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2.
Circ Cardiovasc Qual Outcomes ; 12(7): e005122, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31284738

RESUMO

BACKGROUND: Data sharing accelerates scientific progress but sharing individual-level data while preserving patient privacy presents a barrier. METHODS AND RESULTS: Using pairs of deep neural networks, we generated simulated, synthetic participants that closely resemble participants of the SPRINT trial (Systolic Blood Pressure Trial). We showed that such paired networks can be trained with differential privacy, a formal privacy framework that limits the likelihood that queries of the synthetic participants' data could identify a real a participant in the trial. Machine learning predictors built on the synthetic population generalize to the original data set. This finding suggests that the synthetic data can be shared with others, enabling them to perform hypothesis-generating analyses as though they had the original trial data. CONCLUSIONS: Deep neural networks that generate synthetic participants facilitate secondary analyses and reproducible investigation of clinical data sets by enhancing data sharing while preserving participant privacy.

3.
Curr Treat Options Cardiovasc Med ; 21(5): 21, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30989402

RESUMO

A busy community cardiologist finished reading eight echocardiograms over lunch and started clinic at 1 pm. As three patients waited, "Jane," a 45-year-old graphic designer was seen for "skipped heart beat." She works about 50 h a week, exercises at the local gym, and enjoys eating a healthy diet. About 4 months ago Jane began experiencing her heart "skipping beats." She initially attributed the symptoms to long hours in the office and caffeine. But, over the holiday, her brother purchased a smart watch and she began digitally recording her cardiac rhythm. About a month ago, the device detected possible atrial fibrillation, so she called and scheduled this visit for a cardiology consultation. Upon that visitation, she and her physician reviewed the device readings. While it appeared to be an irregular rhythm, before either considered a treatment plan, they began to ask questions ranging from the following: "Is this an accurate diagnosis?" "What other data are available to better understand the risk of a cardiac arrhythmia?" "How is this data analyzed so that the best treatment plan can be made?" "And, what type of clinical decision support system is required to 'virtually' monitor people like me using digital health devices to improve the efficiency and quality of care delivered in population health?"

4.
J Nucl Cardiol ; 26(4): 1093-1102, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29214611

RESUMO

BACKGROUND: Several publications and guidelines designate diabetes mellitus (DM) as a coronary artery disease (CAD) risk equivalent. The aim of this investigation was to examine DM cardiac risk equivalence from the perspective of stress SPECT myocardial perfusion imaging (MPI). METHODS AND RESULTS: We examined cardiovascular outcomes (cardiac death or nonfatal MI) of 17,499 patients referred for stress SPECT-MPI. Patients were stratified into four categories: non-DM without CAD, non-DM with CAD, DM without CAD, and DM with CAD, and normal or abnormal perfusion. Cardiac events occurred in 872 (5%), with event-free survival best among non-DM without CAD, worst in DM with CAD, and intermediate in DM without CAD, and non-DM with CAD. After multivariate adjustment, risk remained comparable between DM without CAD and non-DM with CAD [AHR 1.0 (95% CI 0.84-1.28), P =0.74]. Annualized event rates for normal subjects were 1.4% and 1.6% for non-DM with CAD and DM without CAD, respectively (P = 0.48) and 3.5% (P = 0.95) for both abnormal groups. After multivariate adjustment, outcomes were comparable within normal [AHR 1.4 (95% CI 0.98-1.96) P = 0.06] and abnormal [AHR 1.1 (95% CI 0.83-1.50) P = 0.49] MPI. CONCLUSIONS: Diabetic patients without CAD have comparable risk of cardiovascular events as non-diabetic patients with CAD after stratification by MPI results. These findings support diabetes as a CAD equivalent and suggest that MPI provides additional prognostic information in such patients.

