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Hallberg S, Banefelt J, Fox KM, Mesterton J, Johansson G, Levin LÅ, Sobocki P, Gandra SR. Lipid-lowering treatment patterns in patients with new cardiovascular events - estimates from population-based register data in Sweden. Int J Clin Pract 2016; 70:222-8. [PMID: 26799539 PMCID: PMC4819716 DOI: 10.1111/ijcp.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess treatment patterns of lipid-lowering therapy (LLT) in patients with hyperlipidaemia or prior cardiovascular (CV) events who experience new CV events. METHODS A retrospective population-based cohort study was conducted using Swedish medical records and registers. Patients were included in the study based on a prescription of LLT or CV event history and followed up for up to 7 years for identification of new CV events and assessment of LLT treatment patterns. Patients were stratified into three cohorts based on CV risk level. All outcomes were assessed during the year following index (the date of first new CV event). Adherence was defined as medication possession ratio (MPR) > 0.80. Persistence was defined as no gaps > 60 days in supply of drug used at index. RESULTS Of patients with major cardiovascular disease (CVD) history (n = 6881), 49% were not on LLT at index. Corresponding data for CV risk equivalent and low/unknown CV risk patients were 37% (n = 3226) and 38% (n = 2497) respectively. MPR for patients on LLT at index was similar across cohorts (0.74-0.75). The proportions of adherent (60-63%) and persistent patients (56-57%) were also similar across cohorts. Dose escalation from dose at index was seen within all cohorts and 2-3% of patients switched to a different LLT after index while 5-6% of patients augmented treatment by adding another LLT. CONCLUSIONS Almost 50% of patients with major CVD history were not on any LLT, indicating a potential therapeutic gap. Medication adherence and persistence among patients on LLT were suboptimal.
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Affiliation(s)
| | | | - K M Fox
- Strategic Healthcare Solutions, LLC, Baltimore, MD, USA
| | - J Mesterton
- Quantify Research, Stockholm, Sweden
- LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - G Johansson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - L-Å Levin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - P Sobocki
- LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden
- IMS Health, Stockholm, Sweden
| | - S R Gandra
- Amgen Inc., Thousand Oaks, CA, United States
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Nelveg-Kristensen KE, Busk Madsen M, Torp-Pedersen C, Køber L, Egfjord M, Berg Rasmussen H, Riis Hansen P. Pharmacogenetic Risk Stratification in Angiotensin-Converting Enzyme Inhibitor-Treated Patients with Congestive Heart Failure: A Retrospective Cohort Study. PLoS One 2015; 10:e0144195. [PMID: 26633885 PMCID: PMC4669156 DOI: 10.1371/journal.pone.0144195] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/13/2015] [Indexed: 12/20/2022] Open
Abstract
Background Evidence for pharmacogenetic risk stratification of angiotensin-converting enzyme inhibitor (ACEI) treatment is limited. Therefore, in a cohort of ACEI-treated patients with congestive heart failure (CHF), we investigated the predictive value of two pharmacogenetic scores that previously were found to predict ACEI efficacy in patients with ischemic heart disease and hypertension, respectively. Score A combined single nucleotide polymorphisms (SNPs) of the angiotensin II receptor type 1 gene (rs275651 and rs5182) and the bradykinin receptor B1 gene (rs12050217). Score B combined SNPs of the angiotensin-converting enzyme gene (rs4343) and ABO blood group genes (rs495828 and rs8176746). Methods Danish patients with CHF enrolled in the previously reported Echocardiography and Heart Outcome Study were included. Subjects were genotyped and categorized according to pharmacogenetic scores A and B of ≤1, 2 and ≥3 each, and followed for up to 10 years. Difference in cumulative incidences of cardiovascular death and all-cause death were assessed by the cumulative incidence estimator. Survival was modeled by Cox proportional hazard analyses. Results We included 667 patients, of whom 80% were treated with ACEIs. Differences in cumulative incidences of cardiovascular death (P = 0.346 and P = 0.486) and all-cause death (P = 0.515 and P = 0.486) were not significant for score A and B, respectively. There was no difference in risk of cardiovascular death or all-cause death between subjects with score A ≤1 vs. 2 (HR 1.03 [95% CI 0.79–1.34] and HR 1.11 [95% CI 0.88–1.42]), score A ≤1 vs. ≥3 (HR 0.80 [95% CI 0.59–1.08] and HR 0.91 [95% CI 0.70–1.20]), score B ≤1 vs. 2 (HR 1.02 [95% CI 0.78–1.32] and HR 0.98 [95% CI 0.77–1.24]), and score B ≤1 vs. ≥3 (HR 1.03 [95% CI 0.75–1.41] and HR 1.05 [95% CI 0.79–1.40]), respectively. Conclusions We found no association between either of the analyzed pharmacogenetic scores and fatal outcomes in ACEI-treated patients with CHF.
