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2.
Hypertension ; 74(4): 1033-1040, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31476905

RESUMO

Hypertension treatment has been implicated in falls, syncope, and orthostatic hypotension (OH), common events among older adults. Whether the choice of antihypertensive agent influences the risk of falls, syncope, and OH in older adults is unknown. ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) was a randomized clinical trial that compared the effects of hypertension first-step therapy on fatal coronary heart disease or nonfatal myocardial infarction (1994-2002). In a subpopulation of ALLHAT participants, age 65 years and older, we determined the relative risk of falls, syncope, OH, or a composite based on Centers for Medicare and Medicaid Services and Veterans Affairs claims, using Cox regression. We also determined the adjusted association of self-reported atenolol use (ascertained at the 1-month visit for indications other than hypertension) on outcomes in Cox models adjusted for age, sex, and race. Among 23 964 participants (mean age 69.8±6.8 years, 45% women, 31% non-Hispanic black) followed for a mean of 4.9 years, we identified 267 falls, 755 syncopes, 249 OH, and 1157 composite claims. There were no significant differences in the cumulative incidences of events across randomized drug assignments. However, amlodipine increased risk of falls during the first year of follow-up compared with chlorthalidone (hazard ratio [95% CI]: 2.24 [1.06-4.74]; P=0.03) or lisinopril (hazard ratio [95% CI]: 2.61 [1.03-6.72]; P=0.04). Atenolol use (N=928) was not associated with any of the 3 individual or composite claims. In older adults, the choice of antihypertensive agent had no effect on risk of fall, syncope, or OH long-term. However, amlodipine increased risk of falls within 1 year of initiation. These short-term findings require confirmation. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Hipotensão Ortostática/epidemiologia , Síncope/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anlodipino/uso terapêutico , Atenolol/uso terapêutico , Clortalidona/uso terapêutico , Feminino , Humanos , Incidência , Masculino , Medicare , Resultado do Tratamento , Estados Unidos
3.
Med Clin North Am ; 103(5): 793-807, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378326

RESUMO

Cardiac arrhythmia is a common cause of syncope. The prompt identification of arrhythmic syncope has diagnostic and prognostic implications. In this article, an approach to identifying and managing arrhythmic syncope is discussed, including key findings from the history, physical examination, electrocardiogram, role of risk stratification, use of supplemental investigations, and treatment.


Assuntos
Arritmias Cardíacas/diagnóstico , Síncope/etiologia , Arritmias Cardíacas/complicações , Eletrocardiografia , Humanos , Exame Físico , Prognóstico , Síncope/epidemiologia
4.
Hypertension ; 74(3): 645-651, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31327266

RESUMO

Alpha-blockers (ABs) are commonly prescribed as part of a multidrug regimen in the management of hypertension. We set out to assess the risk of hypotension and related adverse events with AB use compared with other blood pressure (BP) lowering drugs using a population-based, retrospective cohort study of women (≥66 years) between 1995 and 2015 in Ontario, Canada. Cox proportional hazards examined the association of AB use and hypotension and related events (syncope, fall, and fracture) compared with other BP lowering drugs matched via a high dimensional propensity score. The primary outcome was a composite of hospitalizations for hypotension and related events (syncope, fractures, and falls) within 1 year. From 734 907 eligible women, 14 106 were dispensed an AB (mean age, 75.7; standard deviation 6.9 years, median follow-up 1 year) and matched to 14 106 dispensed other BP lowering agents. The crude incidence rate of hypotension and related events was 95.7 (95% CI [confidence interval], 90.4-101.1, events 1214 [8.6%]) with AB and 79.8 (95% CI, 74.9-84.7 per 1000 person-years, events 1025 [7.3%]) with other BP lowering medications (incident rate ratio, 1.20; 95% CI, 1.10-1.30). The risk was higher for hypotension (hazard ratio, 1.71; 95% CI, 1.33-2.20) and syncope (hazard ratio, 1.44; 95% CI, 1.18-1.75) with no difference in falls, fractures, adverse cardiac events, or all-cause mortality. Treatment of hypertension in women with ABs is associated with a higher risk of hypotension and hypotension-related events compared with other BP lowering agents. Our findings suggest that ABs should be used with caution, even as add on therapy for hypertension.


