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PubMedDate not supplied

Acute pseudo-obstruction in critically ill patients with burns.

Acute pseudo-obstruction of the colon (Ogilvie's syndrome) is a rare but potentially morbid complication of burn injury. Two thousand seven hundred three consecutive critically ill patients with burns were reviewed for findings consistent with pseudo-obstruction. Eight (0.29%) patients were identified. Mean age was 63.5 years, and mean burn size was 24.6% total body surface area. All patients were undergoing mechanical ventilation at the time of diagnosis. Six had a previous cardiac condition or complication, and five were on digoxin. Diagnosis was suspected in seven patients before colonoscopy or surgery. Six patients were treated with colonoscopy alone with one treatment failure. Two deaths occurred during hospitalization. Two late deaths were due to underlying cardiac conditions. The preferred treatment of Ogilvie's syndrome is nasogastric suction, colonic decompression, and close observation with surgery reserved for treatment failures or when diagnosis is in doubt. The incidence of Ogilvie's syndrome in patients with burns appears to be related to nonburn medical conditions, especially cardiopulmonary complications and age, rather than to the burn itself.

Acute Disease↗

PubMed1996

Pulsatile lower limb venous Doppler flow: prevalence and value in cardiac disease diagnosis.

The purpose of this study was to assess the frequency and significance of pulsatile Doppler waveforms in lower limb veins. We used Doppler sonographic data from the common femoral vein. In the first of two groups, the findings in 250 patients were correlated with the presence of cardiac decompensation on concurrent chest radiographs. In the second group, the findings in 81 patients were correlated with the presence of tricuspid regurgitation on Doppler echocardiograms. A venous Doppler sonographic examination was considered normal if spontaneous anterograde phasic flow was present and pulsatile if flow had a cyclic retrograde component. In group 1, 21% had pulsatile waveforms whereas 24% had cardiac decompensation. In group 2, 36% had pulsatile waveforms and 43% had tricuspid regurgitation. A statistically significant correlation was found between the presence of these abnormal waveforms and cardiac decompensation or tricuspid regurgitation, with sensitivities of 57% and 54%, specificities of 91% and 78%, positive predictive values of 66% and 66%, negative predictive values of 87% and 69%, and accuracies of 82% and 68%, respectively. In a subgroup of 55 patients who had both tests for correlation and in whom both were in agreement, the sensitivity of venous Doppler sonographic examination for detecting pathologic cardiac conditions was 79%, specificity was 87%, positive predictive value was 83%, negative predictive value was 84%, and accuracy was 84%. In 77 patients with pulsatile waveforms, including 24 without concurrent chest radiographs or echocardiograms, 63 (82%) had no prior history of cardiac disease. When correlated separately with chest radiograph or Doppler echocardiography, the test is not very sensitive in the diagnosis of cardiac disease; however, when both correlating tests are performed and are in agreement, all diagnostic parameters of the venous Doppler sonographic test, including sensitivity, become fairly high. The presence of pulsatile lower limb venous Doppler flow should alert the sonologist that a pathologic cardiac condition may be the culprit, especially in patients who have no such prior diagnosis.

Adolescent↗

PubMed2003

Sudden cardiac death: a 2400-year-old diagnosis?

Sudden cardiac death is one of the most important causes of mortality in the modern industrialized world. Although it has been described for at least several centuries, we believe in fact that Hippocrates provided a concise, but historically compelling, description of sudden cardiac death in his Aphorisms II, 41: "Those who are subject to frequent and severe fainting attacks without obvious cause die suddenly." This would be the earliest description of sudden cardiac death known. The Aphorism was analyzed in the context of genuine Hippocratic writings as well as ancient Greek culture. The Aphorism describes recurrent syncope in otherwise healthy individuals. Therefore, only certain select cardiac conditions are likely described by this Aphorism. Such conditions-long QT syndrome, hypertrophic cardiomyopathy, congenital coronary artery syndromes, and arrhythmogenic right ventricular dysplasia, chief among them-are linked by a final common pathway of an arrhythmic death. Relying solely on clinical experience based on careful history-taking and keen powers of observation, Hippocrates was the first to describe sudden cardiac death due to a select group of cardiac conditions. This analysis establishes such conditions as being an important cause of sudden death 2400 years ago, much as they are among the most important causes of sudden death today.

