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Mornar Jelavić M, Krstačić G, Perenčević A, Pintarić H. Sexual Activity in Patients with Cardiac Diseases. Acta Clin Croat 2018; 57:141-148. [PMID: 30256023 PMCID: PMC6400344 DOI: 10.20471/acc.2018.57.01.18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
SUMMARY – In this article, we outline the latest guidelines published by the American Heart Association on sexual activity in patients with coronary artery disease, heart failure, structural heart diseases, arrhythmias, implanted pacemakers or cardioverter defibrillators, as well as on treatment options of sexual dysfunction. Sexual activities are similar to mild/moderate physical activity during a short period. Most patients are recommended to involve in sexual activity after prior comprehensive evaluation of physical condition. Those with stable cardiac symptoms and good functional capacity are at a low risk of adverse cardiovascular events, and others require treatment or stabilization before involving in sexual activity. Stress testing is useful in evaluating safety of sexual activity in patients with questionable or undetermined risk. Treatment of sexual dysfunction includes counseling of patients and their sexual partners, and drug treatment with phosphodiesterase inhibitors (sildenafil, tadalafil, vardenafil) which have been demonstrated to be safe and effective, in men, and with serotonin reuptake inhibitors (flibanserin) and local vaginal estrogen administration in women. In conclusion, in routine clinical practice, patients should be approached individually and multidisciplinarily in order to detect and eliminate the factors that interfere with normal sexual activities and disturb the quality of life.
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Affiliation(s)
| | - Goran Krstačić
- Institute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia.,School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Aleksandra Perenčević
- Department of Internal Medicine and Dialysis, Zagreb-East Health Center, Zagreb, Croatia
| | - Hrvoje Pintarić
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia.,Cardiac Catheterization Laboratory, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Gebregeorgise DT, Belay YM, Kälvemark Sporrong S. Sildenafil citrate use in Addis Ababa: characteristics of users and pharmacists' dispensing practices. Int J Clin Pharm 2017; 40:67-73. [PMID: 29134487 DOI: 10.1007/s11096-017-0558-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 11/02/2017] [Indexed: 12/17/2022]
Abstract
Background Studies have reported misuse of sildenafil citrate for recreational purpose, not least by healthy young men. This is becoming a major concern, for medical and other reasons. Objective The aim of this study was to document the characteristics of sildenafil citrate users and to explore the dispensing practices of the medicine in selected community pharmacies in Addis Ababa, Ethiopia. Setting Data was collected in community pharmacies in Addis Ababa, Ethiopia. Method A survey, using a self-administrated questionnaire, was conducted among customers who purchased sildenafil citrate from community pharmacies. Simple descriptive statistics were used to analyse data. Also, semi-structured interviews were conducted with community pharmacists. These were analysed thematically. Main outcome measures Socio-demographic characteristics (survey), themes (interviews). Results All survey respondents (n = 197) were men, 57.9% were below 40 years old, 53.8% had never been married and 58.4% had used sildenafil citrate before. A minority (16.2%) were diagnosed with erectile dysfunction. The main reason for buying sildenafil citrate was experimentation (45.7%). Pharmacists reported that sildenafil citrate was often dispensed without a prescription. The reason for this was, according to the interviewees, competition in the market. Also, the medicine was often dispensed without adequate information or counselling. Conclusions Selling and buying sildenafil citrate without a prescription seems to be common practice in pharmacies in Addis Ababa. It is crucial to strengthen the regulatory activity to protect customers from health risks. In addition pharmacy professionals should be supported to work in accordance with professional and legal standards.
