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PubMed2005

[Spanish Cardiac Catheterization and Coronary Intervention Registry. 14th official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2004)].

This article presents the findings of the Spanish Society of Cardiology registry of cardiac catheterization and interventional cardiology in the year 2004. Data were obtained from 121 centers, which comprise almost all cardiac catheterization laboratories in Spain. Of these, 110 performed catheterization mainly in adults, and 11 carried out procedures in only pediatric patients. In 2005, 111,451 diagnostic catheterization procedures were performed, including 97,785 coronary angiograms. This was 6.6% higher than in 2003. The population-adjusted rate was 2263 coronary angiograms per million inhabitants. A total of 45,469 coronary interventions were performed, 12% more than in 2003. The population-adjusted rate was 1052 per million inhabitants. Coronary stents were used in 91.4% of procedures; 68,892 stents were implanted, which was 12% more than in 2003. Of these, 25,148 (36.5%) were drug-eluting stents. Some 7326 percutaneous coronary interventions were carried out in patients with acute myocardial infarction, 20.5% more than in 2003. These accounted for 16.1% of all percutaneous coronary interventions. Among non-coronary interventions, there was a decrease in the number of percutaneous mitral valvuloplasties (8%) and atrial septal defect closures (7%). In addition, there was a small increase in pediatric interventions (12%). Finally, it is important to note that the percentage of centers participating in the registry was high, what ensures that the data presented here are highly representative of the work carried out in cardiac catheterization laboratories in Spain.

Adult↗
PubMed2006

[Spanish Cardiac Catheterization and Coronary Intervention Registry. 15th official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2005)].

This article summarizes the findings contained in the 2005 registry of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology. Data were obtained from 128 centers, which comprise almost all cardiac catheterization laboratories in Spain. Of these, 118 performed catheterizations mainly in adults, while 10 carried out procedures in only pediatric patients. In 2005, 117,245 diagnostic catheterization procedures were performed, including 103,646 coronary angiograms, which was 5.9% more than in 2004. The population-adjusted rate was 2326 coronary angiograms per million inhabitants. A total of 51,689 coronary interventions were performed, which is 13.6% more than in 2004 and which corresponds to a rate of 1161 per million inhabitants. Coronary stents were used in 96% of procedures. Of the 80,569 stents implanted, 41,352 (51.3%) were drugeluting stents. Some 8341 percutaneous coronary interventions were carried out in patients with acute myocardial infarction, which is 13.8% more than in 2004. They accounted for 16.1% of all such interventions. Among the non-coronary interventions recorded, the number of percutaneous mitral valvuloplasties decreased by 7%. The number of procedures carried out to close atrial septal defects increased by 40% compared with 2004. The number of pediatric interventions increased by 1.7%. Finally, it is important to note that a large proportion of laboratories reported results, which helped to ensure that the data summarized here are highly representative of the work carried out at cardiac catheterization laboratories in Spain.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Cardiology '89. Present trends in cardiovascular medicine at the Congress of Cardiology '89 in London April 1989].

This review summarizes selected topics discussed at one of the major congress events in cardiovascular medicine in Great Britain in 1989. The congress was attended during its five days duration by 800 participants from nearly 40 countries. The scientific programme, consisting of invited state-of-art lectures, was divided into following basic topics: coronary heart disease including risk and prevention, arhythmias, hypertension, heart failure, structural heart disease, cardiac imaging and costs-effectiveness of cardiology. The aim of the review is to bring nearer the creative atmosphere and the very advanced postgraduate level of this cardiologic meeting. Due to the actual medico-social importance of current strategies in management of ischemic heart disease and malignant arrhythmias in Czechoslovakia, special interest is devoted to these problems. Based on congress lectures an overview of the atherosclerotic plaque pathology and resulting therapeutic and prognostic implications for the management of unstable angina and myocardial infarction is given. Selected aspects of thrombolytic therapy and its impact on coronary vessel wall and myocardium are discussed, too. Some contemporary problems and updated concepts of both drug and intervention treatment of malignant ventricular arrhythmias are highlighted in a more extensive way, confronting congress speakers and recent publications.

Cardiovascular Diseases↗
PubMed1997

[Research methods in clinical cardiology (VII). Experimental studies in cardiology].