5.
Can J Cardiol ; 34(7): 850-862, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29960614

RESUMO

Worldwide, more than 230 million adults have major noncardiac surgery each year. Although surgery can improve quality and duration of life, it can also precipitate major complications. Moreover, a substantial proportion of deaths occur after discharge. Current systems for monitoring patients postoperatively, on surgical wards and after transition to home, are inadequate. On the surgical ward, vital signs evaluation usually occurs only every 4-8 hours. Reduced in-hospital ward monitoring, followed by no vital signs monitoring at home, leads to thousands of cases of undetected/delayed detection of hemodynamic compromise. In this article we review work to date on postoperative remote automated monitoring on surgical wards and strategy for advancing this field. Key considerations for overcoming current barriers to implementing remote automated monitoring in Canada are also presented.


Assuntos
Monitorização Fisiológica/métodos , Cuidados Pós-Operatórios/métodos , Procedimentos Cirúrgicos Operatórios , Telemedicina/métodos , Sinais Vitais/fisiologia , Humanos
7.
JACC Cardiovasc Imaging ; 11(4): 546-557, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28917688

RESUMO

OBJECTIVES: This study sought to determine whether mobile health (mHealth) device assessments used as clinical decision support tools at the point-of-care can reduce the time to treatment and improve long-term outcomes among patients with rheumatic and structural heart diseases (SHD). BACKGROUND: Newly developed smartphone-connected mHealth devices represent promising methods to diagnose common diseases in resource-limited areas; however, the impact of technology-based care on long-term outcomes has not been rigorously evaluated. METHODS: A total of 253 patients with SHD were randomized to an initial diagnostic assessment with wireless devices in mHealth clinics (n = 139) or to standard-care (n = 114) in India. mHealth clinics were equipped with point-of-care devices including pocket-echocardiography, smartphone-connected-electrocardiogram blood pressure and oxygen measurements, activity monitoring, and portable brain natriuretic peptide laboratory testing. All individuals underwent comprehensive transthoracic echocardiography to assess the severity of SHD. The primary endpoint was the time to referral for therapy with percutaneous valvuloplasty or surgical valve replacement. Secondary endpoints included the probability of a cardiovascular hospitalization and/or death over 1 year. RESULTS: An initial mHealth assessment was associated with a shorter time to referral for valvuloplasty and/or valve replacement (83 ± 79 days vs. 180 ± 101 days; p <0.001) and was associated with an increased probability for valvuloplasty/valve replacement compared to standard-care (34% vs. 32%; adjusted hazard ratio: 1.54; 95% CI: 0.96 to 2.47; p = 0.07). Patients randomized to mHealth were associated with a lower risk of a hospitalization and/or death on follow-up (15% vs. 28%, adjusted hazard ratio: 0.41; 95% CI: 0.21 to 0.83; p = 0.013). CONCLUSIONS: An initial mHealth diagnostic strategy was associated with a shorter time to definitive therapy among patients with SHD in a resource-limited area and was associated with improved outcomes. (A Randomized Trial of Pocket-Echocardiography Integrated Mobile Health Device Assessments in Modern Structural Heart Disease Clinics; NCT02881398).


Assuntos
Ecocardiografia Doppler em Cores/instrumentação , Doenças das Valvas Cardíacas/diagnóstico por imagem , Aplicativos Móveis , Sistemas Automatizados de Assistência Junto ao Leito , Cardiopatia Reumática/diagnóstico por imagem , Smartphone , Telemedicina/instrumentação , Tecnologia sem Fio/instrumentação , Actigrafia/instrumentação , Adulto , Valvuloplastia com Balão , Determinação da Pressão Arterial/instrumentação , Eletrocardiografia/instrumentação , Desenho de Equipamento , Feminino , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/terapia , Implante de Prótese de Valva Cardíaca , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Oximetria/instrumentação , Valor Preditivo dos Testes , Prognóstico , Encaminhamento e Consulta , Cardiopatia Reumática/fisiopatologia , Cardiopatia Reumática/terapia , Índice de Gravidade de Doença , Processamento de Sinais Assistido por Computador , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Estados Unidos , Adulto Jovem
8.
J Am Coll Cardiol ; 70(24): 3018-3025, 2017 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-29241491

RESUMO

Sharing deidentified patient-level research data presents immense opportunities to all stakeholders involved in cardiology research and practice. Sharing data encourages the use of existing data for knowledge generation to improve practice, while also allowing for validation of disseminated research. In this review, we discuss key initiatives and platforms that have helped to accelerate progress toward greater sharing of data. These efforts are being prompted by government, universities, philanthropic sponsors of research, major industry players, and collaborations among some of these entities. As data sharing becomes a more common expectation, policy changes will be required to encourage and assist data generators with the process of sharing the data they create. Patients also will need access to their own data and to be empowered to share those data with researchers. Although medicine still lags behind other fields in achieving data sharing's full potential, cardiology research has the potential to lead the way.