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Affiliation(s)
- Dawit Teshome Gebregeorgise
- University of Copenhagen, Copenhagen, Denmark.,Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yajeb Melesse Belay
- University of Copenhagen, Copenhagen, Denmark.,Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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de Souza Carneiro C, Dias de Oliveira AP, de Lima Lopes J, Bachion MM, Herdman TH, Moorhead SA, Bottura Leite de Barros AL. Outpatient Clinic for Health Education: Contribution to Self-Management and Self-Care for People With Heart Failure. Int J Nurs Knowl 2015; 27:49-55. [DOI: 10.1111/2047-3095.12071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Camila de Souza Carneiro
- Paulista Nursing School; Federal University of São Paulo (EPE, UNIFESP); São Paulo São Paulo Brazil
- Hospital São Paulo (HSP); São Paulo São Paulo Brazil
| | - Ana Paula Dias de Oliveira
- EPE, UNIFESP; São Paulo São Paulo Brazil
- Dante Pazzanese Cardiology Institution (IDPC); São Paulo São Paulo Brazil
| | | | | | | | - Sue A. Moorhead
- College of Nursing; University of Iowa (UIOWA); Iowa City Iowa USA
- Center for Nursing Classification and Clinical Effectiveness; Iowa City Iowa USA
- UIOWA; Iowa City Iowa USA
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Levine GN, Steinke EE, Bakaeen FG, Bozkurt B, Cheitlin MD, Conti JB, Foster E, Jaarsma T, Kloner RA, Lange RA, Lindau ST, Maron BJ, Moser DK, Ohman EM, Seftel AD, Stewart WJ. Sexual activity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2012; 125:1058-72. [PMID: 22267844 DOI: 10.1161/cir.0b013e3182447787] [Citation(s) in RCA: 235] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hebert K, Anand J, Trahan P, Delgado M, Greene J, Julian E, Cuomo J, Gogichaishvili I, Nozadze N, Dias A, Arcement L. Prevalence of erectile dysfunction in systolic heart failure patients in a developing country: Tbilisi, Georgia, Eastern Europe. J Sex Med 2011; 7:3991-6. [PMID: 20701678 DOI: 10.1111/j.1743-6109.2010.01954.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In the past decade, there has been an increasing amount of published information regarding erectile dysfunction (ED) and heart failure (HF) in economically advanced, westernized populations. However, there is a paucity of data regarding ED and HF in developing countries. The country of Georgia is categorized as a lower-middle-income country (LMIC) with an emerging and developing economy. AIM To examine the prevalence of ED in patients with HF from a developing and LMIC and assess the association with depression. METHODS We conducted an observational, cross-sectional study that included male patients 18 years of age or older with an ejection fraction ≤40% by echocardiogram in a heart failure disease management program in Tbilisi, Georgia. The Sexual Health Inventory for Men (SHIM) survey was used to categorize men according to degree of ED. Baseline clinical characteristics known to be associated with ED, such as New York Heart Association functional classification, were also documented. MAIN OUTCOME MEASURES The SHIM survey and the nine-question Patient Health Questionnaire. RESULTS The prevalence of ED was found to be 61.7%. Patients with ED were generally older, had more peripheral vascular disease, and had greater levels of depression than those without ED. CONCLUSIONS There is a high prevalence of ED in patients with HF living in Tbilisi, Georgia. In comparison to previously published data on HF populations, our Georgian population showed lesser degrees of ED. More research is needed to better explain the causality for lower prevalence of ED, but explanations may include lower degrees of diabetes and aspects of treatment such as beta-blocker medication. Health care providers in LMICs should screen all of their male HF patients for ED and provide appropriate therapy.
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Affiliation(s)
- Kathy Hebert
- Department of Cardiology, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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Ponizovsky AM, Averbuch L, Radomislensky I, Grinshpoon A. A multicenter, randomized, open-labeled, parallel group trial of sildenafil in alcohol-associated erectile dysfunction: the impact on psychosocial outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:2510-25. [PMID: 19826560 PMCID: PMC2760426 DOI: 10.3390/ijerph6092510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 09/22/2009] [Indexed: 11/17/2022]
Abstract
To examine the effect of sildenafil on erectile dysfunction (ED) and psychosocial outcomes in alcohol-dependent (AD) men, 108 men with these diagnoses were randomly assigned to either take sildenafil (50 mg) as add-on to standard treatment for AD, or the same treatment without sildenafil, for 12 weeks. Only 50 patients in sildenafil group and 51 in control group twice completed the International Index of Erectile Function (IIEF) and a battery of self-report questionnaires. IIEF scores and psychosocial functioning, self-esteem and support from friends improved only for sildenafil-treated patients (P < 0.001). The high effect sizes suggest that the observed benefits are unlikely to be a placebo effect, although their unspecific nature could not be ruled out. In men with ED associated with AD, sildenafil improves both ED and psychosocial outcomes. Further placebo-controlled clinical trial is warranted.
