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Docherty KF, Campbell RT, Brooksbank KJM, Dreisbach JG, Forsyth P, Godeseth RL, Hopkins T, Jackson AM, Lee MMY, McConnachie A, Roditi G, Squire IB, Stanley B, Welsh P, Jhund PS, Petrie MC, McMurray JJV. Effect of Neprilysin Inhibition on Left Ventricular Remodeling in Patients With Asymptomatic Left Ventricular Systolic Dysfunction Late After Myocardial Infarction. Circulation 2021; 144:199-209. [PMID: 33983794 PMCID: PMC8284373 DOI: 10.1161/circulationaha.121.054892] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with left ventricular (LV) systolic dysfunction after myocardial infarction are at a high risk of developing heart failure. The addition of neprilysin inhibition to renin angiotensin system inhibition may result in greater attenuation of adverse LV remodeling as a result of increased levels of substrates for neprilysin with vasodilatory, antihypertrophic, antifibrotic, and sympatholytic effects. METHODS We performed a prospective, multicenter, randomized, double-blind, active-comparator trial comparing sacubitril/valsartan 97/103 mg twice daily with valsartan 160 mg twice daily in patients ≥3 months after myocardial infarction with a LV ejection fraction ≤40% who were taking a renin angiotensin system inhibitor (equivalent dose of ramipril ≥2.5 mg twice daily) and a β-blocker unless contraindicated or intolerant. Patients in New York Heart Association class ≥II or with signs and symptoms of heart failure were excluded. The primary outcome was change from baseline to 52 weeks in LV end-systolic volume index measured using cardiac magnetic resonance imaging. Secondary outcomes included other magnetic resonance imaging measurements of LV remodeling, change in NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity cardiac troponin I, and a patient global assessment of change questionnaire. RESULTS From July 2018 to June 2019, we randomized 93 patients with the following characteristics: mean age, 60.7±10.4 years; median time from myocardial infarction, 3.6 years (interquartile range, 1.2-7.2); mean LV ejection fraction, 36.8%±7.1%; and median NT-proBNP, 230 pg/mL (interquartile range, 124-404). Sacubitril/valsartan, compared with valsartan, did not significantly reduce LV end-systolic volume index; adjusted between-group difference, -1.9 mL/m2 (95% CI, -4.9 to 1.0); P=0.19. There were no significant between-group differences in NT-proBNP, high-sensitivity cardiac troponin I, LV end-diastolic volume index, left atrial volume index, LV ejection fraction, LV mass index, or patient global assessment of change. CONCLUSIONS In patients with asymptomatic LV systolic dysfunction late after myocardial infarction, treatment with sacubitril/valsartan did not have a significant reverse remodeling effect compared with valsartan. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03552575.
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Affiliation(s)
- Kieran F Docherty
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (K.F.D., R.T.C., K.J.M.B., R.L.G., T.H., A.M.J., M.M.Y.L., G.R., P.W., P.S.J., M.C.P., J.J.V.M.), University of Glasgow, United Kingdom
| | - Ross T Campbell
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (K.F.D., R.T.C., K.J.M.B., R.L.G., T.H., A.M.J., M.M.Y.L., G.R., P.W., P.S.J., M.C.P., J.J.V.M.), University of Glasgow, United Kingdom
| | - Katriona J M Brooksbank
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (K.F.D., R.T.C., K.J.M.B., R.L.G., T.H., A.M.J., M.M.Y.L., G.R., P.W., P.S.J., M.C.P., J.J.V.M.), University of Glasgow, United Kingdom
| | - John G Dreisbach
- Golden Jubilee National Hospital, Glasgow, United Kingdom (J.G.D.)
| | - Paul Forsyth
- Pharmacy Services, National Health Service Greater Glasgow and Clyde, United Kingdom (P.F.)
| | - Rosemary L Godeseth
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (K.F.D., R.T.C., K.J.M.B., R.L.G., T.H., A.M.J., M.M.Y.L., G.R., P.W., P.S.J., M.C.P., J.J.V.M.), University of Glasgow, United Kingdom
| | - Tracey Hopkins
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (K.F.D., R.T.C., K.J.M.B., R.L.G., T.H., A.M.J., M.M.Y.L., G.R., P.W., P.S.J., M.C.P., J.J.V.M.), University of Glasgow, United Kingdom.,Glasgow Clinical Research Imaging Facility (T.H., G.R.), Queen Elizabeth University Hospital, United Kingdom (R.T.C.)
| | - Alice M Jackson
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (K.F.D., R.T.C., K.J.M.B., R.L.G., T.H., A.M.J., M.M.Y.L., G.R., P.W., P.S.J., M.C.P., J.J.V.M.), University of Glasgow, United Kingdom
| | - Matthew M Y Lee
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (K.F.D., R.T.C., K.J.M.B., R.L.G., T.H., A.M.J., M.M.Y.L., G.R., P.W., P.S.J., M.C.P., J.J.V.M.), University of Glasgow, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing (A.M., B.S.), University of Glasgow, United Kingdom
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (K.F.D., R.T.C., K.J.M.B., R.L.G., T.H., A.M.J., M.M.Y.L., G.R., P.W., P.S.J., M.C.P., J.J.V.M.), University of Glasgow, United Kingdom.,Glasgow Clinical Research Imaging Facility (T.H., G.R.), Queen Elizabeth University Hospital, United Kingdom (R.T.C.).,Department of Radiology, Glasgow Royal Infirmary, United Kingdom (G.R.)
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, United Kingdom (I.B.S.)
| | - Bethany Stanley
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing (A.M., B.S.), University of Glasgow, United Kingdom
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (K.F.D., R.T.C., K.J.M.B., R.L.G., T.H., A.M.J., M.M.Y.L., G.R., P.W., P.S.J., M.C.P., J.J.V.M.), University of Glasgow, United Kingdom
| | - Pardeep S Jhund
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (K.F.D., R.T.C., K.J.M.B., R.L.G., T.H., A.M.J., M.M.Y.L., G.R., P.W., P.S.J., M.C.P., J.J.V.M.), University of Glasgow, United Kingdom
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (K.F.D., R.T.C., K.J.M.B., R.L.G., T.H., A.M.J., M.M.Y.L., G.R., P.W., P.S.J., M.C.P., J.J.V.M.), University of Glasgow, United Kingdom
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (K.F.D., R.T.C., K.J.M.B., R.L.G., T.H., A.M.J., M.M.Y.L., G.R., P.W., P.S.J., M.C.P., J.J.V.M.), University of Glasgow, United Kingdom
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Young B, Kotzur M, Gatting L, Bonner C, Ayre J, McConnachie A, Batcup C, McCaffery K, O'Carroll R, Robb KA. The impact of theory-based messages on COVID-19 vaccination intentions: a structured summary of a study protocol for a randomised controlled trial. Trials 2021; 22:311. [PMID: 33926540 PMCID: PMC8082050 DOI: 10.1186/s13063-021-05277-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives Uptake of vaccination against COVID-19 is key to controlling the pandemic. However, a significant proportion of people report that they do not intend to have a vaccine, often because of concerns they have about vaccine side effects or safety. This study will assess the impact of theory-based messages on COVID-19 vaccination intention, drawing on the Necessity-Concerns framework to address previously reported beliefs and concerns about COVID-19 vaccination, and assess whether hypothesised variables (illness coherence, perceived necessity and concerns) mediate change in vaccination intention. Trial design Prospective, parallel two-arm, individually randomised (1:1) trial. Participants Adults aged over 18 years, living in Scotland and not vaccinated for COVID-19. A quota sampling approach will be used with the aim of achieving a nationally representative sample on gender, region and ethnic group, with oversampling of individuals with no educational qualifications or with only school-level qualifications. Intervention and comparator Intervention: Brief exposure to online text and image-based messages addressing necessity beliefs and concerns about COVID-19 vaccination. Comparator: Brief exposure to online text and image-based messages containing general information about COVID-19 and COVID-19 vaccination. Main outcomes Primary outcome: Self-reported intention to receive a vaccine for COVID-19 if invited, immediately post-intervention. Secondary outcomes: Self-reported COVID-19 illness coherence, perceived necessity of a COVID-19 vaccine and concerns about a COVID-19 vaccine, immediately post-intervention. Randomisation Quasi-randomisation performed automatically by online survey software, by creating a variable derived from the number of seconds in the minute that the participant initiates the survey. Participants starting the survey at 0-14 or 30-44 seconds in the minute are allocated to the intervention and 15-29 or 45-59 seconds to the comparator. Blinding (masking) Participants will not be blinded to group assignment but will not be informed of the purpose of the study until they have completed the follow-up survey. Investigators will be blinded to allocation as all procedures will be undertaken digitally and remotely without any investigator contact with participants. Numbers to be randomised (sample size) A total of 1,094 will be randomised 1:1 into two groups with 547 individuals in each. Trial Status Protocol version number 1.0, 26th February 2021. Recruitment status: Not yet recruiting, set to start April 2021 and end April 2021. Trial registration ClinicalTrials.gov, NCT04813770, 24th March 2021. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05277-7.
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He T, Mischak M, Clark AL, Campbell RT, Delles C, Díez J, Filippatos G, Mebazaa A, McMurray JJV, González A, Raad J, Stroggilos R, Bosselmann HS, Campbell A, Kerr SM, Jackson CE, Cannon JA, Schou M, Girerd N, Rossignol P, McConnachie A, Rossing K, Schanstra JP, Zannad F, Vlahou A, Mullen W, Jankowski V, Mischak H, Zhang Z, Staessen JA, Latosinska A. Urinary peptides in heart failure: a link to molecular pathophysiology. Eur J Heart Fail 2021; 23:1875-1887. [PMID: 33881206 PMCID: PMC9291452 DOI: 10.1002/ejhf.2195] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/23/2021] [Accepted: 04/18/2021] [Indexed: 02/06/2023] Open
Abstract
Aims Heart failure (HF) is a major public health concern worldwide. The diversity of HF makes it challenging to decipher the underlying complex pathological processes using single biomarkers. We examined the association between urinary peptides and HF with reduced (HFrEF), mid‐range (HFmrEF) and preserved (HFpEF) ejection fraction, defined based on the European Society of Cardiology guidelines, and the links between these peptide biomarkers and molecular pathophysiology. Methods and results Analysable data from 5608 participants were available in the Human Urinary Proteome database. The urinary peptide profiles from participants diagnosed with HFrEF, HFmrEF, HFpEF and controls matched for sex, age, estimated glomerular filtration rate, systolic and diastolic blood pressure, diabetes and hypertension were compared applying the Mann–Whitney test, followed by correction for multiple testing. Unsupervised learning algorithms were applied to investigate groups of similar urinary profiles. A total of 577 urinary peptides significantly associated with HF were sequenced, 447 of which (77%) were collagen fragments. In silico analysis suggested that urinary biomarker abnormalities in HF principally reflect changes in collagen turnover and immune response, both associated with fibrosis. Unsupervised clustering separated study participants into two clusters, with 83% of non‐HF controls allocated to cluster 1, while 65% of patients with HF were allocated to cluster 2 (P < 0.0001). No separation based on HF subtype was detectable. Conclusions Heart failure, irrespective of ejection fraction subtype, was associated with differences in abundance of urinary peptides reflecting collagen turnover and inflammation. These peptides should be studied as tools in early detection, prognostication, and prediction of therapeutic response.
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Affiliation(s)
- Tianlin He
- Mosaiques Diagnostics GmbH, Hannover, Germany.,Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University Hospital, Aachen, Germany
| | | | - Andrew L Clark
- Academic Cardiology Department, Hull York Medical School in the University of Hull, Kingston upon Hull, UK
| | - Ross T Campbell
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Javier Díez
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra, IdiSNA and CIBERCV, Pamplona, Spain.,Departments of Nephrology and Cardiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, Athens, Greece
| | - Alexandre Mebazaa
- Université de Paris, Unité Inserm MASCOT, Department of Anaesthesiology and Intensive Care, Saint Louis-Lariboisière - Fernand Widal University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Arantxa González
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra, IdiSNA and CIBERCV, Pamplona, Spain
| | - Julia Raad
- Mosaiques Diagnostics GmbH, Hannover, Germany
| | - Rafael Stroggilos
- Biotechnology Division, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Helle S Bosselmann
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics & Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Shona M Kerr
- MRC Human Genetics Unit, Institute of Genetics & Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | | | | | - Morten Schou
- Herlev-Gentofte Hospital, Department of Cardiology, Herlev, Denmark
| | - Nicolas Girerd
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques- Plurithématique 1433, and Inserm 1116 DCAC, CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques- Plurithématique 1433, and Inserm 1116 DCAC, CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kasper Rossing
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale, U1048, Institute of Cardiovascular and Metabolic Disease, Toulouse, France
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques- Plurithématique 1433, and Inserm 1116 DCAC, CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Antonia Vlahou
- Biotechnology Division, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - William Mullen
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Vera Jankowski
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University Hospital, Aachen, Germany
| | - Harald Mischak
- Mosaiques Diagnostics GmbH, Hannover, Germany.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Zhenyu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan A Staessen
- Non-Profit Research Institution Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.,Biomedical Sciences Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
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Graham-Brown MPM, March DS, Young R, Highton PJ, Young HML, Churchward DR, Dungey M, Stensel DJ, Bishop NC, Brunskill NJ, Smith AC, McCann GP, McConnachie A, Burton JO. A randomized controlled trial to investigate the effects of intra-dialytic cycling on left ventricular mass. Kidney Int 2021; 99:1478-1486. [PMID: 34023029 DOI: 10.1016/j.kint.2021.02.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 12/22/2022]
Abstract
Cardiovascular disease is the leading cause of death for patients receiving hemodialysis. Since exercise mitigates many risk factors which drive cardiovascular disease for these patients, we assessed effects of a program of intra-dialytic cycling on left ventricular mass and other prognostically relevant measures of cardiovascular disease as evaluated by cardiac MRI (the CYCLE-HD trial). This was a prospective, open-label, single-blinded cluster-randomized controlled trial powered to detect a 15g difference in left ventricular mass measured between patients undergoing a six-month program of intra-dialytic cycling (exercise group) and patients continuing usual care (control group). Pre-specified secondary outcomes included measures of myocardial fibrosis, aortic stiffness, physical functioning, quality of life and ventricular arrhythmias. Outcomes were analyzed as intention-to-treat according to a pre-specified statistical analysis plan. Initially, 130 individuals were recruited and completed baseline assessments (65 each group). Ultimately, 101 patients completed the trial protocol (50 control group and 51 exercise group). The six-month program of intra-dialytic cycling resulted in a significant reduction in left ventricular mass between groups (-11.1g; 95% confidence interval -15.79, -6.43), which remained significant on sensitivity analysis (missing data imputed) (-9.92g; 14.68, -5.16). There were significant reductions in both native T1 mapping and aortic pulse wave velocity between groups favoring the intervention. There was no increase in either ventricular ectopic beats or complex ventricular arrhythmias as a result of exercise with no significant effect on physical function or quality of life. Thus, a six-month program of intradialytic cycling reduces left ventricular mass and is safe, deliverable and well tolerated.
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Affiliation(s)
- Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute of Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health, Loughborough University, Loughborough, UK
| | - Daniel S March
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute of Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Robin Young
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Patrick J Highton
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health, Loughborough University, Loughborough, UK
| | - Hannah M L Young
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Darren R Churchward
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Maurice Dungey
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health, Loughborough University, Loughborough, UK
| | - David J Stensel
- National Institute of Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health, Loughborough University, Loughborough, UK
| | - Nicolette C Bishop
- National Institute of Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health, Loughborough University, Loughborough, UK
| | - Nigel J Brunskill
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute of Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute of Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute of Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health, Loughborough University, Loughborough, UK.
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Pellicori P, Doolub G, Wong CM, Lee KS, Mangion K, Ahmad M, Berry C, Squire I, Lambiase PD, Lyon A, McConnachie A, Taylor RS, Cleland JG. COVID-19 and its cardiovascular effects: a systematic review of prevalence studies. Cochrane Database Syst Rev 2021; 3:CD013879. [PMID: 33704775 PMCID: PMC8078349 DOI: 10.1002/14651858.cd013879] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A small minority of people with coronavirus disease 2019 (COVID-19) develop a severe illness, characterised by inflammation, microvascular damage and coagulopathy, potentially leading to myocardial injury, venous thromboembolism (VTE) and arterial occlusive events. People with risk factors for or pre-existing cardiovascular disease may be at greater risk. OBJECTIVES To assess the prevalence of pre-existing cardiovascular comorbidities associated with suspected or confirmed cases of COVID-19 in a variety of settings, including the community, care homes and hospitals. We also assessed the nature and rate of subsequent cardiovascular complications and clinical events in people with suspected or confirmed COVID-19. SEARCH METHODS We conducted an electronic search from December 2019 to 24 July 2020 in the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, covid-19.cochrane.org, ClinicalTrials.gov and EU Clinical Trial Register. SELECTION CRITERIA We included prospective and retrospective cohort studies, controlled before-and-after, case-control and cross-sectional studies, and randomised controlled trials (RCTs). We analysed controlled trials as cohorts, disregarding treatment allocation. We only included peer-reviewed studies with 100 or more participants, and excluded articles not written in English or only published in pre-print servers. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results and extracted data. Given substantial variation in study designs, reported outcomes and outcome metrics, we undertook a narrative synthesis of data, without conducting a meta-analysis. We critically appraised all included studies using the Joanna Briggs Institute (JBI) checklist for prevalence studies and the JBI checklist for case series. MAIN RESULTS We included 220 studies. Most of the studies originated from China (47.7%) or the USA (20.9%); 9.5% were from Italy. A large proportion of the studies were retrospective (89.5%), but three (1.4%) were RCTs and 20 (9.1%) were prospective. Using JBI's critical appraisal checklist tool for prevalence studies, 75 studies attained a full score of 9, 57 studies a score of 8, 31 studies a score of 7, 5 studies a score of 6, three studies a score of 5 and one a score of 3; using JBI's checklist tool for case series, 30 studies received a full score of 10, six studies a score of 9, 11 studies a score of 8, and one study a score of 5 We found that hypertension (189 studies, n = 174,414, weighted mean prevalence (WMP): 36.1%), diabetes (197 studies, n = 569,188, WMP: 22.1%) and ischaemic heart disease (94 studies, n = 100,765, WMP: 10.5%) are highly prevalent in people hospitalised with COVID-19, and are associated with an increased risk of death. In those admitted to hospital, biomarkers of cardiac stress or injury are often abnormal, and the incidence of a wide range of cardiovascular complications is substantial, particularly arrhythmias (22 studies, n = 13,115, weighted mean incidence (WMI) 9.3%), heart failure (20 studies, n = 29,317, WMI: 6.8%) and thrombotic complications (VTE: 16 studies, n = 7700, WMI: 7.4%). AUTHORS' CONCLUSIONS This systematic literature review indicates that cardiometabolic comorbidities are common in people who are hospitalised with a COVID-19 infection, and cardiovascular complications are frequent. We plan to update this review and to conduct a formal meta-analysis of outcomes based on a more homogeneous selected subsample of high-certainty studies.
