35 results on '"Randomized controlled trial"'
Search Results
2. A randomized, Double-blind Clinical Trial of the Three-month Effect of Garlic Administration on Cardiac Outcomes in Patients with Heart Failure.
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Azish, Sima, Garakyaraghi, Mohammad, Vakhshoori, Mehrbod, Heidarpour, Maryam, Behjati, Mohaddeseh, Heshmat-Ghahdarijani, Kiyan, Omoomi, Sepehr, Fakhrolmobasheri, Mohammad, Shafie, Davood, and Sarrafzadegan, Nizal
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HEART failure patients , *GARLIC , *CARDIAC patients , *CLINICAL trials , *VENTRICULAR ejection fraction - Abstract
BACKGROUND: Garlic may have anti-oxidanmayti-hypertensive and anti-hyperlipidemic properties. However, the effects of its administration on cardiac function in heart failure (HF) patients impact require further investigation. We aimed to evaluate garlic prescription effects on cardiac outcomes and quality of life scores in Iranian HF patients. METHODS: From August to December 2020, a randomized, double-blind clinical trial was conducted. Individuals with heart failure (New York heart association (NYHA) functional class of II and III) referred to private clinics in Isfahan, Iran, were randomly assigned to intervention (n=80) and control (n=80) groups. They have received 500 mg of odorless garlic tablets or the same shape and dosage of placebo twice daily for three months. Laboratory data, cardiac outcomes (end-diastolic diameter, ventricular septal thickness, NYHA functional class, left ventricular ejection fraction), quality of life score (Minnesota living with HF questionnaire), and the Modified Borg Scale (MBS) were all evaluated at the baseline and the end of the trial. RESULTS: The population's mean age was 58.1±13.5 years (55% males). Patients who consumed garlic had remarkably improved functional class compared to placebo takers and their baseline (NYHA practical class of II, 79.4% vs. 50.6%, P<0.001 and 79.4% vs. 54%, P=0.006, respectively). MBS levels were significantly lower among garlic consumers (baseline: 2.52±0.5, after three months: 2.2±1.06, P= 0.040). CONCLUSIONS: Garlic administration may improve cardiac function and breathe in HF patients. Complementary research is necessary to confirm our findings. [ABSTRACT FROM AUTHOR]
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- 2022
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3. A double-blinded, placebo-controlled randomized trial evaluating the efficacy and safety of Zhigancao Tang granules for treating HFpEF: study protocol for a randomized controlled trial.
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Zhang, Na, Zhao, Yingli, Liu, Yu, Tang, Nuo, Zheng, Wang, Mao, Meijiao, Liu, Qingcheng, Shen, Lin, and Deng, Bing
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DRUG efficacy , *RANDOMIZED controlled trials , *PLACEBOS , *CHINESE medicine , *CLINICAL trials , *QUALITY of life , *BLIND experiment , *HEART failure - Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by diastolic dysfunction. Despite the increasing incidence of HFpEF, there is no available therapy that reduces the mortality rate of HFpEF. Zhigancao Tang has been used traditionally for the treatment of cardiovascular diseases in China. The use of traditional Chinese medicine (TCM) is associated with improvements in clinical syndromes and quality of life of patients. A randomized clinical trial should be conducted to provide clear evidence regarding the efficacy and safety of Zhigancao Tang granules for the treatment of HFpEF.Methods: A randomized, double-blinded, placebo-controlled clinical trial was proposed. A total of 122 patients with HFpEF will be randomly assigned to receive Zhigancao Tang granules or placebo for 12 weeks. The primary outcome measure is cardiac function. The secondary outcomes include measurement of the integral TCM syndrome score, echocardiography, 6-min walk test, N-terminal-pro hormone B-type natriuretic peptide level, atrial natriuretic peptide level, Minnesota Living with Heart Failure scale, and Lee's scale. The outcome measures will be evaluated at baseline, 4 weeks, and 12 weeks. Adverse events will be evaluated from baseline till the 12-week follow-up period.Discussion: The results of this trial will demonstrate whether Zhigancao Tang granules are effective and safe for treating HFpEF.Trial Registration: ClinicalTrials.gov NCT04317339 . Registered on 23 March 2020. [ABSTRACT FROM AUTHOR]- Published
- 2021
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4. Why patients decline participation in an intervention to reduce re-hospitalization through patient activation: whom are we missing?
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Flink, Maria, Brandberg, Carina, and Ekstedt, Mirjam
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HOSPITAL care , *PATIENT Activation Measure , *RANDOMIZED controlled trials , *QUANTITATIVE research , *CONTENT analysis , *HEART failure treatment , *OBSTRUCTIVE lung disease treatment , *AGE distribution , *CLINICAL trials , *RESEARCH funding , *PATIENT participation , *MOTIVATIONAL interviewing , *PATIENT readmissions - Abstract
Background: Despite worldwide interest in reducing re-hospitalization, there is limited knowledge regarding characteristics of patients who chose to decline participation in such efforts and why. The aim is to explore reasons to decline participation in an intervention using motivational interviewing to reduce re-hospitalization through patient activation for persons with chronic obstructive pulmonary disease or heart failure.Methods: This study uses data from 385 patients who were asked about participating in a randomized controlled trial; of these, 232 declined participation. Data on age, gender, and diagnosis were collected for those who agreed to participate and those who declined. Reasons to decline participation were collected for those who were asked to participate but refused. The stated reasons to decline were analyzed using content analysis, and the categories identified were used for the statistical analysis.Results: The main reasons for declining participation were having sufficient support (17.5%), no need for support (16%), being too ill (14.6%), and lack of time for illness-related activities (14.2%). A statistically significant negative association between age and willingness to participate was found (odds ratio = - 0.03, 95% confidence interval 0.95-0.99).Conclusions: Those who agreed to participate were younger than non-participants, and non-participants either lacked time for illness-related activities or did not have the energy needed to become involved in the intervention.Trial Registration: ClinicalTrials.gov, NCT02823795 . Registered on 1 July 2016. [ABSTRACT FROM AUTHOR]- Published
- 2019
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5. Discontinuation and non‐publication of heart failure randomized controlled trials: a call to publish all trial results
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Stefan D. Anker, Marco Metra, Safi U. Khan, Izza Shahid, Gregg C. Fonarow, Javed Butler, Stephen J. Greene, Gerasimos Filippatos, Rami Doukky, Nava Asad, and Muhammad Shahzeb Khan
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medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Heart failure ,Discontinuation ,030204 cardiovascular system & hematology ,Cardiorespiratory Medicine and Haematology ,Shahid ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Clinical trials ,Randomized controlled trial ,law ,Non-publication ,Original Research Articles ,Medicine ,Humans ,030212 general & internal medicine ,Original Research Article ,Randomized Controlled Trials as Topic ,Enrolment ,Non‐publication ,business.industry ,Trial Phase ,medicine.disease ,Clinical trial ,Patient accrual ,Cross-Sectional Studies ,lcsh:RC666-701 ,Ethical concerns ,Physical therapy ,Cardiology and Cardiovascular Medicine ,business - Abstract
Author(s): Khan, Muhammad Shahzeb; Shahid, Izza; Asad, Nava; Greene, Stephen J; Khan, Safi U; Doukky, Rami; Metra, Marco; Anker, Stefan D; Filippatos, Gerasimos S; Fonarow, Gregg C; Butler, Javed | Abstract: AimsDiscontinuation or non-publication of trials may hinder scientific progress and violates the commitment made to research participants. We sought to identify the prevalence of discontinuation and non-publication of heart failure (HF) clinical trials.Methods and resultsWe conducted a cross-sectional search of ClinicalTrials.gov to identify all completed and discontinued HF clinical trials. We limited our search to only include trials that were completed by 31 December 2017. Trials were investigated to identify reasons for discontinuation. Informative termination was defined as trial termination due to safety or efficacy concerns. Data pertaining to the trial phase, funding, intervention, enrolment, and trial completion date were extracted for each trial. A total of 572 trials were included. Of these, 21% (nn=n118) were discontinued before completion. Patient accrual was the most frequently cited reason (nn=n42; 36%) for trial discontinuation, followed by informative termination (nn=n16; 14%) and funding (nn=n14; 12%). Overall, 24n780 patients were enrolled in trials that were terminated. Of trials that were completed and not terminated, nearly one-third (nn=n131/454; 29%) were not published. Seventy-nine (24%) trials were published within 12nmonths, 192 (59%) within 24nmonths, and 252 (78%) trials within 36nmonths.ConclusionsDiscontinuation and non-publication of HF trials is common. This raises ethical concerns towards participants who volunteer for research and are exposed to potential risks, inconvenience, and discomfort without furthering scientific progress.
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- 2021
6. The impact of torasemide on haemodynamic and neurohormonal stress, and cardiac remodelling in heart failure - TORNADO: a study protocol for a randomized controlled trial.
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Balsam, Paweł, Ozierański, Krzysztof, Tymińska, Agata, Główczyńska, Renata, Peller, Michał, Fojt, Anna, Cacko, Andrzej, Sieradzki, Bartosz, Bakuła, Elwira, Markulis, Maciej, Kowalik, Robert, Huczek, Zenon, Filipiak, Krzysztof J., Opolski, Grzegorz, and Grabowski, Marcin
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HEART failure , *HEMODYNAMICS , *RANDOMIZED controlled trials , *FUROSEMIDE , *QUALITY of life , *PHARMACOKINETICS , *AMBULATORY electrocardiography , *CHRONIC diseases , *CLINICAL trials , *COMPARATIVE studies , *CONVALESCENCE , *DRUGS , *ECHOCARDIOGRAPHY , *EXPERIMENTAL design , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH protocols , *MEMBRANE proteins , *NEUROTRANSMITTERS , *RESEARCH , *SULFONAMIDES , *TIME , *EVALUATION research , *VENTRICULAR remodeling , *TREATMENT effectiveness , *DIAGNOSIS , *THERAPEUTICS - Abstract
Background: Approximately 50% of heart failure patients are readmitted to hospital within 6 months, owing to deterioration of their condition. Thus, symptomatic treatment of heart failure requires significant improvement. The aim of this study is to compare the effects of torasemide and furosemide on biochemical parameters of haemodynamic and neurohormonal compensation, myocardial remodelling, clinical outcomes and quality of life in patients with chronic heart failure.Methods: This is a multicentre, randomized, open, blinded endpoint phase-IV trial. The study includes 120 heart failure patients in NYHA (New York Heart Association) functional class II-IV, treated with optimal heart failure therapy, with indications for use of loop diuretics. At enrolment, patients are stable, with a fixed dose of loop diuretics. Patients are randomized to treatment with furosemide or torasemide (randomization 1:1). After randomization, the current fixed dose of furosemide is continued or is replaced by an equipotential dose of torasemide (4:1). The study consists of two control visits (3 and 6 months after enrolment) with minimal follow-up of 6 months. Assessment involves clinical examination, Quality of Life Questionnaire, laboratory tests, echocardiography, electrocardiography, 24 h Holter-electrocardiography monitoring, 6 -min walk test and assessment of fluid retention. Any need for dose adjustment is assessed during the observation. The primary objective is to compare the effects of torasemide and furosemide on clinical and biochemical parameters of haemodynamic and neurohormonal compensation and myocardial remodelling. Secondary objectives include monitoring of: changes in signs and symptoms of heart failure, NYHA functional class, quality of life, dosage changes, rate of readmissions and mortality.Discussion: Despite decades of the diuretic's history, knowledge about diuretic therapy is still unsatisfactory. The most widely used diuretic, furosemide, has a stormy pharmacokinetics and pharmacodynamics, and is associated with a high risk of mortality and hospitalization for worsening heart failure. Reports are very encouraging and suggest beneficial effects of torasemide. Hence, there is a need for further studies of the overall effect of torasemide, compared with furosemide. This can translate into improved quality of life and better prognosis of patients with heart failure.Trial Registration: ClinicalTrials.gov, NCT01942109 . Registered on 24 August 2013. [ABSTRACT FROM AUTHOR]- Published
- 2017
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7. The effect of intravenous ferric carboxymaltose on health-related quality of life in iron-deficient patients with acute heart failure: The results of the AFFIRM-AHF study
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Marco Metra, Marcus Andreas Ohlsson, Basil S. Lewis, Wolfram Doehner, Peter van der Meer, Irakli Khintibidze, Hans Kragten, Bridget-Anne Kirwan, Jose C. Nicolau, Vincent Fabien, Tim Friede, Nicolas Danchin, Ewa A. Jankowska, Gerasimos Filippatos, Alain Cohen-Solal, Fabio Dorigotti, Hadi Skouri, Davor Miličić, Andre Keren, Alexander Parkhomenko, Jarosław Drożdż, David Sim, Stuart J. Pocock, Michael Motro, Javed Butler, Domingo A. Pascual-Figal, Theresa McDonagh, Henry J. Dargie, Josep Comín-Colet, Maria Dorobantu, Mikhail Kosiborod, Frank Ruschitzka, Stephan von Haehling, Piotr Ponikowski, Stefan D. Anker, Felipe Martinez, Cardiovascular Centre (CVC), Restoring Organ Function by Means of Regenerative Medicine (REGENERATE), leboeuf, Christophe, Wrocław Medical University, Socar Research S.A. [Nyon, Switzerland] (SR), London School of Hygiene and Tropical Medicine (LSHTM), Saint Luke's Mid America Heart Institute, University of Missouri [Kansas City] (UMKC), University of Missouri System, University of Mississippi Medical Center (UMMC), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], King‘s College London, Universitatea din Bucuresti (UB), Medical University of Łódź (MUL), National and Kapodistrian University of Athens (NKUA), Université d'Athènes (UOA), Assuta Hospital in Ramat HaHayal [Tel Aviv-Yafo, Israel] (AHRH), Tbilisi State University, Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Prague University of Economics and Business, Università degli Studi di Brescia = University of Brescia (UniBs), Civic Hospital of Brescia, University of Zagreb, Skane University Hospital [Malmo], Lund University [Lund], National Scientific Center 'M.D. Strazhesko Institute of Cardiology' [Kyiv, Ukraine] (NSC/MDSIC), Universidad de Murcia, University hospital of Zurich [Zurich], National Heart Centre Singapore (NHCS), American University of Beirut Faculty of Medicine and Medical Center (AUB), University Medical Center Groningen [Groningen] (UMCG), Rappaport faculty of Medicine, Technion - Israel Institute of Technology [Haifa], L’Hospitalet de Llobregat [Barcelona, Spain], Institut d'Investigació Biomèdica de Bellvitge [Barcelone] (IDIBELL), University Medical Center Göttingen (UMG), German Center for Cardiovascular Research (DZHK), Berlin Institute of Health (BIH), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), University of Glasgow, Tel Aviv University (TAU), Kfar Saba and Sackler School of Medicine, Vifor Pharma Ltd [Glattbrugg, Switzerland], and University College of London [London] (UCL)
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medicine.medical_specialty ,Randomization ,Heart diseases ,Iron ,Health-related quality of life ,Population ,Heart failure ,030204 cardiovascular system & hematology ,Placebo ,law.invention ,Malalties del cor ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Quality of life ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,law ,Clinical Research ,Internal medicine ,medicine ,Humans ,Clinical Trials ,AcademicSubjects/MED00200 ,030212 general & internal medicine ,education ,education.field_of_study ,Ejection fraction ,Dèficit de ferro ,Anemia, Iron-Deficiency ,business.industry ,Iron deficiency ,Acute heart failure ,medicine.disease ,Confidence interval ,3. Good health ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Dietary Supplements ,Intravenous ferric carboxymaltose therapy ,Iron deficiency diseases ,Randomized clinical trial ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Patients with heart failure (HF) and iron deficiency experience poor health-related quality of life (HRQoL). We evaluated the impact of intravenous (IV) ferric carboxymaltose (FCM) vs. placebo on HRQoL for the AFFIRM-AHF population. Methods and results The baseline 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12), which was completed for 1058 (535 and 523) patients in the FCM and placebo groups, respectively, was administered prior to randomization and at Weeks 2, 4, 6, 12, 24, 36, and 52. The baseline KCCQ-12 overall summary score (OSS) mean ± standard error was 38.7 ± 0.9 (FCM group) and 37.1 ± 0.8 (placebo group); corresponding values for the clinical summary score (CSS) were 40.9 ± 0.9 and 40.1 ± 0.9. At Week 2, changes in OSS and CSS were similar for FCM and placebo. From Week 4 to Week 24, patients assigned to FCM had significantly greater improvements in OSS and CSS scores vs. placebo [adjusted mean difference (95% confidence interval, CI) at Week 4: 2.9 (0.5–5.3, P = 0.018) for OSS and 2.8 (0.3–5.3, P = 0.029) for CSS; adjusted mean difference (95% CI) at Week 24: 3.0 (0.3–5.6, P = 0.028) for OSS and 2.9 (0.2–5.6, P = 0.035) for CSS]. At Week 52, the treatment effect had attenuated but remained in favour of FCM. Conclusion In iron-deficient patients with HF and left ventricular ejection fraction, Graphical Abstract
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- 2021
8. What clinical trials of ablation for atrial fibrillation tell us - and what they do not
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Ram Amuthan and Anne B. Curtis
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Topics in Review ,Cardiac arrhythmia ,Atrial fibrillation ,Catheter ablation ,medicine.disease ,Ablation ,law.invention ,Clinical trial ,Pharmacotherapy ,Clinical trials ,Randomized controlled trial ,law ,RC666-701 ,Heart failure ,Clinical outcomes ,medicine ,Diseases of the circulatory (Cardiovascular) system ,business ,Intensive care medicine - Abstract
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in clinical practice. Radiofrequency and cryoballoon catheter ablation are therapeutic options in addition to antiarrhythmic drug therapy for the treatment of AF. Ablation is effective at reducing recurrent atrial arrhythmias and also in the reduction of AF burden. Besides arrhythmia control, improvement in quality of life and clinical outcomes are also desirable goals with AF treatment. Randomized clinical trials have evaluated ablation in several patient populations, including symptomatic patients as first-line or second-line therapy, asymptomatic patients, and patients with heart failure. These trials clarify the durability of ablation in arrhythmia control, clarify quality-of-life improvement, and identify patient populations in whom ablation may be expected to improve clinical outcomes. In this review, we summarize the major clinical trials involving ablation; discuss the strengths, weakness, and clinical implications of these trials; and highlight the knowledge gaps in our current understanding of AF ablation for future clinical studies., Graphical abstract