Assuntos
Pesquisa Biomédica , Cardiologia/estatística & dados numéricos , Disseminação de Informação/métodos , Humanos
10.
Artigo em Inglês | MEDLINE | ID: mdl-29017997

RESUMO

BACKGROUND: The appropriate use criteria considers cardiac stress testing within 2 years after percutaneous coronary intervention (PCI) to be rarely appropriate, unless prompted by symptoms or change in clinical status. Little is known about the patterns of cardiac stress testing after PCI in the single-payer Canadian healthcare system, where mechanisms for reimbursement are different from the United States. METHODS AND RESULTS: Frequency and timing of cardiac stress testing within 2 years of PCI performed between April 2004 and March 2013 in Ontario, Canada, was determined from linked provincial databases. Subsequent rates of coronary angiography and revascularization after stress testing were ascertained. Of the 112 691 patients with PCI, 67 442 (59.8%) underwent at least 1 stress test, with 38 267 (34.0%) undergoing repeat stress testing (ie, >1 stress test) within 2 years. Patients who underwent stress testing were younger, had less medical comorbidities, were more likely to reside in urban areas, and had higher incomes. Spikes in incidence of repeat stress testing were observed at 3 to 4 months, 6 to 7 months, and 12 to 13 months after the prior stress test. Of those tested, only 5.9% underwent subsequent coronary angiography, and only 3.1% underwent repeat revascularization within 60 days of stress testing. CONCLUSIONS: More than half of all patients undergo cardiac stress testing within 2 years of PCI, with one third undergoing repeat stress tests. Only 1 of 30 tested patients underwent repeat revascularization. These findings reinforce the appropriate use criteria recommendations against routine stress testing after PCI. Further work is needed to aid with the selection of patients most likely to benefit from stress testing after PCI.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/terapia , Teste de Esforço/tendências , Intervenção Coronária Percutânea , Padrões de Prática Médica/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Angiografia Coronária/tendências , Doença da Artéria Coronariana/fisiopatologia , Teste de Esforço/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Intervenção Coronária Percutânea/efeitos adversos , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Sistema de Registros , Retratamento/tendências , Fatores de Tempo , Tomografia Computadorizada de Emissão/tendências , Resultado do Tratamento , Procedimentos Desnecessários/tendências , Adulto Jovem
11.
JMIR Res Protoc ; 5(3): e149, 2016 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-27480247

