7 results on '"Rodrigo Bagur"'
Search Results
2. Discharge against medical advice after hospitalisation for acute myocardial infarction
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Rodrigo Bagur, Annabelle Santos Volgman, Chun Shing Kwok, Ashish Patwala, Mamas A. Mamas, David L. Fischman, Mirvat Alasnag, Glen P. Martin, Diane Barker, and Mary Norine Walsh
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Male ,medicine.medical_specialty ,Databases, Factual ,Population ,Myocardial Infarction ,Psychological intervention ,Acute myocardial infarction ,030204 cardiovascular system & hematology ,Patient Readmission ,Odds ,Cohort Studies ,Treatment Refusal ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,parasitic diseases ,medicine ,Clinical endpoint ,Unplanned readmission ,Humans ,Psychology ,030212 general & internal medicine ,Myocardial infarction ,quality and outcomes of care ,education ,Aged ,Health Services Needs and Demand ,education.field_of_study ,business.industry ,Against medical advice ,Middle Aged ,RC666 ,medicine.disease ,Quality Improvement ,Patient Discharge ,United States ,Hospitalization ,Emergency medicine ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
BackgroundDischarge against medical advice (AMA) occurs infrequently but is associated with poor outcomes. There are limited descriptions of discharges AMA in national cohorts of patients with acute myocardial infarction (AMI). This study aims to evaluate discharge AMA in AMI and how it affects readmissions.MethodsWe conducted a cohort study of patients with AMI in USA in the Nationwide Readmission Database who were admitted between the years 2010 and 2014. Descriptive statistics were presented for variables according to discharge home or AMA. The primary end point was all-cause 30-day unplanned readmissions and their causes.Results2663 019 patients were admitted with AMI of which 10.3% (n=162 070) of 1569 325 patients had an unplanned readmission within 30 days. The crude rate of discharge AMA remained stable between 2010 and 2014 at 1.5%. Discharge AMA was an independent predictor of unplanned all-cause readmissions (OR 2.27 95% CI 2.14 to 2.40); patients who discharged AMA had >twofold increased crude rate of readmission for AMI (30.4% vs 13.4%) and higher crude rate of admissions for neuropsychiatric reasons (3.2% vs 1.3%). After adjustment, discharge AMA was associated with increased odds of readmissions for AMI (OR 3.65 95% CI 3.31 to 4.03, pConclusionsDischarge AMA occurs in 1.5% of the population with AMI and these patients are at higher risk of early readmissions for re-infarction. Interventions should be developed to reduce discharge AMA in high-risk groups and initiate interventions to avoid adverse outcomes and readmission.
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- 2018
3. Measurement and prognosis of frail patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis
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Bob Kiaii, Rodrigo Bagur, Janet Martin, Ava John-Baptiste, Adam Hashi, Emily Dawson, Ran Bi, Michelle Yeschin, Jessica Moodie, Zhe Li, and Davy Cheng
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medicine.medical_specialty ,Transcatheter aortic ,Frail Elderly ,Subgroup analysis ,Cardiovascular Medicine ,030204 cardiovascular system & hematology ,vascular surgery ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Epidemiology ,Humans ,Medicine ,030212 general & internal medicine ,Aged ,business.industry ,valvular heart disease ,Aortic Valve Stenosis ,General Medicine ,Vascular surgery ,Prognosis ,medicine.disease ,Cardiac surgery ,Stenosis ,Treatment Outcome ,Meta-analysis ,epidemiology ,business ,cardiac surgery - Abstract
ObjectivesOur objectives were to review the literature to identify frailty instruments in use for transcatheter aortic valve implantation (TAVI) recipients and synthesise prognostic data from these studies, in order to inform clinical management of frail patients undergoing TAVI.MethodsWe systematically reviewed the literature published in 2006 or later. We included studies of patients with aortic stenosis, diagnosed as frail, who underwent a TAVI procedure that reported mortality or clinical outcomes. We categorised the frailty instruments and reported on the prevalence of frailty in each study. We summarised the frequency of clinical outcomes and pooled outcomes from multiple studies. We explored heterogeneity and performed subgroup analysis, where possible. We also used Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to assess the overall certainty of the estimates.ResultsOf 49 included studies, 21 used single-dimension measures to assess frailty, 3 used administrative data-based measures, and 25 used multidimensional measures. Prevalence of frailty ranged from 5.67% to 90.07%. Albumin was the most commonly used single-dimension frailty measure and the Fried or modified Fried phenotype were the most commonly used multidimensional measures. Meta-analyses of studies that used either the Fried or modified Fried phenotype showed a 30-day mortality of 7.86% (95% CI 5.20% to 11.70%) and a 1-year mortality of 26.91% (95% CI 21.50% to 33.11%). The GRADE system suggests very low certainty of the respective estimates.ConclusionsFrailty instruments varied across studies, leading to a wide range of frailty prevalence estimates for TAVI recipients and substantial heterogeneity. The results provide clinicians, patients and healthcare administrators, with potentially useful information on the prognosis of frail patients undergoing TAVI. This review highlights the need for standardisation of frailty measurement to promote consistency.PROSPERO registration numberCRD42018090597.
