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https://www.readbyqxmd.com/read/29776337/should-statin-guidelines-consider-patient-preferences-eliciting-preferences-of-benefit-and-harm-outcomes-of-statins-for-primary-prevention-of-cardiovascular-disease-in-the-sub-saharan-african-and-european-contexts
#1
Henock G Yebyo, Hélène E Aschmann, Tsung Yu, Milo A Puhan
BACKGROUND: Patient preferences are key parameters to evaluate benefit-harm balance of statins for primary prevention but they are not readily available to guideline developers and decision makers. Our study aimed to elicit patient preferences for benefit and harm outcomes related to use of statins for primary cardiovascular disease prevention and to examine how the preferences differ across economically and socio-culturally different environments. METHODS: We conducted preference-eliciting surveys using best-worst scaling designed with a balanced incomplete-block design (BIBD) on 13 statins-related outcomes on 220 people in Ethiopia and Switzerland...
May 18, 2018: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/29773586/seafood-long-chain-n-3-polyunsaturated-fatty-acids-and-cardiovascular-disease-a-science-advisory-from-the-american-heart-association
#2
REVIEW
Eric B Rimm, Lawrence J Appel, Stephanie E Chiuve, Luc Djoussé, Mary B Engler, Penny M Kris-Etherton, Dariush Mozaffarian, David S Siscovick, Alice H Lichtenstein
Since the 2002 American Heart Association scientific statement "Fish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular Disease," evidence from observational and experimental studies and from randomized controlled trials continues to emerge to further substantiate the beneficial effects of seafood long-chain n-3 polyunsaturated fatty acids and cardiovascular disease. A recent American Heart Association science advisory addressed the specific effect of n-3 polyunsaturated fatty acid supplementation on clinical cardiovascular events...
May 17, 2018: Circulation
https://www.readbyqxmd.com/read/29772576/wake-up-stroke-versus-stroke-with-known-onset-time-clinical-and-multimodality-ct-imaging-characteristics
#3
Jan W Dankbaar, Henri P Bienfait, Coen van den Berg, Edwin Bennink, Alexander D Horsch, Tom van Seeters, Irene C van der Schaaf, L Jaap Kappelle, Birgitta K Velthuis
BACKGROUND: Current guidelines for the treatment of acute ischemic stroke are mainly based on the time between symptom onset and initiation of treatment. This time is unknown in patients with wake-up stroke (WUS). We investigated clinical and multimodality CT imaging characteristics on admission in patients with WUS and in patients with a stroke with a known onset time. METHODS: All patients were selected from a large prospective cohort study (Dutch acute stroke study)...
May 17, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29769180/factors-associated-with-delay-in-carotid-endarterectomy-for-patients-with-symptomatic-severe-internal-carotid-artery-stenosis-a-case-control-study
#4
Daniel Meyer, Erwin Karreman, David Kopriva
BACKGROUND: The Canadian Best Practice Recommendations for Stroke Care (2008 update) recommend that patients with neurologic symptoms secondary to severe internal carotid artery stenosis undergo carotid endarterectomy within 14 days of symptom onset to prevent stroke. The purpose of this study was to identify patient and system factors associated with meeting, or failing to meet, the guideline. METHODS: In this case-control study, potential study participants were identified through an electronic search of the Discharge Abstract Database...
May 15, 2018: CMAJ Open
https://www.readbyqxmd.com/read/29768672/catheter-ablation-for-atrial-fibrillation-on-uninterrupted-direct-oral-anticoagulants-a-safe-approach
#5
V Sawhney, M Shaukat, E Volkova, N Jones, R Providencia, S Honarbakhsh, G Dhillon, A Chow, M Lowe, P Lambiase, M Dhinoja, S Sporton, M J Earley, R J Schilling, R J Hunter
BACKGROUND: Current consensus guidelines suggest DOACs are interrupted peri-procedurally for catheter ablation (CA) of AF. However, this may predispose patients to thromboembolic complications. This study investigates the safety of CA for AF on uninterrupted DOACs compared to uninterrupted warfarin. METHODS: Single centre, retrospective study of consecutive patients undergoing CA for AF. All patients were heparinised prior to trans-septal puncture with a target activated clotting time (ACT) of 300-350 seconds...
