Кардиология, кардиохирургия, торакальная хирургия

[Наталья П.]

[Ссылки доступны только зарегистрированным пользователям ]
april 2005
East London summary guidelines
Coronary Heart Disease (Primary and Secondary Prevention)

[Наталья П.]

[Ссылки доступны только зарегистрированным пользователям ]
Clinical Statements/Guidelines

[Ссылки доступны только зарегистрированным пользователям ]
Clinical Practice Guidelines
National Heart, Lung, and Blood Institute

[Наталья П.]

[Ссылки доступны только зарегистрированным пользователям ]
Thoracic Surgical Procedures

[Ссылки доступны только зарегистрированным пользователям ]
Cardiovascular Surgical Procedures

[Наталья П.]

[Ссылки доступны только зарегистрированным пользователям ] (регистрация бесплатная)
The Lancet, Volume 366, Issue 9496, Pages 1545-1553
L. Lindholm, B. Carlberg, O. Samuelsson
Should beta blockers remain first choice in the treatment of primary hypertension?
A meta-analysis.

BACKGROUND: Beta blockers have been used widely in the treatment of hypertension and are recommended as first-line drugs in hypertension guidelines. However, a preliminary analysis has shown that atenolol is not very effective in hypertension. We aim to substantially enlarge the data on atenolol and analyse the effect of different beta blockers.
METHODS: The Cochrane Library and PubMed were searched for beta blocker treatment in patients with primary hypertension. Data were then entered into the Cochrane Collaboration Review Manager package and were summarised in meta-analyses. 13 randomised controlled trials (n=105 951) were included in a meta-analysis comparing treatment with beta blockers with other antihypertensive drugs. Seven studies (n=27 433) were included in a comparison of beta blockers and placebo or no treatment.
FINDINGS: The relative risk of stroke was 16% higher for beta blockers (95% CI 4-30%) than for other drugs. There was no difference for myocardial infarction. When the effect of beta blockers was compared with that of placebo or no treatment, the relative risk of stroke was reduced by 19% for all beta blockers (7-29%), about half that expected from previous hypertension trials. There was no difference for myocardial infarction or mortality.
INTERPRETATION: In comparison with other antihypertensive drugs, the effect of beta blockers is less than optimum, with a raised risk of stroke. Hence, we believe that beta blockers should not remain first choice in the treatment of primary hypertension and should not be used as reference drugs in future randomised controlled trials of hypertension.

[Наталья П.]

[Ссылки доступны только зарегистрированным пользователям ] (регистрация бесплатная):
Lancet. 2004 Nov 6-12;364(9446):1684-9. Related Articles, Links
Erratum in:
Lancet. 2005 Feb 19;365(9460):656.
Comment in:
ACP J Club. 2005 May-Jun;142(3):59.

Atenolol in hypertension: is it a wise choice?

BACKGROUND: Atenolol is one of the most widely used beta blockers clinically, and has often been used as a reference drug in randomised controlled trials of hypertension. However, questions have been raised about atenolol as the best reference drug for comparisons with other antihypertensives. Thus, our aim was to systematically review the effect of atenolol on cardiovascular morbidity and mortality in hypertensive patients.
METHODS: Reports were identified through searches of The Cochrane Library, MEDLINE, relevant textbooks, and by personal communication with established researchers in hypertension. Randomised controlled trials that assessed the effect of atenolol on cardiovascular morbidity or mortality in patients with primary hypertension were included.
FINDINGS: We identified four studies that compared atenolol with placebo or no treatment, and five that compared atenolol with other antihypertensive drugs. Despite major differences in blood pressure lowering, there were no outcome differences between atenolol and placebo in the four studies, comprising 6825 patients, who were followed up for a mean of 4.6 years on all-cause mortality (relative risk 1.01 [95% CI 0.89-1.15]), cardiovascular mortality (0.99 [0.83-1.18]), or myocardial infarction (0.99 [0.83-1.19]). The risk of stroke, however, tended to be lower in the atenolol than in the placebo group (0.85 [0.72-1.01]). When atenolol was compared with other antihypertensives, there were no major differences in blood pressure lowering between the treatment arms. Our meta-analysis showed a significantly higher mortality (1.13 [1.02-1.25]) with atenolol treatment than with other active treatment, in the five studies comprising 17671 patients who were followed up for a mean of 4.6 years. Moreover, cardiovascular mortality also tended to be higher with atenolol treatment than with other antihypertensive treatment. Stroke was also more frequent with atenolol treatment.
INTERPRETATION: Our results cast doubts on atenolol as a suitable drug for hypertensive patients. Moreover, they challenge the use of atenolol as a reference drug in outcome trials in hypertension.

