1
|
Hjollund NHI, Larsen LP, de Thurah AL, Grove BE, Skuladottir H, Linnet H, Friis RB, Johnsen SP, May O, Jensen AL, Hansen TK, Taarnhøj GA, Tolstrup LK, Pappot H, Ivarsen P, Dørflinger L, Jessen A, Sørensen NT, Schougaard LMV, Team TA. Patient-reported outcome (PRO) measurements in chronic and malignant diseases: ten years' experience with PRO-algorithm-based patient-clinician interaction (telePRO) in AmbuFlex. Qual Life Res 2023; 32:1053-1067. [PMID: 36639598 PMCID: PMC10063508 DOI: 10.1007/s11136-022-03322-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patient-reported Outcome (PRO) measures may be used as the basis for out-patient follow-up instead of fixed appointments. The patients attend follow-up from home by filling in questionnaires developed for that specific aim and patient group (telePRO). The questionnaires are handled in real time by a specific algorithm, which assigns an outcome color reflecting clinical need. The specific questionnaires and algorithms (named solutions) are constructed in a consensus process with clinicians. We aimed to describe AmbuFlex' telePRO solutions and the algorithm outcomes and variation between patient groups, and to discuss possible applications and challenges. METHODS TelePRO solutions with more than 100 processed questionnaires were included in the analysis. Data were retrieved together with data from national registers. Characteristics of patients, questionnaires and outcomes were tabulated for each solution. Graphs were constructed depicting the overall and within-patient distribution of algorithm outcomes for each solution. RESULTS From 2011 to 2021, 29 specific telePRO solutions were implemented within 24 different ICD-10 groups. A total of 42,015 patients were referred and answered 171,268 questionnaires. An existing applicable instrument with cut-off values was available for four solutions, whereas items were selected or developed ad hoc for the other solutions. Mean age ranged from 10.7 (Pain in children) to 73.3 years (chronic kidney disease). Mortality among referred patients varied between 0 (obesity, asthma, endometriosis and pain in children) and 528 per 1000 patient years (Lung cancer). There was substantial variation in algorithm outcome across patient groups while different solutions within the same patient group varied little. DISCUSSION TelePRO can be applied in diseases where PRO can reflect clinical status and needs. Questionnaires and algorithms should be adapted for the specific patient groups and clinical aims. When PRO is used as replacement for clinical contact, special carefulness should be observed with respect to patient safety.
Collapse
Affiliation(s)
- Niels Henrik I Hjollund
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark.
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Louise Pape Larsen
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
| | | | - Birgith Engelst Grove
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
| | | | - Hanne Linnet
- Department of Oncology, Gødstrup Hospital, Herning, Denmark
| | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole May
- Department of Medicine, Gødstrup Hospital, Herning, Denmark
| | | | | | - Gry Assam Taarnhøj
- Department of Oncology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Lærke Kjær Tolstrup
- Department of Oncology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Per Ivarsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Anne Jessen
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
| | - Nanna Toxvig Sørensen
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
| | - Liv Marit Valen Schougaard
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
| | - The AmbuFlex Team
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
| |
Collapse
|
2
|
Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
Collapse
Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Lynggaard V, Zwisler AD, Taylor RS, May O, Mortensen J, Nielsen CV. Short- and long-term effects of the patient education strategy-learning and coping-in cardiac rehabilitation: a randomized controlled trial (LC-REHAB). Health Educ Res 2021; 36:41-60. [PMID: 33755118 DOI: 10.1093/her/cyaa051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
The objectives were to assess the short- and long-term effect of the patient education strategy 'Learning and Coping' (LC) in cardiac rehabilitation (CR) on health-related quality of life, patient education impact, cardiac risk factors and lifestyle. In total, 825 patients hospitalized with ischaemic heart disease or heart failure were randomized to either LC-CR or standard CR at three Danish hospitals. Teaching approach in LC-CR was situational, inductive and reflective, with experienced patients as co-educators and supplemental interviews. Teaching approach in standard CR was structured and deductive. Outcomes were assessed immediately after CR, and after 3 months (short term), and after 3 years (long term). Between-arm differences in favour of LC-CR were SF-12 'role emotional' (3.7, 95% CI: 0.6-6.8) and MDI depression score (0.9, 0.1-1.8) immediately after CR, exercise capacity (4 W, 1-9) at 3 months and SF-12 'role physical' (4.6, 0.1-9.0) (long term). Between-arm differences in favour of controls were waist circumference (-1.7 cm, -2.3 to -1.0) immediately after CR and HeiQ domain 'Constructive attitudes and approaches' (0.11, 0.04-0.18), triglycerides (-0.12 mmol/l, -0.21 to -0.02), systolic blood pressure (-3.12 mmHg, -5.66 to -0.58) at 3 months. Adding LC strategies to CR provides inconsistent short-term results but improves 'role physical' long term.
Collapse
Affiliation(s)
- V Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Gødstrup Hospital (Formerly known as Regional Hospital West Jutland), 61 Gammel Landevej, 7400 Herning, Denmark
| | - A D Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Nyborg, Denmark
| | - R S Taylor
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Nyborg, Denmark
- MRC/CSO Social and Public Health Sciences Unit, Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - O May
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - J Mortensen
- Department of Nuclear Medicine, Gødstrup Hospital, Herning, Denmark
| | - C V Nielsen
- Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| |
Collapse
|
4
|
Andersen A, Waziri F, Schultz JG, Holmboe S, Becker SW, Jensen T, Søndergaard HM, Dodt KK, May O, Mortensen UM, Kim WY, Mellemkjær S, Nielsen-Kudsk JE. Pulmonary vasodilation by sildenafil in acute intermediate-high risk pulmonary embolism: a randomized explorative trial. BMC Pulm Med 2021; 21:72. [PMID: 33639897 PMCID: PMC7916297 DOI: 10.1186/s12890-021-01440-7] [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: 03/03/2020] [Accepted: 02/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate if acute pulmonary vasodilation by sildenafil improves right ventricular function in patients with acute intermediate-high risk pulmonary embolism (PE). METHODS Single center, explorative trial. Patients with PE were randomized to a single oral dose of sildenafil 50 mg (n = 10) or placebo (n = 10) as add-on to conventional therapy. The time from hospital admission to study inclusion was 2.3 ± 0.7 days. Right ventricular function was evaluated immediately before and shortly after (0.5-1.5 h) randomization by right heart catheterization (RHC), trans-thoracic echocardiography (TTE), and cardiac magnetic resonance (CMR). The primary efficacy endpoint was cardiac index measured by CMR. RESULTS Patients had acute intermediate-high risk PE verified by computed tomography pulmonary angiography, systolic blood pressure of 135 ± 18 (mean ± SD) mmHg, increased right ventricular/left ventricular ratio 1.1 ± 0.09 and increased troponin T 167 ± 144 ng/L. Sildenafil treatment did not improve cardiac index compared to baseline (0.02 ± 0.36 l/min/m2, p = 0.89) and neither did placebo (0.00 ± 0.34 l/min/m2, p = 0.97). Sildenafil lowered mean arterial blood pressure (- 19 ± 10 mmHg, p < 0.001) which was not observed in the placebo group (0 ± 9 mmHg, p = 0.97). CONCLUSION A single oral dose of sildenafil 50 mg did not improve cardiac index but lowered systemic blood pressure in patients with acute intermediate-high risk PE. The time from PE to intervention, a small patient sample size and low pulmonary vascular resistance are limitations of this study that should be considered when interpreting the results. TRIAL REGISTRATION The trial was retrospectively registered at www.clinicaltrials.gov (NCT04283240) February 2nd 2020, https://clinicaltrials.gov/ct2/show/NCT04283240?term=NCT04283240&draw=2&rank=1 .
Collapse
Affiliation(s)
- Asger Andersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Farhad Waziri
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Jacob Gammelgaard Schultz
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Sarah Holmboe
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | | | - Tage Jensen
- Department of Internal Medicine, Region Hospital of Randers, Randers, Denmark
| | | | - Karen Kaae Dodt
- Department of Internal Medicine, Region Hospital of Horsens, Horsens, Denmark
| | - Ole May
- Department of Internal Medicine, Region Hospital of Herning, Herning, Denmark
| | - Ulrik Markus Mortensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Søren Mellemkjær
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Jens Erik Nielsen-Kudsk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| |
Collapse
|
5
|
Lynggaard V, Zwisler AD, Taylor RS, May O, Nielsen CV. Effects of the patient education strategy 'Learning and Coping' in cardiac rehabilitation on readmissions and mortality: a randomized controlled trial (LC-REHAB). Health Educ Res 2020; 35:cyz034. [PMID: 31999315 DOI: 10.1093/her/cyz034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
We assessed the effects of the patient education strategy 'Learning and Coping' (LC) in cardiac rehabilitation (CR) on mortality and readmissions by exploring results from the LC-REHAB trial. In all, 825 patients with ischaemic heart disease or heart failure were randomized to the intervention arm (LC-CR) or the control arm (standard CR) at three hospitals in Denmark. LC-CR was situational and inductive, with experienced patients as co-educators supplemented with two individual interviews. Group-based training and education hours were the same in both arms. Outcomes were time to death or readmission, length of stay and absolute number of deaths or readmissions. No between-arm differences were found in time to death, first readmission, or length of stay. Within 30 days after completion of CR, the absolute number of all-cause readmissions was 117 in the LC arm and 146 in the control arm, adjusted odds ratio 78 (95% CI: 0.61-1.01), P = 0.06. This trend diminished over time. Adding LC strategies to standard CR showed a short term but no significant long-term effect on mortality or readmissions. However, the study was not powered to detect differences in mortality and morbidity. Thus, a risk of overseeing a true effect was present.