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- 2021
9. Victoria Trial: Vericiguat Joins the Big League, or does it?
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Andrew J.S. Coats
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High rate ,Pediatrics ,medicine.medical_specialty ,clinical trials ,therapy ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Ejection fraction ,Notice ,sgc stimulators ,business.industry ,lcsh:R ,heart failure ,lcsh:Medicine ,Disease ,League ,medicine.disease ,law.invention ,Randomized controlled trial ,law ,lcsh:RC666-701 ,Heart failure ,medicine ,Vericiguat ,business - Abstract
The VICTORIA trial showed Vericiguat once daily (titrated up to 10 mg) significantly reduced its primary end-point, the composite of death from cardiovascular causes or first hospitalization for heart failure, in 5050 class II-IV HFrEF patients (LVEF5,314 pg/mL) being almost significantly worse on Vericiguat with a HR of 1.16 (0.99-1.35). So the two major areas where Vericiguat may have received special notice appear to be less impressive when we look in detail at the trial results. How do we therefore place Vericiguat in the wake of VICTORIA? It is a proven therapy in a disease which still has residual high rates of clinical mortality and morbidity. It conveyed a benefit on top of other therapies, thus it should be not ignored and may indeed be a very effective therapy in some patients.
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- 2020
10. Mesenchymal Precursor Cells as Adjunctive Therapy in Recipients of Contemporary Left Ventricular Assist Devices.
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Ascheim, Deborah D., Gelijns, Annetine C., Goldstein, Daniel, Moye, Lemuel A., Smedira, Nicholas, Lee, Sangjin, Klodell, Charles T., Szady, Anita, Parides, Michael K., Jeffries, Neal O., Skerrett, Donna, Taylor, Doris A., Rame, J. Eduardo, Milano, Carmelo, Rogers, Joseph G., Lynch, Janine, Dewey, Todd, Eichhorn, Eric, Sun, Benjamin, and Feldman, David
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MESENCHYMAL stem cells , *LEFT heart ventricle , *ARTIFICIAL implants , *CLINICAL trials , *TREATMENT of myocarditis - Abstract
Background--Allogeneic mesenchymal precursor cells (MPCs) injected during left ventricular assist device (LVAD) implantation may contribute to myocardial recovery. This trial explores the safety and efficacy of this strategy. Methods and Results--In this multicenter, double-blind, sham-procedure controlled trial, 30 patients were randomized (2:1) to intramyocardial injection of 25 million MPCs or medium during LVAD implantation. The primary safety end point was incidence of infectious myocarditis, myocardial rupture, neoplasm, hypersensitivity reaction, and immune sensitization (90 days after randomization). Key efficacy end points were functional status and ventricular function while temporarily weaned from LVAD support (90 days after randomization). Patients were followed up until transplant or 12 months after randomization, whichever came first. Mean age was 57.4 (±13.6) years, mean left ventricular ejection fraction was 18.1%, and 66.7% were destination therapy LVADs. No safety events were observed. Successful temporary LVAD weaning was achieved in 50% of MPC and 20% of control patients at 90 days (P=0.24); the posterior probability that MPCs increased the likelihood of successful weaning was 93%. At 90 days, 3 deaths (30%) occurred in control patients, and none occurred in MPC patients. Mean left ventricular ejection fraction after successful wean was 24.0% (MPC=10) and 22.5% (control=2; P=0.56). At 12 months, 30% of MPC patients and 40% of control patients were successfully temporarily weaned from LVAD support (P=0.69), and 6 deaths (30%) occurred in MPC patients. Donor-specific HLA sensitization developed in 2 MPC and 3 control patients and resolved by 12 months. Conclusions--In this preliminary trial, administration of MPCs appeared to be safe, and there was a potential signal of efficacy. Future studies will evaluate the potential for higher or additional doses to enhance the ability to wean LVAD recipients off support. Clinical Trial Registration--URL: http://www.clinicaltrials.gov. Unique identifier: NCT01442129. [ABSTRACT FROM AUTHOR]
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- 2014
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11. Conflicting findings between the Mitra-Fr and the Coapt trials: Implications regarding the cost-effectiveness of percutaneous repair for heart failure patients with severe secondary mitral regurgitation
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Xavier Armoiry, Peter Auguste, Jean-François Obadia, Martin Connock, Matériaux, ingénierie et science [Villeurbanne] (MATEIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS), Hôpital Louis Pradel [CHU - HCL], and Hospices Civils de Lyon (HCL)
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Economics ,Cost effectiveness ,Cost-Benefit Analysis ,Extrapolation ,Social Sciences ,030204 cardiovascular system & hematology ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,law ,Medicine and Health Sciences ,030212 general & internal medicine ,Randomized Controlled Trials as Topic ,[PHYS]Physics [physics] ,Numerical Analysis ,Percutaneous repair ,Multidisciplinary ,Mitral Valve Insufficiency ,3. Good health ,Case model ,Physical Sciences ,Engineering and Technology ,Medicine ,Incremental cost-effectiveness ratio ,Research Article ,Biotechnology ,medicine.medical_specialty ,Drug Research and Development ,Death Rates ,Science ,Cost-Effectiveness Analysis ,Cardiology ,Bioengineering ,Research and Analysis Methods ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Health Economics ,Population Metrics ,medicine ,Humans ,Clinical Trials ,Intensive care medicine ,Heart Failure ,Pharmacology ,Mitral regurgitation ,Discounting ,Population Biology ,business.industry ,Biology and Life Sciences ,medicine.disease ,Economic Analysis ,Randomized Controlled Trials ,Health Care ,Heart failure ,Medical Devices and Equipment ,Clinical Medicine ,business ,Mathematics - Abstract
Purpose Two randomized controlled trials (RCTs), Mitra-Fr and Coapt, evaluating the benefit of percutaneous repair (PR) for heart failure (HF) patients with severe mitral regurgitation, have led to conflicting results. We aimed to evaluate the impact of these trial results on the cost-effectiveness of PR using effectiveness inputs from the two RCTs. Methods We developed a time varying Markov type model with three mutually exclusive health states: alive without HF hospitalisation, alive with HF hospitalisation, and dead. Clinically plausible extrapolations beyond observed data were obtained by developing parametric modelling for overall survival and HF hospitalisations using published data from each trial. We adopted the perspective of the French Health System and used a 30-year time horizon. Results were expressed as € / quality-adjusted life year (QALY) gained using utility inputs from literature. Findings Results are presented using treatment efficacy measures from Mitra-F and Coapt trials respectively. With the Mitra-Fr data, after annual discounting, the base case model generated an incremental 0.00387 QALY at a cost of €25,010, yielding an incremental cost effectiveness ratio (ICER) of €6,467,032 / QALY. The model was sensitive to changes made to model inputs. There was no potential of PR being cost-effective. With the Coapt data, the model generated 1.19 QALY gain at a cost of €26,130 yielding an ICER of €21,918 / QALY and at a threshold of >€50,000/QALY PR had a probability of 1 of being cost-effective. Implications Cost effectiveness results were conflicting; reconciling differences between trials is a priority and could promote optimal cost effectiveness analyses and resource allocation.
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- 2020
12. Routine versus selective cardiac magnetic resonance in non-ischemic heart failure -- OUTSMART-HF: study protocol for a randomized controlled trial (IMAGE-HF (heart failure) project 1-B).
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Paterson, Ian, Wells, George A., Ezekowitz, Justin A., White, James A., Friedrich, Matthias G., Mielniczuk, Lisa M., O¿Meara, Eileen, Chow, Benjamin, DeKemp, Rob A., Klein, Ran, Dennie, Carole, Dick, Alexander, Coyle, Doug, Dwivedi, Girish, Rajda, Miroslaw, Wright, Graham A., Laine, Mika, Hanninen, Helena, Larose, Eric, and Connelly, Kim A.
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CLINICAL trials , *MAGNETIC resonance , *HEART failure , *CARDIAC imaging , *ETIOLOGY of diseases , *ECHOCARDIOGRAPHY - Abstract
Background Imaging has become a routine part of heart failure (HF) investigation. Echocardiography is a first-line test in HF given its availability and it provides valuable diagnostic and prognostic information. Cardiac magnetic resonance (CMR) is an emerging clinical tool in the management of patients with non-ischemic heart failure. Current ACC/AHA/CCS/ESC guidelines advocate its role in the detection of a variety of cardiomyopathies but there is a paucity of high quality evidence to support these recommendations. The primary objective of this study is to compare the diagnostic yield of routine cardiac magnetic resonance versus standard care (that is, echocardiography with only selective use of CMR) in patients with non-ischemic heart failure. The primary hypothesisis that the routine use of CMR will lead to a more specific diagnostic characterization of the underlying etiology of non-ischemic heart failure. This will lead to a reduction in the non-specific diagnoses of idiopathic dilated cardiomyopathy and HF with preserved ejection fraction. Design Tertiary care sites in Canada and Finland, with dedicated HF and CMR programs, will randomize consecutive patients with new or deteriorating HF to routine CMR or selective CMR. All patients will undergo a standard clinical echocardiogram and the interpreter will assign the most likely HF etiology. Those undergoing CMR will also have a standard examination and will be assigned a HF etiology based upon the findings. The treating physician's impression about non-ischemic HF etiology will be collected following all baseline testing (including echo ± CMR). Patients will be followed annually for 4 years to ascertain clinical outcomes, quality of life and cost. The expected outcome is that the routine CMR arm will have a significantly higher rate of infiltrative, inflammatory, hypertrophic, ischemic and 'other' cardiomyopathy than the selective CMR group. Discussion This study will be the first multicenter randomized, controlled trial evaluating the role of CMR in non-ischemic HF. Non-ischemic HF patients will be randomized to routine CMR in order to determine whether there are any gains over management strategies employing selective CMR utilization. The insight gained from this study should improve appropriate CMR use in HF. NCT01281384. [ABSTRACT FROM AUTHOR]
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- 2013
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13. Rationale and design of the SERVE-HF study: treatment of sleep-disordered breathing with predominant central sleep apnoea with adaptive servo-ventilation in patients with chronic heart failure.
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Cowie, Martin R., Woehrle, Holger, Wegscheider, Karl, Angermann, Christiane, d'Ortho, Marie ‐ Pia, Erdmann, Erland, Levy, Patrick, Simonds, Anita, Somers, Virend K., Zannad, Faiez, and Teschler, Helmut
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SLEEP apnea syndrome treatment , *CHEYNE-Stokes respiration , *HEART failure , *MECHANICAL ventilators , *HOSPITAL care , *CLINICAL trials , *RANDOMIZED controlled trials - Abstract
Aims Central sleep apnoea/Cheyne–Stokes respiration (CSA/CSR) is a risk factor for increased mortality and morbidity in heart failure (HF). Adaptive servo-ventilation (ASV) is a non-invasive ventilation modality for the treatment of CSA/CSR in patients with HF. Methods SERVE-HF is a multinational, multicentre, randomized, parallel trial designed to assess the effects of addition of ASV (PaceWave™, AutoSet CS™; ResMed) to optimal medical management compared with medical management alone (control group) in patients with symptomatic chronic HF, LVEF ≤45%, and predominant CSA. The trial is based on an event-driven group sequential design, and the final analysis will be performed when 651 events have been observed or the study is terminated at one of the two interim analyses. The aim is to randomize ∼1200 patients to be followed for a minimum of 2 years. Patients are to stay in the trial up to study termination. The first patient was randomized in February 2008 and the study is expected to end mid 2015. The primary combined endpoint is the time to first event of all-cause death, unplanned hospitalization (or unplanned prolongation of a planned hospitalization) for worsening (chronic) HF, cardiac transplantation, resuscitation of sudden cardiac arrest, or appropriate life-saving shock for ventricular fibrillation or fast ventricular tachycardia in implantable cardioverter defibrillator patients. Perspectives The SERVE-HF study is a randomized study that will provide important data on the effect of treatment with ASV on morbidity and mortality, as well as the cost-effectiveness of this therapy, in patients with chronic HF and predominantly CSA/CSR. Trial registration ISRCTN19572887 [ABSTRACT FROM AUTHOR]
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- 2013
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14. Clinical Outcomes by Race and Ethnicity in the Systolic Blood Pressure Intervention Trial (SPRINT): A Randomized Clinical Trial
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Carolyn F. Pedley, Karen C. Johnson, Timothy E. Craven, Glenn M. Chertow, Roberto Pisoni, Adam P. Bress, Capri G. Foy, Jiang He, Jeff Whittle, Paul K. Whelton, Jackson T. Wright, Carolyn H Still, Barry I. Freedman, James P. Lash, John B. Kostis, Barry M. Wall, Carlos J. Rodriguez, and James R. Powell
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Male ,Original Contributions ,Hispanics ,Myocardial Infarction ,Blood Pressure ,race and ethnicity ,030204 cardiovascular system & hematology ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,law ,Ethnicity ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Aged, 80 and over ,African Americans ,Standard treatment ,Hazard ratio ,Hispanic or Latino ,Middle Aged ,clinical outcomes ,3. Good health ,Treatment Outcome ,Female ,Acute coronary syndrome ,medicine.medical_specialty ,hypertension ,Systole ,Black People ,White People ,03 medical and health sciences ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Acute Coronary Syndrome ,Antihypertensive Agents ,Aged ,Heart Failure ,clinical trials ,business.industry ,Racial Groups ,medicine.disease ,Confidence interval ,Editor's Choice ,Blood pressure ,Socioeconomic Factors ,business - Abstract
BACKGROUND The Systolic Blood Pressure Intervention Trial (SPRINT) showed that targeting a systolic blood pressure (SBP) of ≤ 120 mm Hg (intensive treatment) reduced cardiovascular disease (CVD) events compared to SBP of ≤ 140 mm Hg (standard treatment); however, it is unclear if this effect is similar in all racial/ethnic groups. METHODS We analyzed SPRINT data within non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic subgroups to address this question. High-risk nondiabetic hypertensive patients (N = 9,361; 30% NHB; 11% Hispanic) 50 years and older were randomly assigned to intensive or standard treatment. Primary outcome was a composite of the first occurrence of a myocardial infarction, acute coronary syndrome, stroke, decompensated heart failure, or CVD death. RESULTS Average postbaseline SBP was similar among NHW, NHB, and Hispanics in both treatment arms. Hazard ratios (HRs) (95% confidence interval) (intensive vs. standard treatment groups) for primary outcome were 0.70 (0.57–0.86), 0.71 (0.51–0.98), 0.62 (0.33–1.15) (interaction P value = 0.85) in NHW, NHB, and Hispanics. CVD mortality HRs were 0.49 (0.29–0.81), 0.77 (0.37–1.57), and 0.17 (0.01–1.08). All-cause mortality HRs were 0.61 (0.47–0.80), 0.92 (0.63–1.35), and 1.58 (0.73–3.62), respectively. A test for differences among racial/ethnic groups in the effect of treatment assignment on all-cause mortality was not significant (Hommel-adjusted P value = 0.062) after adjustment for multiple comparisons. CONCLUSION Targeting a SBP goal of ≤ 120 mm Hg compared to ≤ 140 mm Hg led to similar SBP control and was associated with similar benefits and risks among all racial ethnic groups, though NHBs required an average of ~0.3 more medications. CLINICAL TRIALS REGISTRATION Trial Number NCT01206062, ClinicalTrials.gov Identifier at https://clinicaltrials.gov/ct2/show/NCT01206062.