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Affiliation(s)
| | - Majbritt Busk Madsen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | | | - Lars Køber
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Egfjord
- Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Peter Riis Hansen
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
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Cole GD, Patel SJ, Zaman N, Barron AJ, Raphael CE, Mayet J, Francis DP. "Triple therapy" of heart failure with angiotensin-converting enzyme inhibitor, beta-blocker, and aldosterone antagonist may triple survival time: shouldn't we tell patients? JACC-HEART FAILURE 2015; 2:545-8. [PMID: 25301161 DOI: 10.1016/j.jchf.2014.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/25/2014] [Accepted: 04/03/2014] [Indexed: 01/09/2023]
Abstract
Prescription and adherence to medical therapy for heart failure are disappointing despite convincing randomized controlled trial (RCT) evidence for angiotensin-converting enzyme inhibition, beta-blockade, and aldosterone antagonism. In this study, we report an imbalanced approach amongst clinicians, who describe focusing during patient consultations on perceived risks of therapy rather than survival benefits. Only one-half of clinicians mention increased lifespan, and very few suggest to the patient how large this gain might be. We calculate from the available RCT data that, for patients whose lifespan is limited by heart failure, triple therapy triples lifespan.
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Affiliation(s)
- Graham D Cole
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom.
| | - Sheetal J Patel
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Nabeela Zaman
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Anthony J Barron
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Claire E Raphael
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Jamil Mayet
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Darrel P Francis
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom
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Krogager ML, Eggers-Kaas L, Aasbjerg K, Mortensen RN, Køber L, Gislason G, Torp-Pedersen C, Søgaard P. Short-term mortality risk of serum potassium levels in acute heart failure following myocardial infarction. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:245-51. [PMID: 27418967 PMCID: PMC4900739 DOI: 10.1093/ehjcvp/pvv026] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 12/02/2022]
Abstract
AIMS Diuretic treatment is often needed in acute heart failure following myocardial infarction (MI) and carries a risk of abnormal potassium levels. We examined the relation between different levels of potassium and mortality. METHODS AND RESULTS From Danish national registries we identified 2596 patients treated with loop diuretics after their first MI episode where potassium measurement was available within 3 months. All-cause mortality was examined according to seven predefined potassium levels: hypokalaemia <3.5 mmol/L, low normal potassium 3.5-3.8 mmol/L, normal potassium 3.9-4.2 mmol/L, normal potassium 4.3-4.5 mmol/L, high normal potassium 4.6-5.0 mmol/L, mild hyperkalaemia 5.1-5.5 mmol/L, and severe hyperkalaemia: >5.5 mmol/L. Follow-up was 90 days and using normal potassium 3.9-4.2 mmol/L as a reference, we estimated the risk of death with a multivariable-adjusted Cox proportional hazard model. After 90 days, the mortality rates in the seven potassium intervals were 15.7, 13.6, 7.3, 8.1, 10.6, 15.5, and 38.3%, respectively. Multivariable-adjusted risk for death was statistically significant for patients with hypokalaemia [hazard ratio (HR): 1.91, confidence interval (95%CI): 1.14-3.19], and mild and severe hyperkalaemia (HR: 2, CI: 1.25-3.18 and HR: 5.6, CI: 3.38-9.29, respectively). Low and high normal potassium were also associated with increased mortality (HR: 1.84, CI: 1.23-2.76 and HR: 1.55, CI: 1.09-2.22, respectively). CONCLUSION Potassium levels outside the interval 3.9-4.5 mmol/L were associated with a substantial risk of death in patients requiring diuretic treatment after an MI.
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Affiliation(s)
| | | | - Kristian Aasbjerg
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Peter Søgaard
- Department of Cardiology and Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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Katsanos S, Bistola V, Parissis JT. Acute Heart Failure Syndromes in the Elderly: The European Perspective. Heart Fail Clin 2015; 11:637-45. [PMID: 26462103 DOI: 10.1016/j.hfc.2015.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Acute heart failure (AHF) in the elderly is an increasingly common clinical problem associated with high in-hospital, short- and long-term mortality rates worldwide. Elderly patients with AHF have different clinical and pathophysiological profiles compared with younger ones. Prevalent cardiovascular comorbidities in the elderly are arterial hypertension and atrial fibrillation, whereas ischemic heart disease and associated risk factors are more common in younger patients. There is a need for greater dissemination of heart failure guidelines and for involvement of multidisciplinary teams for optimizing treatment and eliminating disparities in care in this vulnerable patient group across both sides of the Atlantic.
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Affiliation(s)
- Spyridon Katsanos
- Heart Failure Unit, Attikon University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
| | - Vasiliki Bistola
- Heart Failure Unit, Attikon University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
| | - John T Parissis
- Heart Failure Unit, Attikon University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece.
