2011 November 19

Coronary computed tomography angiography for the evaluation of patients with acute chest pain.

Nov 192011

Coronary computed tomography angiography for the evaluation of patients with acute chest pain.

Int J Clin Pract. 2011 Dec;65(12):1267-73

Authors: Rajani R, Brum RL, Preston R, Carr-White G, Berman DS

Abstract
Acute chest pain is a common presenting complaint of patients attending emergency room departments. Despite this, it can often be challenging to completely exclude a diagnosis of acute coronary syndrome following an initial standard clinical and biochemical evaluation. As a result of this, patients are often admitted to hospital until the treating clinician is satisfied that this diagnosis can be excluded. This process imparts a significant health economic burden by not only increasing hospital bed occupancy rates but also by the unnecessary layering of diagnostic investigations. With the rapid advances in coronary computed tomography angiography (CTA), there has been considerable interest in whether coronary CTA may be a viable alternative to this current standard care. We review the current literature and supporting evidence for utilising coronary CTA in the evaluation of patients presenting with acute chest pain in terms of its diagnostic accuracy, safety, cost-effectiveness and prognostic implications.

PMID: 22093533 [PubMed - in process]

Link to Article at PubMed

Systolic heart failure in South Asians.

Int J Clin Pract Start a Discussion »

Nov 192011

Systolic heart failure in South Asians.

Int J Clin Pract. 2011 Dec;65(12):1274-82

Authors: Shantsila E, Lip GY, Gill PS

Abstract
Heart failure (HF) is a common condition leading to an unfavourable prognosis and impaired quality of life. In this review, we provide an overview of published literature on possible epidemiological and pathophysiological differences between patients with systolic HF of South Asian origin and those from other ethnic groups (mainly White). Systolic HF tends to manifest earlier among South Asians and with frequent hospital admissions. However, survival for such patients appears to be significantly better compared with the White group, which might be associated with different patterns of HF. For example, this could be attributed to a lower prevalence of left ventricular systolic dysfunction in South Asian subjects. Indeed, the high prevalence of hypertension and diabetes among South Asians may predispose to diastolic HF with preserved systolic function. In addition, because of underrepresentation of South Asians in clinical trials, there are little data on optimal management of this ethnic group.

PMID: 22093534 [PubMed - in process]

Link to Article at PubMed

Mortality and morbidity of heart failure treated with digoxin. A propensity-matched study.

Int J Clin Pract Start a Discussion »

Nov 192011

Mortality and morbidity of heart failure treated with digoxin. A propensity-matched study.

Int J Clin Pract. 2011 Dec;65(12):1250-8

Authors: Andrey JL, Romero S, García-Egido A, Escobar MA, Corzo R, Garcia-Dominguez G, Lechuga V, Gómez F

Abstract
Background:? The role of digoxin in the prognosis of patients with heart failure (HF) remains unclear. Aims:? To evaluate the relationship of commencing treatment with digoxin (CTDig) with the mortality and the morbidity of patients with HF. Methods:? Prospective study over 8?years on 4467 patients with HF. Main outcomes were all-cause and cardiovascular mortality, hospitalisations and visits. We analyse the independent relationship of CTDig, with the mortality and the morbidity, stratifying patients for cardiovascular comorbidity, after propensity score-matching for potential confounders (1421 patients who CTDig vs. another 1421 patients non-exposed to digoxin). Results:? During a median follow up of 46.1?months, 1872 patients (65.9%) died, and 2203 (77.5%) were hospitalised. CTDig was associated with a lower all-cause mortality (HR =?0.90 [95% CI, 0.84-0.97]), and cardiovascular mortality (HR =?0.87 [0.81-0.96]), hospitalisation (HR =?0.91 [0.86-0.97]), 30-day readmission for HF (HR =?0.88 [0.79-0.95]), and visits (HR =?0.94 [0.90-0.98]) (p?<?0.001 in all cases), after adjustment for the propensity to take digoxin, other medications, and other potential confounders. These effects of digoxin were independent of gender, or type of HF (systolic or non-systolic). Conclusion:? The data suggest that therapy with digoxin is associated with an improved mortality and morbidity of HF, including women and patients with non-systolic HF.

PMID: 22093531 [PubMed - in process]

Link to Article at PubMed

Incidence of Serious Upper and Lower Gastrointestinal Events in Older Adults with and without Alzheimer’s Disease.

J Am Geriatr Soc Start a Discussion »

Nov 192011

Incidence of Serious Upper and Lower Gastrointestinal Events in Older Adults with and without Alzheimer's Disease.

