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Laxmi S Mehta, Theresa M Beckie, Holli A DeVon, Cindy L Grines, Harlan M Krumholz, Michelle N Johnson, Kathryn J Lindley, Viola Vaccarino, Tracy Y Wang, Karol E Watson, Nanette K Wenger
Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease...
March 1, 2016: Circulation
Ijaz A Khan, Chandra K Nair, Narpinder Singh, Ramesh M Gowda, Reshma C Nair
Atrioventricular node blocking agents including beta-adrenergic blockers, non-dihydropyridine calcium channel blockers and digoxin are usually effective in controlling ventricular rate in atrial fibrillation and flutter. Intravenous beta-blockers and non-dihydropyridine calcium channel blockers are equally effective in rapidly controlling the ventricular rate. The addition of digoxin to the regimen causes a favorable outcome but digoxin as a single agent is generally less effective in slowing the ventricular rate in acute setting...
October 2004: International Journal of Cardiology
Denis Roy, Mario Talajic, Stanley Nattel, D George Wyse, Paul Dorian, Kerry L Lee, Martial G Bourassa, J Malcolm O Arnold, Alfred E Buxton, A John Camm, Stuart J Connolly, Marc Dubuc, Anique Ducharme, Peter G Guerra, Stefan H Hohnloser, Jean Lambert, Jean-Yves Le Heuzey, Gilles O'Hara, Ole Dyg Pedersen, Jean-Lucien Rouleau, Bramah N Singh, Lynne Warner Stevenson, William G Stevenson, Bernard Thibault, Albert L Waldo
BACKGROUND: It is common practice to restore and maintain sinus rhythm in patients with atrial fibrillation and heart failure. This approach is based in part on data indicating that atrial fibrillation is a predictor of death in patients with heart failure and suggesting that the suppression of atrial fibrillation may favorably affect the outcome. However, the benefits and risks of this approach have not been adequately studied. METHODS: We conducted a multicenter, randomized trial comparing the maintenance of sinus rhythm (rhythm control) with control of the ventricular rate (rate control) in patients with a left ventricular ejection fraction of 35% or less, symptoms of congestive heart failure, and a history of atrial fibrillation...
June 19, 2008: New England Journal of Medicine
Navkaranbir S Bajaj, Rajat Kalra, Himanshu Aggarwal, Sameer Ather, Saurabh Gaba, Garima Arora, David C McGiffin, Mustafa Ahmed, Stella Aslibekyan, Pankaj Arora
BACKGROUND: Significant controversy exists regarding the best approach for nonculprit vessel revascularization in patients with multivessel coronary artery disease presenting with ST-segment elevation myocardial infarction. We conducted a systematic investigation to pool data from current randomized controlled trials (RCTs) to assess optimal treatment strategies in this patient population. METHODS AND RESULTS: A comprehensive search of SCOPUS from inception through May 2015 was performed using predefined criteria...
December 14, 2015: Journal of the American Heart Association
John J V McMurray, Milton Packer, Akshay S Desai, Jim Gong, Martin P Lefkowitz, Adel R Rizkala, Jean Rouleau, Victor C Shi, Scott D Solomon, Karl Swedberg, Michael R Zile
AIMS: Although the focus of therapeutic intervention has been on neurohormonal pathways thought to be harmful in heart failure (HF), such as the renin-angiotensin-aldosterone system (RAAS), potentially beneficial counter-regulatory systems are also active in HF. These promote vasodilatation and natriuresis, inhibit abnormal growth, suppress the RAAS and sympathetic nervous system, and augment parasympathetic activity. The best understood of these mediators are the natriuretic peptides which are metabolized by the enzyme neprilysin...
September 2013: European Journal of Heart Failure
R Gupta, T J Gan
'Enhanced recovery after surgery' protocols implement a series of peri-operative interventions intended to improve recovery after major operations, one aspect of which is fluid management. The pre-operative goal is to prepare a hydrated, euvolaemic patient by avoiding routine mechanical bowel preparation and by encouraging patients to drink clear liquids up to two hours before induction of anaesthesia. The intra-operative goal is to achieve a 'zero' fluid balance at the end of uncomplicated surgery: goal-directed fluid therapy is recommended for poorly prepared or sick patients or those undergoing more complex surgery...
