49 results on '"O'Connor, Christopher"'
Search Results
2. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial
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O'Connor, Christopher M., Whellan, David J., Lee, Kerry L., Keteyian, Steven J., Cooper, Lawton S., Ellis, Stephen J., Leifer, Eric S., Kraus, William E., Kitzman, Dalana W., Blumenthal, James A., Rendall, David S., Miller, Nancy Houston, Fleg, Jerome L., Schulman, Kevin A., McKelvie, Robert S., Zannad, Faiez, and Pina, Deana L.
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Heart failure -- Prevention ,Heart failure -- Research ,Cardiac patients -- Physiological aspects ,Cardiac patients -- Health aspects ,Exercise -- Usage ,Exercise -- Health aspects - Abstract
A study was conducted to evaluate the efficacy and safety of using exercise training in improving the condition of patients with chronic heart failure. Results indicated that exercise training was effective in modest significant reductions in hospitalization and mortality associated with cardiac failure.
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- 2009
3. Long-term outcomes and costs of ventricular assist devices among Medicare beneficiaries
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Hernandez, Adrian F., Shea, Alisa M., Milano, Carmelo, A, Rogers, Joseph G., Hammill, Bradley G., O'Connor, Christopher M., Peterson, Eric D., and Curtis, Lesley H.
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Company business management ,Medicare -- Management - Abstract
A study was conducted to ascertain the long-term results among beneficiaries of Medicare who had received only ventricular devices for mechanical circulation or after open-heart surgery. Results showed that Medicare beneficiaries who received a mechanical ventricular assist device risked early mortality and morbidity among other factors.
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- 2008
4. Effects of tezosentan on symptoms and clinical outcomes in patients with acute heart failure
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McMurray, John J.V., Teerlink, John R., Cotter, Gadi, Bourge, Robert C., Cleland, John G.F., Jondeau, Guillaume, Krum, Henry, Metra, Marco, O'Connor, Christopher M., Parker, John D., Torre-Amione, Guillermo, van Veldhuisen, Dirk J., Lewsey, Jim, Frey, Aline, Rainisio, Maurizio, and Kobrin, Isaac
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Endothelin -- Research ,Heart failure -- Research ,Tezosentan -- Research - Abstract
A study is conducted to find if endothelin receptor antagonist tezosentan improves outcomes in patients with acute heart failure. The results suggest that tezosentan did not improve symptoms or clinical outcomes in patients with acute heart failure.
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- 2007
5. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure
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Gheorghiade, Mihai, Abraham, William T., Albert, Nancy M., Greenberg, Barry H., O'Connor, Christopher M., She, Lilin, Stough, Wendy Gattis, Yancy, Clyde W., Young, James B., and Fonarow, Gregg C.
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Heart failure -- Risk factors ,Heart failure -- Patient outcomes ,Heart failure -- Care and treatment ,Hypertension -- Risk factors - Abstract
A cohort study is conducted to evaluate the relationship between systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. The results suggest that systolic hypertension is common in patients hospitalized for heart failure and systolic blood pressure is an independent predictor of morbidity and mortality in patients with heart failure with either reduced or relatively preserved systolic function.
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- 2006
6. Impact of the pulmonary artery catheter in critically ill patients: Meta-analysis of randomized clinical trials
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Shah, Monica R., Hasselblad, Vic, Binanay, Cynthia, O'Connor, Christopher M., Sopko, George, Califf, Robert M., and Stevenson, Lynne W.
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Cardiac catheterization -- Health aspects ,Terminally ill persons -- Health aspects ,Lung diseases -- Diagnosis ,Lung diseases -- Care and treatment - Abstract
A meta-analysis of thirteen published clinical trials was performed to estimate the impact of the pulmonary artery catheter (PAC) device in critically ill patients. Use of the PAC was found to neither increase overall mortality or days in hospital nor confer any benefit, indicating the lack of a clear strategy leading to improved survival with the PAC.
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- 2005
7. Azithromycin for the secondary prevention of coronary heart disease events: a randomized controlled trial
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O'Connor, Christopher M., Dunne, Michael W., Pfeffer, Marc A., Muhlestein, Joseph B., Yao, Louis, Gupta, Sandeep, Benner, Rebecca J., Fisher, Marian R., and Cook, Thomas D.
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Chlamydia infections -- Drug therapy ,Heart attack -- Prevention ,Azithromycin -- Evaluation - Abstract
The antibiotic azithromycin did not reduce the risk of a second heart attack or premature death in 7,747 heart attack patients. All of the patients also tested positive for Chlamydia pneumoniae, a bacteria that has been linked to coronary artery disease. For this reason, doctors believed an antibiotic might benefit these patients. In this particular study, it did not.
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- 2003
8. Sertraline treatment of major depression in patients with acute MI or unstable angina
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Glassman, Alexander H., O'Connor, Christopher M., Califf, Robert M., Swedberg, Karl, Schwartz, Peter, Bigger, J. Thomas, Jr., Krishnan, K. Ranga Rama, Zyl, Louis T. van, Swenson, J. Robert, Finkel, Mitchell S., Landau, Charles, Shapiro, Peter A., Pepine, Carl J., Mardekian, Jack, and Harrison, Wilma M.
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Sertraline -- Evaluation ,Depression, Mental -- Drug therapy ,Cardiac patients -- Psychological aspects - Abstract
The antidepressant drug sertraline is safe when used to treat depression in patients who have unstable angina or who have had a heart attack. Angina is the medical term for chest pain originating in the heart. In a study of 369 patients, sertraline had no adverse effects on the heart when compared to a placebo, or inactive substance.
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- 2002
9. Antidepressant use, depression, and survival in patients with heart failure
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O'Connor, Christopher M., Jiang, Wei, Kuchibhatla, Maragatha, Mehta, Rajendra H., Clary, Greg L., Cuffe, Michael S., Christopher, Eric J., Alexander, Jude D., Califf, Robert M., and Krishnan, Ranga R.
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Heart failure -- Patient outcomes ,Heart failure -- Research ,Antidepressants -- Dosage and administration ,Antidepressants -- Research ,Depression, Mental -- Research ,Mortality -- United States ,Mortality -- Research ,Health - Published
- 2008
10. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF
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Fonarow, Gregg C., Abraham, William T., Albert, Nancy M., Stough, Wendy Gattis, Gheorghiade, Mihai, Greenberg, Barry H., O'Connor, Christopher M., Pieper, Karen, Sun, Jie Lena, Yancy, Clyde W., and Young, James B.
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Heart failure -- Care and treatment ,Heart failure -- Patient outcomes ,Heart failure -- Research ,Hospitals -- Admission and discharge ,Hospitals -- Influence ,Hospitals -- Research ,Health - Published
- 2008
11. Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE Trial
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Gheorghiade, Mihai, Rossi, Joseph S., Cotts, William, Shin, David D., Hellkamp, Anne S., Pina, Ileana L., Fonarow, Gregg C., DeMarco, Teresa, Pauly, Daniel F., Rogers, Joseph, DiSalvo, Thomas G., Butler, Javed, Hare, Joshua M., Francis, Gary S., Stough, Wendy Gattis, and O'Connor, Christopher M.
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Heart failure -- Diagnosis ,Heart failure -- Development and progression ,Heart failure -- Care and treatment ,Heart failure -- Patient outcomes ,Hyponatremia -- Physiological aspects ,Hyponatremia -- Research ,Cardiac patients -- Prognosis ,Prognosis -- Research ,Health - Published
- 2007
12. Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure: results of the organized program to initiate lifesaving treatment in hospitalized patients with heart failure (OPTIMIZE-HF)
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Fonarow, Gregg C., Abraham, William T., Albert, Nancy M., Gattis Stough, Wendy, Gheorghiade, Mihai, Greenberg, Barry H., O'Connor, Christopher M., Pieper, Karen, Sun, Jie Lena, Yancy, Clyde W., and Young, James B.
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Heart failure -- Patient outcomes ,Heart failure -- Care and treatment ,Angiotensin converting enzyme -- Dosage and administration ,Practice guidelines (Medicine) -- Research ,Hospitals -- Admission and discharge ,Hospitals -- Research ,Patients -- Care and treatment ,Patients -- Quality management ,Patients -- Research ,Health - Published
- 2007
13. Relationship of depression to death or hospitalization in patients with heart failure
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Sherwood, Andrew, Blumenthal, James A., Trivedi, Ranak, Johnson, Kristy S., O'Connor, Christopher M., Adams, Kirkwood F., Jr., Dupree, Carla Sueta, Waugh, Robert A., Bensimhon, Daniel R., Gaulden, Laura, Christenson, Robert H., Koch, Gary G., and Hinderliter, Alan L.