May 16, 2018: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/29768161/-practical-aspects-of-anticoagulant-therapy-in-patients-with-atrial-fibrillation-and-arterial-hypertension
#6
Z D Kobalava, A A Shavarov
Atrial fibrillation (AF) represents the most frequent sustained cardiac arrhythmia, the prevalence of AF is 1-2 % in the general population and up to 6 % for population over 80 years. Arterial hypertension (AH) is the commonest background comorbidity in patients with AF. Patients with AF have 3-6‑fold increased risk of ischemic stroke in comparison to that in general population, additionally the presence of AH leads an 2-3‑fold increase in risk of subsequent stroke. Current clinical guidelines recommend long-time anticoagulant treatment for prevention of stroke and thromboembolic complications in majority of patients with confirmed AF...
2018: Kardiologiia
https://www.readbyqxmd.com/read/29766770/mri-guided-thrombolysis-for-stroke-with-unknown-time-of-onset
#7
Götz Thomalla, Claus Z Simonsen, Florent Boutitie, Grethe Andersen, Yves Berthezene, Bastian Cheng, Bharath Cheripelli, Tae-Hee Cho, Franz Fazekas, Jens Fiehler, Ian Ford, Ivana Galinovic, Susanne Gellissen, Amir Golsari, Johannes Gregori, Matthias Günther, Jorge Guibernau, Karl Georg Häusler, Michael Hennerici, André Kemmling, Jacob Marstrand, Boris Modrau, Lars Neeb, Natalia Perez de la Ossa, Josep Puig, Peter Ringleb, Pascal Roy, Enno Scheel, Wouter Schonewille, Joaquin Serena, Stefan Sunaert, Kersten Villringer, Anke Wouters, Vincent Thijs, Martin Ebinger, Matthias Endres, Jochen B Fiebach, Robin Lemmens, Keith W Muir, Norbert Nighoghossian, Salvador Pedraza, Christian Gerloff
Background Under current guidelines, intravenous thrombolysis is used to treat acute stroke only if it can be ascertained that the time since the onset of symptoms was less than 4.5 hours. We sought to determine whether patients with stroke with an unknown time of onset and features suggesting recent cerebral infarction on magnetic resonance imaging (MRI) would benefit from thrombolysis with the use of intravenous alteplase. Methods In a multicenter trial, we randomly assigned patients who had an unknown time of onset of stroke to receive either intravenous alteplase or placebo...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29762202/hypertension-guideline-update-a-new-guideline-for-a-new-era
#8
Sondra M DePalma, Cheryl Dennison Himmelfarb, Eric J MacLaughlin, Sandra J Taler
In the United States, hypertension affects about one-third of adults and contributes to one out of every seven deaths. Evidence-based treatment is associated with reductions in incidence of stroke, myocardial infarction, and heart failure as well as associated disability and death. This article reviews the ACC/AHA Task Force on Clinical Practice Guidelines' 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Key changes include reclassification of BP stages and lowering of hypertension treatment goals...
May 8, 2018: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/29760852/altered-mental-status-current-evidence-based-recommendations-for-prehospital-care
#9
REVIEW
Ashley Sanello, Marianne Gausche-Hill, William Mulkerin, Karl A Sporer, John F Brown, Kristi L Koenig, Eric M Rudnick, Angelo A Salvucci, Gregory H Gilbert
Introduction: In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29758114/time-well-spent-in-recanalizing-complex-cerebrovascular-occlusions
#10
Perttu J Lindsberg
After publication of several randomized, controlled trials demonstrating the efficacy of mechanical thrombectomy (MT) following intravenous t-PA (IV t-PA) the current guidelines of acute management of cerebrovascular have been revised (1,2). In addition to IV t-PA within 4,5 hours applied in a wide spectrum of ischemic stroke subtypes, MT has been proven as the second therapeutic target in a longer time window in much more selected cases of large vessel occlusions (LVO). This article is protected by copyright...
May 14, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29756640/aortic-valve-hemodynamics-in-atrial-fibrillation-should-the-highest-doppler-signal-be-used-to-estimate-severity-of-aortic-stenosis
#11
Said Alsidawi, Sana Khan, Sorin V Pislaru, Vuyisile T Nkomo
Grading severity of AS in AF is complicated by varying stroke volumes associated with fluctuating maximum velocities and pressure gradients across the aortic valve. Current guidelines recommend averaging five continuous-wave peak velocity and mean gradient (MG) Doppler signals across the aortic valve when estimating severity of AS in AF. However, it is unknown when grading severity of AS how the average of multiple Doppler signals vs the highest Doppler signal in AF compares to the Doppler signals when the patient is in normal sinus rhythm...
