Pub Date : 2024-05-01DOI: 10.1016/j.cjco.2023.11.024
Laurie-Anne Boivin-Proulx MD, MSc , Kevin R. Bainey MD, MSc , Guillaume Marquis-Gravel MD , Michelle M. Graham MD
Background
Balancing the effects of dual antiplatelet therapy (DAPT) in the era of potent purinergic receptor type Y, subtype 12 (P2Y12) inhibitors remains a challenge in the management of acute coronary syndrome (ACS).
Methods
We conducted a systematic review and meta-analysis following a 2-stage process consisting of searching for systematic reviews published between 2019 and November 2022. We included randomized controlled trials (RCTs) of ACS patients treated with percutaneous coronary intervention comparing (i) ticagrelor- vs prasugrel-based DAPT and (ii) P2Y12 inhibitor de-escalation strategies. Outcomes of interest were major adverse cardiovascular events (MACE), all-cause death, stent thrombosis, and major bleeding. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model.
Results
Eight RCTs (n = 5571) compared ticagrelor to prasugrel. Ticagrelor was associated with an increased risk of MACE compared to prasugrel (RR 1.23, 95% CI 1.01-1.49, moderate certainty), without significant differences in death, stent thrombosis, or major bleeding. In 2 RCTs (n = 3343) comparing clopidogrel-based DAPT de-escalation after 1 month to potent P2Y12 inhibitor–based DAPT continuation, clopidogrel de-escalation did not significantly alter the incidence of MACE, death, or stent thrombosis, but reduced that of major bleeding (RR 0.51, 95% CI 0.28-0.92, high certainty). The effect of prasugrel dose de-escalation was inconclusive for all outcomes based on one trial.
Conclusions
Ticagrelor was associated with an increase in MACE compared with prasugrel, based on low-certainty evidence, whereas de-escalation to clopidogrel after 1 month of potent P2Y12 inhibitor was associated with a decrease in incidence of major bleeding without increasing thrombotic outcomes in ACS patients post-percutaneous coronary intervention.
{"title":"Potent P2Y12 Inhibitor Selection and De-escalation Strategies in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: Systematic Review and Meta-analysis","authors":"Laurie-Anne Boivin-Proulx MD, MSc , Kevin R. Bainey MD, MSc , Guillaume Marquis-Gravel MD , Michelle M. Graham MD","doi":"10.1016/j.cjco.2023.11.024","DOIUrl":"10.1016/j.cjco.2023.11.024","url":null,"abstract":"<div><h3>Background</h3><p>Balancing the effects of dual antiplatelet therapy (DAPT) in the era of potent purinergic receptor type Y, subtype 12 (P2Y<sub>12</sub>) inhibitors remains a challenge in the management of acute coronary syndrome (ACS).</p></div><div><h3>Methods</h3><p>We conducted a systematic review and meta-analysis following a 2-stage process consisting of searching for systematic reviews published between 2019 and November 2022. We included randomized controlled trials (RCTs) of ACS patients treated with percutaneous coronary intervention comparing (i) ticagrelor- vs prasugrel-based DAPT and (ii) P2Y<sub>12</sub> inhibitor de-escalation strategies. Outcomes of interest were major adverse cardiovascular events (MACE), all-cause death, stent thrombosis, and major bleeding. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model.</p></div><div><h3>Results</h3><p>Eight RCTs (n = 5571) compared ticagrelor to prasugrel. Ticagrelor was associated with an increased risk of MACE compared to prasugrel (RR 1.23, 95% CI 1.01-1.49, moderate certainty), without significant differences in death, stent thrombosis, or major bleeding. In 2 RCTs (n = 3343) comparing clopidogrel-based DAPT de-escalation after 1 month to potent P2Y<sub>12</sub> inhibitor–based DAPT continuation, clopidogrel de-escalation did not significantly alter the incidence of MACE, death, or stent thrombosis, but reduced that of major bleeding (RR 0.51, 95% CI 0.28-0.92, high certainty). The effect of prasugrel dose de-escalation was inconclusive for all outcomes based on one trial.</p></div><div><h3>Conclusions</h3><p>Ticagrelor was associated with an increase in MACE compared with prasugrel, based on low-certainty evidence, whereas de-escalation to clopidogrel after 1 month of potent P2Y<sub>12</sub> inhibitor was associated with a decrease in incidence of major bleeding without increasing thrombotic outcomes in ACS patients post-percutaneous coronary intervention.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 5","pages":"Pages 677-688"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X23003451/pdfft?md5=19196f5ae31d609862c2de921ace3dd0&pid=1-s2.0-S2589790X23003451-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138614604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.cjco.2024.01.008
Alexander C. Egbe MD, MPH, MS , William R. Miranda MD , C. Charles Jain MD , Luke J. Burchill MBBS, PhD , Omar Abozied MBBS , Marwan H. Ahmed MBBS , Maan Jokhadar MD , Snigdha Karnakoti MBBS , Heidi M. Connolly MD
Background
Data are limited about the effect (or lack thereof) of sex on clinical outcomes in adults with coarctation of the aorta (COA). The purpose of this study was to compare atherosclerotic cardiovascular disease (ASCVD) risk profile, blood pressure (BP) data, echocardiographic indices, and mortality between men and women with COA.
