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Discharge heart rate and 1-year clinical outcomes in heart failure patients with atrial fibrillation

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Chinese Medical Journal 2022年第1期135卷 52-62页

作者： Fuwei Xing Xin Zheng Lihua Zhang Shuang Hu Xueke Bai Danli Hu Bing Li Jing Li Department of Cardiology The First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouGuangdong 510080China National clinical Research Center for Cardiovascular Diseases NHC Key Laboratory of Clinical Research for Cardiovascular MedicationsState Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeNational Center for Cardiovascular DiseasesBeijing 100037China Department of Cardiology The Third Hospital of Jilin UniversityChangchunJilin 130031China

Background: The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF ***: In this analysis, we enrolled 1760 hospitalized HF patients with AF from the China Patient-centered evaluative Assessment of Cardiac Events Prospective Heart Failure study from August 2016 to May 2018. Patients were categorized into three groups with low (<65 beats per minute [bpm]), moderate (65-85 bpm), and high (≥86 bpm) heart rate measured at *** proportional hazard models were employed to explore the association between heart rate and 1-year primary outcome, which was defined as a composite outcome of all-cause death and HF ***: Among 1760 patients, 723 (41.1%) were women, the median age was 69 (interquartile range [IQR]: 60-77) years, median discharge heart rate was 75 (IQR: 69-84) bpm, and 934 (53.1%) had an LVEF <50%. During 1-year follow-up, a total of 792 (45.0%) individuals died or had at least one HF hospitalization. After adjusting for demographic characteristics, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the groups with low (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05-1.68,P = 0.020) and high (HR: 1.34, 95% CI: 1.07-1.67,P = 0.009) heart rate were associated with a higher risk of 1-year primary outcome compared with the moderate group. A significant interaction between discharge heart rate and LVEF for the primary outcome was observed (P for interaction was 0.045). Among the patients with LVEF ≥50%, only those with high heart rate were associated with a higher risk of primary outcome compared with the g

关键词： Atrial fibrillation Heart failure Heart rate Left ventricular ejection fraction

Physician-Rated Utility of Procedure Videos for Teaching Procedures in the Emergency Department, Overall and during Emergency Department Crowding

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International Journal of clinical Medicine 2012年第7期3卷 758-764页

作者： Clare L. Atzema R. Alexandra Stefan Refik Saskin Greg Michlik Peter C. Austin Department of Emergency Services Sunnybrook Health Sciences Centre Toronto Canada Division of Emergency Medicine Department of Medicine University of Toronto Toronto Canada The Institute for clinical evaluative sciences Toronto Canada

Background: Real-time use of procedure videos as educational tools has not been studied. We sought to determine whether viewing a video of a medical procedure prior to procedure performance in the emergency department improves the quality of teaching of procedures, and whether videos are particularly beneficial during periods of emergency department crowding. Methods: In this single-centre, prospective, before and after study standardized data collection forms were completed by both trainees and supervising emergency physicians (EPs) at the end of each emergency department shift in the before (August 2008-March 2009) and after (August 2009-March 2010) phase. Online procedure videos were introduced on emergency department computers in the after phase. The primary outcome measure was EP rating of the quality of teaching provided (5-point Likert scale). The interaction between crowding and videos was also assessed, to determine whether videos provide a specific additional benefit during periods of emergency department crowding. Results: There were 1159 procedures performed by 192 trainees. Median procedures performed per shift was 1.0 (IQR 0 - 2.0). Mean EP rating of teaching provided was significantly higher in the group that viewed videos, at 4.2 versus 3.7 (p 0.001). In the adjusted analysis, EP ratings increased by 0.5 with a video (p 0.001), while the odds of a score of 5.0 were 2.2 times greater if a video was viewed (p = 0.03). The interaction of crowding and procedure videos was not significant (the use of videos increased the average score by 0.24 in times of crowding compared to times of non-crowding, p = 0.19). Conclusions: Use of procedural videos was associated with EP perception of improved quality of teaching provided around procedures. While EPs rated the quality of their teaching as improved overall, the effect of videos on teaching quality was the same in crowded settings as it was in non-crowded setting.

