European journal of internal medicine
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Eur. J. Intern. Med. · Feb 2020
ReviewThe ESC 2019 CCS guidelines: Have we left our patients and scientific evidence behind?
The ESC CCS 2019 guidelines recognize that successful management of anginal symptoms relies on effective therapy tailored to individual patient characteristics but do not provide any specific advice or clarity on how to utilize pharmacotherapy in order to achieve these goals. In this review, we are going to summarize and discuss the main points of disagreement.
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Eur. J. Intern. Med. · Feb 2020
ReviewProton pump inhibitors and cardiovascular adverse effects: Real or surreal worries?
Proton pump inhibitors (PPIs) are among the most widely prescribed agents, either for treatment or prophylaxis of gastrointestinal (GI) disease, that are often administered for prolonged or chronic use. Patients with cardiovascular (CV) disease frequently receive PPIs for prophylaxis against GI bleeding due to common use of antithrombotic drugs. Over the last several years there is a growing number of reports associating chronic PPI use with a variety of serious CV and non-CV adverse effects. ⋯ As the indications for prolonged, particularly lifelong, prophylactic use of PPIs are not compelling and in the light of evidence of serious CV and other adverse effects, clinicians have to reconsider such long-term use of these drugs. Importantly, histamine 2 blockers have not been found to be associated with increased CV risk and thus may be an alternative therapeutic option in certain patients. These issues are amply discussed together with the potential mechanisms of these pleiotropic and off-target effects of PPIs, which are also depicted in an illustrative schema; data are also presented on differential effects of specific agents involved, alternative modes of therapy available, and relevant current guidelines on this issue.
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Eur. J. Intern. Med. · Feb 2020
Comparative influence of Acute Illness Severity and comorbidity on mortality.
The extent to which illness severity and comorbidity determine the outcome of an emergency medical admission is uncertain. We aim to quantitate the relative effect of these factors on mortality. ⋯ High AISS and Comorbidity Scores were predictive of 30-day in-hospital mortality and relatively common in emergency medical admissions. There is a strong interaction between the two scores.