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Depression, Mental -- Research ,Cardiac patients -- Psychological aspects ,Cardiac patients -- Prognosis ,Hospital patients -- Psychological aspects ,Hospital patients -- Prognosis ,Health - Published
- 2007
14. Effects of mental stress on myocardial ischemia during daily life
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Gullette, Elizabeth C.D., Blumenthal, James A., Babyak, Michael, Jiang, Wei, Waugh, Robert A., Frid, David J., O'Connor, Christopher M., Morris, James J., and Krantz, David S.
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Ischemia -- Psychological aspects ,Stress (Psychology) -- Physiological aspects - Abstract
Mental stress may increase the risk of myocardial ischemia, which is reduced blood flow to the heart. Researchers attached portable ECG recorders to 132 patients with coronary artery disease and a history of myocardial ischemia so they could be monitored for 48 hours. The patients kept a diary of the times they experienced tension, sadness or frustration. In the 58 patients who experienced myocardial ischemia, these feelings doubled the risk of ischemia after adjustment for other factors., Objective. -- To determine the relative risk of myocardial ischemia triggered by specific emotions during daily life. Design and Setting -- Relative risk was calculated by the recently developed case-crossover method, in which the frequency of a presumed trigger during nonischemic, or control, hours is compared with the trigger's frequency during ischemic, or case, hours. Outpatients at Duke University Medical Center, Durham, NC, underwent 48 hours of ambulatory electrocardiographic (ECG) monitoring with concurrent self-report measures of activities and emotions. Occurrences of negative emotions in the hour before the onset of myocardial ischemia were compared with their usual frequency based on all hours in which ischemia did not occur. Subjects. -- From a sample of 132 patients with coronary artery disease and recent evidence of exercise-induced ischemia who underwent 48 hours of ambulatory ECG monitoring, 58 patients exhibited ambulatory ischemia and were included in the analysis. Outcome Measures. -- Myocardial ischemia during 48-hour ECG monitoring was defined as horizontal or downsloping ST-segment depression of 1 mm (0.1 mV) or more for 1 minute or longer compared with resting baseline. The ECG data were cross-tabulated with subjects' concurrent diary ratings of 3 negative emotions -- tension, sadness, and frustration -- and 2 positive emotions -- happiness and feeling in control -- on a 5-point scale of intensity. Results. -- The unadjusted relative risk of occurrence of myocardial ischemia in the hour following high levels of negative emotions was 3.0 (95% confidence interval [CI], 1.5-5.9; P [is less than] .01) for tension, 2.9 (95% CI, 1.0-8.0; P [is less than] .05) for sadness, and 2.6 (95% CI, 1.3-5.1; P [is less than] .01) for frustration. The corresponding risk ratios adjusted for physical activity and time of day were 2.2 (95% CI, 1.1 -4.5; P [is less than] .05) for tension, 2.2 (95% CI, 0.7-6.4; P=.16) for sadness, and 2.2 (95% CI, 1.1-4.3; P [is less than] .05) for frustration. Conclusions. -- Mental stress during daily life, including reported feelings of tension, frustration, and sadness, can more than double the risk of myocardial ischemia in the subsequent hour. The clinical significance of mental stress-induced ischemia during daily life needs to be further evaluated.
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- 1997
15. Mental stress-induced myocardial ischemia and cardiac events
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Jiang, Wei, Babyak, Michael, Krantz, David S., Waugh, Robert A., Coleman, R. Edward, Hanson, Michael M., Frid, David J., McNulty, Steve, Morris, James J., O'Connor, Christopher M., and Blumenthal, James A.
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Ischemia -- Psychological aspects ,Stress (Psychology) -- Physiological aspects ,Heart diseases -- Psychological aspects - Abstract
Mental stress could contribute to heart disease by causing a decrease in the supply of blood to the heart, a condition called myocardial ischemia. Researchers gave an exercise stress test and a series of mental challenges to 126 people with a history of coronary artery disease and exercise-induced ischemia. The mental challenges included doing math, reading, speaking in public and evaluations for type A behavior. Sixty-seven percent of the patients experienced myocardial ischemia during the mental challenges, measured by radionuclide ventriculography. Sixty-eight percent also experienced exercise-induced ischemia. The participants were followed for at least two years. During the follow-up, 28 patients had a cardiac event such as a heart attack or the need for bypass surgery or angioplasty. Those who had experienced mental stress-induced ischemia were twice as likely to have a cardiac event as those who did not. Each 1% reduction in blood flow during mental stress was linked to an 8% increase in risk of a cardiac event. Math calculations were most strongly linked to myocardial ischemia., Objective.--To assess the clinical significance of mental stress-induced myocardial ischemia in patients with coronary artery disease (CAD). Design and Setting.--Cohort study in outpatients in a tertiary care teaching hospital assessed at baseline and followed up for up to 5 years. Subjects.--A total of 126 volunteer patients (112 men, 14 women; mean age, 59 years) with documented CAD and exercise-induced myocardial ischemia. Outcome Measures.--Patients underwent baseline mental stress and exercise testing using radionuclide ventriculography and 48-hour Holter monitoring. Patients were subsequently contacted by mailed questionnaires or telephone to document cardiac events, including death, nonfatal myocardial infarction, and cardiac revascularization procedures. Logistic regression and Cox proportional hazards models were used to examine the prognostic value of the ischemic measures after adjusting for such potential confounding factors as age, baseline left ventricular ejection fraction (LVEF), and history of myocardial infarction. Results.--Twenty-eight patients (22%) experienced at least 1 cardiac event. Baseline mental stress-induced ischemia was associated with significantly higher rates of subsequent cardiac events (odds ratio, 2.8; 95% confidence interval [CI], 1.0-7.7; P
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- 1996
16. Left ventricular assessment in myocardial infarction: the VALIANT Registry
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Hernandez, Adrian F., Velazquez, Eric J., Solomon, Scott D., Kilaru, Rakhi, Diaz, Rafael, O'Connor, Christopher M., Ertl, George, Maggioni, Aldo P., Rouleau, Jean-Lucien, van Gilst, Wiek, Pfeffer, Marc A., and Califf, Robert M.
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Heart ventricle, Left -- Physiological aspects ,Heart ventricle, Left -- Medical examination ,Heart attack -- Physiological aspects ,Echocardiography -- Usage ,Cardiac catheterization -- Usage ,Medical care -- Quality management ,Medical care -- Evaluation ,Health - Published
- 2005
17. Absence of interaction between atorvastatin or other statins and clopidogrel: results from the interaction study
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Serebruany, Victor L., Midei, Mark G., Malinin, Alex I., Oshrine, Benjamin R., Lowry, David R., Sane, David C., Tanguay, Jean-Francois, Steinhubl, Steven R., Berger, Peter B., O'Connor, Christopher M., and Hennekens, Charles H.
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Statins -- Drug therapy ,Drug interactions -- Research ,Health - Published
- 2004
18. Preoperative evaluation for major noncardiac surgery: focusing in heart failure
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Hernandez, Adrian F., Newby, Kristin, and O'Connor, Christopher M.
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Surgery -- Risk factors ,Surgery -- Capacity ,Preoperative care -- Management ,Heart failure -- Care and treatment ,Company business management ,Health - Published
- 2004
19. The benefit of implementing a heart failure disease management program. (Original Investigation)
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Whellan, David J., Gaulden, Laura, Gattis, Wendy A., Granger, Bradi, Russell, Stuart D., Blazing, Michael A., Cuffe, Michael S., and O'Connor, Christopher M.
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Congestive heart failure -- Drug therapy ,Medical case management -- Evaluation ,Adrenergic beta blockers -- Health aspects ,Health - Abstract
Background: To handle the increasing complexity of congestive heart failure (CHF) care, several new models for the care of patients with CHF have been developed to replace traditional strategies. We undertook this study to evaluate the potential benefit of implementing a CHF disease management program at a tertiary care center, particularly in terms of [beta]-blocker use and cost to the health care system. Methods: After reviewing the literature regarding therapies and management strategies for patients with CHF, we developed the Duke Heart Failure Program. All enrolled patients had 1 of the following: recent CHF hospitalization, ejection fraction less than 20%, or symptoms consistent with New York Heart Association class III or IV. We compared preenrollment and postenrollment medication use and resource utilization. Results: We enrolled 117 patients from July 1998 to April 1999. Mean enrollment time was 4.7 months. [beta]-Blocker use and dose significantly increased (52% vs 76% for [beta]-blocker, P Conclusions: Implementing a CHF disease management program was associated with improved CHF medication dosing and with decreased hospitalization for patients with CHF. A CHF disease management program is an effective method for a health care system to care for patients with CHF. Arch Intern Med. 2001;161:2223-2228
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- 2001
20. Clinical Outcomes and Response to Vericiguat According to Index Heart Failure Event: Insights From the VICTORIA Trial.
