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Ray S, Nair T, Sawhney J, Erwinanto, Rosman A, Reyes E, Go L, Sukonthasarn A, Ariyachaipanich A, Hung PM, Chaudhari H, Malhi HS. Role of β-blockers in the cardiovascular disease continuum: a collaborative Delphi survey-based consensus from Asia-Pacific. Curr Med Res Opin 2023; 39:1671-1683. [PMID: 37694536 DOI: 10.1080/03007995.2023.2256218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE This Delphi method of consensus was designed to develop scientific statements for β-blockers in the continuum of cardiovascular diseases with a special focus on the role of bisoprolol. METHODS Eleven experienced cardiologists from across the Asia-Pacific countries participated in two rounds of the survey. In the first round, experts were asked to rate agreement/disagreement with 35 statements across seven domains regarding the use of β-blockers for treating hypertension, heart failure, coronary artery diseases, co-morbidities, as well as their safety profile, usage pattern, and pharmacokinetic variability. A consensus for a statement could be reached with >70% agreement. RESULTS Except for seven statements, all attained consensus in the first round. In the second round that was conducted virtually, the experts re-appraised their ratings for the seven statements along with a critical appraisal of two additional statements that were suggested by experts in the preceding round. At the end of the second round, the final version included 36 statements (34 original statements, two statements suggested by experts, and the omission of one statement that did not attain consensus). The final version of statements in the second round was disseminated among experts for their approval followed by manuscript development. CONCLUSION Attainment of consensus for almost all statements reconfirms the clinical benefits of β-blockers, particularly β1-selective blockers for the entire spectrum of cardiovascular diseases.
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Affiliation(s)
- Saumitra Ray
- Department of Cardiology, AMRI Hospital (S), West Bengal, Kolkata, India
| | - Tiny Nair
- Department of Cardiology, PRS Hospital, Trivandrum, Kerala, India
| | - Jps Sawhney
- Department of Cardiology, Member Board of Management at Sir Ganga Ram Hospital, New Delhi, India
| | - Erwinanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjajaran University, Jawa Barat, Indonesia
| | | | - Eugene Reyes
- Section of Cardiology, Department of Internal Medicine, UP-Philippine General Hospital, Manila, Philippines
| | - Loewe Go
- Internal Medicine - Cardiology, St. Luke's Medical Center, Taguig, Philippines
| | | | - Aekarach Ariyachaipanich
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Phạm Manh Hung
- National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Harshal Chaudhari
- Merck Specialities Pvt. Ltd., India, an affiliate of Merck KGaA, Darmstadt, Germany
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Chopra HK, Wander GS, Nair T, Ponde CK, Nanda NC, Narula J, Ray S, Venugopal K, Iyengar SS, Kasliwal RR, Chandra P, Prakash S, Bansal S, Rana DS, Kerkar P, Dasbiswas A, Sawhney J, Shanmungasundram S, Kumar V, Vijayalakshmi IB, Pancholia AK, Sharma V, Kapoor A, Swami OC, Isser HS, Rastogi V, Arora YK, Omar AK, Sathe S, Rajput R, Prabhakar D, Paul GJ, Jagia P, Malhotra P, Suryaprakash G, Mittal V, Jagia M, Jabir A, Mishra SS, Routray SN, Sinha AK, Bhargava M, Mahmood K, Lal S, Dabhade D, Bhatia M, Kalra P, Katyal VK, Tandon R, Grover R, Chhabra A, Shastry NR. Angiotensin Receptor-Neprilysin Inhibitor Therapy and Cardiac Remodeling in Heart Failure: Consensus Statement from India. J Assoc Physicians India 2023; 71:11-12. [PMID: 37355795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), β-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).
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Affiliation(s)
- H K Chopra
- Senior Consultant, Department of Cardiology, Medanta Moolchand Heart Center, Delhi
| | - G S Wander
- Professor and Head, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab;Corresponding Author
| | - Tiny Nair
- Head, Department of Cardiology, PRS Hospital, Trivandrum, Kerala
| | - C K Ponde
- Consultant Cardiologist and Head, Department of Cardiology, PD Hinduja National Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Navin C Nanda
- Department of Cardiology Division, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Jagat Narula
- Associate Dean, Chief, Icahn School of Medicine at Mount Sinai (ISMMS); Division of Cardiology, Mount Sinai Hospital, New York, United States of America
| | - Saumitra Ray
- Director, Department of Invasive Cardiology, AMRI Hospital, Kolkata, West Bengal
| | - K Venugopal
- Senior Consultant Cardiologist, KVM Hospital Cherthala and SP Fort Hospital, Thiruvananthapuram, Kerala
| | - S S Iyengar
- Consultant Emeritus and Academic Head, Department of Cardiology, Manipal Hospital, Bengaluru, Karnataka
| | - R R Kasliwal
- Chairman, Department of Clinical and Preventive Cardiology, Medanta The Medicity, Gurugram, Haryana
| | - Praveen Chandra
- Chairman, Department of Interventional and Structural Heart Cardiology, Medanta The Medicity, Gurugram, Haryana
| | - Sunil Prakash