Assuntos
Antagonistas Adrenérgicos alfa/efeitos adversos , Hipertensão/tratamento farmacológico , Hipotensão/induzido quimicamente , Hipotensão/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Antagonistas Adrenérgicos alfa/uso terapêutico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Canadá , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/epidemiologia , Avaliação Geriátrica/métodos , Humanos , Hipertensão/diagnóstico , Hipotensão/fisiopatologia , Incidência , Prognóstico , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Síncope/diagnóstico , Síncope/epidemiologia , Resultado do Tratamento
5.
Med Care ; 57(9): 702-709, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31356411

RESUMO

OBJECTIVE: As part of a multidisciplinary team managing patients with type-2 diabetes, pharmacists need a consistent approach of identifying and prioritizing patients at highest risk of adverse outcomes. Our objective was to identify which predictors of adverse outcomes among type-2 diabetes patients were significant and common across 7 outcomes and whether these predictors improved the performance of risk prediction models. Identifying such predictors would allow pharmacists and other health care providers to prioritize their patient panels. RESEARCH DESIGN AND METHODS: Our study population included 120,256 adults aged 65 years or older with type-2 diabetes from a large integrated health system. Through an observational retrospective cohort study design, we assessed which risk factors were associated with 7 adverse outcomes (hypoglycemia, hip fractures, syncope, emergency department visit or hospital admission, death, and 2 combined outcomes). We split (50:50) our study cohort into a test and training set. We used logistic regression to model outcomes in the test set and performed k-fold validation (k=5) of the combined outcome (without death) within the validation set. RESULTS: The most significant predictors across the 7 outcomes were: age, number of medicines, prior history of outcome within the past 2 years, chronic kidney disease, depression, and retinopathy. Experiencing an adverse outcome within the prior 2 years was the strongest predictor of future adverse outcomes (odds ratio range: 4.15-7.42). The best performing models across all outcomes included: prior history of outcome, physiological characteristics, comorbidities and pharmacy-specific factors (c-statistic range: 0.71-0.80). CONCLUSIONS: Pharmacists and other health care providers can use models with prior history of adverse event, number of medicines, chronic kidney disease, depression and retinopathy to prioritize interventions for elderly patients with type-2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Prioridades em Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , /estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Hipoglicemia/epidemiologia , Modelos Logísticos , Masculino , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Síncope/epidemiologia
7.
Can J Cardiol ; 35(4): 382-388, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30935629

RESUMO

BACKGROUND: Cardiac rehabilitation (CR) intervention programs are currently not part of management in patients with atrial fibrillation (AF). We sought to determine the effect of CR compared with a specialized AF clinic (AFC) and usual care on outcomes in patients with AF. METHODS: This was a single-centre retrospective cohort study that was carried out using 3 databases: the Hearts in Motion database (2010-2014), prospectively collected data in an AFC (2011-2014), and a retrospective chart review for patients in usual care (2009-2012). Three care pathways were compared: (1) CR; (2) AFC; and (3) usual specialist-based care. The main outcome was AF-related emergency department visits and cardiovascular hospitalizations. RESULTS: Of 566 patients with newly diagnosed AF, 133 (23.5%) patients underwent CR, 197 patients (34.8%) attended the AFC, whereas the remaining 236 (41.7%) were followed in a usual specialist-based care clinic. At 1 year, AF-related emergency department visits and cardiovascular hospitalization rates occurred in 7.5% in the CR group, 16.8% in the AFC group, and 29.2% in usual care. After a propensity matched analysis, usual care was associated with the highest rate of the main outcome (odds ratio, 4.91; 95% confidence interval, 2.09-11.53) compared with CR, as did the AFC compared with CR (odds ratio, 2.75; 95% confidence interval, 1.14-6.6). CONCLUSIONS: Among patients with AF, CR was associated with a lower risk of AF-related outcomes. These findings support further study of the use of CR in the management of these patients to determine the optimal model of care for AF patients.


Assuntos
Instituições de Assistência Ambulatorial , Fibrilação Atrial/terapia , Reabilitação Cardíaca , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Idoso , Fibrilação Atrial/epidemiologia , Canadá/epidemiologia , Estudos de Coortes , Fadiga/epidemiologia , Feminino , Parada Cardíaca/epidemiologia , Insuficiência Cardíaca/epidemiologia , Humanos , Ataque Isquêmico Transitório/epidemiologia , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Estudos Retrospectivos , Síncope/epidemiologia
8.
J Am Coll Cardiol ; 73(14): 1756-1765, 2019 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-30975291

