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Journal Cover JRSM Cardiovascular Disease
   [3 followers]  Follow    
  This is an Open Access Journal Open Access journal
     ISSN (Print) 2048-0040 - ISSN (Online) 2048-0040
     Published by Sage Publications Homepage  [749 journals]
  • Risk awareness in secondary stroke prevention: a review of the literature

    • Authors: Slark, J; Sharma, P.
      Pages: 2048004013 - 2048004013
      Abstract: Despite improvements in the diagnosis and treatment of cardiovascular disease through medical advances, it remains the largest single cause of disability and the second leading cause of death on a global scale. Despite this, patient awareness of cardiovascular risk is low and adherence to secondary prevention measures is inadequate. This combined with an ageing population could have serious consequences for both personal and health care costs. Risk management has been used to design strategies to prevent both primary and secondary stroke. These strategies have largely relied upon health professionals providing information, support and monitoring of patients conditions and control of individual risk factors. However, these strategies have not always been successful in the long-term management and prevention of secondary cardiovascular disease. This review explores the literature surrounding risk awareness as a tool to improve patient adherence to medications and lifestyle behaviours to reduce risk of secondary stroke.
      PubDate: 2014-02-04T08:58:43-08:00
      DOI: 10.1177/2048004013514737|hwp:resource-id:spcvd;3/0/2048004013514737
      Issue No: Vol. 3, No. 0 (2014)
  • Computed tomography coronary angiography: Is radiation a concern for the
           gold standard test for anomalous coronary arteries'

    • Authors: Alfakih, K; Sharma, S.
      Pages: 2048004013 - 2048004013
      Abstract: Multi-detector computed tomography is now an established modality for the investigation of coronary artery disease.1,2^ 64-Slice multi-detector computed tomography is the standard requirement by the British society of cardiac imaging and can image the whole heart in four heart beats. The 320 slice multi-detector computed tomography can image the heart in one heart beat, but both technologies depend on B-blockers to slow the patient’s heart rate to 60 beats per minute to ensure excellent image quality and low radiation dose. The faster dual source multi-detector computed tomography is less dependent on B-blockers. The availability and ease of use of multi-detector computed tomography has meant that it is increasingly used in younger patients to rule out coronary artery disease or rule out anomalous coronary arteries. We consider the radiation associated with computed tomography coronary angiography and the available dose reduction techniques.
      PubDate: 2014-02-04T08:58:43-08:00
      DOI: 10.1177/2048004013513745|hwp:resource-id:spcvd;3/0/2048004013513745
      Issue No: Vol. 3, No. 0 (2014)
  • Cardiac rehabilitation with a nurse case manager (GoHeart) across local
           and regional health authorities improves risk factors, self-care and
           psychosocial outcomes. A one-year follow-up study

    • Authors: Hansen, V. B; Maindal, H. T.
      Pages: 2048004014 - 2048004014
      Abstract: Objectives In Denmark, the local and regional health authorities share responsibility for cardiac rehabilitation (CR). The objective was to assess effectiveness of CR across sectors coordinated by a nurse case manager (NCM). Design A one-year follow-up study. Setting A CR programme (GoHeart) was evaluated in a cohort at Lillebaelt Hospital Vejle, DK from 2010 to 2011. Participants Consecutive patients admitted to CR were included. The inclusion criteria were the event of acute myocardial infarction or stable angina and invasive revascularization (left ventricular ejection fraction (LVEF) ≥45%). Main outcome measures Cardiac risk factors, stratified self-care and self-reported psychosocial factors (SF12 and Hospital Anxiety and Depression Scale (HADS)) were assessed at admission (phase IIa), at three months at discharge (phase IIb) and at one-year follow-up (phase III). Intention-to-treat and predefined subgroup analysis on sex was performed. Results Of 241 patients, 183 (75.9%) were included (mean age 63.8 years). At discharge improvements were found in total-cholesterol (p < 0.001), low density lipoprotein (LDL; p < 0.001), functional capacities (metabolic equivalent of tasks (METS), p < 0.01), self-care management (p < 0.001), Health status Short Form 12 version (SF12; physical; p < 0.001 and mental; p < 0.01) and in depression symptoms (p < 0.01). At one-year follow-up these outcomes were maintained; additionally there was improvement in body mass index (BMI; p < 0.05), and high density lipoprotein (HDL; p < 0.05). There were no sex differences. Conclusion CR shared between local and regional health authorities led by a NCM (GoHeart) improves risk factors, self-care and psychosocial factors. Further improvements in most variables were at one-year follow-up.
      PubDate: 2014-10-27T21:39:42-07:00
      DOI: 10.1177/2048004014555922|hwp:resource-id:spcvd;3/0/2048004014555922
      Issue No: Vol. 3, No. 0 (2014)
  • Health-related quality of life and long-term morbidity and mortality in
           patients hospitalised with systolic heart failure