关键词： Teaching Education Procedures Emergency Department Video

心脏性和非心脏性病症对除颤器植入后存活率的影响

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世界核心医学期刊文摘（心脏病学分册） 2007年第10期3卷 51-52页

作者： Lee D.S. Austin P.C. 孙凯 Institute for clinical evaluative sciences TorontoCanada Dr.

目的:调查接受埋藏式心脏复律除颤器(ICD)患者的预后以及年龄、性别和并存病对存活率的影响。背景:年龄、性别和并存病可能显著影响ICD植入者的预后。方法:利用加拿大安大略省全省数据库。

关键词：心脏性性别病症并存病

Gender differences in mental health service utilization among respondents reporting depression in a national health survey

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Health 2013年第10期5卷 1561-1571页

作者： Katherine L. W. Smith Flora I. Matheson Rahim Moineddin James R. Dunn Hong Lu John Cairney Richard H. Glazier Centre for Research on Inner City Health Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital Toronto Canada Institute for clinical evaluative sciences Toronto Canada

This study examined whether people who self-reported depression sought mental health treatment in the year after being interviewed, and how gender affected utilization. Depression data were obtained from the Canadian Community Health Survey (2000-01), and linked to medical records in Ontario (n = 24,677). Overall, women had higher rates of mental health service utilization, but there were no gender differences in rates of specialist care. The gender difference in mental health contact was greater for those without depression, as opposed to those with depression. Among those without depression, women were significantly more likely than men to use mental health services;however, rates were similar for women and men with depression. This finding suggests that men may be more likely than women to delay seeing a doctor for minor mental health concerns, but will seek help once a problem reaches a threshold.

关键词： Depression Gender Mental Health Service Utilization Survey Medical Records

Determining the hospital cost of anterior epistaxis treatment modalities at a Canadian tertiary care centre

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2019年第4期5卷 193-199页

作者： Harrish Nithianandan Kednapa Thavorn Fatmahalzahra Banaz Kristian Macdonald Andrea Lasso Shaun J.Kilty Faculty of Medicine University of OttawaOttawaOntarioCanada Ottawa Hospital Research Institute(OHRI) OttawaOntarioCanada School of Epidemiology and Public Health University of OttawaOttawaOntarioCanada Institute for clinical and evaluative sciences ICES uOttawaOttawaOntarioCanada Department of Otolaryngology-Head and Neck Surgery The University of OttawaOttawaOntarioCanada Dr.S.Kilty Medicine Prof.Corp. OttawaONCanada

Objective:To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in *** and methods:A cost analysis was conducted based on a retrospective review of Emergency Department visits from January 2012 to May 2014.A consecutive sample of adult patients with a diagnosis of anterior epistaxis was *** epistaxis was managed via one of:Nasal clip,Merocel(R),Silver Nitrate cautery,Vaseline packing,other treatment or no *** the direct and indirect hospital costs(SCDN)for anterior epistaxis treatment were calculated from the hospital's *** linear models were used to assess the association between treatment modalities and total hospital costs while controlling for potential confounding ***:Three hundred and fifty-three patients(49%female)with a mean age of(69.9±18.5)years were included in the *** median(interquartile ranges)costs of treatment ranged from CS227.83(CS167.96,CS328.69)for observation to CS763.98(CS632.25,CS830.23)for Merocel(R).The overall median total hospital costs incurred across all modalities was CS566.24(CS459.61,CS753.46)for the management of anterior *** Nitrate,nasal clip,and observation were statistically associated with a lower cost when compared to Merocel(R)(P<0.001)even after potential confounding factors were ***:Our results show wide difference in the hospital cost of epistaxis across treatment *** cost estimates can help inform future economic evaluation studies aiming to guide the allocation of health care resources for patients with epistaxis.

