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Naomi F Botkin

Publications and source records attributed to Naomi F Botkin.

4 recordsLinked to original sources
PubMed2006

Changing trends in the long-term prognosis of patients with acute myocardial infarction: a population-based perspective.

BACKGROUND: Little contemporary data exist describing changes over time in the postdischarge prognosis of hospital survivors of acute myocardial infarction (AMI). The purpose of our study was to examine recent and multidecade-long (1975-2001) trends in the long-term prognosis of greater Worcester (MA) residents discharged from all metropolitan Worcester hospitals after confirmed AMI. METHODS: A total of 9827 greater Worcester residents with independently validated AMI discharged from all metropolitan Worcester hospitals during 13 annual periods between 1975 and 2001 comprised the study population. A variety of follow-up approaches were used to ascertain the survival status of discharged patients through the end of 2003. RESULTS: Crude unadjusted 1-year postdischarge survival rates declined over time. Suggestions of modest improvements in the multivariable adjusted 1-year postdischarge survival rates were noted, however, in patients discharged from greater Worcester hospitals in the more recent (2001) (adjusted odds of surviving 1.23, 95% CI 0.97-1.55) as compared with earliest study periods (1975/1978). Advancing age, female sex, presence of prior diabetes, stroke, heart failure, or myocardial infarction and occurrence of several clinical complications during hospitalization were significantly related to an adverse postdischarge prognosis. CONCLUSIONS: The results of this investigation provide contemporary insights into the long-term survival of patients with AMI from a more generalizable population-based perspective. Multivariable adjusted analyses revealed slight improvements in postdischarge survival over time. Our data identify several high-risk groups that should be targeted for more aggressive surveillance and increased use of effective cardiac therapies and interventions.

Aged↗
PubMed2005

Asymptomatic valvular disease: who benefits from surgery?

Routine physical examination and noninvasive imaging frequently lead to the diagnosis of valvular heart disease in asymptomatic patients. The decision to proceed to surgical repair or replacement is based on an informed evaluation of the risks of surgery versus those encountered with a nonoperative course. In determining whether symptoms are present, stress testing may be helpful, as many patients with significant valvular lesions have a tendency to limit their daily physical exertion to levels that do not provoke symptoms. The two most feared consequences of conservative management, sudden death and permanent myocardial damage, are rare in asymptomatic patients with severe aortic stenosis or regurgitation. Surgery for asymptomatic aortic stenosis is performed only for certain high-risk subsets of patients, including those with left ventricular dysfunction, ventricular arrhythmia, and critically small valves. Asymptomatic patients with aortic regurgitation and mitral regurgitation should undergo surgery if they have systolic dysfunction or marked ventricular enlargement.

Adult↗
PubMed2004

Aortic valve disease: current recommendations.

Aortic stenosis is a common valvular abnormality. Surgical valve replacement is the standard of care for symptomatic patients with severe aortic stenosis and is appropriate for certain asymptomatic patients. Statin therapy may slow progression of the disease. Contrary to conventional wisdom, vasodilator therapy may in fact be safe and effective in certain instances of severe aortic stenosis. Chronic aortic regurgitation is commonly treated with vasodilator therapy, which is certainly indicated for the asymptomatic patient with hypertension. Surgery is recommended for left ventricular dilatation, diminished ventricular systolic function, or symptoms.

Aortic Valve Insufficiency↗