    • Authors: Berg, J; Lindgren, P, Kahan, T, Schill, O, Persson, H, Edner, M, Mejhert, M.
      Pages: 2048004014 - 2048004014
      Abstract: Background Health-related quality of life has been shown to impact prognosis in chronic heart failure, however with limited long-term follow-up. We analysed data spanning 8–12 years to assess the impact of health-related quality of life using the Nottingham Health Profile on first hospitalisation and mortality, for cardiovascular and all causes. Methods We included 208 patients aged ≥60 years with New York Heart Association class II–IV and left ventricular systolic dysfunction hospitalised in Stockholm during 1996–99. Data on hospital admissions, discharge diagnoses and date and cause of death were collected from administrative databases and medical records until 2007. Cox proportional hazard models were employed to analyse the time to event for mortality and hospitalisations. Results Mean age was 76 years, 58% were male and mean ejection fraction was 34%. Median survival was 4.6 years (range 6 days–11.9 years); 148 patients died. All-cause and cardiovascular mortality were determined by physical mobility (by Nottingham Health Profile), age, gender, diuretic dose and haemoglobin level. Glomerular filtration rate was significant for all-cause mortality, while atrioventricular plane displacement was predictive of cardiovascular mortality. Median time to first all-cause and cardiovascular hospitalisation was 5.7 and 11.2 months, respectively. Time to first all-cause hospitalisation was determined by physical mobility, emotional reactions, age, gender and haemoglobin level, while only physical mobility and diuretic dose predicted time to first cardiovascular hospitalisation. Conclusions In conclusion, in patients with systolic chronic heart failure, physical mobility as part of health-related quality of life is an independent prognostic marker for cardiovascular and all-cause readmissions and mortality over 12 years.
      PubDate: 2014-09-18T05:41:13-07:00
      DOI: 10.1177/2048004014548735|hwp:resource-id:spcvd;3/0/2048004014548735
      Issue No: Vol. 3, No. 0 (2014)
  • Electrocardiogram-based scoring system for predicting secondary pulmonary
           hypertension: A cross-sectional study

    • Authors: Pancholy, S. B; Palamaner Subash Shantha, G, Patel, N. K, Boruah, P, Nanavaty, S, Chandran, S, Sethi, A, Sheth, J.
      Pages: 2048004014 - 2048004014
      Abstract: Objectives In this study, we have developed an electrocardiogram-based scoring system to predict secondary pulmonary hypertension. Design A cross-sectional study. Setting Single tertiary-care hospital in Scranton, Pennsylvania, USA. Participants Five hundred and fifty-two consecutive patients undergoing right heart catheterization between 2006 and 2009. Main outcome measures Surface electrocardiogram was assessed for R-wave in lead V1 ≥ 6mm, R-wave in V6 ≤ 3mm, S-wave in V6 ≥ 3mm, right atrial enlargement, right axis deviation and left atrial enlargement. Pulmonary hypertension was defined as mean pulmonary artery pressure ≥25 mmHg, determined by right heart catheterization. Results A total of 297 (54%) patients in the study cohort had pulmonary hypertension. In total, 332 patients from the study cohort formed the development cohort and the remaining 220 patients formed the validation cohort. In the development cohort, based on log odds ratios of association, RAE, LAE, RAD, R-wave in V1 ≥ 6 mm were assigned scores of 5, 2, 2 and 1, respectively, to form a 10-point scoring system "Scranton PHT (SP) score". SP scores of 5 points and 7 points in DC showed C-statistic of 0.83 and 0.89, respectively, for discriminating pulmonary hypertension. C-statistic for RAE alone was significantly lower compared to an SP score of 7 (0.83 vs. 0.89, P = 0.021). The reliability of SP score in the validation cohort was acceptable. Conclusion SP score provides a good point-of-care tool to predict pulmonary hypertension in patients with clinical suspicion of it.
      PubDate: 2014-09-10T04:58:42-07:00
      DOI: 10.1177/2048004014547599|hwp:resource-id:spcvd;3/0/2048004014547599
      Issue No: Vol. 3, No. 0 (2014)
  • Socioeconomic status does not predict cocaine use among ischemic stroke
           patients: A nested case-control study

