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1.
Cochrane Database Syst Rev ; 9: CD006680, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32990327

RESUMO

BACKGROUND: Symptomatic peripheral arterial disease (PAD) has several treatment options, including angioplasty, stenting, exercise therapy, and bypass surgery. Atherectomy is an alternative procedure, in which atheroma is cut or ground away within the artery. This is the first update of a Cochrane Review published in 2014. OBJECTIVES: To evaluate the effectiveness of atherectomy for peripheral arterial disease compared to other established treatments. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine (AMED) databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 12 August 2019. SELECTION CRITERIA: We included all randomised controlled trials that compared atherectomy with other established treatments. All participants had symptomatic PAD with either claudication or critical limb ischaemia and evidence of lower limb arterial disease. DATA COLLECTION AND ANALYSIS: Two review authors screened studies for inclusion, extracted data, assessed risk of bias and used GRADE criteria to assess the certainty of the evidence. We resolved any disagreements through discussion. Outcomes of interest were: primary patency (at six and 12 months), all-cause mortality, fatal and non-fatal cardiovascular events, initial technical failure rates, target vessel revascularisation rates (TVR; at six and 12 months); and complications. MAIN RESULTS: We included seven studies, with a total of 527 participants and 581 treated lesions. We found two comparisons: atherectomy versus balloon angioplasty (BA) and atherectomy versus BA with primary stenting. No studies compared atherectomy with bypass surgery. Overall, the evidence from this review was of very low certainty, due to a high risk of bias, imprecision and inconsistency. Six studies (372 participants, 427 treated lesions) compared atherectomy versus BA. We found no clear difference between atherectomy and BA for the primary outcomes: six-month primary patency rates (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.94 to 1.20; 3 studies, 186 participants; very low-certainty evidence); 12-month primary patency rates (RR 1.20, 95% CI 0.78 to 1.84; 2 studies, 149 participants; very low-certainty evidence) or mortality rates (RR 0.50, 95% CI 0.10 to 2.66, 3 studies, 210 participants, very low-certainty evidence). One study reported cardiac failure and acute coronary syndrome as causes of death at 24 months but it was unclear which arm the participants belonged to, and one study reported no cardiovascular events. There was no clear difference when examining: initial technical failure rates (RR 0.48, 95% CI 0.22 to 1.08; 6 studies, 425 treated vessels; very low-certainty evidence), six-month TVR (RR 0.51, 95% CI 0.06 to 4.42; 2 studies, 136 treated vessels; very low-certainty evidence) or 12-month TVR (RR 0.59, 95% CI 0.25 to 1.42; 3 studies, 176 treated vessels; very low-certainty evidence). All six studies reported complication rates (RR 0.69, 95% CI 0.28 to 1.68; 6 studies, 387 participants; very low-certainty evidence) and embolisation events (RR 2.51, 95% CI 0.64 to 9.80; 6 studies, 387 participants; very low-certainty evidence). Atherectomy may be less likely to cause dissection (RR 0.28, 95% CI 0.14 to 0.54; 4 studies, 290 participants; very low-certainty evidence) and may be associated with a reduction in bailout stenting (RR 0.26, 95% CI 0.09 to 0.74; 4 studies, 315 treated vessels; very low-certainty evidence). Four studies reported amputation rates, with only one amputation event recorded in a BA participant. We used subgroup analysis to compare the effect of plain balloons/stents and drug-eluting balloons/stents, but did not detect any differences between the subgroups. One study (155 participants, 155 treated lesions) compared atherectomy versus BA and primary stenting, so comparison was extremely limited and subject to imprecision. This study did not report primary patency. The study reported one death (RR 0.38, 95% CI 0.04 to 3.23; 155 participants; very low-certainty evidence) and three complication events (RR 7.04, 95% CI 0.80 to 62.23; 155 participants; very low-certainty evidence) in a very small data set, making conclusions unreliable. We found no clear difference between the treatment arms in cardiovascular events (RR 0.38, 95% CI 0.04 to 3.23; 155 participants; very low-certainty evidence). This study found no initial technical failure events, and TVR rates at six and 24 months showed little difference between treatment arms (RR 2.27, 95% CI 0.95 to 5.46; 155 participants; very low-certainty evidence and RR 2.05, 95% CI 0.96 to 4.37; 155 participants; very low-certainty evidence, respectively). AUTHORS' CONCLUSIONS: This review update shows that the evidence is very uncertain about the effect of atherectomy on patency, mortality and cardiovascular event rates compared to plain balloon angioplasty, with or without stenting. We detected no clear differences in initial technical failure rates or TVR, but there may be reduced dissection and bailout stenting after atherectomy although this is uncertain. Included studies were small, heterogenous and at high risk of bias. Larger studies powered to detect clinically meaningful, patient-centred outcomes are required.


