Risk factors for post coronary artery bypass graft atrial fibrillation: role of obstructive sleep apnea

Resumen En este capítulo comenzamos analizando la cirugía de revascularización miocárdica y su complicación más frecuente, la fibrilación atrial postoperatoria. Analizamos los principales factores de riesgo para la fibrilación atrial postoperatoria y luego discutimos detalladamente la apnea obstructiva del sueño como factor riesgo. En este empeño, describimos cómo se diagnostica la apnea obstructiva del sueño, su pato-fisiología en relación con la fibrilación atrial postoperatoria y los estudios clínicos que recientemente han investigado la asociación entre la apnea obstructiva del sueño y fibrilación atrial postoperatoria. Concluimos con las estrategias de prevención y tratamiento de la fibrilación atrial postoperatoria y la discusión de futuras recomendaciones investigativas

Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Heart failure (HF) is the commonest cause of hospitalization in older adults. Compared to routine hospitalization (RH), hospital at home (HaH)—substitutive hospital-level care in the patient’s home—improves outcomes and reduces costs in patients with general medical conditions. The efficacy of HaH in HF is unknown.</p><p>Methods and Results</p><p>We searched MEDLINE, Embase, CINAHL, and CENTRAL, for publications from January 1990 to October 2014. We included prospective studies comparing substitutive models of hospitalization to RH in HF. At least 2 reviewers independently selected studies, abstracted data, and assessed quality. We meta-analyzed results from 3 RCTs (n = 203) and narratively synthesized results from 3 observational studies (n = 329). Study quality was modest. In RCTs, HaH increased time to first readmission (mean difference (MD) 14.13 days [95% CI 10.36 to 17.91]), and improved health-related quality of life (HrQOL) at both, 6 months (standardized MD (SMD) -0.31 [-0.45 to -0.18]) and 12 months (SMD -0.17 [-0.31 to -0.02]). In RCTs, HaH demonstrated a trend to decreased readmissions (risk ratio (RR) 0.68 [0.42 to 1.09]), and had no effect on all-cause mortality (RR 0.94 [0.67 to 1.32]). HaH decreased costs of index hospitalization in all RCTs. HaH reduced readmissions and emergency department visits per patient in all 3 observational studies.</p><p>Conclusions</p><p>In the context of a limited number of modest-quality studies, HaH appears to increase time to readmission, reduce index costs, and improve HrQOL among patients requiring hospital-level care for HF. Larger RCTs are necessary to assess the effect of HaH on readmissions, mortality, and long-term costs.</p></div

Hospital readmissions and emergency department visits per patient in substitutive versus inpatients in observational studies.

<p>Hospital readmissions and emergency department visits per patient in substitutive versus inpatients in observational studies.</p

Hospital readmissions and all-cause mortality for HaH compared with inpatients in randomized controlled trials.

<p>Hospital readmissions and all-cause mortality for HaH compared with inpatients in randomized controlled trials.</p

Characteristics of included studies.

<p>*Details in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0129282#pone.0129282.s010" target="_blank">S7 Table</a>; for risk of bias, numerator indicates the number of “low risk” categories as per the Cochrane tool (higher fractions have a lower risk of bias).</p><p>†Patients acted as their own controls.</p><p>‡NYHA class only reported for patients who died: 5 class IV, 4 class III, and one class II.</p><p>ACS = acute coronary syndrome; AF = atrial fibrillation; COPD = chronic obstructive pulmonary disease; DC = dilated cardiomyopathy; DM: diabetes mellitus; ECG = electrocardiogram; EF = ejection fraction; HaH = hospital at home; HC = hypertensive cardiopathy; HCE = hypercholesterolemia; HTN = hypertension; IHD = ischemic heart disease; IV = intravenous; NR = not reported; NYHA = New York Heart Association; OT = occupational therapy; PC = prospective cohort; PT = physical therapy; RC = restrictive cardiomyopathy; RCT = randomized controlled trial; RD = respiratory disease; RF = renal failure; RH = routine hospitalization; RI = respiratory infection; SD = standard deviation; VD = valve disease.</p><p>Characteristics of included studies.</p

Health-related quality of life for HaH compared with inpatients at 6- and 12-month follow-up in randomized controlled trials.

<p>Health-related quality of life for HaH compared with inpatients at 6- and 12-month follow-up in randomized controlled trials.</p

Summary of evidence search and selection.

<p>Summary of evidence search and selection.</p

Disease-modifying anti-rheumatic drugs for rheumatoid arthritis: A systematic review and network meta-analysis

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective is to compare the benefits and harms of different disease‐modifying anti‐rheumatic drugs (DMARDs) as initial therapy and after failure of conventional synthetic DMARDs or biologic or targeted synthetic DMARDs in adults with rheumatoid arthritis through a network meta‐analysis (NMA). A secondary objective is to rank the interventions for both benefits and harms. This protocol describes the approach for separate NMAs for the three populations of interest (described below), which we intend to publish as three separate Cochrane Reviews. 1) Disease‐modifying anti‐rheumatic drugs for rheumatoid arthritis as initial therapy: a systematic review and network meta‐analysis 2) Disease‐modifying anti‐rheumatic drugs for rheumatoid arthritis after failure of conventional synthetic disease‐modifying anti‐rheumatic drugs: a systematic review and network meta‐analysis 3) Disease‐modifying anti‐rheumatic drugs for rheumatoid arthritis after failure of biologic or targeted synthetic therapy: a systematic review and network meta‐analysi