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- 2021
4. Frailty in patients undergoing transcatheter aortic valve implantation: a protocol for a systematic review
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Jessica Moodie, Rodrigo Bagur, Emily Dawson, Davy Cheng, Ava John-Baptiste, Bob Kiaii, Janet Martin, and Zhe Li
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medicine.medical_specialty ,Frail Elderly ,Subgroup analysis ,Cardiovascular Medicine ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,systematic review ,Quality of life ,Aortic valve replacement ,Protocol ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Adverse effect ,Prospective cohort study ,Survival analysis ,Aged ,Frailty ,business.industry ,aortic stenosis ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Checklist ,Stenosis ,Treatment Outcome ,transcathter aortic valve implantation ,Quality of Life ,prognosis ,business ,030217 neurology & neurosurgery - Abstract
IntroductionAortic stenosis is a significant cause of morbidity and mortality in older patients. The advent of transcatheter aortic valve implantation (TAVI) offers an alternative to surgical aortic valve replacement for patients with severe symptomatic aortic stenosis who are at high or intermediate risk of adverse events. Existing evidence highlights the importance of frailty as a predictor of poor outcomes post-TAVI. The objective of this study is to review the operationalisation of frailty instruments for TAVI recipients and determine clinical outcomes and the change in quality of life in frail patients undergoing TAVI.Methods and analysisMethods are reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. We will search relevant databases to identify published, completed but unpublished and ongoing studies. We will include studies of patients with aortic stenosis, diagnosed as frail and who underwent a TAVI procedure that report mortality, clinical outcomes or health-related quality of life. Retrospective or prospective cohort studies, randomised controlled trials and non-randomised controlled trials will be eligible for inclusion. Two researchers will independently screen articles for inclusion, with disagreements resolved by a third reviewer. One researcher will extract data with audit by a second researcher. The risk of bias in studies will be evaluated using the Quality in Prognosis Studies tool. Meta-analysis of mortality, survival curve and the change in quality of life will be performed if appropriate. Subgroup analysis, sensitivity analysis and meta-regression will be performed if necessary.Ethics and disseminationDue to the nature of this study, no ethical issues are foreseen. We will disseminate the results of our systematic review through a peer-reviewed journal.Trial registration numberCRD42018090597.