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Hamood H, Hamood R, Green MS, Almog R. Determinants of adherence to evidence-based therapy after acute myocardial infarction. Eur J Prev Cardiol 2015. [DOI: 10.1177/2047487315597209] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hatem Hamood
- Department of Cardiology, Bnai-Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Leumit Health Services, Karmiel, Israel
| | - Rola Hamood
- School of Public Health, University of Haifa, Israel
| | | | - Ronit Almog
- School of Public Health, University of Haifa, Israel
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Hamood H, Hamood R, Green MS, Almog R. Effect of adherence to evidence-based therapy after acute myocardial infarction on all-cause mortality. Pharmacoepidemiol Drug Saf 2015; 24:1093-104. [DOI: 10.1002/pds.3840] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 05/03/2015] [Accepted: 06/30/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Hatem Hamood
- Department of Cardiology, Bnai Zion Medical Center, The Bruce Rappaport Faculty of Medicine; Technion Israel Institute of Technology; Haifa Israel
- Leumit Health Services; Karmiel Israel
| | - Rola Hamood
- School of Public Health; University of Haifa; Haifa Israel
| | | | - Ronit Almog
- School of Public Health; University of Haifa; Haifa Israel
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de Albuquerque DC, de Souza JD, Bacal F, Rohde LEP, Bernardez-Pereira S, Berwanger O, Almeida DR. I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes. Arq Bras Cardiol 2015; 104:433-42. [PMID: 26131698 PMCID: PMC4484675 DOI: 10.5935/abc.20150031] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. OBJECTIVE Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. METHODS Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. RESULTS A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. CONCLUSION The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.
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Affiliation(s)
| | | | - Fernando Bacal
- Instituto do Coração (InCor) do Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Otavio Berwanger
- Instituto de Pesquisa, Hospital do Coração, São Paulo, SP,
Brazil
| | - Dirceu Rodrigues Almeida
- Universidade Federal de São Paulo, UNIFESP, São Paulo, SP;
Sociedade Brasileira de Cardiologia - Departamento de Insuficiência Cardíaca (DEIC) -
Brazil
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59
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Witt CT, Kronborg MB, Nohr EA, Mortensen PT, Gerdes C, Nielsen JC. Optimization of heart failure medication after cardiac resynchronization therapy and the impact on long-term survival. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:182-8. [DOI: 10.1093/ehjcvp/pvv016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/25/2015] [Indexed: 11/15/2022]
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Chen HY, Saczynski JS, Lapane KL, Kiefe CI, Goldberg RJ. Adherence to evidence-based secondary prevention pharmacotherapy in patients after an acute coronary syndrome: A systematic review. Heart Lung 2015; 44:299-308. [PMID: 25766041 DOI: 10.1016/j.hrtlng.2015.02.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/04/2015] [Accepted: 02/08/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To synthesize current evidence on medication adherence rates and associated risk factors in patients after an acute coronary syndrome (ACS). METHODS A systematic review was conducted. Five electronic databases and article bibliographies were searched for publications from 1990 to 2013 which assessed adherence to secondary prevention pharmacotherapy in adults after hospital discharge for an ACS. Identified studies were screened using pre-defined criteria for eligibility. A standardized form was used for data abstraction. Methodological quality was assessed using modified criteria for quantitative studies. RESULTS Sixteen studies met our inclusion criteria. Post-discharge medication adherence rates at 1-year ranged between 54% and 86%. There were no consistent predictors of non-adherence across all cardiac medication classes examined. CONCLUSIONS Adherence to secondary prevention pharmacotherapy was suboptimal in patients after hospital discharge for an ACS. Risk factors associated with non-adherence were examined in a limited number of studies, and the associations varied between these investigations.
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Affiliation(s)
- Han-Yang Chen
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA.
| | - Jane S Saczynski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA; Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
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Gjesing A, Gislason GH, Christensen SB, Jørgensen ME, Mérie C, Norgaard ML, Poulsen HE, Gustafsson F, Køber L, Torp-Pedersen C, Andersson C. Use of quinine and mortality-risk in patients with heart failure--a Danish nationwide observational study. Pharmacoepidemiol Drug Saf 2015; 24:310-8. [PMID: 25656791 DOI: 10.1002/pds.3746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 09/03/2014] [Accepted: 12/08/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE Leg cramps are common in patients with heart failure. Quinine is frequently prescribed in low doses to these patients, but safety of this practice is unknown. We studied the outcomes associated with use of quinine in a nationwide cohort of patients with heart failure. METHODS Through individual-level-linkage of Danish national registries, we identified patients discharged from first-time hospitalization for heart failure in 1997-2010. We estimated the risk of mortality associated with quinine treatment by time-dependent Poisson regression models. RESULTS A total of 135 529 patients were included, with 14 510 patients (11%) using quinine at some point. During a median time of follow-up of 989 days (interquartile range 350-2004) 88 878 patients (66%) died. Patients receiving quinine had slightly increased mortality risk, adjusted incidence rate ratio (IRR) 1.04 (95% confidence interval [CI] 1.01 to 1.07). The risks differed according to concomitant β-blocker treatment. For patients treated with both quinine and β-blockers IRR was 1.15 (95% CI 1.09 to 1.21) vs. 0.99 (95% CI 0.96 to 1.03) for patients treated with quinine but not β-blockers. The risks were highest shortly after initiation of therapy: for the first 14 days of treatment IRR was 2.12 (95% CI 1.54 to 2.93) for patients in treatment with β-blockers and 1.17 (95% CI 0.86 to 1.59) for patients not treated with β-blockers. CONCLUSIONS Use of quinine was common and associated with increased mortality in heart failure, especially if administered together with β-blockers and shortly after treatment initiation. Mechanisms underlying the findings remain to be established.