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- 2017
15. The Heart failure and Optimal Outcomes from Pharmacy Study (HOOPS): rationale, design, and baseline characteristics.
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Lowrie, Richard, Mair, Frances S., Greenlaw, Nicola, Forsyth, Paul, McConnachie, Alex, Richardson, Janice, Khan, Nina, Morrison, Deborah, Messow, Claudia-Martina, Rae, Brian, and McMurray, John J.V.
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HEART failure treatment , *PRIMARY care , *HEALTH outcome assessment , *PHARMACY , *RANDOMIZED controlled trials , *ACE inhibitors , *ANGIOTENSIN-receptor blockers , *CLINICAL trials - Abstract
Aims The effect on mortality and morbidity of pharmacist-led intervention to optimize pharmacological therapy in patients with systolic heart failure (HF) has not been tested in a large-scale, long-term, clinical trial. Methods We describe the rationale and design of a UK, primary care-based, prospective cluster-randomized controlled trial of a pharmacist-led intervention in HF and report baseline characteristics of the patients randomized. Eighty-seven practices (1092 patients) were assigned to the intervention arm and 87 practices (1077 patients) to usual care. The average age of patients at baseline was 71 years, 70% were male, 86% were treated with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and 62% with a beta-blocker. Data for the primary outcome of death from any cause or hospitalization for HF will be available up to 31 December 2010, giving a mean follow-up of 5 years. More than 750 patients would have experienced the primary outcome during this period. The first secondary outcome is death from any cause or hospitalization for a cardiovascular reason. Deaths and hospitalizations are being identified using the Scottish National Health Service electronic patient record-linkage system (hence the delay between the end of follow-up and database lock). Conclusion This trial is powered to provide a robust evaluation of the effect of pharmacist-led treatment optimization in patients with systolic HF in primary care. [ABSTRACT FROM AUTHOR]
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- 2011
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16. Randomized Trial of Cardiac Resynchronization in Mildly Symptomatic Heart Failure Patients and in Asymptomatic Patients With Left Ventricular Dysfunction and Previous Heart Failure Symptoms
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Linde, Cecilia, Abraham, William T., Gold, Michael R., St. John Sutton, Martin, Ghio, Stefano, and Daubert, Claude
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HEART diseases , *THERAPEUTICS , *HEART failure patients , *CLINICAL trials , *HEALTH outcome assessment , *LEFT heart ventricle diseases , *HOSPITAL care , *MEDICAL care research - Abstract
Objectives: We sought to determine the effects of cardiac resynchronization therapy (CRT) in New York Heart Association (NYHA) functional class II heart failure (HF) and NYHA functional class I (American College of Cardiology/American Heart Association stage C) patients with previous HF symptoms. Background: Cardiac resynchronization therapy improves left ventricular (LV) structure and function and clinical outcomes in NYHA functional class III and IV HF with prolonged QRS. Methods: Six hundred ten patients with NYHA functional class I or II heart failure with a QRS ≥120 ms and a LV ejection fraction ≤40% received a CRT device (±defibrillator) and were randomly assigned to active CRT (CRT-ON; n = 419) or control (CRT-OFF; n = 191) for 12 months. The primary end point was the HF clinical composite response, which scores patients as improved, unchanged, or worsened. The prospectively powered secondary end point was LV end-systolic volume index. Hospitalization for worsening HF was evaluated in a prospective secondary analysis of health care use. Results: The HF clinical composite response end point, which compared only the percent worsened, indicated 16% worsened in CRT-ON compared with 21% in CRT-OFF (p = 0.10). Patients assigned to CRT-ON experienced a greater improvement in LV end-systolic volume index (−18.4 ± 29.5 ml/m2 vs. −1.3 ± 23.4 ml/m2, p < 0.0001) and other measures of LV remodeling. Time-to-first HF hospitalization was significantly delayed in CRT-ON (hazard ratio: 0.47, p = 0.03). Conclusions: The REVERSE (REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction) trial demonstrates that CRT, in combination with optimal medical therapy (±defibrillator), reduces the risk for heart failure hospitalization and improves ventricular structure and function in NYHA functional class II and NYHA functional class I (American College of Cardiology/American Heart Association stage C) patients with previous HF symptoms. (REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction [REVERSE]; NCT00271154). [Copyright &y& Elsevier]
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- 2008
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17. Selexipag treatment for pulmonary arterial hypertension associated with congenital heart disease after defect correction: insights from the randomised controlled GRIPHON study
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Gérald Simonneau, Olivier Sitbon, Maurice Beghetti, Victor F. Tapson, Nazzareno Galiè, Irene M. Lang, Hossein Ardeschir Ghofrani, R Preiss, Lilla Di Scala, Marius M. Hoeper, Sean Gaine, Richard N. Channick, Kelly Chin, Vallerie V. McLaughlin, Lewis J. Rubin, Beghetti M., Channick R.N., Chin K.M., Di Scala L., Gaine S., Ghofrani H.-A., Hoeper M.M., Lang I.M., McLaughlin V.V., Preiss R., Rubin L.J., Simonneau G., Sitbon O., Tapson V.F., and Galie N.
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Male ,Heart disease ,030204 cardiovascular system & hematology ,Selexipag ,Pulmonary arterial hypertension ,law.invention ,chemistry.chemical_compound ,Congenital heart disease ,Disease progression ,Efficacy ,Randomised controlled trial ,0302 clinical medicine ,Randomized controlled trial ,law ,Acetamides ,polycyclic compounds ,Cardiac Surgical Procedure ,Research Articles ,ddc:618 ,Middle Aged ,Antihypertensive Agent ,Treatment Outcome ,Pyrazines ,Cardiology ,Female ,Drug Monitoring ,Cardiology and Cardiovascular Medicine ,Research Article ,Human ,Adult ,Heart Defects, Congenital ,medicine.medical_specialty ,Poor prognosis ,Hypertension, Pulmonary ,03 medical and health sciences ,Double-Blind Method ,Early Medical Intervention ,Internal medicine ,medicine ,Humans ,Clinical Trials ,In patient ,cardiovascular diseases ,Cardiac Surgical Procedures ,Antihypertensive Agents ,Proportional Hazards Models ,business.industry ,medicine.disease ,Institutional repository ,chemistry ,Heart failure ,Proportional Hazards Model ,business ,Acetamide - Abstract
Aims: Patients with pulmonary arterial hypertension associated with congenital heart disease (CHD-PAH) after defect correction have a poor prognosis compared with other CHD-PAH patients. Therefore, it is important that these patients are treated as early and effectively as possible. Evidence supporting the use of PAH therapies in patients with corrected CHD-PAH from randomised controlled trials is limited. The purpose of these analyses was to characterise the corrected CHD-PAH patients from the GRIPHON study and examine the response to selexipag. Methods and results: Out of the 110 patients diagnosed with corrected CHD-PAH, 55 had atrial septal defects, 38 had ventricular septal defects, 14 had persistent ducti arteriosus, and 3 had defects not further specified. Hazard ratios (HR) and 95% confidence intervals (CI) for the primary composite endpoint were calculated using Cox proportional hazard models. Compared with the non-CHD patients from GRIPHON, patients with corrected CHD-PAH were slightly younger, with a greater proportion being treatment-naive and in World Health Organization functional class I/II. The rate of the primary composite endpoint of morbidity/mortality was lower in patients with corrected CHD-PAH who were treated with selexipag compared with those treated with placebo (HR 0.58; 95% CI 0.25, 1.37). The most common adverse events were those known to be related to selexipag. Conclusions: These post-hoc analyses of GRIPHON provide valuable information about a large population of patients with corrected CHD-PAH, and suggest that selexipag may delay disease progression and was well-tolerated in patients with corrected CHD-PAH.
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- 2019
18. Heart failure medication after a first hospital admission and risk of heart failure readmission, focus on beta-blockers and renin-angiotensin-aldosterone system medication: A retrospective cohort study in linked databases
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H. Joost Kruik, Carine J.M. Doggen, Gerard C.M. Linssen, Marissa C. van Maaren, Edith M. Heintjes, Job van der Palen, Willemien J. Kruik-Kollöffel, Kris L. L. Movig, TechMed Centre, and Health Technology & Services Research
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Male ,Epidemiology ,Angiotensin-Converting Enzyme Inhibitors ,Cardiovascular Medicine ,computer.software_genre ,Diagnostic Radiology ,law.invention ,Renin-Angiotensin System ,Randomized controlled trial ,law ,Medicine and Health Sciences ,Cardiovascular Imaging ,Diuretics ,Carvedilol ,Multidisciplinary ,Database ,Radiology and Imaging ,Hazard ratio ,Confounding ,Angiography ,Drugs ,Prognosis ,Magnetic Resonance Imaging ,Hospitals ,Hospitalization ,Medicine ,Female ,Research Article ,Cohort study ,medicine.drug ,Drug Research and Development ,Imaging Techniques ,Science ,Adrenergic beta-Antagonists ,Cardiology ,Research and Analysis Methods ,Patient Readmission ,Angiotensin Receptor Antagonists ,Diagnostic Medicine ,medicine ,Humans ,Clinical Trials ,cardiovascular diseases ,Aged ,Retrospective Studies ,Heart Failure ,Pharmacology ,business.industry ,Retrospective cohort study ,medicine.disease ,Randomized Controlled Trials ,Health Care ,Health Care Facilities ,Medical Risk Factors ,Heart failure ,Observational study ,Clinical Medicine ,business ,computer - Abstract
Background This study assessed the association between heart failure (HF) medication (angiotensin-converting-enzyme inhibitors (ACEI)/angiotensin-receptor blockers (ARB), beta-blockers (BB), mineralocorticoid-receptor antagonists (MRA) and diuretics) and HF readmissions in a real-world unselected group of patients after a first hospital admission for HF. Furthermore we analysed readmission rates for ACEI versus ARB and for carvedilol versus β1-selective BB and we investigated the effect of HF medication in relation to time since discharge. Methods and findings Medication at discharge was determined with dispensing data from the Dutch PHARMO Database Network including 22,476 patients with HF between 2001 and 2015. After adjustment for age, gender, number of medications and year of admission no associations were found for users versus non-users of ACEI/ARB (hazard ratio, HR = 1.01; 95%CI 0.96–1.06), BB (HR = 1.00; 95%CI 0.95–1.05) and readmissions. The risk of readmission for patients prescribed MRA (HR = 1.11; 95%CI 1.05–1.16) or diuretics (HR = 1.17; 95%CI 1.09–1.25) was higher than for non-users. The HR for ARB relative to ACEI was 1.04 (95%CI 0.97–1.12) and for carvedilol relative to β1-selective BB 1.33 (95%CI 1.20–1.46). Post-hoc analyses showed a protective effect shortly after discharge for most medications. For example one month post discharge the HR for ACEI/ARB was 0.77 (95%CI 0.69–0.86). Although we did try to adjust for confounding by indication, probably residual confounding is still present. Conclusions Patients who were prescribed carvedilol have a higher or at least a similar risk of HF readmission compared to β1-selective BB. This study showed that all groups of HF medication -some more pronounced than others- were more effective immediately following discharge.
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- 2020
19. Role of probiotics in patients with colorectal cancer: a systematic review protocol of randomised controlled trial studies
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Abdelkodose Mohammed Al-Kabsi, Salasawati Hussin, Mohammed A. Alshawsh, and Ifeoma Julieth Dikeocha
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medicine.medical_specialty ,Databases, Factual ,Colorectal cancer ,Intracardiac pressure ,law.invention ,Randomized controlled trial ,law ,medicine ,Humans ,In patient ,Intensive care medicine ,Adverse effect ,Randomized Controlled Trials as Topic ,Protocol (science) ,Motivation ,clinical trials ,business.industry ,Probiotics ,microbiology ,General Medicine ,medicine.disease ,Clinical trial ,Oncology ,gastrointestinal tumours ,Heart failure ,Colonic Neoplasms ,Medicine ,Colorectal Neoplasms ,business ,Systematic Reviews as Topic - Abstract
IntroductionColorectal cancer is one of the leading causes of cancer-related morbidity worldwide and it has been reported to be associated with poor lifestyle habits which include excess tobacco and alcohol intake as well as genetics and age factors. Probiotics such as the lactic acid bacteria and Bifidobacterium as well as probiotic containing foods (kombucha, kefir, miso etc) have received lots of attention as anticancer agents for prevention and treatment. The effects of the administration of probiotics to patients with colorectal cancer is the primary goal of this systematic review. The overall aim is to assess how the use of probiotics in patients with colorectal cancer helps in the management of colorectal cancer and its effect on the diversity of gut microbiota. The final systematic review will provide a comprehensive evidence base for the use and efficacy of probiotics in patient with colorectal cancer care.Methods and analysisThe systematic review, will be conducted by extensively searching different databases such as PubMed, Web of Science, Scopus, Wiley and ProQuest to identify randomised controlled trials (with no time frame) which relate to the administration of probiotics to patients with colorectal cancer. The search strategy will include words like colorectal cancer, probiotics, Bifidobacterium, clinical trials etc. A systematic search of databases was performed between 17 and 20 January 2020. Two reviewers will independently review the studies and also search the reference lists of the eligible studies to obtain more references. Data will be extracted from the eligible studies using standardised data extraction form. After assessing the risk of bias, qualitative analysis will be used to synthesise the systematic review.Ethics and disseminationThis is a protocol for a systematic review; therefore, it doesn’t require any ethics approval. We intend to disseminate the protocol in a peer reviewed journal.