关键词： Anterior epistaxis Nasal packing Cautery Silver nitrate Hospital costs

Beta-blockers and 1-year clinical outcomes in hospitalized heart failure patients with atrial fibrillation

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Journal of Geriatric Cardiology 2021年第9期18卷 728-738页

作者： Fu-Wei XING Li-Hua ZHANG Hai-Bo ZHANG Xue-Ke BAI Dan-Li HU Xin ZHENG Jing LI National clinical Research Center for Cardiovascular Diseases NHC Key Laboratory of Clinical Research for Cardiovascular MedicationsState Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeNational Center for Cardiovascular DiseasesBeijingChina

OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ejection fraction(LVEF)*** We enrolled hospitalized HF patients with AF from China Patient-centered evaluative Assessment of Cardiac Events Prospective Heart Failure *** proportional hazard regression models were employed to calculate hazard ratio of *** primary outcome was all-cause *** Among 1762 HF patients with AF(756 women[41.4%]),1041(56%)received beta-blockers at discharge and 1272(72.2%)had an LVEF>40%.During one year follow up,all-cause death occurred in 305(17.3%),cardiovascular death occurred in203 patients(11.5%),and rehospitalizations for HF occurred in 622 patients(35.2%).After adjusting for demographic characteristics,social economic status,smoking status,medical history,anthropometric characteristics,and medications used at discharge,the use of beta-blockers at discharge was not associated with all-cause death[hazard ratio(HR):0.86;95%Confidence Interval(CI):0.65-1.12;P=0.256],cardiovascular death(HR:0.76,95%CI:0.52-1.11;P=0.160),or the composite outcome of all-cause death and HF rehospitalization(HR:0.97,95%CI:0.82-1.14;P=0.687)in the entire *** were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death,cardiovascular death,or composite *** the adjusted models,the use of beta-blockers at discharge was not associated with all-cause death,cardiovascular death,or composite outcome across the different levels of LVEF:reduced(clinical outcomes,regardless of LVEF.

关键词： Beta-blockers and 1-year clinical outcomes in hospitalized heart failure patients with atrial fibrillation

急性心肌梗死医疗保险患者介入治疗与药物治疗强度区域变化对远期预后的影响

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美国医学会杂志（中文版） 2005年第4期24卷 195-203页

作者： Therese A. Stukel F. Lee Lucas David E. Wennberg 王淑敏（译）胡大一（校） Center for the evaluative clinical sciences Dartmouth Medical School Hanover NH Institute for clinical evaluative sciences TorontoOntario Department of Health Policy Managernent and Evaluation Faculty of Medicine University of Toronto Toronto Center for Outcomes Research and Evaluation Maine Medical Center Portland

背景：与药物治疗比较，急性心肌梗死（acute myocardial infarction，AMI）患者介入治疗强度存在显著的地区差异，这种差异在卫生及政策方面的意义还不清楚。目标：评价接受积极治疗患者的相关临床特征；评估居住于积极采取介入治疗策... 详细信息

背景：与药物治疗比较，急性心肌梗死（acute myocardial infarction，AMI）患者介入治疗强度存在显著的地区差异，这种差异在卫生及政策方面的意义还不清楚。目标：评价接受积极治疗患者的相关临床特征；评估居住于积极采取介入治疗策略地区的AMI患者与居住于积极采取药物治疗策略地区的患者相比，是否具有更好的远期生存率。设计、地点及患者：在158831例老年医疗保险患者中进行该项全国性队列研究。患者于1994～1995年因首次发生并确诊AMI而入院，随访7年（平均随访3．6年）。根据居住地区介入治疗（30天内接受心导管手术）与药物治疗（出院时对适宜的患者应用β-阻滞剂）强度进行分析。基线资料来自心血管协作项目，并与医疗保险管理资料联合。主要观察指标：7年随访期间的远期生存率。结果：各地区AMI基线严重程度相似。在所有地区，较年轻、较健康的患者与年老的高危患者相比，更可能接受介入治疗和药物治疗。更多实施介入治疗的地区具备更多的心脏导管室条件；这些地区的患者无论年龄、临床指征还是危险特点如何，均更多接受介入治疗。介入和药物治疗策略采用率最高的地区与介入和药物治疗采用率最低的地区，两者未经校正的7年绝对生存率差异为6．2％。对于ST抬高和非ST抬高AMI患者，其生存率随着地区介入治疗和药物治疗强度的增高而升高。在药物治疗比例较高的地区，随着介入治疗的增加，相应的生存率提高很少甚或没有提高。结论：老年医疗保险AMI患者接受较为积极的药物治疗对改善人群的生存有益。