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Lam, Carolyn S. P., Giczewska, Anna, Sliwa, Karen, Edelmann, Frank, Refsgaard, Jens, Bocchi, Edimar, Ezekowitz, Justin A., Hernandez, Adrian F., O'Connor, Christopher M., Roessig, Lothar, Patel, Mahesh J., Pieske, Burkert, Anstrom, Kevin J., and Armstrong, Paul W.
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- 2021
- Full Text
- View/download PDF
21. Stress management and exercise training in cardiac patients with myocardial ischemia: effects on prognosis and evaluation of mechanisms
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Blumenthal, James A., Jiang, Wei, Babyak, Michael A., Krantz, David S., Frid, David J., Coleman, R. Edward, Waugh, Robert, Hanson, Michael, Appelbaum, Mark, O'Connor, Christopher, and Morris, James J.
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Coronary heart disease -- Exercise therapy ,Stress management -- Health aspects ,Exercise therapy -- Evaluation ,Health - Abstract
Background: Previous studies have demonstrated that myocardial ischemia can be elicited by mental stress in the laboratory and during daily life and that ischemia induced by mental stress is associated with an increased risk for future cardiac events in patients with coronary artery disease. Objectives: To examine the extent to which ischemia induced by mental stress can be modified by exercise or stress management, and to evaluate the impact of these interventions on clinical outcomes. Methods: One hundred seven patients with coronary artery disease and ischemia documented during mental stress testing or ambulatory electrocardiographic monitoring were randomly assigned to a 4-month program of exercise or stress management training. Patients living at a distance from the facility formed a nonrandom, usual care comparison group. Myocardial ischemia was reassessed following treatment, and patients were contacted annually for as long as 5 years to document cardiac events, including death, nonfatal myocardial infarction, and cardiac revascularization procedures. Results: Twenty-two patients (21%) experienced at least 1 cardiac event during a mean ([+ or -] SD) follow-up period of 38 [+ or -] 17 months. Stress management was associated with a relative risk of 0.26 compared with controls. The relative risk for the exercise group also was lower than that of controls, but the effect did not reach statistical significance. Stress management also was associated with reduced ischemia induced by mental stress and ambulatory ischemia. Conclusion: These data suggest that behavioral interventions offer additional benefit over and above usual medical care in cardiac patients with evidence of myocardial ischemia. Arch Intern Med. 1997;157:2213-2223
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- 1997
22. Effect of Vericiguat vs Placebo on Quality of Life in Patients With Heart Failure and Preserved Ejection Fraction: The VITALITY-HFpEF Randomized Clinical Trial.
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Armstrong, Paul W., Lam, Carolyn S. P., Anstrom, Kevin J., Ezekowitz, Justin, Hernandez, Adrian F., O'Connor, Christopher M., Pieske, Burkert, Ponikowski, Piotr, Shah, Sanjiv J., Solomon, Scott D., Voors, Adriaan A., She, Lilin, Vlajnic, Vanja, Carvalho, Francine, Bamber, Luke, Blaustein, Robert O., Roessig, Lothar, Butler, Javed, and VITALITY-HFpEF Study Group
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ENZYME metabolism ,RESEARCH ,EXERCISE tolerance ,HETEROCYCLIC compounds ,ORAL drug administration ,REGRESSION analysis ,MEDICAL cooperation ,TREATMENT failure ,RANDOMIZED controlled trials ,QUALITY of life ,BLIND experiment ,HOSPITAL care ,STROKE volume (Cardiac output) ,STATISTICAL sampling ,HEART failure - Abstract
Importance: Patients with heart failure and preserved ejection fraction (HFpEF) are at high risk of mortality, hospitalizations, and reduced functional capacity and quality of life.Objective: To assess the efficacy of the oral soluble guanylate cyclase stimulator vericiguat on the physical limitation score (PLS) of the Kansas City Cardiomyopathy Questionnaire (KCCQ).Design, Setting, and Participants: Phase 2b randomized, double-blind, placebo-controlled, multicenter trial of 789 patients with chronic HFpEF and left ventricular ejection fraction 45% or higher with New York Heart Association class II-III symptoms, within 6 months of a recent decompensation (HF hospitalization or intravenous diuretics for HF without hospitalization), and with elevated natriuretic peptides, enrolled at 167 sites in 21 countries from June 15, 2018, through March 27, 2019; follow-up was completed on November 4, 2019.Interventions: Patients were randomized to receive vericiguat, up-titrated to 15-mg (n = 264) or 10-mg (n = 263) daily oral dosages, compared with placebo (n = 262) and randomized 1:1:1.Main Outcomes and Measures: The primary outcome was change in the KCCQ PLS (range, 0-100; higher values indicate better functioning) after 24 weeks of treatment. The secondary outcome was 6-minute walking distance from baseline to 24 weeks.Results: Among 789 randomized patients, the mean age was 72.7 (SD, 9.4) years; 385 (49%) were female; mean EF was 56%; and median N-terminal pro-brain natriuretic peptide level was 1403 pg/mL; 761 (96.5%) completed the trial. The baseline and 24-week KCCQ PLS means for the 15-mg/d vericiguat, 10-mg/d vericiguat, and placebo groups were 60.0 and 68.3, 57.3 and 69.0, and 59.0 and 67.1, respectively, and the least-squares mean changes were 5.5, 6.4, and 6.9, respectively. The least-squares mean difference in scores between the 15-mg/d vericiguat and placebo groups was -1.5 (95% CI, -5.5 to 2.5; P = .47) and between the 10-mg/d vericiguat and placebo groups was -0.5 (95% CI, -4.6 to 3.5; P = .80). The baseline and 24-week 6-minute walking distance mean scores in the 15-mg/d vericiguat, 10-mg/d vericiguat, and placebo groups were 295.0 m and 311.8m , 292.1 m and 318.3 m, and 295.8 m and 311.4 m, and the least-squares mean changes were 5.0 m, 8.7 m, and 10.5 m, respectively. The least-squares mean difference between the 15-mg/d vericiguat and placebo groups was -5.5 m (95% CI, -19.7 m to 8.8 m; P = .45) and between the 10-mg/d vericiguat and placebo groups was -1.8 m (95% CI, -16.2 m to 12.6 m; P = .81), respectively. The proportions of patients who experienced symptomatic hypotension were 6.4% in the 15-mg/d vericiguat group, 4.2% in the 10-mg/d vericiguat group, and 3.4% in the placebo group; those with syncope were 1.5%, 0.8%, and 0.4%, respectively.Conclusions and Relevance: Among patients with HFpEF and recent decompensation, 24-week treatment with vericiguat at either 15-mg/d or 10-mg/d dosages compared with placebo did not improve the physical limitation score of the KCCQ.Trial Registration: ClinicalTrials.gov Identifier: NCT03547583. [ABSTRACT FROM AUTHOR]- Published
- 2020
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23. Assessment of Limitations to Optimization of Guideline-Directed Medical Therapy in Heart Failure From the GUIDE-IT Trial: A Secondary Analysis of a Randomized Clinical Trial.
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Fiuzat, Mona, Ezekowitz, Justin, Alemayehu, Wendimagegn, Westerhout, Cynthia M., Sbolli, Marco, Cani, Dario, Whellan, David J., Ahmad, Tariq, Adams, Kirkwood, Piña, Ileana L., Patel, Chetan B., Anstrom, Kevin J., Cooper, Lawton S., Mark, Daniel, Leifer, Eric S., Felker, G. Michael, Januzzi, James L., and O'Connor, Christopher M.
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- 2020
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24. Effect of Natriuretic Peptide-Guided Therapy on Hospitalization or Cardiovascular Mortality in High-Risk Patients With Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial.