- Published
- 2020
20. Home-based rehabilitation for heart failure with reduced ejection fraction: mixed methods process evaluation of the REACH-HF multicentre randomised controlled trial
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Jennifer Wingham, Julia Frost, Jackie Miles, Colin J Greaves, Nicky Britten, Kate Jolly, Hasnain M Dalal, Fiona C Warren, Rod S Taylor, Sally Singh, Charles Abraham, Patrick Doherty, and Kevin Paul
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Psychological intervention ,030204 cardiovascular system & hematology ,Rehabilitation Medicine ,law.invention ,Interviews as Topic ,primary care ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Randomized controlled trial ,law ,Intervention (counseling) ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Heart Failure ,clinical trials ,Rehabilitation ,business.industry ,Research ,Attendance ,Stroke Volume ,General Medicine ,Middle Aged ,United Kingdom ,Self Care ,Clinical trial ,Treatment Outcome ,Physical therapy ,Patient Compliance ,Female ,business ,qualitative research ,Qualitative research - Abstract
ObjectiveTo identify and explore change processes explaining the effects of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention taking account of reach, amount of intervention received, delivery fidelity and patient and caregiver perspectives.DesignMixed methods process evaluation parallel to a randomised controlled trial using data from the intervention group (REACH-HF plus usual care).SettingFour centres in the UK (Birmingham, Cornwall, Gwent and York).ParticipantsPeople with heart failure with reduced ejection fraction (HFrEF) and their caregivers.MethodsThe REACH-HF intervention consisted of a self-help manual for patients with HFrEF and caregivers facilitated over 12 weeks by trained healthcare professionals. The process evaluation used multimodal mixed methods analysis. Data consisted of audio recorded intervention sessions; demographic data; intervention fidelity scores for intervention group participants (107 patients and 53 caregivers); qualitative interviews at 4 and 12 months with a sample of 19 patients and 17 caregivers.Outcome measuresQuantitative data: intervention fidelity and number, frequency and duration of intervention sessions received. Qualitative data: experiences and perspectives of intervention participants and caregivers.ResultsIntervention session attendance with facilitators was high. Fidelity scores were indicative of adequate quality of REACH-HF intervention delivery, although indicating scope for improvement in several areas. Intervention effectiveness was contingent on matching the intervention implementation to the concerns, beliefs and goals of participants. Behaviour change was sustained when shared meaning was established. Respondents’ comorbidities, socio-economic circumstances and existing networks of support also affected changes in health-related quality of life.ConclusionsBy combining longitudinal mixed methods data, the essential ingredients of complex interventions can be better identified, interrogated and tested. This can maximise the clinical application of research findings and enhance the capacity of multidisciplinary and multisite teams to implement the intervention.Trial registration numberISRCTN25032672; Pre-results.
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- 2019
21. Repetitive levosimendan infusions for patients with advanced chronic heart failure in the vulnerable post-discharge period
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Pölzl, Gerhard, Allipour Birgani, Shadad, Comín Colet, Josep, Delgado, Juan F., Fedele, Francesco, García Gonzáles, Martín J., Gustafsson, Finn, Masip, Josep, Papp, Zoltán, Störk, Stefan, Ulmer, Hanno, Vrtovec, Bojan, Wikström, Gerhard, and Altenberger, Johann
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advanced heart failure ,global rank endpoint ,hospitalization ,levosimendan ,n-terminal pro-brain natriuretic peptide ,randomized controlled trial ,cardiotonic agents ,dose-response relationship, drug ,double-blind method ,drug administration schedule ,follow-up studies ,heart failure ,humans ,infusions, intravenous ,simendan ,stroke volume ,treatment outcome ,patient discharge ,Cardiotonic Agents ,Levosimendan ,Risk factors in diseases ,Advanced heart failure ,Study Designs ,Heart failure ,Insuficiència cardíaca ,dose-response relationship ,Drug Administration Schedule ,Hospital patients ,Clinical trials ,Double-Blind Method ,Humans ,Cardiac and Cardiovascular Systems ,Infusions, Intravenous ,Simendan ,Global rank endpoint ,Heart Failure ,Malalts hospitalitzats ,Study Design ,N‐terminal pro‐brain natriuretic peptide ,Kardiologi ,Dose-Response Relationship, Drug ,Factors de risc en les malalties ,drug ,Stroke Volume ,Patient Discharge ,infusions ,Hospitalization ,N-terminal pro-brain natriuretic peptide ,Treatment Outcome ,Randomized controlled trial ,intravenous ,Follow-Up Studies ,Assaigs clínics - Abstract
Hospitalization for acute heart failure (HF) is associated with a substantial morbidity burden and with associated healthcare costs and an increased mortality risk. However, few if any major medical innovations have been witnessed in this area in recent times. Levosimendan is a first‐in‐class calcium sensitizer and potassium channel opener indicated for the management of acute HF. Experience in several clinical studies has indicated that administration of intravenous levosimendan in intermittent cycles may reduce hospitalization and mortality rates in patients with advanced HF; however, none of those trials were designed or powered to give conclusive insights into that possibility. This paper describes the rationale and protocol of LeoDOR (levosimendan infusions for patients with advanced chronic heart failure), a randomized, double‐blind, placebo‐controlled, international, multicentre trial that will explore the efficacy and safety of intermittent levosimendan therapy, in addition to optimized standard therapy, in patients following hospitalization for acute HF. Salient features of LeoDOR include the use of two treatment regimens, in order to evaluate the effects of different schedules and doses of levosimendan during a 12 week treatment phase, and the use of a global rank primary endpoint, in which all patients are ranked across three hierarchical groups ranging from time to death or urgent heart transplantation or implantation of a ventricular assist device to time to rehospitalization and, lastly, time‐averaged proportional change in N‐terminal pro‐brain natriuretic peptide. Secondary endpoints include changes in HF symptoms and functional status at 14 weeks.
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- 2018
22. Design and Rationale of the Phase 3 ATTR-ACT Clinical Trial (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial)
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C. Hahn, Sanjiv J. Shah, Mathew S. Maurer, Steven Riley, Giampaolo Merlini, Perry M. Elliott, Alison Flynn, Claudio Rapezzi, Balarama Gundapaneni, Márcia Waddington Cruz, Jeffrey H. Schwartz, Marla B. Sultan, Maurer, Mathew S., Elliott, Perry, Merlini, Giampaolo, Shah, Sanjiv J., Cruz, Márcia Waddington, Flynn, Alison, Gundapaneni, Balarama, Hahn, Carolyn, Riley, Steven, Schwartz, Jeffrey, Sultan, Marla B., and Rapezzi, Claudio
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Tafamidis ,Pathology ,Cardiomyopathy ,heart failure ,Administration, Oral ,Benzoxazole ,Disease ,030204 cardiovascular system & hematology ,Amyloid Neuropathies ,Bioinformatics ,law.invention ,chemistry.chemical_compound ,Familial ,0302 clinical medicine ,Randomized controlled trial ,law ,double-blind method ,Medicine ,Randomized Controlled Trials as Topic ,Benzoxazoles ,cardiomyopathie ,biology ,Amyloidosis ,amyloid ,Disease Management ,Phase III as Topic ,Administration ,Disease Progression ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,Human ,Oral ,medicine.medical_specialty ,macromolecular substances ,NO ,03 medical and health sciences ,Humans ,Clinical Trials ,cardiomyopathies ,mutation ,Amyloid Neuropathies, Familial ,business.industry ,nutritional and metabolic diseases ,medicine.disease ,Clinical trial ,Amyloid Neuropathy ,Transthyretin ,Clinical Trials, Phase III as Topic ,chemistry ,biology.protein ,business ,030217 neurology & neurosurgery - Abstract
Transthyretin amyloidosis is a rare, life-threatening disease resulting from aggregation and deposition of transthyretin amyloid fibrils in various tissues. There are 2 predominate phenotypic presentations of the disease: transthyretin familial amyloid polyneuropathy, which primarily affects the peripheral nerves, and transthyretin cardiomyopathy (TTR-CM), which primarily affects the heart. However, there is a wide overlap with symptoms at presentation and disease course being highly variable and influenced by the underlying transthyretin mutation, age of the affected individual, sex, and geographic location. Treatment of transthyretin amyloidosis is typically focused on symptom management. Although tafamidis has been shown to delay neurologic progression of transthyretin familial amyloid polyneuropathy, there are no approved pharmacologic therapies shown to improve survival in TTR-CM. The natural history of TTR-CM is poorly characterized, which presents difficulties for the design of large-scale trials for new treatments. This review provides a brief overview of TTR-CM and the challenges of identifying clinically meaningful end points and study parameters to determine the efficacy of treatments for rare diseases. The design and rationale behind the ongoing phase 3 ATTR-ACT study (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial), an international, multicenter, double-blind, placebo-controlled, randomized clinical trial, is also outlined. The ATTR-ACT study will provide important insight into the efficacy and safety of tafamidis for the treatment of TTR-CM. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01994889.
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- 2017
23. No benefits of statins for sudden cardiac death prevention in patients with heart failure and reduced ejection fraction: A meta-analysis of randomized controlled trials
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H. Le, Bernard Burnand, M. Fall, Muaamar Al-Gobari, François Gueyffier, Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE)
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[SDV]Life Sciences [q-bio] ,030204 cardiovascular system & hematology ,Sudden Cardiac Death ,law.invention ,Sudden cardiac death ,Mathematical and Statistical Techniques ,0302 clinical medicine ,Randomized controlled trial ,law ,Cause of Death ,Odds Ratio ,Medicine and Health Sciences ,Medicine ,030212 general & internal medicine ,ComputingMilieux_MISCELLANEOUS ,Randomized Controlled Trials as Topic ,Cause of death ,Multidisciplinary ,Ejection fraction ,Drugs ,Research Assessment ,3. Good health ,Treatment Outcome ,Meta-analysis ,Physical Sciences ,Cardiology ,Statistics (Mathematics) ,Research Article ,medicine.medical_specialty ,Drug Research and Development ,Systematic Reviews ,Death Rates ,Science ,Research and Analysis Methods ,03 medical and health sciences ,Internal medicine ,Humans ,Clinical Trials ,Statistical Methods ,Demography ,Heart Failure ,Pharmacology ,Death, Sudden, Cardiac/epidemiology ,Death, Sudden, Cardiac/etiology ,Death, Sudden, Cardiac/prevention & control ,Heart Failure/complications ,Heart Failure/physiopathology ,Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ,Publication Bias ,Stroke Volume ,business.industry ,Statins ,Publication bias ,medicine.disease ,Randomized Controlled Trials ,Death, Sudden, Cardiac ,Relative risk ,Heart failure ,People and Places ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Clinical Medicine ,business ,Mathematics ,Meta-Analysis ,Ejection Fraction - Abstract
Background and objectivesStatins showed mixed results in heart failure (HF) patients. The benefits in major HF outcomes, including all-cause mortality and sudden cardiac death (SCD), have always been discordant across systematic reviews and meta-analyses. We intended to systematically identify and appraise the available evidence that evaluated the effectiveness of statins in clinical outcomes for HF patients.DesignSystematic review and meta-analysis.Data sourcesWe searched, until April 28, 2016: Medline, Embase, ISI Web of Science and EBM reviews (Cochrane DSR, ACP journal club, DARE, CCTR, CMR, HTA, and NHSEED), checked clinicaltrials.gov for ongoing trials and manually searched references of included studies.Eligibility criteria for selecting studiesWe identified 24 randomized clinical trials that evaluated the efficacy of statins for HF patients. All randomized clinical trials were assessed for risk of bias and pooled together in a meta-analysis. Pre-specified outcomes were sudden cardiac death, all-cause mortality, and hospitalization for worsening heart failure.ResultsStatins did not reduce sudden cardiac death (SCD) events in HF patients [relative risk (RR) 0.92, 95% confidence interval (CI) 0.70 to 1.21], all-cause mortality [RR 0.88, 95% CI 0.75 to 1.02] but significantly reduced hospitalization for worsening heart failure (HWHF) although modestly [RR 0.79, 95% CI 0.66 to 0.94]. Nevertheless, estimated predictive intervals were insignificant in SCD, all-cause mortality and HWHF [RR, 0.54 to 1.63, 0.64 to 1.19, and 0.54 to 1.15], respectively. An important finding was the possible presence of publication bias, small-study effects and heterogeneity of the trials conducted in HF patients.ConclusionsStatins do not reduce sudden cardiac death, all-cause mortality, but may slightly decrease hospitalization for worsening heart failure in HF patients. The evaluation of the risk of biases suggested moderate quality of the published results. Until new evidence is available, this study supports the 2013 ACCF/AHA guidelines to not systematically prescribe statins in "only" HF patients, which should help avoid unnecessary polypharmacy.