Assuntos
Angioplastia com Balão/métodos , Aterectomia/métodos , Doença Arterial Periférica/terapia , Síndrome Coronariana Aguda/mortalidade , Angioplastia com Balão/mortalidade , Aterectomia/mortalidade , Causas de Morte , Insuficiência Cardíaca/mortalidade , Humanos , Doença Arterial Periférica/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents
2.
Cochrane Database Syst Rev ; 9: CD012780, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32996586

RESUMO

BACKGROUND: Serious illness is often characterised by physical/psychological problems, family support needs, and high healthcare resource use. Hospital-based specialist palliative care (HSPC) has developed to assist in better meeting the needs of patients and their families and potentially reducing hospital care expenditure. There is a need for clarity on the effectiveness and optimal models of HSPC, given that most people still die in hospital and also to allocate scarce resources judiciously. OBJECTIVES: To assess the effectiveness and cost-effectiveness of HSPC compared to usual care for adults with advanced illness (hereafter patients) and their unpaid caregivers/families. SEARCH METHODS: We searched CENTRAL, CDSR, DARE and HTA database via the Cochrane Library; MEDLINE; Embase; CINAHL; PsycINFO; CareSearch; National Health Service Economic Evaluation Database (NHS EED) and two trial registers to August 2019, together with checking of reference lists and relevant systematic reviews, citation searching and contact with experts to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the impact of HSPC on outcomes for patients or their unpaid caregivers/families, or both. HSPC was defined as specialist palliative care delivered by a palliative care team that is based in a hospital providing holistic care, co-ordination by a multidisciplinary team, and collaboration between HSPC providers and generalists. HSPC was provided to patients while they were admitted as inpatients to acute care hospitals, outpatients or patients receiving care from hospital outreach teams at home. The comparator was usual care, defined as inpatient or outpatient hospital care without specialist palliative care input at the point of entry into the study, community care or hospice care provided outside of the hospital setting. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We assessed risk of bias and extracted data. To account for use of different scales across studies, we calculated standardised mean differences (SMDs) with 95% confidence intervals (CIs) for continuous data. We used an inverse variance random-effects model. For binary data, we calculated odds ratio (ORs) with 95% CIs. We assessed the evidence using GRADE and created a 'Summary of findings' table. Our primary outcomes were patient health-related quality of life (HRQoL) and symptom burden (a collection of two or more symptoms). Key secondary outcomes were pain, depression, satisfaction with care, achieving preferred place of death, mortality/survival, unpaid caregiver burden, and cost-effectiveness. Qualitative data was analysed where available. MAIN RESULTS: We identified 42 RCTs involving 7779 participants (6678 patients and 1101 caregivers/family members). Twenty-one studies were with cancer populations, 14 were with non-cancer populations (of which six were with heart failure patients), and seven with mixed cancer and non-cancer populations (mixed diagnoses). HSPC was offered in different ways and included the following models: ward-based, inpatient consult, outpatient, hospital-at-home or hospital outreach, and service provision across multiple settings which included hospital. For our main analyses, we pooled data from studies reporting adjusted endpoint values. Forty studies had a high risk of bias in at least one domain. Compared with usual care, HSPC improved patient HRQoL with a small effect size of 0.26 SMD over usual care (95% CI 0.15 to 0.37; I2 = 3%, 10 studies, 1344 participants, low-quality evidence, higher scores indicate better patient HRQoL). HSPC also improved other person-centred outcomes. It reduced patient symptom burden with a small effect size of -0.26 SMD over usual care (95% CI -0.41 to -0.12; I2 = 0%, 6 studies, 761 participants, very low-quality evidence, lower scores indicate lower symptom burden). HSPC improved patient satisfaction with care with a small effect size of 0.36 SMD over usual care (95% CI 0.41 to 0.57; I2 = 0%, 2 studies, 337 participants, low-quality evidence, higher scores indicate better patient satisfaction with care). Using home death as a proxy measure for achieving patient's preferred place of death, patients were more likely to die at home with HSPC compared to usual care (OR 1.63, 95% CI 1.23 to 2.16; I2 = 0%, 7 studies, 861 participants, low-quality evidence). Data on pain (4 studies, 525 participants) showed no evidence of a difference between HSPC and usual care (SMD -0.16, 95% CI -0.33 to 0.01; I2 = 0%, very low-quality evidence). Eight studies (N = 1252 participants) reported on adverse events and very low-quality evidence did not demonstrate an effect of HSPC on serious harms. Two studies (170 participants) presented data on caregiver burden and both found no evidence of effect of HSPC (very low-quality evidence). We included 13 economic studies (2103 participants). Overall, the evidence on cost-effectiveness of HSPC compared to usual care was inconsistent among the four full economic studies. Other studies that used only partial economic analysis and those that presented more limited resource use and cost information also had inconsistent results (very low-quality evidence). Quality of the evidence The quality of the evidence assessed using GRADE was very low to low, downgraded due to a high risk of bias, inconsistency and imprecision. AUTHORS' CONCLUSIONS: Very low- to low-quality evidence suggests that when compared to usual care, HSPC may offer small benefits for several person-centred outcomes including patient HRQoL, symptom burden and patient satisfaction with care, while also increasing the chances of patients dying in their preferred place (measured by home death). While we found no evidence that HSPC causes serious harms, the evidence was insufficient to draw strong conclusions. Although these are only small effect sizes, they may be clinically relevant at an advanced stage of disease with limited prognosis, and are person-centred outcomes important to many patients and families. More well conducted studies are needed to study populations with non-malignant diseases and mixed diagnoses, ward-based models of HSPC, 24 hours access (out-of-hours care) as part of HSPC, pain, achieving patient preferred place of care, patient satisfaction with care, caregiver outcomes (satisfaction with care, burden, depression, anxiety, grief, quality of life), and cost-effectiveness of HSPC. In addition, research is needed to provide validated person-centred outcomes to be used across studies and populations.


