American heart journal
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American heart journal · Jul 2007
Randomized Controlled Trial Multicenter Study Comparative StudyGlobal outcomes of ST-elevation myocardial infarction: comparisons of the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis In Myocardial Infarction study 25 (ExTRACT-TIMI 25) registry and trial.
Outcomes in patients with ST-elevation myocardial infarction (STEMI) differ between those in clinical trials and those in routine practice, as well as across different regions. We hypothesized that adjustment for baseline risk would minimize such variations. ⋯ Patients in the registry had higher mortality than those in the trial. This difference could be explained by the higher baseline risk of patients in the registry. After adjusting for baseline risk, the GNI of the country in which the patient presented did not contribute to predicting in-hospital mortality.
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American heart journal · Jul 2007
Randomized Controlled Trial Multicenter StudySexual function, satisfaction, and association of erectile dysfunction with cardiovascular disease and risk factors in cardiovascular high-risk patients: substudy of the ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNT Study in ACE-INtolerant Subjects with Cardiovascular Disease (ONTARGET/TRANSCEND).
Erectile dysfunction (ED) is a common disorder in middle-aged men and is significantly influenced by cardiovascular risk factors (CVRFs) and cardiovascular disease. The substudy of the ONTARGET/TRANSCEND trials evaluates the relationship of erectile function to baseline characteristics and current treatment in cardiovascular high-risk patients who have been enrolled in these trials. The effects of treatment with telmisartan and ramipril, alone or in combination, including a telmisartan versus placebo arm will be determined prospectively during a follow-up of 4 years. ⋯ The ONTARGET/TRANSCEND-ED substudy shows a significant influence of cardiovascular disease on erectile function. In contrast to prior smaller studies, drug therapy and CVRF seem to play a minor role in cardiovascular high-risk patients. Follow-up data will provide information whether angiotensin-converting enzyme inhibitors, angiotensin I antagonists, or a combination thereof are able to improve erectile function.
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American heart journal · Jul 2007
Improving the use of evidence-based heart failure therapies in the outpatient setting: the IMPROVE HF performance improvement registry.
Evidence-based consensus treatment guidelines are available to assist physicians with the management of chronic heart failure (HF). Although it has been generally presumed that physicians incorporate these treatment guidelines into clinical practice, the actual assimilation of evidence-based strategies and guidelines has been demonstrated to be less than ideal. Studies of HF care show that treatment guidelines are slowly adopted and inconsistently applied and, thus, often fail to lead to improvements in patient care and outcomes. ⋯ Seven performance measures to quantify the quality of outpatient HF care were explicitly developed by the IMPROVE HF Steering Committee. The primary objective is to observe, over the aggregate of IMPROVE HF practice sites, a relative > or = 20% improvement in at least 2 of the 7 performance measures at 24 months, compared with baseline. Deidentified clinical data from the medical records of a planned 43,000 patients from 160 US cardiology practices will be included in this study.
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American heart journal · Jun 2007
Controlled Clinical TrialImpaired peripheral endothelial function in severe idiopathic pulmonary hypertension correlates with the pulmonary vascular response to inhaled iloprost.
Pulmonary endothelial function is known to be impaired in subjects with idiopathic pulmonary arterial hypertension (IPAH), but peripheral endothelial dysfunction and its predictive value for pulmonary vasoreactivity have not been previously investigated. ⋯ Idiopathic pulmonary arterial hypertension is associated with peripheral endothelial dysfunction. Peripheral endothelium-dependent vasoreactivity correlates with the PVRII. It remains to be established if FMD has the potential as a clinical tool for noninvasive estimation of pulmonary vasoreactivity in IPAH.
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American heart journal · Jun 2007
Comparative StudyInteractions between heparins, glycoprotein IIb/IIIa antagonists, and coronary intervention. The Global Registry of Acute Coronary Events (GRACE).
The purpose of this study is to evaluate hospital mortality and major bleeding rates among patients receiving low molecular weight heparin (LMWH), unfractionated heparin (UFH), or both, and to investigate whether concomitant glycoprotein (GP) IIb/IIIa antagonists and coronary intervention affect patterns of use and outcomes with different heparins. ⋯ In patients with non-ST-elevation ACS without GP IIb/IIIa antagonists, LMWH was associated with a lower mortality rate and more bleeding episodes in PCI-treated patients than UFH; no differences occurred with GP IIb/IIIa antagonists. Elderly patients managed medically with GP IIb/IIIa antagonists and either heparin had a very high major bleeding risk.