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2009 Canadian Hypertension Education Program recommendations: the scientific summary--an annual update.

https://arctichealth.org/en/permalink/ahliterature151166
Source
Can J Cardiol. 2009 May;25(5):271-7
Publication Type
Article
Date
May-2009
Author
Norman R C Campbell
Nadia A Khan
Michael D Hill
Guy Tremblay
Marcel Lebel
Janusz Kaczorowski
Finlay A McAlister
Richard Z Lewanczuk
Sheldon Tobe
Author Affiliation
Department of Medicine, University of Calgary, Calgary, Canada. ncampbel@ucalgary.ca
Source
Can J Cardiol. 2009 May;25(5):271-7
Date
May-2009
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Attitude to Health
Blood Pressure Determination
Canada
Combined Modality Therapy
Diet, Sodium-Restricted
Female
Health Knowledge, Attitudes, Practice
Health Promotion - organization & administration
Humans
Hypertension - diagnosis - therapy
Life Style
Male
Patient Education as Topic
Program Evaluation
Randomized Controlled Trials as Topic
Severity of Illness Index
Abstract
The present report highlights the key messages of the 2009 Canadian Hypertension Education Program (CHEP) recommendations for the management of hypertension and the supporting clinical evidence. In 2009, the CHEP emphasizes the need to improve the control of hypertension in people with diabetes. Intensive reduction in blood pressure (to less than 130/80 mmHg) in people with diabetes leads to significant reductions in mortality rates, disability rates and overall health care system costs, and may lead to improved quality of life. The CHEP recommendations continue to emphasize the important role of patient self-efficacy by promoting lifestyle changes to prevent and control hypertension, and encouraging home measurement of blood pressure. Unfortunately, most Canadians make only minor changes in lifestyle after a diagnosis of hypertension. Routine blood pressure measurement at all appropriate visits, and screening for and management of all cardiovascular risks are key to blood pressure management. Many young hypertensive Canadians with multiple cardiovascular risks are not treated with antihypertensive drugs. This is despite the evidence that individuals with multiple cardiovascular risks and hypertension should be strongly considered for antihypertensive drug therapy regardless of age. In 2009, the CHEP specifically recommends not to combine an angiotensin-converting enzyme inhibitor with an angiotensin receptor blocker in people with uncomplicated hypertension, diabetes (without micro- or macroalbuminuria), chronic kidney disease (without nephropathy [micro- or overt proteinuria]) or ischemic heart disease (without heart failure).
Notes
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PubMed ID
19417857 View in PubMed
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Acute asthma in children and adolescents: should inhaled anticholinergics be added to beta(2)-agonists?

https://arctichealth.org/en/permalink/ahliterature182008
Source
Am J Respir Med. 2003;2(2):109-15
Publication Type
Article
Date
2003
Author
Laurie H Plotnick
Francine M Ducharme
Author Affiliation
Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada. drplotnick@sympatico.ca
Source
Am J Respir Med. 2003;2(2):109-15
Date
2003
Language
English
Publication Type
Article
Keywords
Acute Disease
Administration, Inhalation
Adolescent
Adrenergic beta-Agonists - administration & dosage
Anti-Asthmatic Agents - administration & dosage
Asthma - diagnosis - drug therapy
Canada
Child
Child, Preschool
Cholinergic Antagonists - administration & dosage
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Female
Humans
Male
Prognosis
Randomized Controlled Trials as Topic
Recurrence
Severity of Illness Index
Treatment Outcome
Abstract
Children and adolescents experiencing acute exacerbations of asthma benefit from the use of beta(2)-adrenoceptor agonists (beta(2)-agonists) and systemic corticosteroids. However, there have been conflicting reports regarding the efficacy of inhaled anticholinergic agents. This article summarizes the evidence provided by randomized controlled trials studying the efficacy of adding inhaled anticholinergic agents to beta(2)-agonists in nonhospitalized children and adolescents with acute exacerbations of asthma. This systematic review of randomized controlled trials suggests that the addition of inhaled anticholinergic agents to beta(2)-agonists is beneficial in children and adolescents, particularly those with severe exacerbations of asthma. When given in repeated doses, the addition of inhaled anticholinergic agents to beta(2)-agonists improves lung function and reduces the risk of hospital admission by 25%. Several treatment regimens, namely ipratropium bromide (250 or 500 microg per dose) every 20-60 minutes for two to three doses have been tested with similar beneficial effects. The addition of a single dose of an inhaled anticholinergic agent to beta(2)-agonists improves lung function but does not prevent hospital admission. The review did not identify any beneficial effects of anticholinergic agents in children with nonsevere asthma. Use of anticholinergic agents was not associated with increase in the incidence of nausea, vomiting or tremor. In conclusion, the addition of repeated doses of an inhaled anticholinergic agent to inhaled beta(2)-agonist is indicated in the emergency room management of children and adolescents with acute asthma, particularly those with severe exacerbations.
PubMed ID
14720010 View in PubMed
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Acute heart failure: lessons learned so far.