Assuntos
Cuidadores/estatística & dados numéricos , Serviços Hospitalares de Assistência Domiciliar/economia , Cuidados Paliativos/economia , Cuidados Paliativos/métodos , Assistência Terminal/economia , Assistência Terminal/métodos , Assistência Ambulatorial/economia , Viés , Cuidadores/psicologia , Análise Custo-Benefício , Família , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Hospitalização/economia , Humanos , Neoplasias/mortalidade , Neoplasias/terapia , Manejo da Dor/estatística & dados numéricos , Satisfação do Paciente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Avaliação de Sintomas/estatística & dados numéricos
3.
PLoS One ; 15(9): e0238829, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32997657

RESUMO

BACKGROUND: Patients with comorbid conditions have a higher risk of mortality with SARS-CoV-2 (COVID-19) infection, but the impact on heart failure patients living near a disease hotspot is unknown. Therefore, we sought to characterize the prevalence and outcomes of COVID-19 in a live registry of heart failure patients across an integrated health care system in Connecticut. METHODS: In this retrospective analysis, the Yale Heart Failure Registry (NCT04237701) that includes 26,703 patients with heart failure across a 6-hospital integrated health care system in Connecticut was queried on April 16th, 2020 for all patients tested for COVID-19. Sociodemographic and geospatial data as well as, clinical management, respiratory failure, and patient mortality were obtained via the real-time registry. Data on COVID-19 specific care was extracted by retrospective chart review. RESULTS: COVID-19 testing was performed on 900 symptomatic patients, comprising 3.4% of the Yale Heart Failure Registry (N = 26,703). Overall, 206 (23%) were COVID- 19+. As compared to COVID-19-, these patients were more likely to be older, black, have hypertension, coronary artery disease, and were less likely to be on renin angiotensin blockers (P<0.05, all). COVID-19- patients tended to be more diffusely spread across the state whereas COVID-19+ were largely clustered around urban centers. 20% of COVID-19+ patients died, and age was associated with increased risk of death [OR 1.92 95% CI (1.33-2.78); P<0.001]. Among COVID-19+ patients who were ≥85 years of age rates of hospitalization were 87%, rates of death 36%, and continuing hospitalization 62% at time of manuscript preparation. CONCLUSIONS: In this real-world snapshot of COVID-19 infection among a large cohort of heart failure patients, we found that a small proportion had undergone testing. Patients found to be COVID-19+ tended to be black with multiple comorbidities and clustered around lower socioeconomic status communities. Elderly COVID-19+ patients were very likely to be admitted to the hospital and experience high rates of mortality.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Insuficiência Cardíaca/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Sistema de Registros , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Estudos de Coortes , Comorbidade , Connecticut , Prestação Integrada de Cuidados de Saúde , Feminino , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos
4.
High Blood Press Cardiovasc Prev ; 27(5): 399-408, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32770527

RESUMO

INTRODUCTION: The association of patients with heart failure (HF) and preserved ejection fraction (HFpEF) and with type 2 diabetes mellitus (T2DM) is strong and related additionally to blood pressure (BP). AIMS: To analyze distinctive clinical profiles among patients with HFpEF both with and without T2DM. METHODS: The study was based on a Spanish National Registry (multicenter and prospective) of patients with HF (DICUMAP), that enrolled outpatients with HF who underwent an ambulatory BP monitoring (ABPM) and then were followed-up for 1 year. We categorized patients according to the presence/absence of T2DM then building different clusters based on K-medoids algorithm. RESULTS: 103 patients were included. T2DM was present in 44.7%. The patients with T2DM were grouped into two clusters and those without T2DM into three. All patients with T2DM had kidney disease and anemia. Among them, cluster 2 had higher systolic blood pressure and pulse pressure (PP) with a bad outcome (p = 0.03) regarding HF mortality and readmissions, influenced by eGFR (HR 0.93, 95% CI 0.97-0.87, p = 0.04), and hemoglobin (HR 0.65, 95% CI 0.71-0.63, p = 0.03). Among those without T2DM, cluster 3 had a pathological ABPM pattern with the highest PP, cluster 4 was slightly similar to cluster 2, and cluster 5 expressed a more benign pattern without differences on both, HF mortality and readmissions. CONCLUSIONS: Patients with HFpEF and T2DM expressed two different profiles depending on neurohormonal activation and arterial stiffness with prognostic implications. Patients without T2DM showed three profiles depending on ABPM pattern, kidney disease and PP without prognostic repercussion.


Assuntos
Pressão Sanguínea , Diabetes Mellitus Tipo 2/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Volume Sistólico , Função Ventricular Esquerda , Idoso , Idoso de 80 Anos ou mais , Anemia/mortalidade , Anemia/fisiopatologia , Monitorização Ambulatorial da Pressão Arterial , Análise por Conglomerados , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/terapia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Humanos , Nefropatias/mortalidade , Nefropatias/fisiopatologia , Masculino , Readmissão do Paciente , Prognóstico , Sistema de Registros , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo
5.
Am Heart J ; 228: 57-64, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32828047