Death, Sudden, Cardiac↗

PubMed2006

The impact of interventional cardiology for the management of adults with congenital heart defects.

The objective of this study is to assess the impact of interventional cardiology procedures for the management of ACHD. The interventional approach to the management of CHD in the adult population is becoming increasingly recognized as the preferred treatment option for a wide number of congenital cardiac conditions. The files of all consecutive patients over 18 years of age who were hospitalized in our department from January 2000 to December 2004 were reviewed. Over the study period, 1,115 ACHD (583 women; mean age 41 +/- 13.8, years, range 18-72 years) were hospitalized in our department; 752 patients underwent cardiac catheterization and 82.4% of them had an interventional procedure carried out. ASD (329/620) and PFO (159/620) closure account for 78% of all the procedures carried out, with a 2.7% of major complications incidence (all of them closing ASDs). Other procedures such as stenting aortic coarctation (40/620), ventricular septal defect closure (33/620), patent ductus arteriosus embolization (30/620), pulmonary valvuloplasty (12/620), stenting pulmonary artery branches (8/620), etc (5/620) were carried out. The most important complication was one death, which occurred in the case of a 22-year-old woman after stent implantation for a recurrent aortic coarctation. A trivial residual shunt was detected in only 5% of the patients who had a 6-month follow-up after VSD closure; no residual shunt was found after PDA embolization during the 12-month follow-up. In conclusion, we believe that the interventional approach is a safe and successful treatment option for a wide number of congenital cardiac conditions. The increasing use of catheter interventions for these patients will be responsible for an increase of complex cases in surgery.

Adolescent↗

PubMed1995

General practitioners' requirements from a hospital cardiology department.

The requirements of 500 general practitioners from a hospital department of cardiology were sought and assessed from a questionnaire. One hundred and twenty two general practitioners caring for 766,384 patients responded. The most important inpatient service requirement was that cardiologists should be responsible for the management of patients with acute myocardial infarction and other acute cardiac conditions. The expertise and reputation of the consultant cardiologist and the waiting time for an appointment were the two most important outpatient service requirements. The least important aspect was the time patients waited in clinic to see a doctor. Fundholders considered price of outpatient consultations to be unimportant. Waiting times for cardiac catheterisation and non-invasive cardiac investigations together with the quality of the investigation equipment and the technical staff were all considered to be important requirements. Most general practitioners wanted protocols for managing common cardiac conditions. The majority wanted an open access investigation service to reduce outpatient waiting times. Those who did not want an open access service explained that they would not be confident in interpreting the results or deciding subsequent management. An understanding of the requirements of general practitioners is helpful in planning and developing hospital services.

Ambulatory Care↗

PubMed2000

Assessment of knowledge of guidelines for the prevention of infective endocarditis amongst clinicians in a teaching hospital.