Experimental designs in clinical investigation are discussed in this article. Guideline examples have been used in the area of Cardiology using always the same one only one whenever possible. We have looked for a different perspective from what is generally used in the discussion of the general characteristics of experimental designs, and more specifically of clinical trials and we deal with the aspects of clinical trials which are usually ignored due to their marginal character. We also discuss those characteristics which differentiate clinical trials in respect to other designs and types of questions which are answered by clinical trials. And we finally discuss various aspects such as randomization and its various types (simple, block, stratified, pre-randomized) and variable types of evaluating the answers, masking and the problems in its maintenance, with certain kinds of designs, sample size, etc. There is a brief mention of two particular cases: factorial and cross over designs are both discussed, mentioning their strong and weak points. Likewise, we discuss community trials as another experimental design and examples are provided. Finally, we discuss aspects of criteria: such as, When to stop the trials? or Who are the results applicable to?, and we suggest points to take into consideration when these decisions are made.

Cardiology↗
PubMed1997

[Methods of investigation in clinical cardiology. VIII. Meta-analysis and systematic reviews in cardiology].

Over the last 20 years, the development of meta-analysis has been aimed at obtaining objective synthesis of the available results on specific research questions. The main achievements of meta-analysis include the application of techniques to perform systematic literature searches and to obtain unbiased selection of studies, data extraction and pooled estimates of effect. This paper discusses the methodologic steps to follow when conducting a meta-analysis, with emphasis on study selections, data collection and statistical methods to combine the results from individual studies. We also present a set of guided questions as an aid to critically evaluate the conclusions of published meta-analyses. The application of meta-analytic techniques to cardiology is illustrated using a meta-analysis of the randomized controlled trials of angioplasty versus bypass surgery in the management of patients with ischemic heart disease.

Cardiology↗
PubMed2001

[Guidelines of the Spanish Society of Cardiology on requirements and equipment in hemodynamic and interventional cardiology].

In the last 20 years the work performed in catheterization laboratories has changed greatly, and while also taking the diagnostic aspects also into account, interventional cardiology has acquired an important role. Work in the catheterisation laboratory has evolved from only diagnostic studies of cardiac anatomy and function, and evaluation of potential surgical candidates, to interventional procedures mainly based on catheters techniques. As new diagnostic and interventional procedures are now available, human and technical requirements of the catheterization laboratory have changed. The aim of this report is to make an update of the requirements needed to perform diagnostic and interventional procedures in the cardiac catheterization laboratory.

Cardiac Catheterization↗
PubMed1992

Seventh survey of staffing in cardiology in the United Kingdom 1991. British Cardiac Society, the Cardiology Committee of the Royal College of Physicians, and the Trafford Centre for Medical Research, University of Sussex.

The Seventh Survey of Staffing in Cardiology was conducted with an index date of 31 July 1991. At that time the total number of posts for cardiologists in England and Wales, defined as individuals trained in the specialty and spending at least 40% of their professional time working in it, was 340. Ten individuals worked part time only, making 335 whole time equivalent posts. This number increased from 1990 by 15 (4.7%). There were 67 cardiologists in Scotland and Northern Ireland, making a total for the United Kingdom of 407 posts (402 whole time equivalents). Sixteen Districts in England and Wales had no cardiologist at the time of the survey, and 31 other Districts had less than seven visiting sessions each week. The situation had not improved since the 1990 survey. The population of these 47 Districts is nearly nine million. Scotland had almost 800,000 additional people served by Health Boards without resident cardiologists. The number of senior registrars and lecturers is inadequate to provide a full period of training for most who advance to consultant status, and the situation will worsen from 1995 onwards. A major problem has been a top slice of 10 posts for a research allocation, few of which are occupied by individuals seeking a career in the specialty. These posts should be redesignated to increase training opportunities to counter the present shortfall and facilitate an expansion in consultant posts of at least 5% per annum over the next decade.

Cardiology↗
PubMed1995

[Use of radionuclide isotopes by cardiologists. Results of a French survey. Study group: "Nuclear Cardiology" of the French Society of Cardiology and the Society of Nuclear Medicine and Biophysics].