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- 2019
5. Telephone contact to improve adherence to dual antiplatelet therapy after drug-eluting stent implantation
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Marc Dorais, Josep Rodés-Cabau, Onil Gleeton, Eric Larose, Stéphane Rinfret, Guy Proulx, Louis Roy, Can-Manh Nguyen, Rodrigo Bagur, Easy-Impact Investigators, Isabelle Taillon, Bernard Noël, Jean-Pierre Déry, Gérald Barbeau, Robert De Larochellière, and Olivier F. Bertrand
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Counseling ,Male ,medicine.medical_specialty ,Acute coronary syndrome ,Ticlopidine ,Time Factors ,medicine.medical_treatment ,Context (language use) ,Drug Prescriptions ,Medication Adherence ,law.invention ,Tertiary Care Centers ,Percutaneous Coronary Intervention ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Aged ,Aspirin ,business.industry ,Coronary Thrombosis ,Quebec ,Stent ,Drug-Eluting Stents ,Middle Aged ,Clopidogrel ,medicine.disease ,Patient Discharge ,Telephone ,Surgery ,Treatment Outcome ,Drug-eluting stent ,Multivariate Analysis ,Cohort ,Linear Models ,Drug Therapy, Combination ,Female ,Self Report ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Many patients delay or interrupt dual antiplatelet therapy (DAT) after drug-eluting stent (DES) implantation, which increases the risk of stent thrombosis and death.To test the hypothesis that simple telephone contact made by nurses would improve adherence to and persistence of DAT.Randomised controlled trial.A total of 300 patients (mean±SD 64±10 years, 73% male) were recruited immediately after DES implantation performed between June 2009 and June 2010. The last patient recruited reached the 1-year follow-up time point in June 2011. Patients were randomised to one of two groups: intervention, with four telephone follow-ups, versus a control group. In the intervention group, phone calls were made within 7 days of the DES implantation and at 1, 6 and 9 months to support drug adherence. Control patients were followed as per usual clinical practice. Pharmacy data were collected to assess drug prescription filling and refill.Tertiary care university cardiovascular centre and community.The primary end point was the proportion of days covered with aspirin and clopidogrel over the year after discharge as assessed by pharmacy refill data. Secondary outcome measures included persistence of aspirin and clopidogrel treatment, defined as no gaps longer than 14 days during follow-up.Most patients (73%) underwent DES implantation in the context of an acute coronary syndrome. All patients had drug insurance cover, either from the public plan (59%) or through private plans (41%). Complete pharmacy follow-up data were available for 96% of the cohort. At 12 months, median scores (25th-75th centile) for adherence to aspirin and clopidogrel were 99.2% (97.5-100%) and 99.3% (97.5-100%), respectively, in the intervention group compared with 90.2% (84.2-95.4%) and 91.5% (85.1-96.0%), respectively, in the control group (p0.0001 for aspirin and clopidogrel). Patients in the intervention group were significantly more persistent in the aspirin and clopidogrel treatment than those in the control group. For clopidogrel, 87.2% of patients in the intervention group were still persistent at 12 months compared with only 43.1% in the control group (p0.0001).A simple approach of four telephone calls to patients after DES implantation significantly improved 1-year drug adherence to near-perfect scores. Persistence of DAT was also significantly improved by the intervention.
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- 2013
6. Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis
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Siamak Mohammadi, Josep Rodés-Cabau, Juan Manazzoni, Jacques Métras, Eric Charbonneau, Patrick Mathieu, François Philippon, Mélanie Côté, Pierre Voisine, Richard Baillot, Eric Dumont, Rodrigo Bagur, François Dagenais, Jean Perron, and Daniel Doyle
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Male ,Bradycardia ,Pacemaker, Artificial ,medicine.medical_specialty ,Time Factors ,Severity of Illness Index ,Aortic valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Bundle branch block ,business.industry ,Left bundle branch block ,Incidence ,Quebec ,Arrhythmias, Cardiac ,Retrospective cohort study ,Aortic Valve Stenosis ,Right bundle branch block ,medicine.disease ,Electrodes, Implanted ,Surgery ,Survival Rate ,Stenosis ,Treatment Outcome ,Heart Valve Prosthesis ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Atrioventricular block ,Follow-Up Studies - Abstract
To assess the incidence of conduction disturbances leading to permanent pacemaker implantation (PPI) following isolated aortic valve replacement (AVR) in a large cohort of elderly patients with severe symptomatic aortic stenosis, and to determine the predictive factors and prognostic value of PPI following AVR in such patients.A total of 780 consecutive elderly patients (age 77 ± 4 years, logistic EuroSCORE 10.4 ± 8.5%, STS score 3.5 ± 1.5%) with severe aortic stenosis and no previous pacemaker were analysed.The incidence, clinical indications, timing and predictive factors of PPI within 30 days after AVR and their prognostic value were evaluated.Baseline ECG showed the presence of conduction abnormalities in 37.1% of the patients. Twenty-five patients (3.2%) needed PPI during the index hospitalisation due to the occurrence of complete atrioventricular block (2.6%) or severe bradycardia (0.6%). The presence of preprocedural left bundle branch block (OR 4.65, 95% CI 1.62 to 13.36, p = 0.004) or right bundle branch block (OR 4.21, 95% CI 1.47 to 12.03, p = 0.007) predicted the need for PPI after AVR. The need for PPI was associated with a longer hospital stay (p0.0001). Thirty-day mortality rates were similar between patients with and without PPI (4% vs 3.2%, p = 0.56). Survival rate at 5-year follow-up was 75%, with no differences between patients with and without PPI (p = 0.12).The need for PPI following isolated AVR in elderly patients with severe symptomatic aortic stenosis was low. Pre-existing bundle branch block predicted the need for PPI. PPI determined a longer hospital stay, but had no effect on acute and long-term mortality.
