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At least 991 records · Page 55Linked to original sources
PubMed1998

Effect of time from onset to coming under care on fatality of patients with acute myocardial infarction: effect of resuscitation and thrombolytic treatment. The United Kingdom Heart Attack Study (UKHAS) Collaborative Group.

OBJECTIVE: To examine the relation between time from onset of symptoms and coming under ambulance and hospital care on fatality in patients with evolving acute myocardial infarction, and on the proportions who survive because of resuscitation and thrombolytic treatment. DESIGN: Prospective community and hospital study over two years. Delay was measured from the onset of symptoms to arrival at hospital, and from the onset to coming under care from ambulance personnel. SETTING: Four general hospitals serving three United Kingdom health districts. PATIENTS: 2213 patients under 75 years of age, 111 of whom had been successfully resuscitated from out of hospital cardiac arrest. INTERVENTIONS: Resuscitation from cardiac arrest; thrombolytic treatment. MAIN OUTCOME MEASURES: 30 day fatality and lives saved by the two forms of treatment. RESULTS: Times from symptom onset to coming under hospital care and to starting thrombolytic treatment (given to 53% of patients) were < or = 1 hour in 15% and 2% of patients respectively, < or = 2 hours in 54% and 25%, and < or = 4 hours in 67% and 55%. Overall, 30 day fatality was 138/1000 patients treated; 64/1000 (95% confidence interval 54 to 74) survived because of treatment, and 80% of this salvage was attributable to resuscitation. Delay was an important factor: 107/1000 (60 to 144) lives were saved for those coming under care within 1 hour compared with 21/1000 (5 to 37) for those who delayed for more than 12 hours. Further analysis including the 111 patients with out of hospital arrest showed that 34% of those coming to hospital by ambulance came under ambulance care within 1 hour; for this subset, 30 day fatality was 173/1000, and 136 (109 to 163) lives were saved by treatment. CONCLUSIONS: Results of treatment are strongly related to delay in coming under care. Reduction in delay can reduce mortality from acute myocardial infarction.

Aged↗
PubMed1999

After I had a heart attack and two bypass operations, I was put on Lipitor to lower my cholesterol. My cholesterol was never high--about 170-180 mg/dL. But my HDL was always low and triglycerides were somewhat high. Now my total cholesterol is 124 and my HDL has gone up slightly. My triglycerides are way down. My LDL cholesterol has fallen from 110 to 68. Is there any downside to such a low cholesterol level, other than the need to check my liver function tests?

Explore the source record for details and available documents.

Anticholesteremic Agents↗
PubMed2001

Abstract, closing summary, and table of contents for Laragh's 25 lessons in pathophysiology and 12 clinical pearls for treating hypertension.

These 25 lessons 1) review the roles of plasma renin levels for causing malignant and most essential hypertension and their related vascular injuries (heart attack, heart failure, kidney failure and stroke); 2) review how antihypertensive anti-R drugs that block renin activity (beta blockers, the first converting enzyme inhibitor from venom, and the first angiotensin receptor blocker) were used to reveal plasma renin involvement in the hypertension of medium and high renin patients and to show; 3) that the 30% with low renin essential hypertension do not respond to R drugs, are not prone to heart attack or stroke, and BP is corrected instead by the natriuretic anti-V drugs (diuretics, spironolactone, CCB, alpha blockers); 4) thus, all hypertensives can be divided into R patients who have too much renin vasoconstriction or V patients who instead have predominant sodium-volume mediation. Furthermore, all antihypertensive drug classes can be divided into R drugs that block the renin factor, or V drugs that reduce body sodium volume; 5) these findings document our conception of two biochemically and physiologically different final factors that sustain all BP in which the sodium-volume factor continuously sustains cardiac output and flow while plasma renin-angiotensin sets total peripheral resistance (TPR), which, within the Poiseuille Equation (BP = cardiac output [CO] x TPR) describes our [Na+-volume x renin-angiotensin vasoconstriction] model that supports all normotension or hypertension; 6) in this light, we designed a visit-by-visit method for treating untreated hypertensives using the ambient plasma renin level and BP responses to guide primary drug therapy against either the V or R factor; and 7) for also correcting nonresponders receiving multiple drugs where renin testing correctly guides addition or subtraction of drugs depending on whether the test indicates unresponsiveness due to a reactive sodium-volume excess, or to lack of effectiveness of an R drug in a V patient or of a V drug in an R patient, or from large reactive increases in renin that override the R drug, calling for strengthening the R and/or removing V drugs. This objective, biochemically based method results in effective longterm BP control of nearly all patients using fewer, but the correct drug(s) for each individual.