https://arctichealth.org/en/permalink/ahliterature134305
Source
Can J Cardiol. 2011 May-Jun;27(3):284-95
Publication Type
Article
Author
Jonathan G Howlett
Author Affiliation
Department of Cardiac Sciences, University of Calgary, and Libin Cardiovascular Institute, Calgary, Alberta, Canada. jonathan.howlett@cdha.nshealth.ca
Source
Can J Cardiol. 2011 May-Jun;27(3):284-95
Language
English
Publication Type
Article
Keywords
Acute Disease
Canada
Cardiotonic Agents - therapeutic use
Diuretics - therapeutic use
Drug Therapy, Combination
Early Diagnosis
Female
Heart Failure - diagnosis - drug therapy - mortality
Hospitalization - statistics & numerical data
Humans
Male
Prognosis
Randomized Controlled Trials as Topic
Risk assessment
Severity of Illness Index
Survival Analysis
Treatment Outcome
Vasodilator Agents - therapeutic use
Abstract
Acute heart failure (AHF) affects nearly every Canadian with heart failure (HF) at least once. Despite several attempts, no medical therapies have been shown to improve the natural history of AHF. In addition, the place of diagnosis of AHF is increasingly made in the outpatient setting. In this view, AHF is a moving target, and from recent registry data and from clinical trials, 5 critical lessons regarding the syndrome of AHF emerge: (1) The period of clinical instability preceding AHF may be much longer than previously thought. (2) Refinement of tools used to aid the early and accurate diagnosis of AHF will impact patient outcomes. (3) Standard supportive care of patients with AHF includes early use of diuretics with frequent reassessment in nearly all patients and supplemental vasodilators and oxygen therapy in selected cases. (4) Patients who survive presentation of AHF continue to suffer high rates of re-presentation, death, and rehospitalization following discharge from either hospital or emergency department. (5) Interventions shown to improve patient outcomes for AHF to date are related to process of care rather than new medications or devices. This report reviews the recent literature regarding the presentation, diagnosis, management, and prognosis of AHF. Areas of future research priority are indicated and guidelines for improving treatment are provided. AHF is an important clinical area that has not been as intensively studied as chronic HF; it presents both important needs and exciting opportunities for research and innovation.
PubMed ID
21601768 View in PubMed
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Adherence and perception of medication in patients with chronic heart failure during a five-year randomised trial.

