Expert panel on cost analysis of atrial fibrillation

Objective: To estimate total cost of atrial fibrillation (AF) management concerning acute coronary syndrome, heart failure, stroke and drug related adverse events with respect to clinical practice and available guidelines. Methods: This cost analysis study was based on identification of total costs related to management of acute coronary syndrome, heart failure, stroke and the drug related adverse events in patients with AF based on standardized questionnaire forms filled by experts according to their daily clinical practice and also to ACCF/AHA/ESC guidelines. Total cost included cost items related to treatment, healthcare resources utilization, and diagnostic test and consultations. Results: The yearly cost of acute coronary syndrome per patient was 5.478.43 TL according to expert's view reflecting real clinical practice whereas it was 11.319.44 TL when calculation was based on recommendations in the guidelines. The average total cost of heart failure was 4.523.74 TL according to expert's view whereas it was 2.925.86 TL based on guidelines. The average total cost of stroke was 5.719.25 TL according to expert's view but 7.931.18 TL based on guidelines. Among drug related adverse events, only those related to cardiac adverse events were estimated to be higher according to expert view as compared to guideline recommendations (288.65 vs. 150.99 TL). Conclusions: Reflecting the treatment algorithms in the management of AF and related adverse events, our findings seem to emphasize the extra burden on health economics posed by patients suffering from the uncontrolled disease. (Anadolu Kardiyol Derg 2013; 13: 26-38

Effects of simvastatin only or in combination with continuous combined hormone replacement therapy on serum lipid levels in hypercholesterolaemic post-menopausal women

Aims To evaluate the effects of simvastatin only or combined with continuous hormone replacement therapy on the serum lipid profile in hypercholesterolaemic post-menopausal women. Methods and Results One hundred hypercholesterolaemic post-menopausal women were given either simvastatin 10 mg daily together with oestrogen 0.625 mg and medroxyprogesterone 2.5 mg daily (HRT + simvastatin group) (n:50) or simvastatin 10 mg daily (simvastatin only group) (n:50) in a prospective manner. Serum total, low density lipoprotein, and high density lipoprotein cholesterol and triglyceride levels were measured at baseline, at 3 and 6 months. The initial mean (+/- SD) cholesterol values were as follows for the HRT + simvastatin group and the simvastatin only group, respectively: total cholesterol 240.0 +/- 28.0 and 248.9 +/- 28.2 mg . dl(-1) ; low density lipoprotein cholesterol 174.7 +/- 25.6 and 175.1 +/- 25.9 mg . dl(-1); high density lipoprotein cholesterol 37.2 +/- 5.0 and 39.9 +/- 7.3 mg . dl(-1) Compared with the baseline, total and low density lipoprotein cholesterol levels decreased; and high density lipoprotein cholesterol levels increased significantly at 3 and 6 months in both groups. However, the mean percent reduction in total cholesterol and low density lipoprotein cholesterol was significantly greater in the HRT + simvastatin group compared with the simvastatin only group both at 3 months (12.3 +/- 7.0% vs 8.9 +/- 6.2%; P < 0.01; and 19.0 +/- 10.6% vs 13.2 +/- 10.4%; P < 0.005, respectively) and at 6 months (14.6 +/- 7.7% vs 11.3 +/- 7.4%; P < 0.05 and 23.3 +/- 9.7% vs 15.8 +/- 12.3%; P < 0.005, respectively). The mean percent increase in serum high density lipoprotein cholesterol concentrations was also significantly greater in the HRT + simvastatin group compared with the simvastatin only group at both times (14.6 +/- 11.8% vs 9.8 +/- 11.8%; P < 0.005, at 3 months, and 21.3 +/- 15.2% vs 11.1 +/- 12.5; P < 0.005, at 6 months, respectively). Furthermore, significantly more patients in the HRT + simvastatin group than in the simvastatin only group attained their target treatment goals dictated by the National Cholesterol Education Program Adult Treatment Panel II Guidelines. Although the mean percent decrease in triglyceride levels was significantly greater in the HRT + simvastatin group at 3 months, the significance disappeared at 6 months. Conclusion The combination of simvastatin and continuous combined hormone replacement therapy seems to be more effective than simvastatin only in the treatment of hypercholesterolaemia in post-menopausal women. (C) 2000 The European Society of Cardiology

