446 research outputs found
Heart rate and use of beta-blockers in stable outpatients with coronary artery disease
No full text<p><b>Background:</b> Heart rate (HR) is an emerging risk factor in coronary artery disease (CAD). However, there is little contemporary data regarding HR and the use of HR-lowering medications, particularly beta-blockers, among patients with stable CAD in routine clinical practice. The goal of the present analysis was to describe HR in such patients, overall and in relation to beta-blocker use, and to describe the determinants of HR.</p>
<p><b>Methods and Findings:</b> CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization procedure, evidence of coronary stenosis of >50%, or chest pain associated with proven myocardial ischemia. A total of 33,438 patients from 45 countries in Europe, the Americas, Africa, Middle East, and Asia/Pacific were enrolled between November 2009 and July 2010. Most of the 33,177 patients included in this analysis were men (77.5%). Mean (SD) age was 64.2 (10.5) years, HR by pulse was 68.3 (10.6) bpm, and by electrocardiogram was 67.2 (11.4) bpm. Overall, 44.0% had HR≥70 bpm. Beta-blockers were used in 75.1% of patients and another 14.4% had intolerance or contraindications to beta-blocker therapy. Among 24,910 patients on beta-blockers, 41.1% had HR≥70 bpm. HR≥70 bpm was independently associated with higher prevalence and severity of angina, more frequent evidence of myocardial ischemia, and lack of use of HR-lowering agents.</p>
<p><b>Conclusions:</b> Despite a high rate of use of beta-blockers, stable CAD patients often have resting HR≥70 bpm, which was associated with an overall worse health status, more frequent angina and ischemia. Further HR lowering is possible in many patients with CAD. Whether it will improve symptoms and outcomes is being tested.</p>
Evidence-based vs. 'impressionist' medicine: how best to implement guidelines.
No full textImplementing clinical practice guidelines improves outcomes. This has been shown by several large scale registries. However, in spite of this, guidelines are poorly implemented in clinical practice for a wide variety of reasons. We examine the reasons behind the low uptake of guidelines into routine medical practice. Many physicians are simply not aware that guidelines exist; or they do not believe in them; or they simply do not care to implement them. Economic and social factors may also influence uptake of guidelines. It is the role of professional societies to disseminate best scientific knowledge, and ensure optimum implementation of guidelines. This can be achieved through educational activities and CME credit. Close collaboration between the profession, health authorities, and maybe even the industry could improve uptake of clinical practice guidelines, and thereby improve patient outcome
Rationale and design of a randomized, double-blind, placebo-controlled trial of ivabradine in patients with stable coronary artery disease and left ventricular systolic dysfunction: the morBidity-mortality EvAlUaTion of the I-f inhibitor ivabradine in patients with coronary disease and left ventricULar dysfunction (BEAUTIFUL) Study
No full textBackground Raised resting heart rate (HR) is associated with increased cardiovascular and total mortality. Ivabradine
is a new specific HR-reducing agent, which has been shown to have antianginal and anti-ischemic properties in patients
with stable angina. Because patients with coronary artery disease and left ventricular dysfunction are at high risk of
cardiac events and death, we hypothesized that they could derive particular benefit from a specific HR-lowering agent such
as ivabradine.
Methods BEAUTIFUL is a multicenter, randomized, international, double-blind placebo-controlled trial to evaluate the
superiority of ivabradine over placebo in reducing cardiovascular events in patients with stable coronary artery disease and
left ventricular systolic dysfunction (ejection fraction V39%). The primary end point is the composite of cardiovascular
mortality and hospital admission for acute myocardial infarction or new onset or worsening of heart failure. This event-driven
study will randomize 9650 patients and continue until 950 primary end points have occurred, providing 90% power to
detect a 19% reduction in relative risk. In approximately 660 centers, men and women aged z55 years if nondiabetic and
z18 years if diabetic are randomized to placebo or oral ivabradine (5 mg twice daily for 2 weeks then target dose of
7.5 mg twice daily). Follow-up is expected to last between 18 and 36 months.
