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Absence of sex differences in pharmacotherapy for acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature179138
Source
Can J Cardiol. 2004 Jul;20(9):899-905
Publication Type
Article
Date
Jul-2004
Author
Susan E Jelinski
William A Ghali
Gerry A Parsons
Colleen J Maxwell
Author Affiliation
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Source
Can J Cardiol. 2004 Jul;20(9):899-905
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Anticoagulants - therapeutic use
Aspirin - therapeutic use
Calcium Channel Blockers - therapeutic use
Canada - epidemiology
Cohort Studies
Drug Evaluation
Drug Therapy
Female
Fibrinolytic Agents - therapeutic use
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - drug therapy
Patient Admission
Platelet Aggregation Inhibitors - therapeutic use
Sex Factors
Urban health
Abstract
Previous studies have indicated that sex differences may exist in the pharmacological management of acute myocardial infarction (AMI), with female patients being treated less aggressively.
To determine if previously reported sex differences in AMI medication use were also evident among all AMI patients treated at hospitals in an urban Canadian city.
All patients who had a primary discharge diagnosis of AMI from all three adult care hospitals in Calgary, Alberta, in the 1998/1999 fiscal year were identified from hospital administrative records (n=914). A standardized, detailed chart review was conducted. Information collected from the medical charts included sociodemographic and clinical characteristics, comorbid conditions, and cardiovascular medication use during hospitalization and at discharge.
Similar proportions of female and male patients were treated with thrombolytics, beta-blockers, angiotensin-converting enzyme inhibitors, nitrate, heparin, diuretics and digoxin. Among patients aged 75 years and over, a smaller proportion of female patients received acetylsalicylic acid in hospital than did male patients (87% versus 95%; P=0.026). Multivariable logistic regression analysis revealed that, after correction for age, use of other anticoagulants/antiplatelets and death within 24 h of admission, sex was no longer an independent predictor for receipt of acetylsalicylic acid in hospital. Medications prescribed at discharge were similar between male and female patients.
The results from this Canadian chart review study, derived from detailed clinical data, indicate that the pattern of pharmacological treatment of female and male AMI patients during hospitalization and at discharge was very similar. No sex differences were evident in the treatment of AMI among patients treated in an urban Canadian centre.
PubMed ID
15266360 View in PubMed
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Accuracy of coding for possible warfarin complications in hospital discharge abstracts.

https://arctichealth.org/en/permalink/ahliterature173437
Source
Thromb Res. 2006;118(2):253-62
Publication Type
Article
Date
2006
Author
T. Arnason
P S Wells
C. van Walraven
A J Forster
Author Affiliation
Ottawa Health Research Institute-Clinical Epidemiology Program, Canada.
Source
Thromb Res. 2006;118(2):253-62
Date
2006
Language
English
Publication Type
Article
Keywords
Anticoagulants - therapeutic use
Canada
Hemorrhage - complications
Hospitals, University
Humans
International Classification of Diseases
Medical Records
Reproducibility of Results
Retrospective Studies
Thromboembolism - complications
Warfarin - therapeutic use
Abstract
Hospital discharge abstracts could be used to identify complications of warfarin if coding for bleeding and thromboembolic events are accurate.
To measure the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9CM) codes for bleeding and thromboembolic diagnoses.
University affiliated, tertiary care hospital in Ottawa, Canada.
A random sample of patients discharged between September 1999 and September 2000 with an ICD-9-CM code indicating a bleeding or thromboembolic diagnosis.
Gold-standard coding was determined by a trained chart abstractor using explicit standard diagnostic criteria for bleeding, major bleeding, and acute thromboembolism. The abstractor was blinded to the original coding. We calculated the sensitivity, specificity, positive, and negative predictive values of the original ICD-9CM codes for bleeding or thromboembolism diagnoses.
