المؤلفون: Lisa Curran, Ross Taylor, Daphne Wooda Vivian Garman, Paul Chase, Sukaina Ali Alali, Elad Gelbart, Daniel Bensimhon, W. Frank Peacock

المصدر: Heart & Lung. 50:59-64

مصطلحات موضوعية: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Pilot Projects, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Patient Readmission, 03 medical and health sciences, 0302 clinical medicine, medicine, Hospital discharge, Humans, In patient, Prospective Studies, Lung, Aged, Aged, 80 and over, Heart Failure, business.industry, Monitoring system, Middle Aged, medicine.disease, Readmission rate, Patient Discharge, medicine.anatomical_structure, 030228 respiratory system, Heart failure, Cohort, Emergency medicine, Female, Cardiology and Cardiovascular Medicine, business, Treatment Arm

الوصف: Background Inadequate decongestion is common in hospitalized heart failure (HF) patients and may contribute to readmissions. Our purpose was to use remote dielectric sensing (ReDS) technology to measure lung congestion at discharge in patients admitted with acute HF and to see if a device-targeted intervention could reduce HF readmission rates. Methods We conducted a prospective pilot study of patients admitted with acute decompensated HF randomized to receive standard therapy or ReDS-guided therapy to determine the timing of hospital discharge based on the amount of lung congestion present after diuresis. ReDS measurement was performed for all patients once they were deemed ready for discharge. Patients in the treatment arm with residual lung congestion defined by ReDS ≥39% had HF consultation and further diuresis. Results Of 108 HF patients (50% male, age 73.6 ± 12.6 years, BMI 29.3 ± 4.3 kg/m2, EF 38.5 ± 15.1%, BNP 1138 ± 987 pg/mL), 32% demonstrated residual lung congestion at the time of proposed hospital discharge. ReDS guided therapy triggered additional diuresis in 30% (18/60) of the patients in the treatment arm (average weight loss 5.6 pounds, p = 0.02). 30-day HF readmission rates were similar in the treatment and the control arms (1.7% vs 4.2%; p = 0.44). Patients discharged as planned with residual lung congestion with ReDS ≥39% had higher 30-day readmission rate compared to patients who were adequately decongested at discharge with ReDS Conclusion In our single-center cohort, ReDS testing demonstrated that 32% of HF patients deemed ready for discharge have clinically significant residual lung congestion which was associated with a higher risk of readmission. ReDS-guided management was associated with significant decongestion but not a reduction in HF readmissions in this sample.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0129e4f027ba2438366844b50e3f53efTest
https://doi.org/10.1016/j.hrtlng.2020.07.003Test

المؤلفون: Henry C. Thode, Adam J. Singer, W. Frank Peacock

المصدر: The American Journal of Emergency Medicine. 38:2361-2364

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Time Factors, Multivariate analysis, Hyperkalemia, Predictor variables, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, In patient, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Medical record, Mortality reduction, 030208 emergency & critical care medicine, General Medicine, Emergency department, Middle Aged, Hospitalization, Cross-Sectional Studies, Elevated serum potassium, Potassium, Emergency Medicine, Female, medicine.symptom, Emergency Service, Hospital, business

الوصف: Background Hyperkalemia (HK) is common and associated with mortality. Our purpose was to determine if the rapid correction of elevated serum potassium level (K+) was associated with reduced mortality in emergency department (ED) patients. Methods Design: We reviewed the electronic medical records (EMR) of ED patients with HK (K+ ≥ 5.5 mEq/L) from 10/2016–10/2017. Setting: Large, academic ED. Participants: Adult ED patients presenting with hyperkalemia. Main outcomes and measures: The main outcome was in-hospital mortality. We compared outcomes of patients whose K+ normalized (dropped below 5.5 mEq/L) with those whose K+ did not normalize using chi-square and multivariate analyses to determine the associations between predictor variables and outcomes. Results From 114,977 ED visits, 1033 patients (0.9%, 95%CI 0.85–0.95%) had HK. Their mean (SD) age was 60 (26) years and 58% were male. Of these, 884 had a second K+ measured within a median (IQR) of 5 (3–8) hours. Mortality and admission rates were higher in patients with HK vs. those with normal K+ (8.5% vs. 0.8%, P Conclusions Normalization of K+ during the ED stay in patients with HK is associated with a 50% mortality reduction. Efforts to rapidly identify and treat HK in the ED are needed.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ae03ef38b0efbe1c627674c8df2887b7Test
https://doi.org/10.1016/j.ajem.2019.12.012Test