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Affiliation(s)
- Anne Gjesing
- Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
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Murphy GK, McAlister FA, Eurich DT. Cardiovascular medication utilization and adherence among heart failure patients in rural and urban areas: a retrospective cohort study. Can J Cardiol 2014; 31:341-7. [PMID: 25633910 DOI: 10.1016/j.cjca.2014.11.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/17/2014] [Accepted: 11/25/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Rural residence is a negative prognostic factor for heart failure (HF). The objective was to explore rural and urban differences in the utilization, adherence, and persistence with medications, and mortality among incident HF patients. METHODS Using administrative databases from Alberta (Canada), subjects > 65 years old with a first hospitalization for HF between 1999 and 2008 who survived ≥ 90 days after discharge were identified. Pharmacy claims for renin-angiotensin system (RAS) agents, β-blockers (BBs), digoxin, or spironolactone were identified. The association between rural and urban residence and medication utilization, adherence (optimal adherence defined as ≥ 80% adherence over 1 year), persistence, and 1-year mortality was assessed. RESULTS The cohort included 10,430 patients, with a mean age of 80.2 (SD, 7.7) years, 47% were male, and 25% were rural residents. Rural residents were less likely to receive RAS agents (74% vs 79%, adjusted odds ratio [aOR], 0.78; 95% confidence interval [CI], 0.69-0.89) or BBs (44% vs 54%; aOR, 0.83; 95% CI, 0.73-0.93) than urban residents, but had similar use of other medications. Although < 69% of patients who received RAS agents and 53% who received BBs had optimal adherence, few differences in adherence or persistence were detected among patients in rural vs urban areas. The 1-year mortality rate was significantly lower for patients who demonstrated optimal adherence to RAS agents or BBs (aOR, 0.78; 95% CI, 0.65-0.94) with no significant differences in the first 6 months between patients residing in rural vs urban areas. CONCLUSIONS Rural residents with HF were less likely to receive RAS agents or BBs, but few differences in adherence were noted compared with their urban counterparts. Suboptimal adherence with evidence-based HF therapy was associated with increased risk of mortality.
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Affiliation(s)
- Gaetanne K Murphy
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Finlay A McAlister
- Division of General Internal Medicine, Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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Schou M, Gislason G, Videbaek L, Kober L, Tuxen C, Torp-Pedersen C, Hildebrandt PR, Gustafsson F. Effect of extended follow-up in a specialized heart failure clinic on adherence to guideline recommended therapy: NorthStar Adherence Study. Eur J Heart Fail 2014; 16:1249-55. [DOI: 10.1002/ejhf.176] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 08/22/2014] [Accepted: 08/28/2014] [Indexed: 01/08/2023] Open
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Patterson SM, Cadogan CA, Kerse N, Cardwell CR, Bradley MC, Ryan C, Hughes C. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2014:CD008165. [PMID: 25288041 DOI: 10.1002/14651858.cd008165.pub3] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Inappropriate polypharmacy is a particular concern in older people and is associated with negative health outcomes. Choosing the best interventions to improve appropriate polypharmacy is a priority, hence interest in appropriate polypharmacy, where many medicines may be used to achieve better clinical outcomes for patients, is growing. OBJECTIVES This review sought to determine which interventions, alone or in combination, are effective in improving the appropriate use of polypharmacy and reducing medication-related problems in older people. SEARCH METHODS In November 2013, for this first update, a range of literature databases including MEDLINE and EMBASE were searched, and handsearching of reference lists was performed. Search terms included 'polypharmacy', 'medication appropriateness' and 'inappropriate prescribing'. SELECTION CRITERIA A range of study designs were eligible. Eligible studies described interventions affecting prescribing aimed at improving appropriate polypharmacy in people 65 years of age and older in which a validated measure of appropriateness was used (e.g. Beers criteria, Medication Appropriateness Index (MAI)). DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts of eligible studies, extracted data and assessed risk of bias of included studies. Study-specific estimates were pooled, and a random-effects model was used to yield summary estimates of effect and 95% confidence intervals (CIs). The GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to assess the overall quality of evidence for each pooled outcome. MAIN RESULTS Two studies were added to this review to bring the total number of included studies to 12. One intervention consisted of computerised decision support; 11 complex, multi-faceted pharmaceutical approaches to interventions were provided in a variety of settings. Interventions were delivered by healthcare professionals, such as prescribers and pharmacists. Appropriateness of prescribing was measured using validated tools, including the MAI score post intervention (eight studies), Beers criteria (four studies), STOPP criteria (two studies) and START criteria (one study). Interventions included in this review resulted in a reduction in inappropriate medication usage. Based on the GRADE approach, the overall quality of evidence for all pooled outcomes ranged from very low to low. A greater reduction in MAI scores between baseline and follow-up was seen in the intervention group when compared with the control group (four studies; mean difference -6.78, 95% CI -12.34 to -1.22). Postintervention pooled data showed a lower summated MAI score (five studies; mean difference -3.88, 95% CI -5.40 to -2.35) and fewer Beers drugs per participant (two studies; mean difference -0.1, 95% CI -0.28 to 0.09) in the intervention group compared with the control group. Evidence of the effects of interventions on hospital admissions (five studies) and of medication-related problems (six studies) was conflicting. AUTHORS' CONCLUSIONS It is unclear whether interventions to improve appropriate polypharmacy, such as pharmaceutical care, resulted in clinically significant improvement; however, they appear beneficial in terms of reducing inappropriate prescribing.