Publication Types:
Meta-Analysis

[Наталья П.]

Clinical pathway for the treatment of primary spontaneous pneumothorax in a general surgery department.
Am J Med Qual. 2005 Sep-Oct;20(5):268-76. [Ссылки доступны только зарегистрированным пользователям ]

[Gilarov]

Уважаемая Наталья!
Регистрация-то на Ланцете бесплатная, только по этой регистрации кроме абстракта ничего не получишь.
Это да, но некоторые выборочные статьи они выставляют полнотекстово

С этим приходится мириться

[Наталья П.]

[Ссылки доступны только зарегистрированным пользователям ]
Бразильский ресурс для студентов-медиков
Cardiology

Constrictive Pericarditis
Diastolic Heart Failure
Heart Transplantation
Recent Advances in Heart Failure Treatment : Surgical Procedures. Part II
Recent Advances in Heart Failure Treatment : An Aproach Based on Pathophysiology - Part I
Intra-Aortic Balloon Counterpulsation
Current Trends in the Treatment of Atrial Fibrilation

American College of Cardiology 1997
Summary of the most interesting presentations

[Gilarov]

Новые [Ссылки доступны только зарегистрированным пользователям ]
Кроме того, могу рекомендовать довольно приличный [Ссылки доступны только зарегистрированным пользователям ] Ресурсы доступны после регистрации (бесплатной). Особенно хорош раздел "Whats what?", посвященный клиническим испытаниям.

[Sergnt]

Самый-самый сайт по интервенционной кардиологии
[Ссылки доступны только зарегистрированным пользователям ] (регистрация бесплатно), куча презентаций, много литературы. клинических примеров.

[Igor73]

Scientific Statements and Practice Guidelines Topic List
Following is a topic listing of active American Heart Association medical and scientific statements. Most AHA scientific statements and advisories are published in Circulation. Joint AHA and American College of Cardiology (ACC) statements also appear in the Journal of the American College of Cardiology (JACC).
[Ссылки доступны только зарегистрированным пользователям ]

[Artemij Okhotin]

[Изображения доступны только зарегистрированным пользователям]
Full Text Online Supported by an Educational Grant from [Изображения доступны только зарегистрированным пользователям]
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Некоторые недавние кардиогайды:

Krum H, Jelinek MV, Stewart S, Sindone A, Atherton JJ, Hawkes AL; CHF Guidelines Core Writers.
Guidelines for the prevention, detection and management of people with chronic heart failure in Australia 2006.
Med J Aust. 2006 Nov 20;185(10):549-57.

[Ссылки доступны только зарегистрированным пользователям ]

-------------------------------

U.S. Preventive Services Task Force.
Screening for peripheral arterial disease: recommendation statement.
Am Fam Physician. 2006 Feb 1;73(3):497-500.

[Ссылки доступны только зарегистрированным пользователям ]

----------------------------------------

Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM; American Heart Association.
Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association.
Hypertension. 2006 Feb;47(2):296-308

[Ссылки доступны только зарегистрированным пользователям ]

-----------------------------------------------------

Strickberger SA, Benson DW, Biaggioni I, Callans DJ, Cohen MI, Ellenbogen KA, Epstein AE, Friedman P, Goldberger J, Heidenreich PA, Klein GJ, Knight BP, Morillo CA, Myerburg RJ, Sila CA; American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke; Quality of Care and Outcomes Research Interdisciplinary Working Group; American College of Cardiology Foundation; Heart Rhythm Society; American Autonomic Society.
AHA/ACCF Scientific Statement on the evaluation of syncope: from the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: in collaboration with the Heart Rhythm Society: endorsed by the American Autonomic Society.
Circulation. 2006 Jan 17;113(2):316-27.

[Ссылки доступны только зарегистрированным пользователям ]

[Gilarov]

Европейские гайды.
Клапанные пороки - [Ссылки доступны только зарегистрированным пользователям ]
Диабет, предиабет и сердечно-сосудистая патология - [Ссылки доступны только зарегистрированным пользователям ]
Доступ бесплатный после регистрации.

[Наталья П.]