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- 2017
24. How robust are clinical trials in heart failure?
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Pardeep S. Jhund, Kieran F. Docherty, John J.V. McMurray, Ross T. Campbell, and Mark C. Petrie
- Subjects
medicine.medical_specialty ,Angiotensin-Converting Enzyme Inhibitors ,030204 cardiovascular system & hematology ,law.invention ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,Angiotensin Receptor Antagonists ,0302 clinical medicine ,Randomized controlled trial ,law ,Statistical significance ,Internal medicine ,Clinical endpoint ,Medicine ,Humans ,030212 general & internal medicine ,Randomized Controlled Trials as Topic ,Heart Failure ,clinical trials ,business.industry ,medicine.disease ,Exercise Therapy ,Clinical trial ,Hospitalization ,Sample size determination ,Heart failure ,Chronic Disease ,Practice Guidelines as Topic ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims: Guidelines for the management of chronic heart failure (CHF) cite the results of randomized controlled trials (RCTs) to support treatment recommendations. The significance of an observed treatment-effect relies on the use of a boundary p-value, most commonly p
- Published
- 2016
25. Effectiveness of Telephone-Based Health Coaching for Patients with Chronic Conditions: A Randomised Controlled Trial
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Dirk Heider, Jörg Dirmaier, Hans-Helmut König, Herbert Matschinger, Elisabeth Siegmund-Schultze, Lutz Herbarth, Levente Kriston, Sarah Dwinger, Isaac Bermejo, and Martin Härter
- Subjects
Economics ,Social Sciences ,lcsh:Medicine ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,law ,Medicine and Health Sciences ,030212 general & internal medicine ,lcsh:Science ,Multidisciplinary ,030503 health policy & services ,Mortality rate ,Mental Disorders ,Hazard ratio ,Telephones ,Telemedicine ,Hospitals ,Engineering and Technology ,0305 other medical science ,Research Article ,medicine.medical_specialty ,Randomization ,Health coaching ,Drug Research and Development ,Patients ,Death Rates ,Cardiology ,Equipment ,Health Promotion ,Research and Analysis Methods ,Patient Readmission ,03 medical and health sciences ,Health Economics ,Population Metrics ,Internal medicine ,Mental Health and Psychiatry ,medicine ,Diabetes Mellitus ,Humans ,Clinical Trials ,Demography ,Heart Failure ,Communication Equipment ,Pharmacology ,Population Biology ,business.industry ,lcsh:R ,Biology and Life Sciences ,Odds ratio ,Randomized Controlled Trials ,Telephone ,Clinical trial ,Self Care ,Health Care ,Health Care Facilities ,Propensity score matching ,Chronic Disease ,People and Places ,Physical therapy ,lcsh:Q ,Clinical Medicine ,business ,Program Evaluation ,Health Insurance - Abstract
Background Chronic diseases, like diabetes mellitus, heart disease and cancer are leading causes of death and disability. These conditions are at least partially preventable or modifiable, e.g. by enhancing patients’ self-management. We aimed to examine the effectiveness of telephone-based health coaching (TBHC) in chronically ill patients. Methods and Findings This prospective, pragmatic randomized controlled trial compares an intervention group (IG) of participants in TBHC to a control group (CG) without TBHC. Endpoints were assessed two years after enrolment. Three different groups of insurees with 1) multiple conditions (chronic campaign), 2) heart failure (heart failure campaign), or 3) chronic mental illness conditions (mental health campaign) were targeted. The telephone coaching included evidence-based information and was based on the concepts of motivational interviewing, shared decision-making, and collaborative goal setting. Patients received an average of 12.9 calls. Primary outcome was time from enrolment until hospital readmission within a two-year follow-up period. Secondary outcomes comprised the probability of hospital readmission, number of daily defined medication doses (DDD), frequency and duration of inability to work, and mortality within two years. All outcomes were collected from routine data provided by the statutory health insurance. As informed consent was obtained after randomization, propensity score matching (PSM) was used to minimize selection bias introduced by decliners. For the analysis of hospital readmission and mortality, we calculated Kaplan-Meier curves and estimated hazard ratios (HR). Probability of hospital readmission and probability of death were analysed by calculating odds ratios (OR). Quantity of health service use and inability to work were analysed by linear random effects regression models. PSM resulted in patient samples of 5,309 (IG: 2,713; CG: 2,596) in the chronic campaign, of 660 (IG: 338; CG: 322) in the heart failure campaign, and of 239 (IG: 101; KG: 138) in the mental health campaign. In none of the three campaigns, there were significant differences between IG and CG in time until hospital readmission. In the chronic campaign, the probability of hospital readmission was higher in the IG than in the CG (OR = 1.13; p = 0.045); no significant differences could be found for the other two campaigns. In the heart failure campaign, the IG showed a significantly reduced number of hospital admissions (-0.41; p = 0.012), although the corresponding reduction in the number of hospital days was not significant. In the chronic campaign, the IG showed significantly increased number of DDDs. Most striking, there were significant differences in mortality between IG and CG in the chronic campaign (OR = 0.64; p = 0.005) as well as in the heart failure campaign (OR = 0.44; p = 0.001). Conclusions While TBHC seems to reduce hospitalization only in specific patient groups, it may reduce mortality in patients with chronic somatic conditions. Further research should examine intervention effects in various subgroups of patients, for example for different diagnostic groups within the chronic campaign, or duration of coaching. Trial Registration German Clinical Trials Register DRKS00000584
- Published
- 2016
26. Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- Author
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Frédéric Guitarian, Ivanny Marchant, M. Fall, Chadia El-Khatib, H. Le, Perrine Janiaud, Theodora Bejan-Angoulvant, Michel Cucherat, Margaux Mombled, François Gueyffier, Muaamar Al-Gobari, Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Génétique, immunothérapie, chimie et cancer (GICC), UMR 7292 CNRS [2012-2017] (GICC UMR 7292 CNRS), Université de Tours (UT)-Centre National de la Recherche Scientifique (CNRS), and Université de Tours-Centre National de la Recherche Scientifique (CNRS)
- Subjects
[SDV]Life Sciences [q-bio] ,Myocardial Infarction ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Biochemistry ,law.invention ,Sudden cardiac death ,chemistry.chemical_compound ,Mathematical and Statistical Techniques ,0302 clinical medicine ,Randomized controlled trial ,law ,Odds Ratio ,Medicine and Health Sciences ,Medicine ,Prospective Studies ,Renal Insufficiency ,Lipid Hormones ,030212 general & internal medicine ,Myocardial infarction ,lcsh:Science ,Aldosterone ,ComputingMilieux_MISCELLANEOUS ,Mineralocorticoid Receptor Antagonists ,Randomized Controlled Trials as Topic ,Multidisciplinary ,Mortality rate ,3. Good health ,Treatment Outcome ,Physical Sciences ,Cardiology ,Gynecomastia ,Anatomy ,Statistics (Mathematics) ,Research Article ,medicine.medical_specialty ,Modern medicine ,Drug Research and Development ,Death Rates ,Research and Analysis Methods ,03 medical and health sciences ,Population Metrics ,Adverse Reactions ,Internal medicine ,Humans ,Clinical Trials ,cardiovascular diseases ,Statistical Methods ,Adverse effect ,Demography ,Heart Failure ,Pharmacology ,Population Biology ,business.industry ,lcsh:R ,Biology and Life Sciences ,Renal System ,medicine.disease ,Survival Analysis ,Hormones ,Randomized Controlled Trials ,Death, Sudden, Cardiac ,chemistry ,Heart failure ,People and Places ,Hyperkalemia ,lcsh:Q ,Clinical Medicine ,business ,Mathematics ,Meta-Analysis - Abstract
BACKGROUND AND OBJECTIVES: Sudden cardiac death (SCD) is a severe burden of modern medicine. Aldosterone antagonist is publicized as effective in reducing mortality in patients with heart failure (HF) or post myocardial infarction (MI). Our study aimed to assess the efficacy of AAs on mortality including SCD, hospitalization admission and several common adverse effects. METHODS: We searched Embase, PubMed, Web of Science, Cochrane library and clinicaltrial.gov for randomized controlled trials (RCTs) assigning AAs in patients with HF or post MI through May 2015. The comparator included standard medication or placebo, or both. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Event rates were compared using a random effects model. Prospective RCTs of AAs with durations of at least 8 weeks were selected if they included at least one of the following outcomes: SCD, all-cause/cardiovascular mortality, all-cause/cardiovascular hospitalization and common side effects (hyperkalemia, renal function degradation and gynecomastia). RESULTS: Data from 19,333 patients enrolled in 25 trials were included. In patients with HF, this treatment significantly reduced the risk of SCD by 19% (RR 0.81; 95% CI, 0.67-0.98; p = 0.03); all-cause mortality by 19% (RR 0.81; 95% CI, 0.74-0.88, p
- Published
- 2016
27. Risk of Bias in Systematic Reviews of Non-Randomized Studies of Adverse Cardiovascular Effects of Thiazolidinediones and Cyclooxygenase-2 Inhibitors: Application of a New Cochrane Risk of Bias Tool
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David Henry, Anja Bilandzic, Tiffany Fitzpatrick, and Laura C. Rosella
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NSAIDs ,Myocardial Infarction ,lcsh:Medicine ,030204 cardiovascular system & hematology ,law.invention ,Cohort Studies ,0302 clinical medicine ,Mathematical and Statistical Techniques ,Randomized controlled trial ,law ,Risk Factors ,Odds Ratio ,Medicine and Health Sciences ,030212 general & internal medicine ,media_common ,Observer Variation ,Analgesics ,Evidence-Based Medicine ,Confounding ,Drugs ,Confounding Factors, Epidemiologic ,General Medicine ,Research Assessment ,Systematic review ,Cardiovascular Diseases ,Research Design ,Meta-analysis ,Physical Sciences ,Risk assessment ,Statistics (Mathematics) ,Research Article ,medicine.medical_specialty ,Drug Research and Development ,Confounding Factors (Epidemiology) ,Systematic Reviews ,media_common.quotation_subject ,Cardiology ,Research and Analysis Methods ,Risk Assessment ,COX-2 inhibitors ,03 medical and health sciences ,Bias ,Meta-Analysis as Topic ,medicine ,Humans ,Hypoglycemic Agents ,Clinical Trials ,Statistical Methods ,Intensive care medicine ,Selection Bias ,Selection bias ,Pharmacology ,Heart Failure ,Cyclooxygenase 2 Inhibitors ,business.industry ,lcsh:R ,Reproducibility of Results ,Evidence-based medicine ,Pain management ,Randomized Controlled Trials ,Review Literature as Topic ,Thiazolidinediones ,Clinical Medicine ,business ,Mathematics ,Meta-Analysis - Abstract
Background Systematic reviews of the effects of healthcare interventions frequently include non-randomized studies. These are subject to confounding and a range of other biases that are seldom considered in detail when synthesizing and interpreting the results. Our aims were to assess the reliability and usability of a new Cochrane risk of bias (RoB) tool for non-randomized studies of interventions and to determine whether restricting analysis to studies with low or moderate RoB made a material difference to the results of the reviews. Methods and Findings We selected two systematic reviews of population-based, controlled non-randomized studies of the relationship between the use of thiazolidinediones (TZDs) and cyclooxygenase-2 (COX-2) inhibitors and major cardiovascular events. Two epidemiologists applied the Cochrane RoB tool and made assessments across the seven specified domains of bias for each of 37 component studies. Inter-rater agreement was measured using the weighted Kappa statistic. We grouped studies according to overall RoB and performed statistical pooling for (a) all studies and (b) only studies with low or moderate RoB. Kappa scores across the seven bias domains ranged from 0.50 to 1.0. In the COX-2 inhibitor review, two studies had low overall RoB, 14 had moderate RoB, and five had serious RoB. In the TZD review, six studies had low RoB, four had moderate RoB, four had serious RoB, and two had critical RoB. The pooled odds ratios for myocardial infarction, heart failure, and death for rosiglitazone versus pioglitazone remained significantly elevated when analyses were confined to studies with low or moderate RoB. However, the estimate for myocardial infarction declined from 1.14 (95% CI 1.07–1.24) to 1.06 (95% CI 0.99–1.13) when analysis was confined to studies with low RoB. Estimates of pooled relative risks of cardiovascular events with COX-2 inhibitors compared with no nonsteroidal anti-inflammatory drug changed little when analyses were confined to studies with low or moderate RoB. The exception was a rise in the relative risk associated with ibuprofen from 1.07 (95% CI 0.97–1.18) to 1.14 (95% CI 1.03–1.26). The main limitation of our study was testing the instrument on a narrow range of pharmacoepidemiological studies; we cannot assume our findings extend to a broader range of interventions and settings. Conclusions The Cochrane RoB tool highlighted a wide range of risks of bias in studies included in two widely cited reviews and had the potential to change the conclusions of the reviews. Systematic reviews that incorporate non-randomized studies of medical interventions should include a detailed assessment of RoB for each included study., David Henry and colleagues re-evaluate findings from two systematic reviews using the new ACROBAT-NRSI bias assessment tool for non-randomized studies., Editors' Summary Background In the past, clinicians used their own experience to help them make decisions about the best treatments (interventions) for their patients. Nowadays, “evidence-based medicine”—largely based on findings from randomized controlled trials (RCTs)—guides most clinical decisions. RCTs—studies that compare outcomes in groups of patients chosen at random to receive different interventions—are the best way to assess the efficacy of an intervention (the performance of a treatment under ideal conditions), but individual trials often fail to show a statistically significant difference (a difference unlikely to have arisen by chance) between two interventions. Significant differences between interventions can be detected, however, by undertaking a systematic review (a study that identifies all the RCTs on a given intervention using predefined criteria) and a meta-analysis (a statistical technique for combining, or “synthesizing,” the findings from several independent RCTs). Why Was This Study Done? Systematic reviews of healthcare interventions can also include non-randomized studies, which use administrative databases to identify people receiving different interventions and electronic health records to determine clinical outcomes. However, non-randomized studies of interventions are prone to many “biases” that affect the accuracy of their findings. For example, a potential bias in non-randomized studies is “confounding,” the possibility that an unmeasured characteristic shared by the people receiving a specific intervention, rather than the intervention itself, is responsible for the observed outcome. When undertaking systematic reviews and meta-analyses, it is essential to measure the risk of bias (RoB) in each individual study included in the review and meta-analysis. But, although a widely used tool is available for measuring RoB in RCTs, bias is seldom considered in detail when synthesizing the results of non-randomized studies of interventions. Here, the researchers assess the reliability and usability of ACROBAT-NRSI, a tool developed by Cochrane (an organization that promotes evidence-informed health decision-making) for the assessment of RoB in non-randomized intervention studies. ACROBAT-NRSI assists authors in identifying potential concerns across seven bias domains and assesses the overall RoB of individual non-randomized intervention studies. What Did the Researchers Do and Find? Two of the researchers independently applied the ACROBAT-NRSI process to 37 papers included in two widely cited systematic reviews of non-randomized studies of the relationship between the use of thiazolidinediones (drugs used to treat diabetes, such as rosiglitazone and pioglitazone) and cyclooxygenase-2 (COX-2) inhibitors (nonsteroidal anti-inflammatory drugs [NSAIDs] such as ibuprofen) and major cardiovascular events (heart attack [myocardial infarction] and heart failure). The two researchers largely agreed on their RoB assessments (good inter-rater agreement), which, after training and early experience, took roughly 2.5 hours to complete for each study. In the thiazolidinedione review, six studies had low overall RoB, four had moderate RoB, four had serious RoB, and two had critical RoB. In the COX-2 inhibitor review, two studies low overall RoB, fourteen had moderate RoB, and five had serious RoB. When the researchers restricted meta-analysis to studies with low or moderate RoB, estimates of the pooled relative risks of cardiovascular events with COX-2 inhibitors (compared with no NSAID) changed little, except for a rise in the relative risk associated with ibuprofen. Finally, although the risk estimates for myocardial infarction, heart failure, and death for rosiglitazone compared with pioglitazone remained significantly raised when analyses were confined to studies with low or moderate RoB, there was no significantly increased risk of myocardial infarction when the analysis was confined to studies with low RoB. What Do These Findings Mean? These findings show that there was considerable variability in RoB among the studies included in two systematic reviews of non-randomized intervention studies. Although all 37 studies included in these reviews were originally considered to be of sufficiently high quality for inclusion using less comprehensive—or less RoB-focused—critical appraisal tools, only eight were judged to have low RoB using ACROBAT-NRSI. Notably, exclusion of studies with moderate, serious, or critical RoB resulted in clinically important changes to some of the conclusions of the original reviews. Because the researchers considered only two systematic reviews, their findings may not be generalizable—ACROBAT-NRSI needs further testing across a range of study types. Moreover, because the tool is designed to be used within a team setting, studies are needed to investigate whether the performance of the tool depends on the team’s skill mix. Importantly, however, these findings highlight the importance of including a detailed RoB assessment for each study included in systematic reviews of non-randomized studies of medical interventions. Additional Information This list of resources contains links that can be accessed when viewing the PDF on a device or via the online version of the article at http://dx.doi.org/10.1371/journal.pmed.1001987. More information about ACROBAT-NRSI (A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies of Interventions) is available; the main Cochrane website provides information about Cochrane and its work; the Cochrane Handbook for Systematic Reviews of Interventions has a chapter on including non-randomized studies in systematic reviews Wikipedia has pages on evidence-based medicine, clinical trials, systematic review, and meta-analysis (note that Wikipedia is a free online encyclopedia that anyone can edit; available in several languages) ClinicalTrials.gov, the US National Institutes of Health clinical trials registry, provides additional background information about clinical trials
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- 2015
28. Rationale and design of Ferinject® Assessment in patients with IRon deficiency and chronic Heart Failure (FAIR‐HF) study: a randomized, placebo‐controlled study of intravenous iron supplementation in patients with and without anaemia
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Helmut Drexler, Gerasimos Filippatos, Josep Comin Colet, Barbara von Eisenhart Rothe, Stuart J. Pocock, Claudio Mori, Thomas F. Lüscher, Kenneth Dickstein, Piotr Ponikowski, Stefan D. Anker, Ronnie Willenheimer, and Philip A. Poole-Wilson
- Subjects
Male ,medicine.medical_specialty ,Anemia ,Placebo-controlled study ,Anaemia ,Ferric Compounds ,Gastroenterology ,law.invention ,Clinical Protocols ,Double-Blind Method ,Randomized controlled trial ,Reference Values ,law ,Internal medicine ,medicine ,Humans ,Clinical Trials ,cardiovascular diseases ,Maltose ,Heart Failure ,Ejection fraction ,Anemia, Iron-Deficiency ,biology ,Transferrin saturation ,business.industry ,Iron deficiency ,Ferric carboxymaltose ,medicine.disease ,Chronic heart failure ,Surgery ,Treatment ,Ferritin ,Treatment Outcome ,Research Design ,Heart failure ,Chronic Disease ,Injections, Intravenous ,cardiovascular system ,biology.protein ,Female ,Patient Care ,Cardiology and Cardiovascular Medicine ,business ,Algorithms ,circulatory and respiratory physiology - Abstract
AIMS: Iron deficiency (ID) and anaemia are common in patients with chronic heart failure (CHF). The presence of anaemia is associated with increased morbidity and mortality in CHF, and ID is a major reason for the development of anaemia. Preliminary studies using intravenous (i.v.) iron supplementation alone in patients with CHF and ID have shown improvements in symptom status. FAIR-HF (Clinical Trials.gov NCT00520780) was designed to determine the effect of i.v. iron repletion therapy using ferric carboxymaltose on self-reported patient global assessment (PGA) and New York Heart Association (NYHA) in patients with CHF and ID. METHODS AND RESULTS: This is a multi-centre, randomized, double-blind, placebo-controlled study recruiting ambulatory patients with symptomatic CHF with LVEF < or = 40% (NYHA II) or < or =45% (NYHA III), ID [ferritin
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- 2009
29. Outcomes Research in Cardiovascular Imaging
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James E. Udelson, Frank Peacock, Allen J. Taylor, Philip Greenland, Michael S. Lauer, Robert O. Bonow, Pamela S. Douglas, and Diane E. Bild
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Diagnostic Imaging ,medicine.medical_specialty ,Biomedical Research ,Endpoint Determination ,Consensus Development Conferences as Topic ,Cardiology ,chest pain diagnosis ,Asymptomatic ,Article ,Education ,law.invention ,Coronary artery disease ,Randomized controlled trial ,law ,Internal medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular imaging ,clinical trials ,Framingham Risk Score ,Ejection fraction ,business.industry ,Prognosis ,medicine.disease ,United States ,Clinical trial ,Echocardiography ,Cardiovascular Diseases ,Heart failure ,Practice Guidelines as Topic ,Emergency medicine ,medicine.symptom ,Outcomes research ,National Heart, Lung, and Blood Institute (U.S.) ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
In July of 2008, the National Heart, Lung, and Blood Institute convened experts in noninvasive cardiovascular imaging, outcomes research, statistics, and clinical trials to develop recommendations for future randomized controlled trials of the use of imaging in: 1) screening the asymptomatic patient for coronary artery disease; 2) assessment of patients with stable angina; 3) identification of acute coronary syndromes in the emergency room; and 4) assessment of heart failure patients with chronic coronary artery disease with reduced left ventricular ejection fraction. This study highlights several possible trial designs for each clinical situation.