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Felker, G. Michael, Anstrom, Kevin J., Adams, Kirkwood F., Ezekowitz, Justin A., Fiuzat, Mona, Houston-Miller, Nancy, Januzzi Jr., James L., Mark, Daniel B., Piña, Ileana L., Passmore, Gayle, Whellan, David J., Hongqiu Yang, Cooper, Lawton S., Leifer, Eric S., Desvigne-Nickens, Patrice, O’Connor, Christopher M., Januzzi, James L Jr, Yang, Hongqiu, and O'Connor, Christopher M
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NATRIURETIC peptides ,HEART failure patients ,HOSPITAL care ,CARDIOVASCULAR disease related mortality ,VENTRICULAR ejection fraction ,AT-risk people ,CLINICAL trials ,THERAPEUTIC use of biochemical markers ,HEALTH ,THERAPEUTICS ,HEART failure treatment ,HEART ventricle diseases ,COMPARATIVE studies ,HEART failure ,RESEARCH methodology ,MEDICAL cooperation ,PEPTIDE hormones ,PEPTIDES ,RESEARCH ,STATISTICAL sampling ,EVALUATION research ,RANDOMIZED controlled trials ,TREATMENT effectiveness ,BLIND experiment ,STROKE volume (Cardiac output) - Abstract
Importance: The natriuretic peptides are biochemical markers of heart failure (HF) severity and predictors of adverse outcomes. Smaller studies have evaluated adjusting HF therapy based on natriuretic peptide levels ("guided therapy") with inconsistent results.Objective: To determine whether an amino-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided treatment strategy improves clinical outcomes vs usual care in high-risk patients with HF and reduced ejection fraction (HFrEF).Design, Settings, and Participants: The Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT) study was a randomized multicenter clinical trial conducted between January 16, 2013, and September 20, 2016, at 45 clinical sites in the United States and Canada. This study planned to randomize 1100 patients with HFrEF (ejection fraction ≤40%), elevated natriuretic peptide levels within the prior 30 days, and a history of a prior HF event (HF hospitalization or equivalent) to either an NT-proBNP-guided strategy or usual care.Interventions: Patients were randomized to either an NT-proBNP-guided strategy or usual care. Patients randomized to the guided strategy (n = 446) had HF therapy titrated with the goal of achieving a target NT-proBNP of less than 1000 pg/mL. Patients randomized to usual care (n = 448) had HF care in accordance with published guidelines, with emphasis on titration of proven neurohormonal therapies for HF. Serial measurement of NT-proBNP testing was discouraged in the usual care group.Main Outcomes and Measures: The primary end point was the composite of time-to-first HF hospitalization or cardiovascular mortality. Prespecified secondary end points included all-cause mortality, total hospitalizations for HF, days alive and not hospitalized for cardiovascular reasons, the individual components on the primary end point, and adverse events.Results: The data and safety monitoring board recommended stopping the study for futility when 894 (median age, 63 years; 286 [32%] women) of the planned 1100 patients had been enrolled with follow-up for a median of 15 months. The primary end point occurred in 164 patients (37%) in the biomarker-guided group and 164 patients (37%) in the usual care group (adjusted hazard ratio [HR], 0.98; 95% CI, 0.79-1.22; P = .88). Cardiovascular mortality was 12% (n = 53) in the biomarker-guided group and 13% (n = 57) in the usual care group (HR, 0.94; 95% CI; 0.65-1.37; P = .75). None of the secondary end points nor the decreases in the NT-proBNP levels achieved differed significantly between groups.Conclusions and Relevance: In high-risk patients with HFrEF, a strategy of NT-proBNP-guided therapy was not more effective than a usual care strategy in improving outcomes.Trial Registration: clinicaltrials.gov Identifier: NCT01685840. [ABSTRACT FROM AUTHOR]- Published
- 2017
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25. Enrollment of Older Patients, Women, and Racial and Ethnic Minorities in Contemporary Heart Failure Clinical Trials: A Systematic Review.
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Tahhan, Ayman Samman, Vaduganathan, Muthiah, Greene, Stephen J., Fonarow, Gregg C., Fiuzat, Mona, Jessup, Mariell, Lindenfeld, JoAnn, O'Connor, Christopher M., and Butler, Javed
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- 2018
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26. Beta-Blocker Therapy for Heart Failure: The Evidence Is In, Now the Work Begins
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Califf, Robert M. and O'Connor, Christopher M.
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Heart failure -- Drug therapy ,Adrenergic beta blockers -- Health aspects - Abstract
All patients with heart failure should take a beta blocker as long as they have no reason not to. In 2000, a study on extended-release metoprolol showed that the drug reduced mortality rates, decreased the amount of time spent in a hospital, and improved the patients' quality of life. The treatment appears to be cost effective and may even save money in the long run. Some patients may experience a brief deterioration in the quality of life shortly after beginning the drugs and many are concerned about side effects. But the long-term benefits may outweigh short-term side effects.
- Published
- 2000
27. Relationship of Depression to Increased Risk of Mortality and Rehospitalization in Patients With Congestive Heart Failure
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Jiang, Wei, Alexander, Jude, Christopher, Eric, Kuchibhatla, Maragatha, Gaulden, Laura H., Cuffe, Michael S., Blazing, Michael A., Davenport, Charles, Califf, Robert M., Krishnan, Ranga R., and O'Connor, Christopher M.
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Depression, Mental -- Health aspects ,Cardiac patients -- Psychological aspects ,Congestive heart failure -- Complications ,Health - Abstract
Background: Patients with congestive heart failure (CHF) may have a high prevalence of depression, which may increase the risk of adverse outcomes. Objective: To determine the prevalence and relationship of depression to outcomes of patients hospitalized with CHF. Methods: We screened patients aged 18 years or older having New York Heart Association class II or greater CHF, an ejection fraction of 35% or less, or both, admitted between March 1, 1997, and June 30, 1998, to the cardiology service of one hospital. Patients with a Beck Depression Inventory score of 10 or higher underwent a modified National Institute of Mental Health Diagnostic Interview Schedule to identify major depressive disorder. Primary care providers coordinated standard treatment for CHF and other medical and psychiatric disorders. We assessed all-cause mortality and readmission (rehospitalization) rates 3 months and 1 year after depression assessment. Logistic regression analyses were used to evaluate the independent prognostic value of depression after adjustment for clinical risk factors. Result: Of 374 patients screened, 35.3% had a Beck Depression Inventory score of 10 or higher and 13.9% had major depressive disorder. Overall mortality was 7.9% at 3 months and 16.2% at 1 year. Major depression was associated with increased mortality at 3 months (odds ratio, 2.5 vs no depression; P=.08) and at 1 year (odds ratio, 2.23; P= 04) and readmission at 3 months (odds ratio, 1.90; P=.04) and at 1 year (odds ratio, 3.07; P=.005). These increased risks were independent of age, New York Heart Association class, baseline ejection fraction, and ischemic etiology of CHF. Conclusions: Major depression is common in patients hospitalized with CHF and is independently associated with a poor prognosis. Arch Intern Med. 2001;161:1849-1856
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- 2001
28. Reduction in Heart Failure Events by the Addition of a Clinical Pharmacist to the Heart Failure Management Team
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Gattis, Wendy A., Hasselblad, Vic, Whellan, David J., and O'Connor, Christopher M.
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Heart failure ,Pharmacists -- Statistics ,Mortality -- Statistics ,Health - Abstract
Background: The multidisciplinary approach to managing heart failure has been shown to improve outcomes. The role of a clinical pharmacist in treating heart failure has not been evaluated. Methods: One hundred eighty-one patients with heart failure and left ventricular dysfunction (ejection fraction [is less than] 45) undergoing evaluation in clinic were randomized to an intervention or a control group. Patients in the intervention group received clinical pharmacist evaluation, which included medication evaluation, therapeutic recommendations to the attending physician, patient education, and follow-up telemonitoring. The control group received usual care. The primary end point was combined all-cause mortality and heart failure clinical events. All clinical events were adjudicated by a blinded end point committee. Results: Baseline characteristics were similar except for slightly higher age in the intervention group. Median follow-up was 6 months. All-cause mortality and heart failure events were significantly lower in the intervention group compared with the control group (4 vs 16; P = .005). In addition, patients in the intervention group received higher angiotensin-converting enzyme inhibitor doses as reflected by the median fraction of target reached (25th and 75th percentiles), 1.0 (0.5 and 1) and 0.5 (0.1875 and 1) in the intervention and control groups, respectively (P [is less than] .001). The use of other vasodilators in angiotensin-converting enzyme inhibitor-intolerant patients was higher in the intervention group (75% vs 26%; P = .02). Conclusions: Outcomes in heart failure can be improved with a clinical pharmacist as a member of the multidisciplinary heart failure team. This observation may be due to higher doses of angiotensin-converting enzyme inhibitors and/or closer follow-up. Arch Intern Med. 1999;159:1939-1945
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- 1999
29. Antidepressant use, depression, and poor cardiovascular outcomes: the chicken or the egg?
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O'Connor, Christopher and Fiuzat, Mona
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Depression, Mental -- Patient outcomes ,Cardiovascular diseases -- Patient outcomes ,Cardiovascular diseases -- Risk factors ,Antidepressants -- Usage ,Antidepressants -- Health aspects ,Health - Published
- 2009
30. Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE acute heart failure randomized trial.