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Affiliation(s)
- Susan M Patterson
- No affiliation, 12-22 Linenhall Street, Belfast, Northern Ireland, UK, BT2 8BS
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Gjesing A, Gislason GH, Køber L, Gustav Smith J, Christensen SB, Gustafsson F, Olsen AMS, Torp-Pedersen C, Andersson C. Nationwide trends in development of heart failure and mortality after first-time myocardial infarction 1997-2010: A Danish cohort study. Eur J Intern Med 2014; 25:731-8. [PMID: 25225051 DOI: 10.1016/j.ejim.2014.08.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 08/22/2014] [Accepted: 08/23/2014] [Indexed: 01/01/2023]
Abstract
AIMS Pharmacological and revascularization strategies following myocardial infarction (MI) have changed substantially during the last two decades. We investigated the temporal trends in heart failure (HF) incidence and mortality during the first 90 days following first-time MI between 1997 and 2010 in Denmark. METHODS AND RESULTS Through administrative nationwide registers we identified 89,389 patients without prior HF hospitalized with first MI. The number of patients treated with percutaneous coronary intervention (PCI) days 0-1 after index MI increased from 2.5% in 1997-98 to 38.2% in 2009-10. Treatment with clopidogrel increased from 0.02% in 1997-98 to 68.1% in 2009-10 and statins from 8.1% in 1997-98 to 78.3% in 2009-10. The incidence of HF (defined as HF diagnosis or incident use of loop diuretics) decreased from 23.6% in 1997-98 to 19.6% in 2009-10 (p<0.001). Adjusted for age, sex, and comorbidity, hazard ratio was 0.77 (95% confidence interval [CI] 0.74-0.79) for developing HF in 2009-10, compared with 1997-98. Adjusted for coronary interventions, and pharmacotherapy HR increased to 0.82 (95% confidence interval (CI) 0.79-0.85) compared with 1997-98. The 90-day mortality decreased from 19.6% in 1997-98 to 11.7% in 2009-10 (p<0.001). Adjusted for age, sex, and comorbidity HR was 0.59 (CI 0.55-0.64) in 2009-10 compared with 1997-98; upon additional adjustment for coronary interventions and pharmacotherapy the estimate was 0.75 (95% CI 0.69-0.81). CONCLUSION We found a temporal decrease in HF incidence and mortality during the first 90 days after MI in 1997-2010. This could partly be explained by changes in interventional and pharmacological treatment strategies.
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Affiliation(s)
- Anne Gjesing
- Department of Cardiology, Niels Andersens Vej 65, Gentofte University Hospital, 2900 Hellerup, Denmark.
