6 research outputs found
Czy jest miejsce na terapi臋 inhibitorami fosfodiesterazy typu 5 u chorych z niewydolno艣ci膮 serca?
20-letnia pacjentka z mnogimi powik艂aniami zakrzepowo-zatorowymi
We report a case of young female with remittent bilateral pulmonary embolism and thrombus in the right ventricle, who聽required highly specialized treatment. The coexistence of right heart thrombus with pulmonary thromboembolism is聽uncommon; however, significantly worsens patients prognosis. Treatment is still controversial.Przedstawiono przypadek m艂odej kobiety z nawracaj膮c膮 obustronn膮 zatorowo艣ci膮 p艂ucn膮 i skrzeplin膮 w prawej komorze聽serca, kt贸ra wymaga艂a wysokospecjalistycznego leczenia. Wsp贸艂istnienie skrzepliny w prawym sercu i ostrej zatorowo艣ci聽p艂ucnej jest rzadko艣ci膮, jednak istotnie pogarsza rokowanie pacjent贸w. Leczenie nadal budzi kontrowersje
Ocena wp艂ywu sildenafilu na parametry hemodynamiczne kr膮偶enia p艂ucnego i wydolno艣膰 fizyczn膮 u chorych z przewlek艂膮 skurczow膮 niewydolno艣ci膮 serca z towarzysz膮cym ci臋偶kim wt贸rnym nadci艣nieniem p艂ucnym
Predicting survival in out-of-hospital cardiac arrest patients undergoing targeted temperature management: The Polish Hypothermia Registry Risk Score
Background: Prompt reperfusion and post-resuscitation care, including targeted temperature management(TTM), improve survival in out-of-hospital cardiac arrest (OHCA) patients. To predict inhospital mortality in OHCA patients treated with TTM, the Polish Hypothermia Registry Risk Score (PHR-RS) was developed. The use of dedicated risk stratification tools may support treatment decisions.Methods: Three hundred seventy-six OHCA patients who underwent TTM between 2012 and 2016 were retrospectively analysed and whose data were collected in the Polish Hypothermia Registry. A multivariatelogistic regression model identified a set of predictors of in-hospital mortality that were used to develop a dedicated risk prediction model, which was tested for accuracy.Results: The mean age of the studied population was 59.2 卤 12.9 years. 80% of patients were male, 73.8% had shockable rhythms, and mean time from cardiac arrest (CA) to cardiopulmonary resuscitation (CPR) was 7.2 卤 8.6 min. The inputs for PHR-RS were patient age and score according to the Mild Therapeutic Hypothermia (MTH) Scale. Criteria for the MTH score consisted of time from CA to CPR above 10 min, time from CA to the return of spontaneous circulation above 20 min, in-hospital CA, unwitnessed CA, and non-shockable rhythm, each counted as 1 point. The predictive value of PHR-RS was expressed as an area under the curve of 0.74.Conclusions: PHR-RS is one of the simplest and easiest models to use and enables a reliable prediction of in-hospital mortality in OHCA patients treated with TTM
Czy prewencja udar贸w u chorych z migotaniem przedsionk贸w w Polsce jest por贸wnywalna z innymi krajami Europy? Dane z rejestru GARFIELD-AF
Background: Atrial fibrillation (AF) is the most common clinically-significant arrhythmia in the adult population, and it is a strong independent risk factor for cerebrovascular accidents. Patients with non-valvular AF are five times more likely to suffer a stroke. Despite the clear recommendations for anticoagulant therapy, many clinicians are still reluctant to provide routine oral anticoagulation to patients with AF, despite the potential clinical benefits.
Aim: To compare Polish and European populations of patients with AF and the every-day practice of stroke prevention in Poland and in the rest of Europe.
Methods: We analysed the baseline data from the two first cohorts of patients enrolled in the GARFIELD-AF registry (an ongo颅ing prospective, multicentre, international registry of patients newly diagnosed with AF) in Poland and in the rest of Europe.
Results: Polish AF patients are generally younger (median age 67 years in both cohorts vs. 73 in cohort 1 in the rest of Eu颅rope and 72 in cohort 2), but they carry a burden of more concomitant diseases. There are some noticeable differences in stroke prevention between Poland and the rest of Europe. The use of vitamin K antagonists (VKAs) is generally higher in other European countries in both cohorts (in Poland 41.7% in cohort 1 and 36.9% in cohort 2 vs. 55.5% in cohort 1 and 41.9% in cohort 2 in the rest of Europe). Meanwhile, it is generally more common in Poland to treat patients with both VKAs and antiplatelets (in cohort 1 20.4% of patients in Poland received vs. 12.0% in the rest of Europe). A total of 5.6% of patients in cohort 1 in Poland receive no antithrombotic treatment (it means: no VKA, oral factor Xa or thrombin inhibitors, antiplate颅lets), meanwhile in other countries it amounts to 8.5%. The usage of non-vitamin K oral anticoagulants is growing in Poland similarly to the other European countries.
Conclusions: The GARFIELD-AF registry data shows how distant everyday clinical practice is from the guidelines. It shows that still in Poland, as well as in the rest of Europe, too many patients with low stroke risk are treated with anticoagulants, while too frequently patients at high stroke risk are left with no stroke prevention. Although the tendency to use non-vitamin K oral anticoagulants is growing comparably in Poland and in the rest of Europe, the proportion of patients with intermediate and high stroke risk is not growing and more patients at low stroke risk are treated with anticoagulants.