J Am Geriatr Soc. 2011 Oct 21;

Authors: Wu JH, Guo Z, Kumar S, Lapuerta P

Abstract
OBJECTIVES: To estimate and compare the incidence of serious upper and lower gastrointestinal (GI) events in individuals aged 65 and older with and without Alzheimer's disease (AD). DESIGN: Retrospective cohort study. SETTING: PharMetrics, a large population-based health insurance claims database was used for the study. PARTICIPANTS: Individuals aged 65 and older with a diagnosis of AD (International Classification of Diseases, Ninth Revision, Clinical Modification Code 331.0) were identified between January 1, 2003, and December 31, 2006, using the PharMetrics database. The control cohort consisted of a random sample of health plan enrollees matched to the AD cohort according to age, sex, location, and index year in a 1:1 ratio. MEASURES: The outcomes of interest were serious GI events, including ulceration, perforation, and bleeding in the upper or lower GI tract. RESULTS: Twenty-seven thousand seventy-six individuals with AD were identified. Approximately 66% of them were age 80 and older, and 65% were female. Participants with AD had higher incidence of serious GI events (upper GI: AD vs non-AD: 27.4 vs 17.1/1000 person-years, HR = 1.49, 95%CI = 1.34-1.65; lower GI: AD vs non-AD: 9.4 vs 6.9/1000 person-years, HR = 1.26, 95%CI = 1.06-1.48). The association was also present in participants without a history of GI bleeding (upper GI: HR = 1.54, 95%CI = 1.37-1.73; lower GI: HR = 1.37, 95%CI = 1.14-1.64). CONCLUSION: Participants with AD had higher incidence of serious upper and lower GI events, compared to those without AD. Physicians should recognize the high risk of serious GI events that exists in individuals with AD.

PMID: 22091628 [PubMed - as supplied by publisher]

Link to Article at PubMed

Determinants of Death in the Hospital Among Older Adults.

J Am Geriatr Soc Start a Discussion »

Nov 192011

Determinants of Death in the Hospital Among Older Adults.

J Am Geriatr Soc. 2011 Nov 8;

Authors: Kelley AS, Ettner SL, Wenger NS, Sarkisian CA

Abstract
OBJECTIVES: To investigate patient-level determinants of in-hospital death, adjusting for patient and regional characteristics. DESIGN: Using multivariable regression, the relationship between in-hospital death and participants' social, functional, and health characteristics was investigated, controlling for regional Hospital Care Intensity Index (HCI) from the Dartmouth Atlas of Health Care. SETTING: The Health and Retirement Study, a longitudinal nationally representative cohort of older adults. PARTICIPANTS: People aged 67 and older who died between 2,000 and 2,006 (N = 3,539) were sampled. MEASUREMENTS: In-hospital death. RESULTS: Thirty-nine percent (n = 1,380) of participants died in the hospital (range 34% in Midwest to 45% in Northeast). Nursing home residence, functional dependence, and cancer or dementia diagnosis, among other characteristics, were associated with lower adjusted odds of in-hospital death. Being black or Hispanic, living alone, and having more medical comorbidities were associated with greater adjusted odds, as was higher HCI. Sex, education, net worth, and completion of an advance directive did not correlate with in-hospital death. CONCLUSION: Black race, Hispanic ethnicity, and other functional and social characteristics are correlates of in-hospital death, even after controlling for the role of HCI. Further work must be done to determine whether preferences, provider characteristics and practice patterns, or differential access to medical and community services drive this difference.

PMID: 22092014 [PubMed - as supplied by publisher]

Link to Article at PubMed

Differences in Clinical Features and In-Hospital Outcomes of Older Adults with Tako-Tsubo Cardiomyopathy.

J Am Geriatr Soc Start a Discussion »

Nov 192011

Differences in Clinical Features and In-Hospital Outcomes of Older Adults with Tako-Tsubo Cardiomyopathy.

J Am Geriatr Soc. 2011 Oct 31;

Authors: Citro R, Rigo F, Previtali M, Ciampi Q, Canterin FA, Provenza G, Giudice R, Patella MM, Vriz O, Mehta R, Baldi C, Mehta RH, Bossone E

Abstract
OBJECTIVES: To describe the clinical characteristics and in-hospital outcomes of older adults with tako-tsubo cardiomyopathy (TTC). DESIGN: Partially retrospective, partially prospective observational study. SETTING: Eleven Italian referral cardiac centers included in the Tako-tsubo Italian Network. PARTICIPANTS: One hundred ninety consecutive individuals with TTC (92.1% female, mean age 66) were divided into three groups according to age (<65, n = 78; 65-74, n = 61; ?75, n = 51). MEASUREMENTS: Clinical findings and in-hospital outcomes were evaluated in each group. RESULTS: Participants aged 65 and older had a greater prevalence of hypertension (P = .001) and a lower glomerular filtration rate (P < .001), and those aged 65 to 74 had a greater prevalence of psychiatric disorders (P = .01), ST-segment elevation on admission (P = .01) and a cerebrovascular disease (P = .003) than those younger than 65. Despite similar left ventricular ejection fraction (LVEF) on admission (P = .26), the oldest group had a lower LVEF at discharge (P = .03). Inotropic agents were used more frequently in older adults (P = .03). In-hospital composite adverse events (all-cause death, acute heart failure, life-threatening arrhythmias, stroke, and cardiogenic shock; P = .03) and overall complications (P = .004) were more common in participants aged 75 and older. Overall in-hospital mortality was low (2.8%) but was more prevalent in participants aged 75 and older (6.3%). On multivariate analysis, age of 75 and older (hazard ratio (HR) = 2.45, 95% confidence interval (CI) = 1.28-5.82, P = .04) and LVEF on admission (HR = 0.874, 95% CI = 0.81-0.95, P < .001) were the only independent predictors of in-hospital adverse events. CONCLUSION: The clinical profile of participants aged 75 and older with TTC was different from that of those younger than 75 with TTC, and they had a higher in-hospital complication rate.

PMID: 22092251 [PubMed - as supplied by publisher]

Link to Article at PubMed

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