We reviewed 616 medical records. 361 patients (59%) had a code indicating a bleeding diagnosis, 291 patients (47%) had a code indicating a thromboembolic diagnosis and 36 patients (6%) had a code indicating both. According to the gold standard criteria, 352 patients experienced bleeding, 333 experienced major bleeding, and 188 experienced an acute thromboembolism. For bleeding, the ICD-9CM codes had the following sensitivity, specificity, positive and negative predictive values [95% CI]: 93% [90-96], 88% [83-91], 91% [88-94], and 91% [87-94], respectively. For major bleeding, the ICD-9CM codes had the following sensitivity, specificity, positive and negative predictive values: 94% [91-96], 83% [78-87], 87% [83-90], and 92% [88-95], respectively. For thromboembolism, the ICD-9CM codes had the following sensitivity, specificity, positive and negative predictive values: 97% [94-99], 74% [70-79], 62% [57-68], and 98% [96-99], respectively. By selecting a sub-group of ICD-9CM codes for thromboembolism, the positive predictive value increased to 87%.
In our centre, the discharge abstract could be used to identify and exclude patients hospitalized with a major bleed or thromboembolism. If coding quality for bleeding is similar in other hospitals, these ICD-9-CM diagnostic codes could be used to study population-based warfarin-associated hemorrhagic complications using administrative databases.
PubMed ID
16081144 View in PubMed
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Admission Hyperglycemia and Clinical Outcome in Cerebral Venous Thrombosis.

https://arctichealth.org/en/permalink/ahliterature273503
Source
Stroke. 2016 Feb;47(2):390-6
Publication Type
Article
Date
Feb-2016
Author
Susanna M Zuurbier
Sini Hiltunen
Turgut Tatlisumak
Guusje M Peters
Suzanne M Silvis
Elena Haapaniemi
Nyika D Kruyt
Jukka Putaala
Jonathan M Coutinho
Source
Stroke. 2016 Feb;47(2):390-6
Date
Feb-2016
Language
English
Publication Type
Article
Keywords
Adult
Anticoagulants - therapeutic use
Cerebral Hemorrhage - epidemiology - therapy
Cohort Studies
Coma - epidemiology
Comorbidity
Decompressive Craniectomy
Female
Finland - epidemiology
Humans
Hyperglycemia - drug therapy - epidemiology
Hypoglycemic agents - therapeutic use
Insulin - therapeutic use
Intensive Care Units - utilization
Intracranial Thrombosis - epidemiology - mortality - therapy
Logistic Models
Male
Middle Aged
Netherlands - epidemiology
Odds Ratio
Prognosis
Retrospective Studies
Severity of Illness Index
Sinus Thrombosis, Intracranial - epidemiology - mortality - therapy
Venous Thrombosis - epidemiology - mortality - therapy
Abstract
Admission hyperglycemia is associated with poor clinical outcome in ischemic and hemorrhagic stroke. Admission hyperglycemia has not been investigated in patients with cerebral venous thrombosis.
Consecutive adult patients with cerebral venous thrombosis were included at the Academic Medical Center, The Netherlands (2000-2014) and the Helsinki University Central Hospital, Finland (1998-2014). We excluded patients with known diabetes mellitus and patients without known admission blood glucose. We defined admission hyperglycemia as blood glucose =7.8 mmol/L (141 mg/dL) and severe hyperglycemia as blood glucose =11.1 mmol/L (200 mg/dL). We used logistic regression analysis to determine if admission hyperglycemia was associated with modified Rankin Scale (mRS) score of 3 to 6 or mortality at last follow-up. We adjusted for: age, sex, coma, malignancy, infection, intracerebral hemorrhage, deep cerebral venous thrombosis, and location of recruitment.
Of 380 patients with cerebral venous thrombosis, 308 were eligible. Of these, 66 (21.4%) had admission hyperglycemia with 8 (2.6%) having severe admission hyperglycemia. Coma (31.3% versus 5.0%, P
PubMed ID
26670083 View in PubMed
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Age-related complications and optimal choice of artificial heart valves in elderly patients.