المؤلفون: Ashkan Shoamanesh, Robert G. Hart, Verónica V. Olavarría, Scott D. Berkowitz, Ángel Chamorro, Roland Veltkamp, Stuart J. Connolly, Joan Martí-Fàbregas, Jens Eckstein, Robert Mikulik, W. Frank Peacock, Şerefnur Öztürk, Lesly A. Pearce, Salvatore Rudilosso, Hardi Mundl, Turgut Tatlisumak

المصدر: Stroke. 51:2139-2147

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Infarction, Renal function, Hemorrhage, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Asian People, Double-Blind Method, Rivaroxaban, Risk Factors, Internal medicine, Antithrombotic, medicine, Humans, In patient, Aged, Cerebral Hemorrhage, Advanced and Specialized Nursing, Asia, Eastern, business.industry, Middle Aged, 16. Peace & justice, medicine.disease, 3. Good health, Stroke, Blood pressure, Intracranial Embolism, Embolism, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Major bleeding, Factor Xa Inhibitors, Glomerular Filtration Rate, medicine.drug

الوصف: Background and Purpose: Risks, sites, and predictors of major bleeding during antithrombotic therapies have not been well defined for patients with recent embolic stroke of undetermined source. Methods: Exploratory analysis of major bleeds defined by International Society of Thrombosis and Hemostasis criteria occurring among 7213 participants in international NAVIGATE (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial) embolic stroke of undetermined source randomized trial comparing rivaroxaban 15 mg daily with aspirin 100 mg daily. Results: During a median follow-up of 11 months, 85 major bleeds occurred. The most frequent site was gastrointestinal (38%), followed by intracranial (29%). Assignment to rivaroxaban (hazard ratio [HR], 2.7 [95% CI, 1.7–4.3]), East Asia region (HR, 2.5 [95% CI, 1.6–3.9]), systolic blood pressure ≥160 mm Hg (HR, 2.2 [95% CI, 1.2–3.8]), and reduced estimated glomerular filtration rate (HR, 1.2 per 10 mL/min per 1.73 m 2 decrease, [95% CI, 1.0–1.3]) were independently associated with presence of major bleeds. Five (6%) were fatal. Among 15 patients with intracerebral hemorrhage, 2 (13%) were fatal. There was no evidence of an early high-risk period following initiation of rivaroxaban. The annualized rate of intracerebral hemorrhage was 6-fold higher among East Asian participants (0.67%) versus all other regions (0.11%; HR, 6.3 [95% CI, 2.2–18.0]). Distribution of bleeding sites was similar for rivaroxaban and aspirin. Conclusions: Among embolic stroke of undetermined source patients participating in an international randomized trial, independent predictors of major bleeding were assignment to rivaroxaban, East Asia region, increased systolic blood pressure, and impaired renal function. East Asia as a region was strongly associated with risk of intracerebral hemorrhage. Estimated glomerular filtration rate should be a consideration for stratifying bleeding risk. Registration: URL: https://www.clinicaltrials.govTest . Unique identifier: NCT02313909.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::bb9f7a30fa35f8fafd0d21c2b6a91d6fTest
https://doi.org/10.1161/strokeaha.119.027995Test

المؤلفون: Wesley H. Self, Javed Butler, Deborah B. Diercks, Jin H. Han, Cathy A. Jenkins, John A. Spertus, Karen F. Miller, Gregory J. Fermann, Jon W. Schrock, Adam J. Singer, Douglas Char, Candace D. McNaughton, Sean P. Collins, Dandan Liu, Sangil Lee, William B Stubblefield, Peter S. Pang, Christopher Hogan, Brian Hiestand, Phillip D. Levy, Anna Marie Chang, JoAnn Lindenfeld, Alan B. Storrow, W. Frank Peacock, Yosef Khan, Sarah A. Sterling