The authors report the results of an enquiry carried out amongst French cardiologists to determine their opinion about radionuclide investigations in cardiological practice. Of the 5,050 cardiologists contacted, 1,431 (28.3%) replied. The cardiologists were attracted by the non-invasive nature (84%) of radionuclide techniques and their complementarity with other methods of investigation (74%) but regretted their cost (55%), their lick of availability in emergencies (35%) and, in general, their difficult of access (30%). Only 38% of the cardiologists who replied used radionuclide investigation on an everyday basis, this being impossible for some because of the distance to the nearest centre with these facilities (on average 32 km but exceeding 50 km in 29% of cases, and the delay before obtaining an appointment (average 13 days) which was often excessive, especially for myocardial scintigraphy (thallium or equivalent). Each cardiologist prescribed an average of 5 myocardial scintigraphies, 3 pulmonary scintigraphies and 2 radioisotopic ventriculography per month. These results seem to be an overestimation; in fact, radionuclide investigations are relatively underemployed, probably more because of the factors cited above than because of lack interest or quality, these latter two points being generally judged positively by the majority of cardiologists. Cardiologists require more from the conclusions of the investigation than a simple description of the images obtained. As with all other investigations that they perform themselves, the interpretation of the results must take the clinical context into consideration and form part of the diagnostic and therapeutic management of the patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiology↗
PubMed1997

[Current status of arterial hypertension as a cardiology topic: point of view of the cardiologist. Task force on Arterial Hypertension of the Spanish Cardiology Society].

Even if arterial hypertension (HT) is a process of multiorganic involvement, it is nevertheless in practice, one of the most powerful factors for the development of cardiovascular complications that increases very seriously, both cardiovascular morbidity and mortality. Paradoxically, in Spain, a significant proportion of cardiologists have neglected for many years this disease, at least, at its initial phase, acting mainly, only when the usual and severe cardiovascular complications of HT were clinically well established. Currently, this attitude is changing in such a way, that in the near future, the cardiologist's commitment to HT, will be definitely engaged in both; basic research and clinical aspects. The Spanish Hypertension Working Group, has worked out in an inquiry sent to all Spanish cardiologists, in order to know their point of view in relation to the main aspects involving HT and cardiological practice. This paper collects the results of the answers given anonymously by the doctors.

Cardiology↗
PubMed1997

[Methods of investigation in clinical cardiology. VIII. Socioeconomic evaluation of clinical cardiology practice].

Health services are systems whose mission is to improve the health status of both individuals and society in general. In recent decades, these systems have faced challenges such as their increasing complexity, limited resources, rapid innovation and diffusion of medical technologies, pressures on demand from society and professionals, and the lack of knowledge of the effects of these factors on costs and society's health. In addition, health care expenditures have grown twice as fast as wealth in industrialized countries during the last 25 years. These problems have prompted cost containment as a key issue in health policy and, at the same time, have promoted the development of socioeconomic evaluation as a scientific activity in the frame of health services research. Socioeconomic evaluation tries to determine if the sacrifice made by society, which devotes part of its limited resources to health care, maximizes the outcomes for population. This article describes basic concepts and methods of economic appraisal in health services which are illustrated with examples of clinical practice in cardiology. Common methods of evaluation are described; the relation between the clinical outcome of a procedure and its associated costs is emphasized in explaining the types of efficiency analysis (cost-efficacy, cost-effectiveness, cost-utility, and cost-benefit); and finally a guide for socioeconomic evaluation is provided.

Cardiology↗
PubMed1999

[Need for ambulatory cardiology after-care rehabilitation in the metropolitan area of a large city. Results of the Cologne model of ambulatory cardiologic rehabilitation--phase II].

Within the Cologne Model (CM) of outdoor cardiac rehabilitation (OCR), phase II investigations about the demand for this form of cardiac rehabilitation (CR) after acute cardiac diseases were carried out in three general hospitals, the cardiological and cardiosurgical university hospitals of Cologne. The subsequent questions were investigated: total number of coronary or cardiac operated patients, number of patients with indication for CR, and number of patients corresponding to the restricted indications of CM (age below 65, low risk patient, no cardiac operation). For these groups the acceptance or refusal of CR was checked. Subsequently a sample of patients corresponding to the criteria of CM or of operated patients were confronted with the additional offer of an OCR. The motivation for the acceptance of rehabilitation in specialized hospitals (ICR), OCR or refusal of each kind of CR was inquired. The acceptance of CR in the different groups varied widely. Whereas operated patients in Cologne accept CR in nearly 100% of cases, this is the case in patients after acute myocardial infarction (AMI) in only 50% and in patients after PTCA without AMI in only 5-6%. The analysis of predictors for acceptance brings about that younger patients prefer CR, and if they do, OCR. Patients with the more serious form of disease prefer ICR. Women accept CR more rarely than men, and if they do, they prefer the hospital form. However, this is less gender specific but consequence of the generally more serious form and later onset of CAD in females. Higher educational as well as occupational status favors acceptance of CR and specially OCR. The suspicions that unmarried people prefer OCR and foreigners ICR could not be generally confirmed. Crucial reasons for the form of CR which is accepted or refused are individual ones. ICR is favored by the wish for more safety and better recuperation. For OCR, the comfortable conditions at home with high social support and/or antipathy against hospitals after long clinical treatment are named. Analysis of demand for OCR demonstrates that between 40% in low risk patients (corresponding to CM criteria) and 20% in more serious cases (operated patients) prefer the outhospital form. From these data an estimation of demand for OCR in areas with high population was carried out.

