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1. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

Author: Abdelhamid, N, Abdul Rahman, D, Abdul-Saheb, M, Abreu, P, Abroskina, M, Abu Ahmad, F, Accassat, S, Acciaresi, M, Adami, A, Ahmad, N, Ahmed, F, Alberto Hawkes, M, Alemseged, F, Ali, A, Altavilla, R, Alwis, L, Amarenco, P, Amaro, S, Amaya Sanchez, LE, Amelia Pinto, A, Ameriso, SF, Amin, H, Amino, T, Amjad, AK, Anagnostou, E, Andersen, G, Anderson, C, Anderson, DC, Andrea Falco, M, Andres Mackinnon, F, Andreu, D, Androulakis, M, Angel Gamero, M, Angel Saredo, G, Angeles Diaz, R, Angels Font, M, Anticoli, S, Arauz, A, Arauz Gongora, AA, Araya, P, Arenillas Lara, JF, Arias Rivas, S, Arnold, M, Augustin, S, Avelar, W, Azevedo, E, Babikian, V, Bacellar, A, Badalyan, K, Bae, HJ, Baez Martinez, EM, Bagelmann, H, Bailey, P, Bak, Z, Baker, M, Balazs, A, Baldaranov, D, Balogun, I, Balueva, T, Bankuti, Z, Bar, M, Baranowska, A, Bardutzky, J, Barker Trejo, S, Barlinn, J, Baronnet, F, Barroso, C, Barteys, M, Bartolottiova, T, Barulin, A, Bas, M, Bashir, S, Basile, V, Bathe-Peters, R, Bathula, R, Batista, C, Batur Caglayan, H, Baumgartner, P, Bazan, R, Bazhenova, O, Beaudry, M, Beer, J, Behnam, Y, Beilei, C, Beinlich, A, Bejot, Y, Belkin, A, Benavente, OR, Benjamin, A, Berardi, V, Bereczki, D, Berkowitz, SD, Berlingieri, J, Berrios, W, Berrouschot, J, Bhandari, M, Bhargavah, M, Bicker, H, Bicsak, T, Bilik, M, Bindila, D, Birchenall, J, Birnbaum, L, Black, T, Blacker, D, Blacquiere, D, Blanc-Labarre, C, Blank, C, Blazejewska-Hyzorek, B, Bloch, S, Bodiguel, E, Bogdanov, E, Boos, L, Borcsik, L, Bornstein, N, Bouly, S, Braga, G, Bragado, I, Bravi, MC, Brokalaki, C, Brola, W, Brouns, R, Bruce, D, Brzoska-Mizgalska, J, Buck, B, Buksinska-Lisik, M, Burke, J, Burn, M, Bustamante, G, Cabrejo, L, Cai, K, Cajaraville, S, Calejo, M, Calvet, D, Campillo, J, Campos Costa, E, Camps, P, Can Alaydin, H, Candeloro, E, Canepa, C, Cantu Brito, CG, Cappellari, M, Carcel, C, Cardona Portela, P, Cardoso, F, Carek, M, Carletti, M, Carlos Portilla, J, Caruso, P, Casado-Naranjo, I, Castellini, P, Castro, D, Castro Meira, F, Cavallini, A, Cayuela Caudevilla, N, Cenciarelli, S, Cereda, C, Cerrone, P, Chakrabarti, A, Chaloulos-Iakovidis, P, Chamorro, A, Chandrasena, D, Chang, DI, Che, C, Chembala, J, Chen, J, Chen, Z, Chen, T, Chen, H, Chen, X, Chen, G, Chen, L, Chen, S, Cheripelli, B, Chin, M, Chiquete Anaya, E, Chorazy, M, Christensen, H, Christensen, T, Christian, L, Chu, F, Chung, CS, Clark, W, Clarke, R, Claverie, S, Clemente Agostoni, E, Clissold, B, Coelho, J, Cohen, D, Colakoglu, S, Collas, D, Condurso, R, Connolly, SJ, Consoli, D, Constantin, C, Constantino Silva, AB, Contardo, L, Corlobe, A, Correia, M, Correia, C, Cortijo Garcia, E, Coull, B, Coutts, S, Coveney, S, Cras, P, Crols, R, Crozier, S, Csanyi, A, Csiba, L, Csontos, K, Csuha, R, Cui, L, Cunha, L, Curtze, S, Czerska, M, Czlonkowska, A, Czurko, M, Czuryszkiewicz, M, Dagnino, M, Dai, C, Daineko, A, Dalek, G, Damgaard, D, Danese, A, Dani, K, Danku, V, Dario Toledo, W, Dávalos, A, De Havenon, A, De Keyser, J, De Klippel, N, De La Torre, J, De Pauw, A, De Smedt, A, De Torres, R, De Vries Basson, MM, Dearborn, J, Deganutto, R, Degeorgia, M, Deguchi, I, Del Giudice, A, Delcourt, C, Delgado-Mederos, R, Della Marca, G, Delpont, B, Deltour, S, Demets, DL, Dennis, M, Desai, J, Devine, J, Dhollander, I, Di Mascio, MT, Diaconu, M, Diaz Otero, F, Dietzel, J, Diez-Tejedor, E, Ding, N, Ding, J, Diomedi, M, Dioszeghy, P, Distefano, M, Domigo, V, Dorodnicov, E, Dossi, D, Doubal, F, Druzenko, I, Du, P, Du, J, Duman, T, Duodu, Y, Dutta, D, Dylewicz, L, Eckstein, J, Ehrensperger, E, Ehrlich, S, Einer Allende, G, Elena Halac, B, Elyas, S, Endres, M, Engelbrecht, JM, Engelter, S, Epinat, M, Eren, F, Esbjornsson, M, Escribano, B, Escudero, I, Esisi, B, Essa, B, Esterbauer, M, Evans, N, Eveson, D, Fabio, S, Fang, L, Fanta, S, Fares, M, Fatar, M, Faust, K, Favate, A, Fazekas, F, Federica Denaro, M, Fedin, A, Felipe Amaya, P, Feng, J, Ferencova, K, Fernanda Gilli, M, Fernandez, MD, Fernandez Pirrone, PN, Fernandez Vera, J, Ferrari, J, Ferreira, A, Ferreira Junior, G, Fidler, M, Field, D, Field, T, Figueroa, C, Fiksa, J, Filipov, A, Firstenfeld, A, Fisch, L, Fischer, U, Fisselier, M, Fiszer, U, Fluri, F, Fortea, G, Fotherby, K, Fraczek, A, France, E, Freitas, G, Frey, S, Frick, M, Friedman, A, Friedrich, M, Frisullo, G, Fryze, W, Fuentes Gimeno, B, Fujigasaki, H, Fukuyama, K, Furlan, A, Furlanis, G, Furnace, J, Gabriel, M, Gabriel Reich, E, Gagliardi, RJ, Galati, F, Galli Giqueauk, E, Gallina, A, Gallinella, E, Gallo, J, Gangadharan, S, Gao, Y, Garcia Lopez, R, Garcia Pastor, A, Garcia Sanchez, SM, Garnauf, M, Garnier, P, Gasecki, D, Gasic, K, Gasiorek, K, Gasser, S, Gaugg, M, Gebreyohanns, M, Gebura, K, Geng, J, Geniz Clavijo, M, Georg Haeusler, K, Geran, R, Geremek, M, Gerocs, Z, Ghia, D, Giannandrea, D, Giatsidis, F, Gien Lopez, JA, Gil Nunez, A, Gimenez, L, Giralt, E, Glabinski, A, Gladstone, D, Gliem, M, Gluszkiewicz, M, Goddeau, R, Gogoleva, E, Gokce, M, Goldemund, D, Golikov, K, Gomes Neto, A, Gomez Schneider, M, Gomez-Choco, M, Gomis, M, Gongora-Rivera, JF, Gonysheva, Y, Gonzalez, L, Gonzalez Toledo, ME, Gottschal, M, Gozdzik, I, Grabowski, S, Graf, S, Green, D, Greer, D, Gregorio, T, Greisenegger, S, Greshnova, I, Griebe, M, Grzesik, M, Guan, J, Guarda, S, Gueguen, A, Guidoux, C, Guillermo Povedano, P, Guillon, B, Guiraudg, V, Gunathilagan, G, Guryanova, N, Gusev, V, Gustavo Persi, G, Gutiérrez, R, Guyler, P, Gyuker, N, Hachinski, V, Hajas, A, Hallevi, H, Hankey, G, Hankey, GJ, Hanouskova, L, Hao, L, Haraguchi, K, Haralur Sreekantaiah, Y, Haratz, S, Hargroves, D, Harkness, K, Harmel, P, Harrasser, M, Hart, RG, Harvey, M, Hasan, R, Hasegawa, Y, Hassan, A, Hattori, M, Hatzitolios, A, Hauk, M, Hayashi, T, Hayhoe, H, Hedna, VS, Heine, M, Held, V, Hellwig, S, Henkner, J, Henninger, N, Hermans, S, Hernandez, J, Herrero, D, Hervieu-Begue, M, Herzig, R, Hicken, L, Hieber, M, Hill, M, Hirose, M, Hobeanu, MC, Hobson, B, Hochstetter, M, Hoe Heo, J, Hoffmann, M, Holmstedt, C, Hon, P, Hong, KS, Honma, Y, Horev, A, Horgan, G, Horvath, L, Horvath, M, Hoyer, C, Huang, D, Huang, H, Huber, B, Huhtakangas, J, Hussain, M, Igarashi, S, Iglesias Mohedano, AM, Ignacio Tembl, J, Impellizzeri, M, Inanc, Y, Ioli, P, Irina Aniculaesei, A, Ishida, K, Itabashi, R, Iversen, H, Jagolino, A, Jakab, K, Jander, S, Janka, H, Jankovych, J, Jansen, J, Jasek, L, Javier Alet, M, Javor, L, Jin, X, Jing, P, Joachim, B, Joan Macleod, M, Johnson, M, Jose Martin, J, Joyner, C, Judit Szabo, K, Jun-Oconnell, A, Jura, R, Kaczorowska, B, Kadlcikova, J, Kahles, T, Kakaletsis, N, Kakuk, I, Kalinowska, K, Kaminska, K, Kaneko, C, Kanellos, I, Kapeller, P, Kapica-Topczewska, K, Karasz, O, Karlinski, M, Karlsson, JE, Kasa, K, Kashaeva, E, Kasner, SE, Kaste, M, Kasza, J, Katalin Iljicsov, A, Katsurayama, M, Kaur, S, Kawanishi, M, Kaygorodtseva, S, Ke, K, Kei, A, Keilitz, J, Kellner, J, Kelly, P, Kelly, S, Kemlink, D, Kerekgyarto, M, Keskinarkaus, I, Khairutdinova, D, Khanna, A, Khaw, A, Kholopov, M, Khoumri, C, Kirpicheva, S, Kirshner, H, Kitagawa, K, Kittner, S, Kivioja, R, Klein, F, Kleindorfer, D, Kleinig, T, Klivenyi, P, Knecht, S, Kobayashi, Y, Kobayashi, A, Koch, M, Koehler, L, Koivu, M, Kolianov, V, Koltsov, I, Kondo, T, Konkov, I, Kopecky, S, Korompoki, E, Korpela, J, Kosarz-Lanczek, K, Koutroubi, A, Kovacs, K, Kovacs, T, Kovacs, H, Kowalczyk, K, Kowalska, M, Krajickova, D, Kral, M, Krarup Hansen, C, Kraska, J, Krebs, S, Krejci, V, Kremer, C, Kreuzpointer, R, Krzyzanowska, M, Kucken, D, Kulakowska, A, Kunzmann, J, Kurenkova, N, Kuris, A, Kurkowska-Jastrzebska, I, Kurtenkova, N, Kurushina, O, Kusnick, G, Kustova, M, Kuwashiro, T, Kwan Cha, J, Lago, A, Lagutenko, M, Lajos, B, Lambeck, J, Lamy, C, Landolfi, A, Lanfranconi, S, Lang, W, Lara Lezama, LB, Lara Rodriguez, B, Largo, T, Lasek-Bal, A, Latte, L, Lauer, V, Lavados, P, Le Bouc, R, Leal Cantu, R, Lechner, H, Lecouturier, K, Leder, S, Lee, J, Lee, BC, Leger, A, Leira, E, Leisse, I, Leker, R, Lembo, G, Lenskaya, L, Leyden, J, Li, G, Li, M, Li, S, Li, J, Liamis, G, Liang, H, Liang, Z, Ligot, N, Lin, H, Lindert, R, Lindgren, A, Linna, M, Litwin, T, Liu, K, Liu, X, Llull, L, Lohninger, B, Longoni, M, Loomis, C, Lopes, D, Lopez Fernandez, M, Lopez Garza, N, Lord, A, Louw, S, Lovasz, R, Lowenkopf, T, Lu, Z, Lubke-Detring, SC, Luder, R, Lujan, S, Luo, B, Lupinogina, L, Luschin, G, Lutsep, H, Lvova, A, Ly, J, Grosse, G.M., Ma, H, Ma, C, Machado, M, Machado, C, Macher, S, Machetanz, J, Macian-Montoro, F, Mackey, E, Mackey, A, Maclean, G, Maestre-Moreno, J, Magadan, A, Magyar, T, Mahagney, A, Majid, A, Majjhoo, A, Makaritsis, K, Mandzia, J, Mangas Guijarro, M, Mangion, D, Manios, E, Mann, S, Manning, L, Manno, C, Manuel Garcia, J, Maqueda, V, Mar Castellanos, M, Mar Freijo, M, Marando, C, Marcela Lepera, S, Marcos Couto, J, Maria Bruera, G, Maria Greco, L, Maria Lorenzo, A, Maria Obmann, S, Maria Roa, A, Marini, C, Marinkovic, I, Mario Sumay, G, Mario Torres, C, Marko, M, Markova, S, Markus, H, Marsh, R, Marsili, E, Marta Esnaola, M, Marta Moreno, J, Marti-Fabregas, J, Martina Angelocola, S, Martínez Sánchez, P, Martinez-Majander, N, Martins, S, Marzelik, O, Mastrocola, S, Matamala, G, Matoltsy, A, Matosevic, B, Matsumoto, S, Maud, A, Mauri Cabdevila, G, May, Z, Mayasi, Y, Mayr, A, Mazzoli, T, Mcarthur, K, Mccullough, L, Medina Pech, CE, Medlin, F, Mehdiratta, M, Mehta, S, Mehta, D, Mehta, B, Melis, M, Melnikova, E, Mendez, B, Mendonca, T, Mengual Chirifie, JJ, Menon, N, Mensch, A, Meseguer, E, Messe, S, Metcalf, K, Meyer, N, Michas, F, Micheletti, N, Mikulik, R, Milionis, H, Miller, B, Milling, T, Minelli, C, Minhas, J, Minns, M, Mircea, D, Mishra, S, Mismas, A, Mistri, A, Mitrovic, N, Miyake, H, Modrau, B, Moey, A, Molina, C, Molina, J, Molis, A, Moller, J, Molnar, S, Moniche, F, Monosi, C, Monzani, V, Moonis, M, Morais, R, Morales, L, Morales, A, Morar-Precup, D, Moreton, F, Moro, C, Morozova, E, Morton, M, Morvan, T, Morvan, E, Motko, T, Mowla, A, Mozhejko, E, Muddegowda, G, Mudhar, O, Mueller, T, Muhl, C, Muir, KW, Mundl, H, Munoz, S, Murphy, C, Murphy, S, Murtuzova, A, Musuka, T, Mutzenbach, J, Myint, M, Mysliwy, W, Naccarato, M, Naeije, G, Nagakane, Y, Natarajan, I, Navaratnam, D, Nave, A, Nazliel, B, Nedeltchev, K, Nel, J, Nell, H, Nemeth, R, Nemeth, L, Neto, O, Ng, K, Ngeh, J, Nicolas Chialvo, L, Nieminen, T, Nikkanen, M, Nikl, J, Nikoforova, M, Nishino, S, Nishiyama, Y, Njovane, X, Nogawa, S, Nombela, F, Norrving, B, Nosek, K, Nowak, B, Nowakowska-Sledz, E, Ntaios, G, Numminen, H, Nunez, F, Obadia, M, Oberndorfer, S, Obrezan, A, Ochiai, J, Oczkowski, W, O'Donnell, MJ, Odyniec, A, Oh, K, Ohira, M, Okamoto, Y, Okpala, M, Okubo, S, Olah, L, Olavarria, V, Oleszek, J, Onat Demirci, N, Ondar, V, Ongun, G, Ooyama, K, Orosz, V, Ortiz, R, Osseby, G, Österlund-Tauriala, E, Ovesen, C, Ozcekic Demirhan, S, Ozdoba-Rot, J, Ozturk, S, Ozyurt, E, Pablo Grecco, M, Pablo Povedano, G, Paciaroni, M, Padiglioni, C, Pagola, J, Palasik, W, Panczel, G, Panos, L, Papadopoulos, G, Papadopoulou, E, Papagiannis, A, Papavasileiou, V, Papina, M, Pardo De Donlebun, JR, Parisi, V, Park, JM, Pasten, J, Patel, N, Pavlik, O, Pawelczyk, M, Peacock, WF, Pei, H, Peisker, T, Pena Sedna, LF, Penn, A, Pentek, S, Pepper, E, Pereira, L, Perera, K, Perez, Y, Perez, S, Perez Leguizamon, P, Pernicka, M, Perry, R, Persico, A, Pesant, Y, Peska, S, Peters, D, Peters, G, Pettigrew, L, Phan, T, Philippi, S, Phinney, T, Pico, F, Pidal, A, Piechowski-Jozwiak, B, Pieroni, A, Pineiro, S, Piras, V, Pizova, N, Polanco, J, Polin, M, Polyakov, A, Polychronopoulou, E, Polymeris, A, Popov, D, Poppe, A, Postorino, P, Pozzerese, C, Pradhan, M, Prats, L, Prazdnichkova, E, Prendl, B, Pretorius, M, Profice, P, Prokopenko, S, Pudov, E, Pujol Lereis, V, Punzo Bravo, G, Purroy, F, Qiu, J, Qu, X, Quenardelle, V, Quesada Garcia, H, Radrizzani, L, Radtke, A, Raffelsberger, T, Ramirez Moreno, JM, Ramos-Estebanez, C, Rani, A, Rapantova, P, Rashed, K, Rasheed Nihara, A, Rasmussen, J, Redondo Robles, L, Reif, M, Reiner, P, Rekova, P, Renu, A, Repetto, M, Reyes, P, Reyes Morales, S, Rha, JH, Ribeiro, J, Ricci, S, Richard, C, Rigual, R, Rinaldi, C, Riveira Rodriguez, C, Rizzato, B, Robinson, TG, Rocco, A, Rodrigues, M, Rodriguez, G, Rodriguez Campello, A, Rodriguez Lucci, F, Rodriguez Yanez, M, Roesler, C, Roffe, C, Roine, R, Roine, S, Roldan, A, Romana Pezzella, F, Romano, M, Roos, JS, Rosso, C, Rostrup Kruuse, C, Roth, Y, Roukens, R, Roveri, L, Rozanski, D, Rozniecki, J, Rozsa, C, Rudilosso, S, Ruiz Ares, G, Ruiz Franco, A, Rum, G, Ruuskanen, J, Rybinnik, I, Ryota, K, Saarinen, J, Saavedra, V, Sabben, C, Sabet, A, Sagris, D, Sahlas, J, Sakai, N, Salamanca, P, Salgado, P, Salig, S, Salletmayr, T, Salnikov, M, Samoshkina, O, Samson, Y, Sanak, D, Sànchez Cerón, M, Santalucia, P, Santamaria Cadavid, M, Santiago, P, Santo, G, Sanz Cuesta, B, Sargento, J, Sarraj, A, Sas, K, Sas, A, Satoshi, O, Satsoglou, S, Sattar, N, Savitz, S, Savopoulos, C, Saw, J, Sawicka, M, Sawyer, R, Scandura, T, Schillinger, N, Schindler, J, Schlachetzki, F, Schneider, I, Schuppner, R, Schurig, J, Schwarzbach, CJ, Sebejova, M, Seidel, G, Sekaran, L, Selcuk, D, Selvarajah, J, Semerano, A, Semjen, J, Semushina, D, Sen, S, Seok Park, M, Serena, J, Serhat Tokgoz, O, Serles, W, Serrano, F, Sevin, M, Seynaeve, L, Shah, S, Shamalov, N, Shang, T, Sharma, M, Sharrief, A, Shazam Hussain, M, Shchukin, I, Shen, W, Shepeleva, E, Shinsuke, I, Shmonin, A, Shoamanesh, A, Shuaib, A, Shulga, A, Sibolt, G, Sibon, I, Sicilia, I, Siebert, M, Sieczkowska, E, Sila, C, Silva, AA, Silva, D, Silva, P, Silva, Y, Silvestrini, M, Simony, Z, Simpkins, A, Singh, B, Sinha, D, Sipos, I, Skoda, O, Skowron, P, Skowronska, M, Sliwinska, B, Slonkova, J, Smolkin, A, Smyth, A, Sobolewski, P, Sobota, A, Sohn, SI, Soldatov, M, Solganov, I, Soloveva, L, Solovyeva, E, Sonntag, N, Soors, P, Sorgun, M, Soriano, C, Spence, D, Spengos, K, Sposato, L, Staaf, G, Stadler, K, Stakhovskaya, L, Stamatelopoulos, K, Steinert, S, Stetkarova, I, Stiehm, M, Stocker, R, Stoinski, J, Stoll, A, Stotts, G, Stumpp, A, Sucapane, P, Suenaga, T, Sun, X, Sundararajan, S, Sung Kim, J, Suzuki, H, Svaneborg, N, Szasz, G, Szczuchniak, W, Szczyrba, S, Szegedi, N, Szekely, A, Szewczyk, Z, Szilagyi, G, Szlufik, S, Szoboszlai, K, Szpisjak, L, Sztajzel, R, Sztriha, L, Ta Wil, SE, Taggeselle, J, Takamatsu, K, Takao, M, Taki, W, Takizawa, S, Talahma, M, Tamayo, A, Tan, J, Tanne, D, Tapanainen, A, Tapiola, T, Tarasiuk, J, Tatlisumak, T, Tayal, A, Tcvetkova, S, Teal, P, Tejada Garcia, J, Tejada Meza, H, Tenora, D, Terceno, M, Terentiou, A, Tezcan, S, Thaler, D, Thomson, A, Thouvenot, E, Tiainen, M, Timberg, I, Timsit, S, Tinchon, A, Tirschwell, D, Togay Isikay, C, Tokunaga, K, Tolino, M, Toloza, C, Tomelleri, G, Tomoyuki, K, Tomppo, LM, Tong, Z, Tong, L, Toni, D, Torres, J, Tossavainen, C, Toth, G, Tountopoulou, A, Touze, E, Tovar, M, Toyoda, K, Trillo, S, Trommer, A, Tropepi, D, Tryambake, D, Tu, H, Tuetuencue, S, Tumova, R, Tumpula, O, Turc, G, Tutaj, A, Tynkkynen, J, Uchiyama, S, Uchwat, U, Uhrinyakova, L, Ulku Acar, R, Uluduz Ugurlu, D, Urra, X, Urui, S, Usero Ruiz, M, Vaclavik, D, Vahedi, K, Valikovics, A, Valpas, J, Van Acker, P, Van Daele, W, Vanderschueren, G, Vanina Jure, L, Varela, R, Varga, Z, Varvat, J, Varvyanskaya, N, Vasco Salgado, A, Vasko, P, Vass, L, Vassilopoulou, S, Vastagh, I, Vazquez, P, Vecsei, L, Veltkamp, R, Venti, M, Verdugo, M, Verocai, V, Veronica Marroquin, M, Veronica Simonsini, C, Veverka, T, Vigl, M, Vila, A, Vilar, C, Villanueva Osorio, JA, Virta, J, Vitkova, E, Voglsperger, B, Volna, J, Von Weitzel-Mudersbach, PA, Vora, N, Voznyuk, I, Wach-Klink, A, Wacongne, A, Walters, D, Wang, Y, Wang, J, Wang, L, Wang, X, Wang, W, Wang, N, Wang, D, Wang, H, Warnack, W, Wartenberg, K, Waters, R, Waters, M, Webb, T, Weber, J, Weiss, G, Weissenborn, K, Weitz, JI, Weller, B, Wen, G, Weng, G, Werner, P, Werring, D, Wester, P, Whiteley, W, Whiting, R, Wijeratne, T, Willems, C, Wilson, L, Wilson, C, Winder, T, Windt, J, Winkler, A, Winska-Tereszkiewicz, A, Wisniewska, A, Wittayer, M, Wlodek, A, Wojnarowska-Arendt, A, Wolf, M, Wolff, V, Wolter, C, Wong, A, Wook Nah, H, Worthmann, H, Wu, W, Wu, S, Wunderlich, S, Wurzinger, H, Wyse, DG, Xiao, B, Xiaopeng, W, Ximenez-Carrillo, A, Xiong, L, Xiong, Y, Xiong, W, Xu, Y, Xu, J, Xu, Z, Yalo, B, Yamada, T, Yamasaki, M, Yang, L, Yang, Y, Yang, X, Yang, Q, Yang, B, Yang, J, Yasuhiro, I, Yee Lam, M, Yegappan, C, Yip, S, Ylikallio, E, Ylikotila, P, Yongwon Jin, A, Yoon, BW, Yoshida, Y, Yperzeele, L, Yuan, H, Yuasa, H, Zalewska, J, Zanferrari, C, Zapata, E, Zboznovits, D, Zelenka, I, Zhang, C, Zhang, B, Zhang, S, Zhang, M, Zhang, X, Zhang, J, Zhao, L, Zhirnova, O, Zhou, L, Zielinska-Turek, J, Zinchenko, I, Ziomek, M, Zitzmann, A, Zweifler, R, Zwiernik, J, Kasner, Scott E, Swaminathan, Balakumar, Lavados, Pablo, Sharma, Mukul, Muir, Keith, Veltkamp, Roland, Ameriso, Sebastian F, Endres, Matthias, Lutsep, Helmi, Messé, Steven R, Spence, J David, Nedeltechev, Krassen, Perera, Kanjana, Santo, Gustavo, Olavarria, Veronica, Lindgren, Arne, Bangdiwala, Shrikant, Shoamanesh, Ashkan, Berkowitz, Scott D, Mundl, Hardi, Connolly, Stuart J, and Hart, Robert G
Published: 2018
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2. Troponin is unrelated to outcomes in heart failure patients discharged from the emergency department.