Methods
Retrospective study of adults with COA, and no associated left-sided obstructive lesions, who received care at Mayo Clinic (2003-2022). ASCVD risk profile was assessed as the prevalence of hypertension, hyperlipidemia, type 2 diabetes, obesity, smoking history, and coronary artery disease. A 24-hour BP monitor was used to assess daytime and nighttime BP and calculate nocturnal dipping.
Results
Of 621 patients with isolated COA, 375 (60%) were men, and 246 (40%) were women. Women had similar ASCVD risk profile and daytime BP as men. However, women had less nocturnal dipping (7 ± 5 mm Hg vs 16 ± 7 mm Hg, P < 0.001), higher pulmonary artery mean pressure (23 mm Hg [interquartile range: 16-31] vs 20 mm Hg [interquartile range: 15-28], P = 0.04), and higher pulmonary vascular resistance index (3.41 ± 1.14 WU · m2 vs 3.02 ± 0.76 WU · m2, P = 0.006). Female sex was associated with all-cause mortality (adjusted hazard ratio 1.26, 95% confidence interval 1.04-1.94) and cardiovascular mortality (adjusted hazard ratio 1.38, 95% confidence interval 1.09-2.18).
Conclusions
Women had a higher risk of both cardiovascular mortality and all-cause mortality compared to the risks in men. This difference may be related to the higher-than-expected ASCVD risk factors, abnormal nocturnal blood pressure, and pulmonary hypertension observed in women in this cohort. Further studies are required to identify optimal measures to address these risk factors.
背景关于性别对患有主动脉共动脉症（COA）的成人临床预后的影响（或不影响）的数据很有限。本研究的目的是比较COA患者中男性和女性的动脉粥样硬化性心血管疾病（ASCVD）风险概况、血压（BP）数据、超声心动图指数和死亡率。方法对在梅奥诊所接受治疗（2003-2022年）的患有COA且无相关左侧阻塞性病变的成人进行回顾性研究。ASCVD风险状况是指高血压、高脂血症、2型糖尿病、肥胖、吸烟史和冠状动脉疾病的患病率。结果 在621名孤立性COA患者中，男性375人（60%），女性246人（40%）。女性的 ASCVD 风险状况和日间血压与男性相似。然而，女性夜间血压下降较少（7 ± 5 mm Hg vs 16 ± 7 mm Hg，P < 0.001），肺动脉平均压力较高（23 mm Hg [四分位间范围：16-31] vs 20 mm Hg [四分位间范围：15-28]，P = 0.04），肺血管阻力指数较高（3.41 ± 1.14 WU - m2 vs 3.02 ± 0.76 WU - m2，P = 0.006）。女性性别与全因死亡率（调整后危险比为 1.26，95% 置信区间为 1.04-1.94）和心血管死亡率（调整后危险比为 1.38，95% 置信区间为 1.09-2.18）相关。这一差异可能与该队列中观察到的女性ASCVD风险因素、夜间血压异常和肺动脉高压高于预期有关。要确定应对这些风险因素的最佳措施，还需要进一步的研究。
{"title":"Sex Differences in Outcomes of Adults With Isolated Coarctation of the Aorta","authors":"Alexander C. Egbe MD, MPH, MS , William R. Miranda MD , C. Charles Jain MD , Luke J. Burchill MBBS, PhD , Omar Abozied MBBS , Marwan H. Ahmed MBBS , Maan Jokhadar MD , Snigdha Karnakoti MBBS , Heidi M. Connolly MD","doi":"10.1016/j.cjco.2024.01.008","DOIUrl":"https://doi.org/10.1016/j.cjco.2024.01.008","url":null,"abstract":"<div><h3>Background</h3><p>Data are limited about the effect (or lack thereof) of sex on clinical outcomes in adults with coarctation of the aorta (COA). The purpose of this study was to compare atherosclerotic cardiovascular disease (ASCVD) risk profile, blood pressure (BP) data, echocardiographic indices, and mortality between men and women with COA.</p></div><div><h3>Methods</h3><p>Retrospective study of adults with COA, and no associated left-sided obstructive lesions, who received care at Mayo Clinic (2003-2022). ASCVD risk profile was assessed as the prevalence of hypertension, hyperlipidemia, type 2 diabetes, obesity, smoking history, and coronary artery disease. A 24-hour BP monitor was used to assess daytime and nighttime BP and calculate nocturnal dipping.</p></div><div><h3>Results</h3><p>Of 621 patients with isolated COA, 375 (60%) were men, and 246 (40%) were women. Women had similar ASCVD risk profile and daytime BP as men. However, women had less nocturnal dipping (7 ± 5 mm Hg vs 16 ± 7 mm Hg, <em>P</em> < 0.001), higher pulmonary artery mean pressure (23 mm Hg [interquartile range: 16-31] vs 20 mm Hg [interquartile range: 15-28], <em>P</em> = 0.04), and higher pulmonary vascular resistance index (3.41 ± 1.14 WU · m<sup>2</sup> vs 3.02 ± 0.76 WU · m<sup>2</sup>, <em>P</em> = 0.006). Female sex was associated with all-cause mortality (adjusted hazard ratio 1.26, 95% confidence interval 1.04-1.94) and cardiovascular mortality (adjusted hazard ratio 1.38, 95% confidence interval 1.09-2.18).</p></div><div><h3>Conclusions</h3><p>Women had a higher risk of both cardiovascular mortality and all-cause mortality compared to the risks in men. This difference may be related to the higher-than-expected ASCVD risk factors, abnormal nocturnal blood pressure, and pulmonary hypertension observed in women in this cohort. Further studies are required to identify optimal measures to address these risk factors.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 5","pages":"Pages 759-767"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24000441/pdfft?md5=eacd12a248566ecb345a82ff1a1b56a5&pid=1-s2.0-S2589790X24000441-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nordic walking (NW) has several potential benefits for individuals with cardiovascular (CV) disease, type 2 diabetes, and obesity and/or overweight. NW improves cardiovascular health, including exercise capacity and blood pressure control. NW enhances glycemic control and insulin sensitivity in diabetes, and aids in weight management and body composition improvement. NW offers additional advantages, such as improvement in muscular strength, joint mobility, physical activity levels, and psychological well-being.
