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Sim MG, Teo YN, Teo YH, Syn NL, Li TYW, Yeo LLL, Kong WKF, Tan BYQ, Yip JW, Wong RCC, Poh KK, Yeo TC, Sharma VK, Chai P, Chan MY, Sia CH. Association Between Calcium Supplementation and the Risk of Cardiovascular Disease and Stroke: A Systematic Review and Meta-Analysis. Heart Lung Circ 2023; 32:1230-1239. [PMID: 37743221 DOI: 10.1016/j.hlc.2023.07.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Some observational studies and randomised controlled trials (RCTs) have reported an association between calcium supplementation and increased risk of cardiovascular disease. Previous meta-analyses on the topic, based on data from RCTs and observational studies, have contradictory findings. This meta-analysis was conducted to determine the difference in associated risks of calcium supplementation with cardiovascular disease and stroke in RCTs. METHODS Relevant studies published from database inception to 6 August 2021 were sourced from PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials. Any RCTs focusing on the relationship between calcium supplementation and incidence of cardiovascular disease or stroke were included. Articles were screened independently by two authors, according to the PICO criteria, with disagreements resolved by a third author. RESULTS Twelve RCTs were included in the meta-analysis. Calcium supplementation was not associated with myocardial infarction, total stroke, heart failure admission, and all-cause/cardiovascular mortality. Subgroup analysis focusing on calcium monotherapy/calcium co-therapy with vitamin D, female sex, follow-up duration, and geographical region did not affect the findings. CONCLUSION Calcium supplementation was not associated with myocardial infarction, total stroke, heart failure admission, and cardiovascular/all-cause mortality. Further studies are required to examine and understand these associations.
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Affiliation(s)
- Ming Gin Sim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. http://www.twitter.com/yaoneng_teo
| | - Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas L Syn
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tony Y W Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Leonard L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - William K F Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Benjamin Y Q Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - James W Yip
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Raymond C C Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Kian Keong Poh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Vijay Kumar Sharma
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Mark Y Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore.
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Sim MG, Chan SP, Kojodjojo P, Tan ES. Late pacemaker implantation after atrioventricular nodal reentrant tachycardia ablation: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2022; 33:2297-2304. [PMID: 36124400 DOI: 10.1111/jce.15680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 06/25/2022] [Revised: 08/13/2022] [Accepted: 08/24/2022] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Catheter ablation (CA) of atrioventricular nodal reentrant tachycardia (AVNRT) is associated with late pacemakers for AV block (AVB). We performed a systematic review and meta-analysis of the pooled incidence of late pacemakers for AVB after CA of AVNRT. METHODS AND RESULTS Relevant studies were identified from 4 electronic databases (PubMed, EMBASE, Scopus, Cochrane Trial Register) from inception to 2022. A random effects model was used to calculate the odds of late pacemakers in CA of AVNRT compared to atrioventricular reentrant tachycardia (AVRT). Of 533 articles screened, 13 were included in systematic review. CA for AVNRT was performed in 16,471 patients (mean age 54±17 years, 63% females), of which 68 (0.4%) underwent pacemaker implantation for late AVB. Meta-analysis was performed in 5 of the 13 studies (mean follow-up duration 7±4 years). Patients who underwent CA of AVNRT were older (58±17 vs 52±20 years, p<0.001), and more likely female (60% vs 41%, p<0.001) than AVRT. Pooled estimates of late pacemakers for AVB were higher in CA of AVNRT than AVRT (0.5% vs 0.2%, p=0.006), with CA in AVNRT associated with almost 2-fold increased odds of late pacemakers indicated for AVB (OR 1.94, 95%CI 1.08-3.47, p=0.027) compared to AVRT. CONCLUSION AVNRT ablation is safe but associated with a low but definitely increased risk of requiring pacing in the later years due to AVB. This association is confirmed by pooling over 16,000 AVNRT patients receiving clinically indicated ablation and is helpful in providing informed consent for prospective patients undergoing ablation for AVNRT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ming Gin Sim
- Yong Loo Lin School of Medicine, National University, Singapore
| | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University, Singapore
| | - Pipin Kojodjojo
- Yong Loo Lin School of Medicine, National University, Singapore.,Department of Cardiology, National University Heart Centre, Singapore.,Department of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Eugene Sj Tan
- Yong Loo Lin School of Medicine, National University, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
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Tan ES, Lee JY, Boey E, Soh R, Sim MG, Yeo WT, Seow SC, Kojodjojo P. Use of extendable helix leads for conduction system pacing: differences in lead handling and performance: Conclusion. J Cardiovasc Electrophysiol 2022; 33:1550-1557. [PMID: 35524417 DOI: 10.1111/jce.15528] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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] [Received: 02/15/2022] [Revised: 04/12/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pacing leads with extendable-retractable helix (EHL) are alternatives to fixed-helix leads (FHL) for conduction system pacing (CSP), but data on handling characteristics are limited. This study evaluated a dual-center experience of lead handling and performance during CSP. METHODS AND RESULTS Consecutive patients with His-bundle pacing (HBP) or left bundle branch pacing (LBBP) were evaluated for the primary outcome of lead failure, defined as structural damage to the lead necessitating lead replacement. Differences in pacing characteristics were compared. Among 280 patients (mean age 74±11 years, 44% male, 50% LBBP), 246 (88%) received FHL and 34 (12%) received EHL. Of 299 leads used, lead failure occurred more frequently among patients with EHL than FHL (29% vs 2%, p<0.001), regardless of CSP modality. Majority of damaged leads (89%) in the form of helix deformation were successfully removed, with failure occurring in only 2 patients, both EHL, leading to helix fracture and retention within the septal myocardium. EHL, compared to FHL, was associated with 25-fold increased odds of lead failure (odds ratio 25.21, 95% confidence interval 7.35-86.51), and persisted after adjustment in turn for age, pacing modality and indication. CSP implant success rates did not differ by lead design (FHL 80% vs EHL 71%, p=0.18), with similar pacing thresholds at implant and follow-up. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Eugene Sj Tan
- Department of Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University Singapore
| | - Jie-Ying Lee
- Department of Cardiology, National University Heart Centre, Singapore
| | - Elaine Boey
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Rodney Soh
- Department of Cardiology, National University Heart Centre, Singapore
| | - Ming Gin Sim
- Yong Loo Lin School of Medicine, National University Singapore
| | - Wee-Tiong Yeo
- Department of Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University Singapore
| | - Swee-Chong Seow
- Department of Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University Singapore.,Department of Cardiology, Ng Teng Fong General Hospital, Singapore
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Sim MG, Kamien M, Diamond MR. From novice to proficient general practitioner: a critical incident study. Aust Fam Physician 1996; 25:S59-64. [PMID: 8854408] [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: 02/02/2023]
Abstract
OBJECTIVE To obtain information about any change in the performance or perceptions of doctors undertaking the Royal Australian College of General Practitioners (RACGP) Training Program, with advancing general practice experience. DESIGN The critical incident technique' was used, which is a comparative qualitative analysis. It involved interviews at 12 to 18 months after the basic term interview. SUBJECTS Eighteen Western Australian doctors, who had been interviewed in 1992, at the end of their first 6 months of general practice training and were now completing their advanced or mentor terms in the RACGP Training Program took part in the study. RESULTS Doctors reported an average of 4.4 critical incidents in their first interview and 5.0 in their second interview. The major areas of positive change included relationships with patients and other health care professionals, including supervisors; paediatrics and orthopaedics skills; the skills of developing a therapeutic relationship to enhance patient compliance and the ability to manage complex cardiovascular and psychiatric problems without reliance on specialist referral; attitudes of responsibility for and enjoyment of long term care of patients and families; and reduced levels of anxiety over difficult problems. New or continuing areas of difficulty were found in gynaecology; pharmacotherapy and dermatology; the diagnosis of common complaints with uncommon presentations; the skill of managing difficult or angry patients; the organisation for the follow-up of patients with potentially severe disorders; and in managing feelings of guilt over missed diagnoses or poor management. CONCLUSION An analysis of commonly occurring positive and negative critical incidents shows that RACGP Training Program doctors develop competence, confidence and reduced levels of performance anxiety with advancing experience. All but one doctor found the Training Program helpful in achieving these proficiencies. However, many ongoing areas of difficulty remain. The Critical Incident method is a useful tool for learning and assessment in a vocational training program.
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Affiliation(s)
- M G Sim
- University of Western Australia, Australia
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Abstract
OBJECTIVE To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. DESIGN Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. SUBJECTS Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. RESULTS Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. CONCLUSION The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.
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Affiliation(s)
- M R Diamond
- Department of General Practice, University of Western Australia, Perth
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