المصدر: Circ Cardiovasc Qual Outcomes

مصطلحات موضوعية: medicine.medical_specialty, Health Status, Coaching, Article, law.invention, Quality of life (healthcare), Randomized controlled trial, law, Surveys and Questionnaires, Intervention (counseling), Humans, Medicine, In patient, Heart Failure, business.industry, Emergency department, Kansas, Middle Aged, medicine.disease, Patient Discharge, humanities, Self Care, Treatment Outcome, Kansas City Cardiomyopathy Questionnaire, Heart failure, Quality of Life, Physical therapy, Female, Cardiomyopathies, Emergency Service, Hospital, Cardiology and Cardiovascular Medicine, business

الوصف: Background: We conducted a secondary analysis of changes in the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 over 30 days in a randomized trial of self-care coaching versus structured usual care in patients with acute heart failure who were discharged from the emergency department. Methods: Patients in 15 emergency departments completed the KCCQ-12 at emergency department discharge and at 30 days. We compared change in KCCQ-12 scores between the intervention and usual care arms, adjusted for enrollment KCCQ-12 and demographic characteristics. We used linear regression to describe changes in KCCQ-12 summary scores and logistic regression to characterize clinically meaningful KCCQ-12 subdomain changes at 30 days. Results: There were 350 patients with both enrollment and 30-day KCCQ summary scores available; 166 allocated to usual care and 184 to the intervention arm. Median age was 64 years (interquartile range, 55–70), 37% were female participants, 63% were Black, median KCCQ-12 summary score at enrollment was 47 (interquartile range, 33–64). Self-care coaching resulted in significantly greater improvement in health status compared with structured usual care (5.4-point greater improvement, 95% CI, 1.12–9.68; P =0.01). Improvements in health status in the intervention arm were driven by improvements within the symptom frequency (adjusted odds ratio, 1.62 [95% CI, 1.01–2.59]) and quality of life (adjusted odds ratio, 2.39 [95% CI, 1.46–3.90]) subdomains. Conclusions: In this secondary analysis, patients with acute heart failure who received a tailored, self-care intervention after emergency department discharge had clinically significant improvements in health status at 30 days compared with structured usual care largely due to improvements within the symptom frequency and quality of life subdomains of the KCCQ-12. Registration: URL: https://www.clinicaltrials.govTest ; Unique identifier: NCT02519283.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b2232fdbff3b448b0144337be30e63f0Test
https://doi.org/10.1161/circoutcomes.121.007956Test

المؤلفون: Wolfgang Koenig, James L. Januzzi, W. Frank Peacock, James E. Udelson, Jerome L. Fleg, Andreas A. Kammerlander, John T. Nagurney, Maros Ferencik, Udo Hoffmann, Júlia Karády, Thomas Mayrhofer

المصدر: J Am Coll Cardiol

مصطلحات موضوعية: Adult, Male, Acute coronary syndrome, medicine.medical_specialty, Concordance, Perfusion scanning, 030204 cardiovascular system & hematology, Roche Diagnostics, Sensitivity and Specificity, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, In patient, 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, business.industry, Troponin I, Emergency department, Middle Aged, medicine.disease, Abbott Diagnostics, Female, Cardiology and Cardiovascular Medicine, business