Methods
This open-label study with 3 arms will aim to evaluate the efficacy, safety, and adherence to exercise prescription in obese and/or overweight diabetic patients with CV complications. The primary objective will be to assess the CV performance of participants after a 6-month and a 12-month follow-up period, following a 3-month NW intervention, compared with standard rehabilitation, and with cardiological counseling (control group) training lasting 3 months.
Results
The results of the study will provide valuable insights into the comparative effectiveness of a NW intervention vs standard rehabilitation and control group training in improving CV performance in obese and/or overweight diabetic patients with CV complications. Additionally, safety and adherence data will help inform the feasibility and sustainability of the exercise prescription over an extended period.
Conclusions
These findings may have implications for the development of tailored exercise programs for this specific patient population, with the aim of optimizing CV health outcomes.
{"title":"The VENERE Study: EffectiVenEss of a Rehabilitation Treatment With Nordic Walking in ObEse or OveRweight Diabetic PatiEnts With Cardiovascular Disease","authors":"Anna Torri MD , Eleonora Volpato PsyD, PhD , Giampiero Merati MD , Martina Milani MD , Anastasia Toccafondi , Damiano Formenti PhD , Francesca La Rosa PhD , Simone Agostini PhD , Cristina Agliardi PhD , Letizia Oreni MSc , Alice Sacco MD , Marta Rescaldani MD , Stefano Lucreziotti MD , Ada Giglio MD , Giulia Ferrante MD , Maristella Barbaro MD , Claudio Montalto MD , Stefano Buratti MD , Nuccia Morici MD, PhD","doi":"10.1016/j.cjco.2024.01.002","DOIUrl":"10.1016/j.cjco.2024.01.002","url":null,"abstract":"<div><h3>Background</h3><p>Nordic walking (NW) has several potential benefits for individuals with cardiovascular (CV) disease, type 2 diabetes, and obesity and/or overweight. NW improves cardiovascular health, including exercise capacity and blood pressure control. NW enhances glycemic control and insulin sensitivity in diabetes, and aids in weight management and body composition improvement. NW offers additional advantages, such as improvement in muscular strength, joint mobility, physical activity levels, and psychological well-being.</p></div><div><h3>Methods</h3><p>This open-label study with 3 arms will aim to evaluate the efficacy, safety, and adherence to exercise prescription in obese and/or overweight diabetic patients with CV complications. The primary objective will be to assess the CV performance of participants after a 6-month and a 12-month follow-up period, following a 3-month NW intervention, compared with standard rehabilitation, and with cardiological counseling (control group) training lasting 3 months.</p></div><div><h3>Results</h3><p>The results of the study will provide valuable insights into the comparative effectiveness of a NW intervention vs standard rehabilitation and control group training in improving CV performance in obese and/or overweight diabetic patients with CV complications. Additionally, safety and adherence data will help inform the feasibility and sustainability of the exercise prescription over an extended period.</p></div><div><h3>Conclusions</h3><p>These findings may have implications for the development of tailored exercise programs for this specific patient population, with the aim of optimizing CV health outcomes.</p></div><div><h3>Clinical Trials Registration</h3><p><span>NCT05987410</span><svg><path></path></svg></p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 5","pages":"Pages 735-744"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24000234/pdfft?md5=d56c6d47c4b34f0c3584db996851b138&pid=1-s2.0-S2589790X24000234-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139540644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.cjco.2024.01.001
Ahmad Hayek MD , Blair J. MacDonald BA PharmD , Guillaume Marquis-Gravel MD, MSc , Kevin R. Bainey MD, MSc , Samer Mansour MD , Margaret L. Ackman PharmD , Warren J. Cantor MD , Ricky D. Turgeon BSc(Pharm), PharmD
Background
Ongoing debate remains regarding optimal antithrombotic therapy in patients with atrial fibrillation (AF) and coronary artery disease.
Methods
We performed a systematic review and meta-analysis to synthesize randomized controlled trials (RCTs) comparing the following: (i) dual-pathway therapy (DPT; oral anticoagulant [OAC] plus antiplatelet) vs triple therapy (OAC and dual-antiplatelet therapy) after percutaneous coronary intervention (PCI) or acute coronary syndrome (ACS), and (iii) OAC monotherapy vs DPT at least 1 year after PCI or ACS. Following a 2-stage process, we identified systematic reviews published between 2019 and 2022 on these 2 clinical questions, and we updated the most comprehensive search for additional RCTs published up to October 2022. Outcomes of interest were major adverse cardiovascular events (MACE), death, stent thrombosis, and major bleeding. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model.
Results
Based on 6 RCTs (n = 10,435), DPT reduced major bleeding (RR 0.62, 95% CI 0.52-0.73) and increased stent thrombosis (RR 1.55, 95% CI 1.02-2.36), vs triple therapy after PCI or medically-managed ACS, with no significant differences in MACE and death. In 2 RCTs (n = 2905), OAC monotherapy reduced major bleeding (RR 0.66, 95% CI 0.49-0.91) vs DPT in AF patients with remote PCI or ACS, with no significant differences in MACE or death.
Conclusions
In patients with AF and coronary artery disease, using less-aggressive antithrombotic treatment (DPT after PCI or ACS, and OAC alone after remote PCI or ACS) reduced major bleeding, with an increase in stent thrombosis with recent PCI. These results support a minimalist yet personalized antithrombotic strategy for these patients.
{"title":"Antithrombotic Therapy in Patients With Atrial Fibrillation and Coronary Artery Disease With Recent or Remote Events: Systematic Review and Meta-analysis","authors":"Ahmad Hayek MD , Blair J. MacDonald BA PharmD , Guillaume Marquis-Gravel MD, MSc , Kevin R. Bainey MD, MSc , Samer Mansour MD , Margaret L. Ackman PharmD , Warren J. Cantor MD , Ricky D. Turgeon BSc(Pharm), PharmD","doi":"10.1016/j.cjco.2024.01.001","DOIUrl":"10.1016/j.cjco.2024.01.001","url":null,"abstract":"<div><h3>Background</h3><p>Ongoing debate remains regarding optimal antithrombotic therapy in patients with atrial fibrillation (AF) and coronary artery disease.</p></div><div><h3>Methods</h3><p>We performed a systematic review and meta-analysis to synthesize randomized controlled trials (RCTs) comparing the following: (i) dual-pathway therapy (DPT; oral anticoagulant [OAC] plus antiplatelet) vs triple therapy (OAC and dual-antiplatelet therapy) after percutaneous coronary intervention (PCI) or acute coronary syndrome (ACS), and (iii) OAC monotherapy vs DPT at least 1 year after PCI or ACS. Following a 2-stage process, we identified systematic reviews published between 2019 and 2022 on these 2 clinical questions, and we updated the most comprehensive search for additional RCTs published up to October 2022. Outcomes of interest were major adverse cardiovascular events (MACE), death, stent thrombosis, and major bleeding. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model.</p></div><div><h3>Results</h3><p>Based on 6 RCTs (n = 10,435), DPT reduced major bleeding (RR 0.62, 95% CI 0.52-0.73) and increased stent thrombosis (RR 1.55, 95% CI 1.02-2.36), vs triple therapy after PCI or medically-managed ACS, with no significant differences in MACE and death. In 2 RCTs (n = 2905), OAC monotherapy reduced major bleeding (RR 0.66, 95% CI 0.49-0.91) vs DPT in AF patients with remote PCI or ACS, with no significant differences in MACE or death.</p></div><div><h3>Conclusions</h3><p>In patients with AF and coronary artery disease, using less-aggressive antithrombotic treatment (DPT after PCI or ACS, and OAC alone after remote PCI or ACS) reduced major bleeding, with an increase in stent thrombosis with recent PCI. These results support a minimalist yet personalized antithrombotic strategy for these patients.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 5","pages":"Pages 708-720"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24000210/pdfft?md5=650af0e97f6f4e4a0c1f0377d24db216&pid=1-s2.0-S2589790X24000210-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139539717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.cjco.2023.12.012
Tiffany A. Lee BSc(Pharm), PharmD, PhD(c) , Melanie King PharmD(c) , Stephanie W. Young BSc(Pharm), PharmD, MSc , Ross T. Tsuyuki BSc(Pharm), PharmD, MSc
Background
High blood pressure (BP) is a leading cause of cardiovascular and stroke-related events. Office-based BP measurement has declined in recent years due to the COVID-19 pandemic, which may have resulted in higher rates of undetected and uncontrolled hypertension. To gain a better idea of adult BP levels in Newfoundland and Labrador, we engaged community pharmacists in BP screening on World Hypertension Day.