- Senior Director and Head, Department of Nephrology and Renal Transplantation, BLK-Max Super Speciality Hospital, Delhi
| | - Sandeep Bansal
- Consultant in Cardiology, Professor and Head, Department of Cardiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, Delhi
| | - D S Rana
- Chairman, Department of Nephrology, Sir Ganga Ram Hospital, Delhi
| | - Prafulla Kerkar
- Senior Consultant Interventional Cardiologist, Asian Heart Institute, Mumbai, Maharashtra
| | - Arup Dasbiswas
- Ex Director ICVS, Professor and Head of Department, Department of Cardiology, ICVS; Institute of Postgraduate Medical Education & Research, Kolkata, West Bengal
| | - Jps Sawhney
- Chief of Clinical and Preventive Cardiology, Chairman, Department of Cardiology, Sir Gangaram Hospital, Delhi
| | | | - Viveka Kumar
- Principal Director and Chief of Cath Labs (Pan Max), Department of Cardiac Sciences, Max Hospital, Delhi
| | - I B Vijayalakshmi
- Professor Emeritus, Former Head Pediatric Cardiology, Shri Jayadeva Institute of Cardiovascular sciences and Research, Bengaluru, Karnataka
| | - A K Pancholia
- Head of Department, Department of Clinical and Preventive Cardiology, Arihant Hospital and Research Centre, Indore, Madhya Pradesh
| | - Vinod Sharma
- Head of Cardiology and Vice Chief Executive Officer, National Heart Institute, Delhi
| | - Aditya Kapoor
- Head, Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
| | - Onkar C Swami
- Director, Department of Medical Services, Emcure Pharmaceuticals Ltd., Pune, Maharashtra
| | - H S Isser
- Professor and Consultant, Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital
| | - Vishal Rastogi
- Director, Department of Interventional Cardiology, Head of Advanced Heart Failure Program, Fortis Escort Heart Institute
| | - Y K Arora
- Consultant Cardiologist, National Heart Institute
| | - Ashok K Omar
- Director, Noninvasive Cardiology and Head Heart Command Centres, Fortis Escorts Heart Institute, Delhi
| | - Sunil Sathe
- Interventional Cardiologist, Ruby Hall Clinic, Pune, Maharashtra
| | | | - D Prabhakar
- Consultant Interventional Cardiologist, Ashwin Clinic, Chennai, Tamil Nadu
| | - G Justin Paul
- Professor of Cardiology, Madras Medical College, Chennai, Tamil Nadu
| | - Priya Jagia
- Professor and Head, Department of Cardiovascular Imaging and Endovascular Interventions, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Delhi
| | - Poonam Malhotra
- Senior Professor, Cardiac Anaesthesia, All India Institute of Medical Sciences, Delhi
| | - G Suryaprakash
- Senior Consultant Cardiologist and Clinical Director, Care Hospitals, Hyderabad, Telangana
| | - Vinod Mittal
- Senior Consultant Diabetologist and Head, Centre for Diabetes and Metabolic Diseases, Delhi Heart and Lung Institute
| | - Manish Jagia
- Director, Department of Anaesthesia and Critical care, Moolchand Hospital, Delhi
| | - A Jabir
- Senior Cardiologist and Assistant Professor, Lisie Hospital, Cochin, Kerala
| | - S S Mishra
- Director and Senior Consultant Cardiologist, Med N Heart Clinic, Cuttack, Odisha
| | - S N Routray
- Professor and Head, Department of Cardiology, SCB Medical College, Cuttack, Odisha
| | - Ajay Kumar Sinha
- Senior Consultant, Department of Cardiology, Medanta Heart Institute, Patna, Bihar
| | - Mohan Bhargava
- Director of Cardiology and Interventional Cardiologist, Max hospital, Delhi, India
| | - Kiran Mahmood
- Assistant Professor of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai (ISMMS); Director of Heart Failure Program, Mount Sinai Morningside Hospital, New York, United States of America
| | | | - Dhammdeep Dabhade
- Senior Manager, Department of Medical Services, Emcure Pharmaceuticals Ltd., Pune, Maharashtra
| | - Mona Bhatia
- Principal Director and Head, Department of Radiology and Imaging, Fortis Escorts Heart Institute, Delhi
| | - Pramila Kalra
- Professor and Head, Department of Endocrinology, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka
| | - V K Katyal
- Head of Department, Department of Medicine, Positron Multispecialty and Cancer Hospital, Rohtak, Haryana
| | - Rohit Tandon
- Consultant, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab
| | - Rahul Grover
- Associate Director, Department of Nephrology, Max Hospital, Delhi
| | - Abhinav Chhabra
- Consultant Interventional Cardiologist, Medanta Hospital, Gurugram, Haryana
| | - N R Shastry
- Consultant Cardiologist, Medanta Moolchand Heart Center, Delhi, India
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Chopra HK, Wander GS, Nair T, Ponde CK, Nanda NC, Narula J, Ray S, Venugopal K, Iyengar SS, Kasliwal RR, Chandra P, Prakash S, Bansal S, Rana DS, Kerkar P, Dasbiswas A, Sawhney J, Shanmungasundram S, Kumar V, Vijayalakshmi IB, Pancholia AK, Sharma V, Kapoor A, Swami OC, Isser HS, Rastogi V, Arora YK, Omar AK, Sathe S, Rajput R, Prabhakar D, Paul GJ, Jagia P, Malhotra P, Suryaprakash G, Mittal V, Jagia M, Jabir A, Mishra SS, Routray SN, Sinha AK, Bhargava M, Mahmood K, Bhatia M, Kalra P, Katyal VK, Tandon R, Grover R, Chhabra A, Shastry NR. Role of Iron Therapy in Heart Failure: A Consensus Statement from India. J Assoc Physicians India 2023; 71:11-12. [PMID: 37354511 DOI: 10.5005/japi-11001-0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients.
