Heart : official journal of the British Cardiac Society
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Randomized Controlled Trial Multicenter Study
Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial.
To examine the effects of home-based transitional palliative care for patients with end-stage heart failure (ESHF) after hospital discharge. ⋯ This study provides evidence of the effectiveness of a postdischarge transitional care palliative programme in reducing readmissions and improving symptom control among patients with ESHF.
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An 80-year-old male with a medical history of hypertension, diabetes and moderate calcific aortic stenosis, presented with ischaemic chest pain at rest. Cardiovascular examination revealed soft systolic murmur only. ECG (see online supplementary figure S1) demonstrated inferolateral ST segment depression with ST elevation in lead aVR, suggesting diffuse subendocardial ischaemia possibly consistent with a threatening left main or proximal left anterior descending (LAD) coronary lesion. Emergency coronary angiography demonstrated tandem smooth stenoses in the proximal left circumflex (LCx) and LAD arteries (figure 1A), which persisted throughout the cardiac cycle, and after 200 mcg bolus of intracoronary nitrate. Aortogram is shown (figure 1B). ⋯ What diagnosis underlies the cause of this patient's symptoms? Congenital coronary artery anomaly.Coronary artery vasospasm.Myocardial bridging.Obstructive coronary artery disease.Unruptured left sinus of Valsalva aneurysm.
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Randomized Controlled Trial Comparative Study
Native valve disease in patients with non-valvular atrial fibrillation on warfarin or rivaroxaban.
To compare the characteristics and outcomes of patients with atrial fibrillation (AF) and aortic stenosis (AS) with patients with AF with mitral regurgitation (MR) or aortic regurgitation (AR) and patients without significant valve disease (no SVD). ⋯ We found that patients with AF and AS on oral anticoagulants may have distinctly different efficacy and safety outcomes than patients with MR or AR or no SVD.