Non-ischaemic cardiomyopathy, sudden death and implantable defibrillators: a review and meta-analysis

Objective: The recent Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) trial suggested that implantable cardioverter defibrillators (ICDs) do not reduce overall mortality in patients with non-ischaemic cardiomyopathy (NICM), despite reducing sudden cardiac death. We performed an updated meta-analysis to examine the impact of ICD therapy on mortality in NICM patients. Methods: A systematic search for studies that examined the effect of ICDs on outcomes in NICM was performed. Our analysis compared patients randomised to an ICD with those randomised to no ICD, and examined the endpoint of overall mortality. Results: Six primary prevention trials and two secondary prevention trials were identified that met the pre-specified search criteria. Using a fixed-effects model, analysis of primary prevention trials revealed a reduction in overall mortality with ICD therapy (RR 0.76, 95% CI 0.65 to 0.91). Conclusions: Although our updated meta-analysis demonstrates a survival benefit of ICD therapy, the effect is substantively weakened by the inclusion of the DANISH trial—which is both the largest and most recent of the analysed trials—indicating that the residual pooled benefit of ICDs may reflect the risk of sudden death in older trials which included patients treated sub-optimally by contemporary standards. As such, these data must be interpreted cautiously. The results of the DANISH trial emphasise that there is no ‘one size fits all’ indication for primary prevention ICDs in NICM patients, and clinicians must consider age and comorbidity on an individual basis when determining whether a defibrillator is appropriate

Who benefits from a defibrillator—balancing the risk of sudden versus non-sudden death

Purpose of Review: Treatment with a defibrillator can reduce the risk of sudden death by terminating ventricular arrhythmias. The identification of patient groups in whom this function reduces overall mortality is challenging. In this review, we summarise the evidence for who benefits from a defibrillator. Recent Findings: Recent evidence suggests that contemporary pharmacologic and non-defibrillator device therapies are altering the potential risks and benefits of a defibrillator. Summary: Who benefits from a defibrillator is determined by both the risk of sudden death and the competing risk of other, non-sudden causes of death. The balance of these risks is changing, which calls into question whether historic evidence for the use of defibrillators remains robust in the modern era

Decorrelation estimates for the eigenlevels of the discrete Anderson model in the localized regime

The purpose of the present work is to establish decorrelation estimates for the locally renormalized eigenvalues of the discrete Anderson model near two distinct energies inside the localization region. In dimension one, we prove these estimates at all energies. In higher dimensions, the energies are required to be sufficiently far apart from each other

Anticoagulation therapy in heart failure and sinus rhythm: a systematic review and meta-analysis

Objective: Heart failure is a prothrombotic state, and it has been hypothesised that thrombosis and embolism cause non-fatal and fatal events in heart failure and reduced ejection fraction (HFrEF). We sought to determine the effect of anticoagulant therapy on clinical outcomes in patients with HFrEF who are in sinus rhythm. Methods: We conducted an updated systematic review and meta-analysis to examine the effect of anticoagulation therapy in patients with HFrEF in sinus rhythm. Our analysis compared patients randomised to anticoagulant therapy with those randomised to antiplatelet therapy, placebo or control, and examined the endpoints of all-cause mortality, (re)hospitalisation for worsening heart failure, non-fatal myocardial infarction, non-fatal stroke of any aetiology and major haemorrhage. Results: Five trials were identified that met the prespecified search criteria. Compared with control therapy, anticoagulant treatment did not reduce all-cause mortality (risk ratio [RR] 0.99, 95% CI 0.90 to 1.08), (re)hospitalisation for heart failure (RR 0.97, 95% CI 0.82 to 1.13) or non-fatal myocardial infarction (RR 0.92, 95% CI 0.75 to 1.13). Anticoagulation did reduce the rate of non-fatal stroke (RR 0.63, 95% CI 0.49 to 0.81, p=0.001), but this was offset by an increase in the incidence of major haemorrhage (RR 1.88, 95% CI 1.49 to 2.38, p=0.001). Conclusions: Our meta-analysis provides evidence to oppose the hypothesis that thrombosis or embolism plays an important role in the morbidity and mortality associated with HFrEF, with the exception of stroke-related morbidity

Temporal trends and risk factors for readmission for infections, gastrointestinal and immobility complications after an incident hospitalisation for stroke in Scotland between 1997 and 2005

Background: Improvements in stroke management have led to increases in the numbers of stroke survivors over the last decade and there has been a corresponding increase of hospital readmissions after an initial stroke hospitalisation. The aim of this study was to examine the one year risk of having a readmission due to infective, gastrointestinal or immobility (IGI) complications and to identify temporal trends and any risk factors.<p></p> Methods: Using a cohort of first hospitalised for stroke patients who were discharged alive, time to first event (readmission for IGI complications or death) within 1 year was analysed in a competing risks framework using cumulative incidence methods. Regression on the cumulative incidence function was used to model the risks of having an outcome using the covariates age, sex, socioeconomic status, comorbidity, discharge destination and length of hospital stay.<p></p> Results: There were a total of 51,182 patients discharged alive after an incident stroke hospitalisation in Scotland between 1997–2005, and 7,747 (15.1%) were readmitted for IGI complications within a year of the discharge. Comparing incident stroke hospitalisations in 2005 with 1997, the adjusted risk of IGI readmission did not increase (HR = 1.00 95% CI (0.90, 1.11). However, there was a higher risk of IGI readmission with increasing levels of deprivation (most deprived fifth vs. least deprived fifth HR = 1.16 (1.08, 1.26).<p></p> Conclusions: Approximately 15 in 100 patients discharged alive after an incident hospitalisation for stroke in Scotland between 1997 and 2005 went on to have an IGI readmission within one year. The proportion of readmissions did not change over the study period but those living in deprived areas had an increased risk

