Slow gait speed and cardiac rehabilitation participation in older adults after acute myocardial infarction

Background Lack of participation in cardiac rehabilitation ( CR ) and slow gait speed have both been associated with poor long‐term outcomes in older adults after acute myocardial infarction ( AMI ). Whether the effect of CR participation on outcomes after AMI differs by gait speed is unknown. Methods and Results We examined the association between gait speed and CR participation at 1 month after discharge after AMI , and death and disability at 1 year, in 329 patients aged ≥65 years enrolled in the TRIUMPH (Translational Research Investigating Underlying Disparities in Recovery From Acute Myocardial Infarction: Patients' Health Status) registry. Among these patients, 177 (53.7%) had slow gait speed (&lt;0.8 m/s) and 109 (33.1%) participated in CR . Patients with slow gait speed were less likely to participate in CR compared with patients with normal gait speed (27.1% versus 40.1%; P =0.012). In unadjusted analysis, CR participants with normal gait speed had the lowest rate of death or disability at 1 year (9.3%), compared with those with slow gait speed and no CR participation (43.2%). After adjustment for cardiovascular risk factors and cognitive impairment, both slow gait speed (odds ratio, 2.30; 95% confidence interval, 1.30–4.06) and non‐ CR participation (odds ratio, 2.34; 95 confidence interval, 1.22–4.48) were independently associated with death or disability at 1 year. The effect of CR on the primary outcome did not differ by gait speed ( P =0.70). Conclusions CR participation is associated with reduced risk for death or disability after AMI . The beneficial effect of CR participation does not differ by gait speed, suggesting that slow gait speed alone should not preclude referral to CR for older adults after AMI . </jats:sec

Acute coronary syndrome in the older adults

Coronary heart disease remains the leading cause of death in the developed world. Advanced age is the single strongest risk factor for coronary artery disease (CAD) and independent predictor for poor outcomes following an acute coronary syndrome (ACS). ACS refers to a spectrum of conditions compatible with acute myocardial ischemia and/or infarction due to various degrees of reduction in coronary blood flow as a result of plaque rupture/erosion and thrombosis formation or supply and demand mismatch. Unstable angina and non-ST segment elevation myocardial infarction are often continuous and clinically indistinguishable, collectively referred as non-ST elevation ACS (NSTE-ACS). An abrupt total occlusion of a coronary artery causing transmural myocardial ischemia/necrosis and displaying ST segment elevation or new left bundle branch block on a12-lead ECG leads to the diagnosis of ST segment elevation myocardial infarction (STEMI). NSTE-ACS and STEMI require acute cardiac care. Professional societies have established guidelines for high quality contemporary care for ACS patients, i.e., American Heart Association/American College of Cardiology guidelines for STEMI and NSTE-ACS, European Society of Cardiology guidelines for STEMI and NSTE-ACS, and the United Kingdom National Institute for Health and Care Excellence guidelines for STEMI and NSTE-ACS.[1]–[6] Implementation of evidence-based therapies has significantly decreased mortality and morbidities of ACS.[3],[7],[8] However, these advancements in ACS management have not equally improved outcomes for older adults. Vulnerable older patients continue to be at high risk of poor outcomes, are less likely to receive evidence based care, and have high mortality rates regardless of treatments given.[9],[10] These disparities and challenges in caring for ACS in older adults are well recognized.[11]–[13] This review summarizes the increasing burden and persistent unfavorable outcome of ACS in older adults, and discusses the clinical presentation, diagnosis and strategies for medical and invasive therapy

The use of electronic voting systems in large group lectures: Challenges and opportunities

We describe pedagogical, technical and operational issues associated with the introduction of an electronic voting system into large first-year undergraduate lectures. The rationale for doing so is to transform the lecture experience from a one-way transmission of information in to a two-way conversation between lecturer and students, mediated by the technology. We discuss some of the logistics involved, such as choice of handset, cost and siting within a lecture theatre as well as the aspects of pedagogy, such as the requirements of a good question for these interactive episodes. We present a number of possible use scenarios and evaluate student and staff experiences of the process

Stable ischemic heart disease in the older adults

Ischemic heart disease is caused by atherosclerotic and/or thrombotic obstruction of coronary arteries. Clinical spectrum of ischemic heart disease expands from asymptomatic atherosclerosis of coronary arteries to acute coronary syndromes (ACS) including unstable angina, acute myocardial infarction (non-ST elevation myocardial infarction and ST elevation myocardial infarction). Stable ischemic heart disease (SIHD) refers to patients with known or suspected SIHD who have no recent or acute changes in their symptomatic status, suggesting no active thrombotic process is underway. These patients include those with (1) recent-onset or stable angina or ischemic equivalent symptoms, such as dyspnea or arm pain with exertion; (2) post-ACS stabilized after revascularization or medical therapy; and (3) asymptomatic SIHD diagnosed by abnormal stress tests or imaging studies. This review summarizes clinical features and management of SIHD in the older adult. ACS in older adults is not considered in this review

C-reactive protein does not opsonize early apoptotic human neutrophils, but binds only membrane-permeable late apoptotic cells and has no effect on their phagocytosis by macrophages

BACKGROUND: It has been reported that C-reactive protein (CRP) binds both leukocyte FcγRIIA (CD32) and the plasma membrane of apoptotic cells. Since FcγRIIA becomes functionally enabled during neutrophil apoptosis, we sought to determine whether CRP bound to apoptotic neutrophils via FcγRIIA. METHODS: We prepared directly labelled CRP and demonstrated that it was essentially free of IgG. We looked for evidence of CRP binding to intact, membrane impermeable apoptotic human neutrophils and to FcγRIIA-transfected Jurkat cells. We examined the functional consequences of incubation with CRP upon phagocytosis of apoptotic cells by human monocyte-derived macrophages. RESULTS: We could not detect binding of purified soluble CRP to classical early apoptotic human neutrophils or to FcγRIIA-transfected Jurkat cells. In contrast, membrane-permeable late apoptotic neutrophils exhibited strong CRP binding, which comprised both Ca(2+)-dependent and heparin-inhibitable Ca(2+)-independent components. However, there was no effect of CRP binding upon phagocytosis of late apoptotic neutrophils by macrophages. CONCLUSION: Potential apoptotic cell opsonins such as CRP may bind only to intracellular structures in cells with leaky membranes that have progressed to a late stage of apoptosis

The agronomic performance and nutritional content of oat and barley varieties grown in a northern maritime environment depends on variety and growing conditions

Funding for this research came from the Scottish Government's Rural and Environment Science and Analytical Services Division (RESAS) through their support for this Strategic Partnership project. We are also grateful to Ingvar Andersson at Lantmännen SW Seed AB for supplying seed of the Scandinavian varieties for the trials each year and to the seed merchant William Shearer (Kirkwall) for importing it. We are indebted to Grietje Holtrop from Biomathematics and Statistics Scotland for her help with statistical analysis. Andy Beer (The Royal Zoological Society, Edinburgh) performed all NIRS analysis and Gill Campbell (Rowett Institute of Nutrition and Health) performed the mineral content analysis. The Centre for Sustainable Cropping platform is supported through Scottish Government Underpinning Capacity funding. The Agronomy Institute acknowledges support from the Northern Periphery and Arctic Programme's Northern Cereals project in preparing this publication.Peer reviewedPostprin

FAPRI 2005 World Agricultural Outlook Briefing Book

none available