RESUMO

AIMS: Data regarding outcomes for patients with severe aortic stenosis (AS) with concomitant aortic insufficiency (AI), undergoing transcatheter aortic valve replacement (TAVR) are limited. This study aimed to analyze the prevalence of severe AS with concomitant AI among patients undergoing TAVR and outcomes of TAVR in this patient group. METHODS AND RESULTS: Using data from the STS/ACC-TVT Registry, we identified patients with severe AS with or without concomitant AI who underwent TAVR between 2011 and 2016. Patients were categorized based on the severity of pre-procedural AI. Multivariable proportional hazards regression models were used to examine all-cause mortality and heart failure (HF) hospitalization at 1-year. Among 54,535 patients undergoing TAVR, 42,568 (78.1%) had severe AS with concomitant AI. Device success was lower in patients with severe AS with concomitant AI as compared with isolated AS. The presence of baseline AI was associated with lower 1 year mortality (HR 0.94 per 1 grade increase in AI severity; 95% CI, 0.91-0.98, P < .001) and HF hospitalization (HR 0.87 per 1 grade increase in AI severity; 95% CI, 0.84-0.91, P < .001). CONCLUSIONS: Severe AS with concomitant AI is common among patients undergoing TAVR, and is associated with lower 1 year mortality and HF hospitalization. Future studies are warranted to better understand the mechanisms underlying this benefit. SHORT ABSTRACT: In this nationally representative analysis from the United States, 78.1% of patients undergoing TAVR had severe AS with concomitant AI. Device success was lower in patients with severe AS with concomitant AI as compared with isolated AS. The presence of baseline AI was associated with lower 1 year mortality (HR 0.94 per 1 grade increase in AI severity; 95% CI, 0.91-0.98, P < .001) and HF hospitalization (HR 0.87 per 1 grade increase in AI severity; 95% CI, 0.84-0.91, P < .001).


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Valva Aórtica , Insuficiência Cardíaca , Complicações Pós-Operatórias , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/cirurgia , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Próteses Valvulares Cardíacas , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Sistema de Registros/estatística & dados numéricos , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Estados Unidos/epidemiologia
6.
Ther Adv Cardiovasc Dis ; 14: 1753944720939383, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32715944

RESUMO

This review focuses on the pathogenic role of sodium glucose cotransporter (SGLT)-2 in the development of renal dysfunction and heart failure in patients with diabetes, by emphasizing the concept of reno-cardiac syndrome (kidney injury worsens cardiac condition) and by substantiating the deleterious effect of sympathetic overdrive in this context. Furthermore, the review proposes a mechanistic hypothesis to explain the benefits of SGLT2 inhibitors, specifically that SGLT-2 inhibitors reduce sympathetic activation at the renal level. To illustrate this point, several examples from both animal experiments and clinical observations are introduced. The bidirectional interaction of the heart and kidney were deeply implicated as an exacerbator of heart failure and renal failure without diabetes. Renal cortical ischemia and abnormal glucose metabolism of tubular epithelial cells are likely to exist as common pathologies in nondiabetic heart failure patients. It is no wonder why SGLT-2 inhibitors are specifically being studied even in the absence of diabetes, both for heart failure and also for renal failure.


Assuntos
Síndrome Cardiorrenal/tratamento farmacológico , Nefropatias Diabéticas/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Coração/inervação , Rim/inervação , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Sistema Nervoso Simpático/efeitos dos fármacos , Animais , Síndrome Cardiorrenal/mortalidade , Síndrome Cardiorrenal/fisiopatologia , Nefropatias Diabéticas/mortalidade , Nefropatias Diabéticas/fisiopatologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Fatores de Risco , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Sistema Nervoso Simpático/fisiopatologia , Resultado do Tratamento
7.
Angiology ; 71(10): 948-954, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32705877

RESUMO

We aimed to predict in-hospital mortality of elderly patients with heart failure (HF) by using a risk score model which could be easily applied in routine clinical practice without using an electronic calculator. The study population (n = 1034) recruited from the Journey HF-TR (Patient Journey in Hospital with Heart Failure in Turkish Population) study was divided into a derivation and a validation cohort. The parameters related to in-hospital mortality were first analyzed by univariate analysis, then the variables found to be significant in that analysis were entered into a stepwise multivariate logistic regression (LR) analysis. Patients were classified as low, intermediate, and high risk. A risk score obtained by taking into account the regression coefficients of the significant variables as a result of the LR analysis was tested in the validation cohort using receiver operating characteristic curve analysis. In total, 6 independent variables (age, blood urea nitrogen, previous history of hemodialysis/hemofiltration, inotropic agent use, and length of intensive care stay) associated with in-hospital mortality were included in the analysis. The risk score had a good discrimination in both the derivation and validation cohorts. A new validated risk score to determine the risk of in-hospital mortality of elderly hospitalized patients with HF was developed by including 6 independent predictors.


Assuntos
Insuficiência Cardíaca/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Turquia
8.
Medicine (Baltimore) ; 99(29): e19703, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702806

RESUMO

Long-chain non-coding RNA (lncRNA) Myosin Heavy Chain Associated RNA Transcripts (MHRT) are newly identified cardioprotective lncRNAs. In this study, we investigated the association of MHRT gene single nucleotide polymorphisms with risk and prognosis of chronic heart failure (CHF).Sanger sequencing was performed to detect the genotypes of rs3729830, rs7140721, rs76614781, rs3729829, rs3729828, rs3729825, and rs3729822 loci in the non-coding region of the MHRT gene from 240 patients with CHF and 240 control subjects. After 3 years of follow-up, progression-free survival was recorded in patients with CHF.The risk of CHF in subjects carrying A allele of the MHRT gene rs7140721 locus was 1.43 times higher than that of C allele carriers (95% CI: 1.23-1.62, P < .001). The risk of CHF in subjects carrying A allele of the rs3729829 locus was 1.41 times higher than that of G allele carriers (95% CI: 1.20-1.61, P < .01). The risk of CHF in the carriers of T allele of the rs3729825 locus was 1.89 times higher than that of C allele carriers (adjusted OR = 1.89, 95% CI: 1.66-2.04, P < .01). Further, the level of lncRNA MHRT in the plasma of subjects carrying CA/AA genotype of the rs7140721 locus was significantly higher than that of subjects carrying the CC genotype. The level of lncRNA MHRT in the plasma of subjects carrying GA/AA genotype of the rs3729829 locus was significantly higher than that of subjects carrying the GG genotype. In addition, the level of lncRNA MHRT in subjects with CT/TT genotype of the rs3729825 locus carriers was significantly higher than that in subjects with the CC genotype (P < .05). In addition, significant differences in the mortality of patients with CHF were observed between different genotypes of rs7140721, rs3729829, and rs3729825 loci (P < .001).The single nucleotide polymorphisms of MHRT gene rs7140721, rs3729829, and rs3729825 loci were associated with the risk of CHF and prognosis.