Collapse
Affiliation(s)
- V Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, 61 Gammel Landevej, 7400 Herning, Denmark
| | - A D Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and Institute of Clinical Medicine, University of Southern Denmark, 17 Vestergade, 5800 Nyborg, Denmark
| | - R S Taylor
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and Institute of Clinical Medicine, University of Southern Denmark, 17 Vestergade, 5800 Nyborg, Denmark
- Institute of Health Research, University of Exeter Medical School, St. Luke's Campus, Heavitree Road, EX1 2LU Exeter, UK
| | - O May
- Department of Cardiology, Regional Hospital West Jutland, 61 Gammel Landevej, Herning 7400, Denmark
| | - C V Nielsen
- Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, 2 Bartholins Allé, 8000 Aarhus C, Denmark
- MarselisborgCentret, DEFACTUM, Central Denmark Region, 11 P.P. Ørums Gade, 8000 Aarhus C, Denmark
| |
Collapse
|
6
|
Sejr MH, May O, Damgaard D, Bruun NH, Nielsen JC. Burden of Premature Atrial Complexes and Risk of Recurrent Stroke and Death in Patients with Mild to Moderate Ischemic Stroke. J Stroke Cerebrovasc Dis 2019; 29:104490. [PMID: 31839547 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104490] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/19/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Premature atrial complexes (PACs) meet increased attention as a potential intermediary between sinus rhythm and atrial fibrillation (AF). Patients with even high numbers of PACs do not fulfill current guidelines for oral anticoagulation treatment though an associated stroke risk is suspected. OBJECTIVE We aimed to determine whether a high number of PACs or runs of AF less than 30 seconds in 2-day continuous electrocardiogram (ECG) recording was associated with risk of recurrent ischemic stroke/transient ischemic attack (TIA) or death in a large cohort of patients with acute ischemic stroke or TIA and no prior AF. METHODS We performed 48 hours continuous ECG recording within 1 week after ischemic stroke/TIA. PACs were reported as mean number of PACs per hour. Patients were followed in Danish Stroke Registry, Danish Civil Registration System, and Danish National Patient Registry. Cox Regression analysis was used to calculate hazard ratios. RESULTS We included 1507 patients with TIA (40%) or ischemic stroke (60%), of which 98.7% had mild to moderate strokes. Mean age was 72.9 (7.8) years, 43.4% were females. Follow-up was 2.3 (1.3) years. Hazard ratio for recurrent stroke/TIA or death did not differ between quartiles of PAC burden, nor did any of the 2 components of this composite endpoint. Nonsustained AF less than 30 seconds was not associated with higher risk of recurrent stroke/TIA or death. CONCLUSIONS In a large cohort of patients with recent ischemic stroke or TIA, burden of PACs or nonsustained AF less than 30 seconds were not associated to higher risk of recurrent stroke/TIA or death.
Collapse
Affiliation(s)
- Michala Herskind Sejr
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark.
| | - Ole May
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
| | - Dorte Damgaard
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Henrik Bruun
- Department of Public Health, Biostatistical Advisory Service (BIAS), Aarhus University, Aarhus, Denmark
| | | |
Collapse
|
7
|
Sejr MH, May O, Damgaard D, Sandal BF, Nielsen JC. External continuous ECG versus loop recording for atrial fibrillation detection in patients who had a stroke. Heart 2019; 105:848-854. [PMID: 30898849 DOI: 10.1136/heartjnl-2018-314186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/13/2019] [Accepted: 01/17/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Detection of atrial fibrillation (AF) in patients who had ischaemic stroke and transient ischaemic attack (IS/TIA) is recommended. We aimed to compare external loop recording (ELR) against simultaneous continuous ECG recording for AF detection in patients who had acute IS/TIA and determine sensitivity, specificity and positive predictive value of AF detection using ELR. We hypothesised ELR to detect 15% fewer patients with AF than continuous ECG recording. METHODS In this prospective cohort study, we included 1412 patients who had acute IS/TIA without prior AF. Monitoring was 48 hours. Primary outcome was AF >30 s. Cardiologist verified AF in continuous ECG was gold standard. RESULTS In continuous ECG, 38 (2.7%) patients had AF. ELR automatically categorised 219/1412 patients (15.5%) with AF, including 32/38 (85%) patients with AF in continuous ECG. After cardiologist adjudication of ELR recordings, AF was diagnosed in 57/219 patients, of which 32 (56%) had AF in continuous ECG. For adjudicated AF detection by ELR, sensitivity was 84%, 95% CI (69% to 94%), specificity was 98%, 95% CI (97% to 99%) and positive predictive value was 56%, 95% CI (42% to 69%). CONCLUSION Automatic AF detection with ELR results in an AF diagnosis in more than five patients without AF for each patient with AF as verified in continuous ECG. For adjudicated AF detection by ELR, sensitivity was confirmed to 84% and specificity 98%. Automatic ELR as investigated in this study may be considered to rule out AF, but it is not suitable as a single monitoring device for AF screening in patients early after stroke. TRIAL REGISTRATION NUMBER NCT02155907.
Collapse
Affiliation(s)
- Michala Herskind Sejr
- Department of Cardiology, Cardiovasculair Research Unit, Regional Hospital West Jutland, Herning, Denmark
| | - Ole May
- Department of Cardiology, Cardiovasculair Research Unit, Regional Hospital West Jutland, Herning, Denmark
| | - Dorte Damgaard
- Department of Neurology, Aarhus Universitetshospital, Aarhus, Denmark
| | | | | |
Collapse
|
8
|
May O, Boulanger E, Yatime L, Delguste F, Ghinet A, Billamboz M, Merle N, Dimitrov J, Roumenina L, Frimat M. L’hème, un nouveau ligand du récepteur des produits de glycation avancée (RAGE). Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.048] [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: 10/28/2022]
|
9
|
Lynggaard V, Stampe L, Boettcher M, May O. P1481Effect of a nurse-led post discharge telephone consultation on uptake to cardiac rehabilitation in patients after acute myocardial infarction. A randomised controlled trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1481] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- V Lynggaard
- Regional Hospital West Jutland, Department of Cardiology, Cardiovascular Research Unit, Herning, Denmark
| | - L Stampe
- Regional Hospital West Jutland, Department of Cardiology, Cardiovascular Research Unit, Herning, Denmark
| | - M Boettcher
- Regional Hospital West Jutland, Department of Cardiology, Cardiovascular Research Unit, Herning, Denmark
| | - O May
- Regional Hospital West Jutland, Department of Cardiology, Herning, Denmark
| |
Collapse
|
10
|
May O, Graversen CB, Johansen MØ, Arildsen H. The prognostic value of the frontal QRS-T angle is comparable to cardiovascular autonomic neuropathy regarding long-term mortality in people with diabetes. A population based study. Diabetes Res Clin Pract 2018; 142:264-268. [PMID: 29775674 DOI: 10.1016/j.diabres.2018.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 10/18/2017] [Revised: 03/09/2018] [Accepted: 05/09/2018] [Indexed: 10/14/2022]
Abstract
UNLABELLED Cardiovascular autonomic neuropathy (CAN) is a well known prognostic marker in diabetes. A large angle between the QRS- and the T-wave vector (QRS-T angle) in the electrocardiogram (ECG) has recently been introduced as another marker of poor prognosis. AIM To assess and compare the long-term predictive power of the frontal plane QRS-T angle with CAN in people with diabetes. METHODS In 1992-93 people with diabetes in the municipality of Horsens, Denmark, were identified by the prescription method andan age and gender stratified sample of 240 individuals with diabetes were randomly selected. The presence of CAN was defined using the heart rate response to Valsalva manoeuvre. The QRS-T angle was read using the method described by Gandhi. In July 2015 vital statistics were obtained fromthe Danish Civil Registration System. RESULTS 178 individuals accepted to participate in the study, of which 153 (86%) completed the Valsalva manoeuvre and had sinus rhythm. Total observation time was 21.5 (0.18) years, in which 99 (65%) individuals died. An elevated QRS-T angle and the presence of cardiovascular autonomic neuropathy were both found to be significant predictors of death. In Cox regression analyses, adjusting for the effect of gender, age, duration of diabetes, BMI, total-cholesterol, diabetes type, haemoglobin A1c, smoking status, hypertension and previous MI, an independent prognostic value was found for the QRS-T angle as well as the Valsalva ratio. CONCLUSION A large QRS-T angle and the presence of cardiovascular autonomic neuropathy are both strong and independent long-term predictors of all-cause mortality in people with diabetes.