الوصف: High-sensitivity cardiac troponin (hs-cTn) assays have different analytic characteristics.The goal of this study was to quantify differences between assays for common analytical benchmarks and to determine whether they may result in differences in the management of patients with suspected acute coronary syndrome (ACS).The authors included patients with suspected ACS enrolled in the ROMICAT (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) I and II trials, with blood samples taken at emergency department presentation (ROMICAT-I and -II) or at 2 and 4 h thereafter (ROMICAT-II). hs-cTn concentrations were measured using 3 assays (Roche Diagnostics, Elecsys 2010 platform; Abbott Diagnostics, ARCHITECT i2000SR; Siemens Diagnostics, HsVista). Per blood sample, we determined concordance across analytic benchmarks (limit of detection [LOD]/LOD-99th percentile/99th percentile). Per-patient, the authors determined concordance of management recommendations (rule-out/observe/rule-in) per the 0/2-h algorithm, and their association with diagnostic test findings (coronary artery stenosis50% on coronary computed tomography angiography or inducible ischemia on perfusion imaging) and ACS.Among 1,027 samples from 624 patients (52.8 ± 10.0 years; 39.4% women), samples were classified as LOD (56.3% vs. 10.4% vs. 41.2%; p 0.001), LOD-99th percentile (36.5% vs. 83.5% vs. 52.6; p 0.001),99th percentile (7.2% vs. 6.0% vs. 6.2%) by Roche, Abbott, and Siemens, respectively. A total of 37.4% (n = 384 of 1,027) of blood samples were classified into the same analytical benchmark category, with low concordance across benchmarks (LOD 11.1%; LOD-99th percentile 29.3%;99th percentile 43.6%). Serial samples were available in 242 patients (40.1% women; mean age: 52.8 ± 8.0 years). The concordance of management recommendations across assays was 74.8% (n = 181 of 242) considering serial hs-cTn measurements. Of patients who were recommended to discharge, 19.6% to 21.1% had positive diagnostic test findings and 2.8% to 4.3% had ACS at presentation.Caregivers should be aware that there are significant differences between hs-cTn assays in stratifying individual samples and patients with intermediate likelihood of ACS according to analytical benchmarks that may result in different management recommendations. (Rule Out Myocardial Infarction by Computer Assisted Tomography [ROMICAT]; NCT00990262) (Multicenter Study to Rule Out Myocardial Infarction by Cardiac Computed Tomography [ROMICAT-II]; NCT01084239).

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::25a45e7c5241616efd33aaeffbcb95d6Test
https://europepmc.org/articles/PMC8040768Test/

المؤلفون: Craig I Coleman, Thomas J. Bunz, Mark J. Alberts, W. Frank Peacock, Christine G. Kohn

المصدر: Atherosclerosis. 286:142-146

مصطلحات موضوعية: Male, 0301 basic medicine, medicine.medical_specialty, Arterial disease, medicine.medical_treatment, Disease, 030204 cardiovascular system & hematology, Amputation, Surgical, Peripheral Arterial Disease, 03 medical and health sciences, 0302 clinical medicine, Cost of Illness, Interquartile range, Internal medicine, Prevalence, medicine, Humans, In patient, Hospital Mortality, Aged, Retrospective Studies, Gangrene, business.industry, Health Care Costs, Middle Aged, medicine.disease, Limb ischemia, United States, Hospitalization, Treatment Outcome, 030104 developmental biology, Amputation, Female, Diagnosis code, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures

الوصف: Background and aims We aimed to examine the prevalence, demographics, clinical outcomes and economic burden of hospitalizations for patients with PAD. Methods Using the National Inpatient Sample, we retrospectively evaluated patients hospitalized with PAD in 2014. Hospitalizations in patients with PAD were identified by the presence of an International Classification of Diseases-9th Revision (ICD-9) diagnosis code of 440.20–440.24. We calculated hospitalization rates/100,000 patients, the proportion of hospitalizations with a major adverse limb event (MALE), as well as minor amputation, mortality, median (interquartile range) length-of-stay (LOS) and treatment costs (in 2017 US$). A separate analysis of hospitalizations of patients with clinical limb ischemia defined as Fontaine class III or IV PAD (440.22, resting pain; 440.23–440.24, ulcers or gangrene) was also performed. Results We identified 286,160 hospitalizations for patients with PAD. The rate of hospitalizations for PAD was 89.5/100,000, with 137,050 (or 45%) of these having Fontaine class III-IV disease. The proportion of hospitalizations resulting in MALE, major or minor lower extremity amputation or in-hospital death was 45.8%, 8.9%, 8.2% and 3.1%, respectively. Median hospital LOS was 5 (3, 9) days and costs were $15,755 ($8972, $27,800), resulting in an annual cost burden for hospitalization of patients with PAD of ∼$6.31 billion. In hospitalizations of Fontaine class III-IV PAD, MALE, major and minor amputation and death occurred in 60.9%, 16.8%, 15.8% and 3.3% of cases, respectively. Median LOS and costs were 7 (4, 11) days and $18,984 ($10,913, $31,816). Conclusions Hospitalizations of patients with PAD represent a substantial medical and financial burden for patients and the US healthcare system.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9f45353450013c3a834c9d0e27efb0d0Test
https://doi.org/10.1016/j.atherosclerosis.2019.05.026Test