RESUMO

BACKGROUND: Information on young patients with Brugada syndrome (BrS) and arrhythmic events (AEs) is limited. OBJECTIVES: The purpose of this study was to describe their characteristics and management as well as risk factors for AE recurrence. METHODS: A total of 57 patients (age ≤20 years), all with BrS and AEs, were divided into pediatric (age ≤12 years; n = 26) and adolescents (age 13 to 20 years; n = 31). RESULTS: Patients' median age at time of first AE was 14 years, with a majority of males (74%), Caucasians (70%), and probands (79%) who presented as aborted cardiac arrest (84%). A significant proportion of patients (28%) exhibited fever-related AE. Family history of sudden cardiac death (SCD), prior syncope, spontaneous type 1 Brugada electrocardiogram (ECG), inducible ventricular fibrillation at electrophysiological study, and SCN5A mutations were present in 26%, 49%, 65%, 28%, and 58% of patients, respectively. The pediatric group differed from the adolescents, with a greater proportion of females, Caucasians, fever-related AEs, and spontaneous type-1 ECG. During follow-up, 68% of pediatric and 64% of adolescents had recurrent AE, with median time of 9.9 and 27.0 months, respectively. Approximately one-third of recurrent AEs occurred on quinidine therapy, and among the pediatric group, 60% of recurrent AEs were fever-related. Risk factors for recurrent AE included sinus node dysfunction, atrial arrhythmias, intraventricular conduction delay, or large S-wave on ECG lead I in the pediatric group and the presence of SCN5A mutation among adolescents. CONCLUSIONS: Young BrS patients with AE represent a very arrhythmogenic group. Current management after first arrhythmia episode is associated with high recurrence rate. Alternative therapies, besides defibrillator implantation, should be considered.


Assuntos
Arritmias Cardíacas , Síndrome de Brugada , Parada Cardíaca , Quinidina/uso terapêutico , Medição de Risco/métodos , Prevenção Secundária/métodos , Técnicas de Ablação/métodos , Adolescente , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/genética , Arritmias Cardíacas/prevenção & controle , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/epidemiologia , Síndrome de Brugada/fisiopatologia , Síndrome de Brugada/terapia , Criança , Desfibriladores Implantáveis/estatística & dados numéricos , Eletrocardiografia/métodos , Técnicas Eletrofisiológicas Cardíacas/métodos , Feminino , Parada Cardíaca/diagnóstico , Parada Cardíaca/prevenção & controle , Humanos , Masculino , Anamnese/estatística & dados numéricos , Fatores de Risco , Síncope/diagnóstico , Síncope/epidemiologia , Síncope/etiologia , Adulto Jovem
9.
J Neurol ; 266(6): 1421-1428, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30868219

RESUMO

INTRODUCTION: Moyamoya angiopathy (MMA) is a rare vasopathy, especially among European Caucasians. Data about demographics, clinical presentation, comorbid conditions, radiological findings as well as laboratory and cerebral spinal fluid (CSF) data are sparse. METHODS: Patients with MMA treated in the Alfried Krupp Hospital, Essen, Germany, between 2010 and 2017 with focus on demographic, clinical, radiological and laboratory as well as CSF data were evaluated retrospectively. Patients with non-Caucasian family background were excluded from this study. RESULTS: Altogether 200 European Caucasian patients with MMA were identified. There was a female predominance of 3.2:1. The mean age at first presentation was 32.9 years and the mean age of diagnosis was 36.0 years. Eleven of 194 index patients (5.7%) showed a familial presentation. In 11.6% posterior cerebral artery was additionally involved, in 4% additionally cerebral aneurysm and in 2.5% dysgenesis of corpus callosum was found. Most patients suffered from transient ischemic attacks (71.5%) and stroke (82%). Cerebral hemorrhage was found in 9.5%. Livedo racemosa was an associated symptom in 12.8% of patients and thyroid diseases were found in 23.8%. CONCLUSIONS: Compared with Asian data, cerebral hemorrhages are infrequent and female predominance is accentuated among European Caucasians. Some former unknown rare features like associated livedo racemosa, dysgenesis of corpus callosum and associated syncope have been discovered systematically for the first time in this huge European Caucasian cohort.