RESUMO

BACKGROUND: Tens of thousands of cardiac and vascular surgeries (CaVS) are performed on seniors in Canada and the United Kingdom each year to improve survival, relieve disease symptoms, and improve health-related quality of life (HRQL). However, chronic postsurgical pain (CPSP), undetected or delayed detection of hemodynamic compromise, complications, and related poor functional status are major problems for substantial numbers of patients during the recovery process. To tackle this problem, we aim to refine and test the effectiveness of an eHealth-enabled service delivery intervention, TecHnology-Enabled remote monitoring and Self-MAnagemenT-VIsion for patient EmpoWerment following Cardiac and VasculaR surgery (THE SMArTVIEW, CoVeRed), which combines remote monitoring, education, and self-management training to optimize recovery outcomes and experience of seniors undergoing CaVS in Canada and the United Kingdom. OBJECTIVE: Our objectives are to (1) refine SMArTVIEW via high-fidelity user testing and (2) examine the effectiveness of SMArTVIEW via a randomized controlled trial (RCT). METHODS: CaVS patients and clinicians will engage in two cycles of focus groups and usability testing at each site; feedback will be elicited about expectations and experience of SMArTVIEW, in context. The data will be used to refine the SMArTVIEW eHealth delivery program. Upon transfer to the surgical ward (ie, post-intensive care unit [ICU]), 256 CaVS patients will be reassessed postoperatively and randomly allocated via an interactive Web randomization system to the intervention group or usual care. The SMArTVIEW intervention will run from surgical ward day 2 until 8 weeks following surgery. Outcome assessments will occur on postoperative day 30; at week 8; and at 3, 6, 9, and 12 months. The primary outcome is worst postop pain intensity upon movement in the previous 24 hours (Brief Pain Inventory-Short Form), averaged across the previous 14 days. Secondary outcomes include a composite of postoperative complications related to hemodynamic compromise-death, myocardial infarction, and nonfatal stroke- all-cause mortality and surgical site infections, functional status (Medical Outcomes Study Short Form-12), depressive symptoms (Geriatric Depression Scale), health service utilization-related costs (health service utilization data from the Institute for Clinical Evaluative Sciences data repository), and patient-level cost of recovery (Ambulatory Home Care Record). A linear mixed model will be used to assess the effects of the intervention on the primary outcome, with an a priori contrast of weekly average worst pain intensity upon movement to evaluate the primary endpoint of pain at 8 weeks postoperation. We will also examine the incremental cost of the intervention compared to usual care using a regression model to estimate the difference in expected health care costs between groups. RESULTS: Study start-up is underway and usability testing is scheduled to begin in the fall of 2016. CONCLUSIONS: Given our experience, dedicated industry partners, and related RCT infrastructure, we are confident we can make a lasting contribution to improving the care of seniors who undergo CaVS.

12.
Eur Heart J ; 37(18): 1428-38, 2016 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-26873093

RESUMO

The convergence of science and technology in our dynamic digital era has resulted in the development of innovative digital health devices that allow easy and accurate characterization in health and disease. Technological advancements and the miniaturization of diagnostic instruments to modern smartphone-connected and mobile health (mHealth) devices such as the iECG, handheld ultrasound, and lab-on-a-chip technologies have led to increasing enthusiasm for patient care with promises to decrease healthcare costs and to improve outcomes. This 'hype' for mHealth has recently intersected with the 'real world' and is providing important insights into how patients and practitioners are utilizing digital health technologies. It is also raising important questions regarding the evidence supporting widespread device use. In this state-of-the-art review, we assess the current literature of mHealth and aim to provide a framework for the advances in mHealth by understanding the various device, patient, and clinical factors as they relate to digital health from device designs and patient engagement, to clinical workflow and device regulation. We also outline new strategies for generation and analysis of mHealth data at the individual and population-based levels.


Assuntos
Assistência à Saúde , Tecnologia Biomédica , Humanos , Smartphone , Telemedicina
14.
Pacing Clin Electrophysiol ; 37(10): 1315-23, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25139346

RESUMO

BACKGROUND: Inappropriate shocks (IASs) from implantable cardioverter defibrillators (ICDs) are associated with decreased quality of life, but whether they increase healthcare utilization and treatment costs is unknown. We sought to determine the impact of IASs on subsequent healthcare utilization and treatment costs. METHODS: We conducted a case-control analysis of ICD patients at a single institution from 1997 to 2010 and who had ≥12 months of post-ICD implant follow-up. Cases included all patients experiencing an IAS during the first 12 months after implantation. Eligible control patients did not receive a shock of any kind during the 12 months after implantation. Propensity scores based on 36 covariates (area under curve = 0.78) were used to match cases to controls. We compared the rate (occurrences/person year [PY]) of healthcare utilization immediately following IAS to the end of the 12-month follow-up period to the rate in the no-shock group over 12 months of follow-up. We also compared 12-month postimplant treatment (outpatient clinic, emergency room, and hospitalization) costs in both groups. RESULTS: A total of 76 patients experiencing ≥1 IAS during the first 12 months after implant (contributing 48 PYs) were matched to 76 no-shock patients (contributing 76 PYs). Cardiovascular (CV)-related clinic visit and hospitalization rates were increased following an IAS compared to those not receiving a shock (4.0 vs 3.3 and 0.7 vs 0.5, respectively, P = 0.02 for both). CV-related emergency room visitation (0.15 vs 0.08) rates were also numerically higher following an IAS, but did not reach statistical significance (P = 0.26). Patients experiencing an IAS accrued greater treatment costs during the 12 months postimplant compared to no-shock patients ($13,973 ± $46,345 vs $6,790 ± $19,091, P = 0.001). CONCLUSION: Recipients of IAS utilize the healthcare system more frequently following an IAS than patients not experiencing a shock. This increased utilization results in higher costs of treating IAS patients during the 12 months postimplant.