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Chen, Horng H, Anstrom, Kevin J, Givertz, Michael M, Stevenson, Lynne W, Semigran, Marc J, Goldsmith, Steven R, Bart, Bradley A, Bull, David A, Stehlik, Josef, LeWinter, Martin M, Konstam, Marvin A, Huggins, Gordon S, Rouleau, Jean L, O'Meara, Eileen, Tang, W H Wilson, Starling, Randall C, Butler, Javed, Deswal, Anita, Felker, G Michael, and O'Connor, Christopher M
- Abstract
Importance: Small studies suggest that low-dose dopamine or low-dose nesiritide may enhance decongestion and preserve renal function in patients with acute heart failure and renal dysfunction; however, neither strategy has been rigorously tested.Objective: To test the 2 independent hypotheses that, compared with placebo, addition of low-dose dopamine (2 μg/kg/min) or low-dose nesiritide (0.005 μg/kg/min without bolus) to diuretic therapy will enhance decongestion and preserve renal function in patients with acute heart failure and renal dysfunction.Design, Setting, and Participants: Multicenter, double-blind, placebo-controlled clinical trial (Renal Optimization Strategies Evaluation [ROSE]) of 360 hospitalized patients with acute heart failure and renal dysfunction (estimated glomerular filtration rate of 15-60 mL/min/1.73 m2), randomized within 24 hours of admission. Enrollment occurred from September 2010 to March 2013 across 26 sites in North America.Interventions: Participants were randomized in an open, 1:1 allocation ratio to the dopamine or nesiritide strategy. Within each strategy, participants were randomized in a double-blind, 2:1 ratio to active treatment or placebo. The dopamine (n = 122) and nesiritide (n = 119) groups were independently compared with the pooled placebo group (n = 119).Main Outcomes and Measures: Coprimary end points included 72-hour cumulative urine volume (decongestion end point) and the change in serum cystatin C from enrollment to 72 hours (renal function end point).Results: Compared with placebo, low-dose dopamine had no significant effect on 72-hour cumulative urine volume (dopamine, 8524 mL; 95% CI, 7917-9131 vs placebo, 8296 mL; 95% CI, 7762-8830 ; difference, 229 mL; 95% CI, -714 to 1171 mL; P = .59) or on the change in cystatin C level (dopamine, 0.12 mg/L; 95% CI, 0.06-0.18 vs placebo, 0.11 mg/L; 95% CI, 0.06-0.16; difference, 0.01; 95% CI, -0.08 to 0.10; P = .72). Similarly, low-dose nesiritide had no significant effect on 72-hour cumulative urine volume (nesiritide, 8574 mL; 95% CI, 8014-9134 vs placebo, 8296 mL; 95% CI, 7762-8830; difference, 279 mL; 95% CI, -618 to 1176 mL; P = .49) or on the change in cystatin C level (nesiritide, 0.07 mg/L; 95% CI, 0.01-0.13 vs placebo, 0.11 mg/L; 95% CI, 0.06-0.16; difference, -0.04; 95% CI, -0.13 to 0.05; P = .36). Compared with placebo, there was no effect of low-dose dopamine or nesiritide on secondary end points reflective of decongestion, renal function, or clinical outcomes.Conclusion and Relevance: In participants with acute heart failure and renal dysfunction, neither low-dose dopamine nor low-dose nesiritide enhanced decongestion or improved renal function when added to diuretic therapy.Trial Registration: clinicaltrials.gov Identifier: NCT01132846. [ABSTRACT FROM AUTHOR]- Published
- 2013
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31. Low-Dose Dopamine or Low-Dose Nesiritide in Acute Heart Failure With Renal Dysfunction.
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Horng H. Chen, Anstrom, Kevin J., Givertz, Michael M., Stevenson, Lynne W., Semigran, Marc J., Goldsmith, Steven R., Bart, Bradley A., Bull, David A., Stehlik, Josef, LeWinter, Martin M., Konstam, Marvin A., Huggins, Gordon S., Rouleau, Jean L., O'Meara, Eileen, Wilson Tang, W. H., Starling, Randall C., Butler, Javed, Deswal, Anita, Felker, G. Michael, and O'Connor, Christopher M.
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DOPAMINE ,NESIRITIDE ,HEART failure ,KIDNEY diseases ,KIDNEY glomerulus ,BLOOD plasma ,KIDNEY function tests - Abstract
IMPORTANCE Small studies suggest that low-dose dopamine or low-dose nesiritide may enhance decongestion and preserve renal function in patients with acute heart failure and renal dysfunction; however, neither strategy has been rigorously tested. OBJECTIVE To test the 2 independent hypotheses that, compared with placebo, addition of low-dose dopamine (2 µg/kg/min) or low-dose nesiritide (0.005 µg/kg/min without bolus) to diuretic therapy will enhance decongestion and preserve renal function in patients with acute heart failure and renal dysfunction. DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blind, placebo-controlled clinical trial (Renal Optimization Strategies Evaluation [ROSE]) of 360 hospitalized patients with acute heart failure and renal dysfunction (estimated glomerular filtration rate of 15-60 mL/min/1.73 m²), randomized within 24 hours of admission. Enrollment occurred from September 2010 to March 2013 across 26 sites in North America. INTERVENTIONS Participants were randomized in an open, 1:1 allocation ratio to the dopamine or nesiritide strategy. Within each strategy, participants were randomized in a double-blind, 2:1 ratio to active treatment or placebo. The dopamine (n = 122) and nesiritide (n = 119) groups were independently compared with the pooled placebo group (n = 119). MAIN OUTCOMES AND MEASURES Coprimary end points included 72-hour cumulative urine volume (decongestion end point) and the change In serum cystatin C from enrollment to 72 hours (renal function end point). RESULTS Compared with placebo, low-dose dopamine had no significant effect on 72-hour cumulative urine volume (dopamine, 8524 mL; 95% CI, 7917-9131 vs placebo, 8296 mL; 95% CI, 7762-8830 ; difference, 229 mL; 95% CI, -714 to 1171 mL; P = .59) or on the change in cystatin C level (dopamine, 0.12 mg/L; 95% CI, 0.06-0.18 vs placebo, 0.11 mg/L; 95% CI, 0.06-0.16; difference, 0.01; 95% CI, -0.08 to 0.10; P = .72). Similarly, low-dose nesiritide had no significant effect on 72-hour cumulative urine volume (nesiritide, 8574 mL; 95% CI, 8014-9134 vs placebo, 8296mL; 95% CI, 7762-8830; difference, 279 mL; 95% CI, -618 to 1176 mL; P = .49) or on the change in cystatin C level (nesiritide, 0.07 mg/L; 95% CI, 0.01-0.13 vs placebo, 0.11 mg/L; 95% CI, 0.06-0.16; difference, -0.04; 95% CI, -0.13 to 0.05; P = .36). Compared with placebo, there was no effect of low-dose dopamine or nesiritide on secondary end points reflective of decongestion, renal function, or clinical outcomes. CONCLUSION AND RELEVANCE In participants with acute heart failure and renal dysfunction, neither low-dose dopamine nor low-dose nesiritide enhanced decongestion or improved renal function when added to diuretic therapy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01132846 [ABSTRACT FROM AUTHOR]
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- 2013
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32. Effect of escitalopram on mental stress-induced myocardial ischemia: results of the REMIT trial.