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- 2009
30. The Effects of Comorbidity on the Benefits and Harms of Treatment for Chronic Disease: A Systematic Review
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Deanna K. Martin, John R. O'Leary, Mark Trentelange, Virginia Towle, Terri R. Fried, and Mary K. Goldstein
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Chronic condition ,lcsh:Medicine ,Disease ,Comorbidity ,030204 cardiovascular system & hematology ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,law ,Chronic Kidney Disease ,Medicine and Health Sciences ,Medicine ,030212 general & internal medicine ,lcsh:Science ,education.field_of_study ,Multidisciplinary ,Research Assessment ,3. Good health ,Systematic review ,Treatment Outcome ,Nephrology ,Research Design ,Cardiovascular Diseases ,Meta-analysis ,Observational Studies ,Research Article ,Risk ,medicine.medical_specialty ,Systematic Reviews ,Population ,MEDLINE ,Cardiology ,Research and Analysis Methods ,03 medical and health sciences ,Diabetes Mellitus ,Humans ,Clinical Trials ,education ,Psychiatry ,Intensive care medicine ,Heart Failure ,business.industry ,lcsh:R ,medicine.disease ,Geriatrics ,Metabolic Disorders ,Chronic Disease ,Kidney Failure, Chronic ,lcsh:Q ,Clinical Medicine ,business - Abstract
Background There are concerns about the potential for unintentional harms when clinical practice guidelines are applied to patients with multimorbidity. The objective was to summarize the evidence regarding the effect(s) of comorbidity on the outcomes of medication for an index chronic condition. Methods A systematic review was conducted of studies published in MEDLINE and Cochrane Trials before May 2012. The search strategy was constructed to identify articles indexed with “comorbidity” or a related term or by a given condition and one or more additional specified comorbid conditions. The search yielded 3252 articles, of which 37 passed the title/abstract screening process, and 22 were included after full-text review. An additional 23 articles were identified by screening the reference lists for included articles. Information was extracted on study design; population; therapy; comparison groups; outcome(s); main findings. Findings Indexing of articles was inconsistent, with no term for “multimorbidity,” and rare use of “comorbidity”. Only one article examined the effects of comorbidity per se, finding no benefit of tight control of DM among persons with high comorbidity, defined using a comorbidity index. The remainder examined pairs of conditions, the majority of which were post-hoc analyses of randomized controlled trials and which found no difference in outcomes according to whether a comorbid condition was present. Several demonstrated no difference or an increased risk of adverse outcome among persons with DM and tight control of HTN as compared to usual control. Several demonstrated lack of benefit of statins among persons with end-stage renal disease. Conclusions There is limited evidence regarding the effects of multiple comorbidities on treatment outcomes. The majority of studies demonstrated no effect of a single comorbid condition on outcomes. Additional studies examining a broad range of comorbidity are required, along with clear and consistent indexing to allow for improved synthesis of the evidence.
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- 2014
31. Effects of physician-nurse substitution on clinical parameters: a systematic review and meta-analysis
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Stefan Markun, Sima Djalali, Nahara Anani Martínez-González, Flore Huber-Geismann, Ryan Tandjung, Thomas Rosemann, and University of Zurich
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Viral Diseases ,Non-Clinical Medicine ,Pulmonology ,Health Care Providers ,lcsh:Medicine ,Nurses ,Cochrane Library ,Cardiovascular ,law.invention ,Endocrinology ,Randomized controlled trial ,law ,Medicine ,lcsh:Science ,Randomized Controlled Trials as Topic ,Multidisciplinary ,Parkinson Disease ,Systematic review ,Infectious Diseases ,Neurology ,Meta-analysis ,Hypertension ,Research Article ,11035 Institute of General Practice ,Risk ,Systematic Reviews ,Clinical Research Design ,Cerebrovascular Diseases ,MEDLINE ,610 Medicine & health ,1100 General Agricultural and Biological Sciences ,CINAHL ,Nursing ,1300 General Biochemistry, Genetics and Molecular Biology ,Physicians ,Humans ,Clinical Trials ,Primary Care ,Heart Failure ,Diabetic Endocrinology ,1000 Multidisciplinary ,Primary Health Care ,business.industry ,lcsh:R ,HIV ,Diabetes Mellitus Type 1 ,Diabetes Mellitus Type 2 ,Asthma ,Blood pressure ,Relative risk ,lcsh:Q ,Meta-Analyses ,business - Abstract
BACKGROUND: Physicians' shortage in many countries and demands of high-quality and affordable care make physician-nurse substitution an appealing workforce strategy. The objective of this study is to conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the impact of physician-nurse substitution in primary care on clinical parameters. METHODS: We systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected peer-reviewed RCTs comparing physician-led care with nurse-led care on changes in clinical parameters. Study selection and data extraction were performed in duplicate by independent reviewers. We assessed the individual study risk of bias; calculated the study-specific and pooled relative risks (RR) or weighted mean differences (WMD); and performed fixed-effects meta-analyses. RESULTS: 11 RCTs (N = 30,247) were included; most were from Europe, generally small with higher risk of bias. In all studies, nurses provided care for complex conditions including HIV, hypertension, heart failure, cerebrovascular diseases, diabetes, asthma, Parkinson's disease and incontinence. Meta-analyses showed greater reductions in systolic blood pressure (SBP) in favour of nurse-led care (WMD -4.27 mmHg, 95% CI -6.31 to -2.23) but no statistically significant differences between groups in the reduction of diastolic blood pressure (DBP) (WMD -1.48 mmHg, 95%CI -3.05 to -0.09), total cholesterol (TC) (WMD -0.08 mmol/l, 95%CI -0.22 to 0.07) or glycosylated haemoglobin (WMD 0.12%HbAc1, 95%CI -0.13 to 0.37). Of other 32 clinical parameters identified, less than a fifth favoured nurse-led care while 25 showed no significant differences between groups. LIMITATIONS: disease-specific interventions from a small selection of healthcare systems, insufficient quantity and quality of studies, many different parameters. CONCLUSIONS: trained nurses appeared to be better than physicians at lowering SBP but similar at lowering DBP, TC or HbA1c. There is insufficient evidence that nurse-led care leads to better outcomes of other clinical parameters than physician-led care.
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- 2013
32. Baseline characteristics of patients in the Reduction of Events with Darbepoetin alfa in Heart Failure trial (RED-HF)
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McMurray, J.J.V., Anand, I. S., Diaz, R., Maggioni, A. P., O'Connor, C., Pfeffer, M. A., Solomon, S. D., Tendera, M., van Veldhuisen, D. J., Albizem, M., Cheng, S., Scarlata, D., Swedberg, K., Young, J. B., Amuchastegui, M., Belziti, C., Bluguermann, J., Caccavo, M., Cartasegna, L., Colque, R., Cuneo, C., Fernandez, A., Gabito, A., Goicochea, R., Gonzalez, M., Gorosito, V., Grinfeld, L., Hominal, M., Kevorkian, R., Litvak Bruno, M., Llanos, J., Mackinnon, I., Manuale, O., Marzetti, E., Nul, D., Perna, E., Riccitelli, M., Sanchez, A., Santos, D., Schygiel, P., Toblli, J., Vogel, D., Aggarwal, A., Amerena, J., De Looze, F., Fletcher, P., Hare, D., Ireland, M., Krum, H., Lattimore, J., Marwick, T., Sindone, A., Thompson, P., Waites, J., Altenberger, J., Ebner, C., Lenz, K., Pacher, R., Poelzl, G., Charlier, F., de Ceuninck, M., De Keulenaer, G., Dendale, P., Marechal, P., Mullens, W., Thoeng, J., Vanderheyden, M., Vanhaecke, J., Weytjens, C., Wollaert, B., Albuquerque, D., Almeida, D., Aspe y Rosas, J., Bocchi, E., Bordignon, S., Clausell, N., Kaiser, S., Leaes, P., Martins Alves, S., Montera, M., Moura, L., Pereira de Castro, R., Rassi, S., Reis, A., Saraiva, J., Simoes, M., Souza Neto, J., Teixeira, M., Benov, H., Chompalova, B., Donova, T., Georgiev, P., Gotchev, D., Goudev, A., Grigorov, M., Guenova, D., Hergeldjieva, V., Ivanov, D., Kostova, E., Manolova, A., Marchev, S., Nikolov, F., Popov, A., Raev, D., Tzekova, M., Czarnecki, W., Giannetti, N., Haddad, H., Heath, J., Huynh, T., Lepage, S., Liu, P., Lonn, E., Ma, P., Manyari, D., Moe, G., Parker, J., Pesant, Y., Rajda, M., Ricci, J., Roth, S., Sestier, F., Sluzar, V., Sussex, B., Vizel, S., Antezana, G., Bugueno, C., Castro, P., Conejeros, C., Manriquez, L., Martinez, D., Potthoff, S., Stockins, B., Vukasovic, J., Gregor, P., Herold, M., Jerabek, O., Jirmar, R., Kuchar, R., Linhart, A., Podzemska, B., Soucek, M., Spac, J., Spacek, R., Vodnansky, P., Bronnum-Schou, J., Clemmensen, K., Egstrup, K., Jensen, G., Kjoller-Hansen, L., Kober, L., Markenvard, J., Rokkedal, J., Skagen, K., Torp-Pedersen, C., Tuxen, C., Videbak, L., Laks, T., Vahula, V., Harjola, V., Kettunen, R., Kotila, M., Bauer, F., Cohen Solal, A., Coisne, D., Davy, J., De Groote, P., Dos Santos, P., Funck, F., Galinier, M., Gibelin, P., Isnard, R., Neuder, Y., Roul, G., Sabatier, R., Trochu, J., Anker, S., Denny, S., Dreykluft, T., Flesch, M., Genth-Zotz, S., Hambrecht, R., Hein, J., Jeserich, M., John, M., Kreider-Stempfle, H., Laufs, U., Muellerleile, K., Natour, M., Sandri, M., Schaufele, T., von Hodenberg, E., Weyland, K., Winkelmann, B., Tse, H., Yan, B., Barsi, B., Csikasz, J., Dezsi, C., Edes, I., Forster, T., Karpati, P., Kerekes, C., Kis, E., Kosa, I., Lupkovics, G., Nagy, A., Preda, I., Ronaszeki, A., Tomcsanyi, J., Zamolyi, K., Agarwal, D., Bahl, V., Bordoloi, A., Chockalingam, K., Chopda, M., Chopra, V., Dugal, J., Ghaisas, N., Ghosh, S., Grant, P., Hiremath, S., Iyengar, S., Jagadeesa Subramania, B., Jain, P., Joshi, A., Khan, A., Mullasari, A., Naik, S., Oomman, A., Pai, V., Pareppally Gopal, R., Parikh, K., Patel, T., Prakash, V., Sastry, B., Sathe, S., Sinha, N., Srikanthan, V., Subburamakrishnan, P., Thacker, H., Wander, G., Admon, D., Katz, A., Klainman, E., Lewis, B., Marmor, A., Moriel, M., Mosseri, M., Shotan, A., Weinstein, J., Zimlichman, R., Agostoni, P., Albanese, M., Alunni, G., Bini, R., Boccanelli, A., Bolognese, L., Campana, C., Carbonieri, E., Carpino, C., Checco, L., Cosmi, F., D'Angelo, G., De Cristofaro, M., Floresta, A., Fucili, A., Galvani, M., Ivleva, A., Marra, S., Musca, G., Peccerillo, N., Perrone Filardi, P., Picchio, E., Russo, T., Scelsi, L., Senni, M., Tavazzi, L., Erglis, A., Jasinkevica, I., Kakurina, N., Veze, I., Volans, E., Bagdonas, A., Berukstis, E., Celutkiene, J., Dambrauskaite, A., Jarasuniene, D., Luksiene, D., Rudys, A., Sakalyte, G., Sliaziene, S., Aguilar-Romero, R., Cardona-Munoz, E., Castro-Jimenez, J., Chavez-Herrera, J., Chuquiure Valenzuela, E., De la Pena, G., Herrera, E., Leiva-Pons, J., Lopez Alvarado, A., Mendez Machado, G., Ramos-Lopez, G., Basart, D., Buijs, E., Cornel, J., de Leeuw, M., Dijkgraaf, R., Dunselman, P., Freericks, M., Hamraoui, K., Lenderlink, T., Linssen, G., Lodewick, P., Lodewijks, C., Lok, D., Nierop, P., Ronner, E., Somsen, A., van Dantzig, J., van der Burgh, P., van Kempen, L., van Vlies, B., Voors, A., Wardeh, A., Willems, F., Dickstein, K., Gundersen, T., Hole, T., Thalamus, J., Westheim, A., Dabrowski, M., Gorski, J., Korewicki, J., Kuc, K., Miekus, P., Musial, W., Niegowska, J., Piotrowski, W., Podolec, P., Polonski, L., Ponikowski, P., Rynkiewicz, A., Szelemej, R., Trusz-Gluza, M., Ujda, M., Wojciechowski, D., Wysokinski, A., Camacho, A., Fonseca, C., Monteiro, P., Apetrei, E., Bruckner, I., Carasca, E., Coman, I., Datcu, M., Dragulescu, S., Ionescu, P., Iordachescu-Petica, D., Manitiu, I., Popa, V., Pop-Moldovan, A., Radoi, M., Stamate, S., Tomescu, M., Vita, I., Aroutiounov, G., Ballyuzek, M., Bart, B., Churina, S., Glezer, M., Goloshchekin, B., Kobalava, Z., Kostenko, V., Lopatin, Y., Martynov, A., Orlov, V., Semernin, E., Shogenov, Z., Sidorenko, B., Skvortsov, A., Storzhakov, G., Sulimov, V., Talibov, O., Tereshenko, S., Tsyrline, V., Zadionchenko, V., Zateyshchikov, D., Dzupina, A., Hranai, M., Kmec, J., Micko, K., Murin, J., Pella, D., Sojka, G., Spisak, V., Vahala, P., Vinanska, D., Badat, A., Bayat, J., Dawood, S., Delport, E., Ellis, G., Garda, R., Klug, E., Mabin, T., Naidoo, D., Pretorius, M., Ranjith, N., Van Zyl, L., Weich, H., Anguita, M., Berrazueta, J., Bruguera i Cortada, J., de Teresa, E., Gomez Sanchez, M., Gonzalez