المؤلفون: W. Frank Peacock, Adam J. Singer

المصدر: Journal of Thrombosis and Haemostasis

مصطلحات موضوعية: Risk, medicine.medical_specialty, anticoagulants, pulmonary embolism, medicine.drug_class, Pyridones, venous thromboembolism, Cardiology, Administration, Oral, Review Article, risk stratification, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Ambulatory care, ambulatory care, Rivaroxaban, Health care, Outpatients, Medicine, Humans, In patient, Intensive care medicine, Drug Approval, business.industry, Anticoagulant, Hemodynamics, Treatment options, Hematology, Guideline, Length of Stay, medicine.disease, Prognosis, Pulmonary embolism, Hospitalization, Treatment Outcome, Practice Guidelines as Topic, Pyrazoles, business, Venous thromboembolism

الوصف: Summary Pulmonary embolism (PE) is the most feared clinical presentation of venous thromboembolism (VTE). Patients with PE have traditionally been treated in hospital; however, many are at low risk of adverse outcomes and current guidelines suggest outpatient treatment as an option. Outpatient treatment of PE offers several advantages, including reduced risk of hospital‐acquired conditions and potential cost savings. Despite this, patients with low‐risk PE are still frequently hospitalized for treatment. This narrative review summarizes current guideline recommendations for the identification of patients with low‐risk PE who are potentially suitable for outpatient treatment, using prognostic assessment tools (e.g. the Pulmonary Embolism Severity Index [PESI] and simplified PESI) and clinical exclusion criteria (e.g. Hestia criteria) alone or in combination with additional cardiac assessments. Treatment options are discussed along with recommendations for the follow‐up of patients managed in the non‐hospital environment. The available data on outpatient treatment of PE are summarized, including details on patient selection, anticoagulant choice, and short‐term outcomes in each study. Accumulating evidence suggests that outcomes in patients with low‐risk PE treated as outpatients are at least as good as, if not better than, those of patients treated in the hospital. With mounting pressures on health care systems worldwide, increasing the proportion of patients with PE treated as outpatients has the potential to reduce health care burdens associated with VTE.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c0fe4bcd772446634e598a0c167899b5Test
http://europepmc.org/articles/PMC6849869Test

المؤلفون: James McCord, David E. Winchester, Phillip D. Levy, Frederick A. Masoudi, Anwar Osborne, Deborah B. Diercks, Gregory J. Dehmer, W. Frank Peacock, Michael C. Kontos, Deepak L. Bhatt

المصدر: Journal of the American College of Cardiology. 75(19)

مصطلحات موضوعية: Acute coronary syndrome, medicine.medical_specialty, Chest Pain, media_common.quotation_subject, 030204 cardiovascular system & hematology, Chest pain, Accreditation, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, Quality of life (healthcare), medicine, Acute chest pain, Humans, In patient, 030212 general & internal medicine, Acute Coronary Syndrome, media_common, Quality of Health Care, business.industry, Closing (real estate), medicine.disease, Professional Practice Gaps, Emergency medicine, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Emergency Service, Hospital, Resource utilization

