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3.
J Invasive Cardiol ; 33(10): E805-E807, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34433694

RESUMO

BACKGROUND: Thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) was recommended to minimize distal embolization and to reduce thrombus burden prior to PPCI. Subsequent randomized trials showed no mortality benefit from TA and suggested an increased risk of stroke up to 180 days following TA, although it was not obvious that the procedure alone caused the strokes. METHODS AND RESULTS: This study retrospectively analyzed the periprocedural stroke rate in a series of STEMI patients treated with TA and PPCI at a single, large, tertiary hospital, where a rigorous uniform protocol of aspiration was used in all patients. Of 3734 patients, 1404 patients (38%; group 1) underwent TA as part of the PPCI procedure and 2330 patients (62%; group 2) did not undergo TA. There were no significant clinical differences between the 2 groups. In total, there were 20 strokes (0.54%), with 3 (0.2%) occurring in group 1, and 17 (0.7%) occurring in group 2 (P=.04). The majority of strokes occurred within 5 days of the procedure, and 3 (0.08%) were hemorrhagic. There were 22 intraprocedural deaths (0.6%), related to cardiogenic shock. There were no intraprocedural strokes. CONCLUSIONS: Very low stroke rates immediately post STEMI were seen in patients undergoing TA and PPCI in this real-world study. TA can be performed safely in STEMI patients undergoing PPCI with a short-term stroke risk equivalent to risk without TA. Further studies may be needed to explain the increased incidence of late stroke noted after TA and elucidate causative mechanisms.


Assuntos
Isquemia Encefálica , Trombose Coronária , AVC Isquêmico , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Acidente Vascular Cerebral , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Humanos , Incidência , Intervenção Coronária Percutânea/efeitos adversos , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Trombectomia , Resultado do Tratamento
5.
Heart Lung Circ ; 30(8): 1112-1113, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215362

Assuntos
Cardiologia , Humanos
6.
Heart Lung Circ ; 30(12): 1891-1900, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34219025

RESUMO

BACKGROUND: Cardiac rehabilitation (CR) programs reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. However, many people who experience a cardiac event do not attend or fail to complete their CR program. Little is known about the characteristics of people who drop out compared to those who complete CR. AIMS: To identify subgroups of patients attending a cardiac rehabilitation program who are more likely to dropout prior to final assessment by (1) calculating the dropout rate from the program, (2) quantifying the association between dropout and socio-demographic, lifestyle, and cardiovascular risk factors, and (3) identifying independent predictors of dropout. METHODS: The study population is from a large metropolitan teaching hospital in Sydney, Australia, and consists of all participants consecutively enrolled in an outpatient CR program between 2006 and 2017. Items assessed included diagnoses and co-morbidities, quality of life (SF-36), psychological health (DASS-21), lifestyle factors and physical assessment. Dropout was defined as failure to complete the outpatient CR program and post CR assessment. RESULTS: Of the 3,350 patients enrolled in the CR program, 784 (23.4%; 95%CI: 22.0-24.9%) dropped out prior to completion. The independent predictors of dropout were smoking (OR 2.4; 95%CI: 1.9-3.0), being separated or divorced (OR 2.0; 95%CI: 1.5-2.6), younger age (<55 years) (OR 1.9; 95%CI: 1.6-2.4), obesity (OR 1.6; 95%CI: 1.3-2.0), diabetes (OR 1.6; 95%CI: 1.3-2.0), sedentary lifestyle (OR 1.3; 95%CI: 1.1-1.6) and depressive symptoms (OR 1.3; 95%CI: 1.1-1.6). CONCLUSION: To improve the CR program completion rate, clinicians need to consider the impact of socio-demographic, lifestyle, and cardiovascular risk factors on their patients' ability to complete CR. Tailored strategies which target the independent predictors of dropout are required to promote adherence to CR programs and thereby potentially reduce long-term cardiovascular risk.