May 14, 2018: Echocardiography
https://www.readbyqxmd.com/read/29751339/estimating-the-acute-effects-of-fine-and-coarse-particle-pollution-on-stroke-mortality-of-in-six-chinese-subtropical-cities
#12
Xiaojie Wang, Zhengmin Qian, Xiaojie Wang, Hua Hong, Yin Yang, Yanjun Xu, Xiaojun Xu, Zhenjiang Yao, Lingli Zhang, Craig A Rolling, Mario Schootman, Tao Liu, Jianpeng Xiao, Xing Li, Weilin Zeng, Wenjun Ma, Hualiang Lin
While increasing evidence suggested that PM2.5 is the most harmful fraction of the particle pollutants, the health effects of coarse particles (PM10-2.5 ) have been inconclusive, especially on cerebrovascular diseases, we thus evaluated the effects of PM10 , PM2.5 , and PM10-2.5 on stroke mortality in six Chinese subtropical cities using generalized additive models. We also conducted random-effects meta-analyses to estimate the overall effects across the six cities. We found that PM10 , PM2.5 , and PM10-2.5 were significantly associated with stroke mortality...
May 8, 2018: Environmental Pollution
https://www.readbyqxmd.com/read/29746985/theoretical-personalized-optimum-chest-compression-point-can-be-determined-using-posteroanterior-chest-radiography
#13
Sunho Cho, Won Sup Oh, Sung-Bin Chon, Shinwoo Kim, Keunha Hwang
AIM: Cardiopulmonary resuscitation guidelines suggest the lower sternal half be compressed. However, stroke volume has been assumed to be maximized by compressing the 'point' (P_max.LV) beneath which the left ventricle (LV) is at its maximum diameter. Identifying 'personalized' P_max.LV on computed tomography (CT), we derived and validated rules to estimate P_max.LV using posteroanterior chest radiography (chest_PA). METHODS: A retrospective, cross-sectional study was performed with non-cardiac arrest (CA) adults who underwent chest_PA and CT within 1h (derivation:validation = 3:2)...
May 7, 2018: Resuscitation
https://www.readbyqxmd.com/read/29743285/risk-of-stroke-and-transient-ischaemic-attack-in-patients-with-a-diagnosis-of-resolved-atrial-fibrillation-retrospective-cohort-studies
#14
Nicola J Adderley, Krishnarajah Nirantharakumar, Tom Marshall
OBJECTIVES: To determine rates of stroke or transient ischaemic attack (TIA) and all cause mortality in patients with a diagnosis of "resolved" atrial fibrillation compared to patients with unresolved atrial fibrillation and without atrial fibrillation. DESIGN: Two retrospective cohort studies. SETTING: General practices contributing to The Health Improvement Network, 1 January 2000 to 15 May 2016. PARTICIPANTS: Adults aged 18 years or more with no previous stroke or TIA: 11 159 with resolved atrial fibrillation, 15 059 controls with atrial fibrillation, and 22 266 controls without atrial fibrillation...
May 9, 2018: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/29741531/cost-effectiveness-of-physical-fitness-training-for-stroke-survivors
#15
M Collins, E Clifton, F van Wijck, G E Mead
Background Physical fitness is impaired after stroke, yet fitness training after stroke reduces disability. Several international guidelines recommend that fitness training be incorporated as part of stroke rehabilitation. However, information about cost-effectiveness is limited. Methods A decision tree model was used to estimate the cost-effectiveness of a fitness programme for stroke survivors vs. relaxation (control group). This was based on a published randomised controlled trial, from which evidence about quality of life was used to estimate Quality Adjusted Life Years...
March 2018: Journal of the Royal College of Physicians of Edinburgh
https://www.readbyqxmd.com/read/29740755/optimal-antithrombotic-treatment-of-patients-with-atrial-fibrillation-undergoing-percutaneous-coronary-intervention-triple-therapy-is-too-much
#16
REVIEW
M S Jacobs, R G Tieleman
Patients with atrial fibrillation who undergo a coronary intervention are eligible for both anticoagulation and (dual) antiplatelet therapy ((D)APT). An optimal balance has to be found to reduce the thromboembolic risk (i.e. stroke, systemic embolism and myocardial infarction) and to minimise the increased risk of bleeding with concomitant use of an anticoagulant and (D)APT. Owing to a lack of evidence, the guideline recommendations are predominantly based on expert opinion. Current evidence indicates that the combination of a non-vitamin K oral anticoagulant (NOAC) and clopidogrel is safer than vitamin-K oral antagonists plus DAPT, which increases the risk of bleeding, without clear advantages in regard to efficacy...
