Concordance for cardiovascular risk changes within families of patients with coronary disease participating in a preventive cardiology programme

Aims: To investigate concordance for lifestyle – smoking, diet and physical activity - between married couples when one has developed coronary disease, and concordance for lifestyle change over one year in a nurse-led, multidisciplinary, family centred, prevention programme across six countries. Methods: In the EUROACTION trial consecutive coronary patients were recruited from hospitals, with their partners, to this programme. Concordance for smoking, diet and physical activity, and cardiovascular risk factors, was investigated at the initial assessment, at 16 weeks and one year. Findings: 645 couples attended the initial assessment and 65% of couples returned at one year. At the time of the coronary event, there were nearly two times as many couples, than expected by chance, currently smoking. Couples were also concordant at baseline for saturated fat (r=0.41) fruit and vegetables (r=0.67) and for physical activity (r=0.25). With the exception of total cholesterol, cardiovascular risk factors in couples were all significantly correlated: body mass index (BMI) r=0.22; waist circumference (WC) r=0.12; systolic blood pressure (SBP) r=0.20; total cholesterol (TC) r=0.07; LDL-C r=0.13; HDL-C r=0.27 and fasting blood glucose (FBG) r=0.20 reflecting concordance for lifestyle. The smoking quit rate at one year was significantly higher at 74% in patients with a partner who was a non-smoker compared to 50% in patients with a partner who smoked (p=0.03). There was significant concordance for change at one year between patients and partners for: saturated fat r=0.43; fruit and vegetables r=0.61; physical activity r=0.40; BMI r=0.21; WC r=0.22; SBP r=0.13; TC r=0.21 and HDL-C r=0.34. Patients making the healthiest lifestyle changes were associated with partners making similarly healthy changes. Interpretation: Couples had an unhealthy concordant lifestyle at baseline but became healthier during the course of the preventive cardiology programme, with concordance for change between couples at both 16 weeks and one year. As couples are concordant for lifestyle, with observational evidence of concordance for change, we should focus on couples rather than patients alone

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

Peer reviewe

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Euroaction preventive cardiology programme plus intensive smoking cessation with varenicline

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2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).

Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate

2019 ESC guidelines for the dignosis and management of acute pulmonary embolism developed in collaboration with the european respiratory society (ERS)

Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate