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Zagel AL, Brummel AR, Chacon M, O'Donnell RM, Styles E, Peacock JM. The Impact of Health Equity-Informed Eligibility Criteria to Increase the Delivery of Pharmacist-Delivered Comprehensive Medication Management Services for Patients with High Blood Pressure. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:S141-S151. [PMID: 39041750 PMCID: PMC11268790 DOI: 10.1097/phh.0000000000001962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
OBJECTIVE Evaluate a cardiovascular care intervention intended to increase access to comprehensive medication management (CMM) pharmacy care and improve vascular health goals among socially disadvantaged patients. DESIGN Retrospective electronic health records-based evaluation. SETTING Thirteen health care clinics serving socially vulnerable neighborhoods within a large health system. PARTICIPANTS Hypertensive and hyperlipidemic adult patients. INTERVENTION CMM pharmacists increased recruitment among patients who met clinical criteria in clinics serving more diverse and socially vulnerable communities. CMM pharmacists partnered with patients to work toward meeting health goals through medication management and lifestyle modification. MAIN OUTCOME MEASURES Changes in the engagement of socially disadvantaged patients between preintervention and intervention time periods; vascular health goals (ie, controlled blood pressure, appropriate statin and aspirin therapies, and tobacco nonuse); and the use of health system resources by CMM care group. RESULTS The intervention indicated an overall shift in sociodemographics among patients receiving CMM care (fewer non-Hispanic Whites: N = 1988, 55.81% vs N = 2264, 59.97%, P < .001; greater place-based social vulnerability: N = 1354, 38.01% vs N = 1309, 34.68%, P = .03; more patients requiring interpreters: N = 776, 21.79% vs N = 698, 18.49%, P < .001) compared to the preintervention period. Among patients meeting intervention criteria, those who partnered with CMM pharmacists (N = 439) were more likely to connect with system resources (social work: N = 47, 10.71% vs 163, 3.74%, P < .001; medical specialists: N = 249, 56.72% vs N = 1989, 45.66%; P < .001) compared to those without CMM care (N = 4356). Intervention patients who partnered with CMM pharmacists were also more likely to meet blood pressure (N = 357, 81.32% vs N = 3317, 76.15%, P < .001) and statin goals (N = 397, 90.43% vs N = 3509, 80.56%, P < .001) compared to non-CMM patients. CONCLUSIONS The demographics of patients receiving CMM became more diverse with the intervention, indicating improved access to CMM pharmacists. Cultivating relationships among patients with greater social disadvantage and cardiovascular disease and CMM pharmacists may improve health outcomes and connect patients to essential resources, thus potentially improving long-term cardiovascular outcomes.
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Affiliation(s)
- Alicia L Zagel
- Fairview Pharmacy Services, Minneapolis, Minnesota (Drs Zagel and Brummel and Ms O'Donnell); and Minnesota Department of Health, Cardiovascular Health Unit, Health Promotion & Chronic Disease Division, St Paul, Minnesota (Mss Chacon and Styles and Dr Peacock)
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2
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Benedetto V, De Vita E, Nuti S. Setting priorities in outpatient cardiovascular care to guarantee equitable access: the case of Tuscany region. RESEARCH IN HEALTH SERVICES & REGIONS 2024; 3:11. [PMID: 39177938 DOI: 10.1007/s43999-024-00047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 07/15/2024] [Indexed: 08/24/2024]
Abstract
Universal healthcare systems orient their actions towards promoting, restoring, and improving public health with a particular focus on the need to guarantee equitable access to care. Unwarranted variation in healthcare delivery poses significant challenges to health systems globally, impacting quality of care, financial sustainability, and equity of access. It is therefore important to assist healthcare management in measuring unwarranted variation in order to prioritise intervention strategies to ensure continuity of care and equity. Through an investigation of geographical variation in visit rates and waiting times, the study identifies vulnerable health districts which need priority interventions for patients with cardiovascular disease in the Tuscany region (Italy). Furthermore, a benchmarking-based method for identifying a quantitative estimate of the supply gap to be reduced is proposed. Results illustrate variation in visit rates and waiting times across local health districts in 2021, with some districts experiencing substantially lower rates and longer waiting times compared to the regional median. To address this gap, two targeted interventions aimed at increasing visit volumes and reduced waiting times through advanced training activities, technology integration, and multidisciplinary collaborations are presented. This study contributes to the topic of unwarranted variation by highlighting the necessity of tailored interventions to address diverse healthcare challenges across heterogeneous geographical areas. As healthcare systems globally navigate evolving complexities, the findings and tools presented here offer valuable guidance for policymakers and managers, aiming towards more equitable, efficient, and responsive healthcare services.
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Affiliation(s)
- Vera Benedetto
- Interdisciplinary Research Center "Health Science", Scuola Superiore Sant'Anna, Via Cardinale Maffi 27, Pisa, Italy.
| | - Erica De Vita
- Interdisciplinary Research Center "Health Science", Scuola Superiore Sant'Anna, Via Cardinale Maffi 27, Pisa, Italy
| | - Sabina Nuti
- Interdisciplinary Research Center "Health Science", Scuola Superiore Sant'Anna, Via Cardinale Maffi 27, Pisa, Italy
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3
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Singh R, Chandi SK, Sran S, Aulakh SK, Nijjar GS, Singh K, Singh S, Tanvir F, Kaur Y, Sandhu APS. Emerging Therapeutic Strategies in Cardiovascular Diseases. Cureus 2024; 16:e64388. [PMID: 39131016 PMCID: PMC11317025 DOI: 10.7759/cureus.64388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
Cardiovascular diseases (CVDs), including ischemic heart disease and stroke, are the leading cause of mortality worldwide, causing nearly 20 million deaths annually. Traditional therapies, while effective, have not curbed the rising prevalence of CVDs driven by aging populations and lifestyle factors. This review highlights innovative therapeutic strategies that show promise in improving patient outcomes and transforming cardiovascular care. Emerging pharmacological treatments, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and sodium-glucose co-transporter 2 (SGLT2) inhibitors, introduce novel mechanisms to complement existing therapies, significantly reducing cardiovascular events and mortality. These advancements emphasize the necessity of ongoing clinical trials and research to discover new therapeutic targets. Advanced biological therapies, including gene therapy, stem cell therapy, and RNA-based treatments, offer groundbreaking potential for repairing and regenerating damaged cardiovascular tissues. Despite being in various stages of clinical validation, early results are promising, suggesting these therapies could fundamentally change the CVD treatment landscape. Innovative medical devices and technologies, such as implantable devices, minimally invasive procedures, and wearable technology, are revolutionizing CVD management. These advancements facilitate early diagnosis, continuous monitoring, and effective treatment, driving care out of hospitals and into homes, improving patient outcomes and reducing healthcare costs. Personalized medicine, driven by genetic profiling and biomarker identification, allows for tailored therapies that enhance treatment efficacy and minimize adverse effects. However, the adoption of these emerging therapies faces significant challenges, including regulatory hurdles, cost and accessibility issues, and ethical considerations. Addressing these barriers and fostering interdisciplinary collaboration are crucial for accelerating the development and implementation of innovative treatments. Integrating emerging therapeutic strategies in cardiovascular care holds immense potential to transform CVD management. By prioritizing future research and overcoming existing challenges, a new era of personalized, effective, and accessible cardiovascular care can be achieved.
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Affiliation(s)
- Rajinderpal Singh
- Internal Medicine, Government Medical College Amritsar, Amritsar, IND
| | | | - Seerat Sran
- Internal Medicine, Sri Guru Ram Das University of Health Sciences and Research, Amritsar, IND
| | - Smriti K Aulakh
- Internal Medicine, Sri Guru Ram Das University of Health Sciences and Research, Amritsar, IND
| | | | | | - Sumerjit Singh
- Medicine, Government Medical College Amritsar, Amritsar, IND
| | - Fnu Tanvir
- Medicine, Government Medical College Amritsar, Amritsar, IND
| | - Yasmeen Kaur
- Medicine, Government Medical College Amritsar, Amritsar, IND
| | - Ajay Pal Singh Sandhu
- Medicine, Sri Guru Ram Das University of Health Sciences and Research, Amritsar, IND
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4
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Newson JJ, Bala J, Giedd JN, Maxwell B, Thiagarajan TC. Leveraging big data for causal understanding in mental health: a research framework. Front Psychiatry 2024; 15:1337740. [PMID: 38439791 PMCID: PMC10910083 DOI: 10.3389/fpsyt.2024.1337740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
Over the past 30 years there have been numerous large-scale and longitudinal psychiatric research efforts to improve our understanding and treatment of mental health conditions. However, despite the huge effort by the research community and considerable funding, we still lack a causal understanding of most mental health disorders. Consequently, the majority of psychiatric diagnosis and treatment still operates at the level of symptomatic experience, rather than measuring or addressing root causes. This results in a trial-and-error approach that is a poor fit to underlying causality with poor clinical outcomes. Here we discuss how a research framework that originates from exploration of causal factors, rather than symptom groupings, applied to large scale multi-dimensional data can help address some of the current challenges facing mental health research and, in turn, clinical outcomes. Firstly, we describe some of the challenges and complexities underpinning the search for causal drivers of mental health conditions, focusing on current approaches to the assessment and diagnosis of psychiatric disorders, the many-to-many mappings between symptoms and causes, the search for biomarkers of heterogeneous symptom groups, and the multiple, dynamically interacting variables that influence our psychology. Secondly, we put forward a causal-orientated framework in the context of two large-scale datasets arising from the Adolescent Brain Cognitive Development (ABCD) study, the largest long-term study of brain development and child health in the United States, and the Global Mind Project which is the largest database in the world of mental health profiles along with life context information from 1.4 million people across the globe. Finally, we describe how analytical and machine learning approaches such as clustering and causal inference can be used on datasets such as these to help elucidate a more causal understanding of mental health conditions to enable diagnostic approaches and preventative solutions that tackle mental health challenges at their root cause.
