Asunto(s)
Consenso , Diagnóstico por Imagen/normas , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/cirugía , Guías de Práctica Clínica como Asunto , Sociedades Médicas , Procedimientos Quirúrgicos Vasculares/normas , Anciano , Anciano de 80 o más Años , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Rehabilitación Cardiaca/métodos , Enfermedades Cardiovasculares/prevención & control , Adulto , Factores de Edad , Anciano , Antihipertensivos/uso terapéutico , Biomarcadores/metabolismo , Rehabilitación Cardiaca/economía , Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/etnología , Análisis Costo-Beneficio , Angiopatías Diabéticas/prevención & control , Diagnóstico por Imagen/métodos , Dieta Saludable , Ejercicio Físico/fisiología , Medicina General/métodos , Promoción de la Salud/métodos , Estilo de Vida Saludable , Humanos , Hiperlipidemias/prevención & control , Hipertensión , Persona de Mediana Edad , Afecciones Crónicas Múltiples , Linaje , Pautas de la Práctica en Medicina/normas , Medición de Riesgo , Factores Sexuales , Cese del Hábito de Fumar , Factores SocioeconómicosAsunto(s)
Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/cirugía , Infarto del Miocardio/cirugía , Revascularización Miocárdica/métodos , Intervención Coronaria Percutánea/métodos , Anticoagulantes/uso terapéutico , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/terapia , Transfusión Sanguínea/métodos , Técnicas de Imagen Cardíaca/métodos , Enfermedades de las Arterias Carótidas/complicaciones , Enfermedades de las Arterias Carótidas/cirugía , Enfermedad Crónica , Medios de Contraste/efectos adversos , Toma de Decisiones , Cardiomiopatías Diabéticas/complicaciones , Cardiomiopatías Diabéticas/cirugía , Interacciones Farmacológicas , Fibrinolíticos/uso terapéutico , Rechazo de Injerto/etiología , Insuficiencia Cardíaca/complicaciones , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/cirugía , Corazón Auxiliar , Humanos , Hipoglucemiantes/uso terapéutico , Consentimiento Informado , Infarto del Miocardio/diagnóstico , Grupo de Atención al Paciente/organización & administración , Educación del Paciente como Asunto , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/cirugía , Antagonistas del Receptor Purinérgico P2Y/uso terapéutico , Insuficiencia Renal Crónica/complicaciones , Reoperación , Medición de Riesgo/métodos , Stents , Terapia Trombolítica/métodosRESUMEN
Background Transcatheter aortic valve implantation (TAVI) continues to gain popularity in the management of patients with severe aortic stenosis (SAS). Distribution of resources to maximise appropriate use remains a priority. Design & methods To determine the current perceptions and behaviours regarding SAS patient management, an 18-point multiple-choice questionnaire was distributed to European Society of Cardiology (ESC) Council for Cardiology Practice (CCP) e-journal and/or electronic newsletter subscribers. Respondents to all questions were considered. Sub-analyses based on respondent age, practice setting and geographical location were performed. Results Of 1245 full respondents, 41.5% were aged ≥ 51 years, 22.7% were aged 41-50 years and 35.8% were aged ≤ 40 years. The majority were located in Europe (77.5%), followed by Asia/Oceania (11.6%), America (7.6%) and Africa (3.4%). In-hospital and out-of-hospital cardiologists accounted for 57.4% of and 28.5% of the sample, respectively, with the remainder being general practitioners/other. The majority of respondents (70.1%) claimed to diagnose between one and five cases of SAS per month. Free access to TAVI was reported by 41.2%, being less common for those aged ≤ 40 years (32.7%; p < 0.001), those located in Asia/Oceania, America and Africa (20.1%, 18.1% and 2.4%, respectively; p < 0.01 in each case) and in-hospital compared to out-of-hospital cardiologists (35.7% vs. 54.5%, respectively; p < 0.001). The most common reason for not referring a patient for an aortic valve intervention was assessment that the patient was high risk/non-operable (55.5%), followed by short life expectancy (30.5%). The most common reason for referring a patient for TAVI over surgical replacement was surgical risk score (56.9%). The most commonly perceived main complication of TAVI was stroke (28.9%), while the most frequently selected main benefit was improvement in quality of life (37.2%). A high proportion (82.5%) of respondents believed that TAVI is/may become a viable option for lower-risk SAS patients in future. Conclusion The population of potential TAVI is significant worldwide, with key barriers to referral being access limitations and poor physician education. Strategies to minimise these factors are paramount.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Cardiología , Encuestas Epidemiológicas/métodos , Grupo de Atención al Paciente/normas , Indicadores de Calidad de la Atención de Salud/normas , Sociedades Médicas , Reemplazo de la Válvula Aórtica Transcatéter/estadística & datos numéricos , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico , Europa (Continente) , Calidad de Vida , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVES: The aim of the current study was to estimate adverse event rates while awaiting myocardial revascularization and review criteria for prioritizing patients. METHODS: A PubMed search was performed on 19 January 2015, to identify English-language, original, observational studies reporting adverse events while awaiting coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Rates of death, non-fatal myocardial infarction (MI) and emergency revascularization were calculated as occurrence rates per 1000 patient-weeks and pooled using random-effects models. RESULTS: The search yielded 1323 articles, of which 22 were included with 66 410 patients and 607 675 patient-weeks on the wait list. When awaiting CABG, rates per 1000 patient-weeks were 1.1 [95% confidence interval 0.9-1.3] for death, 1.0 [0.6-1.6] for non-fatal MI and 1.8 [0.8-4.1] for emergency revascularization. Subgroup analyses demonstrated consistent outcomes, and sensitivity analyses demonstrated comparable event rates with low heterogeneity. Higher urgency of revascularization was based primarily on angiographic complexity, angina severity, left ventricular dysfunction and symptoms on stress testing, and such patients with a semi-urgent status had a higher risk of death than patients awaiting elective revascularization (risk ratio at least 2.8). Individual studies identified angina severity and left ventricular dysfunction as most important predictors of death when awaiting CABG. Adverse rates per 1000 patient-weeks for patients awaiting PCI were 0.1 [95% confidence interval 0.0-0.4] for death, 0.4 [0.1-1.2] for non-fatal MI and 0.7 [0.4-1.4] for emergency revascularization but were based on only a few old studies. CONCLUSIONS: Rates of death, non-fatal MI and emergency revascularization when awaiting myocardial revascularization are infrequent but higher in specific patients. Countries that not yet have treatment recommendations related to waiting times should consider introducing a maximum to limit adverse events, particularly when awaiting CABG.