Antihypertensive Agents↗
PubMed2006

Predicting the impact of population level risk reduction in cardio-vascular disease and stroke on acute hospital admission rates over a 5 year period--a pilot study.

UNLABELLED: The brief for this study was to produce a practical, evidence based, financial planning tool, which could be used to present an economic argument for funding a public health-based prevention programme in coronary heart disease (CHD) related illness on the same basis as treatment interventions. OBJECTIVES: To explore the possibility of using multivariate risk prediction equations, derived from the Framingham and other studies, to estimate how many people in a population are likely to be admitted to hospital in the next 5-10 years with cardio vascular disease (CVD) related events such as heart attacks, strokes, heart failure and kidney disease. To estimate the potential financial impact of reductions in hospital admissions, on an 'invest to save' basis, if primary care trusts (PCTs) were to invest in public health based interventions to reduce cardiovascular risk at a population level. STUDY DESIGN: The populations of five UK PCTs were entered into a spreadsheet based decision tree model, in terms of age and sex (this equated to around 620,000 adults). An estimation was made to determine how many people, in each age group, were likely to be diabetic. Population risk factors such as smoking rates, mean body mass index (BMI), mean total cholesterol and mean systolic blood pressure were entered by age group. The spreadsheet then used a variant of the Framingham equation to calculate how many non-diabetic people in each age group were likely to have a heart attack or stroke in the next 5 years. In addition heart failure and dialysis admission rates were estimated based upon risk factors for incidence. The United Kingdom Prospective Diabetes Study (UKPDS) risk engines 56 and 60 were used to calculate the risk of CHD and stroke, respectively, in people with type 2 diabetes. The spreadsheet deducted the number of people likely to die before reaching hospital and produced a predicted number of hospital admissions for each category over a 5-year period. The final part of the calculation attached a cost to the hospital activity using the UK Health Resource Grouping (HRG) tariffs. The predicted number of events in each of the primary care trusts was then compared with the actual number of events the previous year (2004/2005). METHODOLOGY: The study used a decision tree type model, which was populated with data from the research literature. The model applied the risk equations to population data from five primary care trusts to estimate how many people would suffer from an acute CVD related event over the next 5 years. The predicted number of events was then compared with the actual number of acute admissions for heart attacks, strokes, heart failure, acute hypoglycaemic attacks, renal failure and coronary bypass surgery the previous year. RESULTS: The first outcome of the model was to compare the estimated number of people in each PCT likely to suffer from a heart attack, a stroke, heart failure or chronic kidney failure with the actual number the previous year 2004/2005. The predicted number was remarkably accurate in the case of heart attack and stroke. There was some over-prediction of chronic kidney disease (CKD) which could be accounted for by known under-diagnosis in this illness group and the inability of the model to pick up, at this stage, the fact that many CKD patients die of a CHD related event before they reach the stage of requiring renal replacement. The second outcome of the model was to estimate the financial consequence of risk reduction. Moderate reductions in risk in the order of around 2-4% were estimated to lead to saving in acute admission costs or around pounds sterling 5.4 million over 5 years. More ambitious targets of risk reduction in the order of 5-6% led to estimated savings of around pounds sterling 8.7 million. CONCLUSIONS: This study is not presented as the definitive approach to predicting the economic consequences of investment in public health on the cost of secondary care. It is simply a logical, systematic approach to quantifying these issues in order to present a business case for such investment. The research team do not know if the predicted savings would accrue from such investments; it is theoretical at this stage. The point is, however, that if the predictions are correct then the savings will accrue from over 4000 people, from an adult population of around 185,000 not having a heart attack or a stroke or an acute exacerbation of heart failure.

Adolescent↗
PubMed1986

Cholesterol and coronary artery disease. What do clinicians do now?