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Affiliation(s)
- H K Chopra
- Senior Consultant, Department of Cardiology, Medanta Moolchand Heart Institute, Delhi
| | - G S Wander
- Professor and Head, Department of Cardiology, Dayanand Medical College & Hospital (DMCH), Ludhiana, Punjab; Corresponding Author
| | - Tiny Nair
- Head, Department of Cardiology, PRS Hospital, Trivandrum, Kerala
| | - C K Ponde
- Consultant Cardiologist and Head, Department of Cardiology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra
| | - Navin C Nanda
- Department of Cardiology Division, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Jagat Narula
- Associate Dean and Chief, Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai, New York
| | - Saumitra Ray
- Director, Department of Invasive Cardiology, AMRI Hospitals, Kolkata, West Bengal
| | - K Venugopal
- Senior Consultant Cardiologist, KVM Hospital Cherthala and SP Fort Hospital, Trivandrum, Kerala
| | - S S Iyengar
- Consultant Emeritus and Academic Head, Department of Cardiology, Manipal Hospital, Bengaluru, Karnataka
| | - R R Kasliwal
- Chairman, Department of Clinical and Preventive Cardiology, Heart Institute at Medanta, Gurgaon, Haryana
| | - Praveen Chandra
- Chairman, Department of Interventional and Structural Heart Cardiology, Medanta Moolchand Heart Institute, Gurgaon, Haryana
| | - Sunil Prakash
- Senior Director and Head, Department of Nephrology and Renal Transplantation, BLK-Max Super Speciality Hospital, Delhi
| | - Sandeep Bansal
- Consultant in Cardiology, Professor and Head, Department of Cardiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, Delhi
| | - D S Rana
- Chairman, Department of Nephrology, Sir Ganga Ram Hospital, Delhi
| | - Prafulla Kerkar
- Senior Consultant Interventional Cardiologist, Asian Heart Institute, Mumbai, Maharashtra
| | - Arup Dasbiswas
- Ex Director ICVS, Professor and Head of Department, Department of Cardiology, ICVS, Institute of Postgraduate Medical Education & Research (IPGMER), Kolkata, West Bengal
| | - Jps Sawhney
- Chief Clinical and Preventive Cardiology and Chairman, Department of Cardiology, Sir Ganga Ram Hospital, Delhi
| | | | - Viveka Kumar
- Principal Director and Chief of Cath Labs (Pan Max), Department of Cardiac Sciences, Max Super Speciality Hospital, Delhi
| | - I B Vijayalakshmi
- Emeritus Professor and Former Head Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka
| | - A K Pancholia
- Head of the Department and Clinical and Preventive Cardiology, Arihant Hospital & Research Centre, Indore, Madhya Pradesh
| | - Vinod Sharma
- Head of Cardiology and Vice Chief Executive Officer, National Heart Institute, Delhi
| | - Aditya Kapoor
- Head, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
| | - Onkar C Swami
- Director, Department of Medical Services, Emcure Pharmaceuticals Ltd., Pune, Maharashtra
| | - H S Isser
- Professor and Consultant, Department of Cardiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, Delhi
| | - Vishal Rastogi
- Director, Head of Advanced Heart Failure Program, Department of Interventional Cardiology, Fortis Escorts Heart Institute, Delhi
| | - Y K Arora
- Consultant Cardiologist, National Heart Institute, Delhi
| | - Ashok K Omar
- Director of Noninvasive Cardiology and Head Heart Command Centers, Fortis Escorts Heart Institute, Delhi
| | - Sunil Sathe
- Interventional Cardiologist, Ruby Hall Clinic, Pune, Maharashtra
| | | | - D Prabhakar
- Consultant Interventional Cardiologist, Ashwin Clinic, Chennai, Tamil Nadu
| | - G J Paul
- Professor of Cardiology, Madras Medical College, Chennai, Tamil Nadu
| | - Priya Jagia
- Professor and Head, Department of Cardiovascular Imaging and Endovascular Interventions, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Delhi
| | - Poonam Malhotra
- Senior Professor, Cardiac Anaesthesia, All India Institute of Medical Sciences, Delhi
| | - G Suryaprakash
- Senior Consultant Cardiologist and Clinical Director, Care Hospitals, Hyderabad, Telangana
| | - Vinod Mittal
- Senior Consultant Diabetologist and Head, Centre for Diabetes and Metabolic Diseases, Delhi Heart and Lung Institute, Delhi
| | - Manish Jagia
- Director, Department of Anaesthesia and Critical care, Moolchand Hospital, Delhi
| | - A Jabir
- Senior Cardiologist and Assistant Professor, Lisie Hospital, Kochi, Kerala
| | - S S Mishra
- Director and Senior Consultant Cardiologist, Med N Heart Clinic, Cuttack, Odisha
| | - S N Routray
- Professor and Head, Department of Cardiology, Srirama Chandra Bhanj Medical College & Hospital (S.C.B Medical College), Cuttack, Odisha
| | - Ajay K Sinha
- Senior Consultant, Department of Cardiology, Medanta Heart Institute, Patna, Bihar
| | - Mohan Bhargava
- Director Cardiology and Interventional Cardiologist, Max Super Speciality Hospital, Delhi
| | - Kiran Mahmood
- Assistant Professor of Medicine (Cardiology), Icahn School of Medicine, Mount Sinai; Director of Heart Failure Program, Mount Sinai Morningside Hospital, New York
| | - Mona Bhatia
- Principal Director and Head, Department of Radiology and Imaging, Fortis Escorts Heart Institute, Delhi
| | - Pramila Kalra
- Professor and Head, Department of Endocrinology, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka
| | - V K Katyal
- Head, Department of Medicine, Positron Multispecialty and Cancer Hospital, Rohtak, Haryana