Methods
Data collection and BP screening occurred on May 17, 2022. Pharmacists and pharmacy students collected 3 seated BP readings from participants, using an automated device. The average of readings 2 and 3 was used to estimate BP, with elevated BP defined as ≥ 140/90 mm Hg, or ≥ 130/80 mm Hg for individuals with diabetes. Data on participant demographics, access to primary care, medical history, and antihypertensive use were also collected. Data analysis included descriptive statistics and logistic regression techniques.
Results
A total of 460 participants were included in the analysis. The mean age was 56.3 years (standard deviation: 16.95); 63.3% (n = 291) were female; and 43.7% (n = 201) reported having hypertension. Elevated BP was identified in 27% (n = 123). Of those with elevated BP, 41.5% (n = 51) had no history of diagnosed hypertension. Age, sex, and diabetes were statistically significant predictors of elevated BP in the multivariable model.
Conclusions
A large proportion of participants in our study had elevated BP. Targeted measures are needed to improve the detection, treatment, and control of high BP in Newfoundland and Labrador. Community pharmacists can support BP care.
{"title":"Community Pharmacy-Based Blood Pressure Screening in Newfoundland and Labrador, Canada for World Hypertension Day 2022: A Cross-Sectional Study","authors":"Tiffany A. Lee BSc(Pharm), PharmD, PhD(c) , Melanie King PharmD(c) , Stephanie W. Young BSc(Pharm), PharmD, MSc , Ross T. Tsuyuki BSc(Pharm), PharmD, MSc","doi":"10.1016/j.cjco.2023.12.012","DOIUrl":"10.1016/j.cjco.2023.12.012","url":null,"abstract":"<div><h3>Background</h3><p>High blood pressure (BP) is a leading cause of cardiovascular and stroke-related events. Office-based BP measurement has declined in recent years due to the COVID-19 pandemic, which may have resulted in higher rates of undetected and uncontrolled hypertension. To gain a better idea of adult BP levels in Newfoundland and Labrador, we engaged community pharmacists in BP screening on World Hypertension Day.</p></div><div><h3>Methods</h3><p>Data collection and BP screening occurred on May 17, 2022. Pharmacists and pharmacy students collected 3 seated BP readings from participants, using an automated device. The average of readings 2 and 3 was used to estimate BP, with elevated BP defined as ≥ 140/90 mm Hg, or ≥ 130/80 mm Hg for individuals with diabetes. Data on participant demographics, access to primary care, medical history, and antihypertensive use were also collected. Data analysis included descriptive statistics and logistic regression techniques.</p></div><div><h3>Results</h3><p>A total of 460 participants were included in the analysis. The mean age was 56.3 years (standard deviation: 16.95); 63.3% (n = 291) were female; and 43.7% (n = 201) reported having hypertension. Elevated BP was identified in 27% (n = 123). Of those with elevated BP, 41.5% (n = 51) had no history of diagnosed hypertension. Age, sex, and diabetes were statistically significant predictors of elevated BP in the multivariable model.</p></div><div><h3>Conclusions</h3><p>A large proportion of participants in our study had elevated BP. Targeted measures are needed to improve the detection, treatment, and control of high BP in Newfoundland and Labrador. Community pharmacists can support BP care.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 5","pages":"Pages 728-734"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X23003803/pdfft?md5=4b75b80775f675deba5afd710b995d63&pid=1-s2.0-S2589790X23003803-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139019382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.cjco.2023.12.011
Farzad Darabi MD , Nigel S. Tan MD , Katherine S. Allan PhD , Steve Lin MD, MSc , Paul Angaran MD, MSc , Paul Dorian MD, MSc
Background
Patients resuscitated from out-of-hospital cardiac arrest (OHCA) are at high risk of recurrence, posing a substantial burden on healthcare systems. Despite the established benefit of implantable cardioverter defibrillator (ICD) therapy in many such patients, and recommendations by guidelines, few studies have described the proportion of OHCA patients who receive guideline-concordant care.
Methods
The Canadian Institute for Health Information Discharge Abstract Database dataset was used to identify OHCA patients admitted to hospitals across Canada, excluding Quebec. We analyzed all patients without a probable ischemic or bradycardia etiology of cardiac arrest, who survived to discharge, to estimate the ICD implantation rates in patients who were potentially eligible to have an ICD.
Results
Between 2013 and 2017, a total of 10,435 OHCA patients who were admitted to the hospital were captured in the database; 4486 (43%) survived to hospital discharge, and 2580 survivors (57.5%) were potentially eligible to receive an ICD. Among these potentially eligible patients, 757 (29.3%) received an ICD during their index admission or within 30 days after discharge from the hospital. The ICD implantation rate during index admission increased from 13.8% in 2013 to 19.6% in 2017 (P-value for time trend < 0.05). The rate of ICD implantations in potentially eligible patients was higher in urban than in rural settings (19.5% vs 11.1%) and in teaching vs community hospitals (34.7% vs 9.8%).
Conclusions
Although ICD implantation rates show an increasing trend among patients with OHCA who are likely eligible for secondary prevention, significant underutilization of ICDs persists in these patients.