Assuntos
Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Doença de Moyamoya/epidemiologia , Doença de Moyamoya/fisiopatologia , Adolescente , Adulto , Idoso , Agenesia do Corpo Caloso/epidemiologia , Criança , Pré-Escolar , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/complicações , Estudos Retrospectivos , Fatores Sexuais , Dermatopatias Vasculares/epidemiologia , Dermatopatias Vasculares/etiologia , Síncope/epidemiologia , Síncope/etiologia , Adulto Jovem
10.
Ann Emerg Med ; 73(5): 500-510, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30691921

RESUMO

STUDY OBJECTIVE: The prevalence of pulmonary embolism among patients with syncope is understudied. In accordance with a recent study with an exceptionally high pulmonary embolism prevalence, some advocate evaluating all syncope patients for pulmonary embolism, including those with another clear cause for their syncope. We seek to evaluate the pulmonary embolism prevalence among emergency department (ED) patients with syncope. METHODS: We combined data from 2 large prospective studies enrolling adults with syncope from 17 EDs in Canada and the United States. Each study collected the results of pulmonary embolism-related investigations (ie, D-dimer, ventilation-perfusion scan, or computed tomography [CT] pulmonary angiography) and 30-day adjudicated outcomes: pulmonary embolism or nonpulmonary embolism outcome (arrhythmia, myocardial infarction, serious hemorrhage, and death). RESULTS: Of the 9,374 patients enrolled, 9,091 (97.0%; median age 66 years, 51.9% women) with 30-day follow-up were analyzed: 547 (6.0%) were evaluated for pulmonary embolism (278 [3.1%] had D-dimer, 39 [0.4%] had ventilation-perfusion scan, and 347 [3.8%] had CT pulmonary angiography). Overall, 874 patients (9.6%) experienced 30-day serious outcomes: 818 patients (9.0%) with nonpulmonary embolism serious outcomes and 56 (prevalence 0.6%; 95% confidence interval 0.5% to 0.8%) with pulmonary embolism (including 8 [0.2%] out of 3521 patients diagnosed during the index hospitalization and 7 [0.1%] diagnosed after the index visit). Eighty-six patients (0.9%) died, and 4 deaths (0.04%) were related to pulmonary embolism. Only 11 patients (0.1%) with a nonpulmonary embolism serious condition had a concomitant pulmonary embolism. CONCLUSION: The prevalence of pulmonary embolism is very low among ED patients with syncope, including those hospitalized after syncope. Although an underlying pulmonary embolism may cause syncope, clinicians should be cautious about indiscriminate investigations for pulmonary embolism.


Assuntos
Embolia Pulmonar/epidemiologia , Síncope/epidemiologia , Adulto , Idoso , Canadá/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Embolia Pulmonar/mortalidade , Síncope/mortalidade , Estados Unidos/epidemiologia
11.
Ann Clin Transl Neurol ; 6(1): 144-153, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30656192

RESUMO

Objective: Traditional neurology teaching states that when mean arterial pressure dips below a 60 mm Hg threshold, there is an increase in stroke risk due to cerebral hypoperfusion. The aim of this study was to determine whether intensive lowering of systolic blood pressure increases adverse cardiovascular outcomes by examining the association between achieved blood pressure values, specifically mean arterial pressure and pulse pressure, and risk of stroke. Methods: Data from participants in the Systolic Blood Pressure Intervention Trial (SPRINT) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure (BP) trial were examined, using survival analysis to model minimal arterial pressure and average pulse pressure during the study period against risk of stroke, hypotension, and syncope, with death as a competing risk. Results: In both SPRINT and ACCORD participants, there was no increase in stroke risk with achieved mean arterial pressure values below 60 mm Hg. In SPRINT participants, achieved mean arterial pressure values greater than 90 mm Hg were associated with a 247% (HR: 3.47, 95% CI: 2.06-5.85) higher risk of stroke compared with participants in the 80-89 mmHg reference group. No association was found between low achieved pulse pressure values and greater stroke risk in either the SPRINT or ACCORD participants, as well as no association between mean arterial pressure and pulse pressure values and risk of syncope. Interpretation: Intensive lowering of systolic blood pressure does not increase risk of stroke in hypertensive patients, despite extremely low mean arterial pressure or pulse pressure values.


Assuntos
Pressão Sanguínea , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Ensaios Clínicos como Assunto , Feminino , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Hipotensão/complicações , Hipotensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Acidente Vascular Cerebral/complicações , Síncope/complicações , Síncope/epidemiologia
12.
QJM ; 112(5): 343-350, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30690642

