Failure of Guideline Adherence for Intervention in Patients With Severe Mitral Regurgitation

ObjectivesThis study sought to evaluate the incidence with which adult patients with significant mitral regurgitation (MR) do not undergo surgical intervention despite guideline recommendations, and the associated considerations resulting in no intervention.BackgroundDespite the existence of accepted guidelines, many patients with severe symptomatic heart valve disease might not undergo intervention.MethodsAt a single large tertiary medical center, patients were retrospectively identified who had moderate-to-severe or severe MR on echocardiographic imaging during 2005. Clinical data were reviewed to determine indications for intervention and whether surgery was performed.ResultsDuring 2005, 300 patients were identified with significant MR, including 188 with functional MR and 112 with organic MR. Mitral surgery was performed in 30 of 188 patients with functional MR, mostly to treat heart failure or during another cardiac surgical procedure. Mitral surgery was performed in 59 (53%) of 112 patients with organic MR. Among unoperated patients with organic MR, common reasons included stable left ventricular size or function, absence of symptoms, and prohibitive comorbidities. Using American College of Cardiology/American Heart Association guidelines, 1 or more indication for intervention was present in 39 (74%) of 53 unoperated patients. Perioperative mortality risk was not higher for patients who did not undergo surgery (median 1.2%, interquartile range [IQR] 0.4% to 3.3%) than for those who did (median 1.1%, IQR 0.6% to 5.3%; p = 0.71). During follow-up, there were 12 cardiac and 2 unexplained deaths.ConclusionsAmong patients with severe organic MR, surgical intervention occurred in approximately one-half. However, accepted guideline indications for intervention were present in the majority of unoperated patients. Objectively assessed operative risk was not prohibitive in many unoperated patients

Changes in the drylands of Eastern Africa: a review of evidence and data and their implications for efforts to strengthening resilience

Includes Final report, March 2016Changes in the drylands of eastern Africa These reports detail evidence and data of long-term changes in the drylands of eastern Africa and the implications of these for efforts to strengthen resilience within pastoral systems. The region covered includes Ethiopia, South Sudan, Uganda, Kenya, and Somalia. The reports were prepared for a study commissioned by the DFID East Africa Research Hub, and its aims were three-fold: 1. To synthesise evidence across scholarly and available materials on poverty, vulnerability, livelihoods and change in eastern Africa’s drylands; 2. To catalogue national and sub-national datasets on poverty, vulnerability, livelihoods and resilience; and 3. To identify and report on priority, long-term evidence-gaps as well as recommendations on future research and data collection. Led by Dr. Jeremy Lind and Professor Rachel Sabates-Wheeler, the studies are based on a review of over 400 scholarly and grey literature reports, as well as assessment of over 100 data-sets from the region. The main report details the overall findings of the evidence synthesis and mapping of data-sets. A technical note provides in-depth findings of the evidence synthesis and data mapping exercise as well as the methodology that was used. The technical note can be read alongside a catalogue of the evidence that was reviewed and data-sets. A case study report assesses evidence and data of long-term change in five pastoral systems in the region: the Somali zone of Ethiopia, the Borana Plateau in southern Ethiopia, the South Rift Valley in Kenya, the Karamoja region of Uganda, and Bahr al Ghazal in South Sudan.Dfi

A randomized trial of a mobile health intervention to augment cardiac rehabilitation

Abstract Mobile health (mHealth) interventions may enhance positive health behaviors, but randomized trials evaluating their efficacy are uncommon. Our goal was to determine if a mHealth intervention augmented and extended benefits of center-based cardiac rehabilitation (CR) for physical activity levels at 6-months. We delivered a randomized clinical trial to low and moderate risk patients with a compatible smartphone enrolled in CR at two health systems. All participants received a compatible smartwatch and usual CR care. Intervention participants received a mHealth intervention that included a just-in-time-adaptive intervention (JITAI) as text messages. The primary outcome was change in remote 6-minute walk distance at 6-months stratified by device type. Here we report the results for 220 participants enrolled in the study (mean [SD]: age 59.6 [10.6] years; 67 [30.5%] women). For our primary outcome at 6 months, there is no significant difference in the change in 6 min walk distance across smartwatch types (Intervention versus control: +31.1 meters Apple Watch, −7.4 meters Fitbit; p = 0.28). Secondary outcomes show no difference in mean step counts between the first and final weeks of the study, but a change in 6 min walk distance at 3 months for Fitbit users. Amongst patients enrolled in center-based CR, a mHealth intervention did not improve 6-month outcomes but suggested differences at 3 months in some users

A randomized trial of a mobile health intervention to augment cardiac rehabilitation.

Mobile health (mHealth) interventions may enhance positive health behaviors, but randomized trials evaluating their efficacy are uncommon. Our goal was to determine if a mHealth intervention augmented and extended benefits of center-based cardiac rehabilitation (CR) for physical activity levels at 6-months. We delivered a randomized clinical trial to low and moderate risk patients with a compatible smartphone enrolled in CR at two health systems. All participants received a compatible smartwatch and usual CR care. Intervention participants received a mHealth intervention that included a just-in-time-adaptive intervention (JITAI) as text messages. The primary outcome was change in remote 6-minute walk distance at 6-months stratified by device type. Here we report the results for 220 participants enrolled in the study (mean [SD]: age 59.6 [10.6] years; 67 [30.5%] women). For our primary outcome at 6 months, there is no significant difference in the change in 6 min walk distance across smartwatch types (Intervention versus control: +31.1 meters Apple Watch, -7.4 meters Fitbit; p = 0.28). Secondary outcomes show no difference in mean step counts between the first and final weeks of the study, but a change in 6 min walk distance at 3 months for Fitbit users. Amongst patients enrolled in center-based CR, a mHealth intervention did not improve 6-month outcomes but suggested differences at 3 months in some users