January 2016: Anaesthesia
Jason Chertoff, Michael Chisum, Bryan Garcia, Jorge Lascano
Over the last two decades, there have been vast improvements in sepsis-related outcomes, largely resulting from the widespread adoption of aggressive fluid resuscitation and infection control. With increased understanding of the pathophysiology of sepsis, novel diagnostics and resuscitative interventions are being discovered. In recent years, few diagnostic tests like lactate have engendered more attention and research in the sepsis arena. Studies highlighting lactate's prognostic potential for mortality and other outcomes are ubiquitous and largely focus on the early stage of sepsis management, defined as the initial 6 h and widely referred to as the "golden hours...
2015: Journal of Intensive Care
Sammy Elmariah, Laura Mauri, Gheorghe Doros, Benjamin Z Galper, Kelly E O'Neill, Philippe Gabriel Steg, Dean J Kereiakes, Robert W Yeh
BACKGROUND: Treatment with aspirin and a P2Y12 inhibitor is commonly used in patients with cardiovascular disorders. The overall effect of such treatment on all-cause mortality is unknown. In the Dual Antiplatelet Therapy (DAPT) Study, continuation of dual antiplatelet therapy beyond 12 months after coronary stenting was associated with an unexpected increase in non-cardiovascular death. In view of the potential public health importance of these findings, we aimed to assess the effect of extended duration dual antiplatelet therapy on mortality by doing a meta-analysis of all randomised, controlled trials of treatment duration in various cardiovascular disorders...
February 28, 2015: Lancet
Piotr Ponikowski, Dirk J van Veldhuisen, Josep Comin-Colet, Georg Ertl, Michel Komajda, Viacheslav Mareev, Theresa McDonagh, Alexander Parkhomenko, Luigi Tavazzi, Victoria Levesque, Claudio Mori, Bernard Roubert, Gerasimos Filippatos, Frank Ruschitzka, Stefan D Anker
AIM: The aim of this study was to evaluate the benefits and safety of long-term i.v. iron therapy in iron-deficient patients with heart failure (HF). METHODS AND RESULTS: CONFIRM-HF was a multi-centre, double-blind, placebo-controlled trial that enrolled 304 ambulatory symptomatic HF patients with left ventricular ejection fraction ≤45%, elevated natriuretic peptides, and iron deficiency (ferritin <100 ng/mL or 100-300 ng/mL if transferrin saturation <20%)...
March 14, 2015: European Heart Journal
Saeed Darvish-Kazem, Mandark Gandhi, Maura Marcucci, James D Douketis
BACKGROUND: It is unclear how to appropriately manage discontinuation and resumption of antiplatelet therapy in patients with coronary stents who need noncardiac surgery. We undertook a systematic review of the literature to identify practice guideline statements regarding antiplatelet therapy in patients with coronary stents undergoing noncardiac surgery. METHODS: We used six search strategies to identify practice guideline statements that comment on perioperative antiplatelet management for patients with coronary stents undergoing noncardiac surgery...
December 2013: Chest
Luís Beck-da-Silva, Diogo Piardi, Stephan Soder, Luís Eduardo Rohde, Antônio Carlos Pereira-Barretto, Denílson de Albuquerque, Edimar Bocchi, Fábio Vilas-Boas, Lídia Zytynzki Moura, Marcelo W Montera, Salvador Rassi, Nadine Clausell
BACKGROUND: Anemia in heart failure patients and has been associated with increased morbi-mortality. Previous studies have treated anemia in heart failure patients with either erythropoietin alone or combination of erythropoietin and intravenous (i.v.) iron. However, the effect of i.v. or oral (p.o.) iron supplementation alone in heart failure patients with anemia was virtually unknown. AIM: To compare, in a double-blind design, the effects of i.v. iron versus p...
October 9, 2013: International Journal of Cardiology
Ijsbrand T Klip, Josep Comin-Colet, Adriaan A Voors, Piotr Ponikowski, Cristina Enjuanes, Waldemar Banasiak, Dirk J Lok, Piotr Rosentryt, Ainhoa Torrens, Lech Polonski, Dirk J van Veldhuisen, Peter van der Meer, Ewa A Jankowska
BACKGROUND: Iron deficiency (ID) is an emerging problem in patients with chronic heart failure (HF) and can be a potential therapeutic target. However, not much is known about the prevalence, predictors, and prognosis of ID in patients with chronic HF. METHODS: In an international pooled cohort comprising 1,506 patients with chronic HF, we studied the clinical associates of ID and its prognostic consequences. RESULTS: Iron deficiency (defined as a ferritin level <100 μg/L or ferritin 100-299 μg/L with a transferrin saturation <20%) was present in 753 patients (50%)...