Assuntos
Desfibriladores Implantáveis , Falha de Equipamento/economia , Custos de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos
15.
Europace ; 16(1): 47-54, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23954920

RESUMO

AIMS: Hyponatremia is commonly observed among patients with left ventricular (LV) dysfunction and is a marker for adverse outcomes. We aimed to determine the prognostic significance of pre-implant hyponatremia on the outcomes of death, acute decompensated heart failure (ADHF) and appropriate implantable cardioverter-defibrillator (ICD) therapy for ventricular arrhythmias among patients with ICDs. METHODS AND RESULTS: The study population consisted of patients with an ejection fraction ≤40% undergoing ICD implantation (n = 911) for the primary or secondary prevention of sudden cardiac death from 1997 to 2007. The predictive value of the severity of pre-implantation hyponatremia stratified into mild hyponatremia (n = 268, sodium 134-136 mmol/L), moderate hyponatremia (n = 105, sodium 131-133 mmol/L), and severe hyponatremia (n = 31, sodium ≤130 mmol/L) on the risk of death, ADHF, and appropriate ICD therapy for ventricular arrhythmias as compared with patients a normal serum sodium (n = 507, sodium ≥ 137 mmol/L), was calculated using multivariable Cox proportional hazards analyses. During a mean follow-up of 775 ± 750 days as the severity of hyponatremia (from a normal sodium to severe hyponatremia) increased an incremental incidence of death (25% to 61%, P < 0.001) and ADHF (11% to 26%, P = 0.004) was observed with a reduced incidence of ICD therapy for ventricular tachycardia/ventricular fibrillation (37-29%, P = 0.037). Compared with the normal sodium cohort, patients with severe hyponatremia demonstrated an increased risk of death [adjusted hazard ratio (AHR) 2.69 (95% confidence interval, CI 1.57-4.59), P = 0.004] and ADHF [AHR 2.98 (95% CI 1.41-6.30), P = 0.004], with a lower probability of appropriate ICD therapy [AHR 0.68 (95% CI 0.27-0.88), P = 0.031]. CONCLUSION: Hyponatremia is commonly observed among ICD recipients with LV dysfunction. Patients with an increasing severity of hyponatremia are at increased risk of death and HF related morbidity with a reduced incidence of appropriate ICD therapy particularly among patients with severe hyponatremia.


Assuntos
Desfibriladores Implantáveis/estatística & dados numéricos , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/prevenção & controle , Hiponatremia/diagnóstico , Hiponatremia/mortalidade , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/prevenção & controle , Idoso , Comorbidade , Connecticut , Feminino , Humanos , Incidência , Masculino , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/estatística & dados numéricos , Prognóstico , Implantação de Prótese/mortalidade , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
16.
Conn Med ; 77(7): 409-15, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24195179

RESUMO

BACKGROUND: Thyroid stimulating hormone (TSH) abnormalities have been associated with various cardiac arrhythmias. Effect of TSH abnormalities on mortality and implantable cardioverter defibrillators (ICD) behavior in patients with cardiomyopathy has not been investigated. METHODS: Our ICD database includes 1,445 patients between December 1997 and January 2008. TSH levels using the ultra sensitive assay were available in 371 patients. Patients were classified based on TSH levels as: High TSH (N = 102, TSH > 5) and Low TSH (N = 26, TSH < 0.4). TSH groups were compared for mortality, appropriate and inappropriate ICD therapies. RESULTS: A high or low TSH was an independent predictor of all-cause mortality: Hazard ratio (HR) 1.46 (95% CI 1.03-2.08), P = 0.033 and HR 1.76 (95% confidence interval 1.02-3.03), P = 0.043 respectively. TSH abnormalities were not associated with an increased incidence in appropriate or inappropriate ICD therapy. CONCLUSION: A low or high TSH was associated with a higher mortality; however, neither were associated with appropriate or inappropriate ICD therapy after multivariate analysis. Univariate analysis demonstrated an association of high TSH and appropriate ICD therapy. However, multivariate analysis did not show this association. Therefore, we are concluding that TSH levels are predictors of all-cause mortality but not ICD therapy.