| | - Gunnar H Gislason
- Department of Cardiology, Niels Andersens Vej 65, Gentofte University Hospital, 2900 Hellerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark; National Institute of Public Health, University of Southern, Øster Farimagsgade 5 A, 1353 Copenhagen K, Denmark
| | - Lars Køber
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark; Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, Copenhagen University Hospital, 2100 Copenhagen Ø, Denmark
| | - J Gustav Smith
- Department of Cardiology, Lund University, Paradisgatan 2, 221 00 Lund, Sweden; Department of Heart Failure and Valvular Disease, Skåne University Hospital, Paradisgatan 2, 221 00 Lund, Sweden; Department of Clinical Sciences, Clinical Research Centre, Skåne University Hospital, Jan Waldenströms Gata 35, Malmö, Sweden
| | | | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, Copenhagen University Hospital, 2100 Copenhagen Ø, Denmark
| | | | - Christian Torp-Pedersen
- Institute of Health, Science and Technology, Aalborg University, Fredrik Bajers Vej 7D2, 9220 Aalborg, Denmark
| | - Charlotte Andersson
- Department of Cardiology, Niels Andersens Vej 65, Gentofte University Hospital, 2900 Hellerup, Denmark; Department of Clinical Sciences, Clinical Research Centre, Skåne University Hospital, Jan Waldenströms Gata 35, Malmö, Sweden
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Gupta A, Goyal P, Bahl A. Frequency of recovery and relapse in patients with nonischemic dilated cardiomyopathy on guideline-directed medical therapy. Am J Cardiol 2014; 114:883-9. [PMID: 25084692 DOI: 10.1016/j.amjcard.2014.06.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 11/16/2022]
Abstract
Several key clinical questions, such as which patients with dilated cardiomyopathy (DC) will recover, how many will relapse, when will they relapse, and predictors of relapse, have sparse data. The present study examines the frequency and predictors of recovery and relapse in patients with DC. One hundred eighty-eight patients of a nonischemic DC cohort having baseline left ventricular ejection fraction (LVEF) ≤ 40% were divided into 3 groups: improved group with sustained recovery of LVEF to >40% with a net increase in LVEF of ≥ 10% from baseline, not-improved group without change or decrease in LVEF compared with that in baseline including patients with an increase in LVEF <10%, and relapsed group with decrease in LVEF ≥ 10% after initial improvement. Follow-up duration was 50 ± 31 months. One hundred ten patients (59%) did not improve. Of the 78 patients (41%) who improved, 50 (64%) had sustained improvement. Remaining 28 (36%) of the 78 improved patients relapsed on further follow-up of 36 ± 25 months. Baseline LVEF was similar in the 3 groups. Mean LVEF increased from 29 ± 8% to 50 ± 7% (p <0.001) in the improved group, changed from 27 ± 9% to 25 ± 9% (p = 0.95) in the not-improved group, and, after increasing from 30 ± 7% to 52 ± 6%, it decreased to 34 ± 9% (p <0.001) in the relapsed group. Multivariate analysis showed that the only variable associated with recovery of LVEF was shorter QRS duration (odds ratio 0.31, 95% confidence interval 0.15 to 0.67, p = 0.003). Recurrence of left ventricular systolic dysfunction was associated with long QRS duration (odds ratio 3.52, 95% confidence interval 1.27 to 9.76, p = 0.01). In conclusion, with currently recommended medical therapy, 1/4 of patients with nonischemic DC have sustained improvement, and >1/3 of those who improve relapse. QRS duration predicted both recovery and relapse. The survival rate of patients in the improved group was significantly better than that in the other 2 groups (p = 0.03, log-rank).
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Affiliation(s)
- Ankur Gupta
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Puneet Goyal
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Bahl
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Goldstein CM, Gathright EC, Dolansky MA, Gunstad J, Sterns A, Redle JD, Josephson R, Hughes JW. Randomized controlled feasibility trial of two telemedicine medication reminder systems for older adults with heart failure. J Telemed Telecare 2014; 20:293-9. [PMID: 24958355 DOI: 10.1177/1357633x14541039] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We conducted a feasibility study of a telehealth intervention (an electronic pill box) and an m-health intervention (an app on a smartphone) for improving medication adherence in older adults with heart failure. A secondary aim was to compare patient acceptance of the devices. The participants were 60 adults with HF (65% male). Their average age was 69 years and 83% were Caucasian. Patients were randomized using a 2 × 2 design to one of four groups: pillbox silent, pillbox reminding, smartphone silent, smartphone reminding. We examined adherence to 4 medications over 28 days. The overall adherence rate was 78% (SD 35). People with the telehealth device adhered 80% of the time and people with the smartphone adhered 76% of the time. Those who received reminders adhered 79% of the time, and those with passive medication reminder devices adhered 78% of the time, i.e. reminding did not improve adherence. Patients preferred the m-health approach. Future interventions may need to address other contributors to poor adherence such as motivation.