Author: Fermann, GJ, Schrock, JW, Levy, PD, Pang, P, Butler, J, Chang, AM, Char, D, Diercks, D, Han, JH, Hiestand, B, Hogan, C, Jenkins, CA, Kampe, C, Khan, Y, Kumar, VA, Lee, S, Lindenfeld, J, Liu, D, Miller, KF, Peacock, WF, Reilly, CM, Robichaux, C, Rothman, RL, Self, WH, Singer, AJ, Sterling, SA, Storrow, AB, Stubblefield, WB, Walsh, C, Wilburn, J, Collins, SP, Fermann, GJ, Schrock, JW, Levy, PD, Pang, P, Butler, J, Chang, AM, Char, D, Diercks, D, Han, JH, Hiestand, B, Hogan, C, Jenkins, CA, Kampe, C, Khan, Y, Kumar, VA, Lee, S, Lindenfeld, J, Liu, D, Miller, KF, Peacock, WF, Reilly, CM, Robichaux, C, Rothman, RL, Self, WH, Singer, AJ, Sterling, SA, Storrow, AB, Stubblefield, WB, Walsh, C, Wilburn, J, and Collins, SP
Abstract: BACKGROUND: Prior data has demonstrated increased mortality in hospitalized patients with acute heart failure (AHF) and troponin elevation. No data has specifically examined the prognostic significance of troponin elevation in patients with AHF discharged after emergency department (ED) management. OBJECTIVE: Evaluate the relationship between troponin elevation and outcomes in patients with AHF who are treated and released from the ED. METHODS: This was a secondary analysis of the Get with the Guidelines to Reduce Disparities in AHF Patients Discharged from the ED (GUIDED-HF) trial, a randomized, controlled trial of ED patients with AHF who were discharged. Patients with elevated conventional troponin not due to acute coronary syndrome (ACS) were included. Our primary outcome was a composite endpoint: time to 30-day cardiovascular death and/or heart failure-related events. RESULTS: Of the 491 subjects included in the GUIDED-HF trial, 418 had troponin measured during the ED evaluation and 66 (16%) had troponin values above the 99th percentile. Median age was 63 years (interquartile range, 54-70), 62% (n = 261) were male, 63% (n = 265) were Black, and 16% (n = 67) experienced our primary outcome. There were no differences in our primary outcome between those with and without troponin elevation (12/66, 18.1% vs 55/352, 15.6%; P = 0.60). This effect was maintained regardless of assignment to usual care or the intervention arm. In multivariable regression analysis, there was no association between our primary outcome and elevated troponin (hazard ratio, 1.00; 95% confidence interval, 0.49-2.01, P = 0.994). CONCLUSION: If confirmed in a larger cohort, these findings may facilitate safe ED discharge for a group of patients with AHF without ACS when an elevated troponin is the primary reason for admission.
Published: 2022