الوصف: Multiple investigations have shown that a well-designed strategy for managing acute chest pain in patients can result in shorter length of stay and improved resource utilization ([1][1],[2][2]). Care in specialized chest pain units has been shown to achieve a better quality of life at lower cost, a

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0e5e3face18967d8fcecd78684417455Test
https://pubmed.ncbi.nlm.nih.gov/32408982Test

المؤلفون: Thomas Krahn, Matthias Endres, Jan F. Scheitz, Hardi Mundl, Anna Członkowska, Lesly A. Pearce, W. Frank Peacock, Christian H. Nolte, Guillaume Paré, Scott D. Berkowitz, Ashkan Shoamanesh, Mukul Sharma

المصدر: Stroke 51(8), 2386-2394 (2020). doi:10.1161/STROKEAHA.120.029628

مصطلحات موضوعية: Male, blood [Troponin T], Internationality, administration & dosage [Factor Xa Inhibitors], Rivaroxaban, diagnosis [Intracranial Embolism], administration & dosage [Aspirin], Stroke, Aged, 80 and over, administration & dosage [Rivaroxaban], blood [Biomarkers], Troponin T, Middle Aged, diagnosis [Stroke], Embolic stroke, drug therapy [Stroke], Intracranial Embolism, Cardiology, Biomarker (medicine), Female, Cardiology and Cardiovascular Medicine, medicine.drug, medicine.medical_specialty, Cardiac troponin, Risk Assessment, Double-Blind Method, Internal medicine, drug therapy [Intracranial Embolism], medicine, Humans, In patient, ddc:610, Aged, Advanced and Specialized Nursing, Aspirin, Proportional hazards model, business.industry, administration & dosage [Platelet Aggregation Inhibitors], medicine.disease, blood [Stroke], blood [Intracranial Embolism], Neurology (clinical), business, Biomarkers, Platelet Aggregation Inhibitors, Factor Xa Inhibitors, Follow-Up Studies

الوصف: Background and Purpose: Optimal secondary prevention for patients with embolic stroke of undetermined source (ESUS) remains unknown. We aimed to assess whether high-sensitivity cardiac troponin T (hs-cTnT) levels are associated with major vascular events and whether hs-cTnT may identify patients who benefit from anticoagulation following ESUS. Methods: Data were obtained from the biomarker substudy of the NAVIGATE ESUS trial, a randomized controlled trial testing the efficacy of rivaroxaban versus aspirin for secondary stroke prevention in ESUS. Patients were dichotomized at the hs-cTnT upper reference limit (14 ng/L, Gen V, Roche Diagnostics). Cox proportional hazard models were computed to explore the association between hs-cTnT, the combined cardiovascular end point (recurrent stroke, myocardial infarction, systemic embolism, cardiovascular death), and recurrent ischemic stroke. Results: Among 1337 patients enrolled at 111 participating centers in 18 countries (mean age 67±9 years, 61% male), hs-cTnT was detectable in 95% and at/above the upper reference limit in 21%. During a median follow-up of 11 months, the combined cardiovascular end point occurred in 68 patients (5.0%/y, rivaroxaban 28 events, aspirin 40 events; hazard ratio, 0.67 [95% CI, 0.41–1.1]), and recurrent ischemic stroke occurred in 50 patients (4.0%/y, rivaroxaban 16 events, aspirin 34 events, hazard ratio 0.45 [95% CI, 0.25–0.81]). Annualized combined cardiovascular end point rates were 8.2% (9.5% rivaroxaban, 7.0% aspirin) for those above hs-cTnT upper reference limit and 4.8% (3.1% rivaroxaban, 6.6% aspirin) below with a significant treatment modification ( P =0.04). Annualized ischemic stroke rates were 4.7% above hs-cTnT upper reference limit and 3.9% below, with no suggestion of an interaction between hs-cTnT and treatment ( P =0.3). Conclusions: In patients with ESUS, hs-cTnT was associated with increased cardiovascular event rates. While fewer recurrent strokes occurred in patients receiving rivaroxaban, outcomes were not stratified by hs-cTn results. Our findings support using hs-cTnT for cardiovascular risk stratification but not for decision-making regarding anticoagulation therapy in patients with ESUS. Registration: URL: https://www.clinicaltrials.govTest . Unique identifier: NCT02313909.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3546d2ada59e747940a59c86fcd55716Test