https://arctichealth.org/en/permalink/ahliterature226101
Source
J Cardiovasc Surg (Torino). 1991 Jul-Aug;32(4):497-502
Publication Type
Article
Author
L I Thulin
Author Affiliation
Department of Thoracic Surgery, University Hospital, Lund, Sweden.
Source
J Cardiovasc Surg (Torino). 1991 Jul-Aug;32(4):497-502
Language
English
Publication Type
Article
Keywords
Age Factors
Anticoagulants - therapeutic use
Female
Follow-Up Studies
Heart Valve Prosthesis - adverse effects - mortality - statistics & numerical data
Hemorrhage - epidemiology - mortality
Humans
Male
Postoperative Complications - epidemiology - mortality
Prosthesis Design
Sweden - epidemiology
Thromboembolism - epidemiology - mortality
Abstract
The use of bioprosthetic heart valves in elderly patients is presently advocated by many since implanting mechanical valves are considered to result in unacceptable rates of thromboembolism and bleeding. However the somewhat limited durability of bioprostheses has to be acknowledged since a group of elderly patients will eventually require a reoperation due to tissue failure. We have evaluated our policy to implant mechanical heart valve prostheses even in elderly patients based on the conception that we believe that anticoagulation in this group of patients can be handled with a low rate of complications.
PubMed ID
1864880 View in PubMed
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Alcohol intake and prognosis of atrial fibrillation.

https://arctichealth.org/en/permalink/ahliterature113075
Source
Heart. 2013 Aug;99(15):1093-9
Publication Type
Article
Date
Aug-2013
Author
Thure Filskov Overvad
Lars Hvilsted Rasmussen
Flemming Skjøth
Kim Overvad
Ida Ehlers Albertsen
Deirdre A Lane
Gregory Y H Lip
Torben Bjerregaard Larsen
Author Affiliation
Department of Cardiology, Cardiovascular Research Centre, Aalborg University Hospital, Aalborg, Denmark.
Source
Heart. 2013 Aug;99(15):1093-9
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Alcohol Drinking - adverse effects - epidemiology
Anticoagulants - therapeutic use
Atrial Fibrillation - complications - drug therapy - epidemiology
Cohort Studies
Comorbidity
Denmark - epidemiology
Female
Humans
Male
Medical Records, Problem-Oriented - statistics & numerical data
Middle Aged
Outcome Assessment (Health Care) - statistics & numerical data
Risk assessment
Risk factors
Sex Factors
Thromboembolism - epidemiology - etiology - prevention & control
Abstract
To assess alcohol intake as a risk factor for adverse events among patients with incident atrial fibrillation (AF).
Prospective cohort study.
Population based cohort study and nationwide Danish registries.
The Danish Diet, Cancer and Health study included 57 053 participants (27 178 men and 29 875 women) aged between 50 and 64 years. The study population for this study included the 3107 participants (1999 men, 1108 women) who developed incident AF after inclusion.
A composite of thromboembolism or death.
During a median follow-up of 4.9 years 608 deaths and 211 thromboembolic events occurred. Of those who developed AF, 690 (35%) men and 233 (21%) women had a high intake of alcohol (>20 drinks/week for men and >13 drinks/week for women). After adjustment for use of oral anticoagulation and components of the CHA2DS2-VASc score, men with an intake of >27 drinks/week had a higher risk for thromboembolism or death (hazard ratio (HR) 1.33, 95% CI 1.08 to 1.63) than men with an intake of 20 drinks/week also had a higher risk (HR 1.23, 95% CI 0.78 to 1.96) than women in the low intake category. The higher risk among men was primarily driven by mortality (HR 1.51, 95% CI 1.20 to 1.89), whereas the risk found among women was driven by thromboembolism (HR 1.71, 95% CI 0.81 to 3.60).
High alcohol intake predicts thromboembolism or death, even after adjustment for established clinical risk factors, and may help identify high risk AF patients who could be targeted for stroke and cardiovascular prevention strategies.