3. Assessing the safety of interrogating cardiac-implantable electronic devices with brand-mismatched remote interrogators: a pilot study

Author: Le, Tinh, primary, Neuenschwander, James, additional, Cordial, Parker, additional, Sankoe, Mackenzie, additional, Parekh, Ankur, additional, Hiestand, Brian, additional, and Peacock, WF, additional
Published: 2022
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4. Impact of diabetes and on-arrival hyperglycemia on short-term outcomes in acute heart failure patients

Author: Masip J, Povar-Echeverría M, Peacock WF, Jacob J, Gil V, Herrero P, Llorens P, Alquézar-Arbé A, Sánchez C, Martín-Sánchez FJ, Miró Ò, and Researchers of the ICA-SEMES and EAHFE Registry
Subjects: In-hospital mortality, Short-term outcomes, Hyperglycemia, Diabetes, Vulnerable phase, Acute heart failure
Abstract: The impact of diabetes mellitus (DM) and hyperglycemia on short-term prognosis in patients with acute heart failure (AHF) remains controversial as most data comes from series of hospitalized patients. Our purpose was to analyze outcomes in a nation-wide registry of AHF patients attended in emergency department (ED). ED AHF patients were prospectively enrolled, with the index event and the vulnerable post-discharge phase outcomes recorded. The influence of presenting hyperglycemia (> 180 mg/dL) and DM treatment on prognosis were also investigated. All results were adjusted (a) for baseline characteristics. Of 9192 enrolled AHF patients, 4544 (49,4%) were diabetic, with 24% of diabetics and 25.1% of non-diabetic (p = 0.247) directly discharged from the ED also included. Diabetics had higher rates of comorbidities, but were slightly younger and had lower in-hospital and 30 day all-cause mortality than non-diabetics (a-OR = 0.827, 95% CI = 0.690-0980; and a-HR = 0.850, 95% CI = 0.814-1.071, respectively). Conversely, hyperglycemia on-arrival was associated with increased in-hospital, and 30 day all-cause mortality, in both DM (a-OR = 1.933, 95% CI = 1.378-2.712, and a-HR = 1.590, 95% CI = 1.304-1.938, respectively) and non-DM patients (a-OR = 1.498, 95% CI = 1.175-1.909, and a-HR = 1.719, 95% CI = 1.306-2.264, respectively). However, during the vulnerable phase, diabetics had worse short-term outcomes, with higher rates of ED-revisit and rehospitalization. These worse outcomes seemed to be unrelated to the severity of DM. In patients with AHF attended in ED, diabetes was associated with lower index event case fatality, but higher rates of rehospitalization and re-consultation in the vulnerable post-discharge period. Conversely, hyperglycemia at hospital arrival was strongly associated with early mortality, regardless of diabetes status.
Published: 2022

5. The FAST-FURO study: effect of very early administration of intravenous furosemide in the prehospital setting to patients with acute heart failure attending the emergency department

Author: Miró Ò, Harjola P, Rossello X, Gil V, Jacob J, Llorens P, Martín-Sánchez FJ, Herrero P, Martínez-Nadal G, Aguiló S, López-Grima ML, Fuentes M, Álvarez Pérez JM, Rodríguez-Adrada E, Mir M, Tost J, Llauger L, Ruschitzka F, Harjola VP, Mullens W, Masip J, Chioncel O, Peacock WF, Müller C, Mebazaa A, ICA-SEMES Research Group, and University of Zurich
Subjects: medicine.medical_specialty, Emergency Medical Services, New York Heart Association Class, 610 Medicine & health, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Furosemide, Internal medicine, Epidemiology, medicine, Emergency medical services, Humans, 030212 general & internal medicine, Mortality, Original Scientific Papers, Diuretics, Outcome, Heart Failure, business.industry, Emergency department, Acute heart failure, Atrial fibrillation, General Medicine, Odds ratio, medicine.disease, 3. Good health, Heart failure, Acute Disease, 10209 Clinic for Cardiology, Cardiology and Cardiovascular Medicine, business, Emergency Service, Hospital, medicine.drug
Abstract: Aims The effect of early administration of intravenous (IV) furosemide in the emergency department (ED) on short-term outcomes of acute heart failure (AHF) patients remains controversial, with one recent Japanese study reporting a decrease of in-hospital mortality and one Korean study reporting a lack of clinical benefit. Both studies excluded patients receiving prehospital IV furosemide and only included patients requiring hospitalization. To assess the impact on short-term outcomes of early IV furosemide administration by emergency medical services (EMS) before patient arrival to the ED. Methods and results In a secondary analysis of the Epidemiology of Acute Heart Failure in Emergency Departments (EAHFE) registry of consecutive AHF patients admitted to Spanish EDs, patients treated with IV furosemide at the ED were classified according to whether they received IV furosemide from the EMS (FAST-FURO group) or not (CONTROL group). In-hospital all-cause mortality, 30-day all-cause mortality, and prolonged hospitalization (>10 days) were assessed. We included 12 595 patients (FAST-FURO = 683; CONTROL = 11 912): 968 died during index hospitalization [7.7%; FAST-FURO = 10.3% vs. CONTROL = 7.5%; odds ratio (OR) = 1.403, 95% confidence interval (95% CI) = 1.085–1.813; P = 0.009], 1269 died during the first 30 days (10.2%; FAST-FURO = 13.4% vs. CONTROL = 9.9%; OR = 1.403, 95% CI = 1.146–1.764; P = 0.004), and 2844 had prolonged hospitalization (22.8%; FAST-FURO = 25.8% vs. CONTROL = 22.6%; OR = 1.189, 95% CI = 0.995–1.419; P = 0.056). FAST-FURO group patients had more diabetes mellitus, ischaemic cardiomyopathy, peripheral artery disease, left ventricular systolic dysfunction, and severe decompensations, and had a better New York Heart Association class and had less atrial fibrillation. After adjusting for these significant differences, early IV furosemide resulted in no impact on short-term outcomes: OR = 1.080 (95% CI = 0.817–1.427) for in-hospital mortality, OR = 1.086 (95% CI = 0.845–1.396) for 30-day mortality, and OR = 1.095 (95% CI = 0.915–1.312) for prolonged hospitalization. Several sensitivity analyses, including analysis of 599 pairs of patients matched by propensity score, showed consistent findings. Conclusion Early IV furosemide during the prehospital phase was administered to the sickest patients, was not associated with changes in short-term mortality or length of hospitalization after adjustment for several confounders.
Published: 2021

6. The FAST-FURO study: effect of very early administration of intravenous furosemide in the prehospital setting to patients with acute heart failure attending the emergency department

Author: Miro, O, Harjola, P, Rossello, X, Gil, V, Jacob, J, Llorens, P, Martin-Sanchez, FJ, Herrero, P, Martinez-Nadal, G, Aguilo, S, Lopez-Grima, ML, Fuentes, M, Perez, JMA, Rodriguez-Adrada, E, Mir, M, Tost, J, Llauger, L, Ruschitzka, F, Harjola, VP, Mullens, W, Masip, J, Chioncel, O, Peacock, WF, Muller, C, Mebazaa, A, Alquezar A., Rizzi M.A., Herrera S., and ICA-SEMES Res Grp
Subjects: Furosemide, Emergency department, Acute heart failure, Mortality, Diuretics, Outcome
Abstract: Aims The effect of early administration of intravenous (IV) furosemide in the emergency department (ED) on short-term outcomes of acute heart failure (AHF) patients remains controversial, with one recent Japanese study reporting a decrease of in-hospital mortality and one Korean study reporting a lack of clinical benefit. Both studies excluded patients receiving prehospital IV furosemide and only included patients requiring hospitalization. To assess the impact on short-term outcomes of early IV furosemide administration by emergency medical services (EMS) before patient arrival to the ED. Methods and results In a secondary analysis of the Epidemiology of Acute Heart Failure in Emergency Departments (EAHFE) registry of consecutive AHF patients admitted to Spanish EDs, patients treated with IV furosemide at the ED were classified according to whether they received IV furosemide from the EMS (FAST-FURO group) or not (CONTROL group). In-hospital all-cause mortality, 30-day all-cause mortality, and prolonged hospitalization (>10 days) were assessed. We included 12 595 patients (FAST-FURO = 683; CONTROL = 11 912): 968 died during index hospitalization [7.7%; FAST-FURO = 10.3% vs. CONTROL=7.5%; odds ratio (OR) = 1.403, 95% confidence interval (95% CI) = 1.085-1.813; P = 0.009], 1269 died during the first 30 days (10.2%; FAST-FURO = 13.4% vs. CONTROL = 9.9%; OR = 1.403, 95% CI = 1.146-1.764; P = 0.004), and 2844 had prolonged hospitalization (22.8%; FAST-FURO = 25.8% vs. CONTROL = 22.6%; OR = 1.189, 95% CI = 0.995-1.419; P = 0.056). FAST-FURO group patients had more diabetes mellitus, ischaemic cardiomyopathy, peripheral artery disease, left ventricular systolic dysfunction, and severe decompensations, and had a better New York Heart Association class and had less atrial fibrillation. After adjusting for these significant differences, early IV furosemide resulted in no impact on short-term outcomes: OR = 1.080 (95% CI = 0.817-1.427) for in-hospital mortality, OR = 1.086 (95% CI = 0.845-1.396) for 30-day mortality, and OR = 1.095 (95% CI = 0.915-1.312) for prolonged hospitalization. Several sensitivity analyses, including analysis of 599 pairs of patients matched by propensity score, showed consistent findings. Conclusion Early IV furosemide during the prehospital phase was administered to the sickest patients, was not associated with changes in short-term mortality or length of hospitalization after adjustment for several confounders.
Published: 2021

7. Frequency and Predictors of Major Bleeding in Patients With Embolic Strokes of Undetermined Source NAVIGATE-ESUS Trial

Author: Mikulik, R, Eckstein, J, Pearce, LA, Mundl, H, Rudilosso, S, Olavarria, VV, Shoamanesh, A, Chamorro, A, Marti-Fabregas, J, Veltkamp, R, Ozturk, S, Tatlisumak, T, Peacock, WF, Berkowitz, SD, Connolly, SJ, and Hart, RG
Subjects: glomerular filtration rate, infarction, blood pressure, embolism, rivaroxaban
Abstract: Background and Purpose: Risks, sites, and predictors of major bleeding during antithrombotic therapies have not been well defined for patients with recent embolic stroke of undetermined source. Methods: Exploratory analysis of major bleeds defined by International Society of Thrombosis and Hemostasis criteria occurring among 7213 participants in international NAVIGATE (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial) embolic stroke of undetermined source randomized trial comparing rivaroxaban 15 mg daily with aspirin 100 mg daily. Results: During a median follow-up of 11 months, 85 major bleeds occurred. The most frequent site was gastrointestinal (38%), followed by intracranial (29%). Assignment to rivaroxaban (hazard ratio [HR], 2.7 [95% CI, 1.7-4.3]), East Asia region (HR, 2.5 [95% CI, 1.6-3.9]), systolic blood pressure >= 160 mm Hg (HR, 2.2 [95% CI, 1.2-3.8]), and reduced estimated glomerular filtration rate (HR, 1.2 per 10 mL/min per 1.73 m(2)decrease, [95% CI, 1.0-1.3]) were independently associated with presence of major bleeds. Five (6%) were fatal. Among 15 patients with intracerebral hemorrhage, 2 (13%) were fatal. There was no evidence of an early high-risk period following initiation of rivaroxaban. The annualized rate of intracerebral hemorrhage was 6-fold higher among East Asian participants (0.67%) versus all other regions (0.11%; HR, 6.3 [95% CI, 2.2-18.0]). Distribution of bleeding sites was similar for rivaroxaban and aspirin. Conclusions: Among embolic stroke of undetermined source patients participating in an international randomized trial, independent predictors of major bleeding were assignment to rivaroxaban, East Asia region, increased systolic blood pressure, and impaired renal function. East Asia as a region was strongly associated with risk of intracerebral hemorrhage. Estimated glomerular filtration rate should be a consideration for stratifying bleeding risk. Registration: URL:. Unique identifier: NCT02313909.
Published: 2020

8. Myocardial Infarction Can Be Safely Excluded by High-sensitivity Troponin I Testing 3 Hours After Emergency Department Presentation.