Collapse
Affiliation(s)
- O May
- Cardiovasc. Res. Unit, Dept. of Med., Regional Hospital West Jutland, Aarhus University, Denmark.
| | - C B Graversen
- Cardiovasc. Res. Unit, Dept. of Med., Regional Hospital West Jutland, Aarhus University, Denmark
| | - M Ø Johansen
- Cardiovasc. Res. Unit, Dept. of Med., Regional Hospital West Jutland, Aarhus University, Denmark
| | - H Arildsen
- Dept. of Infectious Dis., Aarhus University Hospital, Skejby, Denmark
| |
Collapse
|
11
|
Batailler C, Bonin N, M Wettstein, Nogier A, Martres S, Ollier E, May O, Lustig S. Outcomes of cup revision for ilio-psoas impingement after total hip arthroplasty: Retrospective study of 46 patients. Orthop Traumatol Surg Res 2017; 103:1147-1153. [PMID: 28951281 DOI: 10.1016/j.otsr.2017.07.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 03/05/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Impingement of the ilio-psoas tendon on the acetabular component is a cause of pain after total hip arthroplasty (THA). Studies of cup revision for ilio-psoas impingement (IPI) are scarce and limited in size. We therefore conducted a large multicentre retrospective study with the following objectives: to assess the effectiveness of cup replacement in resolving the impingement syndrome, to determine the frequency and nature of complications after cup revision for IPI, and to identify pre-operative factors associated with good outcomes of cup revision for IPI. HYPOTHESIS Cup revision is effective in resolving the pain due to IPI in selected patients. METHODS This retrospective multicentre study included 46 patients who underwent cup revision because of IPI. Before the revision, 38 (83%) patients had prominence of the anterior cup rim (mean, 9.9±4.5mm (range, 2-22mm) by radiography and 35 (76%) had cup malposition (anteversion<10° and/or inclination>50°). Mean follow-up was 21months (range, 6months to 6 years) and no patient was lost to follow-up. Outcomes at last follow-up were assessed based on the Oxford Hip Score (OHS), patient satisfaction index, complications, and revisions. RESULTS At last follow-up, 39 (85%) patients were satisfied with the revision procedure, a significant improvement versus baseline was noted in the OHS (mean, 43±6; range, 25-48; P<0.001), and 41 patients were free of pain during hip flexion (P<0.001 versus baseline). Complications occurred in 3 (6.5%) patients, but only one complication was severe (deep infection). Recurrent groin pain was reported by 4 (8.7%) patients at last follow-up. None of the factors studied predicted the outcome of revision surgery. DISCUSSION Cup revision for IPI after THA is effective in relieving the groin pain in 80% of patients with anterior cup rim prominence and/or cup malposition. However, complications can occur. Tenotomy may be preferable when the diagnosis is in doubt and/or cup position is acceptable. LEVEL OF EVIDENCE IV, retrospective observational study.
Collapse
Affiliation(s)
- C Batailler
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - N Bonin
- Lyon Ortho Clinic, 29B, avenue des Sources, 69009 Lyon, France
| | - M Wettstein
- ITOLS, clinique de Genolier, route du Muids 3, 1272 Genolier, Switzerland
| | - A Nogier
- Nollet Institute, 23, rue Brochant, 75017 Paris, France
| | - S Martres
- Orthopaedic Department, Hôpital Renée-Sabran, boulevard Edouard-Herriot, 83406 Hyères, France
| | - E Ollier
- U1059, Inserm, dysfonction vasculaire et hémostase, 42023 Saint-Etienne, France
| | - O May
- Centre de chirurgie de la hanche, Médipôle Garonne, 45, rue de Gironis, 31100 Toulouse, France
| | - S Lustig
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | -
- Société francophone d'arthroscopie, 15, rue Ampère, 92500 Rueil Malmaison, France
| |
Collapse
|
12
|
May O, Grunenwald A, Merle N, Gnemmi V, Cloé P, Rybkine T, Paule R, Hazzan M, Dimitrov J, Frémeaux-Bacchi V, Frimat M, Roumenina L. Syndrome hémolytique et urémique atypique : pourquoi le rein ? Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.080] [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: 11/25/2022]
|
13
|
Abstract
BACKGROUND In situ pinning of slipped capital femoral epiphysis (SCFE) results in various degrees of deformity of the femoral head-neck junction. Repetitive trauma from cam-type femoroacetabular impingement (FAI) can lead to labral tears and injury to the articular cartilage causing loss of function. Arthroscopic osteoplasty is an alternative to open procedure and to Southwick/Imhäuser-type osteotomies in symptomatic selected cases. SURGICAL TECHNIQUE The amount of bone to be resected has to be carefully planned pre-operatively. Only gentle traction is applied on a well-padded perineal support. A spherical burr is used to gradually resect the prominence. Intra-operative fluoroscopy is very useful when checking adequate reshaping of the head-neck junction is obtained. RESULTS Arthroscopy often reveals acetabular cartilage lesions, labrum hyperhemia and fraying which rarely require repair. Arthroscopic osteoplasty provides satisfactory pain relief and, to a lesser extent, restores hip internal rotation. CONCLUSION Arthroscopic osteoplasty is more technically and time-demanding in post SCFE than idiopathic FAI. It requires strong arthroscopic skills and experience in hip arthroscopy. It stands as a reasonable alternative to open procedure or flexion osteotomies in symptomatic FAI post mild to moderate SCFE. It provides pain relief and to a lesser extent restores internal rotation of the hip.
Collapse
Affiliation(s)
- F. Accadbled
- Department of Orthopaedics, Children’s Hospital, CHU de Toulouse, France,Correspondence should be sent to: Professor F. Accadbled. Service de Chirurgie Orthopédique et Traumatologique, Hôpital des Enfants 330, avenue de Grande Bretagne, 31059 TOULOUSE cedex 9, France. E-mail:
| | - O. May
- Clinique Médipôle Garonne, 45 rue de Gironis, 31036 Toulouse, France
| | | | - J. Sales de Gauzy
- Department of Orthopaedics, Children’s Hospital, CHU de Toulouse, France
| |
Collapse
|
14
|
May O, Graversen CB, Johansen MØ, Arildsen H. A large frontal QRS-T angle is a strong predictor of the long-term risk of myocardial infarction and all-cause mortality in the diabetic population. J Diabetes Complications 2017; 31:551-555. [PMID: 28065667 DOI: 10.1016/j.jdiacomp.2016.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/16/2016] [Accepted: 12/10/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND A large angle between the QRS vector and the T-wave vector (QRS-T angle) in electrocardiograms (ECGs) has recently been introduced as a marker of poor prognosis. The prognostic value in diabetes is unknown. We assessed the long-term predictive power of the frontal plane QRS-T angle in the diabetic population. METHODS In 1992-93, the diabetic population of the municipality of Horsens, Denmark, was delineated by the prescription method, and an age- and gender-stratified sample of 240 diabetic persons was randomly selected. In 2015, 12-lead ECGs taken in 1993-94 were analyzed. Vital statistics were obtained from the Danish Civil Registration System and data regarding hospitalizations taken from The National Patient Registry in July 2015. RESULTS In total, 178 people agreed to participate (74%) in the study, with the mean (sd) age being 58.9 (10.2) years and 56% being male. The total observation time was 21.5 (0.18) years, during which time 122 (69%) persons died, 32 (18%) suffered a myocardial infarction (MI) and 126 (71%) reached the composite endpoint of non-fatal MI or all-cause death. In Cox regression multivariate analysis a QRS-T angle above 90° was found to be an independent predictor of all-cause death (HR=2.2 (95% CI: 1.3-3.8)), MI (HR=2.95 (95% CI: 1.1-7.7)) and MI or all-cause death (HR=2.0 (95% CI: 1.2-3.5)) (all p<0.05), when adjusting for the effects of co-variates (gender, age, length of diabetes, BMI, total cholesterol, diabetes type, hemoglobin A1c, smoking, hypertension and previous MI). CONCLUSION A large QRS-T angle is a strong, independent long-term predictor of all-cause mortality, MI and MI or all-cause death in the diabetic population.
Collapse
Affiliation(s)
- Ole May
- Cardiovasc. Res. Unit, Dept. of Med., Regional Hospital West Jutland, Aarhus University, Denmark.
| | | | - Mia Østergaard Johansen
- Cardiovasc. Res. Unit, Dept. of Med., Regional Hospital West Jutland, Aarhus University, Denmark
| | - Hanne Arildsen
- Dept. of Infectious Dis., Aarhus University Hospital, Skejby, Denmark
| |
Collapse
|
15
|
Lynggaard V, Nielsen CV, Zwisler AD, Taylor RS, May O. The patient education - Learning and Coping Strategies - improves adherence in cardiac rehabilitation (LC-REHAB): A randomised controlled trial. Int J Cardiol 2017; 236:65-70. [PMID: 28259552 DOI: 10.1016/j.ijcard.2017.02.051] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 12/14/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Despite proven benefits of cardiac rehabilitation (CR), adherence to CR remains suboptimal. This trial aimed to assess the impact of the patient education 'Learning and Coping Strategies' (LC) on patient adherence to an eight-week CR program. METHODS 825 patients with ischaemic heart disease or heart failure were open label randomised to either the LC arm (LC plus CR) or the control arm (CR alone) across three hospital units in Denmark. Both arms received same amount of training and education hours. LC consisted of individual clarifying interviews, participation of experienced patients as co-educators, situational, reflective and inductive teaching. The control arm received structured deductive teaching. The primary outcomes were patient adherence to at least 75% of the exercise training or education sessions. We tested for subgroup effects on the primary outcomes using interaction terms. The primary outcomes were compared across arms using logistic regression. RESULTS More patients in the LC arm adhered to at least 75% of the exercise training sessions than control (80% versus 73%, adjusted odds ratio (OR):1.48; 95% CI:1.07 to 2.05, P=0.018) and 75% of education sessions (79% versus 70%, adjusted OR:1.61, 1.17 to 2.22, P=0.003). Some evidence of larger effects of LC on adherence was seen for patients with heart failure, low education and household income. CONCLUSIONS Addition of LC strategies improved adherence in rehabilitation both in terms of exercise training and education. Patients with heart failure, low levels of education and household income appear to benefit most from this adherence promoting intervention. TRIAL REGISTRATION www.clinicaltrials.gov identifier NCT01668394.
Collapse
Affiliation(s)
- Vibeke Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark.
| | - Claus Vinther Nielsen
- Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark.