Referral for specialist follow-up and its association with post-discharge mortality among patients with systolic heart failure (from the National Heart Failure Audit for England and Wales)

For patients admitted with worsening heart failure, early follow-up after discharge is recommended. Whether outcomes can be improved when follow-up is done by cardiologists is uncertain. We aimed to determine the association between cardiology follow-up and risk of death for patients with heart failure discharged from hospital. Using data from the National Heart Failure Audit (England & Wales), we investigated the effect of referral to cardiology follow-up on 30-day and one-year mortality in 68 772 patients with heart failure and a reduced left ventricular ejection fraction (HFREF) discharged from 185 hospitals between 2007 to 2013. The primary analyses used instrumental variable analysis complemented by hierarchical logistic and propensity matched models. At the hospital level, rates of referral to cardiologists varied from 6% to 96%. The median odds ratio (OR) for referral to cardiologist was 2.3 (95% confidence interval [CI] 2.1, 2.5), suggesting that, on average, the odds of a patient being referred for cardiologist follow-up after discharge differed approximately 2.3 times from one randomly selected hospital to another one. Based on the proportion of patients (per region) referred for cardiology follow-up, referral for cardiology follow-up was associated with lower 30-day (OR 0.70; CI 0.55, 0.89) and one-year mortality (OR 0.81; CI 0.68, 0.95) compared with no plans for cardiology follow-up (i.e., standard follow-up done by family doctors). Results from hierarchical logistic models and propensity matched models were consistent (30-day mortality OR 0.66; CI 0.61, 0.72 and 0.66; CI 0.58, 0.76 for hierarchical and propensity matched models, respectively). For patients with HFREF admitted to hospital with worsening symptoms, referral to cardiology services for follow-up after discharge is strongly associated with reduced mortality, both early and late

Eclipsing Binaries in Open Clusters

Detached eclipsing binaries are very useful objects for calibrating theoretical stellar models and checking their predictions. Detached eclipsing binaries in open clusters are particularly important because of the additional constraints on their age and chemical composition from their membership of the cluster. I compile a list containing absolute parameters of well-studied eclipsing binaries in open clusters, and present new observational data on the B-type systems V1481 Cyg and V2263 Cyg which are members of the young open cluster NGC 7128.Comment: 4 pages, 2 colour figures. Poster presentation for IAUS 240 (Binary Stars as Critical Tools and Tests in Contemporary Astrophysics), Prague, August 2006. The poster itself can be dowloaded in ppt and pdf versions from http://www.astro.keele.ac.uk/~jkt/pubs.htm

Anderson localization for a class of models with a sign-indefinite single-site potential via fractional moment method

A technically convenient signature of Anderson localization is exponential decay of the fractional moments of the Green function within appropriate energy ranges. We consider a random Hamiltonian on a lattice whose randomness is generated by the sign-indefinite single-site potential, which is however sign-definite at the boundary of its support. For this class of Anderson operators we establish a finite-volume criterion which implies that above mentioned the fractional moment decay property holds. This constructive criterion is satisfied at typical perturbative regimes, e. g. at spectral boundaries which satisfy 'Lifshitz tail estimates' on the density of states and for sufficiently strong disorder. We also show how the fractional moment method facilitates the proof of exponential (spectral) localization for such random potentials.Comment: 29 pages, 1 figure, to appear in AH

Features of Chronology and Breeding Success of Pygoscelis papua and P.аdeliae (Spheniscidae) Penguins in the Wilhelm Archipelago (CCAMLR Subarea 48.1)

Objective. To investigate the qualitative changes in the habitats of two most common species penguin populations in the Wilhelm Archipelago Pygoscelis papua and P. adeliae (Spheniscidae) penguins in the CCAMLR Subarea 48.1 under the impact of climate changes and krill fishery.Мета. Дослідити якісні зміни в оселищах двох найпоширеніших видів пінгвінів на архіпелазі Вільгельма Pygoscelis papua та P. adeliae (Spheniscidae) у підрайоні CCAMLR 48.1 під впливом зміни клімату та промислу криля

On the nature of Bose-Einstein condensation in disordered systems

We study the perfect Bose gas in random external potentials and show that there is generalized Bose-Einstein condensation in the random eigenstates if and only if the same occurs in the one-particle kinetic-energy eigenstates, which corresponds to the generalized condensation of the free Bose gas. Moreover, we prove that the amounts of both condensate densities are equal. Our method is based on the derivation of an explicit formula for the occupation measure in the one-body kinetic-energy eigenstates which describes the repartition of particles among these non-random states. This technique can be adapted to re-examine the properties of the perfect Bose gas in the presence of weak (scaled) non-random potentials, for which we establish similar results