Author: Smith, SW, Peacock, WF, Christenson, R, Diercks, DB, Fromm, C, Headden, GF, Hogan, CJ, Kulstad, EB, LoVecchio, F, Nowak, RM, Schrock, JW, Singer, AJ, Storrow, AB, Straseski, J, Wu, AHB, Zelinski, DP, Smith, SW, Peacock, WF, Christenson, R, Diercks, DB, Fromm, C, Headden, GF, Hogan, CJ, Kulstad, EB, LoVecchio, F, Nowak, RM, Schrock, JW, Singer, AJ, Storrow, AB, Straseski, J, Wu, AHB, and Zelinski, DP
Abstract: BACKGROUND: The accuracy and speed by which acute myocardial infarction (AMI) is excluded are an important determinant of emergency department (ED) length of stay and resource utilization. While high-sensitivity troponin I (hsTnI) >99th percentile (upper reference level [URL]) represents a "rule-in" cutpoint, our purpose was to evaluate the ability of the Beckman Coulter hsTnI assay, using various level-of-quantification (LoQ) cutpoints, to rule out AMI within 3 hours of ED presentation in suspected acute coronary syndrome (ACS) patients. METHODS: This multicenter evaluation enrolled adults with >5 minutes of ACS symptoms and an electrocardiogram obtained per standard care. Exclusions were ST-segment elevation or chronic hemodialysis. After informed consent was obtained, blood samples were collected in heparin at ED admission (baseline), ≥1 to 3, ≥3 to 6, and ≥6 to 9 hours postadmission. Samples were processed and stored at -20°C within 1 hour and were tested at three independent clinical laboratories on an immunoassay system (DxI 800, Beckman Coulter). Analytic cutpoints were the URL of 17.9 ng/L and two LoQ cutpoints, defined as the 10 and 20% coefficient of variation (5.6 and 2.3 ng/L, respectively). A criterion standard MI diagnosis was adjudicated by an independent endpoint committee, blinded to hsTnI, and using the universal definition of MI. RESULTS: Of 1,049 patients meeting the entry criteria, and with baseline and 1- to 3-hour hsTnI results, 117 (11.2%) had an adjudicated final diagnosis of AMI. AMI patients were typically older, with more cardiovascular risk factors. Median (IQR) presentation time was 4 (1.6-16.0) hours after symptom onset, although AMI patients presented ~0.5 hour earlier than non-AMI. Enrollment and first blood draw occurred at a mean of ~1 hour after arrival. To evaluate the assay's rule-out performance, patients with any hsTnI > URL were considered high risk and were excluded. The remaining population (n = 829) was divided into four L
Published: 2020

9. Influence of the length of hospitalisation in post-discharge outcomes in patients with acute heart failure: Results of the LOHRCA study

Author: Miró Ò, Padrosa J, Takagi K, Gayat É, Gil V, Llorens P, Martín-Sánchez FJ, Herrero-Puente P, Jacob J, Montero MM, Díez MPL, Traveria L, Torres-Gárate R, Agüera C, Peacock WF, Bueno H, Mebazaa A, ICA-SEMES Research Group, Fuentes M, Gil C, Alonso H, Garmila P, García GL, Yáñez-Palma MC, López SI, Escoda R, Xipell C, Sánchez C, Gaytan JM, Pérez-Durá MJ, Salvo E, Pavón J, Noval A, Torres JM, López-Grima ML, Valero A, Juan MÁ, Aguirre A, Morales JE, Masó SM, Alonso MI, Ruiz F, Franco JM, Mecina AB, Tost J, Sánchez S, Carbajosa V, Piñera P, Nicolás JAS, Garate RT, Alquezar A, Rizzi MA, Herrera S, Roset A, Cabello I, Richard F, Pérez JMÁ, Diez MPL, Álvarez JV, García BP, Sánchez González MGGY, Javaloyes P, Marquina V, Jiménez I, Hernández N, Brouzet B, Ramos S, López A, Andueza JA, Romero R, Ruíz M, Calvache R, Lorca MT, Calderón L, Arriaga BA, Sierra B, Mojarro EM, Bécquer LT, Burillo G, García LL, LaSalle GC, Urbano CA, Soto ABG, Padial ED, Ferrer ES, Garrido M, Lucas FJ, Gaya R, Bibiano C, Mir M, Rodríguez B, Sánchez N, Carballo JL, and Rodríguez-Adrada E
Subjects: humanities, Acute heart failure, Length of hospitalisation, Mortality, Post-discharge outcomes, Readmission, Vulnerability phase
Abstract: Objective: To investigate the relationship between length of hospitalisation (LOH) and post-discharge outcomes in acute heart failure (AHF) patients and to ascertain whether there are different patterns according to department of initial hospitalisation. Methods: Consecutive AHF patients hospitalised in 41 Spanish centres were grouped based on the LOH (< 6/6-10/11-15/ > 15 days). Outcomes were defined as 90-day post-discharge all-cause mortality, AHF readmissions, and the combination of both. Hazard ratios (HRs), adjusted by chronic conditions and severity of decompensation, were calculated for groups with LOH > 6 days vs. LOH < 6 days (reference), and stratified by hospitalisation in cardiology, internal medicine, geriatrics, or short-stay units. Results: We included 8563 patients (mean age: 80 (SD = 10) years, 55.5% women), with a median LOH of 7 days (IQR 4-11): 2934 (34.3%) had a LOH < 6 days, 3184 (37.2%) 6-10 days, 1287 (15.0%) 11-15 days, and 1158 (13.5%) > 15 days. The 90-day post-discharge mortality was 11.4%, readmission 32.2%, and combined end-point 37.4%. Mortality was increased by 36.5% (95%CI = 13.0-64.9) when LOH was 11-15 days, and by 72.0% (95%CI = 42.6-107.5) when > 15 days. Conversely, no differences were found in readmission risk, and the combined end-point only increased 21.6% (95%CI = 8.4-36.4) for LOH > 15 days. Stratified analysis by hospitalisation departments rendered similar post-discharge outcomes, with all exhibiting increased mortality for LOH > 15 days and no significant increments in readmission risk. Conclusions: Short hospitalisations are not associated with worse outcomes. While post-discharge readmissions are not affected by LOH, mortality risk increases as the LOH lengthens. These findings were similar across hospitalisation departments.
Published: 2019

10. The role of atrial fibrillation in the short-term outcomes of patients with acute heart failure

Author: Romero R, Gaytán JM, Aguirre A, Llorens P, Gil V, Herrero P, Jacob J, Martín-Sánchez FJ, Pérez-Durá MJ, Alquézar A, López ML, Roset À, Peacock WF, Hollander JE, Coll-Vinent B, Miró Ò, and ICA-SEMES Research Group
Subjects: Emergency department, Revisit, Hospitalisation, Acute heart failure, Mortality, Atrial fibrillation, humanities, Acute heart failure, Atrial fibrillation, Emergency department, Hospitalisation, Mortality, Outcome, Revisit, Outcome
Abstract: AimsTo investigate whether the presence of atrial fibrillation (AF) is independently associated with adverse short-term outcomes in patients diagnosed with acute heart failure (AHF) in the emergency department (ED).MethodsWe performed a secondary analysis of patients included in the EAHFE registries 4&5. Patients were divided by the presence of sinus rhythm (SR) or AF at ED arrival. The primary outcome was 30-day all-cause mortality. Secondary outcomes included the 30-day post-discharge combined endpoint of ED revisit or hospitalisation due to AHF and all-cause mortality. We recorded 54 independent variables that can affect outcomes. Cox regression was used to investigate adjusted significant associations between AF and outcomes. Analyses were repeated according to whether AF was previously known and whether AF was considered responsible for the AHF episode.ResultsWe analysed 6045 ED visits (mean age 80.4 years, 55.9% women), 3644 (60.3%) with AF. The cumulative 30-day mortality was 9.4%, and the adverse combined endpoint (ACE) was 25.9% (ED revisit with and without hospitalisation were 16.5 and 8.9% and death occurred in 4.7%). No differences were found in outcomes of AHF patients with SR and AF, and among the latter group, no differences were found depending on whether AF was considered responsible for the AHF episode. Patients with previously known AF had significantly lower 30-day mortality and higher post-discharge ACE rates, although these differences disappeared after adjustment for confounders HR 0.782, 95% CI 0.590-1.037, p=0.087; and HR 1.131, 95% CI 0.924-1.385, p=0.234).ConclusionThe coexistence of AF does not impact the short-term outcomes of patients diagnosed with AHF in the ED.
Published: 2019

11. Effects on short term outcome of non-invasive ventilation use in the emergency department to treat patients with acute heart failure: A propensity score-based analysis of the EAHFE Registry

Author: Miró Ò, Martínez G, Masip J, Gil V, Martín-Sánchez FJ, Llorens P, Herrero-Puente P, Sánchez C, Richard F, Lucas-Invernón J, Garrido JM, Mebazaa A, Ríos J, Peacock WF, Hollander JE, Jacob J, and ICA-SEMES Research Group Researchers
Subjects: Emergency department, Non-invasive ventilation, Acute heart failure, Heart failure, Outcome
Abstract: Objective: To assess the effects of non-invasive ventilation (NIV) in emergency department (ED) patients with acute heart failure (AHF) on short term outcomes. Methods: Patients from the EAHFE Registry (a multicenter, observational, multipurpose, cohort-designed database including consecutive AHF patients in 41 Spanish EDs) were grouped based on NIV treatment (NIV+ and NIV-groups). Using propensity score (PS) methodology, we identified two subgroups of patients matched by 38 covariates and compared regarding 30-day survival (primary outcome). Interaction was investigated for age, sex, ischemic cardiomyopathy, chronic obstructive pulmonary disease, AHF precipitated by an acute coronary syndrome (ACS), AHF classified as hypertensive or acute pulmonary edema (APE), and systolic blood pressure (SBP). Secondary outcomes were intensive care unit (ICU) admission; mechanical ventilation; in-hospital, 3-day and 7-day mortality; and prolonged hospitalization (> 7 days). Results: Of 11,152 patients from the EAHFE (age (SD): 80 (10) years; 55.5% women), 718 (6.4%) were NIV+ and had a higher 30-day mortality (HR = 2.229; 95% CI = 1.861-2.670) (p < 0.001). PS matching provided 2 groups of 490 patients each with no significant differences in 30-day mortality (HR = 1.239; 95% CI = 0.905-1.696) (p = 0.182). Interaction analysis suggested a worse effect of NIV on elderly patients (> 85 years, p < 0.001), AHF associated with ACS (p = 0.045), and SBP < 100 mmHg (p < 0.001). No significant differences were found in the secondary endpoints except for more prolonged hospitalizations in NIV+ patients (OR = 1.445; 95% CI = 1.122-1.862) (p = 0.004). Conclusion: The use of NIV to treat AHF in ED is not associated with improved mortality outcomes and should be cautious in old patients and those with ACS and hypotension.
Published: 2018

12. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source

Author: Hart, RG, Sharma, M, Mundl, H, Kasner, SE, Bangdiwala, SI, Berkowitz, SD, Swaminathan, B, Lavados, P, Wang, Y, Davalos, A, Shamalov, N, Mikulik, R, Cunha, L, Lindgren, A, Arauz, A, Lang, W, Czlonkowska, A, Eckstein, J, Gagliardi, RJ, Amarenco, P, Ameriso, SF, Tatlisumak, T, Veltkamp, R, Hankey, GJ, Toni, D, Bereczki, D, Uchiyama, S, Ntaios, G, Yoon, BW, Brouns, R, Endres, M, Muir, KW, Bornstein, N, Ozturk, S, O'Donnell, MJ, Basson, MMD, Pare, G, Pater, C, Kirsch, B, Sheridan, P, Peters, G, Weitz, JI, Peacock, WF, Shoamanesh, A, Benavente, OR, Joyner, C, Themeles, E, and Connolly, SJ
Abstract: BACKGROUND Embolic strokes of undetermined source represent 20% of ischemic strokes and are associated with a high rate of recurrence. Anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, may result in a lower risk of recurrent stroke than aspirin. METHODS We compared the efficacy and safety of rivaroxaban (at a daily dose of 15 mg) with aspirin (at a daily dose of 100 mg) for the prevention of recurrent stroke in patients with recent ischemic stroke that was presumed to be from cerebral embolism but without arterial stenosis, lacune, or an identified cardioembolic source. The primary efficacy outcome was the first recurrence of ischemic or hemorrhagic stroke or systemic embolism in a time-to-event analysis; the primary safety outcome was the rate of major bleeding. RESULTS A total of 7213 participants were enrolled at 459 sites; 3609 patients were randomly assigned to receive rivaroxaban and 3604 to receive aspirin. Patients had been followed for a median of 11 months when the trial was terminated early because of a lack of benefit with regard to stroke risk and because of bleeding associated with rivaroxaban. The primary efficacy outcome occurred in 172 patients in the rivaroxaban group (annualized rate, 5.1%) and in 160 in the aspirin group (annualized rate, 4.8%) (hazard ratio, 1.07; 95% confidence interval [CI], 0.87 to 1.33; P=0.52). Recurrent ischemic stroke occurred in 158 patients in the rivaroxaban group (annualized rate, 4.7%) and in 156 in the aspirin group (annualized rate, 4.7%). Major bleeding occurred in 62 patients in the rivaroxaban group (annualized rate, 1.8%) and in 23 in the aspirin group (annualized rate, 0.7%) (hazard ratio, 2.72; 95% CI, 1.68 to 4.39; P
Published: 2018

