened patients, 60 (37 males; mean age, 65.3 years)
were allocated to sonolysis group and 60 (32; 66.8 years) to control
group. Significantly reduced incidence of new brain infarctions >0.5 mL
(13.3% vs. 26.7%, P =0.109) and infarction volume (P =0.026) were detected
in the sonolysis group. Internal carotid artery stenosis (OR =5.685) and
smoking (OR=4.698) were identified as independent predictors of brain
infarction. No significant group differences were found in stroke
incidence and post-intervention cognitive tests scores (P > 0.05).
Conclusion: Sonolysis during CABG or valve surgery reduces the risk of
larger new brain infarctions.

<27>
Accession Number
72093420
Authors
Hussain N.S. Tong W.L.
Institution
(Hussain, Tong) Division of Nursing, Singapore General Hospital,
Singapore, Singapore
Title
Is electronic educational materials better than printed materials in the
education of patients undergoing elective surgery?-a systematic review.
Source
Proceedings of Singapore Healthcare. Conference: SingHealth DukeNUS
Scientific Congress 2010 Singapore Singapore. Conference Start: 20101015
Conference End: 20101015. Conference Publication: (var.pagings). 19 (pp
S327), 2010. Date of Publication: June 2010.
Publisher
SAGE Publications Inc.
Abstract
Aim: Psychological preoperative preparation is beneficial to patients as
they will be less anxious and be more aware of the expected outcomes.
However there is a lack of consensus on the most effective mode of
providing information to patients undergoing elective surgery. The current
practice involved a lengthy period of information-giving during clinic
consultations supplemented with printed materials. This paper aimed to
summarize the current evidence on the effectiveness of electronic
educational materials versus printed materials in promoting recall and
retention of knowledge by patients undergoing elective surgery. Methods: A
search was done on the databases of Ovid, Cochrane, CINAHL, PubMed and
Google Scholar using the following search terms "preoperative anxiety",
"education", "anxiety and education", "educational programme", "visual
aids", "pamplets", "elective surgery" and "preoperative education" as
informed by the P (population), I (intervention), C (comparator), O
(outcome) framework. P: patients due to undergo elective surgery. I:
Interactive educational material, C: printed materials, O: recall,
retention of knowledge, anxiety and satisfaction level. Results: 1
systematic review, 6 randomised control trials (RCT), 1 cohort study and 1
case review were found. The 6 RCTs retrieved consists of studies done on
patients who underwent Coronary Artery Bypass Surgery, Coronary
Angiography, Breast Reconstruction, Cataract, Regional anaesthesia and Hip
replacement surgery. The RCTs demonstrated that visual images in
combination with verbal instructions have shown to significantly increase
recall and retention. Patients in the electronic interactive digital
education aid group were more satisfied than the control group as all the
necessary information received were adequate and allowed them to better
understand the surgical procedure. Conclusion: High anxiety levels often
affect patients' understanding and recalling of information. Audiovisual
information reduces pre- and post-operative anxiety and can be
particularly useful to those with reading or comprehension difficulties.
The use of patient education by informative video demonstrated a
significant decrease in anxiety level, increase understanding and
satisfaction level of patients undergoing the procedure.

