Changes in characteristics of hospitalized heart failure patients in ten years: a single-center study

SummaryBackgroundProgress in therapy and the ageing patients hospitalized with heart failure may have impacted the characteristics of this patients.AimsWe compared epidemiological data of patients admitted with heart failure during two periods separated by a 10 year interval.MethodsCharacteristics of 353 heart failure patients recruited between 2002 and 2004 with those of 304 heart failure patients recruited between 1992 and 1994 were compared retrospectively.ResultsThere is now a majority of male patients (56.4%) not found ten years ago. The average age is unchanged (75.1±11 then 76.4±11 years) even though the proportion of patients aged over 70 years has increased (75% versus 70%). Hospital length of stay has fallen from 14±9 to 10±7 days. Hospital mortality (8%) are identical. The two main etiologies remain coronary and hypertensive heart disease at 29 and 24% respectively but these proportions are lower than ten years ago (42 and 28% respectively). The ejection fraction is more often preserved (56%) than before (44%). Increased prescription of inhibitors of the renin-angiotensin system and beta-blockers is confirmed. Post-hospital and total mortality has fallen by 50 and 30% from 30 to 16% and 35 to 24% respectively at the expense of a 25% increase in the frequency of hospital readmissions from 29 to 38%.ConclusionEven if mortality has declined, heart failure remains a major public health burden with a significant number of hospital readmissions. Other approaches such as therapeutic education must therefore be developed

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Management of NSTEMI in a hospital without interventional cardiology and without use of GRACE score: Does the clinician appreciation match the GRACE score calculated retrospectively for the coronarography delay?

International audienc

Prise en charge des syndromes coronaires aigus sans sus décalage du ST dans un hôpital sans cardiologie interventionnelle : l’appréciation du clinicien rejoint-elle le score de GRACE dans le délai de réalisation de la coronarographie ?

International audienc

Management of NSTEMI in a hospital without interventional cardiology and without use of GRACE score: Does the clinician appreciation match the GRACE score calculated retrospectively for the coronarography delay?

International audienc

Modern human incursion into Neanderthal territories 54,000 years ago at Mandrin, France

Determining the extent of overlap between modern humans and other hominins in Eurasia, such as Neanderthals and Denisovans, is fundamental to understanding the nature of their interactions and what led to the disappearance of archaic hominins. Apart from a possible sporadic pulse recorded in Greece during the Middle Pleistocene, the first settlements of modern humans in Europe have been constrained to ~45,000 to 43,000 years ago. Here, we report hominin fossils from Grotte Mandrin in France that reveal the earliest known presence of modern humans in Europe between 56,800 and 51,700 years ago. This early modern human incursion in the Rhône Valley is associated with technologies unknown in any industry of that age outside Africa or the Levant. Mandrin documents the first alternating occupation of Neanderthals and modern humans, with a modern human fossil and associated Neronian lithic industry found stratigraphically between layers containing Neanderthal remains associated with Mousterian industries

Quina retouch does not maintain edge angle over reduction

The Quina scraper features an important role in the discussion of European Middle Palaeolithic variability. Explanations for its characteristic retouch and blank morphology have ranged from economic to functional and cultural considerations. One hypothesis is that Quina retouch maintains the edge angle of the retouched margin, allowing the upkeep of high cutting potential despite repeated resharpening. In this study, we examine this hypothesis by using a sample of scrapers from the Middle Palaeolithic site of Roc de Marsal in southwest France. The results show that, when the influence of reduction intensity and flake thickness are controlled, Quina retouch has no detectable impact on the retouched edge angle. Instead, the overall higher edge angles among Quina scrapers are a product of continuous reduction and the use of thicker blanks. We discuss possible factors underlying the occurrence of Quina retouch with respect to lithic economy and function.University of PennsylvaniaKolb Society of the Penn Museum of Anthropology and Archaeolog

Measuring spatial structure in time-averaged deposits insights from Roc de Marsal, France

The use of space, both at the landscape and the site level, is considered an important aspect of hominin adaptations that changed through time. At the site level, spatial analyses are typically conducted on deposits thought to have a high degree of temporal resolution. Sites with highly time-averaged deposits are viewed as inferior for these analyses because repeated site visits obscure individual behavioral events. To the contrary, here, we take the view that behaviors that repeat themselves in a spatially structured way through time are exactly the kinds of behaviors that are potentially significant at an evolutionary timescale. In this framework, time averaging is seen not as a hindrance but rather as a necessary condition for viewing meaningful behavior. To test whether such patterning is visible in time-averaged deposits, we use spatial statistics to analyze a number of indices designed to measure lithic production, use and discard behaviors in a multi-layer, late Neandertal cave site in southwest France. We find that indeed some such patterning does exist, and thus sites with highly time-averaged deposits have the potential to contribute to our understanding of how hominin use of space varied through time. This is useful because a great many archaeological sites have highly time-average deposits. Interpreting the spatial patterning will likely require modeling to create expectations in time-averaged and likely emergent contexts such as these.US National Science FoundationNational Science Foundation (NSF) [09177739, 0551927]Leakey FoundationUniversity of Pennsylvania Research FoundationService Regional de l'Archeologie d'AquitaineRegion Nouvelle-AquitaineConseil General de la DordogneRegion Nouvelle-AquitaineMax Planck SocietyMax Planck SocietyFoundation CELLEXCenter for the Advanced Study of Human Paleobiology at George Washington Universityinfo:eu-repo/semantics/publishedVersio