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cardiology and elderly care

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By Marianne De Nobel i'm a physician in the elderly care at an Hospice and in a nursing home, with people with dementia and /or chronic diseases also i'm working in the primary care
Brian R Lindman, Karen P Alexander, Patrick T O'Gara, Jonathan Afilalo
Transcatheter aortic valve replacement (TAVR) is a transformative innovation that provides treatment for high or prohibitive surgical risk patients with symptomatic severe aortic stenosis who either were previously not referred for or were denied operative intervention. Trials have demonstrated improvements in survival and symptoms after TAVR versus medical therapy; however, there remains a sizable group of patients who die or lack improvement in quality of life soon after TAVR. This raises important questions about the need to identify and acknowledge the possibility of futility in some patients considered for TAVR...
July 2014: JACC. Cardiovascular Interventions
Ruben L Osnabrugge, Suzanne V Arnold, Matthew R Reynolds, Elizabeth A Magnuson, Kaijun Wang, Vincent A Gaudiani, Robert C Stoler, Thomas A Burdon, Neal Kleiman, Michael J Reardon, David H Adams, Jeffrey J Popma, David J Cohen
OBJECTIVES: The purpose of this study was to characterize health status outcomes after transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis among patients at extreme surgical risk and to identify pre-procedural patient characteristics associated with a poor outcome. BACKGROUND: For many patients considering TAVR, improvement in quality of life may be of even greater importance than prolonged survival. METHODS: Patients with severe, symptomatic aortic stenosis who were considered to be at prohibitive risk for surgical aortic valve replacement were enrolled in the single-arm CoreValve U...
February 2015: JACC. Cardiovascular Interventions
Davide Capodanno, Dominick J Angiolillo
Daily administration of low-dose aspirin has proved to be beneficial in preventing recurrent cardiovascular events. However, the role of aspirin for primary prevention in patients with no overt cardiovascular disease is more controversial. In fact, in lower risk patients, the modest benefit in reducing serious vascular events can be offset by the increased risk of bleeding, including intracranial and gastrointestinal hemorrhage. Diabetes mellitus has been associated with a substantially increased risk of both first and recurrent atherothrombotic events, which makes aspirin therapy of potential value in these subjects...
November 15, 2016: Circulation
Margaret M Charpentier, Andrew Bundeff
OBJECTIVE: To review the evidence for strict blood pressure (BP) management in the very elderly, defined as patients aged 80 years and older. DATA SOURCES: A literature search was performed using PubMed (1950 through November 2010) for the MeSH terms hypertension and elderly; subterms of identified MeSH terms (ie, explosion) for the elderly were also searched. A broader search was conducted of PubMed articles published in the past 4 years. Searches were conducted for additional primary literature referenced in identified articles; an updated Cochrane Database review was also performed...
September 2011: Annals of Pharmacotherapy
Wanpen Vongpatanasin
Resistant hypertension-uncontrolled hypertension with 3 or more antihypertensive agents-is increasingly common in clinical practice. Clinicians should exclude pseudoresistant hypertension, which results from nonadherence to medications or from elevated blood pressure related to the white coat syndrome. In patients with truly resistant hypertension, thiazide diuretics, particularly chlorthalidone, should be considered as one of the initial agents. The other 2 agents should include calcium channel blockers and angiotensin-converting enzyme inhibitors for cardiovascular protection...
June 4, 2014: JAMA: the Journal of the American Medical Association
George C Roush, Michael E Ernst, John B Kostis, Suraj Tandon, Domenic A Sica
Hydrochlorothiazide (HCTZ) has often been contrasted with chlorthalidone, but relatively little is known about HCTZ versus indapamide (INDAP). This systematic review retrieved 9765 publications, and from these, it identified 14 randomized trials with 883 patients comparing HCTZ with INDAP and chlorthalidone on antihypertensive potency or metabolic effects. To make fair comparisons, the dose of the diuretic in each arm was assigned 1 of 3 dose levels. In random effects meta-analysis, INDAP and chlorthalidone lowered systolic blood pressure more than HCTZ: -5...
May 2015: Hypertension
Luuk Te Riet, Joep H M van Esch, Anton J M Roks, Anton H van den Meiracker, A H Jan Danser
Blockers of the renin-angiotensin-aldosterone system (RAAS), that is, renin inhibitors, angiotensin (Ang)-converting enzyme (ACE) inhibitors, Ang II type 1 receptor antagonists, and mineralocorticoid receptor antagonists, are a cornerstone in the treatment of hypertension. How exactly they exert their effect, in particular in patients with low circulating RAAS activity, also taking into consideration the so-called Ang II/aldosterone escape that often occurs after initial blockade, is still incompletely understood...