| | - Rohit Tandon
- Consultant, Department of Cardiology, Dayanand Medical College & Hospital (DMCH), Ludhiana, Punjab
| | - Rahul Grover
- Associate Director, Department of Nephrology, Max Super Speciality Hospital, Delhi
| | - Abhinav Chhabra
- Consultant Interventional Cardiologist, Medanta Moolchand Heart Institute, Gurgaon, Haryana
| | - N R Shastry
- Consultant Cardiologist, Medanta Moolchand Heart Institute, Delhi
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Sawhney J, Vanani J, Madan K, Sharma M, Tyagi K, Kandpal B, Mehta A. Achieving the LDL-C goal in Indian patients of acute coronary syndrome with high intensity statin. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Jadhav U, Tiwaskar M, Khan A, Kalmath BC, Ponde CK, Sawhney J, Tripathy MP, Hazra PK, Sahoo PK, Routray SN, Chandra S, Alexander T, Chopra VK. Hypertension in Young Adults in India: Perspectives and Therapeutic Options amongst Clinician's in a Cross Sectional Observational Study. J Assoc Physicians India 2021; 69:11-12. [PMID: 34781615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The prevalence of hypertension in the young adult population is rising in India. Increased arterial stiffness due to RAAS activation and increased sympathetic overactivity due to stress have been implicated as primary factors for the same. This study was aimed to understand the Indian clinician's perspective on approach to management of hypertension in young adults. METHODS A cross sectional observational survey using a structured questionnaire was conducted online with 2287clinicians (cardiologists, diabetologists, consultant physicians and family physicians). RESULTS The prevalence of hypertension was 10-30% as per opinion of 64.8% clinicians. The top three risk factors for hypertension in young were perceived to be smoking, mental stress and obesity. Around 57.4% respondents opined that both increased heart rate and systolic blood pressure were markers of sympathetic overactivity. More than 60% respondents across specialities preferred ARBs to treat hypertension in young adults. Amongst the ARBs, telmisartan was the preferred ARB by >80% respondents. Metoprolol was the preferred beta blocker by almost 64% respondents. The objective of selection of beta-blocker by majority of clinicians due to sympathetic overactivity. Telmisartan and Metoprolol single pill combination achieved the BP goal in 40-60% of patients as reported by 41.3% of the physicians. The combination therapy was well tolerated in young hypertensive patients. CONCLUSIONS Initiation of an early and appropriate antihypertensive treatment in young population may lower the burden of cardiovascular disease in this population. ARBs and beta -blockers were the preferred class of anti-hypertensive drugs in the cohort of young hypertensive patients .
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Affiliation(s)
- Uday Jadhav
- MGM New Bombay Hospital, Vashi, Navi Mumbai, Maharashtra Corresponding Author
| | | | - Aziz Khan
- Crescent Hospital & Heart Centre, Nagpur, Maharashtra
| | - B C Kalmath
- Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra
| | - C K Ponde
- PD Hinduja Hospital & Medical Research Centre, Mumbai, Maharashtra
| | | | | | | | - P K Sahoo
- Apollo Hospital, Bhubaneswar, Orissa
| | | | | | | | - V K Chopra
- Max Super Speciality Hospital, New Delhi
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Dalal J, Sethi KK, Guha S, Ray S, Deb PK, Kirpalani A, Rao Maddury S, Sathyamurthy I, Shah S, Das MK, Chandalia HB, Sawhney J, Thomas J, Kumar V, Chandra N, Khan A, Kumar AS, Suryaprakash G. Screening for Hypertension in Asymptomatic Individuals in India: An Expert Consensus Statement. J Assoc Physicians India 2020; 68:73-79. [PMID: 32610855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Hypertension (HTN) is a rapidly growing epidemic in India. It is no larger restricted to older adults as more young Indians are being diagnosed with HTN. Despite its significant prevalence, the awareness, treatment, and control of HTN remain low in India. Thus, early diagnosis is essential to control HTN and prevent future complications. Screening for HTN can help identify undiagnosed and asymptomatic HTN, and thereby the early use of interventions to control the blood pressure (BP). However, no comprehensive guidelines have been established for effective HTN screening in asymptomatic individuals in an Indian setting. OBJECTIVE To provide consensus recommendations for hypertension screening in India. CONSENSUS RECOMMENDATIONS Screening for HTN can provide more effective control of HTN and reduce the complications. Experts recommended that the initial age at screening should be 18 years. In individuals at a high risk of HTN, targeted screening can be undertaken. BP measurement using an electronic BP recorder (with at least two readings) are required for identifying HTN during screening. In asymptomatic adults with BP <130/85 mmHg and BP of 130-139/85- 89 mmHg, rescreening should be conducted every 3-5 years and at least every year, respectively. Screening for HTN can be cost effective even when universal screening of the entire population is undertaken. CONCLUSION The consensus recommendations would increase the awareness of HTN screening. Screening for HTN can provide more effective control of HTN and reduce the complications.