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Jiang, Wei, Velazquez, Eric J, Kuchibhatla, Maragatha, Samad, Zainab, Boyle, Stephen H, Kuhn, Cynthia, Becker, Richard C, Ortel, Thomas L, Williams, Redford B, Rogers, Joseph G, and O'Connor, Christopher
- Abstract
Importance: Mental stress can induce myocardial ischemia and also has been implicated in triggering cardiac events. However, pharmacological interventions aimed at reducing mental stress-induced myocardial ischemia (MSIMI) have not been well studied.Objective: To examine the effects of 6 weeks of escitalopram treatment vs placebo on MSIMI and other psychological stress-related biophysiological and emotional parameters.Design, Setting, and Participants: The REMIT (Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment) study, a randomized, double-blind, placebo-controlled trial of patients with clinically stable coronary heart disease and laboratory-diagnosed MSIMI. Enrollment occurred from July 24, 2007, through August 24, 2011, at a tertiary medical center.Interventions: Eligible participants were randomized 1:1 to receive escitalopram (dose began at 5 mg/d, with titration to 20 mg/d in 3 weeks) or placebo over 6 weeks.Main Outcomes and Measures: Occurrence of MSIMI, defined as development or worsening of regional wall motion abnormality; left ventricular ejection fraction reduction of 8% or more; and/or horizontal or down-sloping ST-segment depression of 1 mm or more in 2 or more leads, lasting for 3 or more consecutive beats, during 1 or more of 3 mental stressor tasks.Results: Of 127 participants randomized to receive escitalopram (n = 64) or placebo (n = 63), 112 (88.2%) completed end point assessments (n = 56 in each group). At the end of 6 weeks, more patients taking escitalopram (34.2% [95% CI, 25.4%-43.0%]) had absence of MSIMI during the 3 mental stressor tasks compared with patients taking placebo (17.5% [95% CI, 10.4%-24.5%]), based on the unadjusted multiple imputation model for intention-to-treat analysis. A significant difference favoring escitalopram was observed (odds ratio, 2.62 [95% CI, 1.06-6.44]). Rates of exercise-induced ischemia were slightly lower at 6 weeks in the escitalopram group (45.8% [95% CI, 36.6%-55.0%]) than in patients receiving placebo (52.5% [95% CI, 43.3%-61.8%]), but this difference was not statistically significant (adjusted odds ratio; 1.24 [95% CI, 0.60-2.58]; P = .56).Conclusions and Relevance: Among patients with stable coronary heart disease and baseline MSIMI, 6 weeks of escitalopram, compared with placebo, resulted in a lower rate of MSIMI. There was no statistically significant difference in exercise-induced ischemia. Replication of these results in multicenter settings and investigations of other medications for reducing MSIMI are needed.Trial Registration: clinicaltrials.gov Identifier: NCT00574847. [ABSTRACT FROM AUTHOR]- Published
- 2013
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33. Effect of Escitalopram on Mental Stress-Induced Myocardial Ischemia.
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Wei Jiang, Velazquez, Eric J., Kuchibhatla, Maragatha, Samad, Zainab, Boyle, Stephen H., Kuhn, Cynthia, Becker, Richard C., Ortel, Thomas L., Williams Jr, Redford B., Rogers, Joseph G., and O'Connor, Christopher
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ESCITALOPRAM ,CORONARY heart disease treatment ,PSYCHOLOGICAL stress ,BIOPHYSICS ,CLINICAL trials ,PLACEBOS ,EXERCISE - Abstract
The article describes a study that examined the effects of 6 weeks of escitalopram treatment versus placebo on mental stress-induced myocardial ischemia (MSIMI) and other psychological stress-related biophysiological and emotional parameters. It also states that as part of the study, a randomized clinical trial of patients with clinically stable coronary heart disease and laboratory-diagnosed MSIMI was conducted and also states that patients treated with escitalopram, compared with placebo, resulted in a lower rate of MSIMI. It also states that no statistically significant difference was in exercise-induced ischemia.
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- 2013
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34. Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: a randomized clinical trial.
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Redfield, Margaret M, Chen, Horng H, Borlaug, Barry A, Semigran, Marc J, Lee, Kerry L, Lewis, Gregory, LeWinter, Martin M, Rouleau, Jean L, Bull, David A, Mann, Douglas L, Deswal, Anita, Stevenson, Lynne W, Givertz, Michael M, Ofili, Elizabeth O, O'Connor, Christopher M, Felker, G Michael, Goldsmith, Steven R, Bart, Bradley A, McNulty, Steven E, and Ibarra, Jenny C
- Abstract
Importance: Studies in experimental and human heart failure suggest that phosphodiesterase-5 inhibitors may enhance cardiovascular function and thus exercise capacity in heart failure with preserved ejection fraction (HFPEF).Objective: To determine the effect of the phosphodiesterase-5 inhibitor sildenafil compared with placebo on exercise capacity and clinical status in HFPEF.Design: Multicenter, double-blind, placebo-controlled, parallel-group, randomized clinical trial of 216 stable outpatients with HF, ejection fraction ≥50%, elevated N-terminal brain-type natriuretic peptide or elevated invasively measured filling pressures, and reduced exercise capacity. Participants were randomized from October 2008 through February 2012 at 26 centers in North America. Follow-up was through August 30, 2012.Interventions: Sildenafil (n = 113) or placebo (n = 103) administered orally at 20 mg, 3 times daily for 12 weeks, followed by 60 mg, 3 times daily for 12 weeks.Main Outcome Measures: Primary end point was change in peak oxygen consumption after 24 weeks of therapy. Secondary end points included change in 6-minute walk distance and a hierarchical composite clinical status score (range, 1-n, a higher value indicates better status; expected value with no treatment effect, 95) based on time to death, time to cardiovascular or cardiorenal hospitalization, and change in quality of life for participants without cardiovascular or cardiorenal hospitalization at 24 weeks.Results: Median age was 69 years, and 48% of patients were women. At baseline, median peak oxygen consumption (11.7 mL/kg/min) and 6-minute walk distance (308 m) were reduced. The median E/e' (16), left atrial volume index (44 mL/m2), and pulmonary artery systolic pressure (41 mm Hg) were consistent with chronically elevated left ventricular filling pressures. At 24 weeks, median (IQR) changes in peak oxygen consumption (mL/kg/min) in patients who received placebo (-0.20 [IQR, -0.70 to 1.00]) or sildenafil (-0.20 [IQR, -1.70 to 1.11]) were not significantly different (P = .90) in analyses in which patients with missing week-24 data were excluded, and in sensitivity analysis based on intention to treat with multiple imputation for missing values (mean between-group difference, 0.01 mL/kg/min, [95% CI, -0.60 to 0.61]). The mean clinical status rank score was not significantly different at 24 weeks between placebo (95.8) and sildenafil (94.2) (P = .85). Changes in 6-minute walk distance at 24 weeks in patients who received placebo (15.0 m [IQR, -26.0 to 45.0]) or sildenafil (5.0 m [IQR, -37.0 to 55.0]; P = .92) were also not significantly different. Adverse events occurred in 78 placebo patients (76%) and 90 sildenafil patients (80%). Serious adverse events occurred in 16 placebo patients (16%) and 25 sildenafil patients (22%).Conclusion and Relevance: Among patients with HFPEF, phosphodiesterase-5 inhibition with administration of sildenafil for 24 weeks, compared with placebo, did not result in significant improvement in exercise capacity or clinical status.Trial Registration: clinicaltrials.gov Identifier: NCT00763867. [ABSTRACT FROM AUTHOR]- Published
- 2013
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35. Effects of Exercise Training on Depressive Symptoms in Patients With Chronic Heart Failure: The HF-ACTION Randomized Trial.
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Blumenthal, James A., Babyak, Michael A., O'Connor, Christopher, Keteyian, Steven, Landzberg, Joel, Howlett, Jonathan, Kraus, William, Gottlieb, Stephen, Blackburn, Gordon, Swank, Ann, and Whellan, David J.
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RANDOMIZED controlled trials ,PHYSICAL activity ,ALTERNATIVE treatment for mental depression ,AEROBIC exercises ,HEART failure patients ,EXERCISE physiology ,LEFT heart ventricle - Abstract
The article provides information on the HF-ACTION randomized clinical trial which was designed to evaluate whether exercise training will result in greater improvements in depressive symptoms compared with usual care among patients with heart failure. The patients who participated in the study had a left ventricular ejection fraction of 35 percent or lower, and had New York Heart Association class I to IV heart failure. The patients were randomized to aerobic exercise compared with usual care with no exercise prescription. The results showed that 789 or 68 percent of the patients died or were hospitalized in the usual care group compared with 759 or 66 percent in the aerobic exercise group.
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- 2012
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36. Discordance Between Patient-Predicted and Model-Predicted Life Expectancy Among Ambulatory Patients With Heart Failure.
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Allen, Larry A., Yager, Jonathan E., Funk, Michele Jonsson, Levy, Wayne C., Tulsky, James A., Bowers, Margaret T., Dodson, Gwen C., O'Connor, Christopher M., and Felker, G. Michael
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HEART failure ,LIFE expectancy ,HEALTH expectancy ,BIOLOGICAL models ,CARDIAC arrest ,HEALTH status indicators ,LONGEVITY ,HEART diseases ,PSYCHOLOGY ,PROGNOSIS - Abstract
The article presents a study seeking to qualify and compare the survival expectations of patients with heart failure to model-predicted life expectancy in order to identify discrepancies in prognosis. The design and setting of the prospective face-to-face survey of heart failure disease patients and the use of model-predicted life expectancy based on the Seattle Heart Failure Model are described. The outcomes measured include life-expectancy ratio, defined as the ratio of model-predicted to patient-predicted life expectancy. Results showed that ambulatory heart failure patients significantly overestimated their life expectancy compared to model-predictions for survival.
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- 2008
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37. Association Between Performance Measures and Clinical Outcomes for Patients Hospitalized With Heart Failure.