March 13, 2015: Circulation Research
Stephanie Lankhorst, Langeza Saleh, Ah Jan Danser, Anton H van den Meiracker
Angiogenesis inhibition, targeting vascular endothelial growth factor (VEGF) or its receptors, is an established treatment for solid tumors. A common side effect of this treatment is the development of sometimes severe hypertension. This hypertension is associated with a decrease in nitric oxide production, activation of the endothelin-signaling pathway and renin suppression. The mechanism underlying activation of the endothelin-signaling pathway is not fully understood. Both activation of endothelial cells and disinhibition of the VEGF-induced suppression of endothelin production by endothelial cells may be involved...
April 2015: Current Opinion in Pharmacology
Jerome L Fleg, Wilbert S Aronow, William H Frishman
Increasing life expectancy in industrialized societies has resulted in a huge population of older adults with cardiovascular disease. Despite advances in device therapy and surgery, the mainstay of treatment for these disorders remains pharmacological. Hypertension affects two-thirds of older adults and remains a potent risk factor for coronary artery disease, chronic heart failure, atrial fibrillation, and stroke in this age group. Numerous trials have demonstrated reduction in these adverse outcomes with antihypertensive drugs...
January 2011: Nature Reviews. Cardiology
Wilbert S Aronow
Hypertension is a major risk factor for cardiovascular events, including ischemic stroke and hemorrhagic stroke. Reduction of blood pressure by lifestyle measures and antihypertensive drug therapy reduces stroke in elderly men and women. The use of diuretics, beta blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers causes a similar reduction in reducing coronary events and stroke for a given reduction in blood pressure. The American College of Cardiology Foundation/American Heart Association 2011 expert consensus document on hypertension in the elderly recommended that the blood pressure should be reduced to less than 140/90 mm Hg in adults younger than 80 years at high risk for cardiovascular events...
December 2013: Current Hypertension Reports
Majon Muller, Yvo M Smulders, Peter W de Leeuw, Coen D A Stehouwer
No abstract text is available yet for this article.
March 2014: Hypertension
Jonathan P Piccini, Laurent Fauchier
Many patients with atrial fibrillation have substantial symptoms despite ventricular rate control and require restoration of sinus rhythm to improve their quality of life. Acute restoration (ie, cardioversion) and maintenance of sinus rhythm in patients with atrial fibrillation are referred to as rhythm control. The decision to pursue rhythm control is based on symptoms, the type of atrial fibrillation (paroxysmal, persistent, or long-standing persistent), patient comorbidities, general health status, and anticoagulation status...
August 20, 2016: Lancet
Stefanie G Beesems, Marieke T Blom, Martine H A van der Pas, Michiel Hulleman, Esther M M van de Glind, Barbara C van Munster, Jan G P Tijssen, Hanno L Tan, Johannes J M van Delden, Rudolph W Koster
INTRODUCTION: Advanced age is reported to be associated with lower survival after out-of-hospital cardiac arrest (OHCA). We aimed to establish survival rate and neurological outcome at hospital discharge after OHCA in older patients and evaluated whether pre-OHCA comorbidity was associated with favorable neurologic outcome. METHODS: From a prospective registry of all cardiopulmonary resuscitation (CPR) attempts after OHCA, we established survival in 1332 patients aged ≥ 70 years in whom resuscitation with non-traumatic etiology was attempted in 2009-2011...
September 2015: Resuscitation
Shona Kalkman, Lotty Hooft, Johanne M Meijerman, Johannes T A Knape, Johannes J M van Delden
Automatic suspension of do-not-resuscitate (DNR) orders during general anesthesia does not sufficiently address a patient's right to self-determination and is a practice still observed among anesthesiologists today. To provide an evidence base for ethical management of DNR orders during anesthesia and surgery, the authors performed a systematic review of the literature to quantify the survival after perioperative cardiopulmonary resuscitation (CPR). Results show that the probability of surviving perioperative CPR ranged from 32...