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Affiliation(s)
- Jamshed Dalal
- Director, Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra
| | - K K Sethi
- Delhi Heart and Lung Institute, Panchkuian Road, New Delhi
| | | | - Saumitra Ray
- Ramakrishna Mission Seva Pratishthan and Vivekananda Institute of Medical Sciences, Kolkata, West Bengal
| | - P K Deb
- E.S.I. Post-graduate Institute of Medical Science and Research, Kolkata, West Bengal
| | | | | | | | | | | | - H B Chandalia
- Jaslok Hospital and Research Centre, Mumbai, Maharashtra
| | - Jps Sawhney
- Dept. of Cardiology, Sir Ganga Ram Hospital, New Delhi
| | - Joy Thomas
- Dr. Joy Thomas Heart Care, Bharathi Salai, Mugappair West, Chennai, Tamil Nadu
| | - Viveka Kumar
- Consultant Cardiologist, Max Hospital, Saket, New Delhi
| | | | - Aziz Khan
- Crescent Hospital and Heart Centre, Dhantoli, Nagpur, Maharashtra
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Kalra S, Kishor K, Sawhney J, Kumar K, Raza SA, Shrestha D, Aye TT, Chaudhary S, Shaikh K, Somasundaram N, Pathan F, Sahay R, Priya G. The Lipo- Phenotypic Screening Tool for Familial Hypercholesterolaemia. J PAK MED ASSOC 2019; 69:1052-1054. [PMID: 31983747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Familial hypercholesterolaemia (FH) is a common disorder of lipid metabolism. However, it is rarely diagnosed in time, leading to a high burden of preventable cardiovascular (CV) morbidity. The authors describe a lipophenotypic screening tool, which can be used by clinicians to screen for FH. This simple construct is based on history, physical examination, lipid profile and non-invasive cardioimaging. Structured as a bidirectional three column rubric, this tool should be able to improve clinical skills and teaching related to FH.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | | | - Jps Sawhney
- Department of Cardiology, Sir Ganga Ram Hospital New Delhi
| | - Krishna Kumar
- Department of Cardiology, Government Medical College, Trivandum, India
| | - Syed Abbas Raza
- Department of Endocrinology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Dina Shrestha
- Department of Endocrinology, Norvic International Hospital, Kathmandu, Nepal
| | - Than Than Aye
- President, Myanmar Society of Endocrinology & Metabolism, Yangon, Myanmar
| | - Sandeep Chaudhary
- Department of Endocrinology, NMC Speciality Hospital, Al Nahada, Dubai, UAE
| | - Khalid Shaikh
- Department of Medicine, Royal Oman Police Hospital, Muscat, Oman
| | - Noel Somasundaram
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - Rakesh Sahay
- Department of Endocrinology, Osmania Hospital, Hyderabad, India
| | - Gagan Priya
- Department of Endocrinology, Fortis Hospital, Mohali, India
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Iyengar SS, Bansal M, Sawhney J, Wander G, Narasingan SN, Chandra KS, D P, Nair T, Krishnakumar B, Deshpande N, Bardoloi N, Shetty S, Desai N, Pancholia AK, Swamy A. Appropriate use of PCSK9 Inhibitors in India. J Assoc Physicians India 2019; 67:74-85. [PMID: 31311223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The burden of atherosclerotic cardiovascular (CV) disease is alarmingly high and increasing in our country. Dyslipidemia is one of the major modifiable risk factors, and INTERHEART study showed that dyslipidemia had the highest population attributable risk for myocardial infarction. In the management of dyslipidemia, low-density lipoprotein cholesterol (LDL-C) is the primary therapeutic target. In addition to therapeutic lifestyle changes, statins and ezetimibe effectively lower LDL-C and consequently improve CV outcomes. However, there are situations where these drugs fall short of achieving the target or they may not be well tolerated.
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Affiliation(s)
- S S Iyengar
- Consultant Cardiologist, Manipal Hospital, Bangalore, Karnataka
| | - Manish Bansal
- Associate Director, Clinical and Preventive Cardiology , Heart Institute, Medanta Medicity, Gurgaon, Haryana
| | - Jps Sawhney
- Chairman, Deptt. of Cardiology Sir Ganga Ram Hospital, New Delhi
| | - Gurpreet Wander
- Professor & Chief Cardiologist, Hero DMC Heart Institute, Ludhiana, Punjab
| | - S N Narasingan
- Managing Director, SNN Specialties Clinic, Alwarpet , Chennai, Tamil Nadu
| | - K Sarat Chandra
- Consultant Cardiologist, Indo US Superspeciality Hospital, Hyderabad, Telangana
| | - Prabhakar D
- Senior Consultant Interventional Cardiologist, Ashwin Clinic, Dr.Mehta's Hospital, Apollo group of Hospitals, Chennai, Tamil Nadu
| | - Tiny Nair
- Associate Professor of Cardiology, Govt. Medical College, Thiruvananthapuram, Kerala
| | - B Krishnakumar
- Associate Professor of Cardiology, Govt. Medical College, Thiruvananthapuram, Kerala
| | - Nitin Deshpande
- Spandan Heart Institute Research Center, Dhantoli, Nagpur, Maharashtra
| | - Neil Bardoloi
- Managing Director and HOD, Cardiology, Guwahati, Assam
| | - Sadananda Shetty
- Cardiologist, Somaiya Superspeciality Hospital, Mumbai, Maharashtra
| | - Nagaraj Desai
- Cardiologist, Namana Medical Centre, Bangalore, Karnataka