Juanatey, J., Gonzalez-Maqueda, I., Jordana, R., Lupon, J., Manzano, L., Pascual Figal, D., Pulpon, L., Recio, J., Ridocci Soriano, F., Rodriguez Lambert, J., Roig Minguell, E., Romero, J., Valdovinos, P., Klintberg, L., Kronvall, T., Lycksell, M., Morner, S., Rydberg, E., Timberg, I., Wikstrom, G., Moccetti, T., Ashok, J., Banerjee, P., Carr-White, G., Cleland, J., Connolly, E., Francis, M., Greenbaum, R., Kadr, H., Lindsay, S., McMurray, J., Megarry, S., Memon, A., Murdoch, D., Senior, R., Squire, I., Tan, L., Witte, K., Adams, K., Adamson, P., Adler, A., Altschul, L., Altschuller, A., Amirani, H., Anand, I., Andreou, C., Ansari, M., Antonishen, M., Banchs, H., Banerjee, S., Banish, D., Bank, A., Barbagelata, A., Barnard, D., Bellinger, R., Benn, A., Berk, M., Berry, B., Bethala, V., Bilazarian, S., Bisognano, J., Bleyer, F., Blum, M., Boehmer, J., Bouchard, A., Boyle, A., Bozkurt, B., Brown, C., Burlew, B., Burnham, K., Butler, J., Call, J., Cambier, P., Cappola, T., Carlson, R., Chandler, B., Chandra, R., Chandraratna, P., Chernick, R., Colan, D., Colfer, H., Colucci, W., Connelly, T., Costantini, O., Dadkhah, S., Dauber, I., Davis, J., Davis, S., Denning, S., Drazner, M., Dunlap, S., Egbujiobi, L., Elkayam, U., Elliott, J., El-Shahawy, M., Essandoh, L., Ewald, G., Fang, J., Farhoud, H., Felker, G., Fernandez, J., Festin, R., Fishbein, G., Florea, V., Flores, E., Floro, J., Gabris, M., Garg, M., Gatewood, R., Geller, M., Ghali, J., Ghumman, W., Gibbs, G., Gillespie, E., Gilmore, R., Gogia, H., Goldberg, L., Gradus-Pizlo, I., Grainger, T., Gudmundsson, G., Gunawardena, D., Gupta, D., Hack, T., Hall, S., Hamroff, G., Hankins, S., Hanna, M., Hargrove, J., Haught, W., Hauptman, P., Hazelrigg, M., Herzog, C., Heywood, J., Hill, T., Hilton, T., Hirsch, H., Hunter, J., Ibrahim, H., Imburgia, M., Iteld, B., Jackson, B., Jaffrani, N., Jain, D., Jain, A., James, M., Jimenez, J., Johnson, E., Kale, P., Kaneshige, A., Kapadia, S., Karia, D., Karlsberg, R., Katholi, R., Kerut, E., Khoury, W., Kipperman, R., Klapholz, M., Kosinski, E., Kozinn, M., Kraus, D., Krueger, S., Kumar, S., Lader, E., Lee, C., Levy, W., Lewis, E., Light-McGroary, K., Loh, I., Lombardi, W., Machado, C., Maislos, F., Mancini, D., Markus, T., Mather, P., McCants, K., McGrew, F., McLaurin, B., McMillan, E., McNamara, D., Meyer, T., Meymandi, S., Miller, A., Minami, E., Modi, M., Mody, F., Mohanty, P., Moscoso, R., Moskowitz, R., Moustafa, M., Mullen, M., Naz, T., Noonan, T., O'Brien, T., Oellerich, W., Oren, R., Pamboukian, S., Pereira, N., Pitt, W., Porter, C., Prabhu, S., Promisloff, S., Ratkovec, R., Richardson, R., Ross, A., Saleh, N., Saltzberg, M., Sarkar, S., Schmedtje, J., Schneider, R., Schuyler, G., Shanes, J., Sharma, A., Siegel, C., Siegel, R., Silber, D., Singh, V., Singh, N., Singh, J., Sklar, J., Small, R., Smith, A., Smith, E., Smull, D., Sotolongo, R., Staniloae, C., Stapleton, D., Steele, P., Stehlik, J., Stein, M., Tang, W., Thadani, U., Torre-Amoine, G., Trichon, B., Tsai, C., Tummala, R., Van Bakel, A., Vicari, R., Vijay, N., Vijayaraghavan, K., Vittorio, T., Vossler, M., Wagoner, L., Wallis, D., Ward, N., Widmer, M., Wight, J., Wilkins, C., Williams, C., Williams, G., Winchester, M., Winkel, E., Wittmer, B., Wood, D., Wormer, D., Wright, R., Xu, Z., Yasin, M., Zolty, R., J. J. V., Mcmurray, I. S., Anand, R., Diaz, A. P., Maggioni, C., O'Connor, M. A., Pfeffer, S. D., Solomon, M., Tendera, D. J., van Veldhuisen, M., Albizem, S., Cheng, D., Scarlata, K., Swedberg, J. B., Young, M., Amuchastegui, C., Belziti, J., Bluguermann, M., Caccavo, L., Cartasegna, R., Colque, C., Cuneo, A., Fernandez, A., Gabito, R., Goicochea, M., Gonzalez, V., Gorosito, L., Grinfeld, M., Hominal, R., Kevorkian, M., Litvak Bruno, J., Llano, I., Mackinnon, O., Manuale, E., Marzetti, D., Nul, E., Perna, M., Riccitelli, A., Sanchez, D., Santo, P., Schygiel, J., Toblli, D., Vogel, A., Aggarwal, J., Amerena, F., De Looze, P., Fletcher, D., Hare, M., Ireland, H., Krum, J., Lattimore, T., Marwick, A., Sindone, P., Thompson, J., Waite, J., Altenberger, C., Ebner, K., Lenz, R., Pacher, G., Poelzl, F., Charlier, M., de Ceuninck, G., De Keulenaer, P., Dendale, P., Marechal, W., Mullen, J., Thoeng, M., Vanderheyden, J., Vanhaecke, C., Weytjen, B., Wollaert, D., Albuquerque, D., Almeida, J. Aspe y., Rosa, E., Bocchi, S., Bordignon, N., Clausell, S., Kaiser, P., Leae, S., Martins Alve, M., Montera, L., Moura, R., Pereira de Castro, S., Rassi, A., Rei, J., Saraiva, M., Simoe, J., Souza Neto, M., Teixeira, H., Benov, B., Chompalova, T., Donova, P., Georgiev, D., Gotchev, A., Goudev, M., Grigorov, D., Guenova, V., Hergeldjieva, D., Ivanov, E., Kostova, A., Manolova, S., Marchev, F., Nikolov, A., Popov, D., Raev, M., Tzekova, W., Czarnecki, N., Giannetti, H., Haddad, J., Heath, T., Huynh, S., Lepage, P., Liu, E., Lonn, P., Ma, D., Manyari, G., Moe, J., Parker, Y., Pesant, M., Rajda, J., Ricci, S., Roth, F., Sestier, V., Sluzar, B., Sussex, S., Vizel, G., Antezana, C., Bugueno, P., Castro, C., Conejero, L., Manriquez, D., Martinez, S., Potthoff, B., Stockin, J., Vukasovic, P., Gregor, M., Herold, O., Jerabek, R., Jirmar, R., Kuchar, A., Linhart, B., Podzemska, M., Soucek, J., Spac, R., Spacek, P., Vodnansky, J., Bronnum Schou, K., Clemmensen, K., Egstrup, G., Jensen, L., Kjoller Hansen, L., Kober, J., Markenvard, J., Rokkedal, K., Skagen, C., Torp Pedersen, C., Tuxen, L., Videbak, T., Lak, V., Vahula, V., Harjola, R., Kettunen, M., Kotila, F., Bauer, A., Cohen Solal, D., Coisne, J., Davy, P., De Groote, P., Dos Santo, F., Funck, M., Galinier, P., Gibelin, R., Isnard, Y., Neuder, G., Roul, R., Sabatier, J., Trochu, S., Anker, S., Denny, T., Dreykluft, M., Flesch, S., Genth Zotz, R., Hambrecht, J., Hein, M., Jeserich, M., John, H., Kreider Stempfle, U., Lauf, K., Muellerleile, M., Natour, M., Sandri, T., Schaufele, E., von Hodenberg, K., Weyland, B., Winkelmann, H., Tse, B., Yan, B., Barsi, J., Csikasz, C., Dezsi, I., Ede, T., Forster, P., Karpati, C., Kereke, E., Ki, I., Kosa, G., Lupkovic, A., Nagy, I., Preda, A., Ronaszeki, J., Tomcsanyi, K., Zamolyi, D., Agarwal, V., Bahl, A., Bordoloi, K., Chockalingam, M., Chopda, V., Chopra, J., Dugal, N., Ghaisa, S., Ghosh, P., Grant, S., Hiremath, S., Iyengar, B., Jagadeesa Subramania, P., Jain, A., Joshi, A., Khan, A., Mullasari, S., Naik, A., Oomman, V., Pai, R., Pareppally Gopal, K., Parikh, T., Patel, V., Prakash, B., Sastry, S., Sathe, N., Sinha, V., Srikanthan, P., Subburamakrishnan, H., Thacker, G., Wander, D., Admon, A., Katz, E., Klainman, B., Lewi, A., Marmor, M., Moriel, M., Mosseri, A., Shotan, J., Weinstein, R., Zimlichman, P., Agostoni, M., Albanese, G., Alunni, R., Bini, A., Boccanelli, L., Bolognese, C., Campana, E., Carbonieri, C., Carpino, L., Checco, F., Cosmi, G., D'Angelo, M., De Cristofaro, A., Floresta, A., Fucili, M., Galvani, A., Ivleva, S., Marra, G., Musca, N., Peccerillo, PERRONE FILARDI, Pasquale, E., Picchio, T., Russo, L., Scelsi, M., Senni, L., Tavazzi, A., Ergli, I., Jasinkevica, N., Kakurina, I., Veze, E., Volan, A., Bagdona, E., Beruksti, J., Celutkiene, A., Dambrauskaite, D., Jarasuniene, D., Luksiene, A., Rudy, G., Sakalyte, S., Sliaziene, R., Aguilar Romero, E., Cardona Munoz, J., Castro Jimenez, J., Chavez Herrera, E., Chuquiure Valenzuela, G., De la Pena, E., Herrera, J., Leiva Pon, A., Lopez Alvarado, G., Mendez Machado, G., Ramos Lopez, D., Basart, E., Buij, J., Cornel, M., de Leeuw, R., Dijkgraaf, P., Dunselman, M., Freerick, K., Hamraoui, T., Lenderlink, G., Linssen, P., Lodewick, C., Lodewijk, D., Lok, P., Nierop, E., Ronner, A., Somsen, J., van Dantzig, P., van der Burgh, L., van Kempen, B., van Vlie, A., Voor, A., Wardeh, F., Willem, K., Dickstein, T., Gundersen, T., Hole, J., Thalamu, A., Westheim, M., Dabrowski, J., Gorski, J., Korewicki, K., Kuc, P., Mieku, W., Musial, J., Niegowska, W., Piotrowski, P., Podolec, L., Polonski, P., Ponikowski, A., Rynkiewicz, R., Szelemej, M., Trusz Gluza, M., Ujda, D., Wojciechowski, A., Wysokinski, A., Camacho, C., Fonseca, P., Monteiro, E., Apetrei, I., Bruckner, E., Carasca, I., Coman, M., Datcu, S., Dragulescu, P., Ionescu, D., Iordachescu Petica, I., Manitiu, V., Popa, A., Pop Moldovan, M., Radoi, S., Stamate, M., Tomescu, I., Vita, G., Aroutiounov, M., Ballyuzek, B., Bart, S., Churina, M., Glezer, B., Goloshchekin, Z., Kobalava, V., Kostenko, Y., Lopatin, A., Martynov, V., Orlov, E., Semernin, Z., Shogenov, B., Sidorenko, A., Skvortsov, G., Storzhakov, V., Sulimov, O., Talibov, S., Tereshenko, V., Tsyrline, V., Zadionchenko, D., Zateyshchikov, A., Dzupina, M., Hranai, J., Kmec, K., Micko, J., Murin, D., Pella, G., Sojka, V., Spisak, P., Vahala, D., Vinanska, A., Badat, J., Bayat, S., Dawood, E., Delport, G., Elli, R., Garda, E., Klug, T., Mabin, D., Naidoo, M., Pretoriu, N., Ranjith, L., Van Zyl, H., Weich, M., Anguita, J., Berrazueta, J. Bruguera i., Cortada, E., de Teresa, M., Gomez Sanchez, J., Gonzalez Juanatey, I., Gonzalez Maqueda, R., Jordana, J., Lupon, L., Manzano, D., Pascual Figal, L., Pulpon, J., Recio, F., Ridocci Soriano, J., Rodriguez Lambert, E., Roig Minguell, J., Romero, P., Valdovino, L., Klintberg, T., Kronvall, M., Lycksell, S., Morner, E., Rydberg, I., Timberg, G., Wikstrom, T., Moccetti, J., Ashok, P., Banerjee, G., Carr White, J., Cleland, E., Connolly, M., Franci, R., Greenbaum, H., Kadr, S., Lindsay, J., Mcmurray, S., Megarry, A., Memon, D., Murdoch, R., Senior, I., Squire, L., Tan, K., Witte, K., Adam, P., Adamson, A., Adler, L., Altschul, A., Altschuller, H., Amirani, I., Anand, C., Andreou, M., Ansari, M., Antonishen, H., Banch, S., Banerjee, D., Banish, A., Bank, A., Barbagelata, D., Barnard, R., Bellinger, A., Benn, M., Berk, B., Berry, V., Bethala, S., Bilazarian, J., Bisognano, F., Bleyer, M., Blum, J., Boehmer, A., Bouchard, A., Boyle, B., Bozkurt, C., Brown, B., Burlew, K., Burnham, J., Butler, J., Call, P., Cambier, T., Cappola, R., Carlson, B., Chandler, R., Chandra, P., Chandraratna, R., Chernick, D., Colan, H., Colfer, W., Colucci, T., Connelly, O., Costantini, S., Dadkhah, I., Dauber, J., Davi, S., Davi, S., Denning, M., Drazner, S., Dunlap, L., Egbujiobi, U., Elkayam, J., Elliott, M., El Shahawy, L., Essandoh, G., Ewald, J., Fang, H., Farhoud, G., Felker, J., Fernandez, R., Festin, G., Fishbein, V., Florea, E., Flore, J., Floro, M., Gabri, M., Garg, R., Gatewood, M., Geller, J., Ghali, W., Ghumman, G., Gibb, E., Gillespie, R., Gilmore, H., Gogia, L., Goldberg, I., Gradus Pizlo, T., Grainger, G., Gudmundsson, D., Gunawardena, D., Gupta, T., Hack, S., Hall, G., Hamroff, S., Hankin, M., Hanna, J., Hargrove, W., Haught, P., Hauptman, M., Hazelrigg, C., Herzog, J., Heywood, T., Hill, T., Hilton, H., Hirsch, J., Hunter, H., Ibrahim, M., Imburgia, B., Iteld, B., Jackson, N., Jaffrani, D., Jain, A., Jain, M., Jame, J., Jimenez, E., Johnson, P., Kale, A., Kaneshige, S., Kapadia, D., Karia, R., Karlsberg, R., Katholi, E., Kerut, W., Khoury, R., Kipperman, M., Klapholz, E., Kosinski, M., Kozinn, D., Krau, S., Krueger, S., Kumar, E., Lader, C., Lee, W., Levy, E., Lewi, K., Light McGroary, I., Loh, W., Lombardi, C., Machado, F., Maislo, D., Mancini, T., Marku, P., Mather, K., Mccant, F., Mcgrew, B., Mclaurin, E., Mcmillan, D., Mcnamara, T., Meyer, S., Meymandi, A., Miller, E., Minami, M., Modi, F., Mody, P., Mohanty, R., Moscoso, R., Moskowitz, M., Moustafa, M., Mullen, T., Naz, T., Noonan, T., O'Brien, W., Oellerich, R., Oren, S., Pamboukian, N., Pereira, W., Pitt, C., Porter, S., Prabhu, S., Promisloff, R., Ratkovec, R., Richardson, A., Ro, N., Saleh, M., Saltzberg, S., Sarkar, J., Schmedtje, R., Schneider, G., Schuyler, J., Shane, A., Sharma, C., Siegel, R., Siegel, D., Silber, V., Singh, N., Singh, J., Singh, J., Sklar, R., Small, A., Smith, E., Smith, D., Smull, R., Sotolongo, C., Staniloae, D., Stapleton, P., Steele, J., Stehlik, M., Stein, W., Tang, U., Thadani, G., Torre Amoine, B., Trichon, C., Tsai, R., Tummala, A., Van Bakel, R., Vicari, N., Vijay, K., Vijayaraghavan, T., Vittorio, M., Vossler, L., Wagoner, D., Walli, N., Ward, M., Widmer, J., Wight, C., Wilkin, C., William, G., William, M., Winchester, E., Winkel, B., Wittmer, D., Wood, D., Wormer, R., Wright, Z., Xu, M., Yasin, R., Zolty, Faculteit Medische Wetenschappen/UMCG, and Cardiovascular Centre (CVC)
- Subjects