Журнал "Оценка медицинских технологий"
полный текст pdf
[Ссылки доступны только зарегистрированным пользователям ]

Health Technol Assess. 2006 Nov;10(48):1-138.

Evaluation of the ventricular assist device programme in the UK.

Sharples L, Buxton M, Caine N, Cafferty F, Demiris N, Dyer M, Freeman C.

MRC Biostatistics Unit, Cambridge, UK.

OBJECTIVES: To summarise the relevant clinical effectiveness and cost-effectiveness literature, to collect data on survival, transplantation rates, health-related quality of life (HRQoL) and resource use for ventricular assist device (VAD) and non-VAD transplant candidates in the UK, and to construct cost-effectiveness and cost-utility models of VADs in a UK context. Also to investigate the factors that drive costs and survival.
DESIGN: A comprehensive systematic review was carried out. Data were collected from April 2002 to December 2004, with follow-up to March 2005. Cost-effectiveness and cost-utility models of VAD devices were developed based on UK activity and outcomes collected from April 2002 to March 2005.
SETTING: National Specialist Commissioning Advisory Group funded VAD implantation was carried out at the Freeman, Harefield and Papworth transplant centres in the UK.
PARTICIPANTS: Seventy patients were implanted with a VAD as a bridge to transplantation between April 2002 and December 2004. Non-VAD-supported transplant candidates (n = 250), listed at the three centres between April 2002 and December 2004, were divided into an inotrope-dependent group (n = 71) and a non-inotrope-dependent group (n = 179). Although patients in the inotrope-dependent group were closest to the VAD group they were less sick. The last group comprised a hypothetical worst case scenario, which assumed that all VAD patients would die in the intensive care unit (ICU) within 1 month without VAD technology.
INTERVENTIONS: Patients were included who were implanted with a VAD designed for circulatory support for more than 30 days, with intention to bridge to transplantation. A multistate model of VAD and transplant activity was constructed; this was populated by data from the UK.
MAIN OUTCOME MEASURES: Survival from VAD implant or from transplant listing for non-VAD patients to 31 March 2005. Serious adverse events and quality of life measures were used. Cognitive functioning was also assessed. Utility weights were derived from EuroQoL responses to estimate quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios (ICERs) were defined as the additional cost of VADs divided by additional QALYs. Time-horizons were 3 years, 10 years and the lifetime of the patients.
RESULTS: Of 70 VAD patients, 30 (43%) died pretransplant, 31 (44%) underwent transplantation, and four (6%) recovered and had the VAD removed. Five patients (7%) were still supported for median of 279 days at the end of March 2005. Successful bridge-to-transplantation/recovery rates were consistent with published rates. Survival from VAD implantation was 74% at 30 days and 52% at 12 months. There were 320 non-fatal adverse events in 62 patients during 300 months of VAD support, mostly in the first month after implantation. Commonly observed events were bleeding, infection and respiratory dysfunction. Twenty-nine (41%) patients were discharged from hospital with a VAD. The 1-year survival post-transplantation was 84%. For the inotrope-dependent and non-inotrope-dependent transplant candidates, death rates while listed were 10% and 8% and the median waiting times were 16 and 87 days, respectively. For transplant recipients, 1-year survival was 85% and 84%, respectively. Both VAD and non-VAD patients demonstrated similar significant improvements in their New York Heart Association class after transplantation. All patients had poor EQ-5D pretransplantation; after transplantation the groups had similar EQ-5D of 0.76 irrespective of time after surgery. HRQoL was poor in the first month for VAD patients but better for those who waited longer in all groups. VAD patients reported more problems with sleep and rest and with ambulation in the first month. Symptom scores were similar in all groups pretransplant. After transplantation all groups showed a marked and similar improvement in physical and psychosocial function. Mean VAD implant cost, including device, was pound63,830, with costs of VAD support for survivors of pound21,696 in month 1 and pound11,312 in month 2. Main cost drivers were device itself, staffing, ICU stay, hospital stay and events such as bleeding, stroke and infection. For the base case, extrapolating over the lifetime of the patients the mean cost for a VAD patient was pound173,841, with mean survival of 5.63 years and mean QALYs of 3.27. Corresponding costs for inotrope-dependent patients were pound130,905, with mean survival 8.62 years and mean QALYs 4.99. Since inotrope-dependent patients had lower costs and higher QALYs than VAD patients, this group is said to be dominant. Non-inotrope-dependent transplant candidates had similar survival rