Energy drinks and their adverse health effects: A systematic review of the current evidence.

PURPOSE: With the rising consumption of so-called energy drinks over the last few years, there has been a growing body of literature describing significant adverse health events after the ingestion of these beverages. To gain further insight about the clinical spectrum of these adverse events, we conducted a literature review. METHODS: Using PubMed and Google-Scholar, we searched the literature from January 1980 through May 2014 for articles on the adverse health effects of energy drinks. A total of 2097 publications were found. We then excluded molecular and industry-related studies, popular media reports, and case reports of isolated caffeine toxicity, yielding 43 reports. CONCLUSION: Energy drink consumption is a health issue primarily of the adolescent and young adult male population. It is linked to increased substance abuse and risk-taking behaviors. The most common adverse events affect the cardiovascular and neurological systems. The most common ingredient in energy drinks is caffeine, and it is believed that the adverse events are related to its effects, as well as potentiating effects of other stimulants in these drinks. Education, regulation, and further studies are required.

Utilization patterns of single-photon emission cardiac tomography myocardial perfusion imaging studies in a rural tertiary care setting.

BACKGROUND: Appropriate use criteria (AUC) for single-photon emission computed tomographic myocardial perfusion imaging (SPECT MPI) were revised in 2009 to include 15 new clinical scenarios. We assessed multivariable predictors and overall appropriateness of MPI studies performed in a rural tertiary care setting. HYPOTHESIS: We hypothesized that appropriate utilization rates of SPECT MPI imaging in a rural tertiary care center are similar for cardiology and non cardiology providers. METHODS: We reviewed all SPECT MPI studies performed for over a 6-month period at our center. Using 67 scenarios in AUC, we categorized these studies as appropriate, inappropriate, uncertain, or unclassifiable. RESULTS: Of 328 MPI studies, 287 (88%) studies were classified as appropriate, 18 (5.5%) as inappropriate, 23 (7%) as uncertain, and none as unclassifiable. Preoperative testing accounted for 44% of the inappropriate studies; 61% of uncertain tests were ordered for cardiovascular risk assessment in patients with prior normal coronary angiography or normal stress tests. The ordering provider specialty did not show any relation with appropriateness of the test (P = 0.46). Patients with inappropriate and uncertain studies were younger than patients with appropriate studies (P = 0.007). CONCLUSIONS: We found that a majority of MPI studies are performed for appropriate indications regardless of ordering provider specialty. Few common scenarios accounted for the majority of the inappropriate or uncertain studies.

Predictors of cause-specific hospital readmission in patients with heart failure.

BACKGROUND: Repeated hospital readmissions are frequent and increasing over time in patients with heart failure (HF). The predictors for readmission in patients with HF are not completely understood. HYPOTHESIS: The study was undertaken to investigate the time course of readmission by specific cause in patients with HF, and to examine the independent effects of HF etiology and left ventricular (LV) function on cause-specific readmissions. METHODS: A retrospective cohort of 493 consecutive patients with HF was followed for readmission for 16.5 +/- 12.3 months. Ischemic etiology of HF was defined as history of myocardial infarction (MI), coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA), or > or = 70% coronary stenosis. Left ventricular function was assessed echocardiographically. Cause-specific readmissions were classified as HF, cardiovascular disease (CVD) other than HF, and other non-CVD. RESULTS: The annual readmission rate was 56.6%. Median time to readmission was 91 days, with 18.3% patients readmitted within 1 month after discharge. Ischemic etiology independently predicted all-cause readmission: Cox hazard ratio (95% confidence interval): 1.40 (1.11-1.79). This relationship was significant in women (1.83 [1.31-2.55]), but not in men (1.15 [0.82-1.62]), while readmissions were equally frequent in both genders. Similarly, ischemic etiology significantly predicted readmission for CVD in women (4.18 [2.14-8.19]), but not in men (1.49 [0.83-2.67]). However, LV dysfunction independently predicted readmission for recurrent HF (2.44 [1.46-4.08]), while ischemic etiology was not predictive in either gender. CONCLUSIONS: Readmissions for recurrent HF comprise only one-third of total hospital readmissions in patients with HF. Ischemic etiology is a significant predictor of readmission, and most of this effect is mediated through a four-fold increased risk of readmission for CVD other than HF in women. Readmission for recurrent HF is predicted by LV dysfunction but not by ischemic etiology. Patients with HF can be accurately risk stratified for cause-specific readmission with available clinical data.