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Ask not what you can do for us, but what we can do for you.

https://arctichealth.org/en/permalink/ahliterature191206
Source
Can J Cardiol. 2002 Feb;18(2):121, 123
Publication Type
Article
Date
Feb-2002
Author
Ruth L Collins-Nakai
Author Affiliation
Canadian Cardiovascular Society, Edmonton, Canada.
Source
Can J Cardiol. 2002 Feb;18(2):121, 123
Date
Feb-2002
Language
English
French
Publication Type
Article
Keywords
Canada
Cardiology - standards - trends
Humans
Patient Care - standards - trends
Physician's Practice Patterns
Quality Control
PubMed ID
11875579 View in PubMed
Less detail

Cardiorenal syndrome in heart failure: a cardiologist's perspective.

https://arctichealth.org/en/permalink/ahliterature156136
Source
Can J Cardiol. 2008 Jul;24 Suppl B:25B-9B
Publication Type
Article
Date
Jul-2008
Author
Peter P Liu
Author Affiliation
The Heart and Stroke/Richard Lewar Centre of Excellence, and Toronto General Research Institute, University Health Network, Toronto, Ottawa. peter.liu@utoronto.ca
Source
Can J Cardiol. 2008 Jul;24 Suppl B:25B-9B
Date
Jul-2008
Language
English
Publication Type
Article
Keywords
Canada
Cardiology - standards - trends
Cardiotonic Agents - therapeutic use
Combined Modality Therapy
Comorbidity
Diuretics - therapeutic use
Drug Therapy, Combination
Female
Heart Failure - diagnosis - drug therapy - epidemiology
Humans
Kidney Function Tests
Male
Natriuretic Peptide, Brain - therapeutic use
Prognosis
Renal Dialysis - methods
Renal Insufficiency - diagnosis - epidemiology - therapy
Risk assessment
Severity of Illness Index
Survival Analysis
Syndrome
Treatment Outcome
Abstract
One of the most important comorbidities in heart failure is renal dysfunction. Diminished estimated glomerular filtration rate is a potent predictor of cardiovascular mortality and complications. On the other hand, worsening heart failure or acute decompensated heart failure can accelerate worsening of renal function--the so-called cardiorenal syndrome. Risk factors include hypertension, diabetes, elderly age, and prior history of heart or renal failure. The pathophysiology of the cardiorenal syndrome involves intrarenal hemodynamics, transrenal perfusion pressure and systemic neurohormonal factors. Clinical management of the patient with cardiorenal syndrome includes the challenge of diuretic resistance, which may involve correcting the underlying cause, combination diuretics or diuretic infusions. The key to improved outcome is the optimization of proven heart failure therapies. The use of vasodilator therapy is the current mainstay of treatment. Nesiritide, or recombinant B-type natriuretic peptide, has courted controversy regarding its role in cardiorenal syndrome. However, data are emerging that low doses appear to be renal-protective. Other more recent strategies include ultrafiltration, vasopressin antagonists and adenosine antagonists. All of these newer modalities promise more rapid volume removal, but their ultimate impact on survival or preservation of renal function is unknown at the present time. Because of the complex nature of these patients, and the compromised outcome, it is important that cardiologists, nephrologists and internists all work together toward the common goal of protecting the patient with cardiorenal syndrome, and use the best available evidence for management.
Notes
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PubMed ID
18629386 View in PubMed
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Coronary artery bypass graft surgery and primary percutaneous coronary intervention choices in patients with similar coronary anatomy: A computer-based simulation examines the sex gap.

https://arctichealth.org/en/permalink/ahliterature147495
Source
Can J Cardiol. 2009 Nov;25(11):649-53
Publication Type
Article
Date
Nov-2009
Author
B M Meyers
T. Vira
Chi- Ming Chow
B L Abramson
Author Affiliation
St Michael's Hospital, University of Toronto, Toronto, Canada.
Source
Can J Cardiol. 2009 Nov;25(11):649-53
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary - standards - trends
Attitude of Health Personnel
Cardiology - standards - trends
Computer simulation
Confidence Intervals
Coronary Artery Bypass - standards - trends
Coronary Artery Disease - mortality - radiography - therapy
Female
Health Care Surveys
Hospitals, University
Humans
Male
Middle Aged
Ontario
Physician's Practice Patterns - standards - trends
Pilot Projects
Probability
Quality of Health Care
Questionnaires
Risk assessment
Severity of Illness Index
Sex Factors
Survival Analysis
Treatment Outcome
Abstract
Sex differences (or a 'sex gap') exist in the rates of cardiac revascularization. It was evaluated whether physician preference contributes to this difference.
To obtain information on how cardiac specialists manage male and female patients being evaluated for coronary artery disease.
A computer-based patient simulation program was developed. Six sex-matched clinical vignettes (three pairs) with uninterpreted coronary angiograms were shown to specialists, who were blinded to the purpose of the study. The sex-matched scenarios were balanced with respect to symptoms, comorbidities and coronary anatomy. Physicians were surveyed on management and rationale.
Fifty physicians were surveyed, consisting mainly of cardiologists from tertiary cardiac centres in Ontario. Among the three sexmatched pairs, the frequencies at which percutaneous coronary intervention (including drug-eluting stents), bypass surgery and medical therapy were chosen did not differ across sexes. The means for men and women, respectively, were 47% and 50% for percutaneous coronary intervention, 32% and 26% for bypass surgery, and 21% and 24% for medical treatment.
In the present pilot study, cardiac specialists chose similar rates of medical, interventional and surgical procedures independent of a patient's sex. Although large registry trials show that sex differences in management exist, the present data suggest that cardiac specialist preference is less likely to be a factor if coronary angiography was performed. Further research is required to explore the causes of sex discrepancies in cardiac care.
Notes
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PubMed ID
19898697 View in PubMed
Less detail