Assuntos
Insuficiência Cardíaca/sangue , Cadeias Pesadas de Miosina/metabolismo , Polimorfismo de Nucleotídeo Único/genética , RNA Longo não Codificante/genética , Idoso , Alelos , Cardiotônicos , Estudos de Casos e Controles , Doença Crônica , Feminino , Seguimentos , Genótipo , Insuficiência Cardíaca/mortalidade , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Intervalo Livre de Progressão
9.
Arch Cardiovasc Dis ; 113(6-7): 461-472, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32653240

RESUMO

Heart failure affects more than 30 million people worldwide and its prevalence is constantly rising. In 2020, heart transplantation is the only curative treatment, but left ventricular assistance devices (LVADs) are fully integrated into the decision algorithm for management of patients with advanced heart failure, with more than 20,000 devices implanted worldwide in the last decade. Intended to support cardiac output, LVADs remove the blood from the left ventricle and eject it into the proximal aorta. Whereas first-generation LVADs were pulsatile, second- and third-generation LVADs are more reliable, but create a laminar flow, with reduced (or absent) blood flow pulsatility. Concomitantly, several new adverse events, some of them lethal, appeared when continuous-flow LVADs started to be implanted, including acquired von Willebrand disease, gastrointestinal bleeding and aortic valve fusion or regurgitation. This review aims to apply models describing pulsatility (such as the Windkessel effect applied by Frank, Guyton's continuity model of venous return and Sunagawa's left ventricular-arterial coupling) to LVADs, to better understand the physiopathology in patients using continuous-flow devices. This review also covers the means of exploring pulsatility and adverse events associated with a reduction in pulsatility, as well as the possible ways for restoring pulsatility in patients implanted with an LVAD.


Assuntos
Insuficiência Cardíaca/terapia , Coração Auxiliar , Hemodinâmica , Implantação de Prótese/instrumentação , Função Ventricular Esquerda , Animais , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Modelos Cardiovasculares , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/mortalidade , Fluxo Pulsátil , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento
10.
Diab Vasc Dis Res ; 17(4): 1479164120945674, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32722930

RESUMO

AIM: We examined eligibility and preventable cardiovascular disease events in US adults with diabetes mellitus from the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME). METHODS: We identified adults with diabetes mellitus eligible for EMPA-REG OUTCOME based on trial eligibility criteria available from the National Health and Nutrition Examination Surveys, 2007-2016. We estimated composite cardiovascular disease endpoints, as well as all-cause deaths, death from cardiovascular disease and hospitalizations for heart failure from trial treatment and placebo event rates, the difference indicating the preventable events. RESULTS: Among 29,629 US adults aged ⩾18 years (representing 231.9 million), 4672 (27.3 million) had diabetes mellitus, with 342 (1.86 million) meeting eligibility criteria of EMPA-REG OUTCOME. We estimated from trial primary endpoint event rates of 10.5% and 12.1% in the empagliflozin and placebo groups, respectively, that based on the 'treatment' of our 1.86 million estimated EMPA-REG OUTCOME eligible subjects, 12,066 (95% confidence interval: 10,352-13,780) cardiovascular disease events could be prevented annually. Estimated annual preventable deaths from any cause, cardiovascular causes and hospitalizations from heart failure were 17,078 (95% confidence interval: 14,652-19,504), 14,479 (95% confidence interval: 12,422-16,536) and 9467 (95% confidence interval: 8122-10,812), respectively. CONCLUSION: Empagliflozin, if provided to EMPA-REG OUTCOME eligible US adults, may prevent many cardiovascular disease events, cardiovascular and total deaths, as well as heart failure hospitalizations.


Assuntos
Compostos Benzidrílicos/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Tomada de Decisão Clínica , Diabetes Mellitus Tipo 2/tratamento farmacológico , Definição da Elegibilidade , Glucosídeos/uso terapêutico , Seleção de Pacientes , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Ensaios Clínicos como Assunto , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/mortalidade , Progressão da Doença , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/prevenção & controle , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
11.
Cochrane Database Syst Rev ; 7: CD007037, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32700759