Assuntos
Reabilitação Cardíaca , Doenças Cardiovasculares , Austrália/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Fatores de Risco de Doenças Cardíacas , Humanos , Estilo de Vida , Estudos Longitudinais , Pessoa de Meia-Idade , Qualidade de Vida , Fatores de Risco
7.
Circ Cardiovasc Qual Outcomes ; 14(3): e007411, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33663224

RESUMO

Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice with an epidemiological coupling appreciated with advancing age, cardiometabolic risk factors, and structural heart disease. This has resulted in a significant public health burden over the years, evident through increasing rates of hospitalization and AF-related clinical encounters. The resultant gap in health care outcomes is largely twinned with suboptimal rates of anticoagulation prescription and adherence, deficits in symptom identification and management, and insufficient comorbid cardiovascular risk factor investigation and modification. In view of these shortfalls in care, the establishment of integrated chronic care models serves as a road map to best clinical practice. The expansion of integrated chronic care programs, which include multidisciplinary team care, nurse-led AF clinics, and use of telemedicine, are expected to improve AF-related outcomes in the coming years. This review will delve into current gaps in AF care and the role of integrated chronic care models in bridging fragmentations in its management.


Assuntos
Fibrilação Atrial , Prestação Integrada de Cuidados de Saúde , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Hospitalização , Humanos , Acidente Vascular Cerebral , Telemedicina
10.
Heart Lung Circ ; 28(8): 1148-1153, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31230792

RESUMO

Embarking on conducting peer reviews for academic journals can present a new and exciting challenge for early career researchers. This article offers succinct guidance about peer review: not only "what to do" (the Good) but also "what not to do" (the Bad) and "what to never do" (the Ugly). It outlines models of peer review and provides an overview of types of reviewer bias, including conflict of interest. More recent developments in journal peer review, such as author-suggested reviewers as well as manipulation of the peer review process are also discussed. A new position of Editorial Fellow at Heart, Lung and Circulation will provide aspiring researchers the opportunity for multi-faceted involvement with peer review at the Journal.


Assuntos
Conhecimento , Revisão por Pares/métodos , Revisão por Pares/normas , Humanos
12.
Heart Lung Circ ; 27(11): 1381-1387, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30278913

RESUMO

BACKGROUND: Rapid Access Cardiology (RAC) services are hospital co-located cardiologist-led outpatient clinics providing prompt assessment and management of chest pain. This service model is part of chest pain management in the United Kingdom. However, little data exists on RAC services in Australia. Our aim was to describe the introduction of RAC services to an Australian tertiary centre (utility, safety, and acceptability). METHODS: Referrals were accepted for low-intermediate risk chest pain. Referrer and patient clinical data was collected prospectively in the first year of RAC - 4 February 2015 to 4 February 2016. Data was linked to hospital presentations/admissions to identify readmissions/mortality data. RESULTS: Among 520 patients (55.0% male, mean age 55.2 years), 87.6% were referred from emergency and 68.4% assessed within 5 days. The final diagnosis was new coronary artery disease (CAD) in 7.9%, and 81.3% had ≥2 cardiovascular risk factors (diabetes, hyperlipidaemia, hypertension, overweight/obesity, smoker, pre-existing CAD, and chronic renal failure). On average, 0.8 cardiac tests were ordered per person. In total, 35 (6.7%) had invasive coronary angiograms, with 51.4% having obstructive CAD. Patients reported in surveys (82.8% response rate) that 93.0% "strongly agreed" RAC services were useful to the community. Referrers were also "very satisfied" with RAC (7/17) or "satisfied" (9/17). Furthermore, of 336 referrals, referrers reported without RAC they would admit the patient in 11.3% of cases. There were 4.8% (25/520) unplanned cardiovascular readmissions and 0.6% (3/520) of these were for acute coronary syndromes and no deaths. CONCLUSIONS: Outpatient RAC services are an accepted, effective and safe pathway for management of low-intermediate risk chest pain.


Assuntos
Doença da Artéria Coronariana/terapia , Encaminhamento e Consulta/organização & administração , Centros de Atenção Terciária/organização & administração , Humanos
14.
Heart Lung Circ ; 27(7): 893-898, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29857977

RESUMO

Adapting the poet Rudyard Kipling's six honest serving men (what and why, when and how, where and who?), this article aims to give early career authors an introduction to writing reviews, both narrative and systematic. In particular, it offers guidance to aspiring authors in deciding what topic to review and what kind of review to write, and outlines a step-wise process that can be adopted from start to finish.