背景院外心脏骤停（OHCA）后复苏的患者复发的风险很高，给医疗系统带来了沉重的负担。尽管植入式心律转复除颤器（ICD）治疗对许多此类患者有明显的益处，而且指南也提出了建议，但很少有研究说明院外心脏骤停患者接受与指南一致的治疗的比例。结果2013年至2017年期间，数据库共记录了10435名入院的OHCA患者；4486人（43%）存活至出院，2580名存活者（57.5%）可能符合接受ICD治疗的条件。在这些可能符合条件的患者中，有 757 人（29.3%）在指标入院期间或出院后 30 天内接受了 ICD 治疗。索引入院期间的ICD植入率从2013年的13.8%增至2017年的19.6%（时间趋势的P值为< 0.05）。可能符合条件的患者的 ICD 植入率在城市高于农村（19.5% vs 11.1%），在教学医院高于社区医院（34.7% vs 9.8%）。结论虽然在可能符合二级预防条件的 OHCA 患者中，ICD 植入率呈上升趋势，但这些患者的 ICD 使用率仍然严重不足。
{"title":"ICD Implantation Rates in Cardiac Arrest Survivors in Canada","authors":"Farzad Darabi MD , Nigel S. Tan MD , Katherine S. Allan PhD , Steve Lin MD, MSc , Paul Angaran MD, MSc , Paul Dorian MD, MSc","doi":"10.1016/j.cjco.2023.12.011","DOIUrl":"10.1016/j.cjco.2023.12.011","url":null,"abstract":"<div><h3>Background</h3><p>Patients resuscitated from out-of-hospital cardiac arrest (OHCA) are at high risk of recurrence, posing a substantial burden on healthcare systems. Despite the established benefit of implantable cardioverter defibrillator (ICD) therapy in many such patients, and recommendations by guidelines, few studies have described the proportion of OHCA patients who receive guideline-concordant care.</p></div><div><h3>Methods</h3><p>The Canadian Institute for Health Information Discharge Abstract Database dataset was used to identify OHCA patients admitted to hospitals across Canada, excluding Quebec. We analyzed all patients without a probable ischemic or bradycardia etiology of cardiac arrest, who survived to discharge, to estimate the ICD implantation rates in patients who were <em>potentially eligible</em> to have an ICD.</p></div><div><h3>Results</h3><p>Between 2013 and 2017, a total of 10,435 OHCA patients who were admitted to the hospital were captured in the database; 4486 (43%) survived to hospital discharge, and 2580 survivors (57.5%) were <em>potentially eligible</em> to receive an ICD. Among these <em>potentially eligible</em> patients, 757 (29.3%) received an ICD during their index admission or within 30 days after discharge from the hospital. The ICD implantation rate during index admission increased from 13.8% in 2013 to 19.6% in 2017 (<em>P</em>-value for time trend < 0.05). The rate of ICD implantations in <em>potentially eligible</em> patients was higher in urban than in rural settings (19.5% vs 11.1%) and in teaching vs community hospitals (34.7% vs 9.8%).</p></div><div><h3>Conclusions</h3><p>Although ICD implantation rates show an increasing trend among patients with OHCA who are likely eligible for secondary prevention, significant underutilization of ICDs persists in these patients.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 5","pages":"Pages 699-707"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X23003797/pdfft?md5=75d3adea23ed7cee0e92075219816e4c&pid=1-s2.0-S2589790X23003797-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139019923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.cjco.2024.01.010
Abdel Hadi El Hajjar MD , Michel Chedid El Helou MD , Aqieda Bayat MD , Daniel Cantillon MD , Tamanna Singh MD , Tyler Taigen MD , Rohit Moudgil MD, PhD
{"title":"Ventricular Tachycardia as a Late Complication of COVID-19 in a Young Patient With No History of Cardiovascular Disease","authors":"Abdel Hadi El Hajjar MD , Michel Chedid El Helou MD , Aqieda Bayat MD , Daniel Cantillon MD , Tamanna Singh MD , Tyler Taigen MD , Rohit Moudgil MD, PhD","doi":"10.1016/j.cjco.2024.01.010","DOIUrl":"https://doi.org/10.1016/j.cjco.2024.01.010","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 5","pages":"Pages 721-724"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24000465/pdfft?md5=55b06a9f7ca7135623295d54857da73d&pid=1-s2.0-S2589790X24000465-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.cjco.2024.01.006
Yeonsoo Sara Lee BS , Sharonne N. Hayes MD , Patricia J.M. Best MD , Rajiv Gulati MD, PhD , Benjamin R. Gochanour MS , Marysia S. Tweet MD, MS
Background
The COVID-19 pandemic effects among patients with a history of spontaneous coronary artery dissection (SCAD), a cause of acute coronary syndrome associated with emotional and physical stress, are unknown.
Methods
For this cross-sectional cohort study, participants of the Mayo Clinic “Virtual” Multicenter SCAD Registry were surveyed about the COVID-19 pandemic.