https://arctichealth.org/en/permalink/ahliterature83288
Source
Patient Educ Couns. 2006 Jun;61(3):348-53
Publication Type
Article
Date
Jun-2006
Author
Ekman Inger
Andersson Gull
Boman Kurt
Charlesworth Andrew
Cleland John G F
Poole-Wilson Philip
Swedberg Karl
Author Affiliation
The Sahlgrenska Academy, Faculty of Health and Caring Sciences, Institute of Nursing, Göteborg University, Box 457, SE 405 30, Göteborg, Sweden. inger.ekman@fhs.gu.se
Source
Patient Educ Couns. 2006 Jun;61(3):348-53
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adrenergic beta-Antagonists - therapeutic use
Aged
Aged, 80 and over
Analysis of Variance
Carbazoles - therapeutic use
Chi-Square Distribution
Chronic Disease
Female
Follow-Up Studies
Health Knowledge, Attitudes, Practice
Health status
Heart Failure, Congestive - drug therapy - psychology
Humans
Male
Metoprolol - therapeutic use
Multicenter Studies
Patient Compliance - psychology - statistics & numerical data
Patient Education
Propanolamines - therapeutic use
Questionnaires
Randomized Controlled Trials
Severity of Illness Index
Stroke Volume
Sweden
Time Factors
Abstract
OBJECTIVE: Many patients with chronic heart failure (CHF) are thought to be non-adherent to their prescribed medications. The objective was to describe perceptions about and adherence to regular medicines and study medication at baseline and study end in CHF patients participating in a clinical trial. METHODS: In the carvedilol or metoprolol European trial (COMET), patients (N = 3029) with CHF were randomised and followed during a 58-month period. Patients at some Swedish centres answered a questionnaire at baseline and study end concerning their perception of their regular heart medication and study medication. Adherence was established through estimation of drug usage. RESULTS: In the Swedish sub-study, 302 patients responded once to the questionnaire while 107 patients responded both at baseline and at follow-up. At baseline, 94% of the patients stated that they believed that the study medication would make them feel better and 82% believed that their regular heart medication would do so. During the study, patients' belief in their regular cardiac medication significantly increased. Lack of belief in medication at the start of the study was a strong predictor of withdrawal from the trial (64% versus 6.8%; p
PubMed ID
16139468 View in PubMed
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Alcohol consumption and the risk of incident atrial fibrillation among people with cardiovascular disease.

https://arctichealth.org/en/permalink/ahliterature120233
Source
CMAJ. 2012 Nov 6;184(16):E857-66
Publication Type
Article
Date
Nov-6-2012
Author
Yan Liang
Andrew Mente
Salim Yusuf
Peggy Gao
Peter Sleight
Jun Zhu
Robert Fagard
Eva Lonn
Koon K Teo
Author Affiliation
Hamilton Health Sciences,McMaster University, Hamilton, Ontario, Canada. fwliangyan@yahoo.com.cn
Source
CMAJ. 2012 Nov 6;184(16):E857-66
Date
Nov-6-2012
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Alcohol Drinking - blood - epidemiology
Atrial Fibrillation - diagnosis - epidemiology
Binge Drinking - blood - epidemiology
Cardiovascular Diseases - diagnosis - epidemiology
Comorbidity
Confidence Intervals
Female
Humans
Incidence
Male
Middle Aged
Multivariate Analysis
Ontario - epidemiology
Proportional Hazards Models
Randomized Controlled Trials as Topic
Risk assessment
Severity of Illness Index
Sex Distribution
Survival Rate
Abstract
Moderate alcohol consumption may reduce cardiovascular events, but little is known about its effect on atrial fibrillation in people at high risk of such events. We examined the association between moderate alcohol consumption and the risk of incident atrial fibrillation among older adults with existing cardiovascular disease or diabetes.
We analyzed data for 30 433 adults who participated in 2 large antihypertensive drug treatment trials and who had no atrial fibrillation at baseline. The patients were 55 years or older and had a history of cardiovascular disease or diabetes with end-organ damage. We classified levels of alcohol consumption according to median cut-off values for low, moderate and high intake based on guidelines used in various countries, and we defined binge drinking as more than 5 drinks a day. The primary outcome measure was incident atrial fibrillation.
A total of 2093 patients had incident atrial fibrillation. The age- and sex-standardized incidence rate per 1000 person-years was 14.5 among those with a low level of alcohol consumption, 17.3 among those with a moderate level and 20.8 among those with a high level. Compared with participants who had a low level of consumption, those with higher levels had an increased risk of incident atrial fibrillation (adjusted hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.04-1.26, for moderate consumption; 1.32, 95% CI 0.97-1.80, for high consumption). Results were similar after we excluded binge drinkers. Among those with moderate alcohol consumption, binge drinkers had an increased risk of atrial fibrillation compared with non-binge drinkers (adjusted HR 1.29, 95% CI 1.02-1.62).
Moderate to high alcohol intake was associated with an increased incidence of atrial fibrillation among people aged 55 or older with cardiovascular disease or diabetes. Among moderate drinkers, the effect of binge drinking on the risk of atrial fibrillation was similar to that of habitual heavy drinking.
Notes
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PubMed ID
23027910 View in PubMed
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Anaemia, but not iron deficiency, is associated with clinical symptoms and quality of life in patients with severe heart failure and palliative home care: A substudy of the PREFER trial.