| | | | - Ajay Swamy
- Sr. Advisor (Cardiology), Professor Department of Cardiology, MHCTC, Pune, Maharashtra
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9
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Panigrahi I, Kaur A, Sankhyan N, Sawhney J. Infant with osteosclerotic metaphyseal dysplasia and TBX3 gene mutation. N Biotechnol 2018. [DOI: 10.1016/j.nbt.2018.05.1264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Poh KK, Ambegaonkar B, Baxter CA, Brudi P, Buddhari W, Chiang FT, Horack M, Jang Y, Johnson B, Lautsch D, Sawhney J, Vyas A, Yan BP, Gitt AK. Low-density lipoprotein cholesterol target attainment in patients with stable or acute coronary heart disease in the Asia-Pacific region: results from the Dyslipidemia International Study II. Eur J Prev Cardiol 2018; 25:1950-1963. [PMID: 30198749 DOI: 10.1177/2047487318798927] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND As mortality due to cardiovascular disease increases throughout the world, accurate data on risk factors such as hyperlipidemia are required. This is lacking in the Asia-Pacific region. DESIGN The observational Dyslipidemia International Study (DYSIS) II was established to quantify the extent of hyperlipidemia in adults with acute and stable coronary heart disease globally. METHODS Patients with stable coronary heart disease or hospitalised with an acute coronary syndrome were enrolled across nine Asia-Pacific countries from July 2013 to October 2014. Lipid-lowering therapy and low-density lipoprotein cholesterol target attainment (<70 mg/dL) were assessed. The acute coronary syndrome cohort was followed up 4 months post-discharge. RESULTS Of the 4592 patients enrolled, 2794 had stable coronary heart disease and 1798 were admitted with an acute coronary syndrome. In the coronary heart disease cohort, the mean low-density lipoprotein cholesterol level was 86.9 mg/dL, with 91.7% using lipid-lowering therapy and 31% achieving low-density lipoprotein cholesterol of less than 70 mg/dL. In the acute coronary syndrome cohort at admission, the corresponding values were 103.2 mg/dL, 63.4% and 23.0%, respectively. Target attainment was significantly higher in lipid-lowering therapy-treated than non-treated patients in each cohort (32.6% vs. 12.9% and 31.1% vs. 9.0%, respectively). Mean atorvastatin-equivalent dosages were low (20 ± 15 and 22 ± 18 mg/day, respectively), with little use of non-statin adjuvants (13.0% and 6.8%, respectively). Low-density lipoprotein cholesterol target attainment had improved by follow-up for the acute coronary syndrome patients, but remained low (41.7%). CONCLUSIONS Many patients in Asia at very high risk of recurrent cardiovascular events had a low-density lipoprotein cholesterol level above the recommended target. Although lipid-lowering therapy was common, it was not used to its full potential.
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Affiliation(s)
- Kian-Keong Poh
- 1 Department of Cardiology, National University Heart Centre, Singapore.,2 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - Wacin Buddhari
- 5 Division of Cardiovascular Medicine, Chulalongkorn University, Thailand
| | - Fu-Tien Chiang
- 6 Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Martin Horack
- 7 Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Yangsoo Jang
- 8 Division of Cardiology, Yonsei University College of Medicine, Korea
| | - Brett Johnson
- 9 Merck Sharp & Dohme (Australia) Pty Ltd., Australia
| | | | - Jps Sawhney
- 10 Department of Cardiology, Sri Ganga Ram Hospital, Rajinder Nagar, India
| | - Ami Vyas
- 11 Department of Epidemiology, Rutgers University, USA.,12 Department of Pharmacy Practice, University of Rhode Island, USA
| | - Bryan P Yan
- 13 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Anselm K Gitt
- 7 Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.,14 Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Germany
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11
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Trailokya A, Hiremath JS, Sawhney J, Mishra YK, Kanhere V, Srinivasa R, Tiwaskar M. Acenocoumarol: A Review of Anticoagulant Efficacy and Safety. J Assoc Physicians India 2016; 64:88-93. [PMID: 27730796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Anticoagulant treatment is required for the treatment and prevention of thromboembolic disorders. Vitamin K antagonists are commonly used oral anticoagulants worldwide. Acenocoumarol is mono-coumarin derivative with racemic mixture of R (+) and S (-) enantiomers. Efficacy and safety of acenocoumarol has been evaluated in atrial fibrillation, cardiac valve replacement, after myocardial infarction, treatment of deep vein thrombosis, after major surgeries and after critical illness requiring prolonged hospitalization. Acenocoumarol is effective and safe in all age groups. It offers an advantage over warfarin in terms of better stability of anti-coagulant effect. Due to its economic advantage acenocoumarol may be suitable oral anticoagulant for long term use in countries like India.