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Affiliation(s)
| | - Jerzy Bala
- Sapien Labs, Arlington, VA, United States
| | - Jay N. Giedd
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Benjamin Maxwell
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Rady Children’s Hospital – San Diego, San Diego, CA, United States
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5
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Zhang T, Liu N, Xu J, Liu Z, Zhou Y, Yang Y, Li S, Huang Y, Jiang S. Flexible electronics for cardiovascular healthcare monitoring. Innovation (N Y) 2023; 4:100485. [PMID: 37609559 PMCID: PMC10440597 DOI: 10.1016/j.xinn.2023.100485] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/23/2023] [Indexed: 08/24/2023] Open
Abstract
Cardiovascular diseases (CVDs) are one of the most urgent threats to humans worldwide, which are responsible for almost one-third of global mortality. Over the last decade, research on flexible electronics for monitoring and treatment of CVDs has attracted tremendous attention. In contrast to conventional medical instruments in hospitals that are usually bulky, hard to move, monofunctional, and time-consuming, flexible electronics are capable of continuous, noninvasive, real-time, and portable monitoring. Notable progress has been made in this emerging field, and thus a number of significant achievements and concomitant research prospects deserve attention for practical implementation. Here, we comprehensively review the latest progress of flexible electronics for CVDs, focusing on new functions provided by flexible electronics. First, the characteristics of CVDs and flexible electronics and the foundation of their combination are briefly reviewed. Then, four representative applications of flexible electronics for CVDs are elaborated: blood pressure (BP) monitoring, electrocardiogram (ECG) monitoring, echocardiogram monitoring, and direct epicardium monitoring. Their operational principles, progress, merits and demerits, and future efforts are discussed. Finally, the remaining challenges and opportunities for flexible electronics for cardiovascular healthcare are outlined.
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Affiliation(s)
- Tianqi Zhang
- Hangzhou Institute of Technology, Xidian University, Hangzhou 311200, China
| | - Ning Liu
- Department of Gastrointestinal Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, China
| | - Jing Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zeye Liu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Yunlei Zhou
- Hangzhou Institute of Technology, Xidian University, Hangzhou 311200, China
| | - Yicheng Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shoujun Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing 100037, China
| | - Yuan Huang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing 100037, China
| | - Shan Jiang
- Hangzhou Institute of Technology, Xidian University, Hangzhou 311200, China
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6
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Wang S, Liu Z, Yang W, Cao Y, Zhao L, Xie L. Learning-Based Multimodal Information Fusion and Behavior Recognition of Vascular Interventionists' Operating Skills. IEEE J Biomed Health Inform 2023; 27:4536-4547. [PMID: 37363852 DOI: 10.1109/jbhi.2023.3289548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
The operating skills of vascular interventionists have an important impact on the effect of surgery. However, current research on behavior recognition and skills learning of interventionists' operating skills is limited. In this study, an innovative deep learning-based multimodal information fusion architecture is proposed for recognizing and analyzing eight common operating behaviors of interventionists. An experimental platform integrating four modal sensors is used to collect multimodal data from interventionists. The ANOVA and Manner-Whitney tests is used for relevance analysis of the data. The analysis results demonstrate that there is almost no significant difference ( p <0.001) between the actions related to the unimodal data, which cannot be used for accurate behavior recognition. Therefore, a study of the fusion architecture based on the existing machine learning classifier and the proposed deep learning fusion architecture is carried out. The research findings indicate that the proposed deep learning-based fusion architecture achieves an impressive overall accuracy of 98.5%, surpassing both the machine learning classifier (93.51%) and the unimodal data (90.05%). The deep learning-based multimodal information fusion architecture proves the feasibility of behavior recognition and skills learning of interventionist's operating skills. Furthermore, the application of deep learning-based multimodal fusion technology of surgeon's operating skills will help to improve the autonomy and intelligence of surgical robotic systems.
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7
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Li M, Wang P, Zou Y, Wang W, Zhao Y, Liu M, Wu J, Zhang Y, Zhang N, Sun Y. Spleen tyrosine kinase (SYK) signals are implicated in cardio-cerebrovascular diseases. Heliyon 2023; 9:e15625. [PMID: 37180910 PMCID: PMC10172877 DOI: 10.1016/j.heliyon.2023.e15625] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023] Open
Abstract
Post-translational modifications regulate numerous biochemical reactions and functions through covalent attachment to proteins. Phosphorylation, acetylation and ubiquitination account for over 90% of all reported post-translational modifications. As one of the tyrosine protein kinases, spleen tyrosine kinase (SYK) plays crucial roles in many pathophysiological processes and affects the pathogenesis and progression of various diseases. SYK is expressed in tissues outside the hematopoietic system, especially the heart, and is involved in the progression of various cardio-cerebrovascular diseases, such as atherosclerosis, heart failure, diabetic cardiomyopathy, stroke and others. Knowledge on the role of SYK in the progress of cardio-cerebrovascular diseases is accumulating, and many related mechanisms have been discovered and validated. This review summarizes the role of SYK in the progression of various cardio-cerebrovascular diseases, and aims to provide a theoretical basis for future experimental and clinical research targeting SYK as a therapeutic option for these diseases.
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Affiliation(s)
- Mohan Li
- Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Pengbo Wang
- Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Yuanming Zou
- Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Wenbin Wang
- Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Yuanhui Zhao
- Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Mengke Liu
- Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Jianlong Wu
- Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Ying Zhang
- Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
- Institute of Health Sciences, China Medical University, 77 Puhe Road, Shenbei New District, Shenyang, 110001, Liaoning Province, People's Republic of China
- Corresponding author. Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China.
| | - Naijin Zhang
- Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
- Institute of Health Sciences, China Medical University, 77 Puhe Road, Shenbei New District, Shenyang, 110001, Liaoning Province, People's Republic of China
- Key Laboratory of Reproductive and Genetic Medicine (China Medical University), National Health Commission, 77 Puhe Road, Shenbei New District, Shenyang, 110001, Liaoning Province, People's Republic of China
- Corresponding author. Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China.
| | - Yingxian Sun
- Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
- Institute of Health Sciences, China Medical University, 77 Puhe Road, Shenbei New District, Shenyang, 110001, Liaoning Province, People's Republic of China
- Corresponding author. Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China.
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8
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Saxe GN, Bickman L, Ma S, Aliferis C. Mental health progress requires causal diagnostic nosology and scalable causal discovery. Front Psychiatry 2022; 13:898789. [PMID: 36458123 PMCID: PMC9705733 DOI: 10.3389/fpsyt.2022.898789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Nine hundred and seventy million individuals across the globe are estimated to carry the burden of a mental disorder. Limited progress has been achieved in alleviating this burden over decades of effort, compared to progress achieved for many other medical disorders. Progress on outcome improvement for all medical disorders, including mental disorders, requires research capable of discovering causality at sufficient scale and speed, and a diagnostic nosology capable of encoding the causal knowledge that is discovered. Accordingly, the field's guiding paradigm limits progress by maintaining: (a) a diagnostic nosology (DSM-5) with a profound lack of causality; (b) a misalignment between mental health etiologic research and nosology; (c) an over-reliance on clinical trials beyond their capabilities; and (d) a limited adoption of newer methods capable of discovering the complex etiology of mental disorders. We detail feasible directions forward, to achieve greater levels of progress on improving outcomes for mental disorders, by: (a) the discovery of knowledge on the complex etiology of mental disorders with application of Causal Data Science methods; and (b) the encoding of the etiological knowledge that is discovered within a causal diagnostic system for mental disorders.