RESUMO

BACKGROUND: Brugada syndrome (BrS) is a heritable sudden cardiac death (SCD) disease with male predominance. Information on gender difference of BrS remains scarce. AIM: To investigate the gender difference of BrS in Han Chinese. DESIGN: We consecutively enrolled 169 BrS patients (153 males and 16 females) from Han Chinese in Taiwan from 1998 to 2017. METHODS: Clinical characteristics, electrocardiographic parameters and SCN5A mutation status were compared between genders. RESULTS: The percentage of family history of SCD in females was slightly higher (31.3% vs. 15%, P = 0.15). Females exhibited longer QTc (457.8 ± 33.0 vs. 429.5 ± 42.1 ms, P < 0.01). Regarding cumulative event occurrence by age, Mantel-Cox test showed females had earlier age of onset of first cardiac events (SCD or syncope) than males (P = 0.049), which was mainly attributed to syncope (P < 0.01). Males with SCD exhibited longer QRS duration (114.2 ± 26.8 vs. 104.8 ± 15.3 ms, P = 0.02) and QTc (442.5 ± 57.4 vs. 422.9 ± 28.8 ms, P = 0.02). Males with syncope exhibited longer PR interval (181.2 ± 33.7 vs. 165.7 ± 27.1 ms, P = 0.01), whereas females with SCD or syncope had a trend towards slower heart rates (69.1 ± 9.6 vs. 82.2 ± 16.3 bpm, P = 0.10) than female with no or mild symptoms. There was no difference in the percentage of SCN5A mutation between genders. CONCLUSION: Gender difference is present in BrS. Females have longer QTc and suffer from syncope earlier than males. Risk of SCD in males is associated with boarder QRS complex and longer QTc, whereas risk of syncope is associated with longer PR interval in males and slower heart rate in females.


Assuntos
Síndrome de Brugada/genética , Morte Súbita Cardíaca/epidemiologia , Síndrome do QT Longo/epidemiologia , Canal de Sódio Disparado por Voltagem NAV1.5/genética , Fatores Sexuais , Síncope/etiologia , Adulto , Síndrome de Brugada/complicações , Síndrome de Brugada/fisiopatologia , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Feminino , Humanos , Síndrome do QT Longo/etiologia , Masculino , Pessoa de Meia-Idade , Mutação , Sistema de Registros , Medição de Risco , Distribuição por Sexo , Síncope/epidemiologia , Taiwan/epidemiologia
13.
Eur J Emerg Med ; 26(2): 100-104, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29465466

RESUMO

AIM: There is growing evidence of an overlap between unexplained falls and syncope in older adults. Our aim was to examine the prevalence and associated resource utilization of these conditions in an urban emergency department (ED). PATIENTS AND METHODS: A single-centre, prospective, observational study was carried out over a 6-month period. Consecutive patients older than 50 years who presented to the ED because of a fall, collapse or syncope were included. Univariate analysis of demographic data is presented as percentages, mean (SD), 95% confidence intervals (CIs) and medians (interquartile range). Logistic regression modelling was used to examine the association between falls and resource utilization. RESULTS: A total of 561 patients fulfilled the inclusion criteria during the study period. Unexplained fallers accounted for 14.3% (n=80; 95% CI: 13.3-15.3) and syncope for 12.7% (n=71; 95% CI: 11.7-13.6) of all fall presentations. Overall, 50% (n=282; 95% CI: 48.20-52.34) of patients required admission to hospital. Patients with syncope [odds ratio (OR)=2.48, 95% CI: 1.45-4.23], and unexplained falls (OR=2.36, 95% CI: 1.37-4.08) were more likely to require admission than those with an explained falls. Unexplained fallers were nearly five times more likely to suffer recurrent falls (OR=4.97, 95% CI: 2.89-8.56). CONCLUSION: One in four older fallers presenting to ED have symptoms suggestive of syncope or an unexplained fall. There are significant biological consequences of recurrent falls including greater rates of cognitive decline, gait and mobility disturbances, depression and frailty. Recognition that syncope can present as an unexplained fall in older adults is important to ensure that appropriate early modifiable interventions are initiated.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Síncope Vasovagal/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Irlanda , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Síncope/epidemiologia , Síncope Vasovagal/diagnóstico
14.
Am J Emerg Med ; 37(5): 869-872, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30361153

RESUMO

Almost 20% of patients with syncope will experience another event. It is unknown whether recurrent syncope is a marker for a higher or lower risk etiology of syncope. The goal of this study is to determine whether older adults with recurrent syncope have a higher likelihood of 30-day serious clinical events than patients experiencing their first episode. METHODS: This study is a pre-specified secondary analysis of a multicenter prospective, observational study conducted at 11 emergency departments in the US. Adults 60 years or older who presented with syncope or near syncope were enrolled. The primary outcome was occurrence of 30-day serious outcome. The secondary outcome was 30-day serious cardiac arrhythmia. In multivariate analysis, we assessed whether prior syncope was an independent predictor of 30-day serious events. RESULTS: The study cohort included 3580 patients: 1281 (35.8%) had prior syncope and 2299 (64.2%) were presenting with first episode of syncope. 498 (13.9%) patients had 1 prior episode while 771 (21.5%) had >1 prior episode. Those with recurrent syncope were more likely to have congestive heart failure, coronary artery disease, previous diagnosis of arrhythmia, and an abnormal ECG. Overall, 657 (18.4%) of the cohort had a serious outcome by 30 days after index ED visit. In multivariate analysis, we found no significant difference in risk of events (adjusted odds ratio 1.09; 95% confidence interval 0.90-1.31; p = 0.387). CONCLUSION: In older adults with syncope, a prior history of syncope within the year does not increase the risk for serious 30-day events.