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Affiliation(s)
- Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Gemina Doolub
- Department of Cardiology, Bristol Heart Institute, Bristol, UK
| | - Chih Mun Wong
- Department of Cardiology, Southmead Hospital, Bristol, UK
| | - Keng Siang Lee
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Kenneth Mangion
- British Heart Foundation Centre of Research Excellence, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Mahmood Ahmad
- Department of Cardiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Colin Berry
- British Heart Foundation Centre of Research Excellence, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Iain Squire
- NIHR Cardiovascular Research Institute, Glenfield Hospital, Leicester, UK
| | - Pier D Lambiase
- Centre for Cardiology in the Young, The Heart Hospital, University College London Hospitals, London, UK
| | - Alexander Lyon
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Alex McConnachie
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - John Gf Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
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McCallum L, Brooksbank K, McConnachie A, Aman A, Lip S, Dawson J, MacIntyre IM, MacDonald TM, Webb DJ, Padmanabhan S. Rationale and Design of the Genotype-Blinded Trial of Torasemide for the Treatment of Hypertension (BHF UMOD). Am J Hypertens 2021; 34:92-99. [PMID: 33084880 PMCID: PMC7891239 DOI: 10.1093/ajh/hpaa166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Genome-wide association studies have identified single nucleotide polymorphisms (SNPs) near the uromodulin gene (UMOD) affecting uromodulin excretion and blood pressure (BP). Uromodulin is almost exclusively expressed in the thick ascending limb (TAL) of the loop of Henle and its effect on BP appears to be mediated via the TAL sodium transporter, NKCC2. Loop-diuretics block NKCC2 but are not commonly used in hypertension management. Volume overload is one of the primary drivers for uncontrolled hypertension, so targeting loop-diuretics to individuals who are more likely to respond to this drug class, using the UMOD genotype, could be an efficient precision medicine strategy. METHODS The BHF UMOD Trial is a genotype-blinded, multicenter trial comparing BP response to torasemide between individuals possessing the AA genotype of the SNP rs13333226 and those possessing the G allele. 240 participants (≥18 years) with uncontrolled BP, on ≥1 antihypertensive agent for ≥3 months, will receive treatment with Torasemide, 5 mg daily for 16 weeks. Uncontrolled BP is average home systolic BP (SBP) >135 mmHg and/or diastolic BP >85 mmHg. The primary outcome is the change in 24-hour ambulatory SBP area under the curve between baseline and end of treatment. Sample size was calculated to detect a 4 mmHg difference between groups at 90% power. Approval by West of Scotland Research Ethics Committee 5 (16/WS/0160). RESULTS The study should conclude August 2021. CONCLUSIONS If our hypothesis is confirmed, a genotype-based treatment strategy for loop diuretics would help reduce the burden of uncontrolled hypertension. CLINICAL TRIALS REGISTRATION https://clinicaltrials.gov/ct2/show/NCT03354897.
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Affiliation(s)
- Linsay McCallum
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Katriona Brooksbank
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alisha Aman
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Stefanie Lip
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Iain M MacIntyre
- Clinical Pharmacology Unit and Research Centre, University of Edinburgh/BHF Centre of Research Excellence, Edinburgh, UK
| | - Thomas M MacDonald
- MEMO Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - David J Webb
- Clinical Pharmacology Unit and Research Centre, University of Edinburgh/BHF Centre of Research Excellence, Edinburgh, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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57
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Maznyczka AM, McCartney PJ, Oldroyd KG, Lindsay M, McEntegart M, Eteiba H, Rocchiccioli JP, Good R, Shaukat A, Robertson K, Malkin CJ, Greenwood JP, Cotton JM, Hood S, Watkins S, Collison D, Gillespie L, Ford TJ, Weir RAP, McConnachie A, Berry C. Risk Stratification Guided by the Index of Microcirculatory Resistance and Left Ventricular End-Diastolic Pressure in Acute Myocardial Infarction. Circ Cardiovasc Interv 2021; 14:e009529. [PMID: 33591821 DOI: 10.1161/circinterventions.120.009529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The index of microcirculatory resistance (IMR) of the infarct-related artery and left ventricular end-diastolic pressure (LVEDP) are acute, prognostic biomarkers in patients undergoing primary percutaneous coronary intervention. The clinical significance of IMR and LVEDP in combination is unknown. METHODS IMR and LVEDP were prospectively measured in a prespecified substudy of the T-TIME clinical trial (Trial of Low Dose Adjunctive Alteplase During Primary PCI). IMR was measured using a pressure- and temperature-sensing guidewire following percutaneous coronary intervention. Prognostically established thresholds for IMR (>32) and LVEDP (>18 mm Hg) were predefined. Contrast-enhanced cardiovascular magnetic resonance imaging (1.5 Tesla) was acquired 2 to 7 days and 3 months postmyocardial infarction. The primary end point was major adverse cardiac events, defined as cardiac death/nonfatal myocardial infarction/heart failure hospitalization at 1 year. RESULTS IMR and LVEDP were both measured in 131 patients (mean age 59±10.7 years, 103 [78.6%] male, 48 [36.6%] with anterior myocardial infarction). The median IMR was 29 (interquartile range, 17-55), the median LVEDP was 17 mm Hg (interquartile range, 12-21), and the correlation between them was not statistically significant (r=0.15; P=0.087). Fifty-three patients (40%) had low IMR (≤32) and low LVEDP (≤18), 18 (14%) had low IMR and high LVEDP, 31 (24%) had high IMR and low LVEDP, while 29 (22%) had high IMR and high LVEDP. Infarct size (% LV mass), LV ejection fraction, final myocardial perfusion grade ≤1, TIMI (Thrombolysis In Myocardial Infarction) flow grade ≤2, and coronary flow reserve were associated with LVEDP/IMR group, as was hospitalization for heart failure (n=18 events; P=0.045) and major adverse cardiac events (n=21 events; P=0.051). LVEDP>18 and IMR>32 combined was associated with major adverse cardiac events, independent of age, estimated glomerular filtration rate, and infarct-related artery (odds ratio, 5.80 [95% CI, 1.60-21.22] P=0.008). The net reclassification improvement for detecting major adverse cardiac events was 50.6% (95% CI, 2.7-98.2; P=0.033) when LVEDP>18 was added to IMR>32. CONCLUSIONS IMR and LVEDP in combination have incremental value for risk stratification following primary percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02257294.
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Affiliation(s)
- Annette M Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Peter J McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - J Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Christopher J Malkin
- Leeds University and Leeds Teaching Hospitals NHS Trust, United Kingdom (C.J.M., J.P.G.)
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, United Kingdom (C.J.M., J.P.G.)
| | - James M Cotton
- Wolverhampton University Hospital NHS Trust, United Kingdom (J.M.C.)
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Damien Collison
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Lynsey Gillespie
- Project Management Unit, Greater Glasgow and Clyde Health Board, United Kingdom (L.G.)
| | - Thomas J Ford
- Faculty of Medicine, University of Newcastle, Callaghan NSW, Australia (T.J.F.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Robin A P Weir
- University Hospital Hairmyres, East Kilbride, United Kingdom (R.A.P.W.)
| | - Alex McConnachie
- Robertson Centre for Biostatistics (A.M.), University of Glasgow, United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
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58
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Docherty KF, Campbell RT, Brooksbank KJ, Godeseth RL, Forsyth P, McConnachie A, Roditi G, Stanley B, Welsh P, Jhund PS, Petrie MC, McMurray JJ. Rationale and methods of a randomized trial evaluating the effect of neprilysin inhibition on left ventricular remodelling. ESC Heart Fail 2021; 8:129-138. [PMID: 33305513 PMCID: PMC7835504 DOI: 10.1002/ehf2.13137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/16/2020] [Accepted: 11/15/2020] [Indexed: 11/08/2022] Open
Abstract
AIMS In patients at high risk of heart failure following myocardial infarction (MI) as a result of residual left ventricular systolic dysfunction (LVSD), the angiotensin receptor neprilysin inhibitor sacubitril/valsartan may result in a greater attenuation of adverse left ventricular (LV) remodelling than renin angiotensin aldosterone system inhibition alone, due to increased levels of substrates for neprilysin with vasodilatory, anti-hypertrophic, anti-fibrotic, and sympatholytic effects. METHODS We designed a randomized, double-blinded, active-comparator trial to examine the effect of sacubitril/valsartan to the current standard of care in reducing adverse LV remodelling in patients with asymptomatic LVSD following MI. Eligible patients were ≥3 months following MI, had an LV ejection fraction ≤40% as measured by echocardiography, were New York Heart Association functional classification I, tolerant of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at equivalent dose of ramipril 2.5 mg twice daily or greater, and taking a beta-blocker unless contraindicated or intolerant. Patients were randomized to sacubitril/valsartan (target dose 97/103 mg twice daily) or valsartan (target dose 160 mg twice daily). The primary endpoint will be change in LV end-systolic volume indexed for body surface area measured using cardiac magnetic resonance imaging over 52 weeks from randomization. Secondary endpoints include other magnetic resonance imaging-based metrics of LV remodelling, biomarkers associated with LV remodelling and neurohumoral activation, and change in patient well-being assessed using a patient global assessment questionnaire. CONCLUSIONS This trial will investigate the effect of neprilysin inhibition on LV remodelling and the neurohumoral actions of sacubitril/valsartan in patients with asymptomatic LVSD following MI.
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Affiliation(s)
- Kieran F. Docherty
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowG12 8TAUK
| | - Ross T. Campbell
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowG12 8TAUK
- Queen Elizabeth University HospitalGlasgowUK
| | - Katriona J.M. Brooksbank
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowG12 8TAUK
| | - Rosemary L. Godeseth
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowG12 8TAUK
| | - Paul Forsyth
- Pharmacy ServicesNHS Greater Glasgow and ClydeGlasgowUK
| | - Alex McConnachie
- Robertson Centre for BiostatisticsUniversity of GlasgowGlasgowUK
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowG12 8TAUK
- Department of RadiologyGlasgow Royal InfirmaryGlasgowUK
| | - Bethany Stanley
- Robertson Centre for BiostatisticsUniversity of GlasgowGlasgowUK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowG12 8TAUK
| | - Pardeep S. Jhund
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowG12 8TAUK
| | - Mark C. Petrie
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowG12 8TAUK
| | - John J.V. McMurray
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowG12 8TAUK
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59
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Maznyczka AM, McCartney P, Duklas P, McEntegart M, Oldroyd KG, Greenwood JP, Muir D, Chowdhary S, Gershlick AH, Appleby C, Eteiba H, Cotton J, Wragg A, Curzen N, Tait RC, MacFarlane P, Welsh P, Sattar N, Petrie MC, Ford I, Fox KAA, McConnachie A, Berry C. Effect of coronary flow on intracoronary alteplase: a prespecified analysis from a randomised trial. Heart 2021; 107:heartjnl-2020-317828. [PMID: 33436493 DOI: 10.1136/heartjnl-2020-317828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Persistently impaired culprit artery flow ( METHODS In T-TIME (trial of low-dose adjunctive alTeplase during primary PCI), patients ≤6 hours from onset of ST-elevation myocardial infarction (STEMI) were randomised to placebo, alteplase 10 mg or alteplase 20 mg, administered by infusion into the culprit artery, pre-stenting. In this prespecified, secondary analysis, coronary flow was assessed angiographically at the point immediately before drug administration. Microvascular obstruction, myocardial haemorrhage and infarct size were assessed by cardiovascular magnetic resonance (CMR) at 2-7 days and 3 months. RESULTS TIMI flow was assessed after first treatment (balloon angioplasty/aspiration thrombectomy), immediately pre-drug administration, in 421 participants (mean age 61±10 years, 85% male) and was 3, 2 or 1 in 267, 134 and 19 participants respectively. In patients with TIMI flow ≤2 pre-drug, there was higher incidence of microvascular obstruction with alteplase (alteplase 20 mg (53.1%) and 10 mg (59.5%) combined versus placebo (34.1%); OR=2.47 (95% CI 1.16 to 5.22, p=0.018) interaction p=0.005) and higher incidence of myocardial haemorrhage (alteplase 20 mg (53.1%) and 10 mg (57.9%) combined vs placebo (27.5%); OR=3.26 (95% CI 1.44 to 7.36, p=0.004) interaction p=0.001). These effects were not observed in participants with TIMI 3 flow pre-drug. There were no interactions between TIMI flow pre-drug, alteplase and 3-month CMR findings. CONCLUSION In patients with impaired culprit artery flow ( TRIAL REGISTRATION NUMBER NCT02257294.
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Affiliation(s)
- Annette Marie Maznyczka
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Peter McCartney
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
| | - Patrycja Duklas
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Keith G Oldroyd
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - John P Greenwood
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Douglas Muir
- James Cook University Hospital, Middlesbrough, UK
| | | | | | - Clare Appleby
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Hany Eteiba
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
| | - James Cotton
- Department of Cardiology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | | | - Nick Curzen
- Wessex Cardiac Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Campbell Tait
- Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Keith A A Fox
- Department of Cardiology, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin Berry
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Brosnahan N, Leslie W, McCombie L, Barnes A, Thom G, McConnachie A, Messow CM, Sattar N, Taylor R, Lean MEJ. Brief formula low-energy-diet for relapse management during weight loss maintenance in the Diabetes Remission Clinical Trial (DiRECT). J Hum Nutr Diet 2021; 34:472-479. [PMID: 33406285 DOI: 10.1111/jhn.12839] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Weight loss maintenance (WLM) is critical for sustaining type 2 diabetes (T2D) remission, but poorly evidenced. We evaluated brief return to formula low-energy-diet (LED) as relapse treatments (RTs) during the WLM phase of the Diabetes Remission Clinical Trial (DiRECT). METHODS This post-hoc evaluation included all participants commencing the WLM phase of DiRECT. The protocol offered RT when regain of >2 kg occurred. RESULTS In total, 123/149 (83%) DiRECT intervention participants commenced the WLM phase after 26 (17%) had withdrawn prior to the WLM phase. Most participants [99/123 (80%)] regained >2 kg during the WLM phase, among whom 60/99 (61%) were recorded as using RT and 39/99 (39%) not using any RT. At baseline, RT users had a higher mean (SD) body mass index [35.8 (4.9) kg m-2 vs. 33.8 (3.9) kg m-2 , p = 0.0231] and had greater social deprivation (P = 0.0003) than non-users, although otherwise the groups were similar. Weight loss ≥ 2k g was achieved in 30/93 (32%) of RT attempts. At 2 years, those regaining >2 kg and using RT (n = 60) had mean (SD) weight losses of 7.4 (6.1) kg, with 25 (42%) remissions and 7 (12%) programme withdrawals. Those regaining >2 kg but not using RT (n = 39) had weight losses of 8.8 (6.0) kg, with 21 (54%) remissions and 4 (10%) programme withdrawals (all not significant). Twelve participants were never recorded as having regained >2 kg or using RTs and, at 2 years, their weight losses were 12.9 (9.2) kg, with 4 (33%) remissions and 8 (67%) programme withdrawals. CONCLUSIONS Most people with T2D experience weight regain >2 kg during the 2 years after substantial weight loss with a LED. Only one-third of RTs corrected their 2-kg regain, resulting in similar weight losses, remissions and programme withdrawals at 2 years compared to those not using RTs; however, both groups had weight losses below those not recorded as regaining >2 kg during WLM.
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Affiliation(s)
- Naomi Brosnahan
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Wilma Leslie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Louise McCombie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Alison Barnes
- Human Nutrition Research Centre, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - George Thom
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Claudia Martina Messow
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Roy Taylor
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
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Sullivan FM, Mair FS, Anderson W, Armory P, Briggs A, Chew C, Dorward A, Haughney J, Hogarth F, Kendrick D, Littleford R, McConnachie A, McCowan C, McMeekin N, Patel M, Rauchhaus P, Ritchie L, Robertson C, Robertson J, Robles-Zurita J, Sarvesvaran J, Sewell H, Sproule M, Taylor T, Tello A, Treweek S, Vedhara K, Schembri S. Earlier diagnosis of lung cancer in a randomised trial of an autoantibody blood test followed by imaging. Eur Respir J 2021; 57:2000670. [PMID: 32732334 PMCID: PMC7806972 DOI: 10.1183/13993003.00670-2020] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022]
Abstract
The EarlyCDT-Lung test is a high-specificity blood-based autoantibody biomarker that could contribute to predicting lung cancer risk. We report on the results of a phase IV biomarker evaluation of whether using the EarlyCDT-Lung test and any subsequent computed tomography (CT) scanning to identify those at high risk of lung cancer reduces the incidence of patients with stage III/IV/unspecified lung cancer at diagnosis compared with the standard clinical practice at the time the study began.The Early Diagnosis of Lung Cancer Scotland (ECLS) trial was a randomised controlled trial of 12 208 participants at risk of developing lung cancer in Scotland in the UK. The intervention arm received the EarlyCDT-Lung test and, if test-positive, low-dose CT scanning 6-monthly for up to 2 years. EarlyCDT-Lung test-negative and control arm participants received standard clinical care. Outcomes were assessed at 2 years post-randomisation using validated data on cancer occurrence, cancer staging, mortality and comorbidities.At 2 years, 127 lung cancers were detected in the study population (1.0%). In the intervention arm, 33 out of 56 (58.9%) lung cancers were diagnosed at stage III/IV compared with 52 out of 71 (73.2%) in the control arm. The hazard ratio for stage III/IV presentation was 0.64 (95% CI 0.41-0.99). There were nonsignificant differences in lung cancer and all-cause mortality after 2 years.ECLS compared EarlyCDT-Lung plus CT screening to standard clinical care (symptomatic presentation) and was not designed to assess the incremental contribution of the EarlyCDT-Lung test. The observation of a stage shift towards earlier-stage lung cancer diagnosis merits further investigations to evaluate whether the EarlyCDT-Lung test adds anything to the emerging standard of low-dose CT.
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Affiliation(s)
| | - Frances S Mair
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Pauline Armory
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Andrew Briggs
- Dept of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cindy Chew
- Radiology, NHS Lanarkshire, Bothwell, UK
| | - Alistair Dorward
- Respiratory Medicine, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - John Haughney
- General Practice, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Fiona Hogarth
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Denise Kendrick
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Roberta Littleford
- Centre for Clinical Research, University of Queensland, Saint Lucia, Australia
| | - Alex McConnachie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Manish Patel
- Respiratory Medicine, NHS Lanarkshire, Bothwell, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Lewis Ritchie
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Chris Robertson
- Dept of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - John Robertson
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | - Herbert Sewell
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Agnes Tello
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kavita Vedhara
- School of Medicine, University of Nottingham, Nottingham, UK
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62
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Docherty KF, Campbell RT, Brooksbank KJ, Godeseth RL, Forsyth P, McConnachie A, Roditi G, Stanley B, Welsh P, Jhund PS, Petrie MC, McMurray JJ. A Randomized Trial Comparing The Effect Of Sacubitril/Valsartan To Valsartan On Left Ventricular Remodeling In Patients With Asymptomatic Left Ventricular Systolic Dysfunction After Myocardial Infarction. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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63
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Mangion K, Morrow A, Bagot C, Bayes H, Blyth KG, Church C, Corcoran D, Delles C, Gillespie L, Grieve D, Ho A, Kean S, Lang NN, Lennie V, Lowe DJ, Kellman P, Macfarlane PW, McConnachie A, Roditi G, Sykes R, Touyz RM, Sattar N, Wereski R, Wright S, Berry C. The Chief Scientist Office Cardiovascular and Pulmonary Imaging in SARS Coronavirus disease-19 (CISCO-19) study. Cardiovasc Res 2020; 116:2185-2196. [PMID: 32702087 PMCID: PMC7454350 DOI: 10.1093/cvr/cvaa209] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND COVID-19 is typically a primary respiratory illness with multisystem involvement. The prevalence and clinical significance of cardiovascular and multisystem involvement in COVID-19 remain unclear. METHODS This is a prospective, observational, multicentre, longitudinal, cohort study with minimal selection criteria and a near-consecutive approach to screening. Patients who have received hospital care for COVID-19 will be enrolled within 28 days of discharge. Myocardial injury will be diagnosed according to the peak troponin I in relation to the upper reference limit (URL, 99th centile) (Abbott Architect troponin I assay; sex-specific URL, male: >34 ng/L; female: >16 ng/L). Multisystem, multimodality imaging will be undertaken during the convalescent phase at 28 days post-discharge (Visit 2). Imaging of the heart, lung, and kidneys will include multiparametric, stress perfusion, cardiovascular magnetic resonance imaging, and computed tomography coronary angiography. Health and well-being will be assessed in the longer term. The primary outcome is the proportion of patients with a diagnosis of myocardial inflammation. CONCLUSION CISCO-19 will provide detailed insights into cardiovascular and multisystem involvement of COVID-19. Our study will inform the rationale and design of novel therapeutic and management strategies for affected patients. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04403607.