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Affiliation(s)
- Glenn N. Saxe
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, United States
| | - Leonard Bickman
- Ontrak Health, Inc., Henderson, NV, United States
- Department of Psychology, Florida International University, Miami, FL, United States
| | - Sisi Ma
- Program in Data Science, Department of Medicine, Clinical and Translational Science Institute, Institute for Health Informatics, School of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Constantin Aliferis
- Program in Data Science, Department of Medicine, Clinical and Translational Science Institute, Institute for Health Informatics, School of Medicine, University of Minnesota, Minneapolis, MN, United States
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9
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Khan AA, Siddiqui SA, Yasmin F, Abidi SM, Tariq R, Ahmed H, Murtaza N, Jawed F, Lashkerwala SS, Moin A, Shah SMI, Ullah I, Yousaf Z, Faizan M, Shahid MH. The Era of Polypills in the Management of Cardiovascular Diseases: Are We There Yet? Curr Probl Cardiol 2022:101233. [PMID: 35490770 DOI: 10.1016/j.cpcardiol.2022.101233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/24/2022] [Indexed: 11/03/2022]
Abstract
Cardiovascular Diseases (CVD) are the leading cause of mortality globally. Wald and Law proposed the idea of a 'polypill'; a fixed dose combination therapy (FDC) in the form of a single pill to curb the CVD epidemic. Such a drug would include the combination of a broad spectrum of drugs including cholesterol lowering drugs, antihypertensive drugs, anti-platelet drugs, anti-coagulation drugs, anti-arrhythmic drugs, which are frequently integrated to combat specific CVDs. This 'polypill' holds the potential to pose several advantages like increased compliance, improved quality of life, risk factor control, psychological relief, and cost effectiveness along with minimal side effects. Several trials (like TIPS, UMPIRE, PolyIran etc.) have tested different treatment strategies to test the hypothesis of Wald and Law. Unlike the past physicians are now highly aware of this new strategy.The future of polypill in the management of CVD lies in a strategy where polypills are treated supplementary to the already existing preventive care, which includes lifestyle modifications and efforts to reduce tobacco use.
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Affiliation(s)
- Arsalan Aamir Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Farah Yasmin
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Rabbia Tariq
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Hiba Ahmed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Noor Murtaza
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Fareeha Jawed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Ariba Moin
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Irfan Ullah
- Department of Internal Medicine, Kabir Medical College, Gandhara University, Peshawar, Pakistan.
| | - Zohaib Yousaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Muhammad Faizan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
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10
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Parveen A, Devika R. Fibrinolytic Enzyme - An Overview. Curr Pharm Biotechnol 2022; 23:1336-1345. [PMID: 34983344 DOI: 10.2174/1389201023666220104143113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/21/2021] [Accepted: 10/13/2021] [Indexed: 11/22/2022]
Abstract
Cardiovascular diseases, like coronary heart disease or artery disorders (arteriosclerosis, including artery solidification), heart failure (myocardial infarction), arrhythmias, congestive heart condition, stroke, elevated vital signs (hypertension), rheumatic heart disorder, and other circulatory system dysfunctions are the most common causes of death worldwide. Cardiovascular disorders are treated with stenting, coronary bypass surgery grafting, anticoagulants, antiplatelet agents, and other pharmacological and surgical procedures; however, these have limitations due to their adverse effects. Fibrinolytic agents degrade fibrin through enzymatic and biochemical processes. There are various enzymes that are currently used as a treatment for CVDs, like Streptokinase, Nattokinase, Staphylokinase, Urokinase, etc. These enzymes are derived from various sources like bacteria, fungi, algae, marine organisms, plants, snakes, and other organisms. This review deals with the fibrinolytic enzymes, their mechanisms, sources, and their therapeutic potential.
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Affiliation(s)
- Parveen A
- Department of Biotechnology, Biotechnology, Aarupadai Institute of Technology, Vinayaka Missions University, Chennai, India
| | - Devika R
- Department of Biotechnology, Biotechnology, Aarupadai Institute of Technology, Vinayaka Missions University, Chennai, India
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11
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Turkson-Ocran RAN, Ogunwole SM, Hines AL, Peterson PN. Shared Decision Making in Cardiovascular Patient Care to Address Cardiovascular Disease Disparities. J Am Heart Assoc 2021; 10:e018183. [PMID: 34612050 PMCID: PMC8751878 DOI: 10.1161/jaha.120.018183] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - S Michelle Ogunwole
- Department of Medicine The Johns Hopkins University School of Medicine Baltimore MD.,The Johns Hopkins Center for Health Equity Baltimore MD
| | - Anika L Hines
- Department of Medicine The Johns Hopkins University School of Medicine Baltimore MD.,The Johns Hopkins Center for Health Equity Baltimore MD.,Department of Health Behavior and Policy Virginia Commonwealth University School of Medicine Richmond VA
| | - Pamela N Peterson
- Division of Cardiology University of Colorado, Anschutz Medical Campus Aurora CO.,Division of Cardiology Denver Health Medical Center Denver CO
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12
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Xu D, Sheng JQ, Hu PJH, Huang TS, Hsu CC. A Deep Learning-Based Unsupervised Method to Impute Missing Values in Patient Records for Improved Management of Cardiovascular Patients. IEEE J Biomed Health Inform 2021; 25:2260-2272. [PMID: 33095720 DOI: 10.1109/jbhi.2020.3033323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Physicians increasingly depend on electronic health records (EHRs) to manage their patients. However, many patient records have substantial missing values that pose a fundamental challenge to their clinical use. To address this prevailing challenge, we propose an unsupervised deep learning-based method that can facilitate physicians' use of EHRs to improve their management of cardiovascular patients. By building on the deep autoencoder framework, we develop a novel method to impute missing values in patient records. To demonstrate its clinical applicability and values, we use data from cardiovascular patients and evaluate the proposed method's imputation effectiveness and predictive efficacy, in comparison with six prevalent benchmark techniques. The proposed method can impute missing values and predict important patient outcomes more effectively than all the benchmark techniques. This study reinforces the importance of adequately addressing missing values in patient records. It further illustrates how effective imputations can enable greater predictive efficacy with regard to important patient outcomes, which are crucial to the use of EHRs and health analytics for improved patient management. Supported by the complete data imputed by the proposed method, physicians can make timely patient outcome estimations (predictions) and therapeutic treatment assessments.
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13
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Development of a preference-based heart disease-specific health state classification system using MacNew heart disease-related quality of life instrument. Qual Life Res 2021; 31:257-268. [PMID: 34037917 DOI: 10.1007/s11136-021-02884-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The MacNew Heart Disease Health-Related Quality of Life Instrument (MacNew) is a validated, clinically sensitive, 27-item disease-specific questionnaire. This study aimed to develop a new heart disease-specific classification system for the MacNew amenable for use in health state valuation. METHODS Patients with heart disease attending outpatient clinics and inpatient wards in Brisbane, Australia, completed MacNew. The development of the new disease-specific classification system included three stages. First, a principal component analysis (PCA) established dimensionality. Second, Rasch analysis was used to select items for each dimension. Third, Rasch analysis was used to explore response-level reduction. In addition, clinician and patient judgement informed item selection. RESULTS Participants included 685 patients (acute coronary 6%, stable coronary 41%, chronic heart failure 20%). The PCA identified 4 dimensions (restriction, emotion, perception of others, and symptoms). The restriction dimension was divided into physical and social dimensions. One item was selected from each to be included in the classification system. Three items from the emotional dimension and two symptom items were also selected. The final classification system had seven dimensions with four severity levels in each: physical restriction; excluded from doing things with other people; worn out or low in energy; frustrated, impatient or angry; unsure and lacking in self-confidence; shortness of breath; and chest pain. CONCLUSION This study generated a brief heart disease-specific classification system, consisting of seven dimensions with four severity levels in each. The classification system is amenable to valuation to enable the generation of utility value sets to be developed for use in economic evaluation.
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Cirera L, Ballesta M, Márquez-Calderón S, Chirlaque MD, Saez M, Salmerón D. Partial contributions and temporal trends of leading causes of death during the last four decades in Spain. Public Health 2020; 189:81-90. [PMID: 33188998 DOI: 10.1016/j.puhe.2020.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/18/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The study was conducted to assess time trend shifts of leading causes of death and their partial contributions over the years 1975-2016 in Spain. STUDY DESIGN A longitudinal ecological epidemiologic design was conducted to analyse linear trend period shifts using joinpoint regression as the annual percentage of change (APC) in the period 1975-2016. The partial contributions were illustrated as the rate ratio of a singular-cause to their major-cause shift periods. RESULTS HIV/AIDS shaped the increasing trend period of infectious diseases in 1989-1995 (APC = 25.3, P < 0.05) and the decreasing trend in 1995-1999 and 1999-2016. Lung cancer fell gradually from 1994 in men (-0.4, P < 0.05); however, in women, the condition continued increasing from 1990 (P < 0.05). Dementia types influenced mental and neurological disease drifts. The recent trend for circulatory periods (1980-2016) was mainly modulated by cardiac ischaemia, with increased partial contributions (25%, 32% and 30%). Traffic accidents defined the descending tendency of external causes. CONCLUSIONS Spain showed a Western pattern in descended rates, including non-decreasing trends in mental and neurological diseases, pancreatic cancer, drug abuse and suicide. Trend shifts and partial contributions illustrated targets for further mortality reduction.
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Affiliation(s)
- L Cirera
- Department of Epidemiology, Regional Health Council of Murcia, Ronda de Levante, 11, 30011, Murcia, Spain; IMIB-Arrixaca, Murcia, Spain; Department of Health & Social Sciences, Murcia University, Campus de Espinardo, 30100, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - M Ballesta
- Department of Epidemiology, Regional Health Council of Murcia, Ronda de Levante, 11, 30011, Murcia, Spain; IMIB-Arrixaca, Murcia, Spain; Department of Health & Social Sciences, Murcia University, Campus de Espinardo, 30100, Murcia, Spain.
| | - S Márquez-Calderón
- Andalusian Ministry of Heatlh - Institute of Statistics and Cartography of Andalusia, Calle Leonardo da Vinci, 21, 41092, Seville, Spain.
| | - M-D Chirlaque
- Department of Epidemiology, Regional Health Council of Murcia, Ronda de Levante, 11, 30011, Murcia, Spain; IMIB-Arrixaca, Murcia, Spain; Department of Health & Social Sciences, Murcia University, Campus de Espinardo, 30100, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - M Saez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Carrer Universitat de Girona, 10, 17071, Girona, Spain; Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain.
| | - D Salmerón
- IMIB-Arrixaca, Murcia, Spain; Department of Health & Social Sciences, Murcia University, Campus de Espinardo, 30100, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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15
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Ceretta ML, Noordzij M, Luxardo R, De Meester J, Abad Diez JM, Finne P, Heaf JG, Couchoud C, Kramar R, Collart F, Cases A, Palsson R, Reisæter AV, Rydell H, Massy ZA, Jager KJ, Kramer A. Changes in co-morbidity pattern in patients starting renal replacement therapy in Europe-data from the ERA-EDTA Registry. Nephrol Dial Transplant 2019; 33:1794-1804. [PMID: 29361126 DOI: 10.1093/ndt/gfx355] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/24/2017] [Indexed: 12/31/2022] Open
Abstract
Background Patients starting renal replacement therapy (RRT) for end-stage renal disease often present with one or more co-morbidities. This study explored the prevalence of co-morbidities in patients who started RRT in Europe during the period from 2005 to 2014. Methods Using data from patients aged 20 years or older from all 11 national or regional registries providing co-morbidity data to the European Renal Association - European Dialysis and Transplant Association Registry, we examined the prevalence of the following co-morbidities: diabetes mellitus (DM) (primary renal disease and/or co-morbidity), ischaemic heart disease (IHD), congestive heart failure (CHF), peripheral vascular disease (PVD), cerebrovascular disease (CVD) and malignancy. Results Overall, 70% of 7578 patients who initiated RRT in 2014 presented with at least one co-morbidity: 39.0% presented with DM, 25.0% with IHD, 22.3% with CHF, 17.7% with PVD, 16.4% with malignancy and 15.5% with CVD. These percentages differed substantially between countries. Co-morbidities were more common in men than in women, in older patients than in younger patients, and in patients on haemodialysis at Day 91 when compared with patients on peritoneal dialysis. Between 2005 and 2014 the prevalence of DM and malignancy increased over time, whereas the prevalence of IHD and PVD declined. Conclusions More than two-thirds of patients initiating RRT in Europe have at least one co-morbidity. With the rising age at the start of RRT over the last decade, there have been changes in the co-morbidity pattern: the prevalence of cardiovascular co-morbidities decreased, while the prevalence of DM and malignancy increased.
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Affiliation(s)
- Maria L Ceretta
- Uruguayan Dialysis Registry, Uruguayan Society of Nephrology, Montevideo, Uruguay
| | - Marlies Noordzij
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Rosario Luxardo
- Nephrology Service, Hospital Italiano de Buenos Aires, CABA, Buenos Aires, Argentina
| | - Johan De Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | - Jose M Abad Diez
- Servicio Aragonés de la Salud, Gobierno de Aragón, Zaragoza, Spain
| | - Patrik Finne
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Cécile Couchoud
- REIN Registry, Agence de la biomédecine, Saint-Denis La Plaine, France
| | | | | | - Aleix Cases
- Nephrology Unit Hospital Clinic, Barcelona, Spain.,Registre de Malalts Renals de Catalunya, Barcelona, Spain
| | - Runolfur Palsson
- Division of Nephrology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Anna V Reisæter
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Helena Rydell
- Swedish Renal Registry, Jönköping, Sweden.,Lund University, Lund, Sweden.,Skane University Hospital, Lund, Sweden
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 1018 team 5, Research Centre in Epidemiology and Population Health (CESP), University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anneke Kramer
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Clemens DL, Duryee MJ, Hall JH, Thiele GM, Mikuls TR, Klassen LW, Zimmerman MC, Anderson DR. Relevance of the antioxidant properties of methotrexate and doxycycline to their treatment of cardiovascular disease. Pharmacol Ther 2019; 205:107413. [PMID: 31626869 DOI: 10.1016/j.pharmthera.2019.107413] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/15/2019] [Indexed: 12/21/2022]
Abstract
Many medications exhibit clinical benefits that are unrelated to their primary therapeutic uses. In many cases, the mechanisms underpinning these pleotropic effects are unknown. Two commonly prescribed medications that exhibit pleotropic benefits in cardiovascular disease and other diseases associated with chronic inflammation are methotrexate (MTX) and doxycycline (DOX). The vast majority of cardiovascular disease is associated with atherosclerosis. Because atherosclerosis is a chronic inflammatory disease, possible mechanisms by which MTX and DOX reduce inflammation have been investigated. Interestingly, the primary structure of both of these medications contain aromatic phenolic rings, which resemble polyphenols that are known to possess antioxidant activity. Inflammation and oxidative stress are intimately related. Inflammation promotes oxidative stress, which in turn leads to further inflammation; in this way, oxidative stress and inflammation can establish a self-perpetuating cycle. It has been shown that MTX and DOX act as antioxidants and are capable of scavenging free radicals and the reactive oxygen species (ROS) superoxide (O2-). Furthermore, both MTX and DOX inhibit the formation of malondialdehyde acetaldehyde (MAA) adducts, products of oxidative stress and lipid peroxidation. Importantly, MAA-adducts are highly immunogenic and initiate inflammatory responses; thereby, fueling the cycle of inflammation and oxidative stress that results in chronic inflammation. Thus, reducing the formation of MAA-adducts may ameliorate inflammation that leads to ROS production and in this way, break the self-sustaining cycle of oxidative stress and inflammation. It is possible that the under-recognized antioxidant properties of these medications may be a mechanism by which they and other medications provide pleotropic benefit in the treatment of chronic inflammatory disease.
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Affiliation(s)
- Dahn L Clemens
- Department of Internal Medicine, University of Nebraska Medical Center, 982650 Nebraska Medical Center, Omaha, NE, 68198-2265, United States; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, 4101 Woolworth Ave., Omaha, NE, 68105, United States; Fred and Pamela Buffet Cancer Center, Nebraska Medical Center, Omaha, NE, 68114, United States
| | - Michael J Duryee
- Department of Internal Medicine, University of Nebraska Medical Center, 982650 Nebraska Medical Center, Omaha, NE, 68198-2265, United States; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, 4101 Woolworth Ave., Omaha, NE, 68105, United States
| | - Johnathan H Hall
- Department of Internal Medicine, University of Nebraska Medical Center, 982650 Nebraska Medical Center, Omaha, NE, 68198-2265, United States
| | - Geoffrey M Thiele
- Department of Internal Medicine, University of Nebraska Medical Center, 982650 Nebraska Medical Center, Omaha, NE, 68198-2265, United States; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, 4101 Woolworth Ave., Omaha, NE, 68105, United States
| | - Ted R Mikuls
- Department of Internal Medicine, University of Nebraska Medical Center, 982650 Nebraska Medical Center, Omaha, NE, 68198-2265, United States; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, 4101 Woolworth Ave., Omaha, NE, 68105, United States
| | - Lynell W Klassen
- Department of Internal Medicine, University of Nebraska Medical Center, 982650 Nebraska Medical Center, Omaha, NE, 68198-2265, United States
| | - Matthew C Zimmerman
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, 982650 Nebraska Medical Center, Omaha, NE, 68198-2265, United States
| | - Daniel R Anderson
- Department of Internal Medicine, University of Nebraska Medical Center, 982650 Nebraska Medical Center, Omaha, NE, 68198-2265, United States.
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Guo Y, Huang S, Ma Y, Zhang J, Wen Y, Zhou L, Yuan G, Cheng J. MiR-377 mediates the expression of Syk to attenuate atherosclerosis lesion development in ApoE−/− mice. Biomed Pharmacother 2019; 118:109332. [DOI: 10.1016/j.biopha.2019.109332] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 01/31/2023] Open
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18
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Gao M, Li Y, Wang F, Zhang S, Qu Z, Wan X, Wang X, Yang J, Tian D, Zhang W. The effect of smoke-free legislation on the mortality rate of acute myocardial infarction: a meta-analysis. BMC Public Health 2019; 19:1269. [PMID: 31533693 PMCID: PMC6749716 DOI: 10.1186/s12889-019-7408-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/31/2019] [Indexed: 12/29/2022] Open
Abstract
Background Several studies have demonstrated that smoke-free legislation is associated with a reduced risk of mortality from acute myocardial infarction (AMI). This study aimed to examine and quantify the potential effect of smoke-free legislation on AMI mortality rate in different countries. Methods Studies were identified using a systematic search of the scientific literature from electronic databases, including PubMed, Web of Science, ScienceDirect, Embase, Google Scholar, and China National Knowledge Infrastructure (CNKI), from their inception through September 30, 2017. A random effects model was employed to estimate the overall effects of smoke-free legislation on the AMI mortality rate. Subgroup analysis was performed to explore the possible causes of heterogeneity in risk estimates based on sex and age. The results of meta-analysis after excluding the studies with a high risk of bias were reported in this study. Results A total of 10 eligible studies with 16 estimates of effect size were included in this meta-analysis. Significant heterogeneity in the risk estimates was identified (overall I2 = 94.6%, p < 0.001). Therefore, a random effects model was utilized to estimate the overall effect of smoke-free legislation. There was an 8% decline in AMI mortality after introducing smoke-free legislation (RR = 0.92, 95% confidence interval (CI): 0.90–0.94). The results of subgroup analyses showed that smoke-free legislation was significantly associated with lower rates of mortality for the following 5 diagnostic subgroups: smoke-free in workplaces, restaurants and bars (RR = 0.92, 95% CI: 0.90–0.95), smaller sample size (RR = 0.92, 95% CI: 0.89–0.95), study location in Europe (RR = 0.90, 95% CI: 0.85–0.94), regional study area (RR = 0.92, 95% CI: 0.89–0.94), and no previous local smoke-free legislation (RR = 0.91, 95% CI: 0.90–0.93). However, there was not much difference in AMI mortality rates after the legislation between the longer (RR = 0.92, 95% CI: 0.86–0.98) and shorter follow-up duration subgroups (RR = 0.92, 95% CI: 0.89–0.94). Conclusion Smoke-free legislation could significantly reduce the AMI mortality rate by 8%. The reduction in the AMI mortality rate was more significant in studies with more comprehensive laws, without prior smoke-free bans, with a smaller sample size, at the regional level, and with a location in Europe. Electronic supplementary material The online version of this article (10.1186/s12889-019-7408-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Min Gao
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Yanyu Li
- School of Humanities and Social Sciences, North China Electric Power University, Baoding, 071000, China
| | - Fugang Wang
- People's Bank of China Jinan Branch, Jinan, 250021, China
| | - Shengfa Zhang
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Zhiyong Qu
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Xiaohua Wang
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Jie Yang
- Tobacco control office, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Donghua Tian
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Weijun Zhang
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China.
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19
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Marković-Peković V, Bojanić L, Stoisavljević-Šatara S. The characteristics of the outpatient utilisation of medicines in the Republic of Srpska in the period 2009-2017. SCRIPTA MEDICA 2019. [DOI: 10.5937/scriptamed50-23716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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20
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Ortendahl JD, Diamant AL, Toth PP, Cherepanov D, Harmon AL, Broder MS. Protecting the gains: What changes are needed to prevent a reversal of the downward cardiovascular disease mortality trend? Clin Cardiol 2018; 42:47-55. [PMID: 30318600 DOI: 10.1002/clc.23097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 01/02/2023] Open
Abstract
AIMS Cardiovascular disease (CVD) mortality has decreased over 60% over the past 50 years in the United States; however, emerging data indicate CVD incidence may be rising because of shifting demographics, increasing risk factor prevalence, and competing needs for limited resources. We projected CVD mortality from 2015 to 2040 given varying informed assumptions regarding changes in risk factor prevalence, uptake of current therapeutic options, and future innovations. METHODS A microsimulation model was used to project US CVD mortality trends. National Health and Nutrition Examination Survey data were used to estimate population-level trends in CVD risk factors. Risk factors were used to generate Framingham Risk Scores for cohorts of 1 000 000 individuals from the general population to determine each individuals' CVD risk. Annual cardiovascular incidence, prevalence, and mortality were projected for scenarios differing by uptake of current therapies, anticipated pharmaceutical innovations with variable efficacy, risk factor prevalence, and changes in health disparities. RESULTS When incorporating a demographic shift, continued changes in risk factors, current treatment utilization, and no major innovations, we predicted the CVD mortality rate would increase 41% by 2040. If innovations providing incremental benefits equal to those associated with the introduction of statins are identified and widely utilized, CVD mortality could remain constant through 2040. With more efficacious innovations, CVD mortality could be further reduced. CONCLUSIONS Given demographic and risk prevalence changes, increasing access and adherence to current preventative therapeutics could slow the expected mortality increase, but new therapies may be needed to maintain the downward trend in CVD deaths.
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Affiliation(s)
- Jesse D Ortendahl
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
| | - Allison L Diamant
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Peter P Toth
- Preventative Cardiology, CGH Medical Center, Sterling, Illinois.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dasha Cherepanov
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
| | - Amanda L Harmon
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
| | - Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
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21
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Abstract
The heart failure accounts for the highest mortality rate all over the world. The development of preventive therapeutic approaches is still in their infancy. Owing to the extremely high energy demand of the heart, the bioenergetics pathways need to respond efficiently based on substrate availability. The metabolic regulation of such heart bioenergetics is mediated by various rate limiting enzymes involved in energy metabolism. Although all the pertinent mechanisms are not clearly understood, the progressive decline in the activity of metabolic enzymes leading to diminished ATP production is known to cause progression of the heart failure. Therefore, metabolic therapy that can maintain the appropriate activities of metabolic enzymes can be a promising approach for the prevention and treatment of the heart failure. The flavonoids that constitute various human dietary ingredients also effectively offer a variety of health benefits. The flavonoids target a variety of metabolic enzymes and facilitate effective management of the equilibrium between production and utilization of energy in the heart. This review discusses the broad impact of metabolic enzymes in the heart functions and explains how the dysregulated enzyme activity causes the heart failure. In addition, the prospects of targeting dysregulated metabolic enzymes by developing flavonoid-based metabolic approaches are discussed.
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22
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König M, Drewelies J, Norman K, Spira D, Buchmann N, Hülür G, Eibich P, Wagner GG, Lindenberger U, Steinhagen-Thiessen E, Gerstorf D, Demuth I. Historical trends in modifiable indicators of cardiovascular health and self-rated health among older adults: Cohort differences over 20 years between the Berlin Aging Study (BASE) and the Berlin Aging Study II (BASE-II). PLoS One 2018; 13:e0191699. [PMID: 29385202 PMCID: PMC5792001 DOI: 10.1371/journal.pone.0191699] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/09/2018] [Indexed: 02/07/2023] Open
Abstract
Background The last decades have seen great advances in the understanding, treatment, and prevention of cardiovascular disease (CVD). Although mortality rates due to CVD have declined significantly in the last decades, the burden of CVD is still high, particularly in older adults. This raises the question whether contemporary populations of older adults are experiencing better or worse objective as well as subjective health than earlier-born cohorts. The aim of this study was to examine differences in modifiable indicators of cardiovascular health (CVH), comparing data obtained 20 years apart in the Berlin Aging Study (BASE, 1990–93) and the Berlin Aging Study II (BASE-II, 2009–2014). Methods Serial cross-sectional analysis of 242 propensity-score-matched participants of BASE (born 1907–1922) and BASE-II (born 1925–1942). Body mass index (BMI), blood pressure, total cholesterol, glycated hemoglobin (HbA1c), diet, smoking and physical activity were operationalized according to the “Life’s simple 7“(LS7) criteria of the American Heart Association. Results 121 matched pairs were identified based on age, sex, and education. In the later-born BASE-II sample, the mean LS7 score was significantly higher than in the earlier-born sample (7.8±1.8 vs. 6.4±2.1, p<0.001), indicating better CVH. In detail, diet, physical activity, smoking, cholesterol, and HbA1c were more favorable, whereas blood pressure was significantly higher in individuals from the later-born cohort. BMI did not differ significantly between the two matched samples. Notably, despite better CVH, later-born individuals (BASE-II) reported lower self-rated health, presumably because of higher health expectations. Conclusions Overall, cardiovascular health was significantly better in the later-born cohort, but several notable exceptions exist.