Results
Among 1352 participants, 727 (53.8%) completed surveys between June 2, 2021 and September 29, 2021. The majority of respondents (96.7%) were female, with a mean age of 54.9 ± 9.4 years. At the time of completing the survey, which was early in the pandemic, 91 respondents (12.6%) reported having prior COVID-19 symptoms, with < 1% experiencing hospitalization (n = 4) or cardiac complications (n = 6). A total of 14% had ≥ moderate anxiety symptoms, per the General Anxiety Disorder-7 item survey, and 11.8% had ≥ moderate depressive symptoms, per the Patient Health Questionnaire-9 item. Higher stress scores on the Likert scale were correlated with pandemic-related reduction in work hours and/or pay and/or unemployment (P = 0.013), remote work and/or change of job (P < 0.001), and loss of insurance and/or medical coverage (P = 0.025). A higher anxiety level, as measured on the Likert scale, was correlated with pandemic-related remote work and/or change of job (P = 0.007) and loss of insurance and/or medical coverage (P = 0.008). Since the start of the pandemic, 54% of respondents reported having at least monthly chest pain. Chest pain and COVID symptoms were each associated with higher scores on the General Anxiety Disorder-7 item survey and the Patient Health Questionnaire-9 item.
Conclusions
Early in the pandemic, COVID-19 symptoms, hospitalization, and cardiac complications were uncommon among SCAD patients. The burden of anxiety and depressive symptoms was minimal to mild, similar to that in prior reports. Likert-scale measures of stress and anxiety were higher among persons with work and/or pay reduction and/or unemployment, remote work and/or change of job, and loss of insurance and/or medical coverage. Over half of respondents reported experiencing chest pain, which was correlated with depressive and anxiety symptoms, highlighting an overarching clinical need.
{"title":"Early Effects of the COVID-19 Pandemic on Patients in a Virtual Multicenter Spontaneous Coronary Artery Dissection (SCAD) Registry","authors":"Yeonsoo Sara Lee BS , Sharonne N. Hayes MD , Patricia J.M. Best MD , Rajiv Gulati MD, PhD , Benjamin R. Gochanour MS , Marysia S. Tweet MD, MS","doi":"10.1016/j.cjco.2024.01.006","DOIUrl":"10.1016/j.cjco.2024.01.006","url":null,"abstract":"<div><h3>Background</h3><p>The COVID-19 pandemic effects among patients with a history of spontaneous coronary artery dissection (SCAD), a cause of acute coronary syndrome associated with emotional and physical stress, are unknown.</p></div><div><h3>Methods</h3><p>For this cross-sectional cohort study, participants of the Mayo Clinic “Virtual” Multicenter SCAD Registry were surveyed about the COVID-19 pandemic.</p></div><div><h3>Results</h3><p>Among 1352 participants, 727 (53.8%) completed surveys between June 2, 2021 and September 29, 2021. The majority of respondents (96.7%) were female, with a mean age of 54.9 ± 9.4 years. At the time of completing the survey, which was early in the pandemic, 91 respondents (12.6%) reported having prior COVID-19 symptoms, with < 1% experiencing hospitalization (n = 4) or cardiac complications (n = 6). A total of 14% had ≥ moderate anxiety symptoms, per the General Anxiety Disorder-7 item survey, and 11.8% had ≥ moderate depressive symptoms, per the Patient Health Questionnaire-9 item. Higher stress scores on the Likert scale were correlated with pandemic-related reduction in work hours and/or pay and/or unemployment (<em>P</em> = 0.013), remote work and/or change of job (<em>P</em> < 0.001), and loss of insurance and/or medical coverage (<em>P</em> = 0.025). A higher anxiety level, as measured on the Likert scale, was correlated with pandemic-related remote work and/or change of job (<em>P</em> = 0.007) and loss of insurance and/or medical coverage (<em>P</em> = 0.008). Since the start of the pandemic, 54% of respondents reported having at least monthly chest pain. Chest pain and COVID symptoms were each associated with higher scores on the General Anxiety Disorder-7 item survey and the Patient Health Questionnaire-9 item.</p></div><div><h3>Conclusions</h3><p>Early in the pandemic, COVID-19 symptoms, hospitalization, and cardiac complications were uncommon among SCAD patients. The burden of anxiety and depressive symptoms was minimal to mild, similar to that in prior reports. Likert-scale measures of stress and anxiety were higher among persons with work and/or pay reduction and/or unemployment, remote work and/or change of job, and loss of insurance and/or medical coverage. Over half of respondents reported experiencing chest pain, which was correlated with depressive and anxiety symptoms, highlighting an overarching clinical need.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 5","pages":"Pages 689-698"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24000271/pdfft?md5=334513589028e1b38cdd0fc038e6e0e0&pid=1-s2.0-S2589790X24000271-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139633991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.cjco.2024.01.003
Julie K.K. Vishram-Nielsen MD, PhD , Fernando Luis Scolari MD, PhD , Chun-Po Steve Fan PhD , Yas Moayedi MD , Heather J. Ross MD, MHSc , Cedric Manlhiot PhD , Melissa A. Allwood MD, PhD , Ana Carolina Alba MD, PhD , Keith R. Brunt PhD , Jeremy A. Simpson PhD , Filio Billia MD, PhD
Background
Diaphragm atrophy can contribute to dyspnea in patients with heart failure (HF) with its link to central neurohormonal overactivation. HF medications that cross the blood-brain barrier could act centrally and improve respiratory function, potentially alleviating diaphragmatic atrophy. Therefore, we compared the benefit of central- vs peripheral-acting HF drugs on respiratory function, as assessed by a single cardiopulmonary exercise test (CPET) and outcomes in HF patients.