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Affiliation(s)
- Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Andrew Morrow
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Hannah Bayes
- Department of Respiratory Medicine, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Colin Church
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Christian Delles
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Douglas Grieve
- Department of Respiratory Medicine, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Sharon Kean
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ninian N Lang
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Vera Lennie
- Department of Cardiology, University Hospital Ayr, Ayrshire and Arran Health Board, Ayr, UK
| | - David J Lowe
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Peter W Macfarlane
- Electrocardiography Core Laboratory, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Alex McConnachie
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Giles Roditi
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Robert Sykes
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Rhian M Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ryan Wereski
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- Department of Cardiology, University Hospital Ayr, Ayrshire and Arran Health Board, Ayr, UK
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Sylvia Wright
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Respiratory Medicine, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
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64
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Al-Mrabeh A, Hollingsworth KG, Shaw JAM, McConnachie A, Sattar N, Lean MEJ, Taylor R. 2-year remission of type 2 diabetes and pancreas morphology: a post-hoc analysis of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol 2020; 8:939-948. [PMID: 33031736 DOI: 10.1016/s2213-8587(20)30303-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The pancreas is small and irregular in shape in people with type 2 diabetes. If these abnormalities are caused by the disease state itself rather than being a predisposing factor, remission of type 2 diabetes should restore normal pancreas morphology. The objective of this study was to determine whether changes in pancreas volume and shape occurred during 2 years of remission. METHODS For this post-hoc analysis, we included a subset of adult participants of the Diabetes Remission Clinical Trial (DiRECT), who had type 2 diabetes and were randomly assigned to a weight management intervention or routine diabetes management. Intervention group participants were categorised as responders (HbA1c <6·5% [48 mmol/mol] and fasting blood glucose <7·0 mmol/L, off all anti-diabetes medication) and non-responders, who were classified as remaining diabetic. Data on pancreas volume and irregularity of pancreas border at baseline, 5 months, 12 months, and 24 months after intervention were compared between responders and non-responders; additional comparisons were made between control group participants with type 2 diabetes and a non-diabetic comparator (NDC) group, who were matched to the intervention group by age, sex, and post-weight-loss weight, to determine the extent of any normalisation. We used a mixed-effects regression model based on repeated measures ANOVA with correction for potential confounding. Magnetic resonance techniques were employed to quantify pancreas volume, the irregularity of the pancreas borders, and intrapancreatic fat content. β-cell function and biomarkers of tissue growth were also measured. FINDINGS Between July 25, 2015, and Aug 5, 2016, 90 participants with type 2 diabetes in the DiRECT subset were randomly assigned to intervention (n=64) or control (n=26) and were assessed at baseline; a further 25 non-diabetic participants were enrolled into the NDC group. At baseline, mean pancreas volume was 61·7 cm3 (SD 16·0) in all participants with type 2 diabetes and 79·8 cm3 (14·3) in the NDC group (p<0·0001). At 24 months, pancreas volume had increased by 9·4 cm3 (95% CI 6·1 to 12·8) in responders compared with 6·4 cm3 (2·5 to 10·3) in non-responders (p=0·0008). Pancreas borders at baseline were more irregular in participants with type 2 diabetes than in the NDC group (fractal dimension 1·138 [SD 0·027] vs 1·097 [0·025]; p<0·0001) and had normalised by 24 months in responders only (1·099 [0·028]). Intrapancreatic fat declined by 1·02 percentage points (95% CI 0·53 to 1·51) in 32 responders and 0·51% (-0·17 to 1·19) in 13 non-responders (p=0·23). INTERPRETATION These data show for the first time, to our knowledge, reversibility of the abnormal pancreas morphology of type 2 diabetes by weight loss-induced remission. FUNDING Diabetes UK.
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Affiliation(s)
- Ahmad Al-Mrabeh
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Kieren G Hollingsworth
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James A M Shaw
- Regenerative Medicine, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Michael E J Lean
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Roy Taylor
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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65
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Lee MMY, Brooksbank KJM, Wetherall K, Mangion K, Roditi G, Campbell RT, Berry C, Chong V, Coyle L, Docherty KF, Dreisbach JG, Labinjoh C, Lang NN, Lennie V, McConnachie A, Murphy CL, Petrie CJ, Petrie JR, Speirits IA, Sourbron S, Welsh P, Woodward R, Radjenovic A, Mark PB, McMurray JJV, Jhund PS, Petrie MC, Sattar N. Effect of Empagliflozin on Left Ventricular Volumes in Patients With Type 2 Diabetes, or Prediabetes, and Heart Failure With Reduced Ejection Fraction (SUGAR-DM-HF). Circulation 2020; 143:516-525. [PMID: 33186500 PMCID: PMC7864599 DOI: 10.1161/circulationaha.120.052186] [Citation(s) in RCA: 205] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors reduce the risk of heart failure hospitalization and cardiovascular death in patients with heart failure and reduced ejection fraction (HFrEF). However, their effects on cardiac structure and function in HFrEF are uncertain. METHODS We designed a multicenter, randomized, double-blind, placebo-controlled trial (the SUGAR-DM-HF trial [Studies of Empagliflozin and Its Cardiovascular, Renal and Metabolic Effects in Patients With Diabetes Mellitus, or Prediabetes, and Heart Failure]) to investigate the cardiac effects of empagliflozin in patients in New York Heart Association functional class II to IV with a left ventricular (LV) ejection fraction ≤40% and type 2 diabetes or prediabetes. Patients were randomly assigned 1:1 to empagliflozin 10 mg once daily or placebo, stratified by age (<65 and ≥65 years) and glycemic status (diabetes or prediabetes). The coprimary outcomes were change from baseline to 36 weeks in LV end-systolic volume indexed to body surface area and LV global longitudinal strain both measured using cardiovascular magnetic resonance. Secondary efficacy outcomes included other cardiovascular magnetic resonance measures (LV end-diastolic volume index, LV ejection fraction), diuretic intensification, symptoms (Kansas City Cardiomyopathy Questionnaire Total Symptom Score, 6-minute walk distance, B-lines on lung ultrasound, and biomarkers (including N-terminal pro-B-type natriuretic peptide). RESULTS From April 2018 to August 2019, 105 patients were randomly assigned: mean age 68.7 (SD, 11.1) years, 77 (73.3%) male, 82 (78.1%) diabetes and 23 (21.9%) prediabetes, mean LV ejection fraction 32.5% (9.8%), and 81 (77.1%) New York Heart Association II and 24 (22.9%) New York Heart Association III. Patients received standard treatment for HFrEF. In comparison with placebo, empagliflozin reduced LV end-systolic volume index by 6.0 (95% CI, -10.8 to -1.2) mL/m2 (P=0.015). There was no difference in LV global longitudinal strain. Empagliflozin reduced LV end-diastolic volume index by 8.2 (95% CI, -13.7 to -2.6) mL/m2 (P=0.0042) and reduced N-terminal pro-B-type natriuretic peptide by 28% (2%-47%), P=0.038. There were no between-group differences in other cardiovascular magnetic resonance measures, diuretic intensification, Kansas City Cardiomyopathy Questionnaire Total Symptom Score, 6-minute walk distance, or B-lines. CONCLUSIONS The sodium-glucose cotransporter 2 inhibitor empagliflozin reduced LV volumes in patients with HFrEF and type 2 diabetes or prediabetes. Favorable reverse LV remodeling may be a mechanism by which sodium-glucose cotransporter 2 inhibitors reduce heart failure hospitalization and mortality in HFrEF. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03485092.
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Affiliation(s)
- Matthew M Y Lee
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.).,Glasgow Royal Infirmary, United Kingdom (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | - Katriona J M Brooksbank
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom
| | - Kirsty Wetherall
- Robertson Centre for Biostatistics (K.W., A.M.), University of Glasgow, United Kingdom
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.).,Glasgow Royal Infirmary, United Kingdom (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | - Ross T Campbell
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.).,Golden Jubilee National Hospital, Glasgow, United Kingdom (R.T.C., C.B., J.G.D., M.C.P.)
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.).,Golden Jubilee National Hospital, Glasgow, United Kingdom (R.T.C., C.B., J.G.D., M.C.P.)
| | - Victor Chong
- University Hospital Crosshouse, Kilmarnock, United Kingdom (V.C.)
| | - Liz Coyle
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom
| | - Kieran F Docherty
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - John G Dreisbach
- Golden Jubilee National Hospital, Glasgow, United Kingdom (R.T.C., C.B., J.G.D., M.C.P.)
| | | | - Ninian N Lang
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - Vera Lennie
- University Hospital Ayr, United Kingdom (V.L.)
| | - Alex McConnachie
- Robertson Centre for Biostatistics (K.W., A.M.), University of Glasgow, United Kingdom
| | - Clare L Murphy
- Royal Alexandra Hospital, Paisley, United Kingdom (C.L.M.)
| | - Colin J Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,University Hospital Monklands, Airdrie, United Kingdom (C.J.P.)
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Glasgow Royal Infirmary, United Kingdom (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | - Iain A Speirits
- West Glasgow Ambulatory Care Hospital, United Kingdom (I.A.S.)
| | | | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom
| | - Rosemary Woodward
- Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - Aleksandra Radjenovic
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - Pardeep S Jhund
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Glasgow Royal Infirmary, United Kingdom (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.).,Golden Jubilee National Hospital, Glasgow, United Kingdom (R.T.C., C.B., J.G.D., M.C.P.)
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Glasgow Royal Infirmary, United Kingdom (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
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McCartney P, Maznyczka A, McEntegart M, Eteiba H, Greenwood J, Muir D, Chowdhary S, Gershlick A, Appleby C, Cotton J, Wragg A, Curzen N, Oldroyd K, Lindsay M, Rocchiccioli P, Shaukat A, Good R, Watkins S, Robertson K, Malkin CJ, Collison D, Gillespie L, Martin L, Ford T, Petrie M, Weir R, Murphy A, Petrie C, Wetherall K, Macfarlane P, McConnachie A, Berry C. TCT CONNECT-28 Left Ventricular End-Diastolic Pressure in Acute Myocardial Infarction, Association With Infarct Pathology, Left Ventricular Function, and Health Outcomes. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Maznyczka A, McCartney P, Duklas P, Greenwood J, Muir D, Chowdhary S, Curzen N, McEntegart M, Oldroyd K, Gershlick A, Appleby C, Tait C, Cotton J, Wragg A, Sattar N, Fox K, Eteiba H, McConnachie A, Berry C. TCT CONNECT-16 Implications of Impaired Coronary Flow on the Effects of Intracoronary Alteplase During Primary Percutaneous Coronary Intervention. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Maznyczka A, McCartney P, Oldroyd K, Greenwood J, Cotton J, Weir R, McConnachie A, Berry C. TCT CONNECT-15 Risk Stratification Guided by the Index of Microcirculatory Resistance and Left Ventricular End-Diastolic Pressure During Primary Percutaneous Coronary Intervention. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Simpson SA, Matthews L, Pugmire J, McConnachie A, McIntosh E, Coulman E, Hughes K, Kelson M, Morgan-Trimmer S, Murphy S, Utkina-Macaskill O, Moore LAR. An app-, web- and social support-based weight loss intervention for adults with obesity: the 'HelpMeDoIt!' feasibility randomised controlled trial. Pilot Feasibility Stud 2020; 6:133. [PMID: 32968544 PMCID: PMC7501712 DOI: 10.1186/s40814-020-00656-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background Social support has an important role in successful weight loss. The aim of this study was to assess the feasibility and acceptability of an app-, web- and social support-based intervention in supporting adults with obesity to achieve weight loss. Methods The intervention and evaluation methods were tested in a feasibility randomised controlled trial. Adults in the Greater Glasgow and Clyde Health Board area of Scotland with a body mass index ≥ 30 kg/m2 were recruited and randomised 2:1 (intervention to control). The feasibility and acceptability of the intervention and trial methods were assessed against pre-specified progression criteria, via process, economic and outcome evaluation. Three primary outcomes were explored: BMI, diet and physical activity, as well as a number of secondary outcomes. The intervention group had access to the HelpMeDoIt! intervention for 12 months. This encouraged them to (i) set goals, (ii) monitor progress and (iii) harness social support by inviting ‘helpers’ from their existing social network. The control group received a healthy lifestyle leaflet. Results One hundred and nine participants were recruited, with 84 participants (77%) followed-up at 12 months. The intervention and trial methods were feasible and acceptable. Participants and helpers were generally positive. Of the 54 (74%) participants who downloaded the app, 48 (89%) used it. Interview data indicated that HelpMeDoIt! promoted social support from existing social networks to support weight loss. This support was often given outside of the app. Outcomes were compared using linear regression models, with randomised group, the baseline measurement of the outcome, age and gender as predictor variables. These analyses were exploratory and underpowered to detect effects. However, all pre-specified primary outcome effects (BMI, diet and physical activity) had wide confidence intervals and were therefore consistent with clinically relevant benefits. Objective physical activity measures perhaps showed most potential (daily step count (p = 0.098; 1187 steps [− 180, 2555])) and sedentary time (p = 0.022; − 60.8 min [− 110.5, − 11.0]). However, these outcomes were poorly completed. Conclusions The study demonstrated that a novel social support intervention involving support from participants’ close social networks, delivered via app and website, has potential to promote weight loss and is feasible and acceptable. Trial registration ISRCTN, ISRCTN85615983. Registered 25 September 2014
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Affiliation(s)
- Sharon Anne Simpson
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR UK
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR UK
| | - Juliana Pugmire
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Robertson Centre, Boyd Orr Building, Glasgow, G12 8QQ UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment Unit (HEHTA), Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ UK
| | - Elinor Coulman
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park Way, Cardiff, CF14 4YS UK
| | - Kathryn Hughes
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park Way, Cardiff, CF14 4YS UK
| | - Mark Kelson
- College of Engineering, Mathematics and Physical Sciences, School of Mathematics/The Alan Turing Institute, University of Exeter, Harrison Building, Streatham Campus, North Park Road, Exeter, EX4 4QF UK
| | - Sarah Morgan-Trimmer
- Institute of Health Research, College of Medicine and Health, University of Exeter, College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Simon Murphy
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff School of Social Sciences, Cardiff University, Cardiff, CF10 3AT UK
| | - Olga Utkina-Macaskill
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR UK
| | - Laurence Anthony Russell Moore
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR UK
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Schnabel S, van Wijck F, Bain B, Barber M, Dall P, Fleming A, Kerr A, Langhorne P, McConnachie A, Molloy K, Stanley B, Young HJ, Kidd L. Experiences of augmented arm rehabilitation including supported self-management after stroke: a qualitative investigation. Clin Rehabil 2020; 35:288-301. [PMID: 32907393 DOI: 10.1177/0269215520956388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the experiences of stroke survivors and their carers of augmented arm rehabilitation including supported self-management in terms of its acceptability, appropriateness and relevance. DESIGN A qualitative design, nested within a larger, multi-centre randomized controlled feasibility trial that compared augmented arm rehabilitation starting at three or nine weeks after stroke, with usual care. Semi-structured interviews were conducted with participants in both augmented arm rehabilitation groups. Normalization Process Theory was used to inform the topic guide and map the findings. Framework analysis was applied. SETTING Interviews were conducted in stroke survivors' homes, at Glasgow Caledonian University and in hospital. PARTICIPANTS 17 stroke survivors and five carers were interviewed after completion of augmented arm rehabilitation. INTERVENTION Evidence-based augmented arm rehabilitation (27 additional hours over six weeks), including therapist-led sessions and supported self-management. RESULTS Three main themes were identified: (1) acceptability of the intervention (2) supported self-management and (3) coping with the intervention. All stroke survivors coped well with the intensity of the augmented arm rehabilitation programme. The majority of stroke survivors engaged in supported self-management and implemented activities into their daily routine. However, the findings suggest that some stroke survivors (male >70 years) had difficulties with self-management, needing a higher level of support. CONCLUSION Augmented arm rehabilitation commencing within nine weeks post stroke was reported to be well tolerated. The findings suggested that supported self-management seemed acceptable and appropriate to those who saw the relevance of the rehabilitation activities for their daily lives, and embedded them into their daily routines.
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Affiliation(s)
- Stefanie Schnabel
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Frederike van Wijck
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Brenda Bain
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Mark Barber
- Medicine for the Elderly and Stroke, NHS Lanarkshire, University Hospital Monklands, Monkscourt Avenue, Airdrie, South Lanarkshire, UK
| | - Philippa Dall
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Alexander Fleming
- Different Strokes, Different Strokes Central Services, 9 Canon Harnett Court, Wolverton Mill, Milton Keynes, UK
| | - Andrew Kerr
- Bioengineering, University of Strathclyde, Glasgow, UK
| | | | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Kathleen Molloy
- Different Strokes, Different Strokes Central Services, 9 Canon Harnett Court, Wolverton Mill, Milton Keynes, UK
| | - Bethany Stanley
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Heather Jane Young
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Lisa Kidd
- School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
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VAN Vulpen JK, Sweegers MG, Peeters PHM, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, Galvão DA, Chinapaw MJ, Steindorf K, Irwin ML, Stuiver MM, Hayes S, Griffith KA, Mesters I, Knoop H, Goedendorp MM, Mutrie N, Daley AJ, McConnachie A, Bohus M, Thorsen L, Schulz KH, Short CE, James EL, Plotnikoff RC, Schmidt ME, Ulrich CM, VAN Beurden M, Oldenburg HS, Sonke GS, VAN Harten WH, Schmitz KH, Winters-Stone KM, Velthuis MJ, Taaffe DR, VAN Mechelen W, Kersten MJ, Nollet F, Wenzel J, Wiskemann J, Verdonck-DE Leeuw IM, Brug J, May AM, Buffart LM. Moderators of Exercise Effects on Cancer-related Fatigue: A Meta-analysis of Individual Patient Data. Med Sci Sports Exerc 2020; 52:303-314. [PMID: 31524827 DOI: 10.1249/mss.0000000000002154] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Fatigue is a common and potentially disabling symptom in patients with cancer. It can often be effectively reduced by exercise. Yet, effects of exercise interventions might differ across subgroups. We conducted a meta-analysis using individual patient data of randomized controlled trials (RCT) to investigate moderators of exercise intervention effects on cancer-related fatigue. METHODS We used individual patient data from 31 exercise RCT worldwide, representing 4366 patients, of whom 3846 had complete fatigue data. We performed a one-step individual patient data meta-analysis, using linear mixed-effect models to analyze the effects of exercise interventions on fatigue (z score) and to identify demographic, clinical, intervention- and exercise-related moderators. Models were adjusted for baseline fatigue and included a random intercept on study level to account for clustering of patients within studies. We identified potential moderators by testing their interaction with group allocation, using a likelihood ratio test. RESULTS Exercise interventions had statistically significant beneficial effects on fatigue (β = -0.17; 95% confidence interval [CI], -0.22 to -0.12). There was no evidence of moderation by demographic or clinical characteristics. Supervised exercise interventions had significantly larger effects on fatigue than unsupervised exercise interventions (βdifference = -0.18; 95% CI -0.28 to -0.08). Supervised interventions with a duration ≤12 wk showed larger effects on fatigue (β = -0.29; 95% CI, -0.39 to -0.20) than supervised interventions with a longer duration. CONCLUSIONS In this individual patient data meta-analysis, we found statistically significant beneficial effects of exercise interventions on fatigue, irrespective of demographic and clinical characteristics. These findings support a role for exercise, preferably supervised exercise interventions, in clinical practice. Reasons for differential effects in duration require further exploration.