<28>
Accession Number
72083180
Authors
Gordois A.L. Proudfoot E.M. Paoli C.J. Gandra S.R.
Institution
(Gordois, Proudfoot) Covance Market Access Services Inc., Sydney,
Australia
(Paoli, Gandra) Amgen, Inc., Thousand Oaks, CA, United States
Title
Systematic review of productivity losses associated with cardiovascular
disease in Europe.
Source
Value in Health. Conference: ISPOR 18th Annual European Congress Milan
Italy. Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 18 (7) (pp A396), 2015. Date of Publication:
November 2015.
Publisher
Elsevier Ltd
Abstract
Objectives: People with cardiovascular disease (CVD) often require time
off work to recover from illness or surgery (e.g. post-myocardial
infarction (MI) or stroke, individuals incur income losses and output is
reduced for employers and the wider economy). A systematic review was
conducted to identify studies reporting the magnitude of these losses for
European populations, for use in economic analyses. Methods: A systematic
search was conducted in January/February 2015 using Medline, Embase, the
Cochrane Library, and Google, to identify studies published since 2004
reporting productivity losses from CVD overall or pre-defined
cardiovascular conditions (coronary heart disease, MI, stroke, transient
ischemic attack, angina, heart failure, peripheral artery disease,
coronary revascularization). Studies were classified by: country; average
patient or population outcomes; human capital or friction cost method;
scope of losses (absenteeism [work days missed for illness/ recovery],
presenteeism, early retirement/unemployment, premature mortality); CVD
conditions/events. Outcomes were standardized where possible and adjusted
to 2015 prices. Results: Twenty-five European studies were identified.
Twelve reported population costs and one reported population productive
years of life lost only. Monetary losses were generally assessed using the
human capital (12 studies) rather than friction cost method (4 studies).
Annual productivity losses from all CVD across 6 countries ranged from
1.4 billion (absenteeism) to 19.7 billion (premature mortality). One UK
study reported substantially higher annual absenteeism costs of 9.28
billion (3.60 billion friction-adjusted) while mortality costs were less
at 5.23 billion. Twelve studies reported average losses from absenteeism
(10 studies) and/or early retirement (2 studies). Inter-study variations
in results reflect different methods and scopes, although productivity
losses were substantial across different countries and methods.
Conclusions: CVD is associated with substantially high CVD morbidity and
mortality costs. This systematic review comprehensively documents these
losses published for European populations, and is useful for populating
economic models or burden-of-disease studies that adopt a societal
perspective.

<29>
Accession Number
25518953
Authors
Koster G. Wetterslev J. Gluud C. Zijlstra J.G. Scheeren T.W. van der Horst
I.C. Keus F.
Institution
(Koster, Wetterslev, Gluud, Zijlstra, Scheeren, van der Horst, Keus)
Department of Critical Care, University of Groningen, University Medical
Centre Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands,
g.koster@umcg.nl
Title
Effects of levosimendan for low cardiac output syndrome in critically ill
patients: systematic review with meta-analysis and trial sequential
analysis.
Source
Intensive care medicine. 41 (2) (pp 203-221), 2015. Date of Publication:
01 Feb 2015.
Abstract
PURPOSE: To assess the benefits and harms of levosimendan for low cardiac
output syndrome in critically ill patients.
METHODS: We conducted a systematic review with meta-analyses and trial
sequential analyses (TSA) of randomised clinical trials comparing
levosimendan with any type of control. Two reviewers independently
assessed studies for inclusion. The Cochrane Collaboration methodology was
used. Random-effects risk ratios (RR) and 95 % confidence intervals (CI)
were derived for the principal primary outcome mortality at maximal
follow-up.
RESULTS: A total of 88 trials were included in the systematic review and
49 trials (6,688 patients) in the meta-analysis. One trial had low risk of
bias and nine trials (2,490 patients) were considered lower risk of bias.
Trials compared levosimendan with placebo, control interventions, and
other inotropes. Pooling all trials including heterogenous populations was
considered inappropriate. Pooled analysis of 30 trials including
critically ill patients not having cardiac surgery showed an association
between levosimendan and mortality (RR 0.83, TSA-adjusted 95 % CI
0.59-0.97), while trials with lower risk of bias showed no significant
difference (RR 0.83, TSA-adjusted 95 % CI 0.48-1.55). Conventional
meta-analysis of all 14 trials including cardiac surgery patients showed
an association, while lower risk of bias trials showed no association
between levosimendan and mortality (RR 0.52, 95 % CI 0.37-0.73 versus RR
1.02, 95 % CI 0.48-2.16).
CONCLUSIONS: The available evidence is inconclusive whether or not
levosimendan may have a beneficial effect on mortality due to risks of
systematic errors and random errors. Further well-designed randomised
trials are needed.