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Affiliation(s)
- Maximilian König
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Johanna Drewelies
- Department of Psychology, Humboldt University Berlin, Berlin, Germany
| | - Kristina Norman
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Nutrition and Gerontology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
| | - Dominik Spira
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolaus Buchmann
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Gizem Hülür
- Department of Psychology, University of Zurich, Zurich, Switzerland
- University Research Priority Program (URPP) Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Peter Eibich
- Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
| | - Gert G. Wagner
- German Institute for Economic Research, Berlin, Germany
- Max Planck Institute for Human Development, Berlin, Germany
| | - Ulman Lindenberger
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | | | - Denis Gerstorf
- Department of Psychology, Humboldt University Berlin, Berlin, Germany
| | - Ilja Demuth
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
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Hassell T, Hennis A. Chronic Disease Challenges in the Caribbean. Glob Heart 2018; 11:437-438. [PMID: 27938834 DOI: 10.1016/j.gheart.2016.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 10/13/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Anselm Hennis
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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Abell B, Glasziou P, Hoffmann T. The Contribution of Individual Exercise Training Components to Clinical Outcomes in Randomised Controlled Trials of Cardiac Rehabilitation: A Systematic Review and Meta-regression. SPORTS MEDICINE - OPEN 2017; 3:19. [PMID: 28477308 PMCID: PMC5419959 DOI: 10.1186/s40798-017-0086-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 04/27/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND While the clinical benefits of exercise-based cardiac rehabilitation are well established, there is extensive variation in the interventions used within these trials. It is unknown whether variations in individual components of these exercise interventions provide different relative contributions to overall clinical outcomes. This study aims to systematically examine the relationship between individual components of the exercise intervention in cardiac rehabilitation (such as intensity and frequency) and clinical outcomes for people with coronary heart disease. METHODS In this systematic review, eligible trials were identified via searches of databases (PubMed, Allied and Complementary Medicine, EMBASE, PEDro, Science Citation Index Expanded, CINAHL, The Cochrane Library, SPORTDiscus) from citation tracking and hand-searching. Studies were included if they were randomised trials of a structured exercise intervention (versus usual care) for participants with coronary heart disease and reported at least one of cardiovascular mortality, total mortality, myocardial infarction or revascularisation outcomes. Each included trial was assessed using the Cochrane Risk of Bias Tool. Authors were also contacted for missing intervention details or data. Random effects meta-analysis was performed to calculate a summary risk ratio (RR) with 95% confidence interval (CI) for the effect of exercise on outcomes. Random effects meta-regression and subgroup analyses were conducted to examine the association between pre-specified co-variates (exercise components or trial characteristics) and each clinical outcome. RESULTS Sixty-nine trials were included, evaluating 72 interventions which differed markedly in terms of exercise components. Exercise-based cardiac rehabilitation was effective in reducing cardiovascular mortality (RR 0.74, 95% CI 0.65 to 0.86), total mortality (RR 0.90, 95% CI 0.83 to 0.99) and myocardial infarction (RR 0.80, 95% CI 0.70 to 0.92). This effect generally demonstrated no significant differences across subgroups of patients who received various types of usual care, more or less than 150 min of exercise per week and of differing cardiac aetiologies. There was however some heterogeneity observed in the efficacy of cardiac rehabilitation in reducing total mortality based on the presence of lipid lowering therapy (I 2 = 48%, p = 0.15 for subgroup treatment interaction effect). No single exercise component was identified through meta-regression as a significant predictor of mortality outcomes, although reductions in both total (RR 0.81, p = 0.042) and cardiovascular mortality (RR 0.72, p = 0.045) were observed in trials which reported high levels of participant exercise adherence, versus those which reported lower levels. A dose-response relationship was found between an increasing exercise session time and increasing risk of myocardial infarction (RR 1.01, p = 0.011) and the highest intensity of exercise prescribed and an increasing risk of percutaneous coronary intervention (RR 1.05, p = 0.047). CONCLUSIONS Exercise-based cardiac rehabilitation is effective at reducing important clinical outcomes in patients with coronary heart disease. While our analysis was constrained by the quality of included trials and missing information about intervention components, there appears to be little differential effect of variations in exercise intervention, particularly on mortality outcomes. Given the observed effect between higher adherence and improved outcomes, it may be more important to provide exercise-based cardiac rehabilitation programs which focus on achieving increased adherence to the exercise intervention.
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Affiliation(s)
- Bridget Abell
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia.
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia
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Eggermont LHP, Aly MFA, Vuijk PJ, de Boer K, Kamp O, van Rossum AC, Scherder EJA. Cardiac function and cognition in older community-dwelling cardiac patients. Psychogeriatrics 2017; 17:356-363. [PMID: 28417534 DOI: 10.1111/psyg.12245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/01/2016] [Accepted: 12/01/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cognitive deficits have been reported in older cardiac patients. An underlying mechanism for these findings may be reduced cardiac function. The relationship between cardiac function as represented by different echocardiographic measures and different cognitive function domains in older cardiac patients remains unknown. METHODS An older (≥70 years) heterogeneous group of 117 community-dwelling cardiac patients under medical supervision by a cardiologist underwent thorough echocardiographic assessment including left ventricular ejection fraction, cardiac index, left atrial volume index, left ventricular mass index, left ventricular diastolic function, and valvular calcification. During a home visit, a neuropsychological assessment was performed within 7.1 ± 3.8 months after echocardiographic assessment; the neuropsychological assessment included three subtests of a word-learning test (encoding, recall, recognition) to examine one memory function domain and three executive function tests, including digit span backwards, Trail Making Test B minus A, and the Stroop colour-word test. RESULTS Regression analyses showed no significant linear or quadratic associations between any of the echocardiographic functions and the cognitive function measures. CONCLUSIONS None of the echocardiographic measures as representative of cardiac function was correlated with memory or executive function in this group of community-dwelling older cardiac patients. These findings contrast with those of previous studies.
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Affiliation(s)
- Laura H P Eggermont
- Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
| | - Mohamed F A Aly
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiology, University Hospital, Beni-Suef, Egypt
| | - Pieter J Vuijk
- Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
| | - Karin de Boer
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Otto Kamp
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
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Lisauskienė I, Garuolienė K, Gulbinovič J. Utilization of cardiovascular medicines and cardiovascular mortality in Lithuania, Sweden and Norway in 2003-2012. MEDICINA-LITHUANIA 2017; 53:259-267. [PMID: 28844562 DOI: 10.1016/j.medici.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/06/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this ecological study was to evaluate whether any changes in cardiovascular (CV) medicine utilization, population, socioeconomic and health system factors were associated with CV mortality in Lithuania, Sweden and Norway in 2003-2012. MATERIALS AND METHODS CV drug utilization was calculated using the Anatomical Therapeutic Chemical/Defined Daily Dose (DDD) methodology and expressed as a number of DDD per 1000 inhabitants per day (DDD/TID). The CV age-standardized death rate (CV-SDR) and risk factors data were obtained from the WHO, EUROSTAT, and FAOSTAT databases. The multiple linear regression model was used for modeling outcome measures - the relationship between the CV-SDR and CV medicine utilization including socioeconomic (GDP, unemployment and divorce rate), population (alcohol consumption, smoking and amount of kcal per day, consumption of fruit and vegetables, health status self-evaluation) and health system factors (number of hospital beds, practicing physicians and health care expenditure). RESULTS The higher CV medicine utilization in Sweden (307-455 DDD/TID, P<0.001) and Norway (306-394 DDD/TID, P<0.001) was associated with a definite decline in CV-SDR (in Norway from 215 to 146 and in Sweden from 233 to 174). In Lithuania, the increasing but lower consumption of CV medicines (135-360 DDD/TID, P<0.001) and twice higher CV-SDR (from 541 to 447) was registered. A significant inverse correlation was observed between CV-SDR and DDD/TID. We found a strong association between the DDD/TID and the CV-SDR (R2=0.67, P<0.001). There was a strong correlation between CV-SDR and nine factors (P<0.05), except the number of practicing physicians, amount of kcal per day. There was a strong correlation between DDD/TID and nine factors (P<0.05), except the unemployment rate and amount of kcal per day. Association between an increase in the use of medicines and a decrease in CV-SDR was stronger in the case of higher alcohol consumption, higher number of available beds in hospitals and the lower unemployment rate. CONCLUSIONS We confirmed the strong negative correlation between CV medicine utilization and CV mortality in all countries. The strong correlation was found between CV-SDR and nine factors, also between the use of CV medicines and nine factors. The impact of factors on the medicines induced decrease in CV-SDR showed the stronger influence in case of lower unemployment, higher alcohol consumption and higher number of beds for hospitalization.