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Affiliation(s)
- Jonna K VAN Vulpen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | | | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, CANADA
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS
| | - Paul B Jacobsen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Mai J Chinapaw
- Amsterdam UMC, Vrije Universiteit, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, THE NETHERLANDS
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, GERMANY
| | | | - Martijn M Stuiver
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS
| | - Sandi Hayes
- School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, AUSTRALIA
| | | | - Ilse Mesters
- Department of Epidemiology, Maastricht University, THE NETHERLANDS
| | - Hans Knoop
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, THE NETHERLANDS
| | | | - Nanette Mutrie
- Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, UNITED KINGDOM
| | - Amanda J Daley
- School of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, Leicestershire, UNITED KINGDOM
| | - Alex McConnachie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UNITED KINGDOM
| | | | | | - Karl-Heinz Schulz
- Athleticum-Competence Center for Sports- and Exercise Medicine and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, GERMANY
| | - Camille E Short
- Freemasons Foundation Centre of Men's Health, School of Medicine, University of Adelaide, SA, AUSTRALIA
| | - Erica L James
- School of Medicine & Public Health, the University of Newcastle, Callaghan, NSW, AUSTRALIA
| | - Ronald C Plotnikoff
- Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, Callaghan, NSW, AUSTRALIA
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, GERMANY
| | - Cornelia M Ulrich
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | | | | | - Gabe S Sonke
- Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS
| | | | - Kathryn H Schmitz
- Department of Public Health Science, College of Medicine and Cancer Institute, Pennsylvania State University, Hershey, PA
| | - Kerri M Winters-Stone
- Knight Cancer Institute, School of Nursing, Oregon Health & Science University, Portland, OR
| | - Miranda J Velthuis
- Netherlands comprehensive cancer organisation (IKNL), Utrecht, THE NETHERLANDS
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Willem VAN Mechelen
- Amsterdam UMC, Vrije Universiteit, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, THE NETHERLANDS
| | - Marie José Kersten
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, THE NETHERLANDS
| | - Frans Nollet
- Amsterdam UMC, University of Amsterdam Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, THE NETHERLANDS
| | - Jennifer Wenzel
- Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | | | | | | | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
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de Montmollin M, Feller M, Beglinger S, McConnachie A, Aujesky D, Collet TH, Ford I, Gussekloo J, Kearney PM, McCarthy VJC, Mooijaart S, Poortvliet RKE, Quinn T, Stott DJ, Watt T, Westendorp R, Rodondi N, Bauer DC. L-Thyroxine Therapy for Older Adults With Subclinical Hypothyroidism and Hypothyroid Symptoms: Secondary Analysis of a Randomized Trial. Ann Intern Med 2020; 172:709-716. [PMID: 32365355 DOI: 10.7326/m19-3193] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND L-thyroxine does not improve hypothyroid symptoms among adults with subclinical hypothyroidism (SCH). However, those with greater symptom burden before treatment may still benefit. OBJECTIVE To determine whether L-thyroxine improves hypothyroid symptoms and tiredness among older adults with SCH and greater symptom burden. DESIGN Secondary analysis of the randomized, placebo-controlled trial TRUST (Thyroid Hormone Replacement for Untreated Older Adults with Subclinical Hypothyroidism Trial). (ClinicalTrials.gov: NCT01660126). SETTING Switzerland, Ireland, the Netherlands, and Scotland. PARTICIPANTS 638 persons aged 65 years or older with persistent SCH (thyroid-stimulating hormone level of 4.60 to 19.9 mIU/L for >3 months and normal free thyroxine level) and complete outcome data. INTERVENTION L-thyroxine or matching placebo with mock dose titration. MEASUREMENTS 1-year change in Hypothyroid Symptoms and Tiredness scores (range, 0 to 100; higher scores indicate more symptoms) on the Thyroid-Related Quality-of-Life Patient-Reported Outcome Questionnaire among participants with high symptom burden (baseline Hypothyroid Symptoms score >30 or Tiredness score >40) versus lower symptom burden. RESULTS 132 participants had Hypothyroid Symptoms scores greater than 30, and 133 had Tiredness scores greater than 40. Among the group with high symptom burden, the Hypothyroid Symptoms score improved similarly between those receiving L-thyroxine (mean within-group change, -12.3 [95% CI, -16.6 to -8.0]) and those receiving placebo (mean within-group change, -10.4 [CI, -15.3 to -5.4]) at 1 year; the adjusted between-group difference was -2.0 (CI, -5.5 to 1.5; P = 0.27). Improvements in Tiredness scores were also similar between those receiving L-thyroxine (mean within-group change, -8.9 [CI, -14.5 to -3.3]) and those receiving placebo (mean within-group change, -10.9 [CI, -16.0 to -5.8]); the adjusted between-group difference was 0.0 (CI, -4.1 to 4.0; P = 0.99). There was no evidence that baseline Hypothyroid Symptoms score or Tiredness score modified the effects of L-thyroxine versus placebo (P for interaction = 0.20 and 0.82, respectively). LIMITATION Post hoc analysis, small sample size, and examination of only patients with 1-year outcome data. CONCLUSION In older adults with SCH and high symptom burden at baseline, L-thyroxine did not improve hypothyroid symptoms or tiredness compared with placebo. PRIMARY FUNDING SOURCE European Union FP7.
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Affiliation(s)
- Maria de Montmollin
- Inselspital, Bern University Hospital, and Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (M.D., M.F., S.B., N.R.)
| | - Martin Feller
- Inselspital, Bern University Hospital, and Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (M.D., M.F., S.B., N.R.)
| | - Shanthi Beglinger
- Inselspital, Bern University Hospital, and Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (M.D., M.F., S.B., N.R.)
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland (A.M., I.F.)
| | - Drahomir Aujesky
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (D.A.)
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland (T.C.)
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland (A.M., I.F.)
| | - Jacobijn Gussekloo
- Leiden University Medical Center, Leiden, the Netherlands (J.G., R.K.P.)
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork, Ireland (P.M.K.)
| | - Vera J C McCarthy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland (V.J.M.)
| | - Simon Mooijaart
- Institute for Evidence-based Medicine in Old Age, Leiden University Medical Center, Leiden, the Netherlands (S.M.)
| | | | - Terence Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.Q., D.J.S.)
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.Q., D.J.S.)
| | - Torquil Watt
- Copenhagen University Hospital Herlev, Herlev, Denmark, and University of Copenhagen, Copenhagen, Denmark (T.W., R.W.)
| | - Rudi Westendorp
- Copenhagen University Hospital Herlev, Herlev, Denmark, and University of Copenhagen, Copenhagen, Denmark (T.W., R.W.)
| | - Nicolas Rodondi
- Inselspital, Bern University Hospital, and Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (M.D., M.F., S.B., N.R.)
| | - Douglas C Bauer
- University of Copenhagen, Copenhagen, Denmark; and University of California, San Francisco, San Francisco, California (D.C.B.)
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Thomas RJ, McConnachie A, Williams MMA, Stanley B. Dietary intake of broccoli and the risk of cancer in the prostate, lung, colorectal, and ovarian cancer (PCLO) screening trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e13560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13560 Background: The cruciferous vegetable broccoli, are a good source of vitamins, minerals and fibre, as well as thiol phytochemicals (indole-3-carbinol), glucosinolates (isothiocyanates, its metabolite, sulforaphane), carotenoids (lutein and zeaxanthin) and flavonols (kaempferol). Laboratory and human biopsy studies have found that broccoli intake influenced epigenetic expression of genes via blockage of histone deacetylase which reduce inflammation and cancer growth. Clinically, a randomised control study reported dried broccoli extract (along with three other foods) influenced PSA progression in men with prostate cancer1. However, no preventative intervention studies in humans have been conducted and data from cohort studies are inconsistent for its influence on cancer incidence2,3. Methods: We analysed 49,104 people within the intervention arm of the 155,000 participant PLCO screening trial. Histological confirmed cases of any cancer were reported in 8,263 (16.83%) during the 11.5 year follow up. Broccoli consumption was assessed with a food frequency questionnaire (FFQ). Baseline characteristics were compared between broccoli consumption groups using Chi-square and Kruskal-Wallis tests. Cox regression models were used to assess the association between broccoli intake and cancer incidence. Results: Broccoli consumption was associated with reduced cancer incidence: HR 0.95 (CI 0.93-0.97, p < 0.001). This pattern persisted with adjustments for age, sex, race, education level and family history (HR 0.97, CI 0.96-0.99, p = 0.007) as well as smoking, BMI and alcohol consumption (HR 0.98, CI 0.96-0.99, p = 0.010). Conclusions: The study identified an association between increased broccoli consumption and reduced cancer risk. In practical terms, 15g of broccoli, or more, consumed per day (about a small cup) was associated with a 5% lower risk of cancer. Broccoli should continue to be included in healthy eating advice. This data supports the consideration of future prospective intervention studies investigating the role of broccoli as part of a cancer prevention programme. References 1. Thomas et al. The NCRN Pomi-T RCT. Prostate cancer & prostatic diseases (2014), 2,180. 2. Liu et al Cruciferous vegetables inversely linked with breast cancer: Breast (2013), 22;3,309. 3. Bosetti et al Cruciferous vegetables and cancer risk Ann Oncol (2012) 23(8);2198.
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Affiliation(s)
- Robert J. Thomas
- Department of Sports and Exercise Science, Bedford, United Kingdom
| | - Alex McConnachie
- Institute of Health and Wellbeing Galsgow University, Glasgow, United Kingdom
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Thomas RJ, McConnachie A, Stanley B, Williams M. Dietary consumption of tea and the risk of prostate cancer in the prostate, lung, colorectal, and ovarian cancer screening trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13559 Background: The popular beverage tea, brewed from infused leaves of camellia sinesis, contains non-phytoestrogenic polyphenols such as flavonoids, anthocyanidins, flavanols (epigallocatechin gallate); phenolic acids (ellagic acid) and stimulants (caffeine, theophylline). Laboratory studies report tea promotes antioxidant enzyme formation, slows cancer cell proliferation and unblocks apoptosis. Clinically, the Pomi-T randomised study reported tea extract (along with three other foods) reduced PSA progression in men with prostate cancer1. Evidence of prostate cancer prevention, however, from prospective cohort data is conflicting with one recent study even implying an increased risk2. Methods: We analysed 25,097 men within the intervention arm of the 155,000 participant PLCO screening trial. Histological confirmed cases of prostate cancer were reported in 3,088 men (12.3%) during the 11.5 year follow up. Tea consumption was assessed with a food frequency questionnaire (FFQ). Baseline characteristics were compared between groups using Chi-square and Kruskal-Wallis tests. Cox regression models were used to assess the association between tea intake and prostate cancer incidence. Results: Overall tea consumption was associated with a significantly lower risk of prostate cancer (p = 0.009). More precisely, the participants in the highest third of consumption group had a significantly lower risk compared to those in the lowest third (HR 1.16 (CI 1.05-1.29, p = 0.004). This pattern persisted with adjustments for age, sex, race and education level (p = 0.034), family history of cancer (p = 0.037). Those who never drank tea, however, had no statistical lower risk of prostate cancer compared to other groups (p = 0.501). Conclusions: Among tea drinkers, this data revealed a positive association between drinking tea and a reduced risk of prostate cancer. This data supports the consideration of future prospective intervention studies investigating the role of tea as part of a prostate cancer prevention programme. 1. Thomas et al. The NCRN Pomi-T RCT. Prostate cancer & prostatic diseases (2014), 2,180. 2. Reger et al. Dietary isoflavones and prostate cancer risk. Int J. Cancer (2017), 142; 4, 719.
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Affiliation(s)
- Robert J. Thomas
- Department of Oncology Bedford and Addenbrooke's Cambridge University Hospitals, Cambridge, United Kingdom
| | - Alex McConnachie
- Institute of Health and Wellbeing Galsgow University, Glasgow, United Kingdom
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Campbell RT, Jasilek A, Mischak H, Nkuipou-Kenfack E, Latosinska A, Welsh PI, Jackson CE, Cannon J, McConnachie A, Delles C, McMurray JJV. The novel urinary proteomic classifier HF1 has similar diagnostic and prognostic utility to BNP in heart failure. ESC Heart Fail 2020; 7:1595-1604. [PMID: 32383555 PMCID: PMC7373887 DOI: 10.1002/ehf2.12708] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 03/28/2020] [Accepted: 03/31/2020] [Indexed: 12/24/2022] Open
Abstract
AIMS Measurement of B-type natriuretic peptide (BNP) or N-terminal pro-BNP is recommended as part of the diagnostic workup of patients with suspected heart failure (HF). We evaluated the diagnostic and prognostic utility of the novel urinary proteomic classifier HF1, compared with BNP, in HF. HF1 consists of 85 unique urinary peptide fragments thought, mainly, to reflect collagen turnover. METHODS AND RESULTS We performed urinary proteome analysis using capillary electrophoresis coupled with mass spectrometry in 829 participants. Of these, 622 had HF (504 had chronic HF and 118 acute HF) and 207 were controls (62 coronary heart disease patients without HF and 145 healthy controls). The area under the receiver operating characteristic (ROC) curve (AUC) using HF1 for the diagnosis of HF (cases vs. controls) was 0.94 (95% CI, 0.92-0.96). This compared with an AUC for BNP of 0.98 (95% CI, 0.97-0.99). Adding HF1 to BNP increased the AUC to 0.99 (0.98-0.99), P < 0.001, and led to a net reclassification improvement of 0.67 (95% CI, 0.54-0.77), P < 0.001. Among 433 HF patients followed up for a median of 989 days, we observed 186 deaths. HF1 had poorer predictive value to BNP for all-cause mortality and did not add prognostic information when combined with BNP. CONCLUSIONS The urinary proteomic classifier HF1 performed as well, diagnostically, as BNP and provided incremental diagnostic information when added to BNP. HF1 had less prognostic utility than BNP.
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Affiliation(s)
- Ross T Campbell
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK.,Queen Elizabeth University Hospital, Glasgow, UK
| | - Adam Jasilek
- Roberson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Harald Mischak
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK.,Mosaiques Diagnostics GmbH, Hannover, Germany
| | | | | | - Paul I Welsh
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
| | | | | | - Alex McConnachie
- Roberson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
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Jackson AM, Zhang R, Findlay I, Robertson K, Lindsay M, Morris T, Forbes B, Papworth R, McConnachie A, Mangion K, Jhund PS, McCowan C, Berry C. Healthcare disparities for women hospitalized with myocardial infarction and angina. Eur Heart J Qual Care Clin Outcomes 2020; 6:156-165. [PMID: 31346604 PMCID: PMC7132925 DOI: 10.1093/ehjqcco/qcz040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 01/01/2023]
Abstract
AIMS Ischaemic heart disease persists as the leading cause of death in both men and women in most countries and sex disparities, defined as differences in health outcomes and their determinants, may be relevant. We examined sex disparities in presenting characteristics, treatment and all-cause mortality in patients hospitalized with myocardial infarction (MI) or angina. METHODS AND RESULTS We conducted a cohort study of all patients admitted with MI or angina (01 October 2013 to 30 June 2016) from a secondary care acute coronary syndrome e-Registry in NHS Scotland linked with national registers of community drug dispensation and mortality data. A total of 7878 patients hospitalized for MI or angina were prospectively included; 3161 (40%) were women. Women were older, more deprived, had a greater burden of comorbidity, were more often treated with guideline-recommended therapy preadmission and less frequently received immediate invasive management. Men were more likely to receive coronary angiography [adjusted odds ratio (OR) 1.52, confidence interval (CI) 1.37-1.68] and percutaneous coronary intervention (adjusted OR 1.68, CI 1.52-1.86). Women were less comprehensively treated with evidence-based therapies post-MI. Women had worse crude survival, primarily those with ST-elevation myocardial infarction (14.3% vs. 8.0% at 1 year, P < 0.001), but this finding was explained by differences in baseline factors. Men with non-ST-elevation myocardial infarction had a higher risk of all-cause death at 30 days [adjusted hazard ratio (HR) 1.72, CI 1.16-2.56] and 1 year (adjusted HR 1.38, CI 1.12-1.69). CONCLUSION After taking account of baseline risk factors, sex differences in treatment pathway, use of invasive management, and secondary prevention therapies indicate disparities in guideline-directed management of women hospitalized with MI or angina.
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Affiliation(s)
- Alice M Jackson
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Ruiqi Zhang
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
| | - Iain Findlay
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Road, Paisley PA2 9PN, UK
| | - Keith Robertson
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Road, Paisley PA2 9PN, UK
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
| | - Mitchell Lindsay
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
- Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
| | | | - Brian Forbes
- AstraZeneca UK, Capability Green, Luton LU1 3LU, UK
| | - Richard Papworth
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
| | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Pardeep S Jhund
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Colin McCowan
- School of Medicine, Medical and Biological Sciences Building, University of St Andrews, North Haugh, St Andrews KY16 9TF, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
- Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
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Zhyzhneuskaya SV, Al-Mrabeh A, Peters C, Barnes A, Aribisala B, Hollingsworth KG, McConnachie A, Sattar N, Lean MEJ, Taylor R. Time Course of Normalization of Functional β-Cell Capacity in the Diabetes Remission Clinical Trial After Weight Loss in Type 2 Diabetes. Diabetes Care 2020; 43:813-820. [PMID: 32060017 DOI: 10.2337/dc19-0371] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 12/29/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess functional β-cell capacity in type 2 diabetes during 2 years of remission induced by dietary weight loss. RESEARCH DESIGN AND METHODS A Stepped Insulin Secretion Test with Arginine was used to quantify functional β-cell capacity by hyperglycemia and arginine stimulation. Thirty-nine of 57 participants initially achieved remission (HbA1c <6.5% [<48 mmol/mol] and fasting plasma glucose <7 mmol/L on no antidiabetic drug therapy) with a 16.4 ± 7.7 kg weight loss and were followed up with supportive advice on avoidance of weight regain. At 2 years, 20 participants remained in remission in the study. A nondiabetic control (NDC) group, matched for age, sex, and weight after weight loss with the intervention group, was studied once. RESULTS During remission, median (interquartile range) maximal rate of insulin secretion increased from 581 (480-811) pmol/min/m2 at baseline to 736 (542-998) pmol/min/m2 at 5 months, 942 (565-1,240) pmol/min/m2 at 12 months (P = 0.028 from baseline), and 936 (635-1,435) pmol/min/m2 at 24 months (P = 0.023 from baseline; n = 20 of 39 of those initially in remission). This was comparable to the NDC group (1,016 [857-1,507] pmol/min/m2) by 12 (P = 0.064) and 24 (P = 0.244) months. Median first-phase insulin response increased from baseline to 5 months (42 [4-67] to 107 [59-163] pmol/min/m2; P < 0.0001) and then remained stable at 12 and 24 months (110 [59-201] and 125 [65-166] pmol/min/m2, respectively; P < 0.0001 vs. baseline) but lower than that of the NDC group (250 [226-429] pmol/min/m2; P < 0.0001). CONCLUSIONS A gradual increase in assessed functional β-cell capacity occurred after weight loss, becoming similar to that of NDC group participants by 12 months. This result was unchanged at 2 years with continuing remission of type 2 diabetes.
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Affiliation(s)
- Sviatlana V Zhyzhneuskaya
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, U.K
| | - Ahmad Al-Mrabeh
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, U.K
| | - Carl Peters
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, U.K
| | - Alison Barnes
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, U.K
| | | | - Kieren G Hollingsworth
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, U.K
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, U.K
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Michael E J Lean
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, U.K
| | - Roy Taylor
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, U.K.
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Hendry GJ, Bearne L, Foster N, Godfrey E, Hider S, van der Leeden M, Mason H, McConnachie A, McInnes I, Patience A, Sackley C, Sekhon M, Williams A, Woodburn J, Steultjens M. P125 A mixed methods feasibility study of a gait rehabilitation programme for people with early rheumatoid arthritis and foot pain. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Foot pain, a hallmark feature of rheumatoid arthritis (RA), is associated with slow and unsteady gait patterns, and persistent walking disability is common. Great Strides is a new gait rehabilitation programme designed to improve/preserve lower limb function in early RA. It is delivered by physiotherapists or podiatrists over 12-weeks and is supplemented with a home programme and support materials (DVD and illustrated booklet). It consists of a 6-task gait circuit and is underpinned by behaviour change techniques driven by motivational interviewing. The aims of this feasibility study were to 1) evaluate patient acceptability, adherence to, and safety of Great Strides, and 2) identify a suitable primary outcome measure for the main trial.
