American heart journal
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In recent years, international clinical trials have increasingly included large numbers of patients and research sites from developing countries. In South America particularly, enrollment in randomized clinical trials has increased substantially. Despite this significant growth of late, there has been little systematic assessment of the role of this region in cardiovascular clinical trials. ⋯ Labor costs also tend to be lower than those in high-income countries. On the other hand, clinical research in this region of the world faces limitations posed by a relatively small clinical trials network with limited operations expertise, as well as prolonged regulatory approval timelines, diversity in health care systems, limited training opportunities in clinical research, and a low patient level of education. Thus, there are many opportunities to improve the conduct of clinical research in South America, but strategies and systems must be developed to overcome barriers in this economically growing region and to establish a robust infrastructure for clinical trials, including high-quality investigator networks.
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American heart journal · Jun 2013
Multicenter Study Comparative StudyTransitional adherence and persistence in the use of aldosterone antagonist therapy in patients with heart failure.
Aldosterone antagonist therapy is recommended for selected patients with heart failure and reduced ejection fraction. Adherence to therapy in the transition from hospital to home is not well understood. ⋯ Most eligible patients were not prescribed aldosterone antagonist therapy at discharge from a heart failure hospitalization. Eligible patients without a discharge prescription seldom initiated therapy as outpatients. Most patients who were prescribed an aldosterone antagonist at discharge filled the prescription within 90 days and remained on therapy.
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American heart journal · Jun 2013
Comparative StudyEvaluating early repeat emergency department use in patients with atrial fibrillation: a population-based analysis.
Emergency department (ED) use by patients with atrial fibrillation is high and will accelerate with the aging of the population. In patients with atrial fibrillation who are discharged from the ED, we aimed to describe their subsequent outpatient care, return ED visits, and management strategies associated with early return. ⋯ Among older patients with atrial fibrillation discharged from an ED in the province of Ontario, 9% make 1 or more repeat visits within 14 days. Reductions in repeat emergency visits by low-risk patients are associated with timely specialist follow-up care.
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American heart journal · Jun 2013
Comparative StudyGender differences in clinical outcomes among diabetic patients hospitalized for cardiovascular disease.
The risk of incident cardiovascular disease (CVD) has been shown to be greater among diabetic women than men, but gender differences in clinical outcomes among diabetic patients hospitalized with CVD are not established. We aimed to determine if hemoglobin A1c (HbA1c) was associated with 30-day and 1-year CVD rehospitalization and total mortality among diabetic patients hospitalized for CVD, overall and by gender. ⋯ Risk of 30-day CVD rehospitalization was 8.5-fold higher among diabetic women hospitalized for CVD with HbA1c ≥7% vs <7%; no association was observed among men. A trend for increased 30-day/1-year mortality risk with HbA1c <6% deserves further study.
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American heart journal · Jun 2013
Multicenter Study Comparative StudyAtrial fibrillation among Medicare beneficiaries hospitalized with sepsis: incidence and risk factors.
Newly diagnosed atrial fibrillation (AF) during severe sepsis is associated with increased risks of in-hospital stroke and mortality. However, the prevalence, incidence, and risk factors associated with AF during the sepsis syndromes are unclear. ⋯ Atrial fibrillation is common among critically ill patients with sepsis. Acute factors, rather than preexisting cardiovascular comorbid conditions, are associated with increased risk for newly diagnosed AF during sepsis, suggesting that mechanisms of newly diagnosed AF during sepsis may differ from the general population of patients with AF.