A significant minority of instances of endocarditis appear to be the result of invasive procedures performed in susceptible patients with underlying cardiac conditions. Absence, or inappropriate administration, of antimicrobial prophylaxis could expose the patient to the development of a potentially lethal infection. This study was formulated, therefore, to assess the knowledge of guidelines for the prevention of infective endocarditis among hospital-based physicians and surgeons. A multiple choice test was developed, including: (1) cardiac conditions at increased risk for development of infection; (2) procedures more likely to be associated with bacteraemia and endocarditis; and (3) type and route of antimicrobials prescribed when endocarditis prophylaxis is indicated. The quality of the test was determined in several ways. Success was defined as a pass rate of 11 of 18 questions (61%). The test was taken by 153 of 251 (60%) physicians employed by the hospital; 95 (62%) passed the test. No significant difference in success rates was found according to sex, professional status or medical school. Internists performed substantially better (with a pass rate of 41 of 53, 77%) than both paediatricians (13 of 26, 50%, P<0.05) and surgeons (41 of 74, 55%, P<0.01). The range of success varied from 100% to 36% according to specialty (P<0.001). The mean score was 69+/-21 in the study group and 94+/-10 in a control group of 20 infectious disease physicians (P<0.001). In conclusion, this study demonstrates the need for improved education of hospital-based clinicians regarding endocarditis prophylaxis recommendations.

Antibiotic Prophylaxis↗

PubMed1987

Lower extremity amputees with peripheral vascular disease: graded exercise testing and results of prosthetic training.

Thirty-nine subjects, mean age 72 (range 52 to 89), with a leg amputation because of peripheral vascular disease performed graded exercise testing at the start of their prosthetic training program. Their walking performance at the end of the program was assessed and compared with the test findings. They had a history and rest electrocardiogram (ECG) examination which revealed cardiac problems in 75% of the patients. The exercise test was performed on a specially designed arm ergometer permitting coordinated exercise of arm and trunk muscles. Cardiac condition was judged by the achieved peak heart rate (mean 125 +/- 3.8 beats per minute) and observed ECG abnormalities. In only three patients exercise-induced ECG abnormalities were found at peak workload. The mean peak workload was 52 +/- 1.9W. It was concluded from these results that the average physical and cardiac condition is poor in vascular leg amputees. In 34 patients (87%) the prosthetic training was successful. Fourteen patients needed a walking frame and twenty could walk without a walking frame. The probability of achieving walking without a walking frame was 70% in patients with peak workload above 45W and 30% in those with peak workload lower than 45W.

Aged↗

PubMedDate not supplied

Beyond administrative data: characterizing cardiorespiratory disease episodes among patients visiting the emergency department.

We attempted to address deficiencies in administrative health service data during a study of cardiorespiratory emergency department visits. From 1994-1996, we obtained data on 9,264 visits and conducted 1,772 follow-up interviews. The median interval between symptoms and visit ranged from 0.8 days (95% CI 0-1.7) for cardiac conditions to 4.0 days for chronic obstructive pulmonary disease (COPD) (95% CI 2.7-5.3) and respiratory infections (95% CI 3.5-4.5). Infection was the most common trigger of respiratory visits. Although most had improved at follow-up, symptoms persisted following the visit for a mean of 4.5 days (95% CI 3.8-5.4) for cardiac conditions to 8.4 days (95% CI 7.2-9.5) for COPD. Among adults aged < 70, the mean number of reduced activity days per episode ranged from 4.7 (95% CI 3.9-5.4) for asthma to 6.6 (95% CI 5.9-7.4) for respiratory infections. Our data assist in interpreting epidemiological studies based on administrative data, and illustrate the broad impacts of cardiorespiratory disease episodes.

Adolescent↗

PubMed2002

[Patients admitted with atrial fibrillation to a regional hospital].

INTRODUCTION: It is well known that the incidence of atrial fibrillation increased with age over 65 years. However the role and incidence of atrial fibrillation in the admission in the regional hospital was not investigated. The aim of the study was to investigate the incidence, the commonest presenting features, associated cardiac conditions and the different types of atrial fibrillation which were admitted to our regional hospital during the last 10 month. RESULTS: The incidence of atrial fibrillation was 13% (mean age: 71 years). The presenting features were dyspnea (28%), palpitation (25%), heart failure (19%), angina (10%), syncope/vertigo (5%), symptoms-free (13%). The most frequently associated cardiac condition was hypertension (64%). The patients were treated with the following antiarrhythmic drugs: beta-adrenergic blocker: 25%, propafenon (15%), propafenon and beta-adrenergic blocker (25%), sotalol (17%), amiodarone (13%), others (5%). CONCLUSION: Nowadays atrial fibrillation is still a remarkable percentage of hospital admission. The most frequent clinical features were not the signs of arrhythmia but the signs of heart failure and ischaemic heart disease. In the treatment of atrial fibrillation the use of digoxin and class IA type antiarrhythmic agents were remarkably decreased and the use of class III, IC and beta-adrenergic blockers increased.

