Myocardial fibrosis in stroke survivors

Stroke survivors are most likely to die of cardiac death, yet few undergo comprehensive cardiac assessment to look for reversible causes. Myocardial fibrosis (MF) is not only the hallmark of cardiomyopathy, but also a substrate for sudden cardiac death, ventricular tachyarrhythmia and heart failure. Procollagen carboxyl-terminal telopeptide (PICP) was found to be a marker of MF. The relationship between PICP and cardiac abnormalities in stroke survivors is unknown. We recently showed that MF in stroke survivors can be treated by spironolactone and amiloride in a randomised placebo-controlled cross-over study with reduction in PICP levels and QTc [1]

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Use of antidepressant medication following acquired brain injury: concise guidance

Depression is increasingly recognised as a common sequel to acquired brain injury and the use of antidepressant medication in this context has increased markedly over recent years. However, these drugs are not without side effects – some of them serious – and they should not be used without proper evaluation and monitoring. This set of concise guidance was developed jointly by the British Society of Rehabilitation Medicine, the British Geriatrics Society and the Royal College of Physicians, to guide clinicians working with people who have brain injury of any cause (ie stroke, trauma, anoxia, infection etc). The guidance covers (a) screening and assessment of depression in the context of brain injury, (b) issues to consider and discuss with the patient and their family before starting treatment, and (c) proper treatment planning and evaluation – including planned withdrawal at the end of treatment

Predictors of distress following an acute stroke: disability, control cognitions, and satisfaction with care

Whilst clinical predictors of distress following acute stroke have been identified (e.g., lesion site), this study hypothesised that greater prediction would be achieved by addressing individual differences in patients' cognitions (e.g., perceived control, satisfaction with care, recovery confidence) and coping responses. We examined these relationships in a longitudinal study of 71 survivors of acute stroke. Measures were collected at three time points: 10-20 days after the stroke, and one month and six months after hospital discharge. Stepwise multiple regression analyses were performed using only significant bivariate correlates and where the dependent variables were residualised scores which controlled for baseline levels of anxiety and depression. Satisfaction with treatment and confidence in recovery at one month predicted anxiety outcome at six months, and satisfaction with advice and confidence in recovery at one month predicted depression outcome at six months. These results offer tentative suggestions for interventions targeting patient cognitions and improving patient satisfaction.</p