Methods
This study was a multi-centre (n = 3), single arm, repeated measures (pre- and post-intervention) design, with interviews exploring participants’ intervention perceptions. People with early (<2 years) RA who had foot pain were invited to participate. Intervention acceptability was evaluated using a 3-item intervention acceptability questionnaire. Adherence was evaluated using the Exercise Adherence Rating Scale (EARS). Safety was monitored using case report forms. Complementary mixed methods integrated descriptive quantitative acceptability, adherence, safety and thematic analyses to corroborate findings. Measurement properties of candidate primary outcomes (10-metre walking time, Foot Function Index disability subscale [FFI-DS], Recent Onset Arthritis Disability lower extremity subscale, and Patient-Reported Outcomes Measurement Information System physical function short-form) were evaluated against a 7-point Change in Walking Ability scale (CWA).
Results
35 participants (68.6% female) with median age (inter-quartile range [IQR]) 60 [49-68] years and disease duration 9 [4-16] months), were recruited over 9 months and 23 (67%) completed 12-week follow-up. 12 participants completed interviews after the 12-week intervention period. Intervention acceptability was excellent; 21/23 were confident that it could help the problem; 21/23 reported that they would recommend it to a friend; 22/23 indicated it made sense to them. Intervention adherence was moderate, with a median [IQR] EARS score of 12/24 [7-19]. 1 participant reported transient post-exercise soreness. No serious adverse events were reported that were related to the intervention. From interviews, 10/12 participants reported they had continued with the intervention after 12-weeks. Participants revealed that the intervention provided structure and control to their day/week. Additional perceptions of benefit reported included improvements to lower limb joint health, and feelings of increased confidence to return to, or progress to further exercise in the community. The main challenge identified by some participants was lack of space to do the intervention at home. Correlations with the CWA were better for FFI-DS change-scores.
Conclusion
Great Strides has excellent acceptability and appears safe for people with early RA. Levels of adherence may be improved by intervention refinement. FFI-DS scores were theoretically consistent for selection as primary outcome for the main trial.
Disclosures
G.J. Hendry None. L. Bearne None. N. Foster None. E. Godfrey None. S. Hider None. M. van der Leeden None. H. Mason None. A. McConnachie None. I. McInnes None. A. Patience None. C. Sackley None. M. Sekhon None. A. Williams None. J. Woodburn None. M. Steultjens None.
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Affiliation(s)
- Gordon J Hendry
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
| | - Lindsay Bearne
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UNITED KINGDOM
| | - Nadine Foster
- School of Primary, Community and Social Care, Keele University, Keele, UNITED KINGDOM
| | - Emma Godfrey
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UNITED KINGDOM
| | - Samantha Hider
- School of Primary, Community and Social Care, Keele University, Keele, UNITED KINGDOM
- Haywood Academic Rheumatology Unit, Midlands Partnership Foundation Trust, Stafford, UNITED KINGDOM
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UNITED KINGDOM
| | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
| | - Aimie Patience
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
| | - Catherine Sackley
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UNITED KINGDOM
| | - Mandeep Sekhon
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UNITED KINGDOM
| | - Anita Williams
- School of Health and Society, University of Salford, Salford, UNITED KINGDOM
| | - James Woodburn
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
| | - Martijn Steultjens
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
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Sekhon M, Godfrey E, Hendry G, Foster NE, Hider S, van der Leeden M, Mason H, McConnachie A, McInnes I, Patience A, Sackley C, Steultjens M, Williams A, Woodburn J, Bearne L. P105 Therapists acceptability of delivering a psychologically informed gait rehabilitation intervention in early rheumatoid arthritis (GREAT): a qualitative interview study. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Great Strides is a brief psychologically informed gait rehabilitation intervention (two compulsory face-to-face sessions and up to four optional sessions delivered over 3 months) aimed at improving lower limb function for adults with early rheumatoid arthritis (RA). As part of the Gait Rehabilitation in Early Arthritis Trial (GREAT) feasibility study, physiotherapists and podiatrists received two days of bespoke training delivered by psychologists, physiotherapists and podiatrists on i) the gait rehabilitation exercise programme (six walking exercises) ii) aspects of motivational interviewing (MI) and iii) delivery of key behaviour change techniques (BCTs) to facilitate motivation and adherence to the Great Strides intervention. The training was supported by a bespoke therapist manual and session checklists. The aim of this study was to explore therapists’ acceptability of: (1) the bespoke training received and (2) delivering the intervention within the GREAT feasibility study.
Methods
All 10 therapists who received training were invited to complete semi-structured interviews. The topic guide was informed by the Theoretical Framework of Acceptability (TFA). Interviews were audio recorded, professionally transcribed and a deductive thematic analysis was applied. Data were coded into six TFA constructs (Affective Attitude; Burden; Intervention Coherence; Opportunity Costs; Perceived Effectiveness; Self-efficacy).
Results
Nine out of ten therapists (four physiotherapists, five podiatrists) participated in the semi-structured interviews. Five therapists (four physiotherapists, one podiatrist) delivered the Great Strides intervention. Key barriers and enablers with regards to the acceptability of the bespoke training and intervention delivery were identified. Training: Therapists liked the supportive training environment (affective attitude), understood the purpose of the training sessions (intervention coherence), reported that the role play exercises aided their confidence in applying MI and BCTs (self-efficacy) and found that the training sessions were vital preparation for delivering the intervention (perceived effectiveness). Aspects of training which were considered unacceptable included the lack of time to attend the training sessions (opportunity costs). Delivery: All therapists enjoyed applying MI and BCTs to encourage participants to complete the gait exercises (affective attitude) and valued the opportunity to provide individualised care (intervention coherence). Barriers associated with acceptability included the use of trial-related materials (e.g. checklist) during intervention delivery (burden), interference of intervention delivery with routine clinical workload (opportunity costs) and the time delay between receiving training and initial intervention delivery (perceived effectiveness).
Conclusion
Both GREAT intervention training and delivery were considered acceptable to most therapists. The results have guided key refinements for training and intervention delivery for the GREAT internal pilot and full trial (e.g. remote access to training, timing of training in relation to intervention delivery). These refinements have the potential to improve the bespoke training and enhance the delivery of the Great Strides intervention maximising efficiency and potential for effectiveness.
Disclosures
M. Sekhon None. E. Godfrey None. G. Hendry None. N.E. Foster None. S. Hider None. M. van der Leeden None. H. Mason None. A. McConnachie None. I. McInnes None. A. Patience None. C. Sackley None. M. Steultjens None. A. Williams None. J. Woodburn None. L. Bearne None.
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Affiliation(s)
- Mandeep Sekhon
- Faculty of Life Sciences and Medicine, King's College London, London, UNITED KINGDOM
| | - Emma Godfrey
- Faculty of Life Sciences and Medicine, King's College London, London, UNITED KINGDOM
| | - Gordon Hendry
- School of Health Sciences, Glasgow Caledonian University,, Glasgow, UNITED KINGDOM
| | - Nadine E Foster
- Institute for Primary Care and Health Sciences, Keele University, Keele, UNITED KINGDOM
| | - Samantha Hider
- School of Primary, Community and Social Care, Keele University, Keele, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Staffordshire UK, UNITED KINGDOM
| | | | - Helen Mason
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK, UNITED KINGDOM
| | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
| | - Aimie Patience
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
| | - Catherine Sackley
- Faculty of Life Sciences and Medicine, King's College London, London, UNITED KINGDOM
| | - Martin Steultjens
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
| | - Anita Williams
- School of Health and Society, University of Salford, Salford, UNITED KINGDOM
| | - Jim Woodburn
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
| | - Lindsay Bearne
- Faculty of Life Sciences and Medicine, King's College London, London, UNITED KINGDOM
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McCartney PJ, Maznyczka AM, Eteiba H, McEntegart M, Oldroyd KG, Greenwood JP, Maredia N, Schmitt M, McCann GP, Fairbairn T, McAlindon E, Tait C, Welsh P, Sattar N, Orchard V, Corcoran D, Ford TJ, Radjenovic A, Ford I, McConnachie A, Berry C. Low-Dose Alteplase During Primary Percutaneous Coronary Intervention According to Ischemic Time. J Am Coll Cardiol 2020; 75:1406-1421. [PMID: 32216909 PMCID: PMC7109518 DOI: 10.1016/j.jacc.2020.01.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Microvascular obstruction affects one-half of patients with ST-segment elevation myocardial infarction and confers an adverse prognosis. OBJECTIVES This study aimed to determine whether the efficacy and safety of a therapeutic strategy involving low-dose intracoronary alteplase infused early after coronary reperfusion associates with ischemic time. METHODS This study was conducted in a prospective, multicenter, parallel group, 1:1:1 randomized, dose-ranging trial in patients undergoing primary percutaneous coronary intervention. Ischemic time, defined as the time from symptom onset to coronary reperfusion, was a pre-specified subgroup of interest. Between March 17, 2016, and December 21, 2017, 440 patients, presenting with ST-segment elevation myocardial infarction within 6 h of symptom onset (<2 h, n = 107; ≥2 h but <4 h, n = 235; ≥4 h to 6 h, n = 98), were enrolled at 11 U.K. hospitals. Participants were randomly assigned to treatment with placebo (n = 151), alteplase 10 mg (n = 144), or alteplase 20 mg (n = 145). The primary outcome was the amount of microvascular obstruction (MVO) (percentage of left ventricular mass) quantified by cardiac magnetic resonance imaging at 2 to 7 days (available for 396 of 440). RESULTS Overall, there was no association between alteplase dose and the extent of MVO (p for trend = 0.128). However, in patients with an ischemic time ≥4 to 6 h, alteplase increased the mean extent of MVO compared with placebo: 1.14% (placebo) versus 3.11% (10 mg) versus 5.20% (20 mg); p = 0.009 for the trend. The interaction between ischemic time and alteplase dose was statistically significant (p = 0.018). CONCLUSION In patients presenting with ST-segment elevation myocardial infarction and an ischemic time ≥4 to 6 h, adjunctive treatment with low-dose intracoronary alteplase during primary percutaneous coronary intervention was associated with increased MVO. Intracoronary alteplase may be harmful for this subgroup. (A Trial of Low-Dose Adjunctive Alteplase During Primary PCI [T-TIME]; NCT02257294).
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Affiliation(s)
- Peter J McCartney
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Annette M Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, United Kingdom
| | - Neil Maredia
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Matthias Schmitt
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Gerry P McCann
- University of Leicester and the National Institute for Health Research Leicester Biomedical Research Center, Leicester, United Kingdom
| | - Timothy Fairbairn
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Elisa McAlindon
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Campbell Tait
- Department of Hematology, Royal Infirmary, Glasgow, United Kingdom
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom
| | - Vanessa Orchard
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom
| | - Thomas J Ford
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Aleksandra Radjenovic
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom.
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Smith M, Francq B, McConnachie A, Wetherall K, Pelosi A, Morrison J. Clinical judgement, case complexity and symptom scores as predictors of outcome in depression: an exploratory analysis. BMC Psychiatry 2020; 20:125. [PMID: 32183799 PMCID: PMC7076946 DOI: 10.1186/s12888-020-02532-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/04/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Clinical guidelines for depression in adults recommend the use of outcome measures and stepped care models in routine care. Such measures are based on symptom severity, but response to treatment is likely to also be influenced by personal and contextual factors. This observational study of a routine clinical sample sought to examine the extent to which "symptom severity measures" and "complexity measures" assess different aspects of patient experience, and how they might relate to clinical outcomes, including disengagement from treatment. METHODS Subjects with symptoms of depression (with or without comorbid anxiety) were recruited from people referred to an established Primary Care Mental Health Team using a stepped care model. Each participant completed three baseline symptom measures (the Personal Health Questionnaire (PHQ), Generalised Anxiety Disorder questionnaire (GAD) and Clinical Outcomes in Routine Evaluation (CORE-10)), and two assessments of "case complexity" (the Minnesota-Edinburgh Complexity Assessment Measure (MECAM) and a local complexity assessment). Clinician perception of likely completion of treatment and patient recovery was also assessed. Outcome measures were drop out and clinical improvement on the PHQ. RESULTS 298 subjects were recruited to the study, of whom 258 had a sufficient dataset available for analysis. Data showed that the three measures of symptom severity used in this study (PHQ, GAD and CORE-10) seemed to be measuring distinct characteristics from those associated with the measures of case complexity (MECAM, previous and current problem count). Higher symptom severity scores were correlated with improved outcomes at the end of treatment, but there was no association between outcome and complexity measures. Clinicians could predict participant drop-out from care with some accuracy, but had no ability to predict outcome from treatment. CONCLUSIONS These results highlight the extent to which drop-out complicates recovery from depression with or without anxiety in real-world settings, and the need to consider other factors beyond symptom severity in planning care. The findings are discussed in relation to a growing body of literature investigating prognostic indicators in the context of models of collaborative care for depression.
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Affiliation(s)
- M. Smith
- grid.413301.40000 0001 0523 9342NHS Greater Glasgow and Clyde, Glasgow, UK
| | - B. Francq
- grid.7942.80000 0001 2294 713XInstitute of Statistics, Biostatistics and Actuarial Sciences, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - A. McConnachie
- grid.8756.c0000 0001 2193 314XRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - K. Wetherall
- grid.8756.c0000 0001 2193 314XRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - J. Morrison
- grid.8756.c0000 0001 2193 314XSenate Office, University of Glasgow, Glasgow, UK
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Sidik NP, McEntegart M, Roditi G, Ford TJ, McDermott M, Morrow A, Byrne J, Adams J, Hargreaves A, Oldroyd KG, Stobo D, Wu O, Messow CM, McConnachie A, Berry C. Rationale and design of the British Heart Foundation (BHF) Coronary Microvascular Function and CT Coronary Angiogram (CorCTCA) study. Am Heart J 2020; 221:48-59. [PMID: 31911341 PMCID: PMC7029345 DOI: 10.1016/j.ahj.2019.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/26/2019] [Indexed: 12/31/2022]
Abstract
Microvascular and/or vasospastic anginas are relevant causes of ischemia with no obstructive coronary artery disease (INOCA) in patients after computed tomography coronary angiography (CTCA). OBJECTIVES Our research has 2 objectives. The first is to undertake a diagnostic study, and the second is to undertake a nested, clinical trial of stratified medicine. DESIGN A prospective, multicenter, randomized, blinded, sham-controlled trial of stratified medicine (NCT03477890) will be performed. All-comers referred for clinically indicated CTCA for investigation of suspected coronary artery disease (CAD) will be screened in 3 regional centers. Following informed consent, eligible patients with angina symptoms are enrolled before CTCA and remain eligible if CTCA excludes obstructive CAD. Diagnostic study: Invasive coronary angiography involving an interventional diagnostic procedure (IDP) to assess for disease endotypes: (1) angina due to obstructive CAD (fractional flow reserve ≤0.80); (2) microvascular angina (coronary flow reserve <2.0 and/or index of microvascular resistance >25); (3) microvascular angina due to small vessel spasm (acetylcholine); (4) vasospastic angina due to epicardial coronary spasm (acetylcholine); and (5) noncoronary etiology (normal coronary function). The IDP involves direct invasive measurements using a diagnostic coronary guidewire followed by provocation testing with intracoronary acetylcholine. The primary outcome of the diagnostic study is the reclassification of the initial CTCA diagnosis based on the IDP. Stratified medicine trial: Participants are immediately randomized 1:1 in the catheter laboratory to therapy stratified by endotype (intervention group) or not (control group). The primary outcome of the trial is the mean within-subject change in Seattle Angina Questionnaire score at 6 months. Secondary outcomes include safety, feasibility, diagnostic utility (impact on diagnosis and certainty), and clinical utility (impact on treatment and investigations). Health status assessments include quality of life, illness perception, anxiety-depression score, treatment satisfaction, and physical activity. Participants who are not randomized will enter a follow-up registry. Health and economic outcomes in the longer term will be assessed using electronic patient record linkage. VALUE CorCTCA will prospectively characterize the prevalence of disease endotypes in INOCA and determine the clinical value of stratified medicine in this population.
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Affiliation(s)
- Novalia P Sidik
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Thomas J Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; University of New South Wales, Sydney, Australia
| | - Michael McDermott
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew Morrow
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - John Byrne
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jacqueline Adams
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - David Stobo
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Claudia-Martina Messow
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
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Simpson SA, Matthews L, Pugmire J, McConnachie A, McIntosh E, Coulman E, Hughes K, Kelson M, Morgan-Trimmer S, Murphy S, Utkina-Macaskill O, Moore L. An app-, web- and social support-based weight loss intervention for adults with obesity: the HelpMeDoIt! feasibility RCT. Public Health Res 2020. [DOI: 10.3310/phr08030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background
Finding solutions to rising levels of obesity continues to be a major public health focus. Social support has an important role in successful weight loss, and digital interventions can reach a large proportion of the population at low cost.
Objective
To develop and assess the feasibility and acceptability of an application (app), web- and social support-based intervention in supporting adults with obesity to achieve weight loss goals.
Design
Stage 1 – intervention development phase involved three focus groups (n = 10) with users, and think-aloud interviews and field testing with another group (n = 28). Stage 2 – the intervention and evaluation methods were explored in a feasibility randomised controlled trial with economic and process evaluation.
Setting
Greater Glasgow and Clyde, UK.
Participants
Adults with a body mass index of ≥ 30kg/m2 who owned a smartphone and were interested in losing weight were randomised 2 : 1 (intervention : control) and followed up at 12 months. Recruitment took place in April–October 2016.
Interventions
The intervention group had access to HelpMeDoIt! for 12 months. This encouraged them to (1) set goals, (2) monitor progress and (3) harness social support by inviting ‘helpers’ from their existing social network. The control group received a healthy lifestyle leaflet.
Main outcome measures
Data from stage 1 informed the intervention design. Key measures in stage 2 assessed the feasibility and acceptability of the intervention and trial methods against prespecified progression criteria. Three primary outcomes were explored: body mass index, diet and physical activity. Secondary outcomes included weight, waist and hip circumference, social support, self-efficacy, motivation, mental health, health-related quality of life, NHS resource use, participant-borne costs and intervention costs. Qualitative interviews with participants (n = 26) and helpers (n = 9) explored the feasibility and acceptability of the trial methods and intervention.
Results
Stage 1 produced (1) a website that provided evidence-based information for lifestyle change and harnessing social support, and (2) an app that facilitated goal-setting, self-monitoring and supportive interaction between participants and their helper(s). Progression criteria were met, demonstrating that the intervention and trial methods were feasible and acceptable. A total of 109 participants (intervention, n = 73; control, n = 36) were recruited, with 84 participants (77%: intervention, 71%; control, 89%) followed up at 12 months. Data were successfully collected for most outcome measures (≥ 82% completion). Participants and helpers were generally positive, although helper engagement with the app was low. Of the 54 (74%) participants who downloaded the app, 48 (89%) used it twice or more, 28 helpers enrolled via the app, and 19 (36%) participants interacted with their helper(s) via the app. Interview data indicated that HelpMeDoIt! prompted support from helpers that often occurred without the helpers using the app.
Limitations
Early technical problems meant that some participants and helpers had difficulty accessing the app. Ethical constraints meant that we were unable to contact helpers directly for interview.
Conclusions
The HelpMeDoIt! study demonstrated that a weight loss intervention delivered via an app and a website is feasible and acceptable. Progression criteria were met, supporting further evaluation of the intervention.
Future work
To further explore (1) the motivation and engagement of helpers, (2) the programme theory and (3) the effectiveness and cost-effectiveness of the intervention.
