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Study objectives: B-type natrluretic peptide (BNP) and N-termlnal pro BNP (NTproBNP) have been shown to correlate with pulmonary arterial wedge pressure (PAW) in patients with heart failure. We studied whether [...]

To describe the clinical course of patients admitted to a nonintensive care telemetry unit and to determine whether telemetry identifies patients at risk for transfer to the intensive care unit (ICU), 467 patients hospitalized for cardiac monitoring in a nonintensive care telemetry unit were followed until death or discharge. The American College of Cardiology guidelines for telemetry use were applied: 65% of patients were class I (monitoring definitely indicated); 33% class II (probably indicated); and 2% class III (not indicated). in 5 patients (1%), telemetry contributed to the decision for a transfer to the ICU. In 462 patients, telemetry added no significant information. Thirty-eight patients (8.1%) were transferred to an ICU: 22 because of cardiac deterioration and 16 because of noncardiac clinical deterioration. Eighteen percent of patients in class I (95% confidence interval [CI], 14.1 to 22.8), 12% in class II (95% CI, 6.7 to 17), and none in class III (95% CI, 0 to 26) were transferred to the ICU (p = 0.03). Nine patients died (1.9%), 4 with terminal illness. Three patients died while on telemetry: 1 had metastatic lung cancer and 2 died suddenly of cardiac causes during initial evaluation on the ward. Telemetry identified the terminal rhythm in the 3 patients. Patients admitted to a non-ICU monitored ward with ischemic syndromes, heart failure, and arrhythmia rarely deteriorated. Patients who did deteriorate were recognized clinically without appreciable contribution from the monitoring process it remains unproven that heart rhythm monitoring in general practice units improves patient care. (Am J Cardiol 1994;74:357-362)

PURPOSE: Elevated cholesterol levels are a major risk factor for coronary heart disease, which remains a significant problem in patients beyond age 65 years. Because drug therapy for the control of hypercholesterolemia in elderly patients is frequently considered to be indicated, we investigated the efficacy and safety of pravastatin in the treatment of elderly subjects with primary hypercholesterolemia. PATIENTS AND METHODS: In this 96-week, multicenter, double-blind, placebo-controlled study, 142 subjects (95 women, 47 men) 64 to 90 years of age with elevated cholesterol levels despite dietary intervention were randomized to receive pravastatin 20 mg at bedtime or matching placebo (2:1). Dosage could be doubled after 8 weeks, a bile acid-binding resin could be added after 16 weeks, and nicotinic acid or probucol could be added after 32 weeks, as needed, to adequately lower the low-density lipoprotein cholesterol (LDL-C) levels. RESULTS: Significant reductions in the levels of LDL-C (-30.9%), total cholesterol (Total-C; -21.9%), and triglycerides (TG; -16.7%) and significant increases in the levels of high-density lipoprotein cholesterol (HDL-C; 11.3%) were noted in the group receiving pravastatin treatment at 16 weeks (P [less than or equal to]0.001 compared with baseline, P [less than or equal to]0.001 compared with placebo). The cholesterol-lowering effects of pravastatin were sustained throughout the 96 weeks of the trial. Pravastatin was well tolerated, with an overall incidence of adverse event nearly identical to that of placebo. CONCLUSIONS: in this study, pravastatin was well tolerated and effective in lowering LDL-C, Total-C, and TG and in raising HDL-C during long-term treatment of elderly patients with primary hypercholesterolemia.

The present study was designed to test the effect of pravastatin, a new, 3-hydroxy-3-mothylglutaryl coenzyme A reductase inhibitor, on the progression of coronary artery disease in patients with moderate hypercholesterolemia. Angiographic entry criteria included the presence of [is greater than or equal to] 1 stenosis [is greater than or equal to] 50% in a major opicardial coronary artery, and certification of film quality through the core angiography laboratory. Patients qualified for randomization if after diet stabilization their low density lipoprotein cholesterol concentrations were [is greater than or equal to] 30 and

Study objectives: Aortic dissection generally is an acute catastrophe. Rapid diagnosis is critical. We hypothesized that the quality of history taking contributes to the accuracy of diagnosis in patients with [...]

Study objectives: To identify the risk of thromboembolism after withholding or reversing the effect of warfarin therapy following a major hemorrhage. Design: Retrospective medical record review. Setting: Tertiary-care hospital. Patients: [...]

Ghassan M Kazmouz, MD(*); Howard S Rosman, MD; Dallas J Seffern, RN; Subhi Sbahi, MD; James Martin, MD and Alvaro A Giraldo, MD. Cardiology, St. John Hospital and Medical Center, [...]

To the Editor: A recent article by Jefic and coworkers (1) (July 2005) on the utility of N-terminal pro-brain natriuretic peptide (NTproBNP) for estimation of pulmonary artery occlusion pressure (PAOP) [...]

Is It Enough for a Predictive Diagnosis? To the Editor: We read with interest the pattern that Rosman and colleagues (September 1998)[1] have developed to take histories in patients with [...]