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Affiliation(s)
- Ingrida Lisauskienė
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Kristina Garuolienė
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; The Ministry of Health, Vilnius, Lithuania
| | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; State Medicines Control Agency under the Ministry of Health, Vilnius, Lithuania
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Hegde VA, Biederman RWW, Mikolich JR. Cardiovascular Magnetic Resonance Imaging-Incremental Value in a Series of 361 Patients Demonstrating Cost Savings and Clinical Benefits: An Outcome-Based Study. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2017; 11:1179546817710026. [PMID: 28579858 PMCID: PMC5439571 DOI: 10.1177/1179546817710026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 04/16/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study was designed to assess the clinical impact and cost-benefit of cardiovascular magnetic resonance imaging (CMR). In the face of current health care cost concerns, cardiac imaging modalities have come under focused review. Data related to CMR clinical impact and cost-benefit are lacking. METHODS AND RESULTS Retrospective review of 361 consecutive patients (pts) who underwent CMR exams was conducted. Indications for CMR were tabulated for appropriateness criteria. Components of the CMR exam were identified along with evidence of clinical impact. The cost of each CMR exam was ascertained along with cost savings attributable to the CMR exam for calculation of an incremental cost-effectiveness ratio. A total of 354 of 361 pts (98%) had diagnostic quality studies. Of the 361 pts, 350 (97%) had at least 1 published Appropriateness Criterion for CMR. A significant clinical impact attributable to CMR exam results was observed in 256 of 361 pts (71%). The CMR exam resulted in a new diagnosis in 69 of 361 (27%) pts. Cardiovascular magnetic resonance imaging results avoided invasive procedures in 38 (11%) pts and prevented additional diagnostic testing in 26 (7%) pts. Comparison of health care savings using CMR as opposed to current standards of care showed a net cost savings of $833 037, ie, per patient cost savings of $2308. CONCLUSIONS Cardiovascular magnetic resonance imaging provides diagnostic image quality in >98% of cases. Cardiovascular magnetic resonance imaging findings have documentable clinical impact on patient management in 71% of pts undergoing the exam, in a cost beneficial manner.
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Affiliation(s)
- Vinayak A Hegde
- Department of Cardiovascular Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
- Department of Cardiovascular Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Robert WW Biederman
- Department of Cardiovascular Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
- Department of Cardiovascular Medicine, Drexel University College of Medicine, Pittsburgh, PA, USA
| | - J Ronald Mikolich
- Department of Cardiovascular Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, PA, USA
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Dzau VJ, Balatbat CA. Cardiovascular Research and the National Academy of Medicine: Advancing Progress in Science and Medicine. Circ Res 2017; 120:23-26. [DOI: 10.1161/circresaha.116.310358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Impact by Citations and Downloads: What are Heart, Lung and Circulation's Top 25 Articles of All Time? Heart Lung Circ 2016; 25:743-9. [DOI: 10.1016/j.hlc.2016.05.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Technology for Diagnosis, Treatment, and Prevention of Cardiometabolic Disease in India. Prog Cardiovasc Dis 2016; 58:620-9. [DOI: 10.1016/j.pcad.2016.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 02/28/2016] [Indexed: 12/26/2022]
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Xie D, Leng Y, Jing F, Huang N. A brief review of bio-tribology in cardiovascular devices. BIOSURFACE AND BIOTRIBOLOGY 2015. [DOI: 10.1016/j.bsbt.2015.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Budish E, Roin BN, Williams H. Do firms underinvest in long-term research? Evidence from cancer clinical trials. THE AMERICAN ECONOMIC REVIEW 2015; 105:2044-2085. [PMID: 26345455 PMCID: PMC4557975 DOI: 10.1257/aer.20131176] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We investigate whether private research investments are distorted away from long-term projects. Our theoretical model highlights two potential sources of this distortion: short-termism and the fixed patent term. Our empirical context is cancer research, where clinical trials - and hence, project durations - are shorter for late-stage cancer treatments relative to early-stage treatments or cancer prevention. Using newly constructed data, we document several sources of evidence that together show private research investments are distorted away from long-term projects. The value of life-years at stake appears large. We analyze three potential policy responses: surrogate (non-mortality) clinicaltrial endpoints, targeted R&D subsidies, and patent design.
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Affiliation(s)
- Eric Budish
- University of Chicago Booth School of Business, 5807 South Woodlawn Avenue, Chicago IL 60637,
| | - Benjamin N Roin
- MIT Sloan School of Management, 50 Memorial Drive, E62-465, Cambridge MA 02142,
| | - Heidi Williams
- MIT Department of Economics and NBER, 77 Massachusetts Avenue, E17-222, Cambridge MA 02139,
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Intapad S, Ojeda NB, Dasinger JH, Alexander BT. Sex differences in the developmental origins of cardiovascular disease. Physiology (Bethesda) 2014; 29:122-32. [PMID: 24583768 DOI: 10.1152/physiol.00045.2013] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The Developmental Origins of Health and Disease (DOHaD) proposes that adverse events during early life program an increased risk for cardiovascular disease. Experimental models provide proof of concept but also indicate that insults during early life program sex differences in adult blood pressure and cardiovascular risk. This review will highlight the potential mechanisms that contribute to the etiology of sex differences in the developmental programming of cardiovascular disease.
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Affiliation(s)
- Suttira Intapad
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
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Schoenthaler A, Kalet A, Nicholson J, Lipkin M. Does improving patient-practitioner communication improve clinical outcomes in patients with cardiovascular diseases? A systematic review of the evidence. PATIENT EDUCATION AND COUNSELING 2014; 96:3-12. [PMID: 24795073 PMCID: PMC4091848 DOI: 10.1016/j.pec.2014.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/27/2014] [Accepted: 04/06/2014] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To conduct a systematic literature review appraising the effects of interventions to improve patient-practitioner communication on cardiovascular-related clinical outcomes. METHODS Databases were searched up to March 27, 2013 to identify eligible studies that included interventions to improve patient and/or practitioner communication skills and assessment of a cardiovascular-related clinical outcome in adults ≥18 years of age. RESULTS Fifteen papers were reviewed: the primary focus in seven studies was the patient; seven included a practitioner-focused intervention and one targeted both. Two patient-focused and two practitioner-focused studies demonstrated a beneficial effect of the intervention compared to a control group. Patient-focused studies were designed to improve patients' information-seeking and question-asking skills with their practitioner. Practitioner-focused studies were designed to either improve practitioner's general patient-centered communication or risk communication skills. CONCLUSION Few interventions targeting patient-practitioner communication have assessed the impact on cardiovascular-related clinical outcomes, limiting the ability to determine effectiveness. Additional rigorous research supported by theoretical frameworks and validated measurement is needed to understand the potential of patient-practitioner communication to improve cardiovascular-related clinical outcomes. PRACTICE IMPLICATIONS Investments in communication skills trainings in medical education and practice are needed in order to attain the full potential of patient-centered care on cardiovascular-related clinical outcomes.
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Affiliation(s)
- Antoinette Schoenthaler
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, USA.
| | - Adina Kalet
- Section of Primary Care, Division of General Internal Medicine, Department of Medicine, NYU School of Medicine, New York, USA
| | - Joseph Nicholson
- NYU Health Sciences Libraries, Department of Medical Library, NYU School of Medicine, New York, USA
| | - Mack Lipkin
- Section of Primary Care, Division of General Internal Medicine, Department of Medicine, NYU School of Medicine, New York, USA
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Rajabali A, Heist EK. Sudden cardiac death: a critical appraisal of the implantable cardioverter defibrillator. Int J Clin Pract 2014; 68:458-64. [PMID: 24372939 DOI: 10.1111/ijcp.12306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IMPORTANCE Approximately 350,000 Americans still die of sudden cardiac death each year. This exceeds the number of patients who die annually from stroke, lung cancer, breast cancer and AIDS combined. OBJECTIVE This review aims to trace the history of implantable cardioverter defibrillators (ICD) with reference to landmark trials and their influence on the formulation of Medicare guidelines for ICD implantation criteria. This paper will also discuss the cost-effectiveness of ICDs and the quality of life after implantation. The reasons for the disparity between guidelines for implantation and actual clinical practice will be elucidated, with suggestions for improving overall clinical performance. RESULTS AND CONCLUSION The ICD has been shown to be cost-effective in reducing sudden cardiac death and all-cause mortality. However, the existing recommendations for ICD implantation have yet to translate completely into clinical practice. Barriers to implementation of existing guidelines include knowledge gaps in the referring physician practices, lack of validated screening tools to assess patient candidacy for the device and patient understanding of the need for the device. Future strategies to increase compliance with the existing guidelines and improve clinical performance are areas of potential research focus.
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Affiliation(s)
- A Rajabali
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
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Gialama F, Prezerakos P, Maniadakis N. The cost effectiveness of implantable cardioverter defibrillators: a systematic review of economic evaluations. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:41-9. [PMID: 24243517 DOI: 10.1007/s40258-013-0069-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) is the most common cause of death in developed countries, with more than 3 million people dying yearly. Implantable cardioverter defibrillators (ICDs) are considered to be an effective treatment in the primary and secondary prevention of SCD; however, their cost is considerable and this poses questions regarding whether they are worth the investment relative to less expensive pharmacotherapy. OBJECTIVE The aim of this systematic review is to investigate existing evidence regarding the cost effectiveness of ICD therapy and to identify the key drivers of cost effectiveness, for the purpose of informing interested policy and decision makers. METHODOLOGY A systematic review of the literature concerning the cost effectiveness of ICDs was undertaken. Electronic databases, including PubMed, Cochrane and Health Economic Evaluations Database were searched based on appropriate terms and their combinations. Economic evaluation studies that examined the cost effectiveness of ICDs were selected and 34 were included for evaluation. RESULTS Findings from the present analysis show that ICD therapy, in properly selected patients who are at high risk of sudden cardiac death, is associated with similar or better cost-effectiveness ratios compared with other well accepted conventional treatments. The cost effectiveness of ICDs is influenced by several factors, including ICD efficacy and safety, impact on patient quality of life, device original implantation cost, frequency and cost of battery replacement, patient demographics and risk profile and analysis time horizon. CONCLUSION ICDs may represent a cost-effective option relative to pharmacotherapy in appropriately selected patient groups. The cost-effectiveness ratios appear to be at acceptable and comparable levels to other established treatments in cardiovascular and non-cardiovascular diseases. However, cost effectiveness is highly related to several factors and hence economic efficiency is highly dependent on conditions that need to be fulfilled for each individual case in medical practice. The aforementioned factors and technological advances imply that to ensure cost-effective use of ICD therapy, continuous research is needed.