April 2013: American Heart Journal
Jonas Oldgren, Lars Wallentin, John H Alexander, Stefan James, Birgitta Jönelid, Gabriel Steg, Johan Sundström
BACKGROUND: Oral anticoagulation in addition to antiplatelet treatment after an acute coronary syndrome might reduce ischaemic events but increase bleeding risk. We performed a meta-analysis to evaluate the efficacy and safety of adding direct thrombin or factor-Xa inhibition by any of the novel oral anticoagulants (apixaban, dabigatran, darexaban, rivaroxaban, and ximelagatran) to single (aspirin) or dual (aspirin and clopidogrel) antiplatelet therapy in this setting. METHODS AND RESULTS: All seven published randomized, placebo-controlled phase II and III studies of novel oral anticoagulants in acute coronary syndromes were included...
June 2013: European Heart Journal
Antonio L Dans, Stuart J Connolly, Lars Wallentin, Sean Yang, Juliet Nakamya, Martina Brueckmann, Michael Ezekowitz, Jonas Oldgren, John W Eikelboom, Paul A Reilly, Salim Yusuf
BACKGROUND: The Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) trial showed that dabigatran etexilate 150 mg BID was superior and dabigatran etexilate 110 mg BID was noninferior to warfarin in preventing stroke and systemic embolism in patients with atrial fibrillation. In this subgroup analysis, we assess the efficacy and safety of dabigatran in patients who did and did not receive concomitant antiplatelets. METHODS AND RESULTS: All comparisons used a Cox proportional hazards model with adjustments made for risk factors for bleeding...
February 5, 2013: Circulation
Dion Stub, Karen Smith, Stephen Bernard, Janet E Bray, Michael Stephenson, Peter Cameron, Ian Meredith, David M Kaye
BACKGROUND: The role of routine supplemental oxygen for patients with uncomplicated acute myocardial infarction (AMI) has recently been questioned. There is conflicting data on the possible effects of hyperoxia on ischemic myocardium. The few clinical trials examining the role of oxygen in AMI were performed prior to the modern approach of emergent reperfusion and advanced medical management. METHODS: Air Verses Oxygen In myocarDial infarction study (AVOID Study) is a prospective, multi-centre, randomized, controlled trial conducted by Ambulance Victoria and participating metropolitan Melbourne hospitals with primary percutaneous coronary intervention capabilities...
March 2012: American Heart Journal
Chamila M Geeganage, Hans-Christoph Diener, Ale Algra, Christopher Chen, Eric J Topol, Reinhard Dengler, Hugh S Markus, Matthew W Bath, Philip M W Bath
BACKGROUND AND PURPOSE: Antiplatelets are recommended for patients with acute noncardioembolic stroke or transient ischemic attack. We compared the safety and efficacy of dual versus mono antiplatelet therapy in patients with acute ischemic stroke or transient ischemic attack. METHODS: Completed randomized controlled trials of dual versus mono antiplatelet therapy in patients with acute (≤3 days) ischemic stroke/transient ischemic attack were identified using electronic bibliographic searches...
April 2012: Stroke; a Journal of Cerebral Circulation
Stefan D Anker, Josep Comin Colet, Gerasimos Filippatos, Ronnie Willenheimer, Kenneth Dickstein, Helmut Drexler, Thomas F Lüscher, Claudio Mori, Barbara von Eisenhart Rothe, Stuart Pocock, Philip A Poole-Wilson, Piotr Ponikowski
AIMS: Iron deficiency (ID) and anaemia are common in patients with chronic heart failure (CHF). The presence of anaemia is associated with increased morbidity and mortality in CHF, and ID is a major reason for the development of anaemia. Preliminary studies using intravenous (i.v.) iron supplementation alone in patients with CHF and ID have shown improvements in symptom status. FAIR-HF (Clinical NCT00520780) was designed to determine the effect of i.v. iron repletion therapy using ferric carboxymaltose on self-reported patient global assessment (PGA) and New York Heart Association (NYHA) in patients with CHF and ID...
November 2009: European Journal of Heart Failure
C L Athanasuleas, A W Stanley, G D Buckberg, V Dor, M DiDonato, E H Blackstone
OBJECTIVES: The goal of this study was to evaluate the safety and efficacy of surgical anterior ventricular endocardial restoration (SAVER). The procedure excludes noncontracting segments in the dilated remodeled ventricle after anterior myocardial infarction. BACKGROUND: Anterior infarction leads to change in ventricular shape and volume. In the absence of reperfusion, dyskinesia develops. Reperfusion by thrombolysis or angioplasty leads to akinesia. Both lead to congestive heart failure by dysfunction of the remote muscle...
April 2001: Journal of the American College of Cardiology
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