PubMed ID
23766449 View in PubMed
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Analgesic use before and after oral anticoagulant initiation--a population-based study in Finland.

https://arctichealth.org/en/permalink/ahliterature270013
Source
Eur J Clin Pharmacol. 2015 Jun;71(6):723-32
Publication Type
Article
Date
Jun-2015
Author
Jenni Ilomäki
Arja Helin-Salmivaara
Risto Huupponen
Maria Rikala
Carl M Kirkpatrick
Maarit Jaana Korhonen
Source
Eur J Clin Pharmacol. 2015 Jun;71(6):723-32
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Aged, 80 and over
Analgesics - adverse effects - therapeutic use
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Anticoagulants - therapeutic use
Cross-Over Studies
Drug Interactions
Female
Finland
Hemorrhage - chemically induced
Humans
Male
Middle Aged
Odds Ratio
Risk
Abstract
Due to potential drug-drug interactions and subsequent bleeding risk, analgesic use should be reviewed when an oral anticoagulant is initiated. The aim of this study was to compare use of non-steroidal anti-inflammatory drugs (NSAIDs) and other analgesics before and after oral anticoagulant initiation.
All individuals who initiated warfarin, dabigatran, or rivaroxaban between January 2012 and September 2013 were identified from the Finnish Prescription Register. Prevalence of analgesic use during 3 months after oral anticoagulant initiation was compared to analgesic use during 4 months before initiation. Analgesics included were NSAIDs, paracetamol, paracetamol in doses = 2 g/day, tramadol, and other opioids. Conditional logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI).
In total, 54,025 initiated warfarin, 16,894 rivaroxaban, and 1569 dabigatran. The odds of NSAID use decreased among warfarin initiators (odds ratio (OR) 0.10; 95% confidence interval (CI) 0.09-0.10); 2.6% used NSAID after initiation. In contrast, the odds of NSAID use increased among rivaroxaban (OR 3.56; 95% CI 3.37-3.75) and dabigatran initiators (OR 1.44; 95% CI 1.16-1.78). The proportions using NSAIDs after the initiation were 69 and 32%, respectively. However, NSAID use decreased among dabigatran initiators with confirmed atrial fibrillation (OR 0.46; 95% CI 0.23-0.92) and among rivaroxaban initiators with a daily dose of = 15 mg (OR 0.28; 95% CI 0.19-0.40).
The use of NSAIDs decreases extensively among warfarin initiators which is encouraging. However, the use of NSAIDs increases among rivaroxaban and dabigatran initiators. This is a concern as the bleeding risk may increase due to potential pharmacodynamic interactions.
PubMed ID
25911438 View in PubMed
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An instrument for measuring health-related quality of life in patients with Deep Venous Thrombosis (DVT): development and validation of Deep Venous Thrombosis Quality of Life (DVTQOL) questionnaire.

