American heart journal
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American heart journal · Nov 2006
Reperfusion of acute myocardial infarction in North Carolina emergency departments (RACE): study design.
Despite the accumulation of almost 2 decades of data in support of rapid reperfusion therapy for ST-segment elevation myocardial infarction (STEMI), the United States healthcare system still faces serious challenges in providing reperfusion to all eligible patients in a timely fashion. American College of Cardiology/American Heart Association guidelines call for systematic interventions aimed at improving both the proportion of patients receiving reperfusion and the timeliness of treatment. We designed a project (RACE) that incorporates standardized protocols and integrated systems for treatment and timely transfer (when appropriate) of patients with STEMI in 5 geographic regions in North Carolina. ⋯ The main outcomes of interest are rates of reperfusion and time to treatment. Collected data will also provide important insights into barriers to timely reperfusion. The goal of the RACE project is to provide a model for improving the care of patients with STEMI by identifying those features associated with significant improvement, as well as those imposing significant barriers to appropriate therapy.
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American heart journal · Nov 2006
Randomized Controlled Trial Multicenter StudyThe effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial.
Patients undergoing vascular surgery comprise the highest risk group for perioperative cardiac mortality and morbidity after noncardiac procedures. Many current guidelines recommend the use of beta-blockers in all patients undergoing vascular surgery. We report a trial of the perioperative administration of metoprolol and its effects on the incidence of cardiac complications at 30 days and 6 months after vascular surgery. ⋯ Our results showed metoprolol was not effective in reducing the 30-day and 6-month postoperative cardiac event rates. Prophylactic use of perioperative beta-blockers in all vascular patients is not indicated.
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American heart journal · Nov 2006
Rationale and design of a randomized, double-blind, placebo-controlled trial of ivabradine in patients with stable coronary artery disease and left ventricular systolic dysfunction: the morBidity-mortality EvAlUaTion of the I(f) inhibitor ivabradine in patients with coronary disease and left ventricULar dysfunction (BEAUTIFUL) study.
Raised resting heart rate (HR) is associated with increased cardiovascular and total mortality. Ivabradine is a new specific HR-reducing agent, which has been shown to have antianginal and anti-ischemic properties in patients with stable angina. Because patients with coronary artery disease and left ventricular dysfunction are at high risk of cardiac events and death, we hypothesized that they could derive particular benefit from a specific HR-lowering agent such as ivabradine. ⋯ BEAUTIFUL will be the first major outcome trial of a specific HR-reducing agent. The study results are expected in 2008.
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American heart journal · Nov 2006
Risks and benefits of combining aspirin with anticoagulant therapy in patients with atrial fibrillation: an exploratory analysis of stroke prevention using an oral thrombin inhibitor in atrial fibrillation (SPORTIF) trials.
Aspirin is used in combination with anticoagulant therapy in patients with atrial fibrillation (AF), but evidence of additional efficacy is not available. ⋯ Aspirin combined with anticoagulant therapy was associated with no reduction in stroke, systemic embolism, or myocardial infarction in patients with AF. Aspirin combined with warfarin was associated with an incremental rate of major bleeding of 1.6% per year. No increased major bleeding occurred with aspirin and ximelagatran. These results suggest that the risks associated with addition of aspirin to anticoagulation in patients with AF outweigh the benefit.
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American heart journal · Nov 2006
Influence of history of heart failure on diagnostic performance and utility of B-type natriuretic peptide testing for acute dyspnea in the emergency department.
The aim of this study was to assess the impact of a history of heart failure (HF) on emergency department (ED) B-type natriuretic peptide (BNP) testing and impact of feedback of BNP level to ED physicians. ⋯ B-type natriuretic peptide test performance for diagnosis of dyspnea cause is significantly reduced in patients with a history of HF and must be taken into consideration in the evaluation of such patients in the ED.