聽Wst臋p: Migotanie przedsionk贸w (AF) jest najcz臋艣ciej wyst臋puj膮c膮 istotn膮 klinicznie arytmi膮 w populacji doros艂ych i stanowi silny niezale偶ny czynnik ryzyka zdarze艅 sercowo-naczyniowych. Pacjenci z niezastawkowym AF s膮 5-krotnie bardziej na颅ra偶eni na wyst膮pienie udaru niedokrwiennego. Mimo jasnych rekomendacji dotycz膮cych leczenia przeciwzakrzepowego wielu lekarzy wci膮偶 nie stosuje rutynowo tej terapii u pacjent贸w z AF, mimo potencjalnych korzy艣ci klinicznych tego leczenia.
Cel: Celem niniejszej pracy by艂o por贸wnanie polskiej populacji pacjent贸w z AF z populacj膮 chorych z AF w pozosta艂ych krajach europejskich oraz por贸wnanie codziennej praktyki profilaktyki udar贸w w Polsce i innych krajach Europy.
Metody: GARFIELD-AF jest trwaj膮cym prospektywnym, wieloo艣rodkowym, mi臋dzynarodowym rejestrem pacjent贸w z nowo rozpoznanym AF. Analizuje si臋 w nim dane wyj艣ciowe dw贸ch pierwszych kohort pacjent贸w w艂膮czonych do badania w Polsce i w pozosta艂ych krajach Europy.
Wyniki: Polscy pacjenci z AF s膮 m艂odsi ni偶 pacjenci z AF w pozosta艂ych krajach Europy (mediana wieku 67 lat w obu kohor颅tach w Polsce vs. 73 lat w kohorcie 1 i 72 lat w kohorcie 2 w pozosta艂ych krajach Europy), ale s膮 cz臋艣ciej obci膮偶eni licznymi chorobami towarzysz膮cymi. Zauwa偶alne s膮 r贸偶nice w profilaktyce udar贸w mi臋dzy Polsk膮 a pozosta艂ymi krajami europejskimi. Cz臋sto艣膰 stosowania antagonist贸w witaminy K (VKA) jest generalnie wy偶sza w pozosta艂ych krajach Europy w obu kohortach (w Polsce 41,7% w kohorcie 1 i 36,9% w kohorcie 2 vs. 55,5% w kohorcie 1 i 41,9% w kohorcie 2 w pozosta艂ych krajach Europy). Jednocze艣nie 艂膮czona terapia VKA i lekami przeciwp艂ytkowymi jest stosowana cz臋艣ciej w Polsce (20,4% w kohorcie 1 w Polsce vs. 12,0% w pozosta艂ych krajach Europy). 5,6% pacjent贸w w kohorcie 1 w Polsce nie jest poddanych 偶adnej terapii przeciwzakrzepowej (tzn. nie otrzymuje VKA, doustnych inhibitor贸w czynnika Xa lub trombiny ani lek贸w przeciwp艂ytkowych), natomiast w pozosta艂ych krajach Europy 8,5% pacjent贸w nie stosuje takiego leczenia. Cz臋sto艣膰 przyjmowania doustnych antykoagulant贸w nieb臋d膮cych antagonistami witaminy K ro艣nie w Polsce por贸wnywalnie z ich wykorzystaniem w pozosta艂ych krajach Europy.
Wnioski: Dotychczasowe wyniki rejestru GARFIELD-AF jednoznacznie wskazuj膮, jak daleka od wytycznych jest codzienna prak颅tyka kliniczna dotycz膮ca profilaktyki udar贸w u chorych z AF. Zar贸wno w Polsce, jak i w pozosta艂ych krajach europejskich zbyt wielu pacjent贸w z niskim ryzykiem udaru jest leczonych przeciwzakrzepowo, podczas gdy zbyt rzadko pacjenci z najwy偶szych grup ryzyka s膮 obj臋ci w艂a艣ciw膮 profilaktyk膮 udaru. Mimo 偶e stosowanie doustnych antykoagulant贸w nieb臋d膮cych antagonistami witaminy K ro艣nie zar贸wno w Polsce, jak i w pozosta艂ych krajach europejskich, nie ro艣nie grupa chorych wysokiego ryzyka obj臋tych profilaktyk膮 przeciwzakrzepow膮, zwi臋ksza si臋 natomiast odsetek pacjent贸w z grupy niskiego ryzyka leczonych przeciwzakrzepowo
Results of targeted temperature management of patients after sudden out鈥憃f鈥慼ospital cardiac arrest: a comparison between intensive general and cardiac care units
Background: Targeted temperature management (TTM) is used to treat patients after sudden out鈥憃f鈥慼ospital cardiac arrest (OHCA).
Aims: The aim of the study was to compare the results of TTM between intensive general and cardiac care units (ICCUs).
Methods: The Polish Registry of Therapeutic Hypothermia obtained data on 377 patients with OHCA from 26 centers (257 and 120 patients treated at the ICCU and intensive care unit [ICU], respectively). Eligibility for TTM was based on the current inclusion criteria for therapy. Medical history as well as data on TTM and additional treatment were analyzed. The main outcomes included in鈥慼ospital survival and complications as well as neurologic assessment using the Glasgow Coma Scale (GCS) and Rankin scale.
Results: Both ICU and ICCU patients were mostly male (mean age, 60 years). There were no significant differences regarding the medical history, mechanism of arrhythmia responsible for OHCA, GCS score on admission, time of cardiopulmonary resuscitation activities, and the time to target temperature (33掳C). Coronary angiography and the use of dual antiplatelet therapy, intra鈥慳ortic balloon pump, intravascular hypothermia, dopamine, and dobutamine were more common in ICCU patients, while ICU patients more often received norepinephrine. Pneumonia and acute renal failure were more frequent in the ICCU group. Death occurred in 17% and 20% of ICU and ICCU patients, respectively (P = 0.57). The Rankin class after 48 hours since discontinuation of sedation and at discharge was comparable between groups.
Conclusions: The ICCU has become a considerable alternative to the ICU to treat OHCA patients with TTM