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Fonarow, Gregg C., Abraham, William T., Albert, Nancy M., Stough, Wendy Gattis, Gheorghiade, Mihai, Greenberg, Barry H., O'Connor, Christopher M., Pieper, Karen, Sun, Jie Lena, Yancy, Clyde, and Young, James B.
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ANGIOTENSINS ,HEART failure ,MORTALITY ,HEART diseases ,SMOKING cessation ,HEALTH outcome assessment ,HOSPITAL care ,EVALUATION of medical care - Abstract
The authors present the results of a study that determined that heart failure performance measures, with the exception of the prescription of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at hospital discharge, have little relationship to patient mortality and the combination of mortality or rehospitalization in the first 60 to 90 days after hospital discharge. Performance measures studied included discharge instructions, evaluation of left ventricular systolic function, smoking cessation, anticoagulant administration and the use of angiotensin-converting enzyme inhibitors.
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- 2007
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38. Preoperative Evaluation for Major Noncardiac Surgery: Focusing on Heart Failure.
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Hernandez, Adrian F., Newby, L. Kristin, and O'Connor, Christopher M.
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OPERATIVE surgery ,RISK assessment ,HEART failure ,DISEASE complications ,HEART diseases - Abstract
The number of patients undergoing major noncardiac surgery has steadily increased over the last decade. Cardiovascular complications are important and often feared by patients, surgeons, and anesthesiologists. Although preoperative risk assessment has improved since Goldman and colleagues published their landmark article that introduced the Multifactorial Index of Cardiac Risk 25 years ago, it continues to require modification, especially with the increasing prevalence of heart failure and the increase in procedures performed in the elderly. This review will summarize preoperative assessment and perioperative management with an emphasis on heart failure. [ABSTRACT FROM AUTHOR]
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- 2004
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39. Effects of Tolvaptan, a Vasopressin Antagonist, in Patients Hospitalized With Worsening Heart Failure: A Randomized Controlled Trial.
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Gheorghiade, Mihai, Gattis, Wendy A., O'Connor, Christopher M., Adams, Jr, Kirkwood F., Elkayam, Uri, Barbagelata, Alejandro, Ghali, Jalal K., Benza, Raymond L., McGrew, Frank A., Klapholz, Marc, Ouyang, John, and Orlandi, Cesare
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HEART failure ,HEART diseases ,THERAPEUTICS ,VASOPRESSIN ,CARDIOVASCULAR diseases - Abstract
Context Nearly 1 million hospitalizations for chronic heart failure occur yearly in the United States, with most related to worsening systemic congestion. Diuretic use, the mainstay therapy for congestion, is associated with electrolyte abnormalities and worsening renal function. In contrast to diuretics, the vasopressin antagonist tolvaptan may increase net volume loss in heart failure without adversely affecting electrolytes and renal function. Objective To evaluate the short- and intermediate-term effects of tolvaptan in patients hospitalized with heart failure. Design, Setting, and Participants Randomized, double-blind, placebo-controlled, parallel-group, dose-ranging, phase 2 trial conducted at 45 centers in the United States and Argentina and enrolling 319 patients with left ventricular ejection fraction of less than 40% and hospitalized for heart failure with persistent signs and symptoms of systemic congestion despite standard therapy. Intervention After admission, patients were randomized to receive 30, 60, or 90 mg/d of oral tolvaptan or placebo in addition to standard therapy, including diuretics. The study drug was continued for up to 60 days. Main Outcome Measures In-hospital outcome was change in body weight at 24 hours after randomization; outpatient outcome was worsening heart failure (defined as death, hospitalization, or unscheduled visits for heart failure) at 60 days after randomization. Results Median (interquartile range) body weight at 24 hours after randomization decreased by -1.80 (-3.85 to -0.50), -2.10 (-3.10 to -0.85), -2.05 (-2.80 to -0.60), and -0.60 (-1.60 to 0.00) kg in the groups receiving tolvaptan 30, 60, and 90 mg/d, and placebo, respectively (P≤.008 for all tolvaptan groups vs placebo). The decrease in body weight with tolvaptan was not associated with changes in heart rate or blood pressure, nor did it result in hypokalemia or worsening renal function. There were no differences in worsening heart failure at 60 days be... [ABSTRACT FROM AUTHOR]
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- 2004
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40. Azithromycin for the Secondary Prevention of Coronary Heart Disease Events: The WIZARD Study: A Randomized Controlled Trial.
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O'Connor, Christopher M., Dunne, Michael W., Pfeffer, Marc A., Muhlestein, Joseph B., Yao, Louis, Gupta, Sandeep, Benner, Rebecca J., Fisher, Marian R., and Cook, Thomas D.
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- *
CHLAMYDIA , *CORONARY disease , *MYOCARDIAL infarction , *CLINICAL medicine - Abstract
Context: Several lines of evidence have implied an association between Chlamydia pneumoniae infection and atherogenesis. Objective: To determine the effect of 12 weeks of antibiotic therapy on coronary heart disease events in patients with stable coronary artery disease and known C pneumoniae exposure. Design, Setting, and Participants: Randomized, placebo-controlled trial of 7747 adults with previous myocardial infarction that had occurred at least 6 weeks previously (median, 2.6 years) and a C pneumoniae IgG titer of 1:16 or more. Patients were recruited from 271 clinical practices in North America, Europe, Argentina, and India, from October 10, 1997, to July 22, 2001. Intervention: The patients received either azithromycin (600 mg/d for 3 days during week 1, then 600 mg/wk during weeks 2-12; n = 3879) or placebo (n = 3868). Main Outcome Measures: The primary event was the first occurrence of death from any cause, nonfatal reinfarction, coronary revascularization, or hospitalization for angina. Patients were followed up until 1038 events accrued. Results: After a median of 14 months of follow-up, there was no significant risk reduction in the likelihood of a primary event with azithromycin vs placebo (7% [95% confidence interval, -5% to 17%], P = .23). Analysis of hazard ratios suggested early benefits of azithromycin on the primary event and on death or reinfarction, but these decreased over time. There were no significant risk reductions for any of the components of the primary end point including death (8%), recurrent myocardial infarction (7%), revascularization procedures (5%), or hospitalizations for angina (-1%). Adverse events related to study drug were reported by 13.2% of those randomized to receive azithromycin, predominantly a result of diarrhea, compared with 4.6% randomized to receive placebo, and resulted in discontinuation of drug in 1.6% of those taking azithromycin and 0.4% taking placebo. Conclusion: Among stable patients with previous myocar... [ABSTRACT FROM AUTHOR]
- Published
- 2003
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41. Short-term Intravenous Milrinone for Acute Exacerbation of Chronic Heart Failure: A Randomized Controlled Trial.
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Cuffe, Michael S., Califf, Robert M., Adams, Jr, Kirkwood F., Benza, Raymond, Bourge, Robert, Colucci, Wilson S., Massie, Barry M., O'Connor, Christopher M., Pina, Ileana, Quigg, Rebecca, Silver, Marc A., and Gheorghiade, Mihai
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MILRINONE ,HEART failure treatment ,DRUG therapy ,HOSPITAL care - Abstract
Context: Little randomized evidence is available to guide the in-hospital management of patients with an acute exacerbation of chronic heart failure. Although intravenous inotropic therapy usually produces beneficial hemodynamic effects and is labeled for use in the care of such patients, the effect of such therapy on intermediate-term clinical outcomes is uncertain. Objective: To prospectively test whether a strategy that includes short-term use of milrinone in addition to standard therapy can improve clinical outcomes of patients hospitalized with an exacerbation of chronic heart failure. Design: Prospective, randomized, double-blind, placebo-controlled trial conducted from July 1997 through November 1999. Setting: Seventy-eight community and tertiary care hospitals in the United States. Participants: A total of 951 patients admitted with an exacerbation of systolic heart failure not requiring intravenous inotropic support (mean age, 65 years; 92% with baseline New York Heart Association class III or IV; mean left ventricular ejection fraction, 23%). Intervention: Patients were randomly assigned to receive a 48-hour infusion of either milrinone, 0.5 µg/kg per minute initially (n = 477), or saline placebo (n = 472). Main Outcome Measure: Cumulative days of hospitalization for cardiovascular cause within 60 days following randomization. Results: The median number of days hospitalized for cardiovascular causes within 60 days after randomization did not differ significantly between patients given milrinone (6 days) compared with placebo (7 days; P = .71). Sustained hypotension requiring intervention (10.7% vs 3.2%; P<.001) and new atrial arrhythmias (4.6% vs 1.5%; P = .004) occurred more frequently in patients who received milrinone. The milrinone and placebo groups did not differ significantly in in-hospital mortality (3.8% vs 2.3%; P = .19), 60-day mortality (10.3% vs 8.9%; P = .41), or the composite incidence of death or readmission (35.0% vs 35.3%; P = ... [ABSTRACT FROM AUTHOR]
- Published
- 2002
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42. Editor's Correspondence.