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Affiliation(s)
- Alexander M. Ponizovsky
- Mental Health Services, Ministry of Health, 2 Ben Tabai St., Jerusalem 93591, Israel; E-Mail:
| | - Lev Averbuch
- The Department of Substance Dependence Treatment, Ministry of Health, 20 King David St., Jerusalem 91010, Israel; E-Mail:
| | - Ira Radomislensky
- Mental Health Services, Ministry of Health, 2 Ben Tabai St., Jerusalem 93591, Israel; E-Mail:
| | - Alexander Grinshpoon
- Tirat Carmel Mental Health Center, Ministry of Health, 17 Ha’ela St., ‘Tirat Carmel 30200, Israel Sha’ar Menashe Mental Health Center, Ministry of Health, Mobile Post Hefer 37806, Israel; E-Mail:
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Hebert K, Lopez B, Macedo FYB, Gomes CR, Urena J, Arcement LM. Peripheral Vascular Disease and Erectile Dysfunction as Predictors of Mortality in Heart Failure Patients. J Sex Med 2009; 6:1999-2007. [DOI: 10.1111/j.1743-6109.2009.01278.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Al-Ameri H, Kloner RA. Erectile dysfunction and heart failure: the role of phosphodiesterase type 5 inhibitors. Int J Impot Res 2009; 21:149-57. [PMID: 19387454 PMCID: PMC2834326 DOI: 10.1038/ijir.2009.11] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The phosphodiesterase type 5 (PDE-5) inhibitors are effective in treating erectile dysfunction (ED). ED and heart failure (HF) share similar risk factors, and commonly present together. This association has led to questions ranging from the safety and efficacy of PDE-5 inhibitors in HF patients to a possible role for this class of medication to treat HF patients with or without ED. In addition to endothelial dysfunction, there are causes of ED specific to patients with HF including low exercise tolerance, depression and HF medications. Before treating HF patients with PDE-5 inhibitors, patients should be assessed for their risk of a cardiac event during sexual activity. PDE-5 inhibitors are safe and effective in treating ED in HF patients. An improvement in erectile function by PDE-5 inhibitors was associated with an improvement in quality of life and reduction in depression. Several studies demonstrated the effect of PDE-5 inhibitors on HF per se. PDE-5 inhibitors improved endothelial dysfunction, increased exercise tolerance, decreased pulmonary vascular resistance and pulmonary artery pressure, and increased cardiac index. Several mechanisms whereby PDE-5 inhibitors improve HF have been proposed. PDE-5 inhibitors already have a role in treating primary pulmonary hypertension; however additional studies are needed to determine if they will become a standard therapy for HF patients.
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Affiliation(s)
- H Al-Ameri
- The Heart Institute, Good Samaritan Hospital, Los Angeles, CA 90017, USA
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Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials. Can J Cardiol 2009; 25:85-105. [PMID: 19214293 DOI: 10.1016/s0828-282x(09)70477-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. Specific clinical questions that are addressed include: What is right-sided heart failure and how should one approach the diagnostic work-up? What other clinical entities may masquerade as this nebulous condition and how can we tell them apart? When should we be concerned about the presence of myocarditis and how quickly should patients with this condition be referred to an experienced centre? Among the myriad of recently published landmark clinical trials, which ones will impact our standards of clinical care? The goals are to aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada.
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Corvera-Tindel T, Doering LV, Roper J, Dracup K. Emotional Functioning Drives Quality of Life in Men with Heart Failure. ACTA ACUST UNITED AC 2009; 24:2-11. [DOI: 10.1111/j.1751-7117.2009.00026.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Herbert K, Lopez B, Castellano J, Palacio A, Tamari L, Arcemen LM. The prevalence of erectile dysfunction in heart failure patients by race and ethnicity. Int J Impot Res 2009; 20:507-11. [PMID: 18701919 DOI: 10.1038/ijir.2008.35] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Erectile dysfunction (ED) is a common problem in male patients with heart failure (HF). However, no study was found that estimates the prevalence of ED by US ethnic groups with HF. We conducted an observational, cross-sectional study of patients enrolled in a HF disease management program in two sites Louisiana (N=329; 178 white, 99 black) and Florida (N=52; Hispanic). All male patients with an ejection fraction <or=40% were included. The Sexual Health Inventory for Men was used to estimate the prevalence of ED. Overall prevalence of ED was 89% and ED severity did not vary by race/ethnic group. Race/ethnic group differences were found for age, New York Heart Association functional classification, and blood pressure. Hispanic patients had the lowest unadjusted and adjusted prevalence rate of ED (81, 85%) compared to Black (90, 95%) and White (91, 92%) patients. There is a high prevalence of ED in Hispanic, Black and White ethnic groups with HF.
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Affiliation(s)
- K Herbert
- Division of Cardiology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Bibliography. Current world literature. Reconstructive surgery. Curr Opin Urol 2006; 16:460-3. [PMID: 17053527 DOI: 10.1097/mou.0b013e328010dc58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ghofrani HA, Osterloh IH, Grimminger F. Sildenafil: from angina to erectile dysfunction to pulmonary hypertension and beyond. Nat Rev Drug Discov 2006; 5:689-702. [PMID: 16883306 PMCID: PMC7097805 DOI: 10.1038/nrd2030] [Citation(s) in RCA: 388] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In less than 20 years, the first selective type 5 phosphodiesterase inhibitor, sildenafil, has evolved from a potential anti-angina drug to an on-demand oral treatment for erectile dysfunction (Viagra), and more recently to a new orally active treatment for pulmonary hypertension (Revatio). Here we describe the key milestones in the development of sildenafil for these diverse medical conditions, discuss the advances in science and clinical medicine that have accompanied this journey and consider possible future indications for this versatile drug.
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Affiliation(s)
- Hossein A Ghofrani
- Medical Clinic II/V, Department of Internal Medicine, University Hospital Giessen and Marburg, GmbH, Klinikstrasse 36, 35392 Giessen, Germany.
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