8 research outputs found

    Management of Acute Ischaemic Stroke: Recommended Practice Guidelines as a Component of Disease Management

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    Stroke is a leading cause of death and disability and continues to have a great public health impact worldwide. Management of patients with acute ischaemic stroke (IS) has been, until recently, primarily supportive care. A better understanding of the mechanisms of stroke has stimulated a far more aggressive and active treatment strategy, and stroke is now considered a state of medical emergency. Evidence-based protocols for the management of patients with stroke should be implemented in all hospital departments involved in the diagnosis and treatment of such individuals. These protocols should include assessment, investigation, immediate treatment and rehabilitation, as well as secondary prevention and risk factor management strategies. Specialised stroke units are well documented initiatives for optimising the management of patients with stroke and are central to the future of acute stroke management. Establishment of stroke units should receive top priority in strategic planning within the area of stroke management. Immediate and precise evaluation of patients with assumed stroke, including a computerised tomography scan of the brain followed by close monitoring, are essential for preventing medical and neurological complications and for achieving the optimal outcome. Primary treatment of acute IS with thrombolysis is a therapy with substantial risks, but at present is essentially the only available therapy for reversing or reducing effects of acute IS. Antiplatelet therapy with aspirin (acetylsalicylic acid) in the acute phase of IS also has a small but significant effect. Anticoagulant therapy with heparin has not yet proven any net long term benefit in the treatment of acute IS. Likewise, there are currently no convincing data on the efficacy of neuroprotective drugs in a clinical setting. Every patient should have disability needs assessed as soon as possible and a well conceived rehabilitation plan should be made based on the patient's own goals. To reduce the incidence of a subsequent stroke, secondary prevention is essential. Prevention should primarily focus on detection and management of risk factors for stroke, which in many cases influence both the risk of ischaemic and haemorrhagic stroke. These risk factors include hypertension, atrial fibrillation, smoking, diabetes mellitus, alcohol abuse and hyperlipidaemia. In patients with IS, secondary prevention also includes antiplatelet therapy with aspirin and dipyridamole or clopidogrel and the possibility of carotid endarterectomy.Reviews-on-treatment, Reviews-on-disease, Stroke, Thrombolytics, Anticoagulants, Antiplatelets, Practice-guideline, Computerised-tomography, Magnetic-resonance-imaging, Neuroprotectants

    Implementation of patient education for patients with atrial fibrillation: nationwide cross-sectional survey and one-year follow-up

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    BackgroundClinical practice guidelines recommend patient education for patients with atrial fibrillation (AF) as a part of holistic care, however clinical guidelines lack detailed specification the content, structure, and delivery of AF education programmes.AimTo examine the implementation of education for patients with AF in Denmark in relation to coverage, organization and content.MethodsA cross-sectional survey was conducted from February to May 2021. The survey contained questions on the organization, delivery and content of education for patients with AF from all 29 AF outpatient hospital sites in Denmark. The survey was conducted by email and telephone. One-year follow-up was done in May 2022 by e-mail.ResultsPatient education was provided by healthcare professionals in 16 (55%) hospitals. Nurse workforce issues, management, non-prioritisation, and lack of guidance for implementation were reasons for the absence of patient education in 13 (45%) hospitals. The structure of patient education differed in relation to group or individual teaching methods and six different education models were used. Content of the AF disease education was generally similar. At 1-year follow-up, another four hospitals reported offering patient education (69% in total).ConclusionInitially almost half of the hospitals did not provide patient education, but at 1-year follow-up 69% of hospitals delivered patient education. Patient education was heterogeneous in relation to delivery, frequency and duration. Future research should address individualized patient education that may demonstrate superiority in relation to quality of life, less hospital admissions, and increased longevity

    Mobile health technology in atrial fibrillation

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    IntroductionMobile health (mHealth) solutions in atrial fibrillation (AF) are becoming widespread, thanks to everyday life devices, such as smartphones. Their use is validated both in monitoring and in screening scenarios. In the published literature, the diagnostic accuracy of mHealth solutions wide differs, and their current clinical use is not well established in principal guidelines.Areas coveredmHealth solutions have progressively built an AF-detection chain to guide patients from the device's alert signal to the health-care practitioners' (HCPs) attention. This review aims to critically evaluate the latest evidence regarding mHealth devices and the future possible patient's uses in everyday life.Expert opinionThe patients are the first to be informed of the rhythm anomaly, leading to the urgency of increasing the patients' AF self-management. Furthermore, HCPs need to update themselves about mHealth devices use in clinical practice. Nevertheless, these are promising instruments in specific populations, such as post-stroke patients, to promote an early arrhythmia diagnosis in the post-ablation/cardioversion period, allowing checks on the efficacy of the treatment or intervention

    Geographical variation in persistence to oral anticoagulation therapy and clinical outcomes among patients with atrial fibrillation initiating therapy in Denmark, Sweden, Norway and Finland

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    AimTo examine inter-national and regional variations in persistence of oral anticoagulation (OAC) therapy and incidence of clinical outcomes and mortality, among patients with incident atrial fibrillation (AF) in the Nordic countries. MethodsWe conducted a registry-based multinational cohort study of OAC-naive patients diagnosed with AF that redeemed at least one prescription of OAC after AF in Denmark (N = 25 585), Sweden (N = 59 455), Norway (N = 40 046) and Finland (N = 22 415). Persistence was dispensing at least one prescription of OAC from Day 365 after the first prescription and 90 days forward. ResultsPersistence was 73.6% (95% confidence interval 73.0-74.1) in Denmark, 71.1% (70.7-71.4) in Sweden, 89.3% (88.2-90.1) in Norway and 68.6% (68.0-69.3) in Finland. One-year risk of ischemic stroke varied between 2.0% (1.8-2.1) in Norway and 1.5% (1.4-1.6) in Sweden and 1.5% (1.3-1.6) in Finland. One-year risk of major bleeding other than intracranial bleeding varied between 2.1% (1.9-2.2) in Norway and 5.9% (5.6-6.2) in Denmark. One-year mortality risk varied between 9.3% (8.9-9.6) in Denmark and 4.2% (4.0-4.4) in Norway. ConclusionIn OAC-naive patients with incident AF, persistence of OAC therapy and clinical outcomes vary across Denmark, Sweden, Norway and Finland. Initiation of real-time efforts are warranted to ensure uniform high-quality care across nations and regions.Peer reviewe

    Moderate mitral regurgitation in patients undergoing CABG - the MoMIC trial

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    Background. The presence of mild to moderate ischemic mitral regurgitation (IMR) marks a significantly reduced long-term survival and increased hospitalizations due to heart-failure. However, it is common practice in many institutions to refrain from repairing the mitral valve in these patients. There are no available conclusive data to support this practice, and thus there is a need for an adequately powered randomized trial. Study design. The Moderate Mitral Regurgitation In Patients Undergoing CABG (MoMIC) trial is the first international multi-center, large-scale study to clarify whether moderate IMR in CABG patients should be corrected. A total of 550 CABG patients with moderate IMR are to be randomized to treatment of either CABG alone or CABG plus mitral valve correction. The primary end point is a composite end point of mortality and rehospitalization for heart failure at five years. The inclusion and randomization of patients started in February 2008. Implication. If correction of moderate IMR in CABG patients proves to be the superior strategy, most patients should be treated accordingly

    EPIC-Heart: The cardiovascular component of a prospective study of nutritional, lifestyle and biological factors in 520,000 middle-aged participants from 10 European countries

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    EPIC-Heart is the cardiovascular component of the European Prospective Investigation into Cancer and Nutrition ( EPIC), a multi-centre prospective cohort study investigating the relationship between nutrition and major chronic disease outcomes. Its objective is to advance understanding about the separate and combined influences of lifestyle ( especially dietary), environmental, metabolic and genetic factors in the development of cardiovascular diseases by making best possible use of the unusually informative database and biological samples in EPIC. Between 1992 and 2000, 519,978 participants ( 366,521 women and 153,457 men, mostly aged 35 - 70 years) in 23 centres in 10 European countries commenced follow-up for causespecific mortality, cancer incidence and major cardiovascular morbidity. Dietary information was collected with quantitative questionnaires or semi-quantitative food frequency questionnaires, including a 24-h dietary recall sub-study to help calibrate the dietary measurements. Information was collected on physical activity, tobacco smoking, alcohol consumption, occupational history, socio-economic status, and history of previous illnesses. Anthropometric measurements and blood pressure recordings were made in the majority of participants. Blood samples were taken from 385,747 individuals, from which plasma, serum, red cells, and buffy coat fractions were separated and aliquoted for long-term storage. By 2004, an estimated 10,000 incident fatal and non-fatal coronary and stroke events had been recorded. The first cycle of EPIC-Heart analyses will assess associations of coronary mortality with several prominent dietary hypotheses and with established cardiovascular risk factors. Subsequent analyses will extend this approach to non-fatal cardiovascular outcomes and to further dietary, biochemical and genetic factors

    C-peptide, IGF-I, sex-steroid hormones and adiposity: a cross-sectional study in healthy women within the European Prospective Investigation into Cancer and Nutrition (EPIC)

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    Objectives: The risk of some cancers is positively associated with body weight, which may influence circulating levels of sex-steroid hormones, insulin and IGF-I. Interrelationships between these hormones and the associations with adiposity were evaluated in healthy women participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). Methods: A cross-sectional analysis was performed on anthropometric and hormonal data from 743 pre- and 1217 postmenopausal women. Body mass index (BMI) and waist circumference were used as indicators of adiposity. C-peptide, Insulin Growth Factor (IGF)-I, Insulin Growth Factor binding protein (IGFBP)-3, androgens, estrogens and sex hormone binding globulin (SHBG) were measured by immunoassays; free sex steroid concentrations were calculated. Results: BMI and waist circumference were positively correlated with estrogens in postmenopausal women and with C-peptide, free testosterone and inversely with SHBG in all women. C-peptide and IGF-I were inversely correlated with SHBG, and positively with free sex steroids in postmenopausal women. IGF-I was positively associated with postmenopausal estrogens and androgen concentrations in all women. Conclusions: Sex-steroid concentrations appear to be regulated along several axes. Adiposity correlated directly with estrogens in postmenopausal women and with insulin, resulting in lower SHBG and increased levels of free sex steroids. Independent of adiposity and insulin, IGF-I was associated with decreased SHBG levels, and increased concentrations of androgens and postmenopausal estrogens
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