Peripartum cardiomyopathy presenting with repetitive monomorphic ventricular tachycardia

GEMICI, G., ET AL.: Peripartum Cardiomyopathy with Repetitive Ventricular Tachycardia. A 30-year-old asymptomatic pregnant woman at 38 weeks' gestation was noticed to have repetitive monomorphic ventricular tachycardia. A dilated left ventricle with moderately reduced systolic function was found on echocardiographic examination. To the best of our knowledge, a case of peripartum cardiomyopathy presenting with repetitive monomorphic ventricular tachycardia has not been previously reported

QT dispersion increases during intubation in patients with coronary artery disease

Anesthetic drugs have been shown to increase QT interval, however data regarding their effects on QT dispersion (QTd) are scarce, especially in patients with Coronary artery disease (CAD). We tested whether induction of Anesthesia with thiopental and etomidate would increase QTd in patients with CAD. Thirty American Society of Anesthesiologists (ASA) physical status I-II patients without CAD were randomly allocated to groups I (n = 15) and II (n = 15) and 30 ASA physical status III patients with CAD were randomly allocated to groups III (n = 15) and IV (n=15). Anesthesia was induced with thiopental 5-7 mg/kg IV in groups I and III and with etomidate 0.2-0.3 mg/kg IV in groups H and IV. Endotracheal intubation was facilitated with vecuronium bromide 0.1 mg/kg IV. Twelve-lead electrocardiogram (ECG) was recorded in all patients at baseline (ECG(1)), 1 min after the induction agent (ECG(2)), 1 min (ECG,) and 5 min (ECG(4)) after intubation. Anesthesia was maintained with isoflurane and nitrous oxide in 34 % oxygen after ECG, recording. QTd and corrected QT dispersion (QTcd) were calculated. In patients with CAD induced with thiopental, QT dispersion increased significantly during the intubation period compared with baseline (from 43.0 +/- 25.6 ms to 69.2 +/- 25.3 ms; P < .01). Likewise, QT dispersion also increased during intubation in patients with CAD induced with etomidate (from 41.5 +/- 17.2 ms to 80.0 +/- 33.6 ms; P < .001). There was no increase in QT dispersion in patients without known CAD. QT dispersion seems to be increased during the intubation period in patients with CAD regardless of the induction agents used

Evaluation of websites reached using Google in the modern digital era related to approach to cholesterol

Objective: The Google search engine is widely used as a source of medical information; however, legal and medical governance of the accuracy of the content retrieved is lacking. The aim of this study was to assess the most read Turkish-language texts related to cholesterol during a specific period according to the validity of the content. Methods: Google Trends was queried on January 5, 2019 for the search term cholesterol and the 9 other most popular search phrases used in Turkey that included the word cholesterol. In all, 100 links were obtained for each phrase, generating a total of 1000 links. Once duplicates were eliminated, a total of 604 links was used for the study. Since there is currently no validation scoring system for this purpose in the literature, the authors created a checklist according to well-accepted recent guidelines focused on cholesterol. The content of the texts acquired was classified as misleading, insufficient but favorable, or sufficient and favorable. Results: The source of the online texts studied was universities (n=8, 1.3%), hospitals (n=6, 0.9%), personal blogs (n=200, 33.1%), health websites (n=183, 30.2%), and medical journals (n=207, 34.2%). In all, 235 texts (38.9%) were classified as sufficient and favorable and 35 (5.7%) were categorized as misleading. A medical practitioner was named in 378 texts (62.5%). All of the results from universities and hospitals were ranked in the favorable group. A statistical difference in the word count was seen in a comparison of the misleading and favorable texts. Conclusion: Google can connect users to a significant quantity of material related to cholesterol that includes a wide range from misleading information to sufficient and favorable texts. The variation in the quality of the content on websites accessible via Google necessitates that cholesterol resource material should be selected with great care