The American journal of cardiology
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The cost-effectiveness of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in dyspneic patients in emergency departments (EDs) is unknown. The objective of this study was to assess the cost-effectiveness of NT-pro-BNP testing for the evaluation and initial management of patients with dyspnea in the ED setting. A decision model was developed to evaluate the cost-effectiveness of diagnostic assessment and patient management guided by NT-pro-BNP, compared with standard clinical assessment. ⋯ In a sensitivity analysis considering mortality, NT-pro-BNP testing was associated with a 1.0% relative reduction in post-discharge mortality. The optimal use of NT-pro-BNP guidance could reduce the use of echocardiography by up to 58%, prevent 13% of initial hospitalizations, and reduce hospital days by 12%. In conclusion, on the basis of this model, the use of NT-pro-BNP in the diagnostic assessment and subsequent management of patients with dyspnea in the ED setting could lead to improved patient care while providing substantial cost savings to the health care system.
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This study evaluated the utility of atrioventricular (AV) optimization using Doppler echocardiography in patients who undergo cardiac resynchronization therapy (CRT). AV optimization in patients who undergo CRT is performed inconsistently, with few data supporting its utility. Data were collected from 215 patients in New York Heart Association class III or IV heart failure (66% ischemic) who underwent AV optimization <30 days after implantation from 1999 to 2003. ⋯ There was no difference in mortality in patients with final AV delays of >140 ms. In conclusion, AV optimization in patients who underwent CRT resulted in final AV delay settings of >140 ms in 40% of patients. AV delay optimization based on Doppler echocardiographic determination of optimal diastolic filling is useful and safe in patients who undergo CRT.
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Comparative Study
Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention.
Intra-aortic balloon pump (IABP) has been shown to support patients who are at high risk for percutaneous coronary interventions (PCIs) or becoming hemodynamically unstable during PCI, but the longer term outcomes of these strategies are unknown. This study investigated the outcomes of high-risk patients who received a prophylactic IABP (P-IABP) versus patients who required rescue IABP (R-IABP) because of intraprocedural complications. Clinical outcomes of 68 consecutive patients (69 procedures) who underwent high-risk PCI with P-IABP support were compared with those of 46 patients who required R-IABP. ⋯ The incidence of vascular complications was low and comparable except for more major bleeding (15% vs 3%, p = 0.03) in the R-IABP group. In conclusion, patients who undergo high-risk PCI and then receive P-IABP support have favorable outcomes compared with those who require R-IABP for intraprocedural complications. Therefore, in high-risk patients undergoing PCI, liberal use of a P-IABP should be considered.
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Dietary omega-3 fatty acids decrease the risk of cardiovascular disease (CVD). Both epidemiologic and interventional studies have demonstrated beneficial effects of omega-3 fatty acids on many CVD end points, including all CVD (defined as all coronary artery disease [CAD], fatal and nonfatal myocardial infarction [MI], and stroke combined), all CAD, fatal and nonfatal MI, stroke, sudden cardiac death, and all-cause mortality. Much of the evidence comes from studies with fish oil and fish; to a lesser extent, data relate to plant-derived omega-3 fatty acids. ⋯ Fish, including farm-raised fish and their wild counterparts, are the major dietary sources of the longer-chain omega-3 fatty acids. Sources of plant-derived omega-3 fatty acids include flaxseed, flaxseed oil, walnuts, canola oil, and soybean oil. Because of the remarkable cardioprotective effects of omega-3 fatty acids, consumption of food sources that provide omega-3 fatty acids--especially the longer-chain fatty acids (>or=20 carbons) from marine sources--should be increased in the diet to decrease CVD risk significantly.