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Cardiovascular Diseases - Top 30 Publications

Evacetrapib and Cardiovascular Outcomes in High-Risk Vascular Disease.

The cholesteryl ester transfer protein inhibitor evacetrapib substantially raises the high-density lipoprotein (HDL) cholesterol level, reduces the low-density lipoprotein (LDL) cholesterol level, and enhances cellular cholesterol efflux capacity. We sought to determine the effect of evacetrapib on major adverse cardiovascular outcomes in patients with high-risk vascular disease.

Mepolizumab or Placebo for Eosinophilic Granulomatosis with Polyangiitis.

Eosinophilic granulomatosis with polyangiitis is an eosinophilic vasculitis. Mepolizumab, an anti-interleukin-5 monoclonal antibody, reduces blood eosinophil counts and may have value in the treatment of eosinophilic granulomatosis with polyangiitis.

A case of confirmed primary hyperaldosteronism diagnosed despite normal screening investigations.

Primary hyperaldosteronism is a common cause of hypertension in the adult population. We report a case of histologically and biochemically confirmed hyperaldosteronism related to an adrenal adenoma, where initial screening and biochemical tests were potentially misleading. The case highlights the importance of clinical suspicion in the current diagnostic approach to primary hyperaldosteronism.

CDC Grand Rounds: Public Health Strategies to Prevent and Treat Strokes.

Worldwide, stroke is the second leading cause of death and a leading cause of serious long-term disability. In the United States, nearly 800,000 strokes occur each year; thus stroke is the fifth leading cause of death overall and the fourth leading cause of death among women (1). Major advances in stroke prevention through treatment of known risk factors has led to stroke being considered largely preventable. For example, in the United States, stroke mortality rates have declined 70% over the past 50 years, in large part because of important reductions in hypertension, tobacco smoking, and more recently, increased use of anticoagulation for atrial fibrillation (2,3). Although the reduction in stroke mortality is recognized as one of the 10 great public health achievements of the 20th century (4), gains can still be made. Approximately 80% of strokes could be prevented by screening for and addressing known risks with measures such as improving hypertension control, smoking cessation, diabetes prevention, cholesterol management, increasing use of anticoagulation for atrial fibrillation, and eliminating excessive alcohol consumption (5,6).

Left Ventricular Assist Devices for Advanced Heart Failure.

Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey.

To determine adherence to NHMRC eye examination guidelines for Indigenous and non-Indigenous Australian people with diabetes.

Long term risk of severe retinopathy in childhood-onset type 1 diabetes: a data linkage study.

To determine the relationship between glycaemic control trajectory and the long term risk of severe complications in people with type 1 diabetes mellitus, as well as the effects of paediatric and adult HbA1c levels.

Left Ventricular Assist Devices for Advanced Heart Failure.

Left Ventricular Assist Devices for Advanced Heart Failure.

Abdominal Compartment Syndrome as a Complication of Fluid Resuscitation.

Fluid resuscitation is a primary concern of nurse clinicians. Excessive resuscitation with crystalloids places patients at particular risk for many subsequent complications that carry associated increases in mortality and morbidity. Intra-abdominal hypertension and abdominal compartment syndrome are deadly complications of third spacing and capillary leak that occur secondary to excessive fluid resuscitation. Careful consideration is necessary when achieving fluid balance in acutely ill patients, including reducing the use of crystalloids, implementing damage control resuscitation, and establishing measurable resuscitation endpoints. Nurse clinicians are capable of reducing mortality in intra-abdominal hypertension and abdominal compartment syndrome patients by incorporating the latest evidence in fluid resuscitation techniques.

Microvascular Fluid Resuscitation in Circulatory Shock.

The microcirculation is responsible for blood flow regulation and red blood cell distribution throughout individual organs. Patients with circulatory shock have acute failure of the cardiovascular system in which there is insufficient delivery of oxygen to meet metabolic tissue requirements. All subtypes of shock pathophysiology have a hypovolemic component. Fluid resuscitation guided by systemic hemodynamic end points is a common intervention. Evidence shows that microcirculatory shock persists even after optimization of macrocirculatory hemodynamics. The ability for nurses to assess the microcirculation at the bedside in real-time during fluid resuscitation could lead to improved algorithms designed to resuscitate the microcirculation.

Does Evidence Drive Fluid Volume Restriction in Chronic Heart Failure?

Chronic heart failure is a chronic condition that is associated with increased health care expenditures and high rates of morbidity and mortality. Mainstay in heart failure management has been the prescription of a fluid restriction. The purpose of this article is to review the available evidence for fluid restriction in chronic heart failure patients.

Non-Mask-based Therapies for Central Sleep Apnea in Patients with Heart Failure.

Central sleep apnea is common in heart failure and contributes to morbidity and mortality. Symptoms are often similar to those associated with heart failure and a high index of suspicion is needed. Testing is typically done in the sleep laboratory, but home testing equipment can distinguish between central and obstructive events. Treatments are limited. Mask-based therapies have been the primary treatment. Oxygen has some data but lacks long-term studies. Neurostimulation of the phrenic nerve is a new technology that has demonstrated improvement. Coordination of care between sleep specialists and cardiologists is important as the field of central sleep apnea continues to develop.

Device Therapy for Sleep-Disordered Breathing in Patients with Cardiovascular Diseases and Heart Failure.