RESUMO

BACKGROUND: Beta-blockers are an essential part of standard therapy in adult congestive heart failure and therefore, are expected to be beneficial in children. However, congestive heart failure in children differs from that in adults in terms of characteristics, aetiology, and drug clearance. Therefore, paediatric needs must be specifically investigated. This is an update of a Cochrane review previously published in 2009. OBJECTIVES: To assess the effect of beta-adrenoceptor-blockers (beta-blockers) in children with congestive heart failure. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and LILACS up to November 2015. Bibliographies of identified studies were checked. No language restrictions were applied. SELECTION CRITERIA: Randomised, controlled, clinical trials investigating the effect of beta-blocker therapy on paediatric congestive heart failure. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted and assessed data from the included trials. MAIN RESULTS: We identified four new studies for the review update; the review now includes seven studies with 420 participants. Four small studies with 20 to 30 children each, and two larger studies of 80 children each, showed an improvement of congestive heart failure with beta-blocker therapy. A larger study with 161 participants showed no evidence of benefit over placebo in a composite measure of heart failure outcomes. The included studies showed no significant difference in mortality or heart transplantation rates between the beta-blocker and control groups. No significant adverse events were reported with beta-blockers, apart from one episode of complete heart block. A meta-analysis of left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) data showed a very small improvement with beta-blockers. However, there were vast differences in the age, age range, and health of the participants (aetiology and severity of heart failure; heterogeneity of diagnoses and co-morbidities); there was a range of treatments across studies (choice of beta-blocker, dosing, duration of treatment); and a lack of standardised methods and outcome measures. Therefore, the primary outcomes could not be pooled in meta-analyses. AUTHORS' CONCLUSIONS: There is not enough evidence to support or discourage the use of beta-blockers in children with congestive heart failure, or to propose a paediatric dosing scheme. However, the sparse data available suggested that children with congestive heart failure might benefit from beta-blocker treatment. Further investigations in clearly defined populations with standardised methodology are required to establish guidelines for therapy. Pharmacokinetic investigations of beta-blockers in children are also required to provide effective dosing in future trials.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Adolescente , Carbazóis/uso terapêutico , Carvedilol , Criança , Pré-Escolar , Insuficiência Cardíaca/mortalidade , Transplante de Coração/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Metoprolol/uso terapêutico , Propanolaminas/uso terapêutico , Propranolol/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Volume Sistólico
12.
PLoS One ; 15(7): e0236827, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730362

RESUMO

BACKGROUND: Heart failure (HF) is a major cause of morbidity and mortality. However, much of the clinical data is unstructured in the form of radiology reports, while the process of data collection and curation is arduous and time-consuming. PURPOSE: We utilized a machine learning (ML)-based natural language processing (NLP) approach to extract clinical terms from unstructured radiology reports. Additionally, we investigate the prognostic value of the extracted data in predicting all-cause mortality (ACM) in HF patients. MATERIALS AND METHODS: This observational cohort study utilized 122,025 thoracoabdominal computed tomography (CT) reports from 11,808 HF patients obtained between 2008 and 2018. 1,560 CT reports were manually annotated for the presence or absence of 14 radiographic findings, in addition to age and gender. Thereafter, a Convolutional Neural Network (CNN) was trained, validated and tested to determine the presence or absence of these features. Further, the ability of CNN to predict ACM was evaluated using Cox regression analysis on the extracted features. RESULTS: 11,808 CT reports were analyzed from 11,808 patients (mean age 72.8 ± 14.8 years; 52.7% (6,217/11,808) male) from whom 3,107 died during the 10.6-year follow-up. The CNN demonstrated excellent accuracy for retrieval of the 14 radiographic findings with area-under-the-curve (AUC) ranging between 0.83-1.00 (F1 score 0.84-0.97). Cox model showed the time-dependent AUC for predicting ACM was 0.747 (95% confidence interval [CI] of 0.704-0.790) at 30 days. CONCLUSION: An ML-based NLP approach to unstructured CT reports demonstrates excellent accuracy for the extraction of predetermined radiographic findings, and provides prognostic value in HF patients.


Assuntos
Insuficiência Cardíaca/mortalidade , Processamento de Imagem Assistida por Computador/métodos , Processamento de Linguagem Natural , Redes Neurais de Computação , Radiografia Abdominal/métodos , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Estudos de Coortes , Registros Eletrônicos de Saúde , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/patologia , Humanos , Aprendizado de Máquina , Masculino , Prognóstico , Taxa de Sobrevida
13.
PLoS One ; 15(7): e0235152, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634145

RESUMO

BACKGROUND: The prognostic value of chronic obstructive pulmonary disease (COPD) as a comorbidity in heart failure has been well documented. However, the role of pulmonary function indices in patients with heart failure and preserved ejection fraction (HFpEF) remains to be elucidated. METHODS: Subjects with HFpEF received pulmonary function tests and echocardiogram. Total lung capacity (TLC), residual volume (RV), forced expiratory flow rate between 25% and 75% of vital capacity (FEF25-75), forced expiratory volume in the 1st second (FEV1), forced vital capacity (FVC), and vital capacity (VC) were measured. Echocardiographic indices, including pulmonary artery systolic pressure (PASP), the ratio of early ventricular filling flow velocity to the septal mitral annulus tissue velocity (E/e'), and left ventricular mass (LVM), were recorded. National Death Registry was linked for the identification of mortality. RESULTS: A total of 1194 patients (72.4±13.2 years, 59% men) were enrolled. PASP, E/e' and LVM were associated with either obstructive (RV/TLC, FEV1 and FEF25-75) or restrictive (VC and TLC) ventilatory indices. During a mean follow-up of 23.0±12.8 months, 182 patients died. Subjects with COPD had a lower survival rate than those without COPD. While VC, FVC, RV/TLC, and FEV1 were all independently associated with all-cause mortality in patients without COPD, only FEF25-75 was predictive of outcomes in those with COPD. CONCLUSIONS: The abnormalities of pulmonary function were related to the cardiac hemodynamics in patients with HFpEF. In addition, these ventilatory indices were independently associated with long-term mortality, especially in those without COPD.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Volume Sistólico/fisiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Testes de Função Respiratória , Taxa de Sobrevida
14.
Infez Med ; 28(2): 238-242, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: covidwho-528245