Assuntos
Síncope/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Medição de Risco , Fatores de Risco , Síncope/epidemiologia
15.
Vox Sang ; 114(1): 38-46, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30485453

RESUMO

BACKGROUND AND OBJECTIVES: The objective of the present study was to investigate the fear of blood, injections and fainting as barriers to blood donation in a sample of primary healthcare users in a Brazilian municipality. MATERIALS AND METHODS: This is a cross-sectional survey of primary care patients in 12 randomly selected healthcare facilities in Ribeirão Preto, Brazil in 2015-2016. Key variables were lifetime blood donation history, intentions to donate blood among non-donors and current donation practice. To assess fear of blood in general (FBG), fear of injections in general (FIG) and fear of fainting due to fear of injection (FFI), we used the Blood Injection/Fear Scale (BIFS). We tested associations between variables using regression models and conditional inference trees (CIT). RESULTS: A total of 1055 primary healthcare users participated (79·7% female, mean age 40·6 years [SD = 15·2]), 63·4% never donated blood, 13·3% reported they are unable to donate, 6·1% donated only once, 17·2% donated multiple times. Women had higher scores for FIG and FBG. FFI was associated with middle socioeconomic status. Those who never intended to donate exhibited the highest scores in the three dimension of fear. By CIT analysis, being female and high scores for FBG are associated with decreased blood donation. Among males, blood donation frequency is low among those aged 33 years and under. CONCLUSION: Fear of blood, injections and fainting are barriers to blood donation in Brazil. Efforts to recruit and retain blood donors should convey information on blood donation processes and address misconceptions that may increase fear.


Assuntos
Doadores de Sangue/psicologia , Transtornos Fóbicos/epidemiologia , Síncope/epidemiologia , Adulto , Idoso , Doadores de Sangue/estatística & dados numéricos , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Br J Clin Pharmacol ; 85(3): 634-643, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30569481

RESUMO

AIMS: Human papilloma virus (HPV) is the cause of different types of carcinoma. Despite the remarkable effectiveness of the HPV vaccines, there have been many complaints about their risk-benefit profile due to adverse events following immunization (AEFI). The purpose of this study is to analyse the safety profile of the HPV vaccine basing on real-life data derived from reports of suspected AEFIs collected in the US Vaccine Adverse Events Reporting System (VAERS) and assess if the searches on Google overlap with spontaneous reporting. METHODS: We collected all the reports in VAERS between January 2007 to December 2017 related to the HPV vaccines. A disproportionality analysis using reporting odds ratio (ROR) with 95% confidence interval was performed. RESULTS: Over the 10-year period, 55 356 reports of AEFI related to HPV vaccines were retrieved in VAERS, corresponding to 224 863 vaccine-event pairs. The highest number of reports was related to Gardasil (n = 42 244). The two events more frequently reported and statistically significant for HPV vaccines were dizziness (n = 6259; ROR = 2.60; 95% confidence interval 2.53-2.66) and syncope (n = 6004; ROR = 6.28; 95% confidence interval 6.12-6.44). The trends of spontaneous reporting and Google searches overlap. CONCLUSION: The AEFI analysis showed that the events most frequently reported were non-serious and listed in the corresponding summary of product characteristics. Potential safety signals arose regarding less frequent AEFIs that would deserve further investigation. It is extremely important to disseminate correct and evidence-based scientific information.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Tontura/epidemiologia , Vacinas contra Papillomavirus/efeitos adversos , Síncope/epidemiologia , Vacinação/efeitos adversos , Adolescente , Adulto , Criança , Pré-Escolar , Mineração de Dados , Tontura/induzido quimicamente , Feminino , Humanos , Lactente , Internet/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Autorrelato/estatística & dados numéricos , Síncope/induzido quimicamente , Estados Unidos/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Vacinação/estatística & dados numéricos , Adulto Jovem
17.
Pacing Clin Electrophysiol ; 42(2): 257-264, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30569504