Results The first patient was randomized in January 2005.
Conclusion BEAUTIFUL will be the first major outcome trial of a specific HR-reducing agent. The study results are
expected in 2008
Quine's Fluted Fragment is Non-Elementary
No full textWe study the fluted fragment, a decidable fragment of first-order logic with an unbounded number of variables, originally identified by W.V. Quine. We show that the satisfiability problem for this fragment has non-elementary complexity, thus refuting an earlier published claim by W.C. Purdy that it is in NExpTime. More precisely, we consider, for all m greater than 1, the intersection of the fluted fragment and the m-variable fragment of first-order logic. We show that this sub-fragment forces (m/2)-tuply exponentially large models, and that its satisfiability problem is (m/2)-NExpTime-hard. We round off by using a corrected version of Purdy's construction to show that the m-variable fluted fragment has the m-tuply exponential model property, and that its satisfiability problem is in m-NExpTime
Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology
No full textWe found 1 article:
Eur Heart J. 2005 Feb;26(4):384-416. Epub 2005 Jan 28.
Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology.
Nieminen MS, Böhm M, Cowie MR, Drexler H, Filippatos GS, Jondeau G, Hasin Y, Lopez-Sendon J, Mebazaa A, Metra M, Rhodes A, Swedberg K, Priori SG, Garcia MA, Blanc JJ, Budaj A, Cowie MR, Dean V, Deckers J, Burgos EF, Lekakis J, Lindahl B, Mazzotta G, Morais J, Oto A, Smiseth OA, Garcia MA, Dickstein K, Albuquerque A, Conthe P, Crespo-Leiro M, Ferrari R, Follath F, Gavazzi A, Janssens U, Komajda M, Morais J, Moreno R, Singer M, Singh S, Tendera M, Thygesen K; ESC Committe for Practice Guideline (CPG).
Division of Cardiology, Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland. [email protected]
PMID: 15681577 [PubMed - indexed for MEDLINE]Free Articl
Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial
No full text<p><b>Background</b> The BEAUTIFUL study assessed the morbidity and mortality benefits of the heart rate-lowering agent ivabradine. The placebo arm of the BEAUTIFUL trial was a large cohort of patients with stable coronary artery disease and left-ventricular dysfunction. We did a subanalysis of this placebo group to test the hypothesis that elevated resting heart rate at baseline is a marker for subsequent cardiovascular death and morbidity.</p>
<p><b>Methods</b> The association of baseline resting heart rate with cardiovascular outcomes was analysed using Cox proportional hazard models for groups with a heart rate of 70 beats per min (bpm) or greater (2693 patients) versus less than 70 bpm (2745 patients). Additional analyses were done with finer categorisation of heart rate, and with heart rate as a continuous variable.</p>
<p><b>Findings</b> After adjustment for baseline characteristics, patients with heart rates of 70 bpm or greater had increased risk for cardiovascular death (34%, p=0.0041), admission to hospital for heart failure (53%, p<0.0001), admission to hospital for myocardial infarction (46%, p=0.0066), and coronary revascularisation. (38%, p=0.037). For every increase of 5 bpm, there were increases in cardiovascular death (8%, p=0.0005), admission to hospital for heart failure (16%, p<0.0001), admission to hospital for myocardial infarction (7%, p=0.052), and coronary revascularisation. (8%, p=0.034). The analysis of fine-groupings of heart rate suggests that the increase in mortality and heart failure outcomes rises continuously above 70 bpm, whereas the relation is less pronounced for coronary outcomes. For heart failure outcomes, the predictive value of resting heart rate was stronger for earlier events than for later events.</p>
