Heart : official journal of the British Cardiac Society
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It is accepted practice to prescribe beta-blockers in order to retard aortic dilatation and prevent aortic dissection and rupture in patients with Marfan syndrome. A critical review of the published pharmacological studies shows this practice to be based on limited evidence. The data from small clinical and experimental studies with surrogate end points suggest greater potential benefit from alternative drug regimens, and a recent experimental study showed that losartan may interrupt the mechanism of disease as well as deal with its functional consequences. It is now essential to perform large, collaborative, randomised controlled trials with clinical end points of new treatments in Marfan syndrome.
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To determine the diagnostic accuracy of advanced medical priority dispatch system (AMPDS) software used to dispatch public access defibrillation first responders to out-of-hospital cardiac arrests (OHCA). ⋯ The sensitivity of this dispatch process for cardiac arrest is moderate and will constrain the effectiveness of Public Access Defibrillation (PAD) schemes which utilise it.
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To ascertain time trends in rates of hospital admission, operations, in-hospital case fatality and general mortality for congenital heart disease (CHD) in England and Wales. ⋯ Admission rates for CHD have increased over the past decade, particularly amongst patients in older age groups. There has also been a significant decrease in both in-hospital case fatality rates and in general population mortality rates. These trends are consistent with improvements in the quality of care for these patients, improvements in survival and the predicted expansion in the number of adults living with CHD.
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To carry out long-term follow-up after percutaneous closure of patent foramen ovale (PFO) in patients with cryptogenic stroke. ⋯ This study attests to the long-term safety and efficacy of percutaneous PFO closure guided by fluoroscopy only for secondary prevention of paradoxical embolism in a large cohort of consecutive patients.
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Review
Economic burden and the cost-effectiveness of treatment of cardiovascular diseases in Africa.
Cardiovascular disease is the leading cause of death in those over the age of 45 in Africa. The economic toll from cardiovascular diseases is equally devastating, leading to billions of dollars lost due to healthcare costs and reduced productivity from the disabling and fatal outcomes related to diabetes, hypertension, stroke, valvular heart disease, and heart failure. ⋯ This article reviews the economic burden attributable to cardiovascular disease in Africa and many of the potential cost-effective solutions to the large burden. It further outlines many of the areas where we know less and must focus our future research in trying to outline cost-effective solutions.