RESUMO

INTRODUCTION: A spontaneous type I electrocardiogram (ECG) pattern and/or unheralded syncope are conventionally used as risk markers for primary prevention of sudden cardiac arrest/death (SCA/SCD) in Brugada syndrome (BrS). In this study, we determine the prevalence of conventional and newer markers of risk in those with and without previous aborted SCA events. METHODS: All patients with BrS were identified at our institute. History of symptoms was obtained from medical tests or from interviews. Other markers of risk were also obtained, such as presence of (1) spontaneous type I pattern, (2) fractionated QRS (fQRS), (3) early repolarization (ER) pattern, (4) late potentials on signal-averaged ECG (SAECG), and (5) response to programmed electrical stimulation. RESULTS: In 133 patients with Bars, 10 (7%) patients (mean age = 39 ± 11 years; nine males) were identified with a previous ventricular fibrillation/ventricular tachycardia episode (n = 8) or requiring cardio-pulmonary resuscitation (n = 2). None of these patients had a prior history of syncope before their SCA event. Only two (20%) patients reported a history of palpitations or dizziness. None had apneic breathing and three (30%) patients had a family history of SCA. From their ECGs, a spontaneous pattern was only found in one (10%) of these patients. Further, 10% of patients had fQRS, 17% had late potentials on SAECG, 20% had deep S waves in lead I, and 10% had an ER pattern in the peripheral leads. No significant differences were observed in the non-SCA group. CONCLUSION: The majority of BrS patients with previous aborted SCA events did not have a spontaneous type I and/or prior history of syncope. Conventional and newer markers of risk appear to only have limited ability to predict SCA.


Assuntos
Síndrome de Brugada/complicações , Síndrome de Brugada/fisiopatologia , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Síncope/etiologia , Síncope/fisiopatologia , Adulto , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Sobreviventes , Síncope/epidemiologia
18.
Epilepsy Behav ; 90: 168-171, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30576964

RESUMO

INTRODUCTION: Heart rate decrease during epileptic seizures is rare and should be considered in patients with unusual or refractory episodes of syncope or in patients with a history suggestive of both epilepsy and syncope. We systematically reviewed the literature to better understand the clinical signs and risk factors of ictal heart rate decreases. MATERIAL AND METHODS: We performed a literature-search on "ictal bradycardia" and "ictal asystole" in Pubmed and added papers from the references and personal archives. Articles relating to animal studies, seizures without ictal decrease of heart rate, cases without simultaneous electroencephalography (EEG) and electrocardiography (ECG), convulsive syncopes, or cases with bradycardia before seizure onset and articles written in other languages than English, Dutch, German, French, or Spanish were excluded. Full texts of the remaining articles were screened for cases of ictal bradycardia or ictal asystole. Cases were selected on the basis of a self-designed quality score. The relationship of RR wave interval of at least 5 s, signs of syncope, and EEG signs of ischemia were analyzed with chi-square test and identifying 95% confidence intervals. RESULTS: Ictal bradycardia and ictal asystole predominantly occurred during focal seizures with loss of awareness (proportion in the combined group of bradycardia and asystole (p1 + 2) = 0.85) in people with mainly left lateralized (p1 + 2 = 0.64; p = 0.001) temporal lobe seizures (p1 + 2 = 0.91). Seizures with ictal asystole typically started with a heart rate decrease. During ictal asystole in the majority of cases, not only the clinical signs of syncope occurred (change of proportion (Δp) = 0.67; 95% CI: 0.48-0.86; p < 0.0001), i.e., interrupting the seizure semiology, but also the characteristic EEG signs of ischemia (Δp = 0.50; 95% CI: 0.26-0.74; p < 0.001). We found a statistically significant relation between signs of syncope and EEG signs of ischemia (Δp = -0.37; 95% CI: (-0.64)-(-0.10); p < 0.01) but not between duration of asystole (5 s) and either signs of syncope (Δp = -0.36; 95% CI: (-0.77)-0.05; p = 0.03) or EEG signs of ischemia (Δp = -0.37; 95% CI: (-1.07)-0.33; p = 0.16). CONCLUSION: In the ictal bradycardia syndrome, signs of syncope disrupt the semiology of ongoing seizures and are associated with EEG signs of brain ischemia and the duration of the cardiac arrhythmia.