Aftercare↗
PubMed1999

[Guidelines of clinical practice of the Spanish Society of Cardiology. Requirements and equipment of invasive techniques in pediatric cardiology: clinical application].

Invasive techniques in pediatric cardiology have experienced a big change since the 80's. The growth of non-invasive methods for diagnosing congenital heart defects has made the number of diagnostic catheterizations decrease remarkably. On the other hand, the notable development of pediatric interventional catheterization techniques will allow that, in the near future, the number of therapeutic catheterizations overcomes the diagnostic ones in our country. The former are more difficult and dangerous, so they require experienced and skilled hands and more economic resources. This chapter is divided in three main sections: I) Requirements and equipment needed for pediatric invasive techniques; II) Current indications, contraindications and complications of the diagnostic catheterization, and III) Techniques, indications and results of pediatric therapeutic catheterization: current state. Likewise, we state the suitability or not for these therapeutic procedures in different cardiac anomalies.

Age Factors↗
PubMed2002

Clinical features and outcomes of elderly outpatients with heart failure followed up in hospital cardiology units: data from a large nationwide cardiology database (IN-CHF Registry).

BACKGROUND: Congestive heart failure (HF) represents a major public health problem with an age-related increasing prevalence. Despite the high mortality and morbidity in elderly patients with HF, limited clinical and prognostic data are available for development of appropriate prevention and treatment strategies. METHODS: A cohort of 3327 outpatients consecutively enrolled in the Registry of Italian Network on Congestive Heart Failure by 133 cardiology centers was studied. Univariate and multivariate analyses were performed to compare patients <70 and > or =70 years old and to evaluate associations between clinical variables and the 1-year mortality rate and hospitalizations. RESULTS: With respect to the 2294 patients <70 years old, the 1033 (31%) elderly patients were significantly more likely to be female, to be in New York Heart Association (NYHA) class III-IV, and to have preserved left ventricular systolic function (ejection fraction >40%), an ischemic/valvular etiology, and atrial fibrillation/flutter. Elderly patients received angiotensin-converting enzyme inhibitors, beta-blockers, and anticoagulants less frequently than younger patients did. The 1-year mortality rate was significantly higher in patients > or =70 years old (22% vs 13.7%, P <.001). Age was an independent predictor of 1-year mortality, increasing 2.8% by each year of age. Independent predictors of 1-year mortality in elderly patients were (1) > or =1 hospital admission in the previous year (relative risk [RR] 2.09, 95% CI 1.51-2.87), (2) systolic blood pressure (RR 0.98, 95% CI 0.97-0.99), (3) NYHA class III-IV (RR 1.57, 95% CI 1.20-2.07), and (4) age (RR 1.028, 95% CI 1.001-1.056). CONCLUSIONS: Our study confirms that elderly patients (1) are seen in a more advanced stage of HF, (2) are less likely to receive evidence-based treatments, (3) show more frequently preserved systolic function, and (4) have a worse prognosis. Consequently, there is a need to develop more effective and targeted management strategies for this escalating health problem.

Adolescent↗
PubMed2006

Expert consensus (SBC/SBHCI) on the use of drug-eluting stents: recommendations of the Brazilian society of interventional cardiology/ Brazilian society of cardiology for the Brazilian public single healthcare system.