Aged↗

PubMed2003

Management of amiodarone-induced thyrotoxicosis.

Amiodarone is used increasingly in a number of cardiac conditions. Amiodarone is heavily iodinated and can cause thyroid dysfunction. The diagnosis of amiodarone-induced thyrotoxicosis remains difficult and more common causes of thyrotoxicosis need to be considered and excluded. Amiodarone has a significant side effect profile, which includes thyroid dysfunction. Amiodarone is an effective drug and its withdrawal may have significant impact on a patient's already fragile cardiac status. There are three different types of amiodarone-induced thyrotoxicosis (AIT) (I, II and mixed). Identification of the different subtypes of AIT allows a rational and appropriate management strategy to be chosen. Type I occurs in patients with underlying thyroid disease, whilst type II is thought to result from a destructive thyroiditis. Differentiation is based on clinical grounds together with investigations, which can include thyroid function test, radioiodine uptake scanning, measurement of interleukin-6 levels and colour flow Doppler sonography. Amiodarone should be discontinued in both types of AIT if the indication for its use is not a life-threatening cardiac condition. The management of type I centres around antithyroid drugs to control thyrotoxicosis and later consideration of more definitive treatment. Type II AIT responds to steroid therapy, although antithyroid drugs may be useful if symptoms are severe. Therapeutic options for refractory cases of AIT include surgery, radioiodine and plasmapheresis.

Adrenal Cortex Hormones↗

PubMed2002

Understanding of endocarditis risk improves compliance with prophylaxis.

BACKGROUND: Congenital heart disease (CHD) is the most common predisposing cause for childhood infective endocarditis (IE), accounting for 80% of cases. Knowledge about the disease and its complications is a key factor in promoting adherence to prophylaxis recommendations. OBJECTIVE: To assess the level of understanding among caregivers of children with CHD of their disease, risks of IE and attitudes concerning oral health and antibiotic prophylaxis of IE. PATIENTS AND METHODS: Caregivers' knowledge was assessed during outpatient visits using a 15-item questionnaire developed for this study. Answers were related to patients' age, cardiac condition and risk of IE and respondents' age and education level. RESULTS: Of the 97 questionnaires completed, 83 were considered valid. The mean age of patients was 7.7 +/- 5.9 years (range 1 to 24 years). Eleven (13%) patients were at high risk for IE and 30 (36%) at moderate risk. Most respondents (80%) alleged that they knew the patient's cardiac condition but only 37% described it correctly. Twenty-nine respondents (35%) were aware of the risk of IE, while only 13 related that risk to dental procedures. Knowledge of IE risk was associated with respondents' education level (p = 0.03) but not with respondents' age or patients' actual risk of IE. Most respondents (76%) recalled having been advised on oral hygiene measures and declared that their child brushed their teeth at least once a day (92%). Forty-three children (52%) had already been to the dentist and 27 had done so in the previous six-month period. Almost all (42 out of 43) informed the dentist about the child's CHD, but only 20 (48%) reported having received antibiotics before dental procedures. Antibiotic prophylaxis was associated with patients' age (p = 0.04) but not with respondents' education level or actual risk of IE. Being aware of IE risk was significantly associated with better oral hygiene (p = 0.001) and more frequent dental appointments (p = 0.03), independently of education level. CONCLUSIONS: The results of this survey support the need to reinforce information about risks of IE and prophylaxis recommendations among caregivers of children with CHD.

Adolescent↗

PubMed2002

Central-nervous side effects of midazolam during transesophageal echocardiography.

BACKGROUND: Midazolam is a broadly used drug that can enhance tolerance to transesophageal echocardiography (TEE) in patients with cardiac conditions. Adverse reactions to midazolam have been described previously. We describe central-nervous side effects in 6 of 104 consecutive patients. METHODS: One hundred four patients undergoing TEE-diagnostic procedure were investigated. TEE was performed using a SSA 360 Power Vision ultrasound unit (Toshiba, Tokyo, Japan) and a 5- to 6-MHz probe. Indication for TEE was evaluation of cardiac valves (6), search for cardiac embolism (23), patent foramen ovale or atrial septum defect (20), left ventricular dysfunction (11), aortic dissection (7), and other (37). Midazolam and, if necessary, the benzodiazepine antagonist flumazenil (0.25-0.5 mg) were administered intravenously. RESULTS: The mean cumulative dose of midazolam administered in small fractions was 4.8 +/- 2 mg. In 6 of 104 patients (5.7%) clinically significant adverse effects to midazolam occurred. The reactions were aggressiveness, euphoria, depression, and intense hiccups (singultus) despite low doses of midazolam. The severest forms of these adverse effects to midazolam could be successfully treated with intravenous infusion of flumazenil (0.25-0.5 mg intravenously). CONCLUSION: Adverse effects including aggressive, euphoric, or depressive behavior can occur in a significant proportion (6%) of patients with cardiac conditions undergoing TEE after intravenous administration of midazolam. The administration of the benzodiazepine antagonist flumazenil can reverse the adverse effects to midazolam successfully.

Adult↗

PubMed1996

Determinants of early and late results of combined valve operations and coronary artery bypass grafting.

BACKGROUND: Factors determining the outcome of operative correction of valvular abnormalities combined with coronary artery bypass grafting are still incompletely defined. METHODS: Determinants of early and late (more than 90 days) deaths and event-free survival were studied for combined valve operations and coronary artery bypass grafting in 741 patients using multivariate analysis. RESULTS: Ninety-day survival probability was 89% (95% confidence interval, 87% to 92%). Preoperative risk factors for early death were age, female sex, renal failure, New York Heart Association class IV or V, and mitral insufficiency. The operative risk factor was the duration of aortic cross-clamping. Five- and 10-year survival probabilities were 74% (95% confidence interval, 71% to 78%) and 43% (95% confidence interval, 36% to 50%), respectively. Preoperative risk factors for late death were age, preoperative renal failure, New York Heart Association class IV or V, vessel disease, and nonsinus rhythm. Five- and 10-year event-free survival probabilities were 57% (95% confidence interval, 53% to 61%) and 23% (95% confidence interval, 17% to 28%), respectively. Preoperative risk factors for non-event-free survival were age, female sex, reduced left ventricular function, mitral regurgitation, and pacemaker rhythm. CONCLUSION: The demographic factors of age and female sex; the comorbid condition of renal failure; the cardiac conditions of advanced New York Heart Association class, left ventricular function, mitral regurgitation, vessel disease, and cardiac rhythm; and the operative condition of ischemia time are the most important predictors of clinical outcome after combined valve operations and coronary artery bypass grafting.

Age Factors↗

PubMed2000

The value of dipyridamole thallium scintigraphy and dobutamine stress echocardiography as predictors of cardiac complications following reconstruction of the abdominal aorta.