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Denmark.
| | - Rod S Taylor
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Denmark; Institute of Health Research, University of Exeter Medical School, Exeter, England, UK.
| | - Ole May
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark.
| |
Collapse
|
16
|
Sejr MH, Nielsen JC, Damgaard D, Sandal BF, May O. Atrial fibrillation detected by external loop recording for seven days or two-day simultaneous Holter recording: A comparison in patients with ischemic stroke or transient ischemic attack. J Electrocardiol 2017; 50:287-293. [PMID: 28118928 DOI: 10.1016/j.jelectrocard.2017.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) is the most common cardiac cause of ischemic stroke and transient ischemic attack (IS/TIA). AIM To compare the diagnostic value of seven-day external loop recording (ELR) and two-day Holter recording for detecting AF after IS/TIA. METHODS 191 IS/TIA patients without AF history. Endpoint was AF >30s. We started two-day Holter recording and seven-day ELR simultaneously. RESULTS Seven-day ELR and two-day Holter recording detected the same three AF patients. ELR detected another six patients with AF adjudicated by cardiologists, four detections after Holter (3 vs. 7, p=0.125) and two false-positive detections during Holter. Seven-day ELR automatically classified 50/191 patients (26%) with AF, but only 7/50 (14%) were confirmed as AF by cardiologists. CONCLUSION Seven-day ELR did not detect significantly more patients with AF than two-day Holter recording. 86% of patients with ELR-classified AF were false positives, indicating a poor performance of the automatic AF detection algorithm used.
Collapse
Affiliation(s)
- Michala Herskind Sejr
- Cardiovascular Research Unit, Department of Medicine, Regional Hospital West Jutland, Gl. Landevej 61, Herning, Denmark.
| | | | | | | | - Ole May
- Cardiovascular Research Unit, Department of Medicine, Regional Hospital West Jutland.
| |
Collapse
|
17
|
Abstract
With the development of conservative hip surgery techniques, new entities such as microinstability have been identified. Microinstability is a painful supra-physiological mobility of the hip. It results from the association of architectural and functional abnormalities impairing joint stability. These risk factors concern hip joint bone architecture or peri-articular soft tissues. Bone abnormalities are identified on hip assessment parameters. Soft tissues also play a key role in the static and dynamic stability of the hip: the joint capsule, labrum, ligamentum teres and adjacent myotendinous structures affect joint coaptation; any abnormality or iatrogenic lesion concerning these structures may constitute a risk factor for microinstability. Diagnosis is based on interview, clinical examination and imaging. Findings of labral lesions or femoro-acetabular impingement do not rule out microinstability; they may be associated. Treatment is based first on physiotherapy for muscle reinforcement to improve joint coaptation. In case of failure, arthroscopic surgery is indicated for femoro-acetabular impingement and capsular plicature which is being evaluated. Periacetabular osteotomy or shelf acetabuloplasty may be indicated, according to the severity of joint bone architecture abnormality. Microinstability is a multifactorial entity. Lesions induced by microinstability may in turn become risk factors for aggravation. Diagnosis and indications for surgery are thus difficult to establish. Only full clinical examination and exhaustive imaging assessment allow microinstability and associated lesions to be identified.
Collapse
Affiliation(s)
- A Dangin
- CHU Nord Saint-Étienne, chirurgie orthopédique et de traumatologie, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
| | - N Tardy
- Centre osteo-articulaire des Cèdres, parc Sud Galaxie, 5, rue des Tropiques, 38130 Echirolles, France.
| | - M Wettstein
- Chirurgie orthopédique et de traumatologie, institut de traumatologie et d'orthopédie du Léman, chemin des Allinges 10, 1006 Lausanne, Switzerland; Clinique de Genolier, route du Muids, 3, 1272 Genolier, Switzerland.
| | - O May
- Centre de chirurgie de la hanche, 45, rue de Gironis, 31100 Toulouse, France.
| | - N Bonin
- Lyon-Ortho-Clinic, 29B, avenue des Sources, 69009 Lyon, France.
| |
Collapse
|
18
|
Ejlersen JA, Poulsen SH, Mortensen J, May O. Diagnostic value of layer-specific global longitudinal strain during adenosine stress in patients suspected of coronary artery disease. Int J Cardiovasc Imaging 2016; 33:473-480. [PMID: 27878406 DOI: 10.1007/s10554-016-1022-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/12/2016] [Indexed: 12/12/2022]
Abstract
Speckle tracking global longitudinal strain (GLS) from dobutamine stress echocardiography (SE) predicts coronary artery disease (CAD). The diagnostic value of GLS from vasodilator SE and the additional value of layer-specific speckle tracking analysis are unclear. We explored the usefulness of layer-specific GLS and non-layer-specific strain (automated functional imaging, AFI) from adenosine SE. The included 132 patients (67% male, 62.6 (9.0) years), of which 46 (35%) had CAD defined as ≥1 stenosis ≥70% (≥50% in the left main), underwent adenosine SE and invasive coronary angiography. Resting AFI and layer-specific GLS were similar in patients with or without CAD (p > 0.05). The stress-rest difference (Δvalue = stress-value - rest-value) in patients with CAD was less pronounced compared to patients without proved CAD (Δendocardial GLS: -1.2 (3.5)% vs. -5.0 (3.2)%; Δmidventricular GLS: -0.95 (3.0)% vs. -4.2 (2.7)%; Δepicardial GLS: -0.7 (2.5)% vs. -3.4 (2.3)%; ΔAFI: -0.8 (2.9)% vs. -3.6 (3.1)%, p < 0.00001 for all comparisons). The diagnostic value of the three layer-specific GLS values and AFI were statistically similar (p = 0.19). The four Δvalues provided independent predictive value to the risk assessment given by gender, age, wall motion and ΔEF (p = 0.002, AFI and p < 0.0001, layer-specific GLS). The accuracies were acceptable (71-80%) with modest sensitivities (54-65%) and high specificities (80-91%). The deformation response to vasodilator infusion was associated with the presence of CAD. Endocardial, midventricular and epicardial GLS and AFI from adenosine SE had similar diagnostic values. The specificities were high, but the modest sensitivities are a limitation to the clinical application.
Collapse
Affiliation(s)
- June A Ejlersen
- Cardiovascular Research Unit, Herning, Denmark.
- Department of Nuclear Medicine, Regional Hospital Herning, Gl. Landevej 61, 7400, Herning, Denmark.
| | - Steen H Poulsen
- Department of Cardiology, Skejby University Hospital, Aarhus, Denmark
| | - Jesper Mortensen
- Department of Nuclear Medicine, Regional Hospital Herning, Gl. Landevej 61, 7400, Herning, Denmark
| | - Ole May
- Cardiovascular Research Unit, Herning, Denmark
| |
Collapse
|
19
|
Zwisler AD, Rossau HK, Nakano A, Foghmar S, Eichhorst R, Prescott E, Cerqueira C, Soja AMB, Gislason GH, Larsen ML, Andersen UO, Gustafsson I, Thomsen KK, Boye Hansen L, Hammer S, Viggers L, Christensen B, Kvist B, Lindström Egholm C, May O. The Danish Cardiac Rehabilitation Database. Clin Epidemiol 2016; 8:451-456. [PMID: 27822083 PMCID: PMC5094528 DOI: 10.2147/clep.s99502] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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] [Indexed: 12/24/2022] Open
Abstract
Aim of database The Danish Cardiac Rehabilitation Database (DHRD) aims to improve the quality of cardiac rehabilitation (CR) to the benefit of patients with coronary heart disease (CHD). Study population Hospitalized patients with CHD with stenosis on coronary angiography treated with percutaneous coronary intervention, coronary artery bypass grafting, or medication alone. Reporting is mandatory for all hospitals in Denmark delivering CR. The database was initially implemented in 2013 and was fully running from August 14, 2015, thus comprising data at a patient level from the latter date onward. Main variables Patient-level data are registered by clinicians at the time of entry to CR directly into an online system with simultaneous linkage to other central patient registers. Follow-up data are entered after 6 months. The main variables collected are related to key outcome and performance indicators of CR: referral and adherence, lifestyle, patient-related outcome measures, risk factor control, and medication. Program-level online data are collected every third year. Descriptive data Based on administrative data, approximately 14,000 patients with CHD are hospitalized at 35 hospitals annually, with 75% receiving one or more outpatient rehabilitation services by 2015. The database has not yet been running for a full year, which explains the use of approximations. Conclusion The DHRD is an online, national quality improvement database on CR, aimed at patients with CHD. Mandatory registration of data at both patient level as well as program level is done on the database. DHRD aims to systematically monitor the quality of CR over time, in order to improve the quality of CR throughout Denmark to benefit patients.
Collapse
Affiliation(s)
- Ann-Dorthe Zwisler
- Danish Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense
| | - Henriette Knold Rossau
- Danish Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense
| | - Anne Nakano
- Department of Clinical Epidemiology, Aarhus University Hospital; Registry Support Centre (West) - Clinical Quality Improvement & Health Informatics, Aarhus
| | - Sussie Foghmar
- Department of Cardiology, Copenhagen University Hospital, Hvidovre
| | | | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen
| | - Charlotte Cerqueira
- Registry Support Centre (East) - Epidemiology and Biostatistics, Research Centre for Prevention and Health, the Capital Region of Denmark, Glostrup
| | | | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup; The Danish Heart Foundation, Copenhagen; The National Institute of Public Health, University of Southern Denmark
| | | | | | - Ida Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Hvidovre
| | | | | | - Signe Hammer
- Department of Occupational Therapy and Physiotherapy, Herlev Hospital, Herlev
| | - Lone Viggers
- Department of Nutrition, Regional Hospital West Jutland, Holstebro
| | - Bo Christensen
- Department of General Medicine, School of Public Health, Aarhus University, Aarhus
| | - Birgitte Kvist
- Department of Health Care and Prevention, Municipality of Frederikshavn, Frederikshavn
| | | | - Ole May
- Department of Medicine, Cardiovascular Research Unit, Regional Hospital Herning, Herning, Denmark
| |
Collapse
|
20
|
Ejlersen JA, Poulsen SH, Mortensen J, May O. A comparison of the diagnostic value of 2D strain stress echocardiography, myocardial perfusion scintigraphy, and Duke treadmill score in patients suspected of coronary artery disease. Echocardiography 2016; 33:1523-1531. [DOI: 10.1111/echo.13297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- June A. Ejlersen
- Cardiovascular Research Unit; Regional Hospital Herning; Herning Denmark
- Department of Nuclear Medicine; Regional Hospital Herning; Herning Denmark
| | - Steen H. Poulsen
- Department of Cardiology; Skejby University Hospital; Aarhus Denmark
| | - Jesper Mortensen
- Department of Nuclear Medicine; Regional Hospital Herning; Herning Denmark
| | - Ole May
- Cardiovascular Research Unit; Regional Hospital Herning; Herning Denmark
| |
Collapse
|
21
|
Sejr MH, May O, Nielsen JC, Damgaard D. 56-76: External loop recording for 7 days detects more patients with atrial fibrillation compared to 2-day Holter recording in patients with ischemic stroke or transient ischemic attack. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i51c] [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: 11/12/2022] Open
|
22
|
Coulomb R, Essig J, Mares O, Asencio G, Kouyoumdjian P, May O. Clinical results of endoscopic treatment without repair for partial thickness gluteal tears. Orthop Traumatol Surg Res 2016; 102:391-5. [PMID: 26947734 DOI: 10.1016/j.otsr.2016.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 12/18/2015] [Accepted: 01/05/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Various surgical treatments have been proposed for greater trochanteric pain syndrome (GTPS) related to gluteal tendinopathy with partial thickness tears. The clinical results of endoscopic debridement without repair of these gluteal tears are not well known. The objectives of this study were to determine if this procedure leads to: (1) reduction of pain, (2) functional improvement, (3) patient satisfaction (on scale of 0 to 10). HYPOTHESIS Endoscopic treatment without tendon repair provides short-term pain relief in patients with GTPS due to partial thickness gluteal tears. MATERIAL AND METHODS Seventeen patients (16 women, 1 man) with GTPS due to partial thickness gluteal tears that was present for at least 6 months and was refractory to conservative treatment were included in the analysis. The average age at the time of the procedure was 53.5years (17-71). Pain was evaluated with a visual analogue scale (VAS). Functional outcomes were defined using the Harris Hip Score and the UCLA activity score. Satisfaction was evaluated using a VAS and Odom's criteria. RESULTS The average follow-up was 37.6months (12-48). The average preoperative and follow-up values were respectively: (1) Pain: 7.2±1.1 (5-9) versus 3.3±1.9 (1-7) (P<0.001), (2) Harris score: 53.5±8.4 (36-68) versus 79.8±14.7 (45-96) (P<0.001). Seven patients (41.2%) were able to resume sports activities. The average satisfaction score for the surgery was 6.2±2.4 (0-9) at follow-up. Five patients had a poor outcome at the review: four still had pain and one had recurrence of the lateral snapping hip. CONCLUSION Endoscopic treatment without repair of partial thickness gluteal tears is a treatment option with modest clinical results for GTPS patients refractory to conservative treatment. LEVEL OF EVIDENCE IV, retrospective study.
Collapse
Affiliation(s)
- R Coulomb
- CHU Carémeau, place du Pr-Debré, 30029 Nîmes cedex 9, France.
| | - J Essig
- Clinique Médipole-Garonne, 45, rue Gironis, 31036 Toulouse cedex 1, France
| | - O Mares
- CHU Carémeau, place du Pr-Debré, 30029 Nîmes cedex 9, France
| | - G Asencio
- CHU Carémeau, place du Pr-Debré, 30029 Nîmes cedex 9, France
| | - P Kouyoumdjian
- CHU Carémeau, place du Pr-Debré, 30029 Nîmes cedex 9, France
| | - O May
- Clinique Médipole-Garonne, 45, rue Gironis, 31036 Toulouse cedex 1, France
| |
Collapse
|
23
|
Larsen KK, Vestergaard CH, Schougaard LMV, Larsen LP, Jessen A, May O, Hjøllund NH. Contacts to general practice and antidepressant treatment initiation after screening for anxiety and depression in patients with heart disease. Dan Med J 2016; 63:A5185. [PMID: 26836792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Anxiety and depression are found in 20-30% of all persons with heart disease, and depression is known to impact mortality. This paper aimed to describe the effect of systematic screening of this population in terms of use of general practice, psychological therapy and antidepressant treatment. METHODS A population-based cohort study was conducted in 2011-2013 comprising 1,658 people with heart disease treated at a Danish regional hospital. Collected data were based on Danish national registers and patient questionnaires. RESULTS Patients with heart disease and anxiety or depressive symptoms had more general practitioner (GP) contact rates than patients without anxiety or depressive symptoms both before and after the screening. Furthermore, patients with depressive symptoms increased their GP contact rate significantly in the first month after the screening, while this was not the case for patients with anxiety symptoms. Finally, patients with heart disease and anxiety or depressive symptoms more frequently initiated treatment with antidepressants than patients with heart disease without anxiety or depressive symptoms, whereas therapy sessions with a psychologist were rarely used. CONCLUSIONS Heart patients with depressive symptoms may benefit from screening for depression, information about the screening result and a subsequent recommendation to consult their GP in case of signs of depression. -However, the observed effect seems to be modest. FUNDING The study was supported by an unrestricted grant from the Lundbeck Foundation (grant number: R155-2012-11280). TRIAL REGISTRATION none.
Collapse
|
24
|
Kulenovic I, Mortensen MB, Bertelsen J, May O, Dodt KK, Kanstrup H, Falk E. Statin use prior to first myocardial infarction in contemporary patients: Inefficient and not gender equitable. Prev Med 2016; 83:63-9. [PMID: 26687101 DOI: 10.1016/j.ypmed.2015.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 08/03/2015] [Revised: 10/28/2015] [Accepted: 12/06/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Guidelines recommend initiating primary prevention with statins to those at highest cardiovascular risk. We assessed the gender-specific implementation and effectiveness of this risk-guided approach. METHODS We identified 1399 consecutive patients without known cardiovascular disease or diabetes hospitalized with a first myocardial infarction (MI) in Denmark. Statin use before MI was assessed, and cardiovascular risk was calculated using SCORE (Systematic COronary Risk Evaluation). RESULTS Among patients with first MI, 36% were women. Compared with men, they were older (mean 72 vs. 65years) but had a lower estimated risk (median 3.4% vs. 6.7%, SCORE high-risk model in the statin-naïve patients). Statin therapy had been initiated in 12% of women and 10% of men prior to MI. After adding 1.5mmol/L to the total cholesterol concentration of those already on statins, the estimated pre-treatment risk was much lower in women than men (median 3.8% vs. 9.2%, SCORE high-risk model), and only 29% of women would have passed the risk-based treatment threshold defined by the European guidelines (SCORE ≥5%). Estimated risk and statin use correlated directly in men but not in women. Only ~5% of first MI are prevented by the current use of statins in people without diabetes. CONCLUSION In people destined for a first MI, statin therapy is uncommon and prevents few events. Lower-risk women receive as much statins as higher risk men. This gender disparity and inefficient targeting of statins to those at highest risk indicate that risk scoring is not widely used in routine clinical practice in Denmark.
Collapse
Affiliation(s)
- Imra Kulenovic
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | | | - Ole May
- Department of Medicine, Regional Hospital Herning, Denmark
| | - Karen Kaae Dodt
- Department of Cardiology, Regional Hospital Horsens, Denmark
| | - Helle Kanstrup
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Erling Falk
- Department of Cardiology, Aarhus University Hospital, Denmark
| |
Collapse
|
25
|
May O, Søgaard HJ. Enhanced External Counterpulsation Is an Effective Treatment for Depression in Patients With Refractory Angina Pectoris. Prim Care Companion CNS Disord 2015; 17:14m01748. [PMID: 26693035 DOI: 10.4088/pcc.14m01748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/30/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To examine the effect of enhanced external counterpulsation (EECP) on depression in patients with refractory angina pectoris (Canadian Cardiovascular Society class 2-4). METHOD The study was a prospective observational investigation with a 2-month control period preceding the EECP therapy (to minimize a possible effect of the regression-toward-the-mean phenomenon). The patients were examined 2 months before and just before EECP and just after, 3 months after, and 12 months after EECP. Depression was assessed using the Major Depression Inventory and the ICD-10. During EECP, 3 sets of cuffs were fastened around the lower extremities and were inflated sequentially to a pressure of 260 mm Hg in each diastole for 60 minutes 5 days a week for 7 weeks (35 sessions). The study was conducted at a regional hospital in Denmark from May 2006 to January 2011. RESULTS Fifty patients with angina pectoris and an abnormal coronary angiography, with no possibility for revascularization, were included (72% men, mean age of 63 years) between May 2006 and January 2011. The prevalence of depression before EECP was 18%, just after was 2%, 3 months after was 2%, and 12 months after was 4% (P = .013). The depressive state was more severe at a lower age (P = .016). No significant predictors of effect of EECP on depression were found (P > .05), and no association was detected between decline in depressive state and chest pain (P > .05). CONCLUSIONS The study indicates that EECP is an effective treatment for depression in patients with refractory angina pectoris, that depression is more severe in younger patients, and that the effect of EECP on depression is not related to the effect on chest pain. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01112163.