13. The BRONCH-AHF study: effects on short-term outcome of nebulized bronchodilators in emergency department patients diagnosed with acute heart failure

Author: Miró Ò, Tost J, Gil V, Martín-Sánchez FJ, Llorens P, Herrero P, Mebazaa A, Harjola VP, Ríos J, Marco-Hernández J, Collins SP, Peacock WF, Hollander JE, Lorca MT, Jacob J, and ICA-SEMES Research Group
Published: 2018

14. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

Author: Kasner, Scott E, primary, Swaminathan, Balakumar, additional, Lavados, Pablo, additional, Sharma, Mukul, additional, Muir, Keith, additional, Veltkamp, Roland, additional, Ameriso, Sebastian F, additional, Endres, Matthias, additional, Lutsep, Helmi, additional, Messé, Steven R, additional, Spence, J David, additional, Nedeltechev, Krassen, additional, Perera, Kanjana, additional, Santo, Gustavo, additional, Olavarria, Veronica, additional, Lindgren, Arne, additional, Bangdiwala, Shrikant, additional, Shoamanesh, Ashkan, additional, Berkowitz, Scott D, additional, Mundl, Hardi, additional, Connolly, Stuart J, additional, Hart, Robert G, additional, Abdelhamid, N, additional, Abdul Rahman, D, additional, Abdul-Saheb, M, additional, Abreu, P, additional, Abroskina, M, additional, Abu Ahmad, F, additional, Accassat, S, additional, Acciaresi, M, additional, Adami, A, additional, Ahmad, N, additional, Ahmed, F, additional, Alberto Hawkes, M, additional, Alemseged, F, additional, Ali, A, additional, Altavilla, R, additional, Alwis, L, additional, Amarenco, P, additional, Amaro, S, additional, Amaya Sanchez, LE, additional, Amelia Pinto, A, additional, Ameriso, SF, additional, Amin, H, additional, Amino, T, additional, Amjad, AK, additional, Anagnostou, E, additional, Andersen, G, additional, Anderson, C, additional, Anderson, DC, additional, Andrea Falco, M, additional, Andres Mackinnon, F, additional, Andreu, D, additional, Androulakis, M, additional, Angel Gamero, M, additional, Angel Saredo, G, additional, Angeles Diaz, R, additional, Angels Font, M, additional, Anticoli, S, additional, Arauz, A, additional, Arauz Gongora, AA, additional, Araya, P, additional, Arenillas Lara, JF, additional, Arias Rivas, S, additional, Arnold, M, additional, Augustin, S, additional, Avelar, W, additional, Azevedo, E, additional, Babikian, V, additional, Bacellar, A, additional, Badalyan, K, additional, Bae, HJ, additional, Baez Martinez, EM, additional, Bagelmann, H, additional, Bailey, P, additional, Bak, Z, additional, Baker, M, additional, Balazs, A, additional, Baldaranov, D, additional, Balogun, I, additional, Balueva, T, additional, Bankuti, Z, additional, Bar, M, additional, Baranowska, A, additional, Bardutzky, J, additional, Barker Trejo, S, additional, Barlinn, J, additional, Baronnet, F, additional, Barroso, C, additional, Barteys, M, additional, Bartolottiova, T, additional, Barulin, A, additional, Bas, M, additional, Bashir, S, additional, Basile, V, additional, Bathe-Peters, R, additional, Bathula, R, additional, Batista, C, additional, Batur Caglayan, H, additional, Baumgartner, P, additional, Bazan, R, additional, Bazhenova, O, additional, Beaudry, M, additional, Beer, J, additional, Behnam, Y, additional, Beilei, C, additional, Beinlich, A, additional, Bejot, Y, additional, Belkin, A, additional, Benavente, OR, additional, Benjamin, A, additional, Berardi, V, additional, Bereczki, D, additional, Berkowitz, SD, additional, Berlingieri, J, additional, Berrios, W, additional, Berrouschot, J, additional, Bhandari, M, additional, Bhargavah, M, additional, Bicker, H, additional, Bicsak, T, additional, Bilik, M, additional, Bindila, D, additional, Birchenall, J, additional, Birnbaum, L, additional, Black, T, additional, Blacker, D, additional, Blacquiere, D, additional, Blanc-Labarre, C, additional, Blank, C, additional, Blazejewska-Hyzorek, B, additional, Bloch, S, additional, Bodiguel, E, additional, Bogdanov, E, additional, Boos, L, additional, Borcsik, L, additional, Bornstein, N, additional, Bouly, S, additional, Braga, G, additional, Bragado, I, additional, Bravi, MC, additional, Brokalaki, C, additional, Brola, W, additional, Brouns, R, additional, Bruce, D, additional, Brzoska-Mizgalska, J, additional, Buck, B, additional, Buksinska-Lisik, M, additional, Burke, J, additional, Burn, M, additional, Bustamante, G, additional, Cabrejo, L, additional, Cai, K, additional, Cajaraville, S, additional, Calejo, M, additional, Calvet, D, additional, Campillo, J, additional, Campos Costa, E, additional, Camps, P, additional, Can Alaydin, H, additional, Candeloro, E, additional, Canepa, C, additional, Cantu Brito, CG, additional, Cappellari, M, additional, Carcel, C, additional, Cardona Portela, P, additional, Cardoso, F, additional, Carek, M, additional, Carletti, M, additional, Carlos Portilla, J, additional, Caruso, P, additional, Casado-Naranjo, I, additional, Castellini, P, additional, Castro, D, additional, Castro Meira, F, additional, Cavallini, A, additional, Cayuela Caudevilla, N, additional, Cenciarelli, S, additional, Cereda, C, additional, Cerrone, P, additional, Chakrabarti, A, additional, Chaloulos-Iakovidis, P, additional, Chamorro, A, additional, Chandrasena, D, additional, Chang, DI, additional, Che, C, additional, Chembala, J, additional, Chen, J, additional, Chen, Z, additional, Chen, T, additional, Chen, H, additional, Chen, X, additional, Chen, G, additional, Chen, L, additional, Chen, S, additional, Cheripelli, B, additional, Chin, M, additional, Chiquete Anaya, E, additional, Chorazy, M, additional, Christensen, H, additional, Christensen, T, additional, Christian, L, additional, Chu, F, additional, Chung, CS, additional, Clark, W, additional, Clarke, R, additional, Claverie, S, additional, Clemente Agostoni, E, additional, Clissold, B, additional, Coelho, J, additional, Cohen, D, additional, Colakoglu, S, additional, Collas, D, additional, Condurso, R, additional, Connolly, SJ, additional, Consoli, D, additional, Constantin, C, additional, Constantino Silva, AB, additional, Contardo, L, additional, Corlobe, A, additional, Correia, M, additional, Correia, C, additional, Cortijo Garcia, E, additional, Coull, B, additional, Coutts, S, additional, Coveney, S, additional, Cras, P, additional, Crols, R, additional, Crozier, S, additional, Csanyi, A, additional, Csiba, L, additional, Csontos, K, additional, Csuha, R, additional, Cui, L, additional, 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additional, Diaconu, M, additional, Diaz Otero, F, additional, Dietzel, J, additional, Diez-Tejedor, E, additional, Ding, N, additional, Ding, J, additional, Diomedi, M, additional, Dioszeghy, P, additional, Distefano, M, additional, Domigo, V, additional, Dorodnicov, E, additional, Dossi, D, additional, Doubal, F, additional, Druzenko, I, additional, Du, P, additional, Du, J, additional, Duman, T, additional, Duodu, Y, additional, Dutta, D, additional, Dylewicz, L, additional, Eckstein, J, additional, Ehrensperger, E, additional, Ehrlich, S, additional, Einer Allende, G, additional, Elena Halac, B, additional, Elyas, S, additional, Endres, M, additional, Engelbrecht, JM, additional, Engelter, S, additional, Epinat, M, additional, Eren, F, additional, Esbjornsson, M, additional, Escribano, B, additional, Escudero, I, additional, Esisi, B, additional, Essa, B, additional, Esterbauer, M, additional, Evans, N, additional, Eveson, D, additional, Fabio, S, additional, Fang, L, additional, 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additional, Fuentes Gimeno, B, additional, Fujigasaki, H, additional, Fukuyama, K, additional, Furlan, A, additional, Furlanis, G, additional, Furnace, J, additional, Gabriel, M, additional, Gabriel Reich, E, additional, Gagliardi, RJ, additional, Galati, F, additional, Galli Giqueauk, E, additional, Gallina, A, additional, Gallinella, E, additional, Gallo, J, additional, Gangadharan, S, additional, Gao, Y, additional, Garcia Lopez, R, additional, Garcia Pastor, A, additional, Garcia Sanchez, SM, additional, Garnauf, M, additional, Garnier, P, additional, Gasecki, D, additional, Gasic, K, additional, Gasiorek, K, additional, Gasser, S, additional, Gaugg, M, additional, Gebreyohanns, M, additional, Gebura, K, additional, Geng, J, additional, Geniz Clavijo, M, additional, Georg Haeusler, K, additional, Geran, R, additional, Geremek, M, additional, Gerocs, Z, additional, Ghia, D, additional, Giannandrea, D, additional, Giatsidis, F, additional, Gien Lopez, JA, additional, Gil Nunez, A, additional, Gimenez, L, additional, Giralt, E, additional, Glabinski, A, additional, Gladstone, D, additional, Gliem, M, additional, Gluszkiewicz, M, additional, Goddeau, R, additional, Gogoleva, E, additional, Gokce, M, additional, Goldemund, D, additional, Golikov, K, additional, Gomes Neto, A, additional, Gomez Schneider, M, additional, Gomez-Choco, M, additional, Gomis, M, additional, Gongora-Rivera, JF, additional, Gonysheva, Y, additional, Gonzalez, L, additional, Gonzalez Toledo, ME, additional, Gottschal, M, additional, Gozdzik, I, additional, Grabowski, S, additional, Graf, S, additional, Green, D, additional, Greer, D, additional, Gregorio, T, additional, Greisenegger, S, additional, Greshnova, I, additional, Griebe, M, additional, Grzesik, M, additional, Guan, J, additional, Guarda, S, additional, Gueguen, A, additional, Guidoux, C, additional, Guillermo Povedano, P, additional, Guillon, B, additional, Guiraudg, V, additional, Gunathilagan, G, additional, Guryanova, N, additional, Gusev, V, additional, Gustavo Persi, G, additional, Gutiérrez, R, additional, Guyler, P, additional, Gyuker, N, additional, Hachinski, V, additional, Hajas, A, additional, Hallevi, H, additional, Hankey, G, additional, Hankey, GJ, additional, Hanouskova, L, additional, Hao, L, additional, Haraguchi, K, additional, Haralur Sreekantaiah, Y, additional, Haratz, S, additional, Hargroves, D, additional, Harkness, K, additional, Harmel, P, additional, Harrasser, M, additional, Hart, RG, additional, Harvey, M, additional, Hasan, R, additional, Hasegawa, Y, additional, Hassan, A, additional, Hattori, M, additional, Hatzitolios, A, additional, Hauk, M, additional, Hayashi, T, additional, Hayhoe, H, additional, Hedna, VS, additional, Heine, M, additional, Held, V, additional, Hellwig, S, additional, Henkner, J, additional, Henninger, N, additional, Hermans, S, additional, Hernandez, J, additional, Herrero, D, additional, Hervieu-Begue, M, additional, Herzig, R, additional, Hicken, L, additional, Hieber, M, additional, Hill, M, additional, Hirose, M, additional, Hobeanu, MC, additional, Hobson, B, additional, Hochstetter, M, additional, Hoe Heo, J, additional, Hoffmann, M, additional, Holmstedt, C, additional, Hon, P, additional, Hong, KS, additional, Honma, Y, additional, Horev, A, additional, Horgan, G, additional, Horvath, L, additional, Horvath, M, additional, Hoyer, C, additional, Huang, D, additional, Huang, H, additional, Huber, B, additional, Huhtakangas, J, additional, Hussain, M, additional, Igarashi, S, additional, Iglesias Mohedano, AM, additional, Ignacio Tembl, J, additional, Impellizzeri, M, additional, Inanc, Y, additional, Ioli, P, additional, Irina Aniculaesei, A, additional, Ishida, K, additional, Itabashi, R, additional, Iversen, H, additional, Jagolino, A, additional, Jakab, K, additional, Jander, S, additional, Janka, H, additional, Jankovych, J, additional, Jansen, J, additional, Jasek, L, additional, Javier Alet, M, additional, Javor, L, additional, Jin, X, additional, Jing, P, additional, Joachim, B, additional, Joan Macleod, M, additional, Johnson, M, additional, Jose Martin, J, additional, Joyner, C, additional, Judit Szabo, K, additional, Jun-Oconnell, A, additional, Jura, R, additional, Kaczorowska, B, additional, Kadlcikova, J, additional, Kahles, T, additional, Kakaletsis, N, additional, Kakuk, I, additional, Kalinowska, K, additional, Kaminska, K, additional, Kaneko, C, additional, Kanellos, I, additional, Kapeller, P, additional, Kapica-Topczewska, K, additional, Karasz, O, additional, Karlinski, M, additional, Karlsson, JE, additional, Kasa, K, additional, Kashaeva, E, additional, Kasner, SE, additional, Kaste, M, additional, Kasza, J, additional, Katalin Iljicsov, A, additional, Katsurayama, M, additional, Kaur, S, additional, Kawanishi, M, additional, Kaygorodtseva, S, additional, Ke, K, additional, Kei, A, additional, Keilitz, J, additional, Kellner, J, additional, Kelly, P, additional, Kelly, S, additional, Kemlink, D, additional, Kerekgyarto, M, additional, Keskinarkaus, I, additional, Khairutdinova, D, additional, Khanna, A, additional, Khaw, A, additional, Kholopov, M, additional, Khoumri, C, additional, Kirpicheva, S, additional, Kirshner, H, additional, Kitagawa, K, additional, Kittner, S, additional, Kivioja, R, additional, Klein, F, additional, Kleindorfer, D, additional, Kleinig, T, additional, Klivenyi, P, additional, Knecht, S, additional, Kobayashi, Y, additional, Kobayashi, A, additional, Koch, M, additional, Koehler, L, additional, Koivu, M, additional, Kolianov, V, additional, Koltsov, I, additional, Kondo, T, additional, Konkov, I, additional, Kopecky, S, additional, Korompoki, E, additional, Korpela, J, additional, Kosarz-Lanczek, K, additional, Koutroubi, A, additional, Kovacs, K, additional, Kovacs, T, additional, Kovacs, H, additional, Kowalczyk, K, additional, Kowalska, M, additional, Krajickova, D, additional, Kral, M, additional, Krarup Hansen, C, additional, Kraska, J, additional, Krebs, S, additional, Krejci, V, additional, Kremer, C, additional, Kreuzpointer, R, additional, Krzyzanowska, M, additional, Kucken, D, additional, Kulakowska, A, additional, Kunzmann, J, additional, Kurenkova, N, additional, Kuris, A, additional, Kurkowska-Jastrzebska, I, additional, Kurtenkova, N, additional, Kurushina, O, additional, Kusnick, G, additional, Kustova, M, additional, Kuwashiro, T, additional, Kwan Cha, J, additional, Lago, A, additional, Lagutenko, M, additional, Lajos, B, additional, Lambeck, J, additional, Lamy, C, additional, Landolfi, A, additional, Lanfranconi, S, additional, Lang, W, additional, Lara Lezama, LB, additional, Lara Rodriguez, B, additional, Largo, T, additional, Lasek-Bal, A, additional, Latte, L, additional, Lauer, V, additional, Lavados, P, additional, Le Bouc, R, additional, Leal Cantu, R, additional, Lechner, H, additional, Lecouturier, K, additional, Leder, S, additional, Lee, J, additional, Lee, BC, additional, Leger, A, additional, Leira, E, additional, Leisse, I, additional, Leker, R, additional, Lembo, G, additional, Lenskaya, L, additional, Leyden, J, additional, Li, G, additional, Li, M, additional, Li, S, additional, Li, J, additional, Liamis, G, additional, Liang, H, additional, Liang, Z, additional, Ligot, N, additional, Lin, H, additional, Lindert, R, additional, Lindgren, A, additional, Linna, M, additional, Litwin, T, additional, Liu, K, additional, Liu, X, additional, Llull, L, additional, Lohninger, B, additional, Longoni, M, additional, Loomis, C, additional, Lopes, D, additional, Lopez Fernandez, M, additional, Lopez Garza, N, additional, Lord, A, additional, Louw, S, additional, Lovasz, R, additional, Lowenkopf, T, additional, Lu, Z, additional, Lubke-Detring, SC, additional, Luder, R, additional, Lujan, S, additional, Luo, B, additional, Lupinogina, L, additional, Luschin, G, additional, Lutsep, H, additional, Lvova, A, additional, Ly, J, additional, Grosse, G.M., additional, Ma, H, additional, Ma, C, additional, Machado, M, additional, Machado, C, additional, Macher, S, additional, Machetanz, J, additional, Macian-Montoro, F, additional, Mackey, E, additional, Mackey, A, additional, Maclean, G, additional, Maestre-Moreno, J, additional, Magadan, A, additional, Magyar, T, additional, Mahagney, A, additional, Majid, A, additional, Majjhoo, A, additional, Makaritsis, K, additional, Mandzia, J, additional, Mangas Guijarro, M, additional, Mangion, D, additional, Manios, E, additional, Mann, S, additional, Manning, L, additional, Manno, C, additional, Manuel Garcia, J, additional, Maqueda, V, additional, Mar Castellanos, M, additional, Mar Freijo, M, additional, Marando, C, additional, Marcela Lepera, S, additional, Marcos Couto, J, additional, Maria Bruera, G, additional, Maria Greco, L, additional, Maria Lorenzo, A, additional, Maria Obmann, S, additional, Maria Roa, A, additional, Marini, C, additional, Marinkovic, I, additional, Mario Sumay, G, additional, Mario Torres, C, additional, Marko, M, additional, Markova, S, additional, Markus, H, additional, Marsh, R, additional, Marsili, E, additional, Marta Esnaola, M, additional, Marta Moreno, J, additional, Marti-Fabregas, J, additional, Martina Angelocola, S, additional, Martínez Sánchez, P, additional, Martinez-Majander, N, additional, Martins, S, additional, Marzelik, O, additional, Mastrocola, S, additional, Matamala, G, additional, Matoltsy, A, additional, Matosevic, B, additional, Matsumoto, S, additional, Maud, A, additional, Mauri Cabdevila, G, additional, May, Z, additional, Mayasi, Y, additional, Mayr, A, additional, Mazzoli, T, additional, Mcarthur, K, additional, Mccullough, L, additional, Medina Pech, CE, additional, Medlin, F, additional, Mehdiratta, M, additional, Mehta, S, additional, Mehta, D, additional, Mehta, B, additional, Melis, M, additional, Melnikova, E, additional, Mendez, B, additional, Mendonca, T, additional, Mengual Chirifie, JJ, additional, Menon, N, additional, Mensch, A, additional, Meseguer, E, additional, Messe, S, additional, Metcalf, K, additional, Meyer, N, additional, Michas, F, additional, Micheletti, N, additional, Mikulik, R, additional, Milionis, H, additional, Miller, B, additional, Milling, T, additional, Minelli, C, additional, Minhas, J, additional, Minns, M, additional, Mircea, D, additional, Mishra, S, additional, Mismas, A, additional, Mistri, A, additional, Mitrovic, N, additional, Miyake, H, additional, Modrau, B, additional, Moey, A, additional, Molina, C, additional, Molina, J, additional, Molis, A, additional, Moller, J, additional, Molnar, S, additional, Moniche, F, additional, Monosi, C, additional, Monzani, V, additional, Moonis, M, additional, Morais, R, additional, Morales, L, additional, Morales, A, additional, Morar-Precup, D, additional, Moreton, F, additional, Moro, C, additional, Morozova, E, additional, Morton, M, additional, Morvan, T, additional, Morvan, E, additional, Motko, T, additional, 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additional, Stotts, G, additional, Stumpp, A, additional, Sucapane, P, additional, Suenaga, T, additional, Sun, X, additional, Sundararajan, S, additional, Sung Kim, J, additional, Suzuki, H, additional, Svaneborg, N, additional, Szasz, G, additional, Szczuchniak, W, additional, Szczyrba, S, additional, Szegedi, N, additional, Szekely, A, additional, Szewczyk, Z, additional, Szilagyi, G, additional, Szlufik, S, additional, Szoboszlai, K, additional, Szpisjak, L, additional, Sztajzel, R, additional, Sztriha, L, additional, Ta Wil, SE, additional, Taggeselle, J, additional, Takamatsu, K, additional, Takao, M, additional, Taki, W, additional, Takizawa, S, additional, Talahma, M, additional, Tamayo, A, additional, Tan, J, additional, Tanne, D, additional, Tapanainen, A, additional, Tapiola, T, additional, Tarasiuk, J, additional, Tatlisumak, T, additional, Tayal, A, additional, Tcvetkova, S, additional, Teal, P, additional, Tejada Garcia, J, additional, Tejada Meza, H, additional, Tenora, 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Wlodek, A, additional, Wojnarowska-Arendt, A, additional, Wolf, M, additional, Wolff, V, additional, Wolter, C, additional, Wong, A, additional, Wook Nah, H, additional, Worthmann, H, additional, Wu, W, additional, Wu, S, additional, Wunderlich, S, additional, Wurzinger, H, additional, Wyse, DG, additional, Xiao, B, additional, Xiaopeng, W, additional, Ximenez-Carrillo, A, additional, Xiong, L, additional, Xiong, Y, additional, Xiong, W, additional, Xu, Y, additional, Xu, J, additional, Xu, Z, additional, Yalo, B, additional, Yamada, T, additional, Yamasaki, M, additional, Yang, L, additional, Yang, Y, additional, Yang, X, additional, Yang, Q, additional, Yang, B, additional, Yang, J, additional, Yasuhiro, I, additional, Yee Lam, M, additional, Yegappan, C, additional, Yip, S, additional, Ylikallio, E, additional, Ylikotila, P, additional, Yongwon Jin, A, additional, Yoon, BW, additional, Yoshida, Y, additional, Yperzeele, L, additional, Yuan, H, additional, Yuasa, H, additional, Zalewska, J, additional, Zanferrari, C, additional, Zapata, E, additional, Zboznovits, D, additional, Zelenka, I, additional, Zhang, C, additional, Zhang, B, additional, Zhang, S, additional, Zhang, M, additional, Zhang, X, additional, Zhang, J, additional, Zhao, L, additional, Zhirnova, O, additional, Zhou, L, additional, Zielinska-Turek, J, additional, Zinchenko, I, additional, Ziomek, M, additional, Zitzmann, A, additional, Zweifler, R, additional, and Zwiernik, J, additional
Published: 2018
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15. The effect of a short-stay unit on hospital admission and length of stay in acute heart failure: REDUCE-AHF study