https://arctichealth.org/en/permalink/ahliterature294209
Source
Eur J Intern Med. 2017 Dec; 46:35-40
Publication Type
Journal Article
Date
Dec-2017
Author
Kurt Boman
Mona Olofsson
Ann-Charlotte R Bergman
Margareta Brännström
Author Affiliation
Research Unit, Department of Medicine, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. Electronic address: kurt.boman@vll.se.
Source
Eur J Intern Med. 2017 Dec; 46:35-40
Date
Dec-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Aged, 80 and over
Anemia - complications
Anxiety - epidemiology
Depression - epidemiology
Female
Heart Failure - mortality
Home Care Services
Hospitalization - statistics & numerical data
Humans
Iron - deficiency
Linear Models
Logistic Models
Male
Middle Aged
Palliative Care
Prospective Studies
Quality of Life
ROC Curve
Randomized Controlled Trials as Topic
Severity of Illness Index
Sweden
Abstract
To explore the relationships between anaemia or iron deficiency (ID) and symptoms, quality of life (QoL), morbidity, and mortality.
A post-hoc, non-prespecified, explorative substudy of the prospective randomized PREFER trial. One centre study of outpatients with severe HF and palliative need managed with advanced home care. Associations between anaemia, ID, and the Edmonton Symptom Assessment Scale (ESAS), Euro QoL (EQ-5D), Kansas City Cardiomyopathy Questions (KCCQ) were examined only at baseline but at 6months for morbidity and mortality.
Seventy-two patients (51 males, 21 females), aged 79.2±9.1years. Thirty-nine patients (54%) had anaemia and 34 had ID (47%). Anaemia was correlated to depression (r=0.37; p=0.001), anxiety (r=0.25; p=0.04), and reduced well-being (r=0.26; p=0.03) in the ESAS; mobility (r=0.33; p=0.005), pain/discomfort (r=0.27; p=0.02), and visual analogue scale of health state (r=-0.28; p=0.02) in the EQ-5D; and physical limitation (r=-0.27; p=0.02), symptom stability; (r=-0.43; p
PubMed ID
28899603 View in PubMed
Less detail

Are Canadian guidelines for cholesterol lowering in high-risk patients optimal?