Collapse
Affiliation(s)
- Ole May
- Cardiovascular Research Unit, Department of Medicine, Regional Hospital West Jutland (Dr May); and Psychiatric Research Unit West, Regional Psychiatric Services West (Dr Søgaard), Herning, Denmark
| | - Hans Jørgen Søgaard
- Cardiovascular Research Unit, Department of Medicine, Regional Hospital West Jutland (Dr May); and Psychiatric Research Unit West, Regional Psychiatric Services West (Dr Søgaard), Herning, Denmark
| |
Collapse
|
26
|
Dehbarez NT, Lynggaard V, May O, Søgaard R. Learning and coping strategies versus standard education in cardiac rehabilitation: a cost-utility analysis alongside a randomised controlled trial. BMC Health Serv Res 2015; 15:422. [PMID: 26412226 PMCID: PMC4586001 DOI: 10.1186/s12913-015-1072-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 09/18/2015] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Learning and coping education strategies (LC) was implemented to enhance patient attendance in the cardiac rehabilitation programme. This study assessed the cost-utility of LC compared to standard education (standard) as part of a rehabilitation programme for patients with ischemic heart disease and heart failure. METHODS The study was conducted alongside a randomised controlled trial with 825 patients who were allocated to LC or standard rehabilitation and followed for 5 months. The LC approach was identical to the standard approach in terms of physical training and education, but with the addition of individual interviews and weekly team evaluations by professionals. A societal cost perspective including the cost of intervention, health care, informal time and productivity loss was applied. Cost was based on a micro-costing approach for the intervention and national administrative registries for other cost categories. Quality adjusted life years (QALY) were based on SF-6D measurements at baseline, after intervention and follow-up using British preference weights. Multiple imputation was used to handle non-response on the SF-6D. Conventional cost effectiveness methodology was employed to estimate the net benefit of the LC and to illustrate cost effectiveness acceptability curves. The statistical analysis was based on means and bootstrapped standard errors. RESULTS An additional cost of DKK 6,043 (95% CI -5,697; 17,783) and a QALY gain of 0.005 (95% CI -0.001; 0.012) was estimated for LC. However, better utility scores in both arms were due to higher utility while receiving the intervention than better health after the intervention. The probability that LC would be cost-effective did not exceed 29% for any threshold values of willingness to pay per QALY. The alternative scenario analysis was restricted to a health care perspective and showed that the probability of cost-effectiveness increased to 62% over the threshold values. DISCUSSION The LC was unlikely to be cost-effective within 5 months of follow-up from a societal perspective, but longer-term follow-up should be evaluated before a definite conclusion is drawn. CONCLUSION Future research should assess the LC strategies' long-term efficacy and cost-utility. TRIAL REGISTRATION NCT01668394.
Collapse
Affiliation(s)
- Nasrin Tayyari Dehbarez
- Health Economics, Public Health and Quality Improvement, Olof Palmes Alle 15, 8200, Aarhus N, Denmark. .,Department of Public Health, Aarhus University, Bartholins Allé 2, Buldg. 1260, 8000, Aarhus C, Denmark.
| | - Vibeke Lynggaard
- Cardiovascular Research Unit, Regional Hospital West Jutland, 7400, Herning, Denmark.
| | - Ole May
- Cardiovascular Research Unit, Regional Hospital West Jutland, 7400, Herning, Denmark.
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Bartholins Allé 2, Buldg. 1260, 8000, Aarhus C, Denmark. .,Department of Clinical Medicine, Aarhus University, Bartholins Allé 2, Buldg. 1260, 8000, Aarhus C, Denmark.
| |
Collapse
|
27
|
Grunenwald A, May O, Merle N, Noe R, Rybkine T, Rosain J, Frimat M, Frémeaux-Bacchi V, Roumenina L. Rôle de l’hème oxygénase dans la protection rénale contre l’activation du complément en conditions hémolytiques. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.008] [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: 10/23/2022]
|
28
|
May O, Lynggaard V, Mortensen JCA, Malczynski J. Enhanced external counterpulsation – Effect on angina pectoris, QoL and exercise capacity after 1 year. SCAND CARDIOVASC J 2015; 49:1-6. [PMID: 25471629 DOI: 10.3109/14017431.2014.994028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ole May
- Department of Medicine, Regional Hospital West Jutland, Denmark
| | | | | | | |
Collapse
|
29
|
Lynggaard V, May O, Beauchamp A, Nielsen CV, Wittrup I. LC-REHAB: randomised trial assessing the effect of a new patient education method--learning and coping strategies--in cardiac rehabilitation. BMC Cardiovasc Disord 2014; 14:186. [PMID: 25495543 PMCID: PMC4290465 DOI: 10.1186/1471-2261-14-186] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/08/2014] [Indexed: 11/17/2022] Open
Abstract
Background Due to improved treatments and ageing population, many countries now report increasing prevalence in rates of ischemic heart disease and heart failure. Cardiac rehabilitation has potential to reduce morbidity and mortality, but not all patients complete. In light of favourable effects of cardiac rehabilitation it is important to develop patient education methods which can enhance adherence to this effective program. The LC-REHAB study aims to compare the effect of a new patient education strategy in cardiac rehabilitation called ‘learning and coping’ to that of standard care. Further, this paper aims to describe the theoretical basis and details of this intervention. Methods/design Open parallel randomised controlled trial conducted in three hospital units in Denmark among patients recently discharged with ischemic heart disease or heart failure. Patients are allocated to either the intervention group with learning and coping strategies incorporated into standard care in cardiac rehabilitation or the control group who receive the usual cardiac rehabilitation program. Learning and coping consists of two individual clarifying interviews, participation of experienced patients as educators together with health professionals and theory based, situated and inductive teaching. Usual care in cardiac rehabilitation is characterised by a structured deductive teaching style with use of identical pre-written slides in all hospital units. In both groups, cardiac rehabilitation consists of training three times a week and education once a week over eight weeks. The primary outcomes are adherence to cardiac rehabilitation, morbidity and mortality, while secondary outcomes are quality of life (SF-12, Health education impact questionnaire and Major Depression Inventory) and lifestyle and risk factors (Body Mass Index, waist circumference, blood pressure, exercise work capacity, lipid profile and DXA-scan). Data collection occurs four times; at baseline, at immediate completion of cardiac rehabilitation, and at three months and three years after the finished program. Discussion It is expected that learning and coping incorporated in cardiac rehabilitation will improve adherence in cardiac rehabilitation and may decrease morbidity and mortality. By describing learning and coping strategies the study aims to provide knowledge that can contribute to an increased transparency in patient education in cardiac rehabilitation. Trial registration Identifier NCT01668394.
Collapse
Affiliation(s)
- Vibeke Lynggaard
- Regional Hospital West Jutland, Cardiovascular Research Unit, Herning, Denmark.
| | | | | | | | | |
Collapse
|
30
|
May O, Merle N, Paule R, Noel C, Roumenina L, Fremeaux-Bacchi V, Frimat M. Analyse des propriétés de protection contre l’activation du complément et de l’expression d’un phénotype prothrombotique de l’endothélium glomérulaire rénal. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.330] [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: 11/17/2022]
|
31
|
Abstract
OBJECTIVE 2D strain analysis based on speckle tracking (EchoPAC, GE) allows semi-automatic quantification of myocardial deformation. Microbubble contrast (MBC) alters the speckle pattern, but the impact of MBC on speckle tracking has not been thoroughly studied. We investigated whether 2D strain analysis performed on contrast-enhanced recordings obtained with a normal mechanical index (MI) was possible, and evaluated if and how strain measurements and speckle tracking were affected by MBC. METHODS AND RESULTS Twenty-nine patients with normal echocardiograms were consecutively included and divided into two groups dependent on image quality (19 with high (HIQ) and 10 with low image quality (LIQ)). Before, during, three and seven minutes after MBC infusion (SonoVue, Bracco), the three standard apical loops were recorded (MI = 1.0) and analysed twice on two different days. Mean and regional (basal, mid-ventricular and apical) leftventricular peak systolic strain were calculated at each time point. No significant changes over time were detected in mean or regional strain. Reproducibility worsened during and three minutes after MBC infusion and was generally poorer in the LIQ group. Tracking was impaired during MBC for the HIQ group, but improved throughout the examination for the LIQ group. CONCLUSIONS First, it was possible to quantify 2D strain from recordings obtained during or shortly after MBC infusion. Secondly, 2D strain measures were unaffected by the presence of MBC, and, thirdly, the reproducibility and the performance of the tracking algorithm were impaired when high intensities of MBC were present in the circulation.
Collapse
Affiliation(s)
- June Anita Ejlersen
- Cardiovascular Research Unit, Herning Regional Hospital, Herning, Denmark
- Dept. of Nuclear Medicine, Herning Regional Hospital, Herning, Denmark
| | - Ole May
- Cardiovascular Research Unit, Herning Regional Hospital, Herning, Denmark
| |
Collapse
|
32
|
Janečková R, Kubala D, May O, Fedor J, Allan M. Experimental evidence on the mechanism of dissociative electron attachment to formic acid. Phys Rev Lett 2013; 111:213201. [PMID: 24313485 DOI: 10.1103/physrevlett.111.213201] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Indexed: 06/02/2023]
Abstract
Two mechanisms for dissociative electron attachment in HCOOH, the formation of HCOO(-)+H, were proposed in the literature: (i) via a direct electron attachment into a σ* resonance, augmented by dipole binding of the incident electron [G. A. Gallup et al., Phys. Rev. A 79, 042701 (2009)], and (ii) with the 1.8 eV π* resonance as a doorway state, linked to the products by symmetry lowering-distortion of the temporary anion, primarily the C-H bond, from the planar symmetry [T. N. Rescigno et al., Phys. Rev. Lett. 96, 213201 (2006)]. The later mechanism implies a reduction of the cross section upon deuteration of the hydrogen bonded to the C atom, whereas the former mechanism would leave the cross section unaffected. Our experimental absolute cross sections for the four isotopomers of formic acid show that deuteration on the C atom reduces the cross section value only marginally (by 12%) compared to deuteration on the O atom (reduction by a factor of 16), and thus favor mechanism (i).