Author: Miró Ò, Carbajosa V, Peacock WF, Llorens P, Herrero P, Jacob J, Collins SP, Fernández C, Pastor AJ, Martín-Sánchez FJ, and ICA-SEMES group
Subjects: Emergency department, Revisit, Acute heart failure, Length of stay, Short-stay unit, Mortality, Management
Abstract: OBJECTIVE: To determine whether the presence of a short-stay unit(SSU) in a hospital influences the percentage of admissions, length of hospital stay(LOS) and outcomes in emergency department(ED) patients with acute heart failure(AHF). METHOD: Retrospective analysis of AHF patients presenting to one of 34 Spanish ED included in EAHFE registry. Baseline and ED data of patients were collected. Patients were classified into two groups in function of being attended at hospitals with or without a SSU. Main outcome variables were the percentage of admissions from ED, and LOS for admitted patients. Secondary variables were all-cause death and ED revisits for worsening heart failure within 30days following discharge. RESULTS: Of 9078 patients presenting to the ED (SSU 5191; no SSU 3887), 6796 (74.8%) were admitted. Compared to hospitals without a SSU, the admission rate in hospitals with a SSU was 8.9% higher (95%CI 6.5%-11.4%), but 30-day ED revisit and mortality rates were lower among patients discharged directly from the ED (-10.3%, 95%CI -16,9% to -3.7%; and -10.0%, 95%CI -16.6 to -3.4%, respectively). For admitted patients, the overall LOS was 9.3±9.5days, being 2.2days shorter (95%CI -2.7 to -1.7) in hospitals with a SSU, with no significant differences in in-hospital, 30-day mortality or 30-day ED revisit rates. CONCLUSIONS: The data suggest that SSU may improve the safety of emergency care of patients with AHF, but at the cost of a higher rate of hospital admissions, and it may also reduce the LOS for admitted patients without affecting post discharge safety.
Published: 2017

16. Morphine Use in the ED and Outcomes of Patients With Acute Heart Failure: A Propensity Score-Matching Analysis Based on the EAHFE Registry

Author: Miró Ò, Gil V, Martín-Sánchez FJ, Herrero-Puente P, Jacob J, Mebazaa A, Harjola VP, Ríos J, Hollander JE, Peacock WF, Llorens P, and ICA-SEMES Research Group(*)
Subjects: opiates, ED, acute heart failure, morphine, outcome
Abstract: OBJECTIVE: The objective was to determine the relationship between short-term mortality and intravenous morphine use in ED patients who received a diagnosis of acute heart failure (AHF). METHODS: Consecutive patients with AHF presenting to 34 Spanish EDs from 2011 to 2014 were eligible for inclusion. The subjects were divided into those with (M) or without IV morphine treatment (WOM) groups during ED stay. The primary outcome was 30-day all-cause mortality, and secondary outcomes were mortality at different intermediate time points, in-hospital mortality, and length of hospital stay. We generated a propensity score to match the M and WOM groups that were 1:1 according to 46 different epidemiological, baseline, clinical, and therapeutic factors. We investigated independent risk factors for 30-day mortality in patients receiving morphine. RESULTS: We included 6,516 patients (mean age, 81 [SD, 10] years; 56% women): 416 (6.4%) in the M and 6,100 (93.6%) in the WOM group. Overall, 635 (9.7%; M, 26.7%; WOM, 8.6%) died by day 30. After propensity score matching, 275 paired patients constituted each group. Patients receiving morphine had a higher 30-day mortality (55 [20.0%] vs 35 [12.7%] deaths; hazard ratio, 1.66; 95% CI, 1.09-2.54; P = .017). In patients receiving morphine, death was directly related to glycemia (P = .013) and inversely related to the baseline Barthel index and systolic BP (P = .021) at ED arrival (P = .021). Mortality was increased at every intermediate time point, although the greatest risk was at the shortest time (at 3 days: 22 [8.0%] vs 7 [2.5%] deaths; OR, 3.33; 95% CI, 1.40-7.93; P = .014). In-hospital mortality did not increase (39 [14.2%] vs 26 [9.1%] deaths; OR, 1.65; 95% CI, 0.97-2.82; P = .083) and LOS did not differ between groups (median [interquartile range] in M, 8 [7]; WOM, 8 [6]; P = .79). CONCLUSIONS: This propensity score-matched analysis suggests that the use of IV morphine in AHF could be associated with increased 30-day mortality.
Published: 2017

17. Body mass index and mortality in acutely decompensated heart failure across the world: a global obesity paradox

Author: Shah, R, Gayat, E, Januzzi JL Jr, Sato, N, Cohen Solal, A, DI SOMMA, Salvatore, Fairman, E, Harjola, Vp, Ishihara, S, Lassus, J, Maggioni, A, Metra, M, Mueller, C, Mueller, T, Parenica, J, Pascual Figal, D, Peacock, Wf, Spinar, J, van Kimmenade, R, Mebazaa, A, and Great, Network
Subjects: Heart Failure, Male, obesity, Internationality, heart failure, obesity paradox, Acute Disease, Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Middle Aged, Obesity, Prospective Studies, Registries, Body Mass Index, Global Health, 80 and over
Published: 2014

18. Atrial fibrillation impairs the diagnostic performance of cardiac natriuretic peptides in dyspneic patients. results from the BACH Study (Biomarkers in ACute Heart Failure)

Author: Richards, M, DI SOMMA, Salvatore, Mueller, C, Nowak, R, Peacock, Wf, Ponikowski, P, Mockel, M, Hogan, C, Wu, Ah, Clopton, P, Filippatos, Gs, Anand, I, Ng, L, Daniels, Lb, Neath, Sx, Shah, K, Christenson, R, Hartmann, O, Anker, Sd, and Maisel, A.
Subjects: atrial fibrillation, heart failure, natriuretic peptides
Published: 2013

19. Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: results from the BACH (Biomarkers in Acute Heart Failure) trial.

Author: Maisel, A, Neath, S-X, Landsberg, J, Mueller, C, Nowak, RM, Peacock, WF, Ponikowski, P, Möckel, M, Hogan, C, Wu, AHB, Richards, M, Clopton, P, Filippatos, GS, Di Somma, S, Anand, I, Ng, LL, Daniels, LB, Christenson, RH, Potocki, M, McCord, J, Terracciano, G, Hartmann, O, Bergmann, A, Morgenthaler, NG, Anker, SD, Maisel, A, Neath, S-X, Landsberg, J, Mueller, C, Nowak, RM, Peacock, WF, Ponikowski, P, Möckel, M, Hogan, C, Wu, AHB, Richards, M, Clopton, P, Filippatos, GS, Di Somma, S, Anand, I, Ng, LL, Daniels, LB, Christenson, RH, Potocki, M, McCord, J, Terracciano, G, Hartmann, O, Bergmann, A, Morgenthaler, NG, and Anker, SD
Abstract: AIMS: Biomarkers have proven their ability in the evaluation of cardiopulmonary diseases. We investigated the utility of concentrations of the biomarker procalcitonin (PCT) alone and with clinical variables for the diagnosis of pneumonia in patients presenting to emergency departments (EDs) with a chief complaint of shortness of breath. METHODS AND RESULTS: The BACH trial was a prospective, international, study of 1641 patients presenting to EDs with dyspnoea. Blood samples were analysed for PCT and other biomarkers. Relevant clinical data were also captured. Patient outcomes were assessed at 90 days. The diagnosis of pneumonia was made using strictly validated guidelines. A model using PCT was more accurate [area under the curve (AUC) 72.3%] than any other individual clinical variable for the diagnosis of pneumonia in all patients, in those with obstructive lung disease, and in those with acute heart failure (AHF). Combining physician estimates of the probability of pneumonia with PCT values increased the accuracy to >86% for the diagnosis of pneumonia in all patients. Patients with a diagnosis of AHF and an elevated PCT concentration (>0.21 ng/mL) had a worse outcome if not treated with antibiotics (P = 0.046), while patients with low PCT values (<0.05 ng/mL) had a better outcome if they did not receive antibiotic therapy (P = 0.049). CONCLUSION: Procalcitonin may aid in the diagnosis of pneumonia, particularly in cases with high diagnostic uncertainty. Importantly, PCT may aid in the decision to administer antibiotic therapy to patients presenting with AHF in which clinical uncertainty exists regarding a superimposed bacterial infection.
Published: 2012

20. Prediction of short- and long-term outcomes by troponin T levels in low-risk patients evaluated for acute coronary syndromes

Author: I V, Peacock WF, C L, Emerman, E S, McErlean, S A, Deluca, F, van Lente, J S, Rao, and S E, Nissen
Subjects: Male, Chi-Square Distribution, Coronary Disease, Enzyme-Linked Immunosorbent Assay, Middle Aged, Prognosis, Risk Assessment, Sensitivity and Specificity, ROC Curve, Troponin T, Predictive Value of Tests, Acute Disease, Disease Progression, Humans, Female, Longitudinal Studies, Prospective Studies, Biomarkers
Abstract: Recent reports suggest a short series of cardiac troponin (cTnT) testing effectively identifies patients at risk for cardiac events. However, there are few studies validating this strategy. The purpose of this study was to determine the ability of cTnT levels to predict short- and long-term outcomes in low-risk patients with suspected acute coronary syndromes.This prospective longitudinal study was conducted in a 20-bed emergency department observation unit. Patients at low risk for acute coronary ischemia, with a normal creatine kinase-isoenzyme subunit MB (CKMB) index, were admitted to an observation unit for chest pain evaluation. Serum cTnT levels were measured at baseline and at 4, 8, and 16 hours after admission. The main outcome measures were adverse cardiac events (death, acute myocardial infarction, unstable angina, revascularization) during the index visit and within 6 months after discharge. Using manufacturer's recommendations, the cTnT level was considered abnormal if it exceeded 0.2 microg/L.Two hundred sixty-six patients were evaluated. Twenty-one (7.9%) had an adverse event during their index hospitalization. Troponin testing identified only 2 (9.5%) of these patients. Twenty (7.5%) had a cardiac event within 6 months; none were identified by cTnT testing. The sensitivity and specificity were 9.5% and 99.2%, respectively, at the index visit, and 0% and 98.4% at 6 months. The positive and negative predictive values were 50% and 93%, respectively, at the index visit; and 0% and 92% at 6 months.Determination of troponin T levels has a low sensitivity and high specificity for predicting outcomes in low-risk patients evaluated for suspected acute coronary syndromes. This study does not support a strategy of relying solely on troponin testing for disposition decisions.
Published: 2000

21. Preface

Author: Peacock Wf and Neuenschwander Jf nd
Subjects: medicine.medical_specialty, business.industry, Heart failure, Management of heart failure, medicine, General Medicine, Cardiology and Cardiovascular Medicine, medicine.disease, Intensive care medicine, business
Published: 2009

22. PCV93 - Outcomes related to variation in hospital pulmonary embolus observation stay utilization

Author: Weeda, ER, Bunz, TJ, Coleman, CI, Schein, JR, Ashton, Crivera, C, Wildgoose, P, Peacock, WF, and Fermann, GJ
Published: 2016
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23. Letter to the Editor

Author: Peacock Wf
Subjects: Psychotherapist, business.industry, Emergency Medicine, Medicine, business
Published: 2006

24. Guideline Adherence After ST-Segment Elevation Versus Non-ST Segment Elevation Myocardial Infarction.

Author: Somma KA, Bhatt DL, Fonarow GC, Cannon CP, Cox M, Laskey W, Peacock WF, Hernandez AF, Peterson ED, Schwamm L, and Saxon LA
Published: 2012
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25. Care and outcomes of Asian-American acute myocardial infarction patients: findings from the American Heart Association Get With The Guidelines-Coronary Artery Disease program.

Author: Qian F, Ling FS, Deedwania P, Hernandez AF, Fonarow GC, Cannon CP, Peterson ED, Peacock WF, Kaltenbach LA, Laskey WK, Schwamm LH, Bhatt DL, and Get With The Guidelines Steering Committee and Investigators
Published: 2012

26. Diagnosis and management of fluid overload in heart failure and cardio-renal syndrome: the "5B" approach.

Author: Ronco C, Kaushik M, Valle R, Aspromonte N, Peacock WF 4th, Ronco, Claudio, Kaushik, Manish, Valle, Roberto, Aspromonte, Nadia, and Peacock, W Frank 4th
Abstract: Cardio-Renal syndrome may occur as a result of either primarily renal or cardiac dysfunction. This complex interaction requires a tailored approach to manage the underlying pathophysiology while optimizing the patient's symptoms and thus providing the best outcomes. Patients often are admitted to the hospital for signs and symptoms of congestion and fluid overload is the most frequent cause of subsequent re-admission. Fluid management is of paramount importance in the strategy of treatment for heart failure patients. Adequate fluid status should be obtained but a target value should be set according to objective indicators and biomarkers. Once the fluid excess is identified, a careful prescription of fluid removal by diuretics or extracorporeal therapies must be made. While delivering these therapies, adequate monitoring should be performed to prevent unwanted effects such as worsening of renal function or other complications. There is a very narrow window of optimal hydration for heart failure patients. Overhydration can result in myocardial stretching and potential decompensation. Inappropriate dehydration or relative reduction of circulating blood volume may result in distant organ damage caused by inadequate perfusion. We suggest consideration of the "5B" approach. This stands for balance of fluids (reflected by body weight), blood pressure, biomarkers, bioimpedance vector analysis, and blood volume. Addressing these parameters ensures that the most important issues affecting symptoms and outcomes are addressed. Furthermore, the patient is receiving the best possible care while avoiding unwanted side effects of the treatment. [ABSTRACT FROM AUTHOR]
Published: 2012
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27. Fluid overload assessment and management in heart failure patients.

Author: Tuy T and Peacock WF 4th
Published: 2012

28. Influence of age, race, sex, and body mass index on interpretation of midregional pro atrial natriuretic peptide for the diagnosis of acute heart failure: results from the BACH multinational study.

Author: Daniels LB, Clopton P, Potocki M, Mueller C, McCord J, Richards M, Hartmann O, Anand IS, Wu AH, Nowak R, Peacock WF, Ponikowski P, Mockel M, Hogan C, Filippatos GS, Di Somma S, Ng L, Neath SX, Christenson R, and Morgenthaler NG
Published: 2012

29. Myeloperoxidase in the diagnosis of acute coronary syndromes: The importance of spectrum.

Author: Peacock WF, Nagurney J, Birkhahn R, Singer A, Shapiro N, Hollander J, Glynn T, Nowak R, Safdar B, Miller C, Peberdy M, Counselman F, Chandra A, Kosowsky J, Neuenschwander J, Schrock J, Plantholt S, Lewandrowski E, Wong V, and Kupfer K
Published: 2011

30. Impact of diuretic dosing on mortality in acute heart failure using a propensity-matched analysis.

Author: Yilmaz MB, Gayat E, Salem R, Lassus J, Nikolaou M, Laribi S, Parissis J, Follath F, Peacock WF, and Mebazaa A
Published: 2011

31. Clinical practices, complications, and mortality in neurological patients with acute severe hypertension: the Studying the Treatment of Acute hyperTension registry.

Author: Mayer SA, Kurtz P, Wyman A, Sung GY, Multz AS, Varon J, Granger CB, Kleinschmidt K, Lapointe M, Peacock WF, Katz JN, Gore JM, O'Neil B, Anderson FA, and STAT Investigators
Published: 2011
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32. Acute kidney injury and cardiovascular outcomes in acute severe hypertension.

Author: Szczech LA, Granger CB, Dasta JF, Amin A, Peacock WF, McCullough PA, Devlin JW, Weir MR, Katz JN, Anderson FA Jr, Wyman A, Varon J, and Studying the Treatment of Acute Hypertension Investigators
Published: 2010
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33. Low-risk acute heart failure patients: external validation of the Society of Chest Pain Center's recommendations.

Author: Collins SP, Lindsell CJ, Naftilan AJ, Peacock WF, Diercks D, Hiestand B, Maisel A, Storrow AB, Collins, Sean P, Lindsell, Christopher J, Naftilan, Allen J, Peacock, W Frank, Diercks, Deborah, Hiestand, Brian, Maisel, Alan, and Storrow, Alan B
Published: 2009
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34. An analysis of the Association of Society of Chest Pain Centers Accreditation to American College of Cardiology/American Heart Association non-ST-segment elevation myocardial infarction guideline adherence.

Author: Chandra A, Glickman SW, Ou FS, Peacock WF, McCord JK, Cairns CB, Peterson ED, Ohman EM, Gibler WB, and Roe MT
Abstract: STUDY OBJECTIVE: Since 2003, the Society of Chest Pain Centers (SCPC) has provided hospital accreditation for acute coronary syndrome care processes. Our objective is to evaluate the association between SCPC accreditation and adherence to the American College of Cardiology/American Heart Association (ACC/AHA) evidence-based guidelines for non-ST-segment elevation myocardial infarction (NSTEMI). The secondary objective is to describe the clinical outcomes and the association with accreditation. METHODS: We conducted a secondary analysis of data from patients with NSTEMI enrolled in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative in 2005. The analysis explored differences between SCPC-accredited and nonaccredited hospitals in evidence-based therapy given within the first 24 hours (including aspirin, beta-blocker, glycoprotein IIb/IIIa inhibitors, heparin, and ECG within 10 minutes). RESULTS: Of 33,238 patients treated at 21 accredited hospitals and 323 nonaccredited hospitals, those at SCPC-accredited centers (n=3,059) were more likely to receive aspirin (98.1% versus 95.8%; odds ratio [OR] 1.73; 95% confidence interval [CI] 1.06 to 2.83) and beta-blockers (93.4% versus 90.6%; OR 1.68; 95% CI 1.04 to 2.70) within 24 hours than patients at non-SCPC-accredited centers (n=30,179). No difference was observed in obtaining a timely ECG (40.4% versus 35.2%; OR 1.28; 95% CI 0.98 to 1.67), administering a glycoprotein IIb/IIIa inhibitor (OR 1.30; 95% CI 0.93 to 1.80), or administering heparin (OR 1.12; 95% CI 0.74 to 1.70). Also, there was no significant difference in risk-adjusted mortality for patients treated at SCPC hospitals versus nonaccredited hospitals (3.4% versus 3.5%; adjusted OR 1.17; 95% CI 0.88 to 1.55). CONCLUSION: SCPC-accredited hospitals had higher NSTEMI ACC/AHA evidence-based guideline adherence in the first 24 hours of care on 2 of the 5 measures. No difference in outcomes was observed. Further studies are needed to better understand the association between SCPC accreditation and improved care for patients with acute coronary syndrome. [ABSTRACT FROM AUTHOR]
Published: 2009
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35. Design and rationale of the URGENT Dyspnea study: an international, multicenter, prospective study.