RESUMO

The present study is aimed to assess the risk factors for mortality in the first 107 rRT-PCR confirmed cases of SARS-CoV-2 infections in Bolivia. For this observational, retrospective and cross-sectional study, the epidemiological data records were collected from the Hospitals and the Ministry of Health of Bolivia, obtaining the clinical and epidemiological data of the COVID-19 cases that were laboratory-diagnosed during March 2-29, 2020. Samples were tested by rRT-PCR to SARS-CoV-2 at the Laboratory of the National Center of Tropical Diseases (CENETROP), following the protocol Charite, Berlin, Germany. The odds ratio (OR) with respective 95% confidence interval (95%CI) for mortality as dependent variable was calculated. When we comparatively analyzed survivors and non-survivors in this first group of 107 cases in Bolivia, we found that at bivariate analyses, age (±60 years old), hypertension, chronic heart failure, diabetes, and obesity, as well as the requirement of ICU, were significantly exposure variables associated with death. At the multivariate analysis (logistic regression), two variables remained significantly associated, age, ±60 years-old (OR=9.4, 95%CI 1.8-104.1) and hypertension (OR=3.3, 95%CI 1.3-6.3). As expected, age and comorbidities, particularly hypertension, were independent risk factors for mortality in Bolivia in the first 107 cases group. More further studies are required to better define risk factors and preventive measures related to COVID-19 in this and other Latin American countries.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bolívia/epidemiologia , Criança , Intervalos de Confiança , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Complicações do Diabetes/mortalidade , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Obesidade/mortalidade , Razão de Chances , Pandemias , Pneumonia Viral/epidemiologia , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Adulto Jovem
15.
Int J Med Sci ; 17(9): 1281-1292, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-602629

RESUMO

Rationale: Up to date, the exploration of clinical features in severe COVID-19 patients were mostly from the same center in Wuhan, China. The clinical data in other centers is limited. This study aims to explore the feasible parameters which could be used in clinical practice to predict the prognosis in hospitalized patients with severe coronavirus disease-19 (COVID-19). Methods: In this case-control study, patients with severe COVID-19 in this newly established isolation center on admission between 27 January 2020 to 19 March 2020 were divided to discharge group and death event group. Clinical information was collected and analyzed for the following objectives: 1. Comparisons of basic characteristics between two groups; 2. Risk factors for death on admission using logistic regression; 3. Dynamic changes of radiographic and laboratory parameters between two groups in the course. Results: 124 patients with severe COVID-19 on admission were included and divided into discharge group (n=35) and death event group (n=89). Sex, SpO2, breath rate, diastolic pressure, neutrophil, lymphocyte, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), and D-dimer were significantly correlated with death events identified using bivariate logistic regression. Further multivariate logistic regression demonstrated a significant model fitting with C-index of 0.845 (p<0.001), in which SpO2≤89%, lymphocyte≤0.64×109/L, CRP>77.35mg/L, PCT>0.20µg/L, and LDH>481U/L were the independent risk factors with the ORs of 2.959, 4.015, 2.852, 3.554, and 3.185, respectively (p<0.04). In the course, persistently lower lymphocyte with higher levels of CRP, PCT, IL-6, neutrophil, LDH, D-dimer, cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and increased CD4+/CD8+ T-lymphocyte ratio and were observed in death events group, while these parameters stayed stable or improved in discharge group. Conclusions: On admission, the levels of SpO2, lymphocyte, CRP, PCT, and LDH could predict the prognosis of severe COVID-19 patients. Systematic inflammation with induced cardiac dysfunction was likely a primary reason for death events in severe COVID-19 except for acute respiratory distress syndrome.


Assuntos
Betacoronavirus/isolamento & purificação , Causas de Morte , Infecções por Coronavirus/mortalidade , Insuficiência Cardíaca/mortalidade , Pneumonia Viral/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Idoso , Betacoronavirus/patogenicidade , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , China/epidemiologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/virologia , Humanos , L-Lactato Desidrogenase/sangue , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Oximetria , Oxigênio/sangue , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Pró-Calcitonina/sangue , Prognóstico , Curva ROC , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/virologia
16.
J Card Fail ; 26(7): 626-632, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32544622

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a respiratory syndrome with high rates of mortality, and there is a need for easily obtainable markers to provide prognostic information. We sought to determine whether the electrocardiogram (ECG) on hospital presentation provides prognostic information, specifically related to death. METHODS AND RESULTS: We performed a retrospective cohort study in patients with COVID-19 who had an ECG at or near hospital admission. Clinical characteristics and ECG variables were manually abstracted from the electronic health record and first ECG. Our primary outcome was death. THERE WERE: 756 patients who presented to a large New York City teaching hospital with COVID-19 who underwent an ECG. The mean age was 63.3 ± 16 years, 37% were women, 61% of patients were nonwhite, and 57% had hypertension; 90 (11.9%) died. In a multivariable logistic regression that included age, ECG, and clinical characteristics, the presence of one or more atrial premature contractions (odds ratio [OR] 2.57, 95% confidence interval [CI] 1.23-5.36, P = .01), a right bundle branch block or intraventricular block (OR 2.61, 95% CI 1.32-5.18, P = .002), ischemic T-wave inversion (OR 3.49, 95% CI 1.56-7.80, P = .002), and nonspecific repolarization (OR 2.31, 95% CI 1.27-4.21, P = .006) increased the odds of death. ST elevation was rare (n = 5 [0.7%]). CONCLUSIONS: We found that patients with ECG findings of both left-sided heart disease (atrial premature contractions, intraventricular block, repolarization abnormalities) and right-sided disease (right bundle branch block) have higher odds of death. ST elevation at presentation was rare.