BACKGROUND: The aim of this study was to evaluate the ability of dipyridamole thallium scintigraphy and dobutamine stress echocardiography to predict cardiac complications following elective reconstruction of the abdominal aorta in patients with a stable preoperative cardiac condition and to compare this with information obtained from the medical history, ECG and resting echocardiography alone. METHODS: This evaluation was performed from January 1993 until December 1995 as part of a prospective, randomised study in 200 patients, with a mean age of 65 (5% women). Dipyridamole thallium scintigraphy was performed on 195 patients and dobutamine stress echocardiography was added to the protocol in the last 83 patients. Cardiac complications were defined before the start of the study. RESULTS: In the postoperative period 62 cardiac complications occurred (31%). In patients clinically suspected of having coronary artery disease the incidence of complications was 40% (51/126), compared to 15% (11/74) when no coronary pathology was suspected (p<0.001). When reversible defects were present on dipyridamole thallium scintigraphy the incidence of complications was 36% (20/55), compared to 29% (41/140) when no reversible defects had been found (NS). Dobutamine stress echocardiography was impossible or contraindicated in 21 patients. In the remaining patients the incidence of complications was 71% (5/7) when new regional wall motion abnormalities were found, compared to 16% (9/55) when such abnormalities had not been detected (p<0.005). CONCLUSIONS: These data suggest that cardiac complications following reconstruction of the abdominal aorta in patients with a stable cardiac condition are best predicted by dobutamine stress echocardiography. Dipyridamole thallium scintigraphy, however, does not seem to be useful in this respect.

Aged↗

PubMed2006

Impedance cardiography revisited.

UNLABELLED: Previously reported comparisons between cardiac output (CO) results in patients with cardiac conditions measured by thoracic impedance cardiography (TIC) versus thermodilution (TD) reveal upper and lower limits of agreement with two standard deviations (2SD) of approximately +/-2.2 l min(-1), a 44% disparity between the two technologies. We show here that if the electrodes are placed on one wrist and on a contralateral ankle instead of on the chest, a configuration designated as regional impedance cardiography (RIC), the 2SD limit of agreement between RIC and TD is +/-1.0 l min(-1), approximately 20% disparity between the two methods. To compare the performances of the TIC and RIC algorithms, the raw data of peripheral impedance changes yielded by RIC in 43 cardiac patients were used here for software processing and calculating the CO with the TIC algorithm. The 2SD between the TIC and TD was +/-1.7 l min(-1), and after annexing the correcting factors of the RIC formula to the TIC formula, the disparity between TIC and TD further declined to +/-1.25 l min(-1). CONCLUSIONS: (1) in cardiac conditions, the RIC technology is twice as accurate as TIC; (2) the advantage of RIC is the use of peripheral rather than thoracic impedance signals, supported by correcting factors.

Algorithms↗

PubMed2005

Neonatal repair of tetralogy of Fallot results in improved pulmonary artery development without increased need for reintervention.

OBJECTIVE: Despite a continuous improvement in operative outcome the optimal timing for the repair of tetralogy of Fallot (TOF) remains controversial. The purpose of this study was to evaluate the results following neonatal repair of TOF and the need for reintervention associated with this strategy. METHODS: Retrospective review of 66 consecutive patients with TOF and confluent pulmonary arteries, who underwent repair immediately after diagnosis. Group I (n=46) had a median age of 5 days (1-29) and Group II (n=20) had a median age of 56 days (32-270). A transventricular approach was used in all cases, and 58/66 (88%) patients received a transannular patch. The median follow-up interval was 35 months (1-79). RESULTS: There were three early deaths (4.5%) and no late deaths for an actuarial survival rate of 95.4% at 1 and 5 years. Univariate analysis of patient and procedural variables demonstrated that early mortality was only influenced by associated non-cardiac conditions (P=0.04). At median interval of 9.8 months (3-41), 12 patients required additional intervention. During the follow-up period, a significant increase in Nakata index was observed only among neonates. Freedom from reintervention at 1 month, 1 and 5 years was: 100, 84.2 and 81% in group I and 100, 84, 78.9% in group II. Surgical weight below 2.5 kg (P<0.001), low arterial saturation in the early postoperative period (P=0.04) and small preoperative branch pulmonary artery size (<0.01) were associated with need for reintervention during follow-up. CONCLUSIONS: Elective repair of TOF in neonates with confluent central pulmonary arteries has excellent results in the absence of significant associated non-cardiac conditions. While enhancing the development and growth of the pulmonary arteries, neonatal repair affords a freedom from reintervention no different from patients repaired during infancy. Preoperative weight < 2.5 kg and small left pulmonary artery size are associated with higher incidence reintervention during follow-up.