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Affiliation(s)
- Fotini Gialama
- Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 115 21, Athens, Greece
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Maglinte GA, Hays RD, Kaplan RM. US general population norms for telephone administration of the SF-36v2. J Clin Epidemiol 2012; 65:497-502. [PMID: 22269331 PMCID: PMC3582698 DOI: 10.1016/j.jclinepi.2011.09.008] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 07/10/2011] [Accepted: 09/04/2011] [Indexed: 01/22/2023]
Abstract
OBJECTIVE US general population norms for mail administration of the Medical Outcomes Study 36-Item Short Form Version 2 (SF-36v2) were established in 1998. This article reports SF-36v2 telephone-administered norms collected in 2005-2006 for adults aged 35-89 years. STUDY DESIGN AND SETTING The SF-36v2 was administered to 3,844 adults in the National Health Measurement Study (NHMS), a random-digit dial telephone survey. Scale scores and physical and mental component summary (PCS and MCS) scores were computed. RESULTS When compared with 1998 norms (mean=50.00, standard deviation [SD]=10.00), SF-36v2 scores for the 2005-2006 general population tended to be higher: physical functioning (mean=50.68, SD=14.48); role limitations due to physical health problems (mean=49.47, SD=14.71); bodily pain (mean=50.66, SD=16.28); general health perceptions (mean=50.10, SD=16.87); vitality (mean=53.71, SD=15.35); social functioning (mean=51.37, SD=13.93); role limitations due to emotional problems (mean=51.44, SD=13.93); mental health (mean=54.27, SD=13.28); PCS (mean=49.22, SD=15.13); MCS (mean=53.78, SD=13.14). PCS and MCS factor scoring coefficients were similar to those previously reported for the 1998 norms. SF-36v2 norms for telephone administration were created. CONCLUSION The higher scores for NHMS data are likely due to the effect of telephone administration. The 2005-2006 norms can be used as a reference to interpret scale and component summary scores for telephone-administered surveys with the SF-36v2.
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Affiliation(s)
- Gregory A Maglinte
- Department of Health Services, UCLA School of Public Health, Los Angeles, CA 90095, USA.
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Layte R, O'Hara S, Bennett K. Explaining structural change in cardiovascular mortality in Ireland 1995-2005: a time series analysis. Eur J Public Health 2010; 21:597-602. [DOI: 10.1093/eurpub/ckq100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Grootendorst P, Piérard E, Shim M. Life-expectancy gains from pharmaceutical drugs: a critical appraisal of the literature. Expert Rev Pharmacoecon Outcomes Res 2009; 9:353-64. [PMID: 19670996 DOI: 10.1586/erp.09.35] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Several studies suggest that, on the basis of life-expectancy regressions, pharmaceutical drugs are responsible for much of the marked gains in life expectancy observed over the last 50 years. In this article, we critically appraise these studies. METHODS We point out several modeling issues: identification of the contribution of new drugs from advances in disease management, changes in the distribution of healthcare and other confounding factors. RESULTS We suggest that some models produce estimates of pharmaceutical productivity that are implausibly high. Other models have very large forecast errors. Finally, the models that we replicated were found to be sensitive to seemingly innocuous changes in specification. CONCLUSION It is difficult to estimate the biomedical determinants of life expectancy using aggregate data. Analyses using individual level data or perhaps disease-specific data will probably produce more compelling results.
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Affiliation(s)
- Paul Grootendorst
- Faculty of Pharmacy, University of Toronto and Department of Economics, McMaster University, Hamilton ON, 144 College Street, Toronto, ON, M5S 3M2, Canada.
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Professional Accountability in Health System Reform. J Am Coll Cardiol 2009; 54:499-501. [DOI: 10.1016/j.jacc.2009.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 05/09/2009] [Indexed: 11/22/2022]
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Lichtenberg FR. Have newer cardiovascular drugs reduced hospitalization? Evidence from longitudinal country-level data on 20 OECD countries, 1995-2003. HEALTH ECONOMICS 2009; 18:519-534. [PMID: 18634121 DOI: 10.1002/hec.1382] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study examines the effect of changes in the vintage distribution of cardiovascular system drugs on hospitalization and mortality due to cardiovascular disease using longitudinal country-level data. The vintage of a drug is the first year in which it was marketed anywhere in the world. We use annual data on the utilization of over 1100 cardiovascular drugs (active ingredients) in 20 OECD countries during the period 1995-2003. Countries with larger increases in the share of cardiovascular drug doses that contained post-1995 ingredients had smaller increases in the cardiovascular disease hospital discharge rate, controlling for the quantity of cardiovascular medications consumed per person, the use of other medical innovations (computed tomography scanners and magnetic resonance imaging units), potential risk factors (average consumption of calories, tobacco, and alcohol), and demographic variables (population size and age structure, income, and educational attainment). The estimates also indicate that the use of newer cardiovascular drugs has reduced the average length of stay and the age-adjusted cardiovascular mortality rate, but not the number of potential years of life lost due to cardiovascular disease before age 70 per 100,000 population. The estimates indicate that if drug vintage had not increased during 1995-2004, hospitalization and mortality would have been higher in 2004. We estimate that per capita expenditure on cardiovascular hospital stays would have been 70% ($89) higher in 2004 had drug vintage not increased during 1995-2004. Per capita expenditure on cardiovascular drugs would have been lower in 2004 had drug vintage not increased during 1995-2004. However, our estimate of the increase in expenditure on cardiovascular hospital stays is about 3.7 times as large as our estimate of the reduction in per capita expenditure for cardiovascular drugs that would have occurred ($24).
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Wensing M, Ludt S, Campbell S, van Lieshout J, Volbracht E, Grol R. European Practice Assessment of Cardiovascular risk management (EPA Cardio): protocol of an international observational study in primary care. Implement Sci 2009; 4:3. [PMID: 19128457 PMCID: PMC2627825 DOI: 10.1186/1748-5908-4-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 01/07/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite important improvements in available prevention and treatment, cardiovascular diseases (CVD) remain an important cause of morbidity and mortality. Not all high-risk patients and patients with CVD have healthy lifestyles and receive the best possible healthcare. Internationally comparative data are needed to compare cardiovascular risk management in different countries, and to examine the impact of improvement programs and others factors. OBJECTIVES This study aims to provide internationally comparative data on cardiovascular risk management provided in primary care and on health-related lifestyles of patients in Europe. The study will also explore the views of doctors and patients on innovative preventive services for CVDs. DESIGN AND METHODS An observational cross-sectional study is planned. In 10 European countries, stratified samples of 36 practices per country will be recruited. In each practice, three samples of 15 patients each will be sampled: patients with coronary heart disease, patients at high risk for CVD, and healthy adult patients. The quality of cardiovascular risk management has been specified in terms of 44 performance indicators that resulted from an international Delphi-procedure with general practitioners. Most indicators are based on medical records, and some on a structured interview with a contact person of the practice. Lifestyle (smoking, physical exercise, diet) will be measured with previously validated questionnaires that are completed by patients. Additional measures include practice characteristics and exposure to programs to improve cardiovascular care.
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Affiliation(s)
- Michel Wensing
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Germany.
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Abstract
Stem cells have been the focus of numerous investigations to treat diseases as far ranging as diabetes, chronic heart failure and multiple sclerosis over the past decade. The process of stem-cell-based repair of acute injury involves homing and engrafting of the stem cell of interest to the site of injury followed by either differentiation of the stem cell to indigenous end-organ cells or liberation of paracrine factors that lead to preservation and/or optimization of organ function. Recognition of the ability of stem cells to home to sites of acute injury suggests that, if appropriately defined and harnessed, stem cell homing could serve as a means of local drug delivery through the infusion of genetically engineering stem cells that secrete gene products of interest. The authors have recently demonstrated the use of this approach in preclinical studies of acute myocardial function. In addition, the use of engineered cells that home to appropriate niches have been used to correct genetic deficiency states (i.e., severe combined immunodeficiency, diabetes mellitus) in patients with otherwise chronic debilitating diseases. This review focuses on exploiting stem cell homing for gene transfer and on the state of the art and the challenges that face the field.
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Affiliation(s)
- Marc S Penn
- Skirball Laboratory for Cardiovascular Cellular Therapeutics, Department of Cardiovascular Medicine, NE3, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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