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- 2011
7. Antithrombotic therapy in patients receiving saphenous vein coronary artery bypass grafts: a protocol for a systematic review and network meta-analysis
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Karla Solo, Mamas A. Mamas, Tawfiq Choudhury, Conrad Kabali, Janet Martin, Rodrigo Bagur, Ava John-Baptiste, Immaculate F Nevis, and Shahar Lavi
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antithrombotics ,Adult ,medicine.medical_specialty ,Network Meta-Analysis ,coronary artery bypass grafting ,Cardiovascular Medicine ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,law ,Informed consent ,Antithrombotic ,Protocol ,medicine ,Humans ,Saphenous Vein ,Prospective Studies ,030212 general & internal medicine ,coronary heart disease ,Coronary Artery Bypass ,Intensive care medicine ,Clinical pharmacology ,business.industry ,General Medicine ,Guideline ,RC666 ,R1 ,Regimen ,Meta-analysis ,Female ,Observational study ,clinical pharmacology ,business ,Fibrinolytic agent ,Systematic Reviews as Topic - Abstract
Introduction The current evidence for the prevention of saphenous vein graft failure (SVGF) after coronary artery bypass graft (CABG) surgery consists of direct head-to-head comparison of treatments (including placebo) in randomised-controlled trials (RCTs) and observational studies. However, summarising the evidence using traditional pairwise meta-analyses does not allow the inclusion of data from treatments that have not been compared head to head. Exclusion of such comparisons could impact the precision of pooled estimates in a meta-analysis. Hence, to address the challenge of whether aspirin alone or in addition to another antithrombotic agent is a more effective regimen to improve SVG patency, a network meta-analysis (NMA) is necessary. The objectives of this study are to synthesise the available evidence on antithrombotic agents (or their combination) and estimate the treatment effects among direct and indirect treatment comparisons on SVGF and major adverse cardiovascular events, and to generate a treatment ranking according to their efficacy and safety outcomes. Methods We will perform a systematic review of RCTs evaluating antithrombotic agents in patients undergoing CABG. A comprehensive English literature search will be conducted using electronic databases and grey literature resources to identify published and unpublished articles. Two individuals will independently and in duplicate screen potential studies, assess the eligibility of potential studies and extract data. Risk of bias and quality of evidence will also be evaluated independently and in duplicate. We will investigate the data to ensure its suitability for NMA, including adequacy of the outcome data and transitivity of treatment effects. We plan to estimate the pooled direct, indirect and the mixed effects for all antithrombotic agents using a NMA. Ethics and dissemination Due to the nature of the study, there are no ethical concerns nor informed consent required. We anticipate that this NMA will be the first to simultaneously assess the relative effects of multiple antithrombotic agents in patients undergoing CABG. The results of this NMA will inform clinicians, patients and guideline developers the best available evidence on comparative effects benefits of antithrombotic agents after CABG while considering the side effect profile to support future clinical decision-making. We will disseminate the results of our systematic review and NMA through a peer-reviewed journal. PROSPERO registration number CRD42017065678.
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- 2018
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