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Affiliation(s)
- Carly M Goldstein
- Department of Psychology, Kent State University, Kent, Ohio, USA Summa Health System, Akron, Ohio, USA
| | - Emily C Gathright
- Department of Psychology, Kent State University, Kent, Ohio, USA Summa Health System, Akron, Ohio, USA
| | - Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland Ohio, USA
| | - John Gunstad
- Department of Psychology, Kent State University, Kent, Ohio, USA
| | - Anthony Sterns
- Department of Psychology, Kent State University, Kent, Ohio, USA Creative Action LLC, Akron, Ohio, USA
| | | | - Richard Josephson
- Harrington-McLaughlin Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland Ohio, USA Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Joel W Hughes
- Department of Psychology, Kent State University, Kent, Ohio, USA Summa Health System, Akron, Ohio, USA Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland Ohio, USA
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Lamberts M, Lip GY, Ruwald MH, Hansen ML, Özcan C, Kristensen SL, Køber L, Torp-Pedersen C, Gislason GH. Antithrombotic Treatment in Patients With Heart Failure and Associated Atrial Fibrillation and Vascular Disease. J Am Coll Cardiol 2014; 63:2689-98. [DOI: 10.1016/j.jacc.2014.03.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/22/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
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de Peuter OR, Lip GY, Souverein PC, Klungel OH, de Boer A, Büller HR, Kamphuisen PW. Time-trends in treatment and cardiovascular events in patients with heart failure: a pharmacosurveillance study. Eur J Heart Fail 2014; 13:489-95. [DOI: 10.1093/eurjhf/hfq228] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Olav R. de Peuter
- Department of Vascular Medicine; Academic Medical Centre; PO Box 22660 1100DD Amsterdam The Netherlands
| | - Gregory Y.H. Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham UK
| | - Patrick C. Souverein
- Pharmacoepidemiology and pharmacotherapy; Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | - Olaf H. Klungel
- Pharmacoepidemiology and pharmacotherapy; Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | - Anthonius de Boer
- Pharmacoepidemiology and pharmacotherapy; Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | - Harry R. Büller
- Department of Vascular Medicine; Academic Medical Centre; PO Box 22660 1100DD Amsterdam The Netherlands
| | - Pieter W. Kamphuisen
- Department of Vascular Medicine; Academic Medical Centre; PO Box 22660 1100DD Amsterdam The Netherlands
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de Peuter OR, Souverein PC, Klungel OH, Büller HR, de Boer A, Kamphuisen PW. Non-selective vs. selective beta-blocker treatment and the risk of thrombo-embolic events in patients with heart failure. Eur J Heart Fail 2014; 13:220-6. [DOI: 10.1093/eurjhf/hfq176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Olav R. de Peuter
- Department of Vascular Medicine (F4-139); Academic Medical Centre; Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam The Netherlands
| | - Patrick C. Souverein
- Division of Pharmacoepidemiology and Pharmacotherapy; Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Pharmacotherapy; Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | - Harry R. Büller
- Department of Vascular Medicine (F4-139); Academic Medical Centre; Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Pharmacotherapy; Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | - Pieter W. Kamphuisen
- Department of Vascular Medicine (F4-139); Academic Medical Centre; Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam The Netherlands
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Khonsari S, Subramanian P, Chinna K, Latif LA, Ling LW, Gholami O. Effect of a reminder system using an automated short message service on medication adherence following acute coronary syndrome. Eur J Cardiovasc Nurs 2014; 14:170-9. [PMID: 24491349 DOI: 10.1177/1474515114521910] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medication non-adherence leads to a vast range of negative outcomes in patients with coronary artery disease. An automated web-based system managing short message service (SMS) reminders is a telemedicine approach to optimise adherence among patients who frequently forget to take their medications or miss the timing. AIM This paper sought to investigate the effect of automated SMS-based reminders on medication adherence in patients after hospital discharge following acute coronary syndrome (ACS). METHODS An interventional study was conducted at a tertiary teaching hospital in Malaysia. A total of 62 patients with ACS were equally randomised to receive either automated SMS reminders before every intake of cardiac medications or only usual care within eight weeks after discharge. The primary outcome was adherence to cardiac medications. Secondary outcomes were the heart functional status, and ACS-related hospital readmission and death rates. RESULTS There was a higher medication adherence level in the intervention group rather than the usual care group, (χ(2) (2)=18.614, p<0.001). The risk of being low adherent among the control group was 4.09 times greater than the intervention group (relative risk =4.09, 95% confidence interval (CI) 1.82-9.18). A meaningful difference was found in heart functional status between the two study groups with better results among patients who received SMS reminders, (χ(2) (1) = 16.957, p<0.001). CONCLUSION An automated SMS-based reminder system can potentially enhance medication adherence in ACS patients during the early post-discharge period.