The authors review percutaneous coronary intervention (PCI) evolution and its growing application in myocardial revascularization for patients with coronary heart disease in Brazil and worldwide. PCI was introduced in 1977 using only the catheter balloon. Limitations of this method (acute occlusion and coronary restenosis) led to the adoption of coronary stents and more recently the advent of drug-eluting stents2, which were developed to drastically reduce restenosis rates. These developments allowed the exponential growth of percutaneous coronary intervention (PCI) procedures in Brazil which have replaced many bypass surgery procedures and have become the gold standard for the majority of symptomatic patients suffering from coronary artery disease. The preference for this procedure gained new dimensions in 2000 when the Brazilian Public Healthcare System (SUS) began reimbursing for stent procedures. This measure exemplified the importance of the Public Healthcare System's participation in incorporating medical advances and offering a high standard of cardiovascular treatment to a large portion of the Brazilian population. It is emphasized that prevention of in-stent restenosis is complex due to its unpredictable and ubiquitous occurrence. Control of this condition improves quality of life and reduces the recurrence of angina pectoris, the need to perform new revascularization procedures and hospital readmissions. The overall success of the drug-eluting stents has proven to be reliable and consistent in overcoming restenosis and has some beneficial impact for all clinical and angiographic conditions. This paper discusses the adoption and criteria for the use of drug-eluting stents in other countries as well as the recommendations established by the Brazilian Society of Interventional Cardiology for their reimbursement by SUS. The incorporation of new healthcare technology involves two distinct stages. During the first stage, the product is registered with the National Health Surveillance Agency (ANVISA). During this stage the interested company submits to the regulatory agency, results from clinical studies that demonstrate the efficacy and safety of the new device or pharmaceutical product. Frequently, in addition to clinical studies, approval records for clinical use from the regulatory agencies of other countries, mainly the United States of America and the European Community are also submitted. The successful completion of this stage means that the medication or device may be prescribed or used by the physicians in Brazil. The second stage in the incorporation of new healthcare technology involves the reimbursement or financing of the treatment that was approved in the previous stage based on its efficacy and safety. This stage can be more complex than the first one since the new technology, whether a substitution for established treatment methods or the introduction of a new treatment concept, are usually more expensive. The incorporation of new technology requires a cost-effectiveness analysis so that fund administrators can make decisions based on the universal scenario of limited resources to finance healthcare with treatments that are more and more burdensome. The difficulties of funding management are aggravated by medical and social ethical implications that arise when a treatment is approved based on its efficacy and safety but is not made available to patients who could benefit greatly from it. In Brazil, assessment methods for the incorporation of new technology based on reimbursement or financing have not been fully developed for either the private healthcare plans or the Brazilian Public Healthcare System (SUS). The implementation of new technology in both healthcare systems is a slow process and frequently the implementation is a result of the requirements of patients or the organizations that represent them and at times is the result of legal proceedings or political pressure imposed by physicians and their respective scientific societies. Our objective is to review the evolution of percutaneous coronary intervention (PCI) in Brazil and its current status in view of the advent of drug-eluting stents, the growing participation of drug-eluting stents in myocardial revascularization to treat patients with coronary heart disease, as well as, to compare the regulatory standards from Brazil and other countries regarding the incorporation and recommendations for the use of this new technology.

Angioplasty, Balloon, Coronary↗
PubMed1997

Assessing bedside cardiologic examination skills using "Harvey," a cardiology patient simulator.

OBJECTIVE: To assess the cardiovascular physical examination skills of emergency medicine (EM) housestaff and attending physicians. METHODS: Prospective, cohort assessment of EM housestaff and faculty performance on 3 valvular abnormality simulations (mitral regurgitation, mitral stenosis, and aortic regurgitation) conducted on the cardiology patient simulator, "Harvey." Participants examined each of the 3 study disease simulations and proposed a diagnosis (session I). They were then given a cardiac examination form and repeated the programmed simulations (session II). The examination form was used to prompt physicians to interpret 23 separate cardiac findings for each simulation in a multiple-choice format. RESULTS: Forty-six EM housestaff (PGY1-3) and attending physicians were tested over a 2-month study period. Physician responses did not differ significantly among the different levels of postgraduate training. The overall correct response rates for participants were 59% for aortic regurgitation, 48% for mitral regurgitation, and 17% for mitral stenosis. For aortic regurgitation, recognition of a widened pulse pressure and recognition of diastolic decrescendo murmur were associated with a correct diagnosis (p < 0.01). For mitral regurgitation, correct assessment of the contour of the holosystolic murmur predicted a correct diagnosis (p < 0.001). For mitral stenosis, proper characterization of the mitral area diastolic murmur predicted a correct diagnosis (p < 0.001). CONCLUSION: Housestaff and faculty had difficulty establishing a correct diagnosis for simulations of 3 common valvular heart diseases. However, accurate recognition of a few critical signs was associated with a correct diagnosis in each simulation. Training programs may need to focus attention on selected key components of the cardiovascular examination to facilitate teaching of physical diagnosis.

Clinical Competence↗