Trial registration
Current Controlled Trials ISRCTN85615983.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sharon Anne Simpson
- Medical Research Council/Chief Scientist Office (MRC/CSO) Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynsay Matthews
- Medical Research Council/Chief Scientist Office (MRC/CSO) Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Juliana Pugmire
- Medical Research Council/Chief Scientist Office (MRC/CSO) Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment Unit (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Elinor Coulman
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Kathryn Hughes
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Mark Kelson
- School of Mathematics, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Sarah Morgan-Trimmer
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Simon Murphy
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff School of Social Sciences, Cardiff University, Cardiff, UK
| | - Olga Utkina-Macaskill
- Medical Research Council/Chief Scientist Office (MRC/CSO) Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Laurence Moore
- Medical Research Council/Chief Scientist Office (MRC/CSO) Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Maznyczka AM, McCartney PJ, Eteiba H, Greenwood JP, Muir DF, Chowdhary S, Gershlick AH, Appleby C, Cotton JM, Wragg A, Curzen N, Oldroyd KG, Lindsay M, McEntegart M, Rocchiccioli JP, Shaukat A, Good R, Watkins S, Robertson K, Malkin C, Martin L, Gillespie L, Weir RA, Ford TJ, Petrie MC, Murphy A, Petrie CJ, Ramparsad N, Wetherall K, Fox KA, Ford I, McConnachie A, Berry C. One-Year Outcomes After Low-Dose Intracoronary Alteplase During Primary Percutaneous Coronary Intervention: The T-TIME Randomized Trial. Circ Cardiovasc Interv 2020; 13:e008855. [PMID: 32069113 DOI: 10.1161/circinterventions.119.008855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Annette M Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre (A.M.M., P.J.M., K.G.O., T.J.F., M.C.P., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Peter J McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre (A.M.M., P.J.M., K.G.O., T.J.F., M.C.P., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, United Kingdom (J.P.G.)
| | - Douglas F Muir
- James Cook University Hospital NHS Trust, Middlesbrough, United Kingdom (D.F.M., C.M.)
| | - Saqib Chowdhary
- Manchester University NHS Foundation Trust, United Kingdom (S.C.)
| | | | - Clare Appleby
- Liverpool Heart and Chest Hospital NHS Foundation Trust, United Kingdom (C.A.)
| | - James M Cotton
- Wolverhampton University Hospital NHS Trust, United Kingdom (J.M.C.)
| | - Andrew Wragg
- Barts and The London Hospital, London, United Kingdom (A.W.)
| | - Nick Curzen
- University Hospital Southampton Foundation Trust and School of Medicine, University of Southampton, United Kingdom (N.C.)
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre (A.M.M., P.J.M., K.G.O., T.J.F., M.C.P., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - J Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Christopher Malkin
- James Cook University Hospital NHS Trust, Middlesbrough, United Kingdom (D.F.M., C.M.)
| | - Lynn Martin
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | | | - Robin A Weir
- University Hospital Hairmyres, East Kilbride, United Kingdom (R.A.W.)
| | - Thomas J Ford
- British Heart Foundation Glasgow Cardiovascular Research Centre (A.M.M., P.J.M., K.G.O., T.J.F., M.C.P., C.B.), University of Glasgow, United Kingdom
| | - Mark C Petrie
- British Heart Foundation Glasgow Cardiovascular Research Centre (A.M.M., P.J.M., K.G.O., T.J.F., M.C.P., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Aengus Murphy
- University Hospital Monklands, NHS Lanarkshire, United Kingdom (A.M., C.J.P.)
| | - Colin J Petrie
- University Hospital Monklands, NHS Lanarkshire, United Kingdom (A.M., C.J.P.)
| | - Nitish Ramparsad
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing (N.R., K.W., I.F., A.M.), University of Glasgow, United Kingdom
| | - Kirsty Wetherall
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing (N.R., K.W., I.F., A.M.), University of Glasgow, United Kingdom
| | - Keith A Fox
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.F.)
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing (N.R., K.W., I.F., A.M.), University of Glasgow, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing (N.R., K.W., I.F., A.M.), University of Glasgow, United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre (A.M.M., P.J.M., K.G.O., T.J.F., M.C.P., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
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Maznyczka AM, McCartney PJ, Oldroyd KG, Lindsay M, McEntegart M, Eteiba H, Rocchiccioli P, Good R, Shaukat A, Robertson K, Kodoth V, Greenwood JP, Cotton JM, Hood S, Watkins S, Macfarlane PW, Kennedy J, Tait RC, Welsh P, Sattar N, Collison D, Gillespie L, McConnachie A, Berry C. Effects of Intracoronary Alteplase on Microvascular Function in Acute Myocardial Infarction. J Am Heart Assoc 2020; 9:e014066. [PMID: 31986989 PMCID: PMC7033872 DOI: 10.1161/jaha.119.014066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Impaired microcirculatory reperfusion worsens prognosis following acute ST‐segment–elevation myocardial infarction. In the T‐TIME (A Trial of Low‐Dose Adjunctive Alteplase During Primary PCI) trial, microvascular obstruction on cardiovascular magnetic resonance imaging did not differ with adjunctive, low‐dose, intracoronary alteplase (10 or 20 mg) versus placebo during primary percutaneous coronary intervention. We evaluated the effects of intracoronary alteplase, during primary percutaneous coronary intervention, on the index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio. Methods and Results A prespecified physiology substudy of the T‐TIME trial. From 2016 to 2017, patients with ST‐segment–elevation myocardial infarction ≤6 hours from symptom onset were randomized in a double‐blind study to receive alteplase 20 mg, alteplase 10 mg, or placebo infused into the culprit artery postreperfusion, but prestenting. Index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio were measured after percutaneous coronary intervention. Cardiovascular magnetic resonance was performed at 2 to 7 days and 3 months. Analyses in relation to ischemic time (<2, 2–4, and ≥4 hours) were prespecified. One hundred forty‐four patients (mean age, 59±11 years; 80% male) were prospectively enrolled, representing 33% of the overall population (n=440). Overall, index of microcirculatory resistance (median, 29.5; interquartile range, 17.0–55.0), coronary flow reserve(1.4 [1.1–2.0]), and resistive reserve ratio (1.7 [1.3–2.3]) at the end of percutaneous coronary intervention did not differ between treatment groups. Interactions were observed between ischemic time and alteplase for coronary flow reserve (P=0.013), resistive reserve ratio (P=0.026), and microvascular obstruction (P=0.022), but not index of microcirculatory resistance. Conclusions In ST‐segment–elevation myocardial infarction with ischemic time ≤6 hours, there was overall no difference in microvascular function with alteplase versus placebo. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02257294.
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Affiliation(s)
- Annette M Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Peter J McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Richard Good
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Keith Robertson
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Vivek Kodoth
- Leeds University and Leeds Teaching Hospitals NHS Trust Leeds United Kingdom
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust Leeds United Kingdom
| | - James M Cotton
- Wolverhampton University Hospital NHS Trust Wolverhampton United Kingdom
| | - Stuart Hood
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | | | - Julie Kennedy
- Electrocardiology Group Royal Infirmary Glasgow United Kingdom
| | - R Campbell Tait
- Department of Haematology Royal Infirmary Glasgow United Kingdom
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom
| | - Damien Collison
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Lynsey Gillespie
- Project Management Unit Greater Glasgow and Clyde Health Board Glasgow United Kingdom
| | - Alex McConnachie
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,Robertson Centre for Biostatistics Institute of Health and Wellbeing, University of Glasgow Glasgow United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom
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86
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Mark PB, Papworth R, Ramparsad N, Tomlinson LA, Sawhney S, Black C, McConnachie A, McCowan C. Risk factors associated with biochemically detected and hospitalised acute kidney injury in patients prescribed renin angiotensin system inhibitors. Br J Clin Pharmacol 2020; 86:121-131. [PMID: 31663151 PMCID: PMC6983520 DOI: 10.1111/bcp.14141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS Therapy with angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) is a mainstay of treatment for heart failure (HF), diabetes mellitus (DM) and chronic kidney disease (CKD). These agents have been associated with development of acute kidney injury (AKI) during intercurrent illness. Risk factors for AKI in patients prescribed ACEi/ARB therapy are not well described. METHODS We captured the incidence of AKI in patients commencing ACEi/ARB during 2009-2015 using anonymised patient records. Hospital-coded AKI was defined from hospital episode statistics; biochemical AKI was ascertained from laboratory data. Risk factors for biochemically detected and hospitalised AKI were investigated. RESULTS Of 61,318 patients prescribed ACEi/ARB, with 132 885 person years (py) follow-up, there were 1070 hospitalisations with AKI as a diagnosis recorded and a total of 4645 AKI events, including AKI episodes indicated by biochemical KDIGO-based creatinine change criteria. Incidence of any AKI event was 35.0 per 1000-py, hospital-coded AKI was 7.8 per 1000-py and biochemical AKI was 33.7 per 1000-py. Independent risk factors in a multivariable model for hospital-coded AKI events were age, male gender, HF, diabetes, cerebrovascular disease, lower estimated glomerular filtration rate, socioeconomic deprivation, diuretic or non-steroidal anti-inflammatory use (all P < 0.001). CONCLUSION In patients prescribed ACEi/ARB, the highest risk of AKI is associated with conditions which are considered strong evidence-based indications for their prescription. Socio-economic status is an under-reported risk factor for AKI with these agents. Strategies targeted at prevention of AKI may be of benefit, such as enhanced awareness based on higher risk comorbidities.
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Affiliation(s)
- Patrick B. Mark
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
- Glasgow Renal and Transplant UnitQueen Elizabeth University HospitalGlasgowUK
| | - Richard Papworth
- Robertson Centre for Biostatistics, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Nitish Ramparsad
- Robertson Centre for Biostatistics, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | | | - Simon Sawhney
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Science and NutritionUniversity of AberdeenAberdeenUK
| | - Corri Black
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Science and NutritionUniversity of AberdeenAberdeenUK
- Department of Public HealthNHS GrampianAberdeenUK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Colin McCowan
- Robertson Centre for Biostatistics, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
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87
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Ford TJ, Yii E, Sidik N, Good R, Rocchiccioli P, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, McCartney P, Corcoran D, Collison D, Rush C, Stanley B, McConnachie A, Sattar N, Touyz RM, Oldroyd KG, Berry C. Ischemia and No Obstructive Coronary Artery Disease: Prevalence and Correlates of Coronary Vasomotion Disorders. Circ Cardiovasc Interv 2019; 12:e008126. [PMID: 31833416 PMCID: PMC6924940 DOI: 10.1161/circinterventions.119.008126] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/30/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Determine the prevalence and correlates of microvascular and vasospastic angina in patients with symptoms and signs of ischemia but no obstructive coronary artery disease (INOCA). METHODS Three hundred ninety-one patients with angina were enrolled at 2 regional centers over 12 months from November 2016 (NCT03193294). INOCA subjects (n=185; 47%) had more limiting dyspnea (New York Heart Association classification III/IV 54% versus 37%; odds ratio [OR], 2.0 [1.3-3.0]; P=0.001) and were more likely to be female (68% INOCA versus 38% in coronary artery disease; OR, 1.9 [1.5 to 2.5]; P<0.001) but with lower cardiovascular risk scores (ASSIGN score median 20% versus 24%; P=0.003). INOCA subjects had similar burden of angina (Seattle Angina Questionnaire) but reduced quality of life compared with coronary artery disease; subjects (EQ5D-5 L index 0.60 versus 0.65 units; P=0.041). RESULTS An interventional diagnostic procedure with reference invasive tests including coronary flow reserve, microvascular resistance, and vasomotor responses to intracoronary acetylcholine (vasospasm provocation) was performed in 151 INOCA subjects. Overall, 78 (52%) had isolated microvascular angina, 25 (17%) had isolated vasospastic angina, 31 (20%) had both, and 17 (11%) had noncardiac chest pain. Regression analysis showed inducible ischemia on treadmill testing (OR, 7.5 [95% CI, 1.7-33.0]; P=0.008) and typical angina (OR, 2.7 [1.1-6.6]; P=0.032) were independently associated with microvascular angina. Female sex tended to associate with a diagnosis of microvascular angina although this was not significant (OR, 2.7 [0.9-7.9]; P=0.063). Vasospastic angina was associated with smoking (OR, 9.5 [2.8-32.7]; P<0.001) and age (OR, 1.1 per year, [1.0-1.2]; P=0.032]. CONCLUSIONS Over three quarters of patients with INOCA have identifiable disorders of coronary vasomotion including microvascular and vasospastic angina. These patients have comparable angina burden but reduced quality of life compared to patients with obstructive coronary artery disease. Microvascular angina and vasospastic angina are distinct disorders that may coexist but differ in associated clinical characteristics, symptoms, and angina severity. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03193294.
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Affiliation(s)
- Thomas J. Ford
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
- Department of Interventional Cardiology, Gosford Hospital, New South Wales, Australia (T.J.F.)
- University of New South Wales, Sydney, Australia (T.J.F.)
| | - Eric Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Novalia Sidik
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Richard Good
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Paul Rocchiccioli
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Margaret McEntegart
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Stuart Watkins
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Hany Eteiba
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Aadil Shaukat
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Mitchell Lindsay
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Keith Robertson
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Stuart Hood
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Ross McGeoch
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- Department of Interventional Cardiology, University Hospital Hairmyres, East Kilbride, United Kingdom (R. McGeoch, N. Sattar)
| | - Robert McDade
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Peter McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - David Corcoran
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
- Department of Interventional Cardiology, Gosford Hospital, New South Wales, Australia (T.J.F.)
- University of New South Wales, Sydney, Australia (T.J.F.)
- Department of Interventional Cardiology, University Hospital Hairmyres, East Kilbride, United Kingdom (R. McGeoch, N. Sattar)
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, United Kingdom (B.S., A.M.)
| | - Damien Collison
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Christopher Rush
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Bethany Stanley
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, United Kingdom (B.S., A.M.)
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, United Kingdom (B.S., A.M.)
| | - Naveed Sattar
- Department of Interventional Cardiology, University Hospital Hairmyres, East Kilbride, United Kingdom (R. McGeoch, N. Sattar)
| | - Rhian M. Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Keith G. Oldroyd
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Colin Berry
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
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88
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Ford TJ, Stanley B, Sidik N, Good R, Rocchiccioli P, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, Yii E, McCartney P, Corcoran D, Collison D, Rush C, Sattar N, McConnachie A, Touyz RM, Oldroyd KG, Berry C. 1-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA). JACC Cardiovasc Interv 2019; 13:33-45. [PMID: 31709984 PMCID: PMC8310942 DOI: 10.1016/j.jcin.2019.11.001] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 01/09/2023]
Abstract
Objectives The aim of this study was to test the hypothesis that invasive coronary function testing at time of angiography could help stratify management of angina patients without obstructive coronary artery disease. Background Medical therapy for angina guided by invasive coronary vascular function testing holds promise, but the longer-term effects on quality of life and clinical events are unknown among patients without obstructive disease. Methods A total of 151 patients with angina with symptoms and/or signs of ischemia and no obstructive coronary artery disease were randomized to stratified medical therapy guided by an interventional diagnostic procedure versus standard care (control group with blinded interventional diagnostic procedure results). The interventional diagnostic procedure–facilitated diagnosis (microvascular angina, vasospastic angina, both, or neither) was linked to guideline-based management. Pre-specified endpoints included 1-year patient-reported outcome measures (Seattle Angina Questionnaire, quality of life [EQ-5D]) and major adverse cardiac events (all-cause mortality, myocardial infarction, unstable angina hospitalization or revascularization, heart failure hospitalization, and cerebrovascular event) at subsequent follow-up. Results Between November 2016 and December 2017, 151 patients with ischemia and no obstructive coronary artery disease were randomized (n = 75 to the intervention group, n = 76 to the control group). At 1 year, overall angina (Seattle Angina Questionnaire summary score) improved in the intervention group by 27% (difference 13.6 units; 95% confidence interval: 7.3 to 19.9; p < 0.001). Quality of life (EQ-5D index) improved in the intervention group relative to the control group (mean difference 0.11 units [18%]; 95% confidence interval: 0.03 to 0.19; p = 0.010). After a median follow-up duration of 19 months (interquartile range: 16 to 22 months), major adverse cardiac events were similar between the groups, occurring in 9 subjects (12%) in the intervention group and 8 (11%) in the control group (p = 0.803). Conclusions Stratified medical therapy in patients with ischemia and no obstructive coronary artery disease leads to marked and sustained angina improvement and better quality of life at 1 year following invasive coronary angiography. (Coronary Microvascular Angina [CorMicA]; NCT03193294)
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Affiliation(s)
- Thomas J Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; Gosford Hospital, NSW Health, Gosford, Australia
| | - Bethany Stanley
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Novalia Sidik
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Ross McGeoch
- University Hospital Hairmyres, East Kilbride, United Kingdom
| | - Robert McDade
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Eric Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Peter McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Damien Collison
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Christopher Rush
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rhian M Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
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Abstract
BACKGROUND Caring for a child with intellectual disabilities can be a very rewarding but demanding experience. Research in this area has primarily focused on mothers, with relatively little attention given to the mental health of fathers. AIMS The purpose of this review was to summarise the evidence related to the mental health of fathers compared with mothers, and with fathers in the general population. METHOD A meta-analysis was undertaken of all studies published by 1 July 2018 in Medline, PsycINFO, CINAHL and EMBASE, using terms on intellectual disabilities, mental health and father carers. Papers were selected based on pre-defined inclusion and exclusion criteria. RESULTS Of 5544 results, 20 studies met the inclusion criteria and 12 had appropriate data for meta-analysis. For comparisons of fathers with mothers, mothers were significantly more likely to have poor general mental health and well-being (standardised mean difference (SMD) -0.38, 95% CI -0.56 to -0.20), as well as higher levels of depression (SMD, -0.46; 95% CI -0.68 to -0.24), stress (SMD, -0.32; 95% CI -0.46 to -0.19) and anxiety (SMD, -0.30; 95% CI -0.50 to -0.10). CONCLUSIONS There is a significant difference between the mental health of father and mother carers, with fathers less likely to exhibit poor mental health. However, this is based on a small number of studies. More data is needed to determine whether the general mental health and anxiety of father carers of a child with intellectual disabilities differs from fathers in the general population.
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Affiliation(s)
- Kirsty Dunn
- Research Assistant, Mental Health and Wellbeing Group, University of Glasgow, UK
| | - Deborah Kinnear
- Senior Lecturer, Mental Health and Wellbeing Group, University of Glasgow, UK
| | - Andrew Jahoda
- Professor, Mental Health and Wellbeing Group, University of Glasgow, UK
| | - Alex McConnachie
- Professor, Mental Health and Wellbeing Group, University of Glasgow, UK
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90
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Mercer SW, Fitzpatrick B, Grant L, Chng NR, McConnachie A, Bakhshi A, James-Rae G, O'Donnell CA, Wyke S. Effectiveness of Community-Links Practitioners in Areas of High Socioeconomic Deprivation. Ann Fam Med 2019; 17:518-525. [PMID: 31712290 PMCID: PMC6846279 DOI: 10.1370/afm.2429] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/23/2019] [Accepted: 03/26/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the effect of a primary care-based community-links practitioner (CLP) intervention on patients' quality of life and well-being. METHODS Quasi-experimental cluster-randomized controlled trial in socioeconomically deprived areas of Glasgow, Scotland. Adult patients (aged 18 years or older) referred to CLPs in 7 intervention practices were compared with a random sample of adult patients from 8 comparison practices at baseline and 9 months. PRIMARY OUTCOME health-related quality of life (EQ-5D-5L, a standardized measure of self-reported health-related quality of life that assesses 5 dimensions at 5 levels of severity). SECONDARY OUTCOMES well-being (Investigating Choice Experiments for the Preferences of Older People Capability Measure for Adults [ICECAP-A]), depression (Hospital Anxiety and Depression Scale, Depression [HADS-D]), anxiety (Hospital Anxiety and Depression Scale, Anxiety [HADS-A]), and self-reported exercise. Multilevel, multiregression analyses adjusted for baseline differences. Patients were not blinded to the intervention, but outcome analysis was masked. RESULTS Data were collected on 288 and 214 (74.3%) patients in the intervention practices at baseline and follow-up, respectively, and on 612 and 561 (92%) patients in the comparison practices. Intention-to-treat analysis found no differences between the 2 groups for any outcome. In subgroup analyses, patients who saw the CLP on 3 or more occasions (45% of those referred) had significant improvements in EQ-5D-5L, HADS-D, HADS-A, and exercise levels. There was a high positive correlation between CLP consultation rates and patient uptake of suggested community resources. CONCLUSIONS We were unable to prove the effectiveness of referral to CLPs based in primary care in deprived areas for improving patient outcomes. Future efforts to boost uptake and engagement could improve overall outcomes, although the apparent improvements in those who regularly saw the CLPs may be due to reverse causality. Further research is needed before wide-scale deployment of this approach.
