Baseline characteristics of patients in the reduction of events with darbepoetin alfa in heart failure trial (RED-HF)

<p>Aims: This report describes the baseline characteristics of patients in the Reduction of Events with Darbepoetin alfa in Heart Failure trial (RED-HF) which is testing the hypothesis that anaemia correction with darbepoetin alfa will reduce the composite endpoint of death from any cause or hospital admission for worsening heart failure, and improve other outcomes.</p> <p>Methods and results: Key demographic, clinical, and laboratory findings, along with baseline treatment, are reported and compared with those of patients in other recent clinical trials in heart failure. Compared with other recent trials, RED-HF enrolled more elderly [mean age 70 (SD 11.4) years], female (41%), and black (9%) patients. RED-HF patients more often had diabetes (46%) and renal impairment (72% had an estimated glomerular filtration rate <60 mL/min/1.73 m2). Patients in RED-HF had heart failure of longer duration [5.3 (5.4) years], worse NYHA class (35% II, 63% III, and 2% IV), and more signs of congestion. Mean EF was 30% (6.8%). RED-HF patients were well treated at randomization, and pharmacological therapy at baseline was broadly similar to that of other recent trials, taking account of study-specific inclusion/exclusion criteria. Median (interquartile range) haemoglobin at baseline was 112 (106–117) g/L.</p> <p>Conclusion: The anaemic patients enrolled in RED-HF were older, moderately to markedly symptomatic, and had extensive co-morbidity.</p&gt

Problems of anticoagulant therapy in elderly cancer patients with atrial fibrillation and hemorrhagic stroke

The problems of antithrombotic and first of all, anticoagulant therapy in patients with concomitant oncological and cardiovascular pathology, especially in gerontological practice, remain to be unsolved. The need to use anticoagulants is dictated by a high risk of thromboembolism in cancer patients combined with age-associated atrial fibrillation. The risk of hemorrhage increases with the age; moreover, there is a risk of dangerous drug interactions due to the need of polymorbid pathology treatment. Thus, the clinical situation sometimes creates difficulties in choosing a proper tactic in patient management and following the existing treatment standards. A clinical case of a patient of an elder age with the recurrence of lung cancer, which has an established high-risk of thromboembolism, and with paroxysmal form of atrial fibrillation and new oral anticoagulants treatment, is considered

Cardioncology in Russia: Start-Off and Prospects

The progress in improving the survival of cancer patients in Russia, as well as throughout the world, means that in the next years it is going to be an increase in the number of disabled people who has achieved remission, or who faces the consequences of high-dose polychemotherapy and/or radiotherapy between courses of cancer treatment. Until recently, the two main socially significant medical problems in Russia, cancer and cardiac, have been rarely united into one. Publications on this topic appeared only in specialized cancer journals and were unknown by a wide range of cardiologists and internists, therefore the involvement of these specialists in the study of theoretical and practical aspects of the management of patients with malignant tumors was limited. Creation of the International Society of Cardioncology (ICOS) contributed to the development of an interest in this interdisciplinary field of modern medicine. However, even today cardiac problems of cancer patients in Russia mostly are limited to the cardiotoxicity studying, but, according to the position of the authors a great attention should be paid to the systemic reactions, including cardiovascular reactions of the organism to the tumor, as well as to the therapeutic issues and cardiac rehabilitation of cancer patients

Therapeutic rehabilitation of cancer patients. Why and what for?

Types of oncological rehabilitation and its objectives are described. It includes information on many manifestations of oncological diseases that an internist has to deal with, which are conditioned not only by the oncological process itself, but by the cancer treatment conducted, as well as the attitude of doctors and patients to cancer pathology. The specific characteristics of the “cancer disease” are described, as well as a combination of somatic disorders which depends on the ongoing or arrested tumor development. It is necessary for doctors to observe the cancer patients before, during and after treatment for complication of cancer or treatment over the life span

Remote consequences of polychemical and radiation therapy: cardiac valve disease complicated by infective endocarditis. Diagnostic and management problems

One of the quite frequent long-term effects of radiation therapy of malignant tumors, such as breast cancer and Hodgkin’s lymphoma primarily, when the irradiation of the mediastinum is performed, is the development of radiation-induced valvular disease. It is noted that the clinical manifestation of valve dysfunction can typically arise approximately 5 years after a course of anticancer radiotherapy. Thereafter in these patients increases the risk of infective endocarditis. However, in therapeutic and oncological clinical practice the difficulty of identifying and making the differential diagnosis of endocarditis in patients with “cancer” history is still quite common. At the moment cases of infective endocarditis after polychemotherapy and radiation therapy are not widely covered for cardiologists and internists in the medical literature. In addition before starting specific treatment due to the possible threat of infectious complications, including endocarditis, in oncology guidelines it is recommended to patients to make a thorough oral cavity sanitation, while the internists are little aware of this need, both at the stage of antitumor therapy and at late period. Today, with the increasing number of patients who are healed or achieved long-term remission after the anticancer treatment, including elderly people, it is necessary to raise the awareness among internists about occurrence options of comorbid disease in these group

Organization of rehabilitation programs for cancer patients based on an interdisciplinary approach

Purpose. To improve the technology of cancer patients' rehabilitation in the multidisciplinary hospital using an interdisciplinary approach at the stages of combined treatment of malignant tumors.Patients and methods. The analysis of 845 cases of admission of cancer patients in a multidisciplinary clinic for oncological rehabilitation, including treatment of complications and co morbid diseases, diagnosis and palliative care, on the specialized treatment stages was made. Based on the diagnosis, clinical status, determination of the clinical potential of these patients the need in medical rehabilitation of cancer patients based on the principles of an interdisciplinary approach was established.Results. A low commitment of oncologists to refer patients to multidisciplinary hospitals for supporting general medical treatment programs, which involve the work of multidisciplinary rehabilitation teams, especially at the initial stages of cancer, was revealed. In 94.1% of cases, based on oncologists' recommendation patients were presented to the multidisciplinary hospital only in the advanced stage of malignant disease. However, 64.8% of patients who came only for the purpose of "hospice" or palliative care treatment were able to continue their anticancer treatment. In 4.9% of cases among patients, who were referred for palliative care, the severity of their condition was mistakenly regarded as a relapse of cancer, whereas it was caused by comorbid pathology.The low interest of cancer patients in rehabilitation programs in the absence of recommendations from oncologists was revealed. It was shown that supportive therapy based on the principles of interdisciplinary approach is not only needed for patients with far-ongoing manifestations of cancer process, but also for patients with stage I-II of cancer, since even at this stage various complications of cancer disease, the consequences of its treatment and also manifestations of a combined pathology are often encountered.Conclusion. A classification of medical problems of cancer patients was proposed. Based on the newly developed methodology, the algorithm of personified rehabilitation support programs of oncological patients' and guidelines for managing patients at the stages of specialized and rehabilitative treatment using principles of an interdisciplinary approach, were created