https://arctichealth.org/en/permalink/ahliterature70975
Source
Health Qual Life Outcomes. 2004 Jun 23;2:30
Publication Type
Article
Date
Jun-23-2004
Author
Ewa Hedner
Jonas Carlsson
Károly R Kulich
Lennart Stigendal
Anders Ingelgård
Ingela Wiklund
Author Affiliation
Experimental Medicine, AstraZeneca, R&D, SE-431 83 Mölndal, Sweden. Ewa.Hedner@astrazeneca.com
Source
Health Qual Life Outcomes. 2004 Jun 23;2:30
Date
Jun-23-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Female
Humans
Male
Middle Aged
Pilot Projects
Psychometrics - instrumentation
Quality of Life - psychology
Questionnaires
Sex Factors
Sickness Impact Profile
Sweden
Treatment Outcome
Venous Thrombosis - drug therapy - physiopathology - psychology
Warfarin - therapeutic use
Abstract
BACKGROUND: Few studies have evaluated patient-reported outcomes in connection with a primary event of deep venous thrombosis, partly due to a lack of disease-specific measures. The aim here was to develop a disease-specific health-related quality of life (HRQL) measure, the deep venous thrombosis quality of life questionnaire (DVTQOL), for patients with recent exposition and treatment of proximal deep venous thrombosis. METHODS: A total of 121 consecutive outpatients (50 % males; mean age 61.2 +/- 14 years) treated with warfarin (Waran) for symptomatic proximal deep venous thrombosis were included in the study. Patients completed the SF-36, EQ-5D and the pilot version of the DVTQOL. RESULTS: Items having: high ceiling and floor effect, items with lower factor loadings than 0.50 and items loading in several factors were removed from the pilot version of DVTQOL. In addition, overlapping and redundant items identified by the Rasch analysis were excluded. The final DVTQOL questionnaire consists of 29 items composing six dimensions depicting problems with: emotional distress; symptoms (e.g. pain, swollen ankles, cramp, bruising); limitation in physical activity; hassle with coagulation monitoring; sleep disturbance; and dietary problems. The internal consistency reliability was high (alpha value ranged from 0.79 to 0.93). The relevant domains of the SF-36 and EQ-5D significantly correlated with DVTQOL, thereby confirming its construct validity. CONCLUSIONS: The DVTQOL is a short and user-friendly instrument with good reliability and validity. Its test-retest reliability and responsiveness to change in clinical trials, however, must be explored.
PubMed ID
15214965 View in PubMed
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An international view of how recent-onset atrial fibrillation is treated in the emergency department.

https://arctichealth.org/en/permalink/ahliterature118794
Source
Acad Emerg Med. 2012 Nov;19(11):1255-60
Publication Type
Article
Date
Nov-2012
Author
Carly Rogenstein
Anne-Maree Kelly
Suzanne Mason
Sandra Schneider
Eddy Lang
Catherine M Clement
Ian G Stiell
Author Affiliation
Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Source
Acad Emerg Med. 2012 Nov;19(11):1255-60
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Adult
Anti-Arrhythmia Agents - therapeutic use
Anticoagulants - therapeutic use
Atrial Fibrillation - diagnosis - therapy
Australasia
Canada
Chi-Square Distribution
Conscious Sedation - methods
Electric Countershock - utilization
Emergency Medicine - standards - trends
Emergency Service, Hospital
Female
Great Britain
Health Care Surveys
Heart rate
Humans
International Cooperation
Male
Middle Aged
Physician's Practice Patterns - trends
Questionnaires
Survival Rate
Treatment Outcome
United States
Abstract
This study was conducted to determine if there is practice variation for emergency physicians' (EPs) management of recent-onset atrial fibrillation (RAF) in various world regions (Canada, United States, United Kingdom, and Australasia).
The authors completed a mail and e-mail survey of members from four national emergency medicine (EM) associations. One prenotification letter and three survey letters were sent to members of the Canadian Association of Emergency Physicians (CAEP; Canada-1,177 members surveyed), American College of Emergency Physicians (ACEP; United States-500), College of Emergency Medicine UK (CEM; United Kingdom-1,864), and Australasian College for Emergency Medicine (ACEM; Australasia-1,188) as per the modified Dillman technique. The survey contained 23 questions related to the management of adult patients with symptomatic RAF (either a first episode or paroxysmal-recurrent) where onset is less than 48 hours and cardioversion is considered a treatment option. Data were analyzed using descriptive and chi-square statistics.
Response rates were as follows: overall, 40.5%; Canada, 43.0%; United States, 50.1%; United Kingdom, 38.1%; and Australasia, 38.0%. Physician demographics were as follows: 72% male and mean (?SD) age 41.7 (?8.39) years. The proportions of physicians attempting rate control as their initial strategy are United States, 94.0%; Canada, 70.7%; Australasia, 61.1%; and United Kingdom, 43.1% (p
PubMed ID
23167856 View in PubMed
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289 records – page 1 of 29.