Assuntos
Betacoronavirus , Bloqueio de Ramo/mortalidade , Infecções por Coronavirus/mortalidade , Eletrocardiografia/mortalidade , Insuficiência Cardíaca/mortalidade , Pneumonia Viral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Eletrocardiografia/métodos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Estudos Retrospectivos
17.
Internist (Berl) ; 61(8): 854-859, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32504300

RESUMO

A case report is presented of fulminant hydroxychloroquine-induced cardiomyopathy in a 57 year-old female patient with a long history of systemic lupus erythematosus. Diagnosis was established based on clinical findings, imaging (echocardiography and cardiac magnetic resonance imaging) as well as endomyocardial biopsy. Despite immediate discontinuation of the medication, the patient died from heart failure within a few days. Since the rare adverse effect described here might be reversible, early diagnosis and discontinuation of hydroxychloroquine are crucial for the prognosis of these patients.


Assuntos
Cardiomiopatias/induzido quimicamente , Insuficiência Cardíaca/mortalidade , Hidroxicloroquina/efeitos adversos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Doenças Musculares/induzido quimicamente , Biópsia , Cardiomiopatias/mortalidade , Ecocardiografia , Evolução Fatal , Feminino , Coração/efeitos dos fármacos , Insuficiência Cardíaca/induzido quimicamente , Humanos , Hidroxicloroquina/uso terapêutico , Imagem por Ressonância Magnética , Pessoa de Meia-Idade
19.
Medicine (Baltimore) ; 99(23): e20636, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502045

RESUMO

ABSTRACTS: To examine the impact of increased managed care activity on 30-day readmission and mortality for acute myocardial infarctions and congestive heart failure in U.S. hospitals following the managed care backlash against managed care cost containment practices.The Centers for Medicare and Medicaid Services (CMS) Hospital Compare files, CMS Hospital Cost Report, CMS Medicare Advantage Enrollment files, and Health Resources and Services Administration Area Resource File data for the period 2008 to 2011 were used to construct the study sample. Multivariate fixed effects regression with robust standard errors, hospital fixed effects, and year fixed effects were used to estimate the impact of managed care penetration on adverse cardiovascular outcomes. Our primary outcome measures were readmission and mortality for patients discharged with acute myocardial infarction and congestive heart failure for acute, non-federal hospitals with emergency rooms. To examine effects of hospital ownership status, not-for-profit hospitals were compared to proprietary hospitals.The main analysis revealed that an increase in managed care penetration was associated with a decline in both 30-day readmission and mortality for acute myocardial infarction and congestive heart failure. In the hospital ownership analysis, only the acute myocardial infarction results for proprietary hospitals was statistically significant. All hospital types reported similar congestive heart failure trends as the full sample; however, proprietary hospitals reported greater declines in readmission and mortality.Increased managed care activity is associated with reductions in hospital readmission and mortality following the legislative and consumer backlash against managed care, with differential impacts across hospital ownership type. These finding highlights the important role of managed care in creating quality improvements in the delivery of care in the hospital setting.


Assuntos
Insuficiência Cardíaca/mortalidade , Programas de Assistência Gerenciada/normas , Infarto do Miocárdio/mortalidade , Readmissão do Paciente/estatística & dados numéricos , Centers for Medicare and Medicaid Services, U.S. , Feminino , Hospitais/classificação , Hospitais/estatística & dados numéricos , Humanos , Incidência , Masculino , Programas de Assistência Gerenciada/economia , Programas de Assistência Gerenciada/estatística & dados numéricos , Medicare Part C/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Estados Unidos
20.
Medicine (Baltimore) ; 99(26): e20663, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590740

RESUMO

BACKGROUND: This study will assess the efficacy and safety of Shenmai injection (SMI) for the treatment of chronic heart failure (CHF). METHODS: The following electronic bibliographic databases will be searched from inception to the March 25, 2020 without language and publication time limitations: MEDLINE, PUBMED, Cochrane Library, Web of Science, Scopus, WANGFANG, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All randomized controlled trials related to the SMI for patients with CHF will be included. All study selection, data extraction, and study quality will be carried out by 2 reviewers. Any disagreements will be solved by a third reviewer through discussion. RevMan 5.3 software will be used for data synthesis and data analysis. RESULTS: This study will summarize the present evidence of SMI for the treatment of patients with CHF. CONCLUSION: The findings of this study will determine whether SMI is effective and safety for the treatment of CHF or not. STUDY REGISTRATION NUMBER: INPLASY202050029.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Doença Crônica/tratamento farmacológico , Doença Crônica/mortalidade , Combinação de Medicamentos , Insuficiência Cardíaca/mortalidade , Humanos , Injeções , Projetos de Pesquisa , Sódio/sangue , Revisões Sistemáticas como Assunto , Urina
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