Non-pharmacological management interventions for COPD: An overview of Cochrane systematic reviews

© 2013 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. This is the protocol for a review and there is no abstract. The objectives are as follows: To a) summarise the evidence, b) identify gaps in the evidence base and c) describe elements of non-pharmacological, non-surgical and non-device interventions for the management of COPD using a standardised taxonomy for disease management adapted from the American Heart Association (Krumholz 2006)

Not all systematic reviews are systematic: A meta-review of the quality of systematic reviews for non-invasive remote monitoring in heart failure

We carried out a critical appraisal and synthesis of the systematic reviews and meta-analyses of remote monitoring for heart failure. A comprehensive literature search identified 65 relevant publications from 3333 citations. Seventeen studies fulfilled the inclusion and exclusion criteria. Seven (41%) systematic reviews pooled results for meta-analysis. Eight (47%) considered all non-invasive remote monitoring strategies. Five (29%) focused on telemonitoring. Four (24%) included both non-invasive and invasive technologies. The reviews were appraised by two independent reviewers for their quality and risk of bias using the AMSTAR tool. According to the AMSTAR criteria, ten (58%) systematic reviews were of poor methodological quality. In the high quality reviews, the relative risk of mortality in patients who received remote monitoring ranged from 0.53 to 0.88. The high quality reviews also reported that remote monitoring reduced the relative risk of all-cause (0.52 to 0.96) and heart failure-related hospitalizations (0.72 to 0.79) and, as a consequence, healthcare costs. However, further research is required before considering widespread implementation of remote monitoring. The subset of the heart failure population that derives the most benefit from intensive monitoring, the best technology, and the optimum duration of monitoring, all need to be identified. © The Author(s) 2013

Cardiovascular disease in women: Implications for improving health outcomes

Objective: To collate data on women and cardiovascular disease in Australia and globally to inform public health campaigns and health care interventions. Design: Literature review. Results: •Women with acute coronary syndromes show consistently poorer outcomes than men, independent of comorbidity and management, despite less anatomical obstruction of coronary arteries and relatively preserved left ventricular function. Higher mortality and complication rates are best documented amongst younger women and those with ST-segment-elevation myocardial infarction.•Sex differences in atherogenesis and cardiovascular adaptation have been hypothesised, but not proven.•Atrial fibrillation carries a relatively greater risk of stroke in women than in men, and anticoagulation therapy is associated with higher risk of bleeding complications.•The degree of risk conferred by single cardiovascular risk factors and combinations of risk factors may differ between the sexes, and marked postmenopausal changes are seen in some risk factors.•Sociocultural factors, delays in seeking care and differences in self-management behaviours may contribute to poorer outcomes in women.•Differences in clinical management for women, including higher rates of misdiagnosis and less aggressive treatment, have been reported, but there is a lack of evidence to determine their effects on outcomes, especially in angina.•Although enrolment of women in randomised clinical trials has increased since the 1970s, women remain underrepresented in cardiovascular clinical trials. Conclusions: Improvement in the prevention and management of CVD in women will require a deeper understanding of women's needs by the community, health care professionals, researchers and government. © 2011 Royal College of Nursing, Australia

Sex differences in dietary consumption and its association with frailty among middle-aged and older Australians: a 10-year longitudinal survey

Background Nutritional status has been considered as a key factor in preventing the development of the frailty syndrome. However, sex-specific dietary consumption transition over time and how it impacts of frailty status are unclear. Method We assessed 113,039 adults (aged 50 years and over) from the 45 and Up Study who had completed both baseline (2006–2009) and follow-up (2012–2015) surveys. Dietary consumption was assessed by a short food frequency questionnaire. Frailty was identified by the FRAIL scale. Multinomial regression models were used to examine the association between a long-term dietary consumption and frailty, stratified by sex. Results Of a total of 113,039 participants, females had a higher percentage of pre-frailty and frailty than males (pre-frailty: 35.5% for female and 30.1% for male; frailty: 4.86% for female and 3.56% for male). As age increased, males had significant decreases in overall dietary risk scores, while females had significant increases in overall dietary risk scores. Males and females with a long-term consumption of adequate fruits, high grains or had a variety of foods were related to a low risk of frailty. Females with a long-term consumption of adequate vegetables or high lean meats and poultry were related to a low risk of frailty. Females with an unhealthy diet at both surveys [Relative Risk Ratio (RRR) = 1.32, 95% CI: 1.18; 1.49], and those with unhealthy diet at either surveys (RRR = 1.28, 95% CI: 1.12; 1.47, RRR = 1.19, 95% CI: 1.04; 1.37) had a higher risk of frailty compared to those had a long-term healthy diet. No association were found between overall dietary risk and frailty for males. Conclusion Males and females changed their dietary consumption as they age. These changes affect its association with frailty, particularly for females. Sex-specific dietary advice in prevention of frailty needs to be further developed

Predictors of health-related quality of life in korean patients with myocardial infarction: a longitudinal observational study