Male ,CHRONIC KIDNEY-DISEASE ,Darbepoetin alfa ,medicine.medical_treatment ,heart failure ,Ciencias de la Salud ,Comorbidity ,Severity of Illness Index ,law.invention ,DOUBLE-BLIND ,Randomized controlled trial ,law ,Interquartile range ,Cause of Death ,Medicine ,Cause of death ,Aged, 80 and over ,Clinical Trials as Topic ,CARDIAC-RESYNCHRONIZATION THERAPY ,HEALTH-STATUS ,Ética Médica ,Middle Aged ,RANDOMIZED CONTROLLED-TRIAL ,Hospitalization ,IRON-DEFICIENCY ,Treatment Outcome ,purl.org/becyt/ford/3 [https] ,Female ,TREATMENT OPTIONS ,Cardiology and Cardiovascular Medicine ,medicine.drug ,medicine.medical_specialty ,CIENCIAS MÉDICAS Y DE LA SALUD ,Anemia ,Cardiac resynchronization therapy ,Heart failure ,Anaemia ,purl.org/becyt/ford/3.3 [https] ,Double-Blind Method ,Internal medicine ,Humans ,Clinical Trials ,ANEMIA ,Erythropoietin ,Aged ,Demography ,anaemia ,business.industry ,MORTALITY ,medicine.disease ,MORBIDITY CHARM PROGRAM ,Clinical trial ,Hematinics ,Physical therapy ,CAUSA DA MORTE ,business - Abstract
AIMS: This report describes the baseline characteristics of patients in the Reduction of Events with Darbepoetin alfa in Heart Failure trial (RED-HF) which is testing the hypothesis that anaemia correction with darbepoetin alfa will reduce the composite endpoint of death from any cause or hospital admission for worsening heart failure, and improve other outcomes. METHODS AND RESULTS: Key demographic, clinical, and laboratory findings, along with baseline treatment, are reported and compared with those of patients in other recent clinical trials in heart failure. Compared with other recent trials, RED-HF enrolled more elderly [mean age 70 (SD 11.4) years], female (41%), and black (9%) patients. RED-HF patients more often had diabetes (46%) and renal impairment (72% had an estimated glomerular filtration rate < 60 mL/min/1.73 m2). Patients in RED-HF had heart failure of longer duration [5.3 (5.4) years], worse NYHA class (35% II, 63% III, and 2% IV), and more signs of congestion. Mean EF was 30% (6.8%). RED-HF patients were well treated at randomization, and pharmacological therapy at baseline was broadly similar to that of other recent trials, taking account of study-specific inclusion/exclusion criteria. Median (interquartile range) haemoglobin at baseline was 112 (106-117) g/L. CONCLUSION: The anaemic patients enrolled in RED-HF were older, moderately to markedly symptomatic, and had extensive co-morbidity. Fil: McMurray, John J. V.. University of Glasgow; Reino Unido Fil: Anand, Inder S.. University of Minnesota; Estados Unidos Fil: Diaz, Rafael. Estudios Clínicos Latinoamérica; Argentina Fil: Maggioni, Aldo P.. Associazione Nazionale Medici Cardiologi Ospedalieri; Italia Fil: O'Connor, Christopher. University of Duke; Estados Unidos Fil: Pfeffer, Marc A.. Brigham and Women’s Hospita; Estados Unidos Fil: Solomon, Scott D.. Brigham and Women’s Hospital; Estados Unidos Fil: Tendera, Micha. Medical University of Silesia; Polonia Fil: van Veldhuisen, Dirk J.. University of Groningen; Países Bajos Fil: Moetaz, Albizem. Amgen Inc.; Estados Unidos Fil: Cheng, Sunfa. Amgen Inc.; Estados Unidos Fil: Scarlata, Debra. Amgen Inc.; Estados Unidos Fil: Swedberg, Karl. University of Gothenburg; Suecia Fil: Young, James B.. Cleveland Clinic. Endocrinology and Metabolism Institute; Estados Unidos Fil: Toblli, Jorge Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: RED-HF Committees Investigators. No especifíca
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- 2013
33. Natriuretic Peptide-Guided Therapy in Chronic Heart Failure: A Meta-Analysis of 2,686 Patients in 12 Randomized Trials
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Francesco Gambardella, Dario Leosco, Gianluigi Savarese, Maria Prastaro, Santo Dellegrottaglie, Bruno Trimarco, Pasquale Perrone-Filardi, Giuseppe Rengo, Savarese, G, Trimarco, Bruno, Dellegrottaglie, S, Prastaro, M, Gambardella, F, Rengo, G, Leosco, Dario, and PERRONE FILARDI, Pasquale
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Male ,Cardiovascular ,law.invention ,Randomized controlled trial ,law ,Natriuretic Peptide, Brain ,Natriuretic peptide ,Odds Ratio ,Randomized Controlled Trials as Topic ,Multidisciplinary ,Mortality rate ,Clinical Pharmacology ,Drug Information ,Age Factors ,Middle Aged ,Brain natriuretic peptide ,Interventional Cardiology ,Hospitalization ,Treatment Outcome ,Meta-analysis ,Cardiology ,Medicine ,Female ,Natriuretic Agents ,Cardiology and Cardiovascular Medicine ,Research Article ,medicine.medical_specialty ,Drugs and Devices ,medicine.drug_class ,Clinical Research Design ,Science ,Cardiovascular Pharmacology ,Pharmacotherapy ,Diagnostic Medicine ,Internal medicine ,medicine ,Humans ,Clinical Trials ,Intensive care medicine ,Aged ,Heart Failure ,business.industry ,Surrogate endpoint ,Odds ratio ,medicine.disease ,Peptide Fragments ,Heart failure ,Chronic Disease ,Meta-Analyses ,business - Abstract
BackgroundThe role of cardiac natriuretic peptides in the management of patients with chronic heart failure (HF) remains uncertain. The purpose of this study was to evaluate whether natriuretic peptide-guided therapy, compared to clinically-guided therapy, improves mortality and hospitalization rate in patients with chronic HF.Methodology/principal findingsMEDLINE, Cochrane, ISI Web of Science and SCOPUS databases were searched for articles reporting natriuretic peptide-guided therapy in HF until August 2012. All randomized trials reporting clinical end-points (all-cause mortality and/or HF-related hospitalization and/or all-cause hospitalization) were included. Meta-analysis was performed to assess the influence of treatment on outcomes. Sensitivity analysis was performed to test the influence of potential effect modifiers and of each trial included in meta-analysis on results. Twelve trials enrolling 2,686 participants were included. Natriuretic peptide-guided therapy (either B-type natriuretic peptide [BNP]- or N-terminal pro-B-type natriuretic peptide [NT-proBNP]-guided therapy) significantly reduced all-cause mortality (Odds Ratio [OR]:0.738; 95% Confidence Interval [CI]:0.596 to 0.913; p = 0.005) and HF-related hospitalization (OR:0.554; CI:0.399 to 0.769; p = 0.000), but not all-cause hospitalization (OR:0.803; CI:0.629 to 1.024; p = 0.077). When separately assessed, NT-proBNP-guided therapy significantly reduced all-cause mortality (OR:0.717; CI:0.563 to 0.914; p = 0.007) and HF-related hospitalization (OR:0.531; CI:0.347 to 0.811; p = 0.003), but not all-cause hospitalization (OR:0.779; CI:0.414 to 1.465; p = 0.438), whereas BNP-guided therapy did not significantly reduce all-cause mortality (OR:0.814; CI:0.518 to 1.279; p = 0.371), HF-related hospitalization (OR:0.599; CI:0.303 to 1.187; p = 0.142) or all-cause hospitalization (OR:0.726; CI:0.509 to 1.035; p = 0.077). [corrected].Conclusions/significanceUse of cardiac peptides to guide pharmacologic therapy significantly reduces mortality and HF related hospitalization in patients with chronic HF. In particular, NT-proBNP-guided therapy reduced all-cause mortality and HF-related hospitalization but not all-cause hospitalization, whereas BNP-guided therapy did not significantly reduce both mortality and morbidity.
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- 2013
34. Biomarker-guided therapies in heart failure: a forum for unified strategies
- Author
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Pieter Muntendam, Michael R. Bristow, Ileana L. Piña, Faiez Zannad, Mona Fiuzat, Alexandre Mebazaa, Ludwig Neyses, François Gueyffier, Christopher M. O'Connor, Alice M. Mascette, Bertram Pitt, Adriaan A. Voors, G. Michael Felker, Kirkwood F. Adams, Nancy L. Geller, Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), and Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)
- Subjects
medicine.medical_specialty ,GENE POLYMORPHISM ,[SDV]Life Sciences [q-bio] ,030204 cardiovascular system & hematology ,Pharmacology ,ACUTE DYSPNEA ,ADRENERGIC-RECEPTOR GENOTYPES ,law.invention ,BRAIN-NATRIURETIC PEPTIDE ,03 medical and health sciences ,biologic markers ,0302 clinical medicine ,Randomized controlled trial ,law ,ROSUVASTATIN MULTINATIONAL TRIAL ,medicine ,media_common.cataloged_instance ,030212 general & internal medicine ,European union ,Intensive care medicine ,media_common ,Biologic marker ,Government ,clinical trials ,business.industry ,DIAGNOSTIC BIOMARKERS ,ASSOCIATION ,BETA(1)-ADRENERGIC RECEPTOR ,medicine.disease ,Systèmes cardiovasculaire & respiratoire [D03] [Sciences de la santé humaine] ,RANDOMIZED-TRIAL ,3. Good health ,cardiovascular diseases ,Clinical trial ,CARDIOVASCULAR-DISEASE ,Pharmacogenetics ,Heart failure ,Biomarker (medicine) ,Personalized medicine ,Cardiovascular & respiratory systems [D03] [Human health sciences] ,Cardiology and Cardiovascular Medicine ,business - Abstract
The complexity of standard medical treatment for heart failure is growing, and such therapy typically involves 5 or more different medications. Given these pressures, there is increasing interest in harnessing cardiovascular biomarkers for clinical application to more effectively guide diagnosis, risk stratification, and therapy. It may be possible to realize an era of personalized medicine for heart failure treatment in which therapy is optimized and costs are controlled. The direct mechanistic coupling of biologic processes and therapies achieved in cancer treatment remains elusive in heart failure. Recent clinical trials and meta-analyses of biomarkers in heart failure have produced conflicting evidence. In this article, which comprises a summary of discussions from the Global Cardiovascular Clinical Trialists Forum held in Paris, France, we offer a brief overview of the background and rationale for biomarker testing in heart failure, describe opportunities and challenges from a regulatory perspective, and summarize current positions from government agencies in the United States and European Union.
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- 2013
35. Efficacy of pimobendan in the prevention of congestive heart failure or sudden death in doberman pinschers with preclinical dilated cardiomyopathy (the PROTECT study)
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M. Patteson, Adrian Boswood, Sonya G. Gordon, Ruth Willis, J. Loureiro, P. Watson, Geoff Culshaw, M. L. O'Sullivan, Sarah Smith, Mark A. Oyama, Joanna Dukes-McEwan, Amara H. Estrada, Michael R. O'Grady, L Braz-Ruivo, Anne French, and Nuala Summerfield
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Male ,Survival ,evidence based medicine ,Kaplan-Meier Estimate ,Cardiovascular ,GUIDELINES ,AMBULATORY ELECTROCARDIOGRAPHY ,law.invention ,Death, Sudden ,Clinical trials ,Randomized controlled trial ,law ,Clinical endpoint ,Dog Diseases ,cardiovascular ,Dilated cardiomyopathy ,ASSOCIATION ,musculoskeletal system ,Standard Articles ,Pyridazines ,DOGS ,cardiology ,ENALAPRIL ,Cardiology ,cardiovascular system ,Female ,medicine.drug ,medicine.medical_specialty ,Cardiotonic Agents ,Placebo ,Sudden death ,survival ,complex mixtures ,Dogs ,Internal medicine ,medicine ,Animals ,MILRINONE ,cardiovascular diseases ,Heart Failure ,clinical trials ,therapy ,General Veterinary ,business.industry ,MORTALITY ,medicine.disease ,Clinical trial ,Pimobendan ,Heart failure ,Evidence based medicine ,UPDATE ,Therapy ,business - Abstract
Background: The benefit of pimobendan in delaying the progression of preclinical dilated cardiomyopathy (DCM) in Dobermans is not reported.\ud \ud Hypothesis: That chronic oral administration of pimobendan to Dobermans with preclinical DCM will delay the onset of CHF or sudden death and improve survival.\ud \ud Animals: Seventy-six client-owned Dobermans recruited at 10 centers in the UK and North America.\ud \ud Methods: The trial was a randomized, blinded, placebo-controlled, parallel group multicenter study. Dogs were allocated in a 1:1 ratio to receive pimobendan (Vetmedin capsules) or visually identical placebo.\ud \ud The composite primary endpoint was prospectively defined as either onset of CHF or sudden death. Time to death from all causes was a secondary endpoint.\ud \ud Results: The proportion of dogs reaching the primary endpoint was not significantly different between groups (P = .1). The median time to the primary endpoint (onset of CHF or sudden death) was significantly longer in the pimobendan (718 days, IQR 441–1152 days) versus the placebo group (441 days, IQR 151–641 days) (log-rank P = 0.0088). The median survival time was significantly longer in the pimobendan (623 days, IQR 491–1531 days) versus the placebo group (466 days, IQR 236–710 days) (log-rank P = .034).\ud \ud Conclusion and Clinical Importance: The administration of pimobendan to Dobermans with preclinical DCM prolongs the time to the onset of clinical signs and extends survival. Treatment of dogs in the preclinical phase of this common cardiovascular disorder with pimobendan can lead to improved outcome.
- Published
- 2012
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