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Affiliation(s)
- Abhijit Trailokya
- Medical Services Division, Abbott Healthcare Private Limited, Mumbai, Maharashtra
| | - J S Hiremath
- Director, Cath Lab, Ruby Hall Clinic, Pune, Maharashtra
| | | | - Y K Mishra
- Director, Department of Cardiovascular Surgery, Fortis Escorts Heart Institute & Research Centre, Delhi
| | - Vivek Kanhere
- Consultant Cardiac Surgeon, Chirayu Cardiac Centre, Bhopal
| | - R Srinivasa
- Senior Professor of Neurology and Head, Dept. of Neurology, MS Ramaiah Medical college and Hospitals, Bangalore, Karnataka
| | - Mangesh Tiwaskar
- Consultant Physician, Asian Heart Institute & Research Centre, Karuna Hospital, Mumbai, Maharashtra
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12
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Pahlajani D, Kaul U, Mishra A, Mullasari A, Sawhney J, Dargad R, Mehta K, Brar S, Radhakrishnan R, McMahon D, Ibrahim S, Sachanandani H, Sinha N. Medical Management and Diagnostic Testing among Stable Angina Patients in India: The STable Angina obseRvational (STAR) Registry. J Assoc Physicians India 2015; 63:20-26. [PMID: 27608862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To study the practice pattern in the management of patients with stable angina (SA) in India. METHODS The Stable Angina obseRvational Registry (STAR) prospectively enrolled patients provisionally diagnosed with SA by non-interventional practicing internists in India. Patients were followed for 3 months after enrollment to assess medical treatment, diagnostic management, and interventional treatment of coronary artery disease (CAD). At the study conclusion, a statistical analysis retrospectively categorized patients not at risk of CAD by the Morise-Jalisi scale though this was not part of the study protocol. RESULTS Between January and May 2012, 2079 patients were enrolled at 131 centres. Mean age was 57 ± 11 years, 62% were men, and 40% had a history of diabetes. Over 90% of patients completed follow-up visit, >85% received statins and antiplatelet medications, >70% received beta blockers, and >60% received angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers. Diagnostic testing rates were low: 93% for electrocardiogram, 44% echocardiogram, 42% chest radiography, 12% stress test, and 8% underwent noninvasive CT or invasive coronary angiography, of which, 86% had abnormal results. After the study, the Morise-Jalisi probability of CAD was intermediate in 42% and high in 51% of patients. Only 3.4% of all patients had coronary revascularization. CONCLUSIONS In a large cohort of Indian patients with SA, disease severity and probability of CAD were high. Clinicians used evidence-based care for medical management, but underutilized diagnostic testing. Patients with SA in India need to be risk-stratified for probability and severity of CAD and, if indicated, receive additional diagnostic testing.
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Affiliation(s)
- Dev Pahlajani
- Department of Cardiology, Breach Candy Hospital, Mumbai, Maharashtra, India
| | - Upendra Kaul
- Department of Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Anil Mishra
- Department of Cardiology, B.M. Birla Heart Research Center, Kolkata, West Bengal, India
| | - Ajit Mullasari
- Department of Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Jps Sawhney
- Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ramesh Dargad
- Department of Cardiology, Stress Test Clinic, Mukund Hospital, Mumbai, Maharashtra, India
| | - Ketan Mehta
- Department of Cardiology, Health Harmony, Mumbai, Maharashtra, India
| | - Sandeep Brar
- Clinical Department, Medtronic, Inc., Santa Rosa, CA, USA
| | | | - Dennis McMahon
- Clinical Department, Medtronic, Inc., Santa Rosa, CA, USA
| | - Sherif Ibrahim
- Clinical Department, Medtronic, Inc., Santa Rosa, CA, USA
| | | | - Nakul Sinha
- Department of Cardiology, Sahara Hospital, Lucknow, Uttar Pradesh, India Received; 04.02.2015; Accepted: 23.03.2015
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13
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Setia N, Saxena R, Sawhney J, Puri R, Verma IC, Arora A. PM292 Genetic Characterization of Familial Hypercholesterolemia in Indian Population. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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14
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Pahlajani D, Kaul U, Mishra A, Mullasari A, Sawhney J, Dargad R, Mehta K, Sinha N. Prospective pre-test and clinical scoring in subjects with suspected coronary disease estimates the probability of coronary artery disease: the Prospective Stable Angina Observational registry, India. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Barrack RL, Lavernia C, Szuszczewicz ES, Sawhney J. Radiographic wear measurements in a cementless metal-backed modular cobalt-chromium acetabular component. J Arthroplasty 2001; 16:820-8. [PMID: 11607896 DOI: 10.1054/arth.2001.26589] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Linear polyethylene wear was measured radiographically and correlated with direct measurements of wear from 21 of 24 liners retrieved at revision. An optical comparator was used to assess linear wear using the shadowgraph technique. Postoperative and prerevision radiographs were reviewed to measure the amount of linear wear radiographically. Seven radiographic methods described in the literature were used: 5 were manual techniques, and 2 techniques used a computer-assisted digitizer. Linear regression analysis showed that there was a statistically significant correlation between the radiographic measurements compared with the direct measurement for 4 of the 5 manual techniques but only 1 of the 2 computerized techniques. Based on these results, radiographic wear measurements of cementless, modular components should be considered qualitative rather than quantitative. There is a significant difference in the measurements obtained among various published techniques. The addition of computer digitization to enhance manual methodology does not improve accuracy.
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Affiliation(s)
- R L Barrack
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA
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16
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Abstract
A consecutive series of revision total knee arthroplasties performed at 3 university-affiliated centers by 3 surgeons was prospectively studied. The same implant was used in all cases. The evaluation included a Knee Society clinical score (KSCS); SF-36; satisfaction survey; and radiographs preoperatively, at 6 and 12 months postoperatively, and annually thereafter. Follow-up averaging 36 months (range, 24-60 months) was obtained in 125 of 138 knees (91%). Twenty-eight knees were infected, and 26 of 28 knees were treated successfully with 2-stage exchange with an interval of 4 to 6 weeks using an antibiotic-impregnated spacer block and intravenous antibiotics. The remaining 99 knees were revised for reasons other than infection, including aseptic component loosening, progressive osteolysis, and component instability. Preoperatively, patients with infection had a significantly decreased arc of motion compared with patients without infection (79 degrees vs 92 degrees; P<.05). There was a strong trend for the infected knees to have a lower preoperative KSCS than the noninfected knees, although this trend did not achieve statistical significance (76 vs. 92; P =.11). Postoperatively, patients with infection continued to have a significantly decreased range of motion (89 degrees vs. 99 degrees; P =.05). The postoperative KSCS was markedly lower in the septic versus aseptic revisions (115 vs. 135; P =.02). Patients with infection had a significantly lower function score (44 vs. 57; P =.03). A significantly higher percentage of patients stated that they were unable to return to normal activities of daily living after septic versus aseptic revision total knee arthroplasty (24% vs. 7%; P<.05). Despite the inferior functional result, patients expressed an equal degree of satisfaction with the results of their treatment in septic versus aseptic revision cases.
