The American journal of medicine
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Re-hospitalization after discharge for acute decompensated heart failure is a common problem. Low-socioeconomic urban patients suffer high rates of re-hospitalization and often over-utilize the emergency department (ED) for their care. We hypothesized that early consultation with a cardiologist in the ED can reduce re-hospitalization and health care costs for low-socioeconomic urban patients with acute decompensated heart failure. ⋯ Early consultation with a cardiologist in the ED as an adjunct to guideline-based follow-up is associated with reduced re-hospitalization and health care cost for low-socioeconomic urban patients with acute decompensated heart failure.
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Comparative Study Observational Study
Early Invasive Versus Initial Conservative Strategies for Women with Non-ST-Elevation Acute Coronary Syndromes: A Nationwide Analysis.
Studies conducted largely in men have shown improved outcomes with an early invasive strategy with non-ST-elevation acute coronary syndrome. In contrast, data have been less conclusive in women, with some trials demonstrating potential harm. This study aims to assess whether an early invasive strategy in women is associated with better outcomes in real-world data. ⋯ In this large contemporary observational analysis of women with non-ST-elevation acute coronary syndrome, an early invasive strategy was associated with lower in-hospital mortality. This benefit was observed in women presenting with non-ST-elevation myocardial infarction but not with unstable angina. These findings provide evidence supporting the guideline recommendations for an early invasive strategy in women with non-ST-elevation acute coronary syndrome and high-risk features (eg, troponin positive).
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The role of physical activity in the relationship between body mass index (BMI) and survival in coronary heart disease is unclear. Our aim was to examine the isolated and combined associations among BMI, physical activity, and mortality in subjects with coronary heart disease. ⋯ Overweight and obese subjects with coronary heart disease had reduced all-cause and cardiovascular disease mortality, but such an obesity paradox was seen only in participants who did not adhere to current recommendations of physical activity.
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The burden of medications near the end of life has recently come under scrutiny, because several studies suggested that people with life-limiting illness receive potentially futile treatments. ⋯ Polypharmacy increases throughout the last year of life of older adults, fueled not only by symptomatic medications but also by long-term preventive treatments of questionable benefit. Clinical guidelines are needed to support physicians in their decision to continue or discontinue medications near the end of life.