5 research outputs found

    Effect of aliskiren on post-discharge outcomes among diabetic and non-diabetic patients hospitalized for heart failure: insights from the ASTRONAUT trial

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    Aims The objective of the Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT) was to determine whether aliskiren, a direct renin inhibitor, would improve post-discharge outcomes in patients with hospitalization for heart failure (HHF) with reduced ejection fraction. Pre-specified subgroup analyses suggested potential heterogeneity in post-discharge outcomes with aliskiren in patients with and without baseline diabetes mellitus (DM). Methods and results ASTRONAUT included 953 patients without DM (aliskiren 489; placebo 464) and 662 patients with DM (aliskiren 319; placebo 343) (as reported by study investigators). Study endpoints included the first occurrence of cardiovascular death or HHF within 6 and 12 months, all-cause death within 6 and 12 months, and change from baseline in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 1, 6, and 12 months. Data regarding risk of hyperkalaemia, renal impairment, and hypotension, and changes in additional serum biomarkers were collected. The effect of aliskiren on cardiovascular death or HHF within 6 months (primary endpoint) did not significantly differ by baseline DM status (P = 0.08 for interaction), but reached statistical significance at 12 months (non-DM: HR: 0.80, 95% CI: 0.64-0.99; DM: HR: 1.16, 95% CI: 0.91-1.47; P = 0.03 for interaction). Risk of 12-month all-cause death with aliskiren significantly differed by the presence of baseline DM (non-DM: HR: 0.69, 95% CI: 0.50-0.94; DM: HR: 1.64, 95% CI: 1.15-2.33; P < 0.01 for interaction). Among non-diabetics, aliskiren significantly reduced NT-proBNP through 6 months and plasma troponin I and aldosterone through 12 months, as compared to placebo. Among diabetic patients, aliskiren reduced plasma troponin I and aldosterone relative to placebo through 1 month only. There was a trend towards differing risk of post-baseline potassium ≥6 mmol/L with aliskiren by underlying DM status (non-DM: HR: 1.17, 95% CI: 0.71-1.93; DM: HR: 2.39, 95% CI: 1.30-4.42; P = 0.07 for interaction). Conclusion This pre-specified subgroup analysis from the ASTRONAUT trial generates the hypothesis that the addition of aliskiren to standard HHF therapy in non-diabetic patients is generally well-tolerated and improves post-discharge outcomes and biomarker profiles. In contrast, diabetic patients receiving aliskiren appear to have worse post-discharge outcomes. Future prospective investigations are needed to confirm potential benefits of renin inhibition in a large cohort of HHF patients without D

    Simulasi Energi dan Keekonomian Sistem Pembangkit Listrik Tenaga Surya (PLTS) untuk Fungsi Peak Load Shaving pada Bangunan di Lingkungan Kampus ITB

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    Pada paper ini, dilakukan simulasi produksi energi dan keekonomian dari sistem PLTS terintegrasi dengan jaringan listrik yang merupakan bagian dari proyek instalasi sistem smart microgrid di bangunan Center for Advanced Sciences (CAS) ITB. Terdapat dua sistem PLTS yang dianalisis yaitu sistem PLTS 40 kWp tanpa baterai, dan sistem PLTS 10 kWp dengan baterai yang terhubung ke beban kritis. Kedua sistem PLTS tersebut dirancang dengan tujuan peak load shaving yang dapat meminimalisir adanya ketidakseimbangan antara produksi energi surya dan permintaan listrik. Kedua sistem dianalisis dengan metoda simulasi berdasarkan aspek energi dan ekonomi menggunakan perangkat lunak PVsyst dan Homer. Dari hasil simulasi sistem PLTS 40 kWp didapatkan nilai performance ratio (PR) sebesar 0,833, renewable fraction (RF) sebesar 18,73%, dan cost of energy (COE) sebesar Rp 1.251,85/kWh yang mana nilai PR dan COE telah memenuhi target bisnis: PR &gt; 0.8 dan COE &lt; Rp 1.467,28/kWh tetapi tidak memenuhi target RF &gt; 35%. Sementara dari hasil simulasi sistem PLTS 10 kWp didapatkan nilai PR sebesar 0,77, RF sebesar 44,38% hingga 52,19% pada rentang depth of discharge 20% - 80%, dan COE sebesar Rp 2.103/kWh hingga Rp 6.315/kWh pada rentang DoD 20% - 80% yang mana hanya nilai RF telah memenuhi target bisnis

    The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

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    © 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

    Prospective observational cohort study on grading the severity of postoperative complications in global surgery research