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Affiliation(s)
- R L Barrack
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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17
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Abstract
The results of revision total knee arthroplasty (TKA) in which a well-fixed patellar component was left in place (retained) were compared with those in which the patellar component was revised to a cemented all-polyethylene component. The patella was retained in 34 cases, 12 of which were metal-backed, and was revised in 39 cases. Data collected on all patients included a Knee Society clinical and radiographic score, SF36, a patellofemoral questionnaire, and a satisfaction survey. There were no differences in clinical score, responses to specific patellofemoral questions, or patient satisfaction between the 2 groups. Retaining a well-fixed patellar component at the time of revision TKA appears to be a viable option with equivalent short-term results to those obtained when the patellar component is revised.
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Affiliation(s)
- R L Barrack
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA
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18
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Moore KD, Barrack RL, Sychterz CJ, Sawhney J, Yang AM, Engh CA. The Effect of Weight-Bearing on the Radiographic Measurement of the Position of the Femoral Head After Total Hip Arthroplasty*. J Bone Joint Surg Am 2000. [PMID: 10653085 DOI: 10.2106/00004623-200001000-00008] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- K D Moore
- Anderson Orthopaedic Research Institute, Alexandria, Virginia 22307, USA
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19
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Abstract
A stratified, unselected sample of 30 patients who underwent revision total hip arthroplasty between 1990 and 1992 for whom complete clinical and financial data were available was studied. Clinical data included age, gender, diagnosis, length of stay, operative time and blood loss. Financial data included cost of implants, bone graft and accessories, hospital charge, and surgeon reimbursement. Results were compared with the results of an analogous group of 50 patients who underwent revision total hip arthroplasty at the same institution between 1995 and 1997. Cases were classified as simple (involving revision of only acetabular liner and/or femoral head), routine (revision of acetabular and/or femoral components), or complex (major structural graft, antiprotrusio cage, impacted grafting). For patients undergoing routine revision total hip arthroplasty, a dramatic decline of 52% occurred in length of stay during the 5-year span (10.7 days to 5.1 days). The average operative time also declined significantly (238 minutes to 199 minutes) as did the average implant cost ($4349 to $2827). Despite this, the average hospital charge increased 16% ($29,666 to $34,328). There was a significant and dramatic 35% decline in surgeon reimbursement ($3240 to $2178). There was no significant difference in surgeon reimbursement between simple, routine, and complex total hip arthroplasty. Patients who underwent complex procedures had a significantly greater length of stay (7.3 versus 5.1 days) and operative time (297 versus 199 minutes). The hospital charge was dramatically higher for patients undergoing complex procedures ($51,290 versus $34,328) but the surgeon reimbursement was lower on average, although not statistically significant ($1926 versus $2178). There was a significant increase in the number and complexity of revision total hip arthroplasties between the two periods. Significant decreases were achieved in length of stay, operating room time, and implant cost. Benefits from these changes were accrued to the hospital but not the surgeon because hospital costs decreased significantly whereas surgeon reimbursements declined dramatically.
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Affiliation(s)
- R L Barrack
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA
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20
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Barrack RL, Rorabeck C, Burt M, Sawhney J. Pain at the end of the stem after revision total knee arthroplasty. Clin Orthop Relat Res 1999:216-25. [PMID: 10546618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A consecutive series of patients undergoing revision total knee arthroplasty was studied prospectively. Clinical and radiographic assessment was performed preoperatively, 6 and 12 months postoperatively, and annually thereafter. Evaluation consisted of a Knee Society clinical score and assessment of patient satisfaction. In addition, patients completed drawings of their lower extremity regarding the location and severity of the pain they experienced preoperatively and at minimum 2-year followup (mean, 36 months; range, 24-48 months). Pain that was localized to the diaphyseal region of the femur or tibia on the drawing was defined as pain at the end of the stem. Clinical, radiographic, and pain drawing data were completed for patients who had 66 of 78 revision total knee arthroplasties performed during the time of the study (85%). All procedures were performed with the same implant system and instrumentation and included fluted cobalt-chrome stems for all patients in whom the stem was implanted without cement and slightly underreamed (press fit). All femoral components had the surface cemented with the stems press fit. Sixteen of the tibial stems were cemented fully, whereas the remaining 50 tibial components were cemented on the surface only with the stems press fit. Localized pain at the end of the stem was present on the femoral side in seven of 66 patients (11%) and in seven of 50 patients with press fit tibial stems (14%). Patients with pain at the end of the stem at 2 to 4 years postoperatively had significantly lower preoperative function scores and overall Knee Society clinical score. Postoperatively, patients with pain at the end of the stem had a significantly lower clinical score; however the postoperative function score and Knee Society clinical score were not significantly different than scores of patients who did not have pain at the end of the stem. There was no correlation between the stem diameter and the occurrence of pain; however, there was a trend for percent canal fill to be higher on the tibial side in patients with pain (71% versus 63%), but this was not statistically significant. Three of the 16 patients with cemented tibial stems (19%) experienced pain at the end of the stem. Patients with press fit stems who had pain at the end of the stem were more likely to express dissatisfaction with the surgical procedure than patients without pain at the end of the stem.
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Affiliation(s)
- R L Barrack
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA
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