https://arctichealth.org/en/permalink/ahliterature176367
Source
Can J Cardiol. 2005 Jan;21(1):85-90
Publication Type
Article
Date
Jan-2005
Author
David H Fitchett
Lawrence A Leiter
Jean-Claude Tardif
Shaun Goodman
Anatoly Langer
Author Affiliation
Canadian Heart Research Centre, Toronto, Ontario. fitchettd@smh.toronto.on.ca
Source
Can J Cardiol. 2005 Jan;21(1):85-90
Date
Jan-2005
Language
English
Publication Type
Article
Keywords
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Heptanoic Acids - administration & dosage
Humans
Hypercholesterolemia - diagnosis - drug therapy
Hypolipidemic Agents - administration & dosage
Male
Maximum Tolerated Dose
Practice Guidelines as Topic
Pravastatin - administration & dosage
Prognosis
Pyrroles - administration & dosage
Quebec
Randomized Controlled Trials as Topic
Risk assessment
Sensitivity and specificity
Severity of Illness Index
Treatment Outcome
Abstract
Recent Canadian lipid guidelines recommend that all high-risk patients receive medication to reduce low density lipoprotein cholesterol (LDL-C) below 2.5 mmol/L. The recently published Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) and Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE IT) studies compared strategies of cholesterol lowering with atorvastatin 80 mg versus pravastatin 40 mg. Atorvastatin halted the progression of atherosclerosis (whereas atherosclerosis progressed in the patients receiving pravastatin), and resulted in a 16% reduction in the primary composite end point (all-cause death, myocardial infarction, unstable angina, revascularization and stroke) compared with the pravastatin-treated group. In the PROVE IT trial, LDL-C was reduced by atorvastatin to 1.6 mmol/L and by pravastatin to 2.46 mmol/L. Although lower LDL-C levels are one explanation for the improved outcomes with atorvastatin, pleiotropic differences of the two statins, such as their effects on inflammation and coagulation, cannot be excluded. Until trials are completed that compare outcomes from LDL-C lowering to different targets with the same statin, it is premature to recommend changes to the current Canadian guidelines. However, future recommendations may suggest much lower LDL-C targets than those currently recommended.
PubMed ID
15685308 View in PubMed
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Brain natriuretic peptide and cardiac resynchronization therapy in patients with mildly symptomatic heart failure.

https://arctichealth.org/en/permalink/ahliterature112755
Source
Circ Heart Fail. 2013 Sep 1;6(5):998-1004
Publication Type
Article
Date
Sep-1-2013
Author
Andrew Brenyo
Alon Barsheshet
Mohan Rao
David T Huang
Wojciech Zareba
Scott McNitt
W Jackson Hall
Derick R Peterson
Scott D Solomon
Arthur J Moss
Ilan Goldenberg
Author Affiliation
Division of Cardiology, and the Department of Biostatistics, University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
Source
Circ Heart Fail. 2013 Sep 1;6(5):998-1004
Date
Sep-1-2013
Language
English
Publication Type
Article
Keywords
Aged
Biological Markers - blood
Canada
Cardiac Resynchronization Therapy - adverse effects - mortality
Cardiac Resynchronization Therapy Devices
Chi-Square Distribution
Defibrillators, Implantable
Electric Countershock - adverse effects - instrumentation - mortality
Europe
Female
Heart Failure - blood - diagnosis - mortality - therapy
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multicenter Studies as Topic
Multivariate Analysis
Natriuretic Peptide, Brain - blood
Proportional Hazards Models
Randomized Controlled Trials as Topic
Retrospective Studies
Risk factors
Severity of Illness Index
Time Factors
Treatment Outcome
United States
Up-Regulation
Abstract
There are limited data on the prognostic implications of brain natriuretic peptide (BNP) assessment in patients with mildly symptomatic heart failure (HF) who receive cardiac resynchronization therapy with a defibrillator (CRT-D).
The effect of elevated baseline and 1-year BNP levels (dichotomized at the upper tertile BNP of 120 pg/mL) on the risk of HF or death was assessed among the cohort of 1197 patients with baseline BNP data enrolled in MADIT (Multicenter Automated Defibrillator Implantation Trial)-CRT. Elevated baseline BNP was associated with a significant 68% (P=0.007) and 58% (P=0.02) increase in the risk of HF or death among MADIT-CRT patients allocated to CRT-D and implantable cardioverter defibrillator-only therapy, respectively. At 1 year of follow-up, patients allocated to CRT-D displayed significantly greater reductions in BNP (26% reduction) levels compared with implantable cardioverter defibrillator-only patients (8% increase; P=0.005). Patients with CRT-D in whom 1-year BNP levels were reduced or remained low experienced a significantly lower risk of subsequent HF or death as compared with patients in whom 1-year BNP levels were high. Similarly, the echocardiographic response to CRT-D was highest among those who maintained low BNP levels or in whom BNP level at 1-year was reduced.
Our findings suggest that assessment of baseline and follow-up BNP provides important prognostic implications in patients with mildly symptomatic HF who receive CRT.
PubMed ID
23801020 View in PubMed
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58 records – page 1 of 6.