May 8, 2018: Netherlands Heart Journal
https://www.readbyqxmd.com/read/29738616/commentary-2018-stroke-guidelines
#17
Andrew D Perron
I read with interest (and some degree of disappointment) the new 2018 Stroke Guidelines published in January of this year that are labeled prominently "Endorsed by SAEM".1 To be clear, my disappointment has nothing to do with the use of tPA in acute ischemic stroke (I am happy to let others lead that charge). I am an admitted agnostic when it comes to the use of tPA (it helps some, it harms others, and we need to be really smart in its use to maximize the former and minimize the latter). Rather, it was notable to me that while the new guidelines touch a large number of specialties (Internal Medicine, Pharmacy, Nutrition, Rehabilitation, Radiology, Neurology, and Interventionalists to name a few), only one specialty merited a new Level 1A recommendation for targeted education This article is protected by copyright...
May 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29736735/current-endovascular-approach-to-the-management-of-acute-ischemic-stroke
#18
REVIEW
Rakesh Khatri, Anantha R Vellipuram, Alberto Maud, Salvador Cruz-Flores, Gustavo J Rodriguez
PURPOSE OF REVIEW: The review provides an overview of current endovascular management of patients with acute ischemic stroke in the light of recent landmark trials proving unequivocal benefit of the intervention. RECENT FINDINGS: Several randomized trials looking at selective groups of patients presenting after an acute ischemic stroke due to large vessel occlusion in the anterior circulation demonstrated an overwhelming benefit of the endovascular treatment compared to intravenous thrombolysis, leading to expedited changes in the American Heart Association/American Stroke Association guidelines...
May 7, 2018: Current Cardiology Reports
https://www.readbyqxmd.com/read/29735587/high-dose-versus-low-dose-pitavastatin-in-japanese-patients-with-stable-coronary-artery-disease-real-cad-a-randomized-superiority-trial
#19
Isao Taguchi, Satoshi Iimuro, Hiroshi Iwata, Hiroaki Takashima, Mitsuru Abe, Eisuke Amiya, Takanori Ogawa, Yukio Ozaki, Ichiro Sakuma, Yoshihisa Nakagawa, Kiyoshi Hibi, Takafumi Hiro, Yoshihiro Fukumoto, Seiji Hokimoto, Katsumi Miyauchi, Tsutomu Yamazaki, Hiroshi Ito, Yutaka Otsuji, Kazuo Kimura, Jun Takahashi, Atsushi Hirayama, Hiroyoshi Yokoi, Kazuo Kitagawa, Takao Urabe, Yasushi Okada, Yasuo Terayama, Kazunori Toyoda, Takehiko Nagao, Masayasu Matsumoto, Yasuo Ohashi, Tetsuji Kaneko, Retsu Fujita, Hiroshi Ohtsu, Hisao Ogawa, Hiroyuki Daida, Hiroaki Shimokawa, Yasushi Saito, Takeshi Kimura, Teruo Inoue, Masunori Matsuzaki, Ryozo Nagai
BACKGROUND: Current guidelines call for high-intensity statin therapy in patients with cardiovascular disease on the basis of several previous "more versus less statins" trials. However, no clear evidence for more versus less statins has been established in an Asian population. METHODS: In this prospective, multicenter, randomized, open-label, blinded end point study, 13 054 Japanese patients with stable coronary artery disease who achieved low-density lipoprotein cholesterol (LDL-C) <120 mg/dL during a run-in period (pitavastatin 1 mg/d) were randomized in a 1-to-1 fashion to high-dose (pitavastatin 4 mg/d; n=6526) or low-dose (pitavastatin 1 mg/d; n=6528) statin therapy...
May 8, 2018: Circulation
https://www.readbyqxmd.com/read/29732592/transcranial-doppler-ultrasound-in-peninsular-arab-patients-with-sickle-cell-disease
#20
Adekunle Adekile, Meaad Hassan, Akram Asbeutah, Mohamed Al-Hinai, Omar Trad, Nayef Farhan
OBJECTIVES: Transcranial Doppler ultrasound is used to identify patients with sickle cell disease (SCD) at risk for stroke. We performed transcranial Doppler studies in patients from 4 countries in the Arabian Peninsula (Kuwait, Oman, Iraq, and United Arab Emirates) to document the prevalence of abnormal transcranial Doppler findings. METHODS: The patients were recruited from outpatient clinics and studied in a steady state. Transcranial Doppler examinations were performed with standard equipment by experienced operators...
May 6, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
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