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Gjesing A, Schou M, Torp-Pedersen C, Køber L, Gustafsson F, Hildebrandt P, Videbaek L, Wiggers H, Demant M, Charlot M, Gislason GH. Patient adherence to evidence-based pharmacotherapy in systolic heart failure and the transition of follow-up from specialized heart failure outpatient clinics to primary care. Eur J Heart Fail 2014; 15:671-8. [DOI: 10.1093/eurjhf/hft011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anne Gjesing
- Department of Cardiology; Gentofte University Hospital; post 635, Niels Andersens Vej 65 2900 Hellerup Denmark
| | - Morten Schou
- Department of Cardiology, Heart Centre, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Epidemiology; Institute of Health, Science and Technology, Aalborg University; Aalborg Denmark
| | - Lars Køber
- Department of Cardiology, Heart Centre, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Finn Gustafsson
- Department of Cardiology, Heart Centre, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Per Hildebrandt
- Department of Cardiology and Endocrinology; Frederiksberg Hospital; Frederiksberg Denmark
| | - Lars Videbaek
- Department of Cardiology; Odense University Hospital; Odense Denmark
| | - Henrik Wiggers
- Department of Cardiology; Aarhus University Hospital; Aarhus Denmark
| | - Malene Demant
- Department of Cardiology; Gentofte University Hospital; post 635, Niels Andersens Vej 65 2900 Hellerup Denmark
| | - Mette Charlot
- Department of Cardiology; Nephrology and Endocrinology, Hillerød Hospital; Hilerød Denmark
| | - Gunnar H. Gislason
- Department of Cardiology; Gentofte University Hospital; post 635, Niels Andersens Vej 65 2900 Hellerup Denmark
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Andersson C, Norgaard ML, Hansen PR, Fosbøl EL, Schmiegelow M, Weeke P, Olesen JB, Raunsø J, Jørgensen CH, Vaag A, Køber L, Torp-Pedersen C, Gislason GH. Heart failure severity, as determined by loop diuretic dosages, predicts the risk of developing diabetes after myocardial infarction: a nationwide cohort study. Eur J Heart Fail 2014; 12:1333-8. [DOI: 10.1093/eurjhf/hfq160] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Charlotte Andersson
- Department of Cardiology; Gentofte Hospital, University of Copenhagen; Niels Andersens Vej 65 DK 2900 Hellerup Denmark
| | - Mette L. Norgaard
- Department of Cardiology; Gentofte Hospital, University of Copenhagen; Niels Andersens Vej 65 DK 2900 Hellerup Denmark
| | - Peter R. Hansen
- Department of Cardiology; Gentofte Hospital, University of Copenhagen; Niels Andersens Vej 65 DK 2900 Hellerup Denmark
| | - Emil L. Fosbøl
- Department of Cardiology; Gentofte Hospital, University of Copenhagen; Niels Andersens Vej 65 DK 2900 Hellerup Denmark
| | - Michelle Schmiegelow
- Department of Cardiology; Gentofte Hospital, University of Copenhagen; Niels Andersens Vej 65 DK 2900 Hellerup Denmark
| | - Peter Weeke
- Department of Cardiology; Gentofte Hospital, University of Copenhagen; Niels Andersens Vej 65 DK 2900 Hellerup Denmark
| | - Jonas B. Olesen
- Department of Cardiology; Gentofte Hospital, University of Copenhagen; Niels Andersens Vej 65 DK 2900 Hellerup Denmark
| | - Jakob Raunsø
- Department of Cardiology; Gentofte Hospital, University of Copenhagen; Niels Andersens Vej 65 DK 2900 Hellerup Denmark
| | - Casper H. Jørgensen
- Department of Cardiology; Gentofte Hospital, University of Copenhagen; Niels Andersens Vej 65 DK 2900 Hellerup Denmark
| | | | - Lars Køber
- The Heart Centre, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology; Gentofte Hospital, University of Copenhagen; Niels Andersens Vej 65 DK 2900 Hellerup Denmark
| | - Gunnar H. Gislason
- Department of Cardiology; Gentofte Hospital, University of Copenhagen; Niels Andersens Vej 65 DK 2900 Hellerup Denmark
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 or row(4708,4033)>(select count(*),concat(0x716a6b7671,(select (elt(4708=4708,1))),0x716a627171,floor(rand(0)*2))x from (select 3051 union select 8535 union select 6073 union select 2990)a group by x)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 8965=8965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (1210=1210) then null else ctxsys.drithsx.sn(1,1210) end) from dual) is null-- xobr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (1664=1487) then null else cast((chr(122)||chr(70)||chr(116)||chr(76)) as numeric) end)) is null-- irzn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 8965=8965-- hjno] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 9453=6189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 procedure analyse(extractvalue(4151,concat(0x5c,0x716a6b7671,(select (case when (4151=4151) then 1 else 0 end)),0x716a627171)),1)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 2863=6232-- jate] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 order by 1-- drbf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (4057=3733) then null else ctxsys.drithsx.sn(1,4057) end) from dual) is null] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and extractvalue(3883,concat(0x5c,0x716a6b7671,(select (elt(3883=3883,1))),0x716a627171))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 3474=cast((chr(113)||chr(106)||chr(107)||chr(118)||chr(113))||(select (case when (3474=3474) then 1 else 0 end))::text||(chr(113)||chr(106)||chr(98)||chr(113)||chr(113)) as numeric)-- crum] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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92
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 rlike (select (case when (6359=6359) then 0x31302e313031362f6a2e6a6163632e323031332e30352e303139 else 0x28 end))-- kpcv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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93
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 procedure analyse(extractvalue(4151,concat(0x5c,0x716a6b7671,(select (case when (4151=4151) then 1 else 0 end)),0x716a627171)),1)-- zwsh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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94
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95
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2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 order by 1#] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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96
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 3529=(select upper(xmltype(chr(60)||chr(58)||chr(113)||chr(106)||chr(107)||chr(118)||chr(113)||(select (case when (3529=3529) then 1 else 0 end) from dual)||chr(113)||chr(106)||chr(98)||chr(113)||chr(113)||chr(62))) from dual)-- fhnu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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97
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (1210=1210) then null else ctxsys.drithsx.sn(1,1210) end) from dual) is null] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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98
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99
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100
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