Assuntos
Arritmias Cardíacas/sangue , Arritmias Cardíacas/terapia , Cardiomiopatias/sangue , Cardiomiopatias/mortalidade , Desfibriladores Implantáveis , Tireotropina/sangue , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/etiologia , Biomarcadores/sangue , Cardiomiopatias/complicações , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico
17.
Ann Noninvasive Electrocardiol ; 18(4): 379-88, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23879278

RESUMO

BACKGROUND: Current guidelines consider the implantation of an implantable cardioverter defibrillator (ICD) a class III indication in patients with a life expectancy of <1 year. An evaluation of concomitant noncardiac conditions may identify patients whom may not derive benefit with ICD therapy. We sought to evaluate the association of the Charlson comorbidity index (CCI) on the prediction of early mortality (EM), death <1 year after ICD implant. METHODS: The study population consisted of patients (n = 1062) undergoing ICD implantation for the primary or secondary prevention of sudden cardiac death from 1997 to 2007. The predictive value of the CCI on the risk of EM and appropriate shock therapy for ventricular arrhythmias as compared to patients without EM after ICD implant was calculated using multivariable Cox proportional hazards and receiver operator analyses. RESULTS: Patients experiencing EM (n = 110) demonstrated higher CCI scores (mean 2.8 ± 1.3 vs 1.5 ± 1.2, P < 0.001) as compared to individuals without EM (n = 963). Among patients with a CCI of 0, 1, 2, 3, 4, and ≥5, the incidence of EM increased from 5% to 78%. The CCI was an independent predictor of EM (AHR 1.4 [95% CI 1.2-1.6], P < 0.001, per single score increase). Patients who experienced EM demonstrated a decreased incidence of appropriate ICD therapy when compared to patients without EM (AHR 0.4 [95% CI 0.2-0.7], P = 0.001). CONCLUSION: Noncardiac conditions are commonly observed among patients undergoing ICD implantation. Guidelines must incorporate a comprehensive assessment of concomitant comorbidities to minimize the risk of EM and to maximize the survival benefit with ICD therapy.


Assuntos
Causas de Morte , Comorbidade , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/mortalidade , Expectativa de Vida , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/terapia , Síndrome de Brugada , Doença do Sistema de Condução Cardíaco , Estudos de Coortes , Feminino , Sistema de Condução Cardíaco/anormalidades , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prevenção Primária/métodos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
18.
Pacing Clin Electrophysiol ; 36(7): 878-84, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23614760

RESUMO

BACKGROUND: Several meta-analyses of the implantable cardioverter-defibrillator (ICD) clinical trials have demonstrated that while men derived a mortality reduction with prophylactic ICD implantation, women did not. These trials also observed that women receive less appropriate ICD shock therapy compared to men. We aimed to investigate this "gender-paradox" among a heterogeneous community cohort of patients receiving ICDs. METHODS: We identified 1,445 consecutive patients undergoing ICD implantation from 1997 to 2007. The study population consisted of 582 patients, of whom 291 were women who could be propensity matched to 291 men, based on age, ejection fraction, implantation indication (primary or secondary), etiology of cardiomyopathy (ischemic or nonischemic), and the presence of a cardiac resynchronization therapy-defibrillator (CRT-D) device. The impact of gender difference on the probability of death and appropriate ICD shocks for ventricular arrhythmias was calculated using multivariable Cox proportional hazards analyses. RESULTS: During a mean follow-up of 909 ± 901 days, compared to men, women demonstrated a similar risk of death (25% vs 25%, adjusted hazard ratio [AHR] 1.05 [95% confidence interval (CI) 0.81-1.35], P = 0.74). In contrast, women demonstrated a decreased probability of appropriate ICD-shock therapy (14% vs 19%, AHR 0.80 [95% CI 0.59-0.88], P = 0.03) compared to men, and among cohorts with a nonischemic cardiomyopathy (10% vs 20%, P < 0.001) and CRT-D devices (7% vs 19%, P = 0.01). CONCLUSION: Among a community cohort with ICDs, women have a similar mortality compared to men while experiencing less appropriate ICD therapy. These results support the findings of a lower arrhythmic mortality among women.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/estatística & dados numéricos , Cardioversão Elétrica/mortalidade , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/prevenção & controle , Pontuação de Propensão , Idoso , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Distribuição por Sexo , Taxa de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologia
19.
Ann Noninvasive Electrocardiol ; 17(4): 405-8, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23094889