المؤلفون: Aušra Kavoliūnienė, Carolyn S.P. Lam, Christian Mueller, Òscar Miró, Vera Regitz-Zagrosek, Aldo P. Maggioni, Alexandre Mebazaa, Alain Cohen-Solal, Adriaan A. Voors, Yuya Matsue, Katsuya Kajimoto, Jiri Parenica, Gregg C. Fonarow, W. Frank Peacock, Eiichi Akiyama, Johan Lassus, Dong-Ju Choi, Etienne Gayat, Ali Ahmed, Jelena Čelutkienė, Justina Motiejūnaitė, Justin A. Ezekowitz, Naoki Sato

المساهمون: Cardiovascular Centre (CVC), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Lithuanian University of Health Sciences [Kaunas, Lithuania], Yokohama City University (YCU), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), Research Center [Associazione Nazionale Medici Cardiologi Ospedalieri] (ANMCO Research Center), Associazione Nazionale Medici Cardiologi Ospedalieri [Firenze] (ANMCO), University of Basel (Unibas), Seoul National University Bundang Hospital (SNUBH), Lithuanian University of health Sciences [Kaunas], Vilnius University [Vilnius], University Hospital Brno, Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Sekikawa Hospital [Tokyo, Japan] (SH), Nippon Medical School [Tokyo, Japan], University of Barcelona, Baylor College of Medicine (BCM), Baylor University, Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Boston University School of Medicine (BUSM), Boston University [Boston] (BU), King‘s College London, University of Alberta, Linköping University (LIU), University of California (UC), Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], leboeuf, Christophe

المصدر: European Heart Journal
European Heart Journal, 41(13), 1357-1364. Oxford University Press
European Heart Journal, 2020, 41 (13), pp.1357-1364. ⟨10.1093/eurheartj/ehaa071⟩

مصطلحات موضوعية: Male, medicine.medical_specialty, CONTEMPORARY MANAGEMENT, Asia, Prognosis, 030204 cardiovascular system & hematology, Lower risk, Ventricular Function, Left, EJECTION FRACTION, 03 medical and health sciences, AGE, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, ESC Report, Medicine, Humans, In patient, 030212 general & internal medicine, Prospective Studies, Registries, PREDICTORS, Heart Failure, Ejection fraction, business.industry, GENDER-RELATED DIFFERENCES, MORTALITY, Hazard ratio, Acute heart failure, Gender, Stroke Volume, medicine.disease, Biological sex, Comorbidity, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Clinical trial, Europe, Editorial, Heart failure, Acute Disease, Female, Cardiology and Cardiovascular Medicine, business

الوصف: Aims Recent data from national registries suggest that acute heart failure (AHF) outcomes might vary in men and women, however, it is not known whether this observation is universal. The aim of this study was to evaluate the association of biological sex and 1-year all-cause mortality in patients with AHF in various regions of the world. Methods and results We analysed several AHF cohorts including GREAT registry (22 523 patients, mostly from Europe and Asia) and OPTIMIZE-HF (26 376 patients from the USA). Clinical characteristics and medication use at discharge were collected. Hazard ratios (HRs) for 1-year mortality according to biological sex were calculated using a Cox proportional hazards regression model with adjustment for baseline characteristics (e.g. age, comorbidities, clinical and laboratory parameters at admission, left ventricular ejection fraction). In the GREAT registry, women had a lower risk of death in the year following AHF [HR 0.86 (0.79–0.94), P Conclusion Globally women with AHF have a lower 1-year mortality and less evidenced-based treatment than men. Differences among countries need further investigation. Our findings merit consideration when designing future global clinical trials in AHF.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8c7aec94455a8592009ae2597d6e9468Test
https://pubmed.ncbi.nlm.nih.gov/32357237Test