关键词：药物治疗策略老年医疗保险急性心肌梗死治疗患者介入治疗治疗强度远期预后远期生存率非ST抬高

子痫前期及大脑二者关系可能与后期痴呆相关,需要深入研究

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英国医学杂志中文版 2019年第5期22卷 249-250页

作者： Joel G Ray Alison L Park 李洁(译) 毛晨晖(校) Departments of Medicine Health Policy Management and Evaluationand Obstetrics and GynecologySt Michael' s HospitalTorontoONCanada Institute for clinical evaluative sciences University of TorontoTorontoONCanada 北京协和医院神经科

在一篇相关的文章里(doi:10.1136/bmj.k4109,摘要见本期第251页),Basil及他的同事研究伴或不伴子痫前期病史的女性患痴呆的风险在中位数为21.1年的随访过后,他们报道至少一次妊娠中患有子痫前期的女性相较于没有此病史的女性患有血管性... 详细信息

在一篇相关的文章里(doi:10.1136/bmj.k4109,摘要见本期第251页),Basil及他的同事研究伴或不伴子痫前期病史的女性患痴呆的风险在中位数为21.1年的随访过后,他们报道至少一次妊娠中患有子痫前期的女性相较于没有此病史的女性患有血管性痴呆的风险高岀3.5倍(共105例),患有阿尔茨海默病的风险高1.5倍(676例),患有其他或非特异性痴呆的风险高1.4倍(947例)。

关键词：血管性痴呆子痫前期大脑阿尔茨海默病非特异性风险中位数女性

Percutaneous coronary interventions in the elderly:a 10-year experience in Northern New England

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Journal of Geriatric Cardiology 2005年第1期2卷 17-22页

作者： David J.Malenka James T.DeVries Samuel J.Shubrooks for the Northern New England Cardiovascular Disease Study Group Section of Cardiology Dartmouth-Hitchcock Medical Center LebanonNH Center for the evaluative clinical sciences Dartmouth Medical SchoolHanoverNHUSA for the Northern New England Cardiovascular Disease Study Group Section of Cardiology Dartmouth-Hitchcock Medical Center LebanonNHUSA for the Northern New England Cardiovascular Disease Study Group Division of Cardiology Beth Israel-Deaconess Medical Center BostonMAUSA Jr

Background There is a paucity of information available for clinical decision making applying to the elderly patient population. Therefore, data of percutaneous coronary interventions (PCI) including demographic information on the elderly patients, procedural practices, and outcomes are needed. Objectives and Methods From consecutive PCIs of participating institutions, demographics data, clinical, angiographic success and adverse clinical outcomes were collected. Standard statistical methods were used to compare crude differences in patient and procedural characteristics across age groups. Results At baseline, the prevalence of comorbid conditions ( renal failure and heart failure) increased with age. Unstable angina or a non-ST elevation MI were the most common indications for PCI across all age groups. Fewer patients ≥ 80 years old were undergoing primary PCI and older patients were somewhat less likely to receive a Ⅱb/Ⅲa receptor blocker. Slightly more patients ≥ 80 years old underwent a 2-vessel PCI ( consistent with them having more multivessel disease) and these patients were more likely to have an intervention on a Type C lesion. Compared to patients ＜ 50 years old, those aged ≥ 70 years old had a significantly increased risk of death, MI, stroke, or vascular complications at the access site. Conclusions This study suggests increasing age is associated with increasing risk for an adverse outcome following PCI. This is in part attributable to case-mix but likely, also related to the changing physiology of aging. Despite the increased risk of the procedure, the clinical success rate for PCI is quite high and makes it a reasonable alternative for the treatment of CAD in the elderly.

关键词： coronary artery disease elderly percutaneous coronary intervention