Methods
A retrospective study was conducted of 624 ambulatory adult HF patients (80% male) with reduced left ventricular ejection fraction ≤ 40% and a complete CPET, followed at a single institution between 2001 and 2017. CPET parameters, and the outcomes all-cause death, a composite endpoint (all-cause death, need for left ventricular assist device, heart transplantation), and all-cause and/or HF hospitalizations, were compared in patients receiving central-acting (n = 550) vs peripheral-acting (n = 74) drugs.
Results
Compared to patients who receive peripheral-acting drugs, patients who receive central-acting drugs had better respiratory function (peak breath-by breath oxygen uptake [VO2], P = 0.020; forced expiratory volume in 1 second [FEV1], P = 0.007), and ventilatory efficiency (minute ventilation / carbon dioxide production [VE/VCO2], P < 0.001; end-tidal carbon dioxide tension [PETCO2], P = 0.015; and trend for forced vital capacity [FVC], P = 0.056). Many of the associations between the CPET parameters and drug type remained significant after multivariate adjustment. Moreover, patients receiving central-acting drugs had fewer composite events (P = 0.023), and HF hospitalizations (P = 0.044), although significance after multivariant correction was not achieved, despite the hazard ratio being 0.664 and 0.757, respectively.
Conclusions
Central-acting drugs were associated with better respiratory function as measured by CPET parameters in HF patients. This could extend to clinically meaningful composite outcomes and hospitalizations but required more power to be definitive in linking to drug effect. Central-acting HF drugs show a role in mitigating diaphragm weakness.
{"title":"Better Respiratory Function in Heart Failure Patients With Use of Central-Acting Therapeutics","authors":"Julie K.K. Vishram-Nielsen MD, PhD , Fernando Luis Scolari MD, PhD , Chun-Po Steve Fan PhD , Yas Moayedi MD , Heather J. Ross MD, MHSc , Cedric Manlhiot PhD , Melissa A. Allwood MD, PhD , Ana Carolina Alba MD, PhD , Keith R. Brunt PhD , Jeremy A. Simpson PhD , Filio Billia MD, PhD","doi":"10.1016/j.cjco.2024.01.003","DOIUrl":"10.1016/j.cjco.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><p>Diaphragm atrophy can contribute to dyspnea in patients with heart failure (HF) with its link to central neurohormonal overactivation. HF medications that cross the blood-brain barrier could act centrally and improve respiratory function, potentially alleviating diaphragmatic atrophy. Therefore, we compared the benefit of central- vs peripheral-acting HF drugs on respiratory function, as assessed by a single cardiopulmonary exercise test (CPET) and outcomes in HF patients.</p></div><div><h3>Methods</h3><p>A retrospective study was conducted of 624 ambulatory adult HF patients (80% male) with reduced left ventricular ejection fraction ≤ 40% and a complete CPET, followed at a single institution between 2001 and 2017. CPET parameters, and the outcomes all-cause death, a composite endpoint (all-cause death, need for left ventricular assist device, heart transplantation), and all-cause and/or HF hospitalizations, were compared in patients receiving central-acting (n = 550) vs peripheral-acting (n = 74) drugs.</p></div><div><h3>Results</h3><p>Compared to patients who receive peripheral-acting drugs, patients who receive central-acting drugs had better respiratory function (peak breath-by breath oxygen uptake [VO<sub>2</sub>], <em>P</em> = 0.020; forced expiratory volume in 1 second [FEV1], <em>P</em> = 0.007), and ventilatory efficiency (minute ventilation / carbon dioxide production [VE/VCO<sub>2</sub>], <em>P</em> < 0.001; end-tidal carbon dioxide tension [PETCO<sub>2</sub>], <em>P</em> = 0.015; and trend for forced vital capacity [FVC], <em>P</em> = 0.056). Many of the associations between the CPET parameters and drug type remained significant after multivariate adjustment. Moreover, patients receiving central-acting drugs had fewer composite events (<em>P</em> = 0.023), and HF hospitalizations (<em>P</em> = 0.044), although significance after multivariant correction was not achieved, despite the hazard ratio being 0.664 and 0.757, respectively.</p></div><div><h3>Conclusions</h3><p>Central-acting drugs were associated with better respiratory function as measured by CPET parameters in HF patients. This could extend to clinically meaningful composite outcomes and hospitalizations but required more power to be definitive in linking to drug effect. Central-acting HF drugs show a role in mitigating diaphragm weakness.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 5","pages":"Pages 745-754"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24000246/pdfft?md5=17508265fa99001010df60e7f6fdc99f&pid=1-s2.0-S2589790X24000246-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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