Age Factors↗

PubMed2002

Effects of physical conditioning on cardiac autonomic function in healthy middle-aged women.

The purpose of this study was to determine whether moderate exercise training affects heart rate variability (HRV) and spontaneous baroreflex (SBR) function in healthy middle-aged women. Thirty-two sedentary women aged 40-59 yr were divided into four groups depending on reproductive state (premenopausal, PrM or postmenopausal, PoM, and training group (exercise or sedentary control group). The electrocardiographic R-R interval and systolic blood pressure (finger plethysmograph) were measured at rest during paced breathing at 16 breaths/min in the left lateral decubitus, sitting, and free standing postures, and during upright cycling at 40% maximal heart rate reserve (MHRR). After initial testing, the exercise groups underwent a 12 week walking program. After training, both exercise groups (PrM and PoM) had a longer R-R interval in all conditions, a higher SBR slope in the sitting and standing posture and lower sympathetic modulation in the standing posture, than the control groups and pre-training levels. During exercise, vagal modulation was higher and sympathetic modulation was lower in both exercise groups compared to pre-training values. Vagal modulation is increased following moderate intensity aerobic conditioning in middle-aged women.

Adult↗

PubMed2005

Patient knowledge and perceptions of atrial fibrillation and anticoagulant therapy: effects of an educational intervention programme. The West Birmingham Atrial Fibrillation Project.

OBJECTIVE: Previous research has demonstrated that patients with atrial fibrillation (AF) possess very little knowledge of their disease, the consequences of AF and the benefits/risks of anti-coagulant therapy. The aim of this pilot study was to examine patient's knowledge and perceptions of AF and their anticoagulant treatment before and after a brief educational intervention. MATERIALS AND METHODS: Ninety-three patients (47 male; mean (S.D.) age 67.3 (11.6) years) completed the baseline interview to assess their knowledge and perceptions of AF. All patients were given an information booklet which explained what AF was, associated symptoms, the possible causes and consequences of AF, treatment options and their benefits/risks, what the INR is and what factors may effect it. The booklet was explained to each patient by the researcher and given to the patient to take away for reference. Thirty-three (35.5%) patients (12 men; mean (S.D.) age 68.0 (13.6) years) completed the follow-up assessment to re-assess their knowledge and perceptions of AF. RESULTS: Only 49% of patients could name their cardiac condition at baseline, although the majority were aware that AF was an arrhythmia (80% baseline vs. 91% follow-up). Only about half the patients perceived AF as a serious condition or were aware that AF predisposes to thromboembolism at baseline. Following the educational intervention there was a non-significant increase in patient knowledge of the risks associated with AF. Of those who completed both questionnaires, 52% were aware that anticoagulants prevented blood clots, which increased to 70% post-intervention. However, few patients were aware of the benefit of stroke prevention associated with anticoagulants at baseline (21%) or after the educational intervention (27%). The intervention had little effect on increasing awareness of the bleeding risks associated with anticoagulants, although three in five people appeared to appreciate these risks. However, the educational intervention significantly improved patient's knowledge of the target INR range and factors that may affect INR levels (p=0.001 and p=0.014, respectively) for those who completed both questionnaires. CONCLUSIONS: Most patients with AF possess very limited knowledge about their cardiac condition, its consequences, and how anticoagulant treatment can benefit them. This pilot study has demonstrated that a brief educational intervention with an information booklet can help to somewhat improve their knowledge about anticoagulation therapy for AF.

Aged↗