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Andrade, Raul J., Lucena, Maria Isabel, Berger, Carmen, Johnstone, Duncan, Fleckman, Philip, Pignatti, Federica, Rozzini, Renzo, Trabucchi, Marco, Yaffe, Kristine, Friedman, Ernest H., Wei Jiang, Krishnan, Ranga R., O'Connor, Christopher M., Collie, Martha E., Higgins, James C., Mortensen, Erik Lykke, Jensen, Hans Henrik, Sanders, Stephanie A., and Reinisch, June Machover
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LETTERS to the editor ,HEPATITIS ,OLDER people physiology ,MENTAL depression ,CONGESTIVE heart failure ,PATIENTS ,DISEASE risk factors - Abstract
Presents letters to the editor in the February 11, 2002 issue of the 'Archives of Internal Medicine.' Acute fulminant hepatitis after treatment with raberprazole and terbinafine; Physical activity and cognitive decline in elderly persons; Recognition and clinical management of depression in congestive heart failure.
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- 2002
43. BNP-Guided Therapy for Heart Failure.
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Piña, Ileana L. and O'Connor, Christopher
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CONGESTIVE heart failure treatment , *PEPTIDES , *CLINICAL trials , *CARDIOVASCULAR disease treatment - Abstract
The authors examine the results of clinical trials which investigated brain natriuretic peptide (BNP)-guided therapy for heart failure. They refer to the trial by Pfisterer et al. published in the issue which examined BNP-guided vs. symptom-guided therapy and the Trial of Intensified vs. Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF). They note the safety of BNP-guided therapy and state the need for a detailed plan of approach to BNP therapy.
- Published
- 2009
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44. Therapy for mental stress-induced myocardial ischemia--reply.
- Author
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Jiang, Wei, O'Connor, Christopher M, and Velazquez, Eric J
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- 2013
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45. Therapy for Mental Stress-Induced Myocardial Ischemia.
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Wei Jiang, O'Connor, Christopher M., and Velazquez, Eric J.
- Subjects
- *
CORONARY disease , *ESCITALOPRAM , *THERAPEUTICS - Abstract
A response by Wei Jiang, Christopher M. O'Connor and Eric J. Velasquez to a letter to the editor about the article "Effect of Escitalopram on Mental Stress-Induced Myocardial Ischemia: Results of the REMIT Trial," in the 2013 issue is presented.
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- 2013
- Full Text
- View/download PDF
46. Pulmonary Artery Catheter Effectiveness in Congestive Heart Failure.
- Author
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Stevenson, Lynne W., O'Connor, Christopher M., and Califf, Robert M.
- Subjects
- *
LETTERS to the editor , *HEART diseases - Abstract
A letter to the editor is presented from the authors of an article about the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness.
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- 2006
- Full Text
- View/download PDF
47. Antibiotics and Coronary Heart Disease—Reply.
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Dunne, Michael W., Benner, Rebecca J., O'Connor, Christopher M., Pfeffer, Marc A., Muhlestein, Joseph B., Yao, Louis, Gupta, Sandeep, Fisher, Marian R., and Cook, Thomas D.
- Subjects
LETTERS to the editor ,CORONARY disease - Abstract
Presents a response to letters to the editor of "The Journal of the American Medical Association" in the January 21, 2004 issue. Discussion of antibiotics and coronary heart disease.
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- 2004
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48. Improving Enrollment of Underrepresented Racial and Ethnic Populations in Heart Failure Trials: A Call to Action From the Heart Failure Collaboratory.
- Author
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DeFilippis EM, Echols M, Adamson PB, Batchelor WB, Cooper LB, Cooper LS, Desvigne-Nickens P, George RT, Ibrahim NE, Jessup M, Kitzman DW, Leifer ES, Mendoza M, Piña IL, Psotka M, Senatore FF, Stein KM, Teerlink JR, Yancy CW, Lindenfeld J, Fiuzat M, O'Connor CM, Vardeny O, and Vaduganathan M
- Subjects
- Black People, Humans, Patient Selection, Racial Groups, Ethnicity, Heart Failure therapy
- Abstract
Importance: Despite bearing a disproportionate burden of heart failure (HF), Black and Hispanic individuals have been poorly represented in HF clinical trials. Underrepresentation in clinical trials limits the generalizability of the findings to these populations and may even introduce uncertainties and hesitancy when translating trial data to the care of people from underrepresented groups. The Heart Failure Collaboratory, a consortium of stakeholders convened to enhance HF therapeutic development, has been dedicated to improving recruitment strategies for patients from diverse and historically underrepresented groups., Observations: Despite federal policies from the US Food and Drug Administration and National Institutes of Health aimed at improving trial representation, gaps in trial enrollment proportionate to the racial and ethnic composition of the HF population have persisted. Increasing trial globalization with limited US enrollment is a major driver of these patterns. Additional barriers to representative enrollment include inequities in care access, logistical issues in participation, restrictive enrollment criteria, and English language requirements., Conclusions and Relevance: Strategies for improving diverse trial enrollment include methodical study design and site selection, diversification of research leadership and staff, broadening of eligibility criteria, community and patient engagement, and broad stakeholder commitment. In contemporary HF trials, diverse trial enrollment is not only feasible but can be efficiently achieved to improve the generalizability and translation of trial knowledge to clinical practice.
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- 2022
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49. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial.
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Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G, Stevenson LW, Francis GS, Leier CV, and Miller LW
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- Female, Heart Failure mortality, Hospital Mortality, Hospitalization, Humans, Male, Middle Aged, Pulmonary Wedge Pressure, Risk, Severity of Illness Index, Survival Analysis, Catheterization, Swan-Ganz adverse effects, Heart Failure physiopathology, Heart Failure therapy
- Abstract
Context: Pulmonary artery catheters (PACs) have been used to guide therapy in multiple settings, but recent studies have raised concerns that PACs may lead to increased mortality in hospitalized patients., Objective: To determine whether PAC use is safe and improves clinical outcomes in patients hospitalized with severe symptomatic and recurrent heart failure., Design, Setting, and Participants: The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) was a randomized controlled trial of 433 patients at 26 sites conducted from January 18, 2000, to November 17, 2003. Patients were assigned to receive therapy guided by clinical assessment and a PAC or clinical assessment alone. The target in both groups was resolution of clinical congestion, with additional PAC targets of a pulmonary capillary wedge pressure of 15 mm Hg and a right atrial pressure of 8 mm Hg. Medications were not specified, but inotrope use was explicitly discouraged., Main Outcome Measures: The primary end point was days alive out of the hospital during the first 6 months, with secondary end points of exercise, quality of life, biochemical, and echocardiographic changes., Results: Severity of illness was reflected by the following values: average left ventricular ejection fraction, 19%; systolic blood pressure, 106 mm Hg; sodium level, 137 mEq/L; urea nitrogen, 35 mg/dL (12.40 mmol/L); and creatinine, 1.5 mg/dL (132.6 micromol/L). Therapy in both groups led to substantial reduction in symptoms, jugular venous pressure, and edema. Use of the PAC did not significantly affect the primary end point of days alive and out of the hospital during the first 6 months (133 days vs 135 days; hazard ratio [HR], 1.00 [95% confidence interval {CI}, 0.82-1.21]; P = .99), mortality (43 patients [10%] vs 38 patients [9%]; odds ratio [OR], 1.26 [95% CI, 0.78-2.03]; P = .35), or the number of days hospitalized (8.7 vs 8.3; HR, 1.04 [95% CI, 0.86-1.27]; P = .67). In-hospital adverse events were more common among patients in the PAC group (47 [21.9%] vs 25 [11.5%]; P = .04). There were no deaths related to PAC use, and no difference for in-hospital plus 30-day mortality (10 [4.7%] vs 11 [5.0%]; OR, 0.97 [95% CI, 0.38-2.22]; P = .97). Exercise and quality of life end points improved in both groups with a trend toward greater improvement with the PAC, which reached significance for the time trade-off at all time points after randomization., Conclusions: Therapy to reduce volume overload during hospitalization for heart failure led to marked improvement in signs and symptoms of elevated filling pressures with or without the PAC. Addition of the PAC to careful clinical assessment increased anticipated adverse events, but did not affect overall mortality and hospitalization. Future trials should test noninvasive assessments with specific treatment strategies that could be used to better tailor therapy for both survival time and survival quality as valued by patients.
- Published
- 2005
- Full Text
- View/download PDF
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