Collapse
Affiliation(s)
- R Janečková
- Department of Chemistry, University of Fribourg, Chemin du Musée 9, 1700 Fribourg, Switzerland
| | | | | | | | | |
Collapse
|
33
|
Thuesen L, May O, Brorholt-Petersen JU, Christensen PD. [Dizziness in patients with heart disease]. Ugeskr Laeger 2013; 175:2712-2715. [PMID: 24629234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In patients with heart disease, dizziness is primarily associated with syncope or pre-syncope and mandates further investigation to obtain a specific diagnosis, estimation of risk of sudden death and treatment options. After a focused history and physical examination, the cause of the problem may be determined in more than half of the patients. The reflex syncope is by far the most common form and may usually be handled by reassurance of the benign nature of the problem. Patients with syncope caused by brachy- or tachy-arrhythmia or structural or ischaemic heart disease should be referred to a cardiological department for specific diagnosis and treatment.
Collapse
Affiliation(s)
- Leif Thuesen
- Medicinsk Afdeling, Regionshospitalet Herning, Gl. Landevej 61, 7400 Herning.
| | | | | | | |
Collapse
|
34
|
May O, Houe N, El Kheyr MA, Sovso M, Lynggaard V. Long term predictive power of the updated ESC clinical risk score: focus on gender. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4001] [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: 11/12/2022] Open
|
35
|
May O, Blom L, Jacobsen BE, Thuesen L, Andersen ME, Dalsgaard D, Niemann T, Husted SE. Primary percutaneous coronary intervention delay for patients living in a peripheral area in Denmark. Dan Med J 2013; 60:A4661. [PMID: 23809971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION In patients with ST-elevation myocardial infarction (STEMI), timely primary percutaneous coronary intervention (PPCI) is superior to thrombolysis and it is the preferred treatment in Denmark. The prognosis depends on the time delay until coronary blood flow is re-established. The purpose of this registry study was to evaluate the PPCI treatment delay of the triage algorithm in a peripheral area in the Region of Central Jutland in the context of European guidelines. MATERIAL AND METHODS From 1 September 2009 through 31 August 2010, we included all PPCI-treated patients from the catchment area of Regional Hospital Herning (RHH) who were diagnosed with probable STEMI based on the first electrocardiography wirelessly transmitted to the physician on call at RHH after symptom onset. RESULTS A total of 101 patients were included, 77% were males and their median age was 63.4 years. The median distance to the PCI centre was 120.3 (range 63.5-174.2) km. The 2008 European guidelines on transportation delay were fulfilled for 35 (35%) patients and the 2012 European guidelines for seven (7%) patients. Overall, 46% of the patients had a delay from first medical contact to PCI < 120 min., 9% a delay < 90 min. and none a delay < 60 min. CONCLUSION Our registry study showed that 35% and 7% of PPCI patients from a peripherally located area in Denmark met the 2008 and 2012 European guidelines for an acceptable transport delay to a PCI centre, respectively. Our current PPCI triage strategy therefore needs reconsideration. FUNDING not relevant. TRIAL REGISTRATION not relevant.
Collapse
Affiliation(s)
- Ole May
- Department of Medicine, Regional Hospital Herning, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
May O. [Patient education in the management of coronary heart disease]. Ugeskr Laeger 2013; 175:1797-1799. [PMID: 23773220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The aim of the review was to assess the effect of patient education in ischaemic heart disease. Thirteen randomised controlled trials of moderate to good quality including 68,556 patients were selected. The effect on mortality, cardiac morbidity, hospitalisation and health-related quality of life was assessed and only non-significant tendencies of effect were found. The authors of the review nevertheless conclude that the review supports current rehabilitation programmes that include patient education. Further research in patient education, especially concerning the most effective methods of education delivery, is needed.
Collapse
Affiliation(s)
- Ole May
- Medicinsk Afdeling, Regionshospitalet Herning, Gl. Landevej 61, 7400 Herning, Denmark.
| |
Collapse
|
37
|
Mortensen MB, Sivesgaard K, Jensen HK, Comuth W, Kanstrup H, Gotzsche O, May O, Bertelsen J, Falk E. Traditional SCORE-based health check fails to identify individuals who develop acute myocardial infarction. Dan Med J 2013; 60:A4629. [PMID: 23673263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Atherosclerotic cardiovascular disease (CVD), including acute myocardial infarction (AMI), is caused by well-known risk factors. They constitute important therapeutic targets, but their predictive value is disputed. We evaluated the effectiveness of the risk scoring system (SCORE) and thresholds for pharmacotherapy re-commended in the European guidelines on CVD prevention. MATERIAL AND METHODS The medical records of 605 consecutive patients hospitalized for a first AMI were reviewed. Patients with pre-existing CVD, diabetes, or incomplete information on risk factors were excluded. Those not treated with statin before AMI were risk stratified based on risk factors. A SCORE ≥ 5% or ≥ 10% was considered to qualify for preventive medication in young adults (age ≤ 60 years) or elderly (age > 60 years), respectively. RESULTS Before AMI, 40 (9%) used statin. Among non-statin users, only five of the 109 young adults had a SCORE ≥ 5%, and 23 of the 284 elderly had a SCORE ≥ 10%. Among women, only three elderly qualified for treatment. More than four times more patients would have qualified for treatment with the high-risk country chart used in 2011. The incremental value of the novel high-density lipoprotein adjusted SCORE charts was limited. CONCLUSION Few patients admitted with a first AMI used statin. Among non-statin users, SCORE and the recommended thresholds for pharmacotherapy identified no women and less than one out of ten men who untreated were destined for an AMI before 61 years of age. The preventive potential of a traditional risk factor-based health check is limited. FUNDING not relevant. TRIAL REGISTRATION not relevant.
Collapse
Affiliation(s)
- Martin B Mortensen
- Kardiologisk Afdeling, Aarhus Universitetshospital, 8200 Aarhus N, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Thuesen L, Niemann T, Husted S, May O, Dalsgaard D. [Flying High]. Ugeskr Laeger 2013; 175:839. [PMID: 23755384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
39
|
Eftekhari A, May O. Effect of enhanced external counterpulsation depends on arterial compliance. Acta Cardiol 2013; 68:47-50. [PMID: 23457909 DOI: 10.1080/ac.68.1.2959631] [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: 10/19/2022]
Abstract
Enhanced external counterpulsation (EECP) is a non-invasive therapy offered to patients with refractory angina pectoris. Previous studies have demonstrated that its clinical effect depends on the diastolic/systolic augmentation ratio (D/S ratio). We hypothesized that the D/S ratio is associated with arterial stiffness measured as pulse wave velocity (PWV) and brachial pulse pressure (PP). Twenty patients with known refractory angina (17 men, 3 women; mean age 64 years) were included and underwent one hour of EECP treatment (Vasomedical Inc., Westbury, NY, USA). Three sets of cuffs were applied around the lower extremities. Gated by electrocardiography (ECG), air was inflated in diastole at a pressure of 260 mmHg and deflated at the start of systole. The D/S ratio was monitored with finger plethysmography. Carotid-femoral pulse wave velocity (PWV) was measured with mechanotransducers (Complior SP, Artech Medical, France). PWV and brachial BP were measured at baseline before EECP. The mean (SD) BP was 140 (23.5)/77 (9.9) mmHg, PP 62.8 (18.3) mmHg and PWV 10.8 (4.4) m/s. EECP treatment increased the D/S ratio during a one-hour session compared with baseline (1.30 (0.11) vs. 0.56 (0.04) P < 0.001), and the D/S ratio at 45 min. was significantly correlated with PWV (r = 0.49, P < 0.05) and PP (r = 0.58, P < 0.05). We demonstrated that the diastolic augmentation (D/S ratio) during EECP treatment depends on arterial stiffness. The results suggest that arterial compliance has a crucial influence on the effect of EECP and that large-artery stiffness may reduce the effect of EECP.
Collapse
Affiliation(s)
- Ashkan Eftekhari
- Department of Internal Medicine, Region Hospital, Herning, Denmark
| | - Ole May
- Department of Internal Medicine, Region Hospital, Herning, Denmark
| |
Collapse
|
40
|
Tarpgaard Jørgensen M, May O. [Improvement of angina, quality of life, and working capacity after enhanced external counterpulsation]. Ugeskr Laeger 2013; 175:114-116. [PMID: 23331940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This case report describes a 43 year-old woman who had had 15 hospital admissions in six years due to chest pain. Repeated coronary angiography showed no significant stenoses, but myocardial scintigraphy revealed reversible ischaemia. In spite of optimal medical treatment, she was in Canadian Cardiovascular Society (CCS) class 3 with a poor quality of life (QoL). After a course of enhanced external counterpulsation the CCS class was reduced to 1, and QoL was significantly improved and remained high for the following three years, resulting in only one hospital admission due to chest pain. The case illustrates that EECP is an efficient therapy for angina pectoris in patients, who are not amenable for invasive procedures.
Collapse
|
41
|
May O. [Enhanced external counterpulsation therapy for patients with angina pectoris]. Ugeskr Laeger 2013; 175:116-119. [PMID: 23331941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Enhanced external counterpulsation (EECP) is a noninvasive therapy offered to patients with angina pectoris who have unacceptable chest pain despite medical treatment and who have no operative options. During EECP three sets of pneumatic cuffs wrapped around the lower extremities are inflated to a pressure of 260-300 mmHg in diastole. This creates an augmented diastolic blood pressure and an increase in coronary blood flow. The therapy is usually given for one hour five days a week in seven weeks. EECP is known to reduce the frequency of angina, increase the quality of life and reduce the frequency of hospitalisation.