<p><b>Interpretation</b> In patients with coronary artery disease and left-ventricular systolic dysfunction, elevated heart rate (70 bpm or greater) identifies those at increased risk of cardiovascular outcomes, with a differential effect on outcomes associated with heart failure and outcomes associated with coronary events.</p>
Анализ промежуточных результатов сравнительного многоцентрового рандомизированного исследования Tendera по изучению дистального лучевого доступа
No full textЛУЧЕВАЯ АРТЕРИЯ /ХИРДИСТАЛЬНЫЙ ЛУЧЕВОЙ ДОСТУПЧРЕСКОЖНАЯ КОРОНАРНАЯ ИНТЕРВЕНЦИЯОСТРЫЙ КОРОНАРНЫЙ СИНДРОМИШЕМИЧЕСКАЯ БОЛЕЗНЬ СЕРДЦАИШЕМИЯ МИОКАРДАМИОКАРДИАЛЬНАЯ ИШЕМИЯЛЕЧЕНИЯ ПРОЦЕССА И РЕЗУЛЬТАТОВ ОЦЕНКАМЕДИЦИНСКАЯ ПОМОЩЬ, РЕЗУЛЬТАТОВ И ПРОЦЕССА ЛЕЧЕНИЯ ОЦЕНКАМНОГОЦЕНТРОВЫЕ ИССЛЕДОВАНИЯСЛЕПОГО ОТБОРА МЕТОД КОНТРОЛИРУЕМЫЙКЛИНИЧЕСКИЕ ИСПЫТАНИЯ РАНДОМИЗИРОВАННЫЕРАНДОМИЗИРОВАННЫЕ ИССЛЕДОВАНИЯ КОНТРОЛИРУЕМЫЕЦель. Доказать безопасность и эффективность дистальной пункции лучевой (ДЛА) артерии при эндоваскулярных вмешательствах в сравнении с традиционным местом пункции лучевой артерии (ЛА) на предплечье путем сравнения непосредственных и отдаленных результатов. Материал и методы. В 2017 г. начато многоцентровое открытое рандомизиированное (1:1) исследование TENDERA (Comparison between Traditional Entrypoint and Distal Puncture of Radial Artery). За 2 года включено 520 пациентов, средний возраст 63,4±10,0 лет (M±сигма). В группу наблюдения (пункция ДЛА) вошли 271 пациент, в группу сравнения (пункция ЛА) – 249 пациентов. В исследование вошли как стабильные пациенты, так и с NSTEMI: группа наблюдения – 39 (14,4%), группа сравнения – 34 (13,7%), p=0,809. Первичная конечная точка – непосредственный (госпитальный) или поздний тромбоз лучевой артерии. Вторичные конечные точки: 1 – композитная точка, осложнения со стороны артерии доступа; 2 – параметры пункции. Результаты. Средняя разница в диаметре ЛА и ДЛА составила 0,3 мм и 0,4 мм, у некоторых пациентов диаметр ДЛА соответствовал ЛА или даже превышал его. Значимо отличается диаметр ЛА и ДЛА у мужчин и женщин, 2,65±0,44 мм и 2,36±0,36 мм (p=0,001), 2,31±0,39 мм и 2,13±0,38 мм (p=0,001). Для удачной пункции ДЛА необходимо значимо больше попыток. 94,1% – процент успеха катетеризации через ДЛА, что значимо меньше, чем через ЛА – 100% (p <0,001). В группе наблюдения получено значимо меньше повторных кровотечений и повторных гемостазов. В отдаленном периоде в группе наблюдения значимо больше гематом на сроках при выписке и через 1 неделю. Заключение. Промежуточный анализ результатов исследования TENDERA показывает, что нет значимой разницы в первичной конечной точке, но значимо меньше в группе наблюдения количество осложнений, связанных с местом пункции – гематома более 5 см в день выписки и через 7 дней.Objective. To prove the safety and efficacy of distal radial artery (DRA) puncture for endovascular interventions versus the traditional forearm radial artery (RA) puncture site by comparing immediate and long-term results. Methods. In 2017, a multicenter, open, randomized (1:1) study TENDERA (Comparison between Traditional Entry Point and Distal Puncture of Radial Artery) was started. During 2 years, 520 patients were included, mean age 63.4±10.0 years. The observation group (DRA puncture) included 271 patients, the comparison group (RA puncture) – 249 patients. The study included both stable patients and those with NSTEMI: the observation group – 39 (14.4%), the comparison group – 34 (13.7%), p=0.809. The primary endpoint is immediate (hospital) or late radial thrombosis. Secondary endpoints are: 1 – composite point, complications from the access artery; 2 – puncture parameters. Results. The average difference in the diameters of the RA and DRA was 0.3 mm and 0.4 mm, in some patients the DRA diameter corresponded to the RA or even exceeded it. The diameter of RA and DRA in men and women significantly differs, 2.65±0.44 mm and 2.36±0.36 mm (p=0.001), 2.31±0.39 mm and 2.13±0.38 mm (p=0.001). Technical success of DRA access requre the number of attempts. 94.1% – the percentage of successful cardiac catheterization performed through the distal radial artery approach, which is significantly less than via RA – 100% (p<0.001). In the observation group, significantly fewer rebleedings and rehemostasis were occured. In the long-term period, there were registered outstandingly more hematomas in the observation group at the time of discharge and after 1 week. Conclusion. Intermediate analysis of the results of the TENDERA study shows that there is no significant difference in the primary endpoint, but the number of complications in the observation group associated with the puncture markedly – hematoma more than 5 cm to the day of discharge and after 7 days
Women and men with stable coronary artery disease have similar clinical outcomes: insights from the international prospective CLARIFY registry
No full text<p>Aims Men and women differ in terms of presentation and management in coronary artery disease (CAD). Whether these differences translate into different clinical outcomes in stable CAD is unclear. We analysed data from the international prospective CLARIFY registry to compare cardiovascular clinical outcomes in men and women with stable CAD.</p>
<p>Methods and results We analysed 1-year outcomes in 30 977 outpatients with stable CAD [23 975 (77.4%) men; 7002 (22.6%) women]. Women were older than men, more likely to have hypertension and diabetes, and less likely to exercise or smoke. They had more frequent angina, but were less likely to have undergone diagnostic non-invasive testing or coronary angiography. Women received less optimized treatment for stable CAD. One-year outcomes were similar for men and women for the composite of cardiovascular death, non-fatal myocardial infarction, or stroke [adjusted rates 1.7 vs. 1.8%, respectively, odds ratio (OR) 0.93, 95% confidence interval (CI) 0.75–1.15]; all-cause death (adjusted 1.5 vs. 1.6%, OR: 0.91, 95% CI: 0.72–1.13); fatal or non-fatal myocardial infarction (adjusted 1.0 vs. 0.9%, OR: 0.81, 95 CI: 0.60–1.08); and cardiovascular death or non-fatal myocardial infarction (adjusted 1.4 vs. 1.4%, OR: 0.89, 95% CI: 0.70–1.12). Fewer women underwent revascularization (2.6 vs. 2.2%, OR: 0.77, 95% CI: 0.64–0.93), although appropriateness was not analysed.1522-9645</p>
<p>Conclusion The risk profiles of women and men with stable CAD differ substantially. However, 1-year outcomes were similar. Fewer women underwent revascularization. Further research is needed to better understand gender determinants of outcome and devise strategies to minimize bias in the management and treatment of women.</p>
Heart rate reduction by pharmacological If current inhibition
No full textHeart rate reduction is becoming a new strategy to treat coronary patients. The
development of heart-rate-lowering drugs, with a more specific activity than
Beta-blockers, coincides with the detection of the sinoatrial pacemaker I(f)
current. The first selective I(f) inhibitor that has been approved for clinical
use is ivabradine. Ivabradine has been shown to reduce heart rate, preserve
myocardial contractility, increase diastolic filling and maintain both small and
large coronary artery vasodilation, whatever the level of exercise, thus ensuring
adequate endocardial blood perfusion during exercise. Furthermore ivabradine
decreases myocardial oxygen consumption and improves myocardial energetics,
protecting the myocardium during acute ischemic conditions and showing favorable
antiremodelling properties in patients with chronic ischemic disease
Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial.
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