    • Authors: Fehnel, C. R; Ayres, A. M, Rost, N. S.
      Pages: 2048004014 - 2048004014
      Abstract: Previous studies of cocaine use and stroke have focused on acute effects of cocaine in perceived high-risk populations. We characterized mechanisms and risk factors for cocaine use among ischemic stroke patients from a broad range of socioeconomic backgrounds to inform medical management decisions and prevention efforts. We studied consecutive adults admitted with acute ischemic stroke to our institution between January 2007 and December 2010 with a history or laboratory confirmation of cocaine use. Age, sex, and race-matched cocaine-negative controls were derived from the same study population. Demographics, risk factors, clinical and imaging data were compared between groups. Among 4073 acute ischemic stroke patients, 91 (2.2%) had a history of cocaine use and/or a positive toxicology screen (cases). Cocaine abusers did not differ from controls by occupation, income, or educational level (P > 0.5). Active tobacco use independently increased the odds of cocaine use among stroke patients (odds ratio 3.9, 95% confidence interval 2.0–7.5), as did the history of migraine (odds ratio 2.5, 95% confidence interval 1.1–5.9). Stroke subtype also predicted cocaine use among stroke patients (odds ratio 0.73, 95% confidence interval 0.58–0.93). Stroke patients with current or past cocaine use could not be distinguished from non-users by socioeconomic factors. Liberal use of toxicology screening among a much broader population of patients is needed for proper identification and management. Further study of causal mechanisms for cardioembolism in cocaine-associated stroke is warranted.
      PubDate: 2014-06-19T08:24:55-07:00
      DOI: 10.1177/2048004014539666|hwp:resource-id:spcvd;3/0/2048004014539666
      Issue No: Vol. 3, No. 0 (2014)
  • Asymptomatic carotid stenosis: What we can learn from the next generation
           of randomized clinical trials

    • Authors: Rubin, M. N; Barrett, K. M, Brott, T. G, Meschia, J. F.
      Pages: 2048004014 - 2048004014
      Abstract: Stroke remains an exceedingly incident and prevalent public health burden across the globe, with an estimated 16 million new strokes per annum and prevalence over 60 million, and extracranial internal carotid artery atherosclerotic disease is an important risk factor for stroke. Randomized trials of surgical treatment were conducted (North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial) and demonstrated efficacy of carotid endarterectomy for secondary prevention of stroke in patients with cerebrovascular events (e.g. ipsilateral stroke, transient ischemic attack, and/or amaurosis fugax) attributable to a diseased artery with 50–99% stenosis. Therapeutic clarity, however, proved elusive with asymptomatic carotid artery disease. Asymptomatic Carotid Atherosclerosis Study (ACAS), Asymptomatic Carotid Surgery Trial, and Veterans Affairs Cooperative Study (VACS) suggested only modest benefit from surgical intervention for primary stroke prevention and the best medical therapy at the time of these trials is not comparable to modern medical therapy. ACT-1, Asymptomatic Carotid Surgery Trial-2, Stent-Protected Angioplasty in asymptomatic Carotid artery stenosis versus Endarterectomy Trial-2, European Carotid Surgery Trial-2, Carotid Revascularization Endarterectomy Versus Stenting Trial-2 are trials that are recent, ongoing, or in development that include diverse populations across Europe and North America, complementary trial designs, and a collaborative spirit that should provide clinicians with evidence that informs best clinical practice for asymptomatic carotid artery disease.
      PubDate: 2014-04-08T07:10:52-07:00
      DOI: 10.1177/2048004014529419|hwp:resource-id:spcvd;3/0/2048004014529419
      Issue No: Vol. 3, No. 0 (2014)
  • Aldosterone synthase inhibitors in hypertension: current status and future

    • Authors: Hargovan, M; Ferro, A.
      Pages: 2048004014 - 2048004014
      Abstract: The renin-angiotensin aldosterone system is a critical mechanism for controlling blood pressure, and exerts most of its physiological effects through the action of angiotensin II. In addition to increasing blood pressure by increasing vascular resistance, angiotensin II also stimulates aldosterone secretion from the adrenal gland. Aldosterone acts to cause an increase in sodium and water reabsorption, thus elevating blood pressure. Although treatment with angiotensin converting enzyme inhibitors initially lowers circulating aldosterone, with chronic treatment aldosterone levels increase back to baseline, a phenomenon termed aldosterone escape; aldosterone blockade may therefore give added value in the treatment of hypertension. The first mineralocorticoid receptor antagonist developed was spironolactone, but its use has been severely hampered by adverse (notably oestrogenic) effects. The more recently developed mineralocorticoid receptor antagonist eplerenone exhibits a better adverse effect profile, although it is not devoid of effects similar to spironolactone. In addition, aldosterone activates non-genomic receptors that are not inhibited by either eplerenone or spironolactone. It is believed that deleterious organ remodelling is mediated by aldosterone via such non-genomic pathways. A new class of drugs, the aldosterone synthase inhibitors, is currently under development. These may offer a novel therapeutic approach for both lowering blood pressure and preventing the non-genomic effects of aldosterone. Here, we will review the cardiovascular effects of aldosterone and review the drugs available that target this hormone, with a particular focus on the aldosterone synthase inhibitors.
      PubDate: 2014-02-10T07:00:50-08:00
      DOI: 10.1177/2048004014522440|hwp:resource-id:spcvd;3/0/2048004014522440
      Issue No: Vol. 3, No. 0 (2014)
School of Mathematical and Computer Sciences
Heriot-Watt University
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