© 2018 Elsevier Inc. Background: Experience of myocardial infarction (MI) negatively affects different aspects of health-related quality of life (HRQoL). Objectives: This study aimed to examine trends in HRQoL of MI patients and to identify demographic, clinical and psychosocial predictors of HRQoL at three months. Methods: A total of 150 patients in South Korea were completed the study questionnaires at baseline. After three months from discharge, 136 participants completed follow-up questionnaires, including the Korean version of the MacNew Quality of Life after Myocardial Infarction Questionnaire (MacNew). Results: HRQoL significantly improved over three months. Younger age, ST-elevation MI, and higher LVEF, lower level of depression, better understanding of the illness and higher perceived social support at baseline were associated with better HRQoL at three months. Conclusion: Providing adequate information about the illness and social support as well as reducing negative psychological experiences in early days after MI may improve HRQoL of MI patients

Correlates of health-related quality of life in patients with myocardial infarction: A literature review

© 2017 Elsevier Ltd Background By the increasing emphasis on health-related quality of life (HRQoL) in patients with myocardial infarction (MI), it is necessary to explore factors that affect HRQoL in this population. Objectives This study aimed to identify correlates of HRQoL in patients with MI. Design A literature review of the factors that affect HRQoL in patients with MI (1995–2016). Data sources Three main databases—CINAHL, MEDLINE and PsychINFO—were searched to retrieve relevant peer-reviewed articles published in English. Review methods In consultation with a medical librarian, we identified relevant MeSH terms and used them for searching the literature: health-related quality of life/quality of life/HRQoL/QoL, myocardial infarction/heart attack/MI and predict*/factor. Data elements were extracted and narratively described variables synthesised into four categories. Results A total of 48 studies met the inclusion criteria and were included in the review. Correlates of HRQoL in patients with MI were identified in the following categories: demographic, behavioural, disease-related, and psychosocial factors. Specific correlates included age and gender-identity for demographic factors; physical activity and smoking for behavioural factors; severity of MI, symptoms, and comorbidities for disease-related factors; anxiety and depression for psychosocial factors. Conclusions Identifying correlates of HRQoL can help identify patients who are at risk for poor HRQoL in the recovery or rehabilitation stage of post-MI. Future intervention should focus on adjustable correlates such as behavioural and psychosocial factors to promote HRQoL among patients after experiencing MI

Implantable device monitoring versus usual care for managing individuals with heart failure

© 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of using implantable device monitoring as an additional management tool for individuals with heart failure, compared with usual care alone

Effectiveness of Direct Oral Anticoagulants in Obese Adults With Atrial Fibrillation: A Systematic Review of Systematic Reviews and Meta-Analysis.

Background: Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia. Obesity is an independent risk factor for AF. Anticoagulants have been strongly recommended by all international guidelines to prevent stroke. However, altered pathophysiology in obese adults may influence anticoagulant pharmacology. Direct oral anticoagulants (DOACs) in the context of obesity and AF have been examined in recent systematic reviews. Despite the similarities in included studies, their results and conclusions do not agree. Methods and Results: The protocol for this review was registered with PROSPERO (CRD42020181510). Seven key electronic databases were searched using search terms such as "atrial fibrillation," "obese,*" "overweight," "novel oral anticoagulant," "direct oral anticoagulant," "DOAC," "NOAC," "apixaban," dabigatran," "rivaroxaban," and "edoxaban" to locate published and unpublished studies. Only systematic reviews with meta-analyses that examined the effect of DOACs in overweight or obese adults with AF, published in the English language, were included. A total of 9,547 articles were initially retrieved. After removing the duplicates, title and abstract review and full-text review, five articles were included in the systematic review. From these only RCTs were included in the meta-analyses. There was disagreement within the published systematic reviews on DOACs in obesity. The results from our meta-analysis did not show any significant difference between all body mass index (BMI) groups for all outcomes at both 12 months and for the entire trial duration. Non-significant differences were seen among the different types of DOACs. Conclusion: There was no difference between the BMI classes in any of the outcomes assessed. This may be due to the limited number of people in the trial that were in the obese class, especially obese class III. There is a need for large prospective trials to confirm which DOACs are safe and efficacious in the obese class III adults and at which dose

Atrial fibrillation and thromboprophylaxis in heart failure: The need for patient-centered approaches to address adherence

Atrial fibrillation is a common arrhythmia in heart failure and a risk factor for stroke. Risk assessment tools can assist clinicians with decision making in the allocation of thromboprophylaxis. This review provides an overview of current validated risk assessment tools for atrial fibrillation and emphasizes the importance of tailoring individual risk and the importance of weighing the benefits of treatment. Further, this review provides details of innovative and patient-centered methods for ensuring optimal adherence to prescribed therapy. Prior to initiating oral anticoagulant therapy, a comprehensive risk assessment should include evaluation of associated cardiogeriatric conditions, potential for adherence to prescribed therapy, frailty, and functional and cognitive ability. © 2013 Ferguson et al, publisher and licensee Dove Medical Press Ltd