March 2016: Anesthesiology
Benjamin R Bell, Alex C Spyropoulos, James D Douketis
The periprocedural management of patients on direct oral anticoagulants (DOACs) is a common but potentially challenging clinical problem because there are few prospective studies to guide clinical decisions. Retrospective analyses from randomized trials and observational data suggest that DOACs can be managed in a standardized manner, based on surgical and patient characteristics, that does not result in excess major bleeding or thrombosis. In a case-based manner, this article presents a perioperative DOAC management algorithm and reviews the available and emerging evidence supporting the safety and efficacy of this approach...
October 2016: Hematology/oncology Clinics of North America
Isabel Montilla Padilla, Roberto Martín-Asenjo, Héctor Bueno
The mean age of patients presenting with acute coronary syndrome (ACS) has been increasing steadily in the last decades, so managing very old patients has become common practice. The oldest patients are under-represented in clinical trials, so specific evidence is scarce. Still, antithrombotic therapy and invasive strategy are the pillars of appropriate treatment even in the oldest patients. However, the elderly population is a heterogeneous group showing important divergences between chronological and biological age, which needs specific evaluation...
August 25, 2016: Heart, Lung & Circulation
Chaudhry M S Sarwar, Lampros Papadimitriou, Bertram Pitt, Ileana Piña, Faiez Zannad, Stefan D Anker, Mihai Gheorghiade, Javed Butler
Disorders of potassium homeostasis can potentiate the already elevated risk of arrhythmia in heart failure. Heart failure patients have a high prevalence of chronic kidney disease, which further heightens the risk of hyperkalemia, especially when renin-angiotensin-aldosterone system inhibitors are used. Acute treatment for hyperkalemia may not be tolerated in the long term. Recent data for patiromer and sodium zirconium cyclosilicate, used to treat and prevent high serum potassium levels on a more chronic basis, have sparked interest in the treatment of hyperkalemia, as well as the potential use of renin-angiotensin-aldosterone system inhibitors in patients who were previously unable to take these drugs or tolerated only low doses...
October 4, 2016: Journal of the American College of Cardiology
Agnese Collamati, Emanuele Marzetti, Riccardo Calvani, Matteo Tosato, Emanuela D'Angelo, Alex N Sisto, Francesco Landi
Chronic heart failure (CHF) is a highly prevalent condition among the elderly and is associated with considerable morbidity, institutionalization and mortality. In its advanced stages, CHF is often accompanied by the loss of muscle mass and strength. Sarcopenia is a geriatric syndrome that has been actively studied in recent years due to its association with a wide range of adverse health outcomes. The goal of this review is to discuss the relationship between CHF and sarcopenia, with a focus on shared pathophysiological pathways and treatments...
July 2016: Journal of Geriatric Cardiology: JGC
Rory Collins, Christina Reith, Jonathan Emberson, Jane Armitage, Colin Baigent, Lisa Blackwell, Roger Blumenthal, John Danesh, George Davey Smith, David DeMets, Stephen Evans, Malcolm Law, Stephen MacMahon, Seth Martin, Bruce Neal, Neil Poulter, David Preiss, Paul Ridker, Ian Roberts, Anthony Rodgers, Peter Sandercock, Kenneth Schulz, Peter Sever, John Simes, Liam Smeeth, Nicholas Wald, Salim Yusuf, Richard Peto
This Review is intended to help clinicians, patients, and the public make informed decisions about statin therapy for the prevention of heart attacks and strokes. It explains how the evidence that is available from randomised controlled trials yields reliable information about both the efficacy and safety of statin therapy. In addition, it discusses how claims that statins commonly cause adverse effects reflect a failure to recognise the limitations of other sources of evidence about the effects of treatment...
September 8, 2016: Lancet
Hemal Bhatt, Lama Ghazi, David Calhoun, Suzanne Oparil
Systolic blood pressure (SBP) is an important predictor of cardiovascular disease (CVD) outcomes. Lowering SBP has been shown to reduce CVD morbidity and mortality, but the optimal SBP target continues to be a topic of intense debate. The Systolic Blood Pressure Intervention Trial (SPRINT) reported a significantly lower risk for CVD outcomes and all-cause mortality by targeting SBP <120 mmHg compared with <140 mmHg in a population of hypertensive persons at high CV risk. In this review, we discuss the strengths, limitations, and generalizability of SPRINT findings to other hypertensive populations that were excluded from the trial, including those with diabetes or prior stroke, <50 years old, and at lower CVD risk...
October 2016: Current Cardiology Reports
2016-09-06 18:55:39
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