Collapse
Affiliation(s)
- Ole May
- Medicinsk Afdeling, Regionshospitalet Herning, Gl. Landevej 61, 7400 Herning, Denmark.
| |
Collapse
|
42
|
Wendelboe Nielsen O, May O, Egstrup K, Schjødt I, Nakano Jensen A, Cerqueira C, Paaske Johnsen S. [The Cardiology Corporate Database]. Ugeskr Laeger 2012; 174:2555. [PMID: 23079458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
43
|
Thuesen L, Dalsgaard D, May O, Husted SE. [Is Danish percutaneous coronary intervention too centralized?]. Ugeskr Laeger 2012; 174:2096; discussion 2096. [PMID: 23110275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
44
|
May O, Khair WAM. Enhanced external counterpulsation has no lasting effect on ambulatory blood pressure. Clin Cardiol 2012; 36:21-4. [PMID: 22886748 DOI: 10.1002/clc.22045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 06/04/2012] [Revised: 07/10/2012] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Enhanced external counterpulsation (EECP) has been reported to reduce blood pressure (BP) using clinic BP readings. The aim of this study was to assess the effect of a course of EECP on BP using ambulatory BP (ABP) measurements. HYPOTHESIS EECP has a lasting BP lowering effect. METHODS Patients referred for EECP due to refractory angina pectoris were consecutively included in the study. The ABPs were measured for 24 hours using a Spacelabs Ultralite 90217 device at 5 time points during the study period: 2 months before the EECP course, just before the EECP course, just after the EECP course, and at 3 and 12 months after EECP. Antihypertensive medication was held constant during the study period. Changes in BP were tested by repeated measures analysis. RESULTS Fifty patients were included in the study. The mean age was 63 years, and 72% were male. The Canadian Cardiovascular Society Angina Grading Scale class improved from a mean of 2.6 to 1.5. The mean daytime ABPs were 114/69, 114/70, 115/71, 114/70, and 116/71 mm Hg and the mean nighttime ABPs were 107/63, 108/63, 106/62, 108/63, and 107/62 mm Hg at 2 months before the EECP course, just before the EECP course, just after the EECP course, and at 3 and 12 months after EECP, respectively (all P > 0.10). Further, when controlling for quartiles of baseline ABP level, no significant change in ABP was found. CONCLUSIONS Enhanced external counterpulsation treatment has no lasting effect on ABP.
Collapse
Affiliation(s)
- Ole May
- Cardiovascular Research Unit, Department of Medicine, Region Hospital Herning, Herning, Denmark.
| | | |
Collapse
|
45
|
May O, Arildsen H. Simple function tests for autonomic neuropathy have a higher predictive value on all-cause mortality in diabetes compared to 24-h heart rate variability. J Diabetes Complications 2012; 26:246-50. [PMID: 22512975 DOI: 10.1016/j.jdiacomp.2012.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Received: 05/16/2011] [Revised: 01/02/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
AIM To compare the long-term predictive power of heart rate variability (HRV) based on 24 h ECG recordings with a battery of simple autonomic function tests with regard to all-cause mortality in diabetic individuals. METHODS 240 diabetic persons were randomly selected from the diabetic population. A 24-h ECG was obtained and analysed on the Pathfinder 700. In the RR Tools Program time domain and frequency domain parameters were computed. Five function tests were conducted: Valsalva ratio, heart rate response to standing (30:15 ratio), expiration/inspiration ratio (E/I ratio), orthostatic blood pressure response (Ortho BP), and increase in diastolic blood pressure during sustained handgrip. RESULTS 178 patients agreed to participate and 136 patients who completed all 5 function tests and had an acceptable ECG recording were included in the analyses. 64 individuals (47%) died during the 15½ year follow-up. Using Cox proportional hazard analyses correcting for age and gender we found that among the HRV parameters only the power in the low frequency band (LF) had an independent predictive value on all-cause mortality (p=0.0002). Multivariate analysis of the five function tests showed that Valsalva (p=0.002), 30:15 ratio (p=0.037), and handgrip (p=0.037) were independent predictors of death. When finally the independent predictors among the function tests and the HRV parameters were assessed in the same model, no significant value could be shown for LF power (p=0.44). CONCLUSION The study indicates that simple autonomic function tests are superior to HRV based on 24-h ECG recordings in predicting all-cause mortality in the diabetic population.
Collapse
Affiliation(s)
- Ole May
- Department of Medicine, Region Hospital Herning, DK-7400 Herning, Denmark.
| | | |
Collapse
|
46
|
Miletic B, May O, Krantz N, Girard J, Pasquier G, Migaud H. De-escalation exchange of loosened locked revision stems to a primary stem design: complications, stem fixation and bone reconstruction in 15 cases. Orthop Traumatol Surg Res 2012; 98:138-43. [PMID: 22340994 DOI: 10.1016/j.otsr.2011.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 03/31/2011] [Revised: 07/25/2011] [Accepted: 08/23/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Femoral stem revision with a locked stem after total hip arthroplasties treats severe bone defects by favoring spontaneous bone reconstruction. Initially, once reconstruction was obtained, the temporary implant was to be replaced by a standard primary component. The use of locked stems has increased, but repeat revision with a short stem which is also called "de-escalation" has not been extensively studied. HYPOTHESIS Repeat revision of a locked stem with a short stem is not associated with any specific morbidity and does not affect the quality of reconstruction obtained, or fixation of the subsequent standard length primary design stem. PATIENTS AND METHODS Fifteen patients whose locked femoral stem was exchanged due to thigh pain and/or radiographic images showing failed osteointegration were analyzed. These 15 patients were all followed-up and evaluated by the Postel Merle d'Aubigné score. Progression of bone defects was evaluated using the Hofmann cortical index. RESULTS There were no difficulties extracting the locked stem and a standard length primary stem was inserted with no associated procedures or bone complications in any of the cases. At a mean follow-up of 55 months (36-84months), thigh pain had disappeared and the Postel Merle d'Aubigné score had increased from 12.6±2.9 (7-16) to 16.5±0.9 (15-18) (P=0.0001). The use of a locked femoral stem resulted in bone reconstruction in all cases, the Hofmann index increased from 30.5%±17.9% (12-71%) before insertion of the locked stem to 43.6%±25.6% (19-90%) at exchange (P<0.05). Bone reconstruction was durable after the exchange with a stable Hofmann index 43.7%±26.2% (17-92%) at the final follow-up (P=0.9). No recurrent loosening occurred. DISCUSSION Revision of a loosened locked femoral stem with a standard design primary stem does not result in any specific increased morbidity, or modify bone reconstruction obtained with the locked stem and results in stable fixation of a new standard length stem. LEVEL OF EVIDENCE IV: retrospective or historical series.
Collapse
Affiliation(s)
- B Miletic
- Lille North of France University, 59000 Lille, France.
| | | | | | | | | | | |
Collapse
|
47
|
May O, Dalsgaard D, Niemann T. [Follow current guidelines for primary PCI]. Ugeskr Laeger 2012; 174:441; author reply 441. [PMID: 22432161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
48
|
|
49
|
May O, Dalsgaard D, Niemann T. [Primary PCI regardless of the transport delay]. Ugeskr Laeger 2012; 174:75; author reply 75. [PMID: 22334896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
50
|
May O, Arildsen H. Long-term predictive power of simple function tests for cardiovascular autonomic neuropathy in diabetes: a population-based study. Acta Diabetol 2011; 48:311-316. [PMID: 21499921 DOI: 10.1007/s00592-011-0283-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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] [Received: 01/11/2011] [Accepted: 04/04/2011] [Indexed: 10/18/2022]
Abstract
No consensus exists on which test is optimal in screening for cardiovascular autonomic neuropathy in diabetic patients. The long-term predictive power of five simple function tests with regard to all-cause mortality in individuals with diabetes from the general population was assessed. The diabetic population in the municipality of Horsens, Denmark, was delineated by the prescription method, and an age- and gender-stratified sample of 240 diabetic persons was randomly selected. Five function tests were conducted: Valsalva ratio, heart rate response to standing (30:15 ratio), expiration/inspiration ratio (E/I ratio), ortostatic blood pressure response (Orto BP) and increase in diastolic blood pressure during sustained handgrip. After a 15½-year follow-up period, vital statistics were obtained from the Danish Civil Registration System. One hundred and seventy eight persons participated, 44% women, 40% type 1 diabetes, mean age 58.9 (SD 10.2) years. In Cox regression analysis, adjusting for age and gender, each test had a significant predictive effect on mortality (all P < 0.05). In the multivariate analysis, only Valsalva ratio (P = 0.0017), 30:15 ratio (P = 0.037) and handgrip (P = 0.037) were predictors of survival. As a binary variable, the presence of CAN was associated with a relative risk of all-cause death of 2.85 (95%CI: 1.75-4.65, P = 0.00003). In the period following the first 5 years, CAN's predictive value remained significant. This study indicates that Valsalva, 30:15 ratio and handgrip, but not E/I ratio and Orto BP, have an independent predictive value with regard to long-term all-cause mortality. Baseline function tests hold prognostic information after at least 5 years.
Collapse
Affiliation(s)
- Ole May
- Department of Medicine, Region Hospital Herning, 7400, Herning, Denmark.
| | - Hanne Arildsen
- Department of Infectious Diseases, Aarhus University Hospital Skejby, 8200, Aarhus N, Denmark
| |
Collapse
|