Coronary atherosclerosis and its clinical sequelae are problems of enormous magnitude. Because the first clinical sign of coronary artery disease may be sudden death, investigators have searched for signs or symptoms of coronary atherosclerosis before it becomes symptomatic. Among these signs or risk factors are elevated plasma levels of total cholesterol or low-density lipoprotein cholesterol, or a reduced level of high-density lipoprotein cholesterol. Recent studies complement older epidemiologic, genetic, metabolic, morphologic, and animal data by demonstrating directly in humans the value of cholesterol change. These studies have shown that a reduction in total plasma cholesterol or in low-density lipoprotein cholesterol and/or an elevation in high-density lipoprotein cholesterol results in decreased development of angina, positive exercise test results, and referral for coronary artery bypass surgery, as well as reductions in more severe cardiovascular end points such as heart attack, heart death, and atherosclerotic plaque progression. In the Lipid Research Clinics Coronary Primary Prevention Trial with hypercholesterolemic men, every 1 percent reduction in plasma cholesterol levels was associated with a 2 percent reduction in coronary risk. Today, the issue is no longer whether a reduction in cholesterol levels is beneficial. The questions now are much more practical: whom to treat, when to treat, and how to treat. The potential public health value of reducing cholesterol levels is enormous. Such a reduction should be espoused by all health care professionals, because it promises a better and longer life for persons at risk for coronary artery disease.

Adolescent↗
PubMedDate not supplied

Hypertension in women.

Hypertension in women has received less attention than hypertension in men, and the major controlled trials of antihypertensive therapy have been carried out in populations made up predominantly of and have emphasised outcomes in men. Recently it has been recognised that women develop high blood pressure, particularly systolic hypertension, at an increased rate as they age, and that this age-related blood pressure increase is exaggerated by the menopause. The age-related rise in blood pressure, particularly systolic blood pressure and pulse pressure, contributes substantially to the age-related increase in risk of heart attack, heart failure, and stroke in middle-aged and elderly women. This article reviews aspects of hypertension epidemiology, pathophysiology, diagnosis and treatment that are important to women's health with particular emphasis on important concomitant cardiovascular disease risk factors such as type 2 diabetes and the menopause. The role of ovarian hormones and their withdrawal in the pathogenesis of hypertension and related target organ damage is considered, as are the results of drug treatment of high blood pressure in women. Blood pressure in pregnancy is discussed in a separate article by Broughton-Pipkin and Roberts.

Age Factors↗
PubMed1988

Diabetes mellitus: an independent risk factor for stroke?

Raised blood pressure is the strongest single risk factor for stroke in the general population. Diabetics are at increased risk of both hypertension and stroke. It is not clear if diabetes mellitus confers an excess risk of stroke that is independent of blood pressure. The authors examined the relation of diabetic status (personal history of diabetes and/or fasting plasma glucose greater than 7.8 mmol per liter) to stroke risk in a population-based cohort of 3,778 adults aged 50-79 years in Rancho Bernardo, California who were followed from 1972 for an average of 12 years. There were 232 stroke cases, 139 of which were ascertained from death certificates. Diabetics had higher mean systolic blood pressures, significantly so in females, and diabetics of both sexes were significantly more obese. Diabetics had greater univariate age-adjusted stroke mortality and morbidity rates than nondiabetics. The increased stroke rates were still apparent in diabetics after stratifying for systolic blood pressure. In multivariate analyses, the relative risks (RRs) for stroke mortality and morbidity associated with diabetes were not significantly changed in men (RR = 1.8) and women (RR = 2.2), after adjusting for the effect of risk factors including age, systolic blood pressure, cholesterol level, obesity, and smoking habits, and excluding persons with personal history of heart attack, heart failure, or stroke. These findings support the hypothesis that diabetes may confer excess risk of stroke independent of blood pressure.

Aged↗
PubMedDate not supplied

Inpatients' ratings of care in 5 common clinical conditions.

OBJECTIVE: Using the dimensions of patient-centered care defined by the Institute of Medicine, this study examined patient satisfaction within 5 clinical conditions. METHOD: Items from the Press Ganey Inpatient Questionnaire were mapped onto the Institute of Medicine dimensions of patient-centered care. A standardized mail-out/mail-back methodology was used to collect data from random samples of patients within 5 days of discharge. SAMPLE: Patients hospitalized for heart attack, heart failure, stroke, pneumonia, or childbirth were included in the study. The sample contained 10,000 patients at 210 hospitals. RESULTS: Patients hospitalized for different clinical conditions expressed different levels of satisfaction. There may be different care needs, expectations, and evaluations of care based on these clinical conditions. However, it is probable that an all-encompassing patient-centered focus would improve care for all of these groups. CONCLUSIONS: Quality improvement professionals should attend to 2 Institute of Medicine dimensions: (1) respect for patient's values, preferences, and expressed needs and (2) emotional support, relieving fear and anxiety. It is in these areas that improved performance will be associated with the greatest increases in patient satisfaction. Four specific issues were identified as quality improvement priorities, regardless of condition: response to complaints; sensitivity to the inconvenience of hospitalization; including patients in decision making; addressing emotional and spiritual needs.

Diagnosis-Related Groups↗