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Affiliation(s)
- Stewart W Mercer
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Bridie Fitzpatrick
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Lesley Grant
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Nai Rui Chng
- College of Social Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Andisheh Bakhshi
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Greg James-Rae
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Catherine A O'Donnell
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Sally Wyke
- College of Social Sciences, University of Glasgow, Glasgow, United Kingdom
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91
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Maznyczka A, McCartney P, Oldroyd KG, McEntegart M, Lindsay M, Eteiba H, Rocchiccioli P, Good R, Shaukat A, Kodoth V, Greenwood J, Robertson K, Cotton J, McConnachie A, Berry C. P2707Invasive coronary physiology during primary percutaneous coronary intervention in patients treated with intracoronary alteplase or placebo: the double-blind T-TIME physiology substudy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Impaired microcirculatory reperfusion worsens prognosis post-primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Intracoronary (IC) alteplase targets persisting thrombus post-reperfusion & distal embolisation. In the T-TIME trial microvascular obstruction on cardiac magnetic resonance (CMR) did not differ with IC alteplase vs placebo.
Purpose
To prospectively determine if index of microcirculatory resistance (IMR) is lower & coronary flow reserve (CFR) or resistive reserve ratio (RRR) are higher (improved) with IC alteplase, & to provide mechanistic insights.
Methods
A pre-planned substudy of the main protocol. From 2016–2017, STEMI patients from 3 UK hospitals ≤6 hrs ischaemic time were randomised in a 1:1:1 dose-ranging, double-blind design. Following standard care reperfusion, alteplase (10 or 20mg) or placebo was infused over 5–10 mins proximal to the culprit lesion pre-stenting. IMR (primary outcome), CFR & RRR (secondary outcomes) were measured in the culprit artery post-PCI. Physiology results were obscured from clinicians acquiring the data, to maintain blinding. CMR was performed 2 days & 3 months post-STEMI. Subgroup analyses were prespecified including by ischaemic time (<2 hours, 2–4 hrs, >4 hrs) & IMR threshold >32.
Results
In 144 patients (mean age 59 yrs, 80% male), IMR, CFR or RRR post-PCI did not differ with alteplase vs placebo (Table). Patients with ischaemic time <2 hrs had a dose related increase in CFR (placebo 1.2 [IQR 1.1–1.7], alteplase 10mg 1.4 [IQR 1.0–1.8], alteplase 20mg 2.0 [IQR 1.8–2.3] p=0.01 for interaction) & RRR (placebo 1.5 [IQR 1.3–1.9], alteplase 10mg 1.6 [1.1–2.2], alteplase 20mg 2.2 [2.0–2.6], p=0.03 for interaction). In subjects with post-PCI IMR>32, % ST-resolution at 60 mins was worse with alteplase 10mg vs placebo (23.1±53.9 vs 50.9±31.5) & in those with IMR≤32% ST-resolution at 60 mins was better with alteplase 20mg vs placebo (68.0±30.7 vs 39.1±43.2), p=0.002 for interaction. The CMR findings in the substudy & overall trial populations were consistent.
Main results Placebo Alteplase 10mg Alteplase 20mg (n=53) (n=41) (n=50) IMR, median (IQR) 33.0 (17.0–57.0) 22.0 (17.0–42.0) 37.0 (20.0–57.8) p=0.15 p=0.78 CFR, median (IQR) 1.3 (1.1–1.8) 1.4 (1.1–1.9) 1.5 (1.1–2.0) p=0.92 p=0.74 RRR, median (IQR) 1.6 (1.3–2.2) 1.6 (1.4–2.6) 1.8 (1.3–2.4) p=0.69 p=0.81 P-values for comparison of alteplase with placebo.
Conclusions
In acute STEMI with ischaemic time ≤6 hrs, IMR, CFR or RRR post-PCI did not differ with alteplase vs placebo. In those with shorter ischaemic times (<2 hrs) CFR & RRR, but not IMR, were improved with alteplase. We observed interactions between alteplase dose, ischaemic time & mechanisms of effect.
Acknowledgement/Funding
Dr Maznyczka is funded by a fellowship from the British Heart Foundation (FS/16/74/32573). T-TIME was funded by grant 12/170/4 from NIHR-EME
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Affiliation(s)
- A Maznyczka
- University of Glasgow, Glasgow, United Kingdom
| | - P McCartney
- University of Glasgow, Glasgow, United Kingdom
| | - K G Oldroyd
- University of Glasgow, Glasgow, United Kingdom
| | - M McEntegart
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - M Lindsay
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - H Eteiba
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - P Rocchiccioli
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - R Good
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - A Shaukat
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - V Kodoth
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - J Greenwood
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - K Robertson
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - J Cotton
- New Cross Hospital, Wolverhampton, United Kingdom
| | | | - C Berry
- University of Glasgow, Glasgow, United Kingdom
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92
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McCartney P, Maznyczka A, Eteiba H, McEntegart M, Greenwood JP, Schmitt M, Maredia N, McCann GP, Fairbairn T, McAlindon E, Oldroyd KG, Orchard V, Radjenovic A, McConnachie A, Berry C. 6030Effects of adjunctive treatment with low-dose alteplase during primary percutaneous coronary intervention according to ischaemic time. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Microvascular obstruction affects half of patients with acute ST-segment elevation myocardial infarction and confers an adverse prognosis.
Purpose
We aimed to determine whether the efficacy and safety of a therapeutic strategy involving low-dose intra-coronary alteplase infused early after coronary reperfusion associates with ischaemic time.
Methods
We conducted a prospective, multicentre, parallel group, 1:1:1 randomised, dose-ranging trial in patients undergoing primary percutaneous coronary intervention. Ischaemic time, defined as the time from symptom onset to coronary reperfusion, was a pre-specified sub-group of interest. Between March 17, 2016, and December 21, 2017, 440 patients presenting at 11 hospitals in the UK were enrolled with follow up to 3 months. Patients with acute myocardial infarction due to occlusion of a major coronary artery presenting ≤6 hours from symptom onset were randomly assigned to treatment with placebo, alteplase 10mg or alteplase 20mg. The primary outcome was the amount of microvascular obstruction disclosed by cardiac magnetic resonance imaging at 2–7 days. Secondary outcomes included infarct size, myocardial haemorrhage, left ventricular ejection fraction, and troponin T area-under-the curve.
Results
440 patients were randomized (figure), the primary endpoint was achieved in 396 (90%), seventeen (3.9%) withdrew and all other patients were followed up to 3 months. In the primary analysis, the amount of microvascular obstruction did not differ between the groups. Their ischaemic times were: ≤2 hours, n=98; ≥2–<4 hours, n=215; and ≥4–6 hours, n=83.
In patients with an ischaemic time ≥4 hours, treatment with alteplase (10 mg, n=26; 20 mg, n=30) was associated with a dose dependent increase in the amount (mean) of microvascular obstruction (% left ventricular mass) compared to placebo (n=27) 1.14 vs. 3.11 vs. 5.20; mean difference on square root scale 0.81 (95% CI 0.21, 1.42), p=0.009. The interaction test between ischaemic time and treatment (active vs. placebo) was not statistically significant p=0.06, however when the interaction was assessed for a trend across treatment groups this did reach statistical significance, p=0.018.
Furthermore, a higher proportion of patients presenting ≥4–6 hours treated with 20 mg of alteplase had myocardial haemorrhage (59.3%) compared to the placebo group (28.0%), odds ratio 3.81 (95% CI 1.19, 12.25), p=0.025. The amount of haemorrhage was also greater; estimated mean difference 3.49 (95% CI 1.22, 5.75), p=0.0026. No between-treatment group differences for myocardial haemorrhage were observed in patients presenting with shorter ischaemic times.
Study flow diagram
Conclusions
In patients presenting with an ischaemic time ≥4 hours, adjunctive treatment with low-dose intra-coronary alteplase during primary PCI was associated with increases in microvascular obstruction and myocardial haemorrhage. The mechanism may involve haemorrhagic transformation within the infarct core.
Acknowledgement/Funding
NIHR EME programme (reference: 12/170/45); British Heart Foundation (BHF reference FS/16/74/32573)
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Affiliation(s)
- P McCartney
- University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, United Kingdom
| | - A Maznyczka
- University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, United Kingdom
| | - H Eteiba
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - M McEntegart
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - M Schmitt
- University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - N Maredia
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - G P McCann
- University Hospital of Leicester, Leicester, United Kingdom
| | - T Fairbairn
- Cardiothoracic Centre Trust of Liverpool, Liverpool, United Kingdom
| | - E McAlindon
- New Cross Hospital, Wolverhampton, United Kingdom
| | - K G Oldroyd
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - V Orchard
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - A Radjenovic
- University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, United Kingdom
| | - A McConnachie
- University of Glasgow, Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, UK, Glasgow, United Kingdom
| | - C Berry
- University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, United Kingdom
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93
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McCowan C, McSkimming P, Papworth R, Kotzur M, McConnachie A, Macdonald S, Wyke S, Crighton E, Campbell C, Weller D, Steele RJC, Robb KA. Comparing uptake across breast, cervical and bowel screening at an individual level: a retrospective cohort study. Br J Cancer 2019; 121:710-714. [PMID: 31481732 PMCID: PMC6889480 DOI: 10.1038/s41416-019-0564-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/16/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We investigated demographic and clinical predictors of lower participation in bowel screening relative to breast and cervical screening. METHODS Data linkage study of routinely collected clinical data from 430,591 women registered with general practices in the Greater Glasgow & Clyde Health Board. Participation in the screening programmes was measured by attendance at breast or cervical screening or the return of a bowel screening kit. RESULTS 72.6% of 159,993 women invited attended breast screening, 80.7% of 309,899 women invited attended cervical screening and 61.7% of 180,408 women invited completed bowel screening. Of the 68,324 women invited to participate in all three screening programmes during the study period, 52.1% participated in all three while 7.2% participated in none. Women who participated in breast (OR = 3.34 (3.21, 3.47), p < 0.001) or cervical (OR = 3.48 (3.32, 3.65), p < 0.001) were more likely to participate in bowel screening. CONCLUSION Participation in bowel screening was lower than breast or cervical for this population although the same demographic factors were associated with uptake, namely lower social deprivation, increasing age, low levels of comorbidity and prior non-malignant neoplasms. As women who complete breast and cervical are more likely to also complete bowel screening, interventions at these procedures to encourage bowel screening participation should be explored.
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Affiliation(s)
- Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, KY16 9TF, UK.
| | - Paula McSkimming
- Robertson Centre for Biostatistics, Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Richard Papworth
- Robertson Centre for Biostatistics, Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Marie Kotzur
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G120XH, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Sara Macdonald
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G129LX, UK
| | - Sally Wyke
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G128RS, UK
| | - Emilia Crighton
- NHS Greater Glasgow and Clyde, Gartnavel Royal Hospital, Glasgow, G120XH, UK
| | | | - David Weller
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK
| | | | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G120XH, UK
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94
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Henderson M, Wittkowski A, McIntosh E, McConnachie A, Buston K, Wilson P, Calam R, Minnis H, Thompson L, O'Dowd J, Law J, McGee E, Wight D. Correction to: Trial of healthy relationship initiatives for the very early years (THRIVE), evaluating Enhanced Triple P for Baby and Mellow Bumps for those with additional social and care needs during pregnancy and their infants who are at higher risk of maltreatment: study protocol for a randomised controlled trial. Trials 2019; 20:557. [PMID: 31506097 PMCID: PMC6737664 DOI: 10.1186/s13063-019-3674-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Marion Henderson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Top Floor 200 Renfield Street, Glasgow, G2 3AX, Scotland.
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, England
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, G12 8QQ, Scotland
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ, Scotland
| | - Katie Buston
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Top Floor 200 Renfield Street, Glasgow, G2 3AX, Scotland
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, The Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, Scotland
| | - Rachel Calam
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, England
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Caledonia House, Royal Hospital for Sick Children, Yorkhill, Glasgow, G3 8SJ, Scotland
| | - Lucy Thompson
- Centre for Rural Health, University of Aberdeen, The Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, Scotland.,Institute of Health and Wellbeing, University of Glasgow, Caledonia House, Royal Hospital for Sick Children, Yorkhill, Glasgow, G3 8SJ, Scotland
| | - John O'Dowd
- NHS Ayrshire and Arran, Afton House, Ailsa Hospital Campus, Dalmellington Road, Ayr, KA6 6AB, Scotland
| | - James Law
- Institute of Health and Society, School of Education, Communication and Language Sciences, University of Newcastle, Newcastle-upon-Tyne, NE1 7RU, England
| | - Elizabeth McGee
- Parenting and Family Support Research Programme, Department of Psychology and Allied Health Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland
| | - Daniel Wight
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Top Floor 200 Renfield Street, Glasgow, G2 3AX, Scotland
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95
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Cacciottolo TM, Perikari A, van der Klaauw A, Henning E, Stadler LKJ, Keogh J, Farooqi IS, Tenin G, Keavney B, Ryan E, Budd R, Bewley M, Coelho P, Rumsey W, Sanchez Y, McCafferty J, Dockrell D, Walmsley S, Whyte M, Liu Y, Choy MK, Tenin G, Abraham S, Black G, Keavney B, Ford T, Stanley B, Good R, Rocchiccioli P, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, Sidik N, McCartney P, Corcoran D, Collison D, Rush C, McConnachie A, Touyz R, Oldroyd K, Berry C, Gazdagh G, Diver L, Marshall J, McGowan R, Ahmed F, Tobias E, Curtis E, Parsons C, Maslin K, D'Angelo S, Moon R, Crozier S, Gossiel F, Bishop N, Kennedy S, Papageorghiou A, Fraser R, Gandhi S, Prentice A, Inskip H, Godfrey K, Schoenmakers I, Javaid MK, Eastell R, Cooper C, Harvey N, Watt ER, Howden A, Mirchandani A, Coelho P, Hukelmann JL, Sadiku P, Plant TM, Cantrell DA, Whyte MKB, Walmsley SR, Mordi I, Forteath C, Wong A, Mohan M, Palmer C, Doney A, Rena G, Lang C, Gray EH, Azarian S, Riva A, Edwards H, McPhail MJW, Williams R, Chokshi S, Patel VC, Edwards LA, Page D, Miossec M, Williams S, Monaghan R, Fotiou E, Santibanez-Koref M, Keavney B, Badat M, Mettananda S, Hua P, Schwessinger R, Hughes J, Higgs D, Davies J. Scientific Business Abstracts of the 113th Annual Meeting of the Association of Physicians of Great Britain and Ireland. QJM 2019; 112:724-729. [PMID: 31505685 DOI: 10.1093/qjmed/hcz175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Perikari
- University of Cambridge Metabolic Research Laboratories
| | | | - E Henning
- University of Cambridge Metabolic Research Laboratories
| | - L K J Stadler
- University of Cambridge Metabolic Research Laboratories
| | - J Keogh
- University of Cambridge Metabolic Research Laboratories
| | - I S Farooqi
- University of Cambridge Metabolic Research Laboratories
| | - G Tenin
- From University of Manchester
| | | | - E Ryan
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - R Budd
- Department of Infection Immunity and Cardiovascular Disease, The Florey Institute for Host-Pathogen Interactions, University of Sheffield
| | - M Bewley
- Department of Infection Immunity and Cardiovascular Disease, The Florey Institute for Host-Pathogen Interactions, University of Sheffield
| | - P Coelho
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - W Rumsey
- Stress and Repair Discovery Performance Unit, Respiratory Therapy Area
| | - Y Sanchez
- Stress and Repair Discovery Performance Unit, Respiratory Therapy Area
| | - J McCafferty
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - D Dockrell
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - S Walmsley
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - M Whyte
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - Y Liu
- From the University of Manchester
| | - M-K Choy
- From the University of Manchester
| | - G Tenin
- From the University of Manchester
| | | | - G Black
- From the University of Manchester
| | | | - T Ford
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - R Good
- Golden Jubilee National Hospital
| | - P Rocchiccioli
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - M McEntegart
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - H Eteiba
- Golden Jubilee National Hospital
| | | | | | | | - S Hood
- Golden Jubilee National Hospital
| | | | - R McDade
- Golden Jubilee National Hospital
| | - N Sidik
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - P McCartney
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - D Corcoran
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - D Collison
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - C Rush
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - R Touyz
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
| | - K Oldroyd
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - Colin Berry
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - G Gazdagh
- School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - L Diver
- West of Scotland Regional Genetics Service, Laboratory Medicine Building, Queen Elizabeth University Hospital
| | - J Marshall
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - R McGowan
- West of Scotland Regional Genetics Service, Laboratory Medicine Building, Queen Elizabeth University Hospital
| | - F Ahmed
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow
| | - E Tobias
- Academic Unit of Medical Genetics and Clinical Pathology, Laboratory Medicine Building, Queen Elizabeth University Hospital, University of Glasgow
| | - E Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - C Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - K Maslin
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - S D'Angelo
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - R Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - S Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - F Gossiel
- Academic Unit of Bone Metabolism, University of Sheffield
| | - N Bishop
- Academic Unit of Child Health, University of Sheffield
| | - S Kennedy
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford
| | - A Papageorghiou
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford
| | - R Fraser
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield
| | - S Gandhi
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield
| | | | - H Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - K Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - I Schoenmakers
- Department of Medicine, Faculty of Medicine and Health Sciences, University of East Anglia
| | - M K Javaid
- NIHR Oxford Biomedical Research Centre, University of Oxford
| | - R Eastell
- Academic Unit of Bone Metabolism, University of Sheffield
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - N Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | | | - A Howden
- School of Life Sciences, University of Dundee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E H Gray
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - S Azarian
- Institute of Hepatology, Foundation for Liver Research
| | - A Riva
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - H Edwards
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - M J W McPhail
- School of Immunology and Microbial Sciences, King's College London
- Institute of Liver Studies & Transplantation, King's College Hospital
| | - R Williams
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - S Chokshi
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - V C Patel
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
- Institute of Liver Studies & Transplantation, King's College Hospital
| | - L A Edwards
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - D Page
- University of Manchester
- Manchester Metropolitan University
| | - M Miossec
- Manchester Metropolitan University
- University of Newcastle
| | | | | | | | | | | | - M Badat
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - S Mettananda
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya
| | - P Hua
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - R Schwessinger
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - J Hughes
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - D Higgs
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - J Davies
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
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Henderson M, Wittkowski A, McIntosh E, McConnachie A, Buston K, Wilson P, Calam R, Minnis H, Thompson L, O'Dowd J, Law J, McGee E, Wight D. Trial of healthy relationship initiatives for the very early years (THRIVE), evaluating Enhanced Triple P for Baby and Mellow Bumps additional social and care needs during pregnancy and their infants who are at higher risk of maltreatment: study protocol for a randomised controlled trial. Trials 2019; 20:499. [PMID: 31412902 PMCID: PMC6694522 DOI: 10.1186/s13063-019-3571-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 07/11/2019] [Indexed: 11/11/2022] Open
Abstract
Background Growing evidence suggests that experiences in the early years play a major role in children’s development in terms of health, wellbeing and educational attainment. The Trial of healthy relationship initiatives for the very early years (THRIVE) aims to evaluate two antenatal group interventions, Enhanced Triple P for Baby and Mellow Bumps, designed for those with additional health or social care needs in pregnancy. As both interventions aim to improve maternal mental health and parenting skills, we hypothesise that in the longer term, participation may lead to an improvement in children’s life trajectories. Methods THRIVE is a three-arm, longitudinal, randomised controlled trial aiming to recruit 500 pregnant women with additional health or social care needs. Participants will be referred by health and social care professionals, predominately midwives. Consenting participants will be block randomised to one of the three arms: Enhanced Triple P for Baby plus care as usual, Mellow Bumps plus care as usual or care as usual. Groups will commence when participants are between 20 and 34 weeks pregnant. Discussion The population we aim to recruit are traditionally referred to as “hard to reach”, therefore we will monitor referrals received from maternity and social care pathways and will be open to innovation to boost referral rates. We will set geographically acceptable group locations for participants, to limit challenges we foresee for group participation and retention. We anticipate the results of the trial will help inform policy and practice in supporting women with additional health and social care needs during antenatal and early postnatal periods. This is currently a high priority for the Scottish and UK Governments. Trial registration International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ISRCTN:21656568. Registered on 28 February 2014 (registered retrospectively (by 3 months)). Electronic supplementary material The online version of this article (10.1186/s13063-019-3571-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marion Henderson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Top Floor 200 Renfield Street, Glasgow, G2 3AX, Scotland.