RESUMO

Bidirectional ventricular tachycardia (BVT) is an uncommon type of polymorphic ventricular tachycardia (PVT) with alternating polarity of the QRS complex most commonly described digitalis toxicity. Recent data has demonstrated the possible molecular basis of this electrocardiographic phenomenon. To our knowledge this is the first reported case of BVT in a patient with orthotopic cardiac transplantation and coronary allograft vasculopathy.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Eletrocardiografia/métodos , Transplante de Coração , Taquicardia Ventricular/diagnóstico , Taquicardia/diagnóstico , Transplante Homólogo , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Doença da Artéria Coronariana/terapia , Desfibriladores Implantáveis , Stents Farmacológicos , Seguimentos , Humanos , Lidocaína/uso terapêutico , Masculino , Pessoa de Meia-Idade , Radiografia , Taquicardia/tratamento farmacológico , Taquicardia/cirurgia , Taquicardia Ventricular/tratamento farmacológico , Taquicardia Ventricular/cirurgia
20.
Resuscitation ; 83(2): 202-7, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21864480

RESUMO

BACKGROUND: Therapeutic hypothermia improves neurologic outcomes in patients resuscitated from cardiac arrest due to ventricular fibrillation. However, its role in patients with cardiac arrest due to non-shockable rhythms (pulseless electrical activity (PEA) and asystole) is unclear. We hypothesized that therapeutic hypothermia favorably impacts neurologic outcome and survival in patients resuscitated from cardiac arrest due to non-shockable rhythms. METHODS: Retrospectively collected data on consecutive adult patients admitted to Hartford Hospital from 1/1/2004 to 11/1/2010 who survived a cardiac arrest due to PEA or asystole were analyzed. Patients who underwent therapeutic hypothermia (1/1/2007-11/1/2010) formed the hypothermia group while patients admitted prior to the institution of therapeutic hypothermia (1/1/2004-1/1/2007) at Hartford Hospital formed the control group. The primary end-point was measured using the Pittsburgh cerebral performance category (CPC) scale and patients were assessed for a good (CPC 1 and 2) or poor (CPC 3-5) neurological outcome prior to discharge from hospital. A secondary end-point was measured as survival at discharge from hospital. RESULTS: Of 100 post-cardiac arrest patients included in the study, 15/52 (29%) patients in the hypothermia group had a good neurologic outcome as compared to 5/43 (10%) patients in the control group (P=0.021). On multivariate analysis, the odds ratio for good neurologic outcome and survival at discharge from the hospital with therapeutic hypothermia as compared to control were 4.35 (95% CI 1.10-17.24, P=0.04) and 5.65 (CI 1.66-19.23, P=0.006) respectively. CONCLUSION: Therapeutic hypothermia is associated with favorable neurologic outcome and survival in patients resuscitated after cardiac arrest due to non-shockable rhythms.


Assuntos
Reanimação Cardiopulmonar/métodos , Coma/etiologia , Parada Cardíaca/terapia , Hipotermia Induzida/métodos , Sobreviventes/estatística & dados numéricos , Idoso , Coma/fisiopatologia , Coma/terapia , Feminino , Seguimentos , Parada Cardíaca/complicações , Parada Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
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