Assuntos
Cardiologia , Medicina Baseada em Evidências , Guias como Assunto , Publicações Periódicas como Assunto/normas , Redação/normas , Humanos
16.
Pathology ; 49(7): 750-756, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29021100

RESUMO

Endomyocardial biopsy (EMB) is a highly-specialised procedure that is associated with some controversy as to its diagnostic role due to its inconsistency in diagnosing a wide variety of cardiac diseases. Given the advances and sophistication in echocardiography and cardiac magnetic resonance imaging (MRI), the vast majority of cardiac diseases can be diagnosed by these non-invasive procedures. Under-sampling and the fact that biopsy site is limited to the right side of the interventricular septum further limits its value. In spite of all these limitations, there still remains a group of pathological conditions that require biopsy for a conclusive diagnosis such as myocarditis, amyloidosis, sarcoidosis and giant cell myocarditis. Correct patient selection and the quantity of tissue samples impart a significant influence on the accuracy of the diagnosis, and thus the value of EMB is variable for each patient. The purpose of this study was to evaluate the role of EMB in patient care, through its ability to either change clinical diagnosis or alter patient management. Our study was based in a single teaching centre. An audit of cardiac biopsies performed over a 10 year period identified 250 patients. We assessed indications, histology, electron microscopic findings, final clinical diagnosis and how they influenced patient management. A definite diagnosis on histology was given in 44 of 250 patients (17.6%). Non-specific findings were observed in the remaining 206 patients (82.4%). Histology influenced patient management in 73 (29.2%) patients. Histological examination in the remaining 177 biopsies (70.8%) did not provide a definite diagnosis or influence patient management. It was additionally found that the number of tissue fragments sampled has significant impact on diagnostic accuracy. A more accurate diagnosis of 45% was obtained when ≥5 fragments were sampled, as compared to 1-3 fragments where accuracy dropped to 20%. Our study indicated that sampling for electron microscopy has very limited value. We found that of 245 biopsies sampled for electron microscopy, only three biopsies (1.2%) had diagnostically useful findings. In our institution procedure related complications were observed in 7 of 250 patients (2.8%). The diagnostic value of EMB is important but limited. Strict triaging of patients according to clinical suspicion and adequate sampling of tissue may increase useful diagnostic information.


Assuntos
Amiloidose/diagnóstico , Cardiopatias/diagnóstico , Miocardite/diagnóstico , Sarcoidose/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Amiloidose/patologia , Amiloidose/cirurgia , Biópsia , Endocárdio/patologia , Endocárdio/cirurgia , Feminino , Cardiopatias/patologia , Cardiopatias/cirurgia , Humanos , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Miocardite/patologia , Miocardite/cirurgia , Sarcoidose/patologia , Sarcoidose/cirurgia , Adulto Jovem
19.
Heart Lung Circ ; 26(7): 724-729, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28117146

RESUMO

BACKGROUND: Extended left internal thoracic artery (LITA) harvesting allows maximal grafting to the anterior and lateral walls with a single ITA conduit. This study evaluates outcomes following the use of a LITA Y graft as the primary grafting strategy. METHODS: Patients who underwent LITA composite Y-grafting (n=198) between 1995 and 2009 were identified from a cardiac surgical database. Follow-up (mean 13.1 years) was obtained by cross-reference with the state death registry and local cardiology databases. RESULTS: Operative mortality was zero in the 168 patients who underwent isolated CABG and was 3.5% overall. There were no episodes of perioperative myocardial infarction. Kaplan-Meier 10-year survival was 75.9%. Independent predictors of worse late survival were age, diabetes, chronic obstructive pulmonary disease and pre-existing left ventricular dysfunction. There were 53 episodes of post-discharge angiography at an average of 5.8 years post LITA Y grafting. Twenty cases of LITA Y graft failure were identified, predominantly affecting the free limb (n=15). The ratio of symptom driven angiography to Y graft failure increased over time. Eighteen patients required revascularisation, percutaneous intervention in 15 and reoperative coronary bypass in three. CONCLUSIONS: Left Internal Thoracic Artery Y grafting is a feasible revascularisation strategy with satisfactory outcomes. These are comparable to other arterial composite graft configurations. A LITA Y allows efficient conduit use without compromising the in situ LITA graft.


Assuntos
Angiografia Coronária , Ponte de Artéria Coronária/métodos , Bases de Dados Factuais , Artéria Torácica Interna , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
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