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, England
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, G12 8QQ, Scotland
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ, Scotland
| | - Katie Buston
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Top Floor 200 Renfield Street, Glasgow, G2 3AX, Scotland
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, The Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, Scotland
| | - Rachel Calam
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, England
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Caledonia House, Royal Hospital for Sick Children, Yorkhill, Glasgow, G3 8SJ, Scotland
| | - Lucy Thompson
- Centre for Rural Health, University of Aberdeen, The Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, Scotland.,Institute of Health and Wellbeing, University of Glasgow, Caledonia House, Royal Hospital for Sick Children, Yorkhill, Glasgow, G3 8SJ, Scotland
| | - John O'Dowd
- NHS Ayrshire and Arran, Afton House, Ailsa Hospital Campus, Dalmellington Road, Ayr, KA6 6AB, Scotland
| | - James Law
- Institute of Health and Society, School of Education, Communication and Language Sciences, University of Newcastle, Newcastle-upon-Tyne, NE1 7RU, England
| | - Elizabeth McGee
- Parenting and Family Support Research Programme, Department of Psychology and Allied Health Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland
| | - Daniel Wight
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Top Floor 200 Renfield Street, Glasgow, G2 3AX, Scotland
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97
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Lee MMY, Petrie MC, Rocchiccioli P, Simpson J, Jackson CE, Corcoran DS, Mangion K, Brown A, Cialdella P, Sidik NP, McEntegart MB, Shaukat A, Rae AP, Hood SHM, Peat EE, Findlay IN, Murphy CL, Cormack AJ, Bukov NB, Balachandran KP, Oldroyd KG, Ford I, Wu O, McConnachie A, Barry SJE, Berry C. Invasive Versus Medical Management in Patients With Prior Coronary Artery Bypass Surgery With a Non-ST Segment Elevation Acute Coronary Syndrome. Circ Cardiovasc Interv 2019; 12:e007830. [PMID: 31362541 PMCID: PMC7664981 DOI: 10.1161/circinterventions.119.007830] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. The benefits of routine invasive management in patients with prior coronary artery bypass grafts presenting with non-ST elevation acute coronary syndromes are uncertain because these patients were excluded from pivotal trials.
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Affiliation(s)
- Matthew M Y Lee
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., A.B., M.B.M., A.S., A.P.R., C.B.), University of Glasgow, United Kingdom.,Department of Cardiology, Western Infirmary, Glasgow, United Kingdom (M.M.Y.L., A.B., M.B.M., C.B.).,Department of Cardiology, Royal Alexandra Hospital, Paisley, United Kingdom (M.M.Y.L., S.H.M.H., E.E.P., I.N.F., C.L.M., A.J.C.).,Department of Cardiology, Glasgow Royal Infirmary, United Kingdom (M.C.P., P.R., A.S., A.P.R., M.M.Y.L.)
| | - Mark C Petrie
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., A.B., M.B.M., A.S., A.P.R., C.B.), University of Glasgow, United Kingdom.,Department of Cardiology, Glasgow Royal Infirmary, United Kingdom (M.C.P., P.R., A.S., A.P.R., M.M.Y.L.)
| | - Paul Rocchiccioli
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., A.B., M.B.M., A.S., A.P.R., C.B.), University of Glasgow, United Kingdom.,Department of Cardiology, Glasgow Royal Infirmary, United Kingdom (M.C.P., P.R., A.S., A.P.R., M.M.Y.L.)
| | - Joanne Simpson
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., A.B., M.B.M., A.S., A.P.R., C.B.), University of Glasgow, United Kingdom
| | - Colette E Jackson
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., A.B., M.B.M., A.S., A.P.R., C.B.), University of Glasgow, United Kingdom
| | - David S Corcoran
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., A.B., M.B.M., A.S., A.P.R., C.B.), University of Glasgow, United Kingdom
| | - Kenneth Mangion
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., A.B., M.B.M., A.S., A.P.R., C.B.), University of Glasgow, United Kingdom
| | - Ammani Brown
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., A.B., M.B.M., A.S., A.P.R., C.B.), University of Glasgow, United Kingdom.,Department of Cardiology, Western Infirmary, Glasgow, United Kingdom (M.M.Y.L., A.B., M.B.M., C.B.)
| | - Pio Cialdella
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.)
| | - Novalia P Sidik
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.)
| | - Margaret B McEntegart
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., A.B., M.B.M., A.S., A.P.R., C.B.), University of Glasgow, United Kingdom.,Department of Cardiology, Western Infirmary, Glasgow, United Kingdom (M.M.Y.L., A.B., M.B.M., C.B.)
| | - Aadil Shaukat
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., A.B., M.B.M., A.S., A.P.R., C.B.), University of Glasgow, United Kingdom.,Department of Cardiology, Glasgow Royal Infirmary, United Kingdom (M.C.P., P.R., A.S., A.P.R., M.M.Y.L.)
| | - Alan P Rae
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., A.B., M.B.M., A.S., A.P.R., C.B.), University of Glasgow, United Kingdom.,Department of Cardiology, Glasgow Royal Infirmary, United Kingdom (M.C.P., P.R., A.S., A.P.R., M.M.Y.L.)
| | - Stuart H M Hood
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.).,Department of Cardiology, Royal Alexandra Hospital, Paisley, United Kingdom (M.M.Y.L., S.H.M.H., E.E.P., I.N.F., C.L.M., A.J.C.)
| | - Eileen E Peat
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.).,Department of Cardiology, Royal Alexandra Hospital, Paisley, United Kingdom (M.M.Y.L., S.H.M.H., E.E.P., I.N.F., C.L.M., A.J.C.)
| | - Iain N Findlay
- Department of Cardiology, Royal Alexandra Hospital, Paisley, United Kingdom (M.M.Y.L., S.H.M.H., E.E.P., I.N.F., C.L.M., A.J.C.)
| | - Clare L Murphy
- Department of Cardiology, Royal Alexandra Hospital, Paisley, United Kingdom (M.M.Y.L., S.H.M.H., E.E.P., I.N.F., C.L.M., A.J.C.)
| | - Alistair J Cormack
- Department of Cardiology, Royal Alexandra Hospital, Paisley, United Kingdom (M.M.Y.L., S.H.M.H., E.E.P., I.N.F., C.L.M., A.J.C.)
| | - Nikolay B Bukov
- Department of Cardiology, Royal Blackburn Hospital, United Kingdom (N.B.B., K.P.B.)
| | | | - Keith G Oldroyd
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.)
| | - Ian Ford
- Robertson Centre for Biostatistics (I.F., A.M.), University of Glasgow, United Kingdom
| | - Olivia Wu
- Health Economics and Health Technology Assessment (O.W.), University of Glasgow, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics (I.F., A.M.), University of Glasgow, United Kingdom
| | - Sarah J E Barry
- Department of Mathematics and Statistics, University of Strathclyde, United Kingdom (S.J.E.B.)
| | - Colin Berry
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R., S.H.M.H., E.E.P., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (M.M.Y.L., M.C.P., P.R., J.S., C.E.J., D.S.C., K.M., A.B., M.B.M., A.S., A.P.R., C.B.), University of Glasgow, United Kingdom.,Department of Cardiology, Western Infirmary, Glasgow, United Kingdom (M.M.Y.L., A.B., M.B.M., C.B.)
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98
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Millar L, McConnachie A, Minnis H, Wilson P, Thompson L, Anzulewicz A, Sobota K, Rowe P, Gillberg C, Delafield-Butt J. Phase 3 diagnostic evaluation of a smart tablet serious game to identify autism in 760 children 3-5 years old in Sweden and the United Kingdom. BMJ Open 2019; 9:e026226. [PMID: 31315858 PMCID: PMC6661582 DOI: 10.1136/bmjopen-2018-026226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Recent evidence suggests an underlying movement disruption may be a core component of autism spectrum disorder (ASD) and a new, accessible early biomarker. Mobile smart technologies such as iPads contain inertial movement and touch screen sensors capable of recording subsecond movement patterns during gameplay. A previous pilot study employed machine learning analysis of motor patterns recorded from children 3-5 years old. It identified those with ASD from age-matched and gender-matched controls with 93% accuracy, presenting an attractive assessment method suitable for use in the home, clinic or classroom. METHODS AND ANALYSIS This is a phase III prospective, diagnostic classification study designed according to the Standards for Reporting Diagnostic Accuracy Studies guidelines. Three cohorts are investigated: children typically developing (TD); children with a clinical diagnosis of ASD and children with a diagnosis of another neurodevelopmental disorder (OND) that is not ASD. The study will be completed in Glasgow, UK and Gothenburg, Sweden. The recruitment target is 760 children (280 TD, 280 ASD and 200 OND). Children play two games on the iPad then a third party data acquisition and analysis algorithm (Play.Care, Harimata) will classify the data as positively or negatively associated with ASD. The results are blind until data collection is complete, when the algorithm's classification will be compared against medical diagnosis. Furthermore, parents of participants in the ASD and OND groups will complete three questionnaires: Strengths and Difficulties Questionnaire; Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations Questionnaire and the Adaptive Behavioural Assessment System-3 or Vineland Adaptive Behavior Scales-II. The primary outcome measure is sensitivity and specificity of Play.Care to differentiate ASD children from TD children. Secondary outcomes measures include the accuracy of Play.Care to differentiate ASD children from OND children. ETHICS AND DISSEMINATION This study was approved by the West of Scotland Research Ethics Service Committee 3 and the University of Strathclyde Ethics Committee. Results will be disseminated in peer-reviewed publications and at international scientific conferences. TRIAL REGISTRATION NUMBER NCT03438994; Pre-results.
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Affiliation(s)
- Lindsay Millar
- Laboratory for Innovation in Autism, University of Strathclyde, Glasgow, UK
- Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Helen Minnis
- Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Aberdeen, UK
| | - Lucy Thompson
- Centre for Rural Health, University of Aberdeen, Aberdeen, UK
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Philip Rowe
- Laboratory for Innovation in Autism, University of Strathclyde, Glasgow, UK
- Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Christopher Gillberg
- Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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99
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Lean MEJ, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, Peters C, Zhyzhneuskaya S, Al-Mrabeh A, Hollingsworth KG, Rodrigues AM, Rehackova L, Adamson AJ, Sniehotta FF, Mathers JC, Ross HM, McIlvenna Y, Welsh P, Kean S, Ford I, McConnachie A, Messow CM, Sattar N, Taylor R. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol 2019; 7:344-355. [PMID: 30852132 DOI: 10.1016/s2213-8587(19)30068-3] [Citation(s) in RCA: 453] [Impact Index Per Article: 90.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The DiRECT trial assessed remission of type 2 diabetes during a primary care-led weight-management programme. At 1 year, 68 (46%) of 149 intervention participants were in remission and 36 (24%) had achieved at least 15 kg weight loss. The aim of this 2-year analysis is to assess the durability of the intervention effect. METHODS DiRECT is an open-label, cluster-randomised, controlled trial done at primary care practices in the UK. Practices were randomly assigned (1:1) via a computer-generated list to provide an integrated structured weight-management programme (intervention) or best-practice care in accordance with guidelines (control), with stratification for study site (Tyneside or Scotland) and practice list size (>5700 or ≤5700 people). Allocation was concealed from the study statisticians; participants, carers, and study research assistants were aware of allocation. We recruited individuals aged 20-65 years, with less than 6 years' duration of type 2 diabetes, BMI 27-45 kg/m2, and not receiving insulin between July 25, 2014, and Aug 5, 2016. The intervention consisted of withdrawal of antidiabetes and antihypertensive drugs, total diet replacement (825-853 kcal per day formula diet for 12-20 weeks), stepped food reintroduction (2-8 weeks), and then structured support for weight-loss maintenance. The coprimary outcomes, analysed hierarchically in the intention-to-treat population at 24 months, were weight loss of at least 15 kg, and remission of diabetes, defined as HbA1c less than 6·5% (48 mmol/mol) after withdrawal of antidiabetes drugs at baseline (remission was determined independently at 12 and 24 months). The trial is registered with the ISRCTN registry, number 03267836, and follow-up is ongoing. FINDINGS The intention-to-treat population consisted of 149 participants per group. At 24 months, 17 (11%) intervention participants and three (2%) control participants had weight loss of at least 15 kg (adjusted odds ratio [aOR] 7·49, 95% CI 2·05 to 27·32; p=0·0023) and 53 (36%) intervention participants and five (3%) control participants had remission of diabetes (aOR 25·82, 8·25 to 80·84; p<0·0001). The adjusted mean difference between the control and intervention groups in change in bodyweight was -5·4 kg (95% CI -6·9 to -4·0; p<0·0001) and in HbA1c was -4·8 mmol/mol (-8·3 to -1·4 [-0·44% (-0·76 to -0·13)]; p=0·0063), despite only 51 (40%) of 129 patients in the intervention group using anti-diabetes medication compared with 120 (84%) of 143 in the control group. In a post-hoc analysis of the whole study population, of those participants who maintained at least 10 kg weight loss (45 of 272 with data), 29 (64%) achieved remission; 36 (24%) of 149 participants in the intervention group maintained at least 10 kg weight loss. Serious adverse events were similar to those reported at 12 months, but were fewer in the intervention group than in the control group in the second year of the study (nine vs 22). INTERPRETATION The DiRECT programme sustained remissions at 24 months for more than a third of people with type 2 diabetes. Sustained remission was linked to the extent of sustained weight loss. FUNDING Diabetes UK.
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Affiliation(s)
- Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Wilma S Leslie
- Human Nutrition, School of Medicine, Dentistry and Nursing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison C Barnes
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Naomi Brosnahan
- Human Nutrition, School of Medicine, Dentistry and Nursing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - George Thom
- Human Nutrition, School of Medicine, Dentistry and Nursing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Louise McCombie
- Human Nutrition, School of Medicine, Dentistry and Nursing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carl Peters
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Sviatlana Zhyzhneuskaya
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Ahmad Al-Mrabeh
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Kieren G Hollingsworth
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Angela M Rodrigues
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Lucia Rehackova
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ashley J Adamson
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Falko F Sniehotta
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - John C Mathers
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | | | - Yvonne McIlvenna
- College of Medical, Veterinary & Life Sciences, and General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Science, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Kean
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Claudia-Martina Messow
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Roy Taylor
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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Welsh P, Preiss D, Hayward C, Shah ASV, McAllister D, Briggs A, Boachie C, McConnachie A, Padmanabhan S, Welsh C, Woodward M, Campbell A, Porteous D, Mills NL, Sattar N. Cardiac Troponin T and Troponin I in the General Population. Circulation 2019; 139:2754-2764. [PMID: 31014085 PMCID: PMC6571179 DOI: 10.1161/circulationaha.118.038529] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is great interest in widening the use of high-sensitivity cardiac troponins for population cardiovascular disease (CVD) and heart failure screening. However, it is not clear whether cardiac troponin T (cTnT) and troponin I (cTnI) are equivalent measures of risk in this setting. We aimed to compare and contrast (1) the association of cTnT and cTnI with CVD and non-CVD outcomes, and (2) their determinants in a genome-wide association study. METHODS High-sensitivity cTnT and cTnI were measured in serum from 19 501 individuals in Generation Scotland Scottish Family Health Study. Median follow-up was 7.8 years (quartile 1 to quartile 3, 7.1-9.2). Associations of each troponin with a composite CVD outcome (1177 events), CVD death (n=266), non-CVD death (n=374), and heart failure (n=216) were determined by using Cox models. A genome-wide association study was conducted using a standard approach developed for the cohort. RESULTS Both cTnI and cTnT were strongly associated with CVD risk in unadjusted models. After adjusting for classical risk factors, the hazard ratio for a 1 SD increase in log transformed troponin was 1.24 (95% CI, 1.17-1.32) and 1.11 (1.04-1.19) for cTnI and cTnT, respectively; ratio of hazard ratios 1.12 (1.04-1.21). cTnI, but not cTnT, was associated with myocardial infarction and coronary heart disease. Both cTnI and cTnT had strong associations with CVD death and heart failure. By contrast, cTnT, but not cTnI, was associated with non-CVD death; ratio of hazard ratios 0.77 (0.67-0.88). We identified 5 loci (53 individual single-nucleotide polymorphisms) that had genome-wide significant associations with cTnI, and a different set of 4 loci (4 single-nucleotide polymorphisms) for cTnT. CONCLUSIONS The upstream genetic causes of low-grade elevations in cTnI and cTnT appear distinct, and their associations with outcomes also differ. Elevations in cTnI are more strongly associated with some CVD outcomes, whereas cTnT is more strongly associated with the risk of non-CVD death. These findings help inform the selection of an optimal troponin assay for future clinical care and research in this setting.
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Affiliation(s)
- Paul Welsh
- Institute of Cardiovascular and Medical Sciences (P.W., S.P., C.W., N.S.), University of Glasgow, United Kingdom
| | - David Preiss
- MRC Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit (D. Preiss), University of Oxford, United Kingdom
| | - Caroline Hayward
- MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine (C.H.), University of Edinburgh, United Kingdom
| | - Anoop S V Shah
- BHF Centre for Cardiovascular Science (A.S.V.S., N.L.M.), University of Edinburgh, United Kingdom
| | - David McAllister
- Institute of Cardiovascular and Medical Sciences (P.W., S.P., C.W., N.S.), University of Glasgow, United Kingdom
| | - Andrew Briggs
- Institute of Health and Wellbeing (A.B.), University of Glasgow, United Kingdom
| | - Charles Boachie
- Robertson Centre for Biostatistics (C.B., A.M.), University of Glasgow, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics (C.B., A.M.), University of Glasgow, United Kingdom
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences (P.W., S.P., C.W., N.S.), University of Glasgow, United Kingdom
| | - Claire Welsh
- Institute of Cardiovascular and Medical Sciences (P.W., S.P., C.W., N.S.), University of Glasgow, United Kingdom
| | - Mark Woodward
- The George Institute for Global Health (M.W.), University of Oxford, United Kingdom.,The George Institute for Global Health, University of New South Wales, Sydney, Australia (M.W.).,Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine (A.C., D. Porteous), University of Edinburgh, United Kingdom.,Usher Institute for Population Health Sciences and Informatics (A.C.), University of Edinburgh, United Kingdom
| | - David Porteous
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine (A.C., D. Porteous), University of Edinburgh, United Kingdom
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science (A.S.V.S., N.L.M.), University of Edinburgh, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences (P.W., S.P., C.W., N.S.), University of Glasgow, United Kingdom
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