Author: Pang PS, Tavares M, Collins SP, Cleland JGF, Hollander J, Nieminen M, Miller C, Courtney DM, Kirk JD, Masip J, Parkhomenko A, Macarie C, Peacock WF, Spinar J, Nowak R, Raev D, Storrow AB, Spisak V, Hamdy A, and Mebazaa A
Published: 2008
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36. Society of Chest Pain Centers Recommendations for the evaluation and management of the observation stay acute heart failure patient: a report from the Society of Chest Pain Centers Acute Heart Failure Committee.

Author: Peacock WF, Fonarow GC, Ander DS, Maisel A, Hollander JE, Januzzi JL Jr, Yancy CW, Collins SP, Gheorghiade M, Weintraub NL, Storrow AB, Pang PS, Abraham WT, Hiestand B, Kirk JD, Filippatos G, Levy P, Amsterdam EA, and Heart Failure Executive Committee
Published: 2008

37. Cardiac troponin and outcome in acute heart failure.

Author: Peacock WF 4th, De Marco T, Fonarow GC, Diercks D, Wynne J, Apple FS, Wu AH, and ADHERE Investigators
Published: 2008

38. Prolonged emergency department stays of non-ST-segment-elevation myocardial infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association guidelines for management and increased adverse events.

Author: Diercks DB, Roe MT, Chen AY, Peacock WF, Kirk JD, Pollack CV Jr, Gibler WB, Smith SC Jr, Ohman M, and Peterson ED
Abstract: STUDY OBJECTIVE: We evaluate the association of emergency department (ED) length of stay with use of guideline-recommended therapies for acute treatments and clinical outcomes. Prolonged ED stays often reflect ED crowding or limited hospital capacity. We hypothesized that patients with non-ST-segment-elevation myocardial infarction who have ED stays of greater than 8 hours may have lower quality of care and worse outcomes. METHODS: Using a secondary analysis of data from an observational registry (Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation of the ACC/AHA Guidelines, CRUSADE), we compared rates of use of 5 individual acute (<24 hours) guideline-recommended therapies in patients with non-ST-segment-elevation myocardial infarction according to ED length of stay. Patients were grouped by length of stay (short [<4 hours], average [4 to 8 hours], or long [>8 hours]). Multivariable analyses were used to determine independent association of ED length of stay with acute medications and inhospital outcomes (death and myocardial infarction). RESULTS: This analysis included 42,780 patients with non-ST-segment-elevation myocardial infarction. The median ED length of stay was 4.3 hours (25th to 75th percentile 2.9, 6.3); 15% of patients stayed longer than 8 hours. Patients who had long ED stays were more likely to be women and nonwhite and less likely to have health maintenance organization or private insurance. After adjustment, patients with long ED stays less often received guideline-recommended acute myocardial infarction therapies. Although risk-adjusted inhospital mortality rates were similar among groups, the rate of recurrent myocardial infarction increased among patients with long ED stays (odds ratio 1.23; 95% confidence interval 1.01 to 1.48) compared with those with average ED length of stay. CONCLUSION: For patients with non-ST-segment-elevation myocardial infarction, long ED stays were associated with decreased use of guideline-recommended therapies and a higher risk of recurrent myocardial infarction. However, there was no observed difference in mortality. Factors associated with prolonged ED length of stay should be evaluated to optimize treatments and outcomes of patients with non-ST-segment-elevation myocardial infarction. [ABSTRACT FROM AUTHOR]
Published: 2007
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39. Acoustic cardiography augments prolonged QRS duration for detecting left ventricular dysfunction.

Author: Zuber M, Attenhofer Jost CH, Kipfer P, Collins SP, Michota F, Peacock WF, Zuber, Michel, Attenhofer Jost, Christine H, Kipfer, Peter, Collins, Sean P, Michota, Frank, and Peacock, W Frank
Abstract: Background: Prolonged QRS duration has been used as a marker for left ventricular (LV) systolic dysfunction (SD) and is used in the evaluation of patients presenting with known or suspected heart failure. The goal of this study was to compare the abilities of QRS duration and simultaneous digital ECG and heart sounds, that is acoustic cardiographic, parameters to identify patients with LV dysfunction.Methods: Our learning population consisted of 171 patients with possible chronic compensated or mildly decompensated heart failure who presented to an ambulatory cardiology clinic for echocardiographic examination. We defined LVSD as a LV ejection fraction < 50%, and estimated LV filling pressures from diastolic measurements. These patients also had acoustic cardiographic recordings from which we obtained a variety of individual ECG and acoustic cardiographic parameters. We used the product of four of these parameters to obtain a diagnostic score for LV dysfunction. We then compared the diagnostic performances of QRS duration and the score on a test population of patients who presented to an emergency department with possible heart failure.Results: In the learning population, the sensitivities/specificities of QRS duration > or =120 ms and the score for prediction of LVSD were 51%/92% and 77%/90%, respectively. In the test population, the score remained superior to QRS duration for detecting LVSD as well as acute decompensated heart failure.Conclusions: Improved identification of LVSD and clinical heart failure can be achieved with a cost-effective bedside screening tool with the simple combination of simultaneously acquired digital ECG and heart sound data. [ABSTRACT FROM AUTHOR]
Published: 2007

40. The elder patient with suspected acute coronary syndromes in the emergency department.

Author: Han JH, Lindsell CJ, Hornung RW, Lewis T, Storrow AB, Hoekstra JW, Hollander JE, Miller CD, Peacock WF, Pollack CV, Gibler WB, and Emergency Medicine Cardiac Research and Education Group Internet Tracking Registry for Acute Coronary Syndromes (i*trACS) Investigators
Published: 2007

41. ED patients with heart failure: identification of an observational unit-appropriate cohort.

Author: Diercks DB, Peacock WF, Kirk JD, and Weber JE
Abstract: OBJECTIVE: To identify factors that define a low-risk cohort of patients with acute decompensated heart failure who are suitable for management in an observation unit. METHODS: Prospective convenience sample of 538 patients who presented to an ED with a diagnosis of congestive heart failure. Observation unit appropriate was defined as a length of stay less than 24 hours and no adverse events (myocardial infarction, death, arrhythmia, or rehospitalization) during the 30-day follow-up period. RESULTS: Study criteria were met by 499 patients (mean age, 61 +/- 15 years), and 234 (47%) were women. Of these, 133 (27%) met the criteria for observation unit appropriateness. Independent predictors were systolic blood pressure of greater than 160 (odds ratio, 1.8; 95% confidence interval, 1.15-2.7) and normal troponin I (odds ratio, 14.7; 95% confidence interval, 1.9-105). CONCLUSION: Initial blood pressure and troponin I can help identify patients with congestive heart failure at low risk for prolonged hospitalization and adverse events and who are reasonable candidates for observation unit management. © 2006 Elsevier Inc. All rights reserved. [ABSTRACT FROM AUTHOR]
Published: 2006
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42. Impact of impedance cardiography on diagnosis and therapy of emergent dyspnea: the ED-IMPACT trial.

Author: Peacock WF, Summers RL, Vogel J, and Emerman CE
Published: 2006

43. Frequency and consequences of recording an electrocardiogram >10 minutes after arrival in an emergency room in non-ST-segment elevation acute coronary syndromes (from the CRUSADE Initiative)

Author: Diercks DB, Peacock WF, Hiestand BC, Chen AY, Pollack CV Jr, Kirk JD, Smith SC Jr, Gibler WB, Ohman EM, Blomkalns AL, Newby LK, Hochman JS, Peterson ED, and Roe MT
Published: 2006
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44. Relationship between risk stratification by cardiac troponin level and adherence to guidelines for non-ST-segment elevation acute coronary syndromes.

Author: Roe MT, Peterson ED, Li Y, Pollack CV Jr., Christenson RH, Peacock WF, Fesmire FM, Newby LK, Jesse RL, Hoekstra JW, Gibler WB, and Ohman EM
Published: 2005
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45. Predictors of emergency department observation unit outcomes.

Author: Burkhardt J, Peacock WF, and Emerman CL
Published: 2005

46. Influence of timing of troponin elevation on clinical outcomes and use of evidence-based therapies for patients with non-ST-segment elevation acute coronary syndromes.

Author: Roe MT, Peterson ED, Pollack CV Jr., Newby LK, Li Y, Christenson RH, Peacock WF, Fesmire FM, Diercks D, Kirk JD, Smith SC Jr., Ohman EM, Gibler WB, and CRUSADE Investigators
Abstract: STUDY OBJECTIVE: Previous studies in clinical trial populations have demonstrated that patients presenting with positive troponin levels have a higher risk of mortality than patients with later positive troponin levels, but the influence of the timing of troponin elevation has not been previously characterized. We evaluate the impact of the timing of troponin elevation on clinical outcomes and adherence to the American College of Cardiology/American Heart Association acute care guidelines for patients with non-ST-segment elevation acute coronary syndromes. METHODS: We examined inhospital outcomes and use of acute (<24 hours) medications and invasive cardiac procedures in 23,184 high-risk patients with non-ST-segment elevation acute coronary syndromes (positive cardiac markers or ischemic ST-segment changes) during 2001 to 2002 from 396 US hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) Initiative. Baseline and peak troponin values were recorded and were designated as positive if above the cutoff value used at each institution to designate definite myocardial necrosis. RESULTS: In the study cohort, 53.2% of patients presented with baseline positive troponin levels, 30.6% had baseline negative/later positive troponin levels, and 16.2% had negative troponin levels during the entire hospitalization. Patients with baseline positive troponin levels had a higher risk of inhospital mortality than patients with baseline negative/later positive troponin levels (6.5% versus 4.1%) and were less likely to undergo early cardiac catheterization or percutaneous coronary intervention. The use of acute aspirin (in approximately 91% of patients), heparin (85%), and beta-blockers (78%) was similar in patients with baseline-positive versus later-positive troponin levels. CONCLUSION: These findings demonstrate that evidence-based therapies and interventions for non-ST-segment elevation acute coronary syndromes are underused in patients with elevated troponin levels, but baseline troponin elevations, which are associated with a higher risk of inhospital mortality, do not stimulate more aggressive care. [ABSTRACT FROM AUTHOR]
Published: 2005
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47. Utilization of early invasive management strategies for high-risk patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative.

Author: Bhatt DL, Roe MT, Peterson ED, Li Y, Chen AY, Harrington RA, Greenbaum AB, Berger PB, Cannon CP, Cohen DJ, Gibson CM, Saucedo JF, Kleiman NS, Hochman JS, Boden WE, Brindis RG, Peacock WF, Smith SC Jr., Pollack CV Jr., and Gibler WB
Abstract: Context: The American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of non-ST-segment elevation acute coronary syndromes (NSTE ACS) recommend early invasive management for high-risk patients, given the benefits with this approach demonstrated in randomized clinical trials.Objectives: To determine the use and predictors of early invasive management strategies (cardiac catheterization <48 hours following presentation) in high-risk patients with NSTE ACS and to examine the association of early invasive management with mortality.Design, Setting, and Patients: The CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) Quality Improvement Initiative evaluated care patterns and outcomes for 17,926 high-risk NSTE ACS patients (positive cardiac markers and/or ischemic electrocardiographic changes) based on ACC/AHA guidelines recommendations at 248 US hospitals with catheterization and revascularization facilities between March 2000 and September 2002.Main Outcome Measures: Use of early invasive management within 48 hours of presentation, predictors of early invasive management, and in-hospital mortality. Results Of the 17,926 patients analyzed, 8037 (44.8%) underwent early cardiac catheterization less than 48 hours following presentation. Predictors of early invasive management included cardiology care, younger age, lack of prior or current congestive heart failure, lack of renal insufficiency, ischemic electrocardiographic changes, positive cardiac markers, white race, and male sex. Patients treated with early invasive management were more likely to be treated with medications and interventions recommended by the ACC/AHA guidelines and had a lower risk of in-hospital mortality after adjusting for differences in clinical characteristics and after comparing propensity-matched pairs (2.5% vs 3.7%, P<.001). Conclusions An early invasive management strategy is not utilized in the majority of high-risk patients with NSTE ACS. This strategy appears to be reserved for patients without significant comorbidities and those cared for by cardiologists and is associated with a lower risk of in-hospital mortality. [ABSTRACT FROM AUTHOR]
Published: 2004
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48. Insurance status and the treatment of myocardial infarction at academic centers [corrected] [published erratum appears in ACAD EMERG MED 2004 Aug;11(8):884].

Author: Hiestand BC, Prall DM, Lindsell CJ, Hoekstra JW, Pollack CV, Hollander JE, Tiffany BR, Peacock WF, Diercks DB, and Gibler WB
Published: 2004

49. Bench to bedside: electrophysiologic and clinical principles of noninvasive hemodynamic monitoring using impedance cardiography.

Author: Summers RL, Shoemaker WC, Peacock WF, Ander DS, and Coleman TG
Published: 2003

50. Clinical case presentation. Syncope in a 19-year-old man.

Author: Luttrell M, Lavonas E, and Peacock WF IV
Published: 1998

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