Pathophysiologic components of upper airway obstruction, reduced tidal volume, and disturbed respiratory drive characterize sleep-disordered breathing. Positive airway pressure (PAP) devices address these components by stabilizing the upper airways (continuous PAP), applying air volumes and mandatory breaths (bilevel PAP), or counterbalancing ventilation (adaptive servoventilation). Although PAP therapies have been shown to improve breathing disturbances, daytime symptoms, and left ventricular function in obstructive sleep apnea and cardiovascular diseases, the effects on mortality are controversial, especially in heart failure and central sleep apnea. Optimal treatment is selected based on polysomnographic findings and symptoms, and applied based on the underlying pathophysiologic components.

Sleep-Disordered Breathing and Arrhythmia in Heart Failure Patients.

Heart failure (HF) treatment remains complex and challenging, with current recommendations aiming at consideration and treatment of comorbidities in patients with HF. Sleep-disordered breathing (SDB) and arrhythmia come into play, as both are associated with quality of life deterioration, and morbidity and mortality increase in patients with HF. Interactions of these diseases are versatile and may appear intransparent in daily practice. Nevertheless, because of their importance for patients' condition and prognosis, SDB and arrhythmia individually, but also through interaction on one another, necessitate attention, following the fact that treatment is requested and desired considering latest research findings and outcomes.

Central Sleep Apnea in Patients with Congestive Heart Failure.

Central sleep apnea and Cheyne-Stokes respiration are commonly observed breathing patterns during sleep in patients with congestive heart failure. Common risk factors are male gender, older age, presence of atrial fibrillation, and daytime hypocapnia. Proposed mechanisms include augmented peripheral and central chemoreceptor sensitivity, which increase ventilator instability during both wakefulness and sleep; diminished cerebrovascular reactivity and increased circulation time, which impair the normal buffering of Paco2 and hydrogen ions and delay the detection of changes in Paco2 during sleep; and rostral fluid shifts that predispose to hypocapnia.

A Practical Approach to the Identification and Management of Sleep-Disordered Breathing in Heart Failure Patients.

Sleep-disordered breathing (SDB) is a major health problem affecting much of the general population. Although SDB is responsible for rapid progression of heart failure (HF) and the worsening morbidity and mortality, advanced HF state is associated with accelerated development of SDB. In the face of recent developments in SDB treatment and availability of effective therapeutic options known to improve quality of life, exercise tolerance, and heart function, most HF patients with SDB are left unrecognized and untreated. This article provides an overview of SDB in HF with focus on practical approaches intended to facilitate screening and treatment.

Rehabilitation of Cardiovascular Disorders and Sleep Apnea.

Obstructive sleep apnea (OSA) is present in more than 50% of patients referred to cardiac rehabilitation units. However, it has been under-recognized in patients after stroke and heart failure. Those with concurrent OSA have a worse clinical course. Early treatment of coexisting OSA with continuous positive airway pressure (CPAP) results in improved rehabilitation outcomes and quality of life. Possible mechanisms by which CPAP may improve recovery include decreased blood pressure fluctuations associated with apneas, and improved left ventricular function, cerebral blood flow, and oxygenation. Early screening and treatment of OSA should be integral components of patients entering cardiac rehabilitation units.

The Effects of Insomnia and Sleep Loss on Cardiovascular Disease.

Sleep loss has negative impacts on quality of life, mood, cognitive function, and heath. Insomnia is linked to poor mood, increased use of health care resources, decreased quality of life, and possibly cardiovascular risk factors and disease. Studies have shown increase in cortisol levels, decreased immunity, and increased markers of sympathetic activity in sleep-deprived healthy subjects and those with chronic insomnia. The literature shows subjective complaints consistent with chronic insomnia and shortened sleep can be associated with development of diabetes, hypertension, and cardiovascular disease. This article explores the relationship between insufficient sleep and insomnia with these health conditions.

Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest.

The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied.

Validity of the Montreal Cognitive Assessment Screener in Adolescents and Young Adults With and Without Congenital Heart Disease.

Cognitive deficits are common, long-term sequelae in children and adolescents with congenital heart disease (CHD) who have undergone surgical palliation. However, there is a lack of a validated brief cognitive screening tool appropriate for the outpatient setting for adolescents with CHD. One candidate instrument is the Montreal Cognitive Assessment (MoCA) questionnaire.

Should Adults Experiencing In-Hospital Cardiac Arrest Be Intubated?

A new study challenges conventional wisdom.

Hypothermia after In-Hospital Cardiac Arrest in Children.

Hypothermia after In-Hospital Cardiac Arrest in Children.

Risk-adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR).

Hospital data used to assess regional variability in disease management and outcomes, including mortality, lack information on disease severity. We describe variance between hospitals in 30-day risk-adjusted mortality rates (RAMRs) for stroke, comparing models that include or exclude stroke severity as a covariate.

Hypothermia after In-Hospital Cardiac Arrest in Children.

Hypothermia after In-Hospital Cardiac Arrest in Children.

Case 13-2017. A 41-Year-Old Man with Hearing Loss, Seizures, Weakness, and Cognitive Decline.

Spironolactone Metabolites in TOPCAT - New Insights into Regional Variation.

Evolocumab Added to Statins to Reduce Progression of Coronary Atherosclerosis-Reply.