Assuntos
Bradicardia/fisiopatologia , Parada Cardíaca/fisiopatologia , Convulsões/fisiopatologia , Síncope/fisiopatologia , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Bradicardia/diagnóstico , Bradicardia/epidemiologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/fisiopatologia , Eletrocardiografia/tendências , Eletroencefalografia/tendências , Feminino , Parada Cardíaca/diagnóstico , Parada Cardíaca/epidemiologia , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Convulsões/diagnóstico , Convulsões/epidemiologia , Síncope/diagnóstico , Síncope/epidemiologia
19.
Can J Cardiol ; 34(12): 1631-1640, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527152

RESUMO

BACKGROUND: The risks and subsequent outcomes of syncope among seniors with chronic kidney disease (CKD) are unclear. METHODS: We conducted a population-based retrospective cohort study of 272,146 patients ≥ 66 years old, in Ontario, Canada, from April 1, 2006, to March 31, 2016. Using administrative health care databases, we examined the association of estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR) with incident syncope and the association of incident syncope with the composite outcome of myocardial infarction, stroke, and death by levels of eGFR/ACR, using adjusted Cox proportional hazards models. RESULTS: A total of 15,074 incident syncopal events occurred during the study period. The adjusted risk for syncope was higher with a lower eGFR and higher ACR in a stepwise manner (eGFR 60 to < 90: HR 1.17 [1.09-1.26] vs eGFR < 30: HR 1.67 (1.50-1.87) with eGFR ≥ 90 referent; ACR > 30: HR 1.15 [1.07-1.24] with ACR < 3 referent). Among the 12,710 patients with a first syncope event and 1 year of follow-up, the adjusted risk for the composite outcome was higher with a lower eGFR and higher ACR in a stepwise manner (eGFR 60 to < 90: HR 1.05 [0.90-1.22] vs eGFR < 30: HR 1.62 [1.34-1.96] with eGFR ≥ 90 referent; ACR > 30: HR 1.77 [1.60-1.96], ACR < 3 referent). CONCLUSIONS: A lower eGFR and higher ACR are associated with a higher risk of a hospital encounter for syncope and of related complications among persons of advanced age.


Assuntos
Albuminúria/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Síncope/epidemiologia , Idoso , Arritmias Cardíacas/epidemiologia , Estudos de Coortes , Creatinina/análise , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Masculino , Infarto do Miocárdio/epidemiologia , Ontário/epidemiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia
20.
Hong Kong Med J ; 24(6): 561-570, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30530868

RESUMO

INTRODUCTION: Congenital long QT syndrome (LQTS) is a genetically transmitted cardiac channelopathy that can lead to sudden cardiac death. This study aimed to report the clinical and genetic characteristics of all young patients diagnosed with LQTS in the only tertiary paediatric cardiology centre in Hong Kong. METHODS: This is a retrospective review of all paediatric and young adult patients diagnosed at our centre with LQTS from January 1997 to December 2016. The diagnosis of LQTS was established with a corrected QT interval (QTc) ≥480 ms, Schwartz score of >3 points, or the presence of a pathogenic mutation. RESULTS: Fifty-nine patients (33 males) from 52 families were included, with a mean age of 8.17 years (range, 0.00-16.95 years) at presentation. Five patients had concomitant congenital heart diseases. The mean follow-up duration was 5.33 ± 4.65 years. The mean QTc in the cohort was 504 ± 47 ms. They presented with syncope and convulsion (49%), cardiac arrest (10%), bradycardia and neonatal atrioventricular block (12%). Fifteen (25%) patients were asymptomatic at diagnosis. Thirty-eight (64.4%) patients were confirmed to have a pathogenic mutation for LQTS genes. Forty-five (76.3%) patients received beta blocker therapy. Thirteen (22.0%) patients required implantable cardioverter defibrillator. There was no mortality in the study period. The 1-, 5-, and 10-year breakthrough cardiac event-free rates were 93.0%, 80.7%, and 72.6%, respectively. CONCLUSION: Identification of the disorder, administration of beta blockers, and lifestyle modification can prevent subsequent cardiac events in LQTS. Genotyping in patients with LQTS is essential in guiding medical therapy and improving prognosis.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Desfibriladores Implantáveis , Cardiopatias Congênitas/epidemiologia , Síndrome do QT Longo/congênito , Adolescente , Adulto , Criança , Pré-Escolar , Eletrocardiografia , Feminino , Seguimentos , Hong Kong/epidemiologia , Humanos , Lactente , Recém-Nascido , Síndrome do QT Longo/genética , Síndrome do QT Longo/terapia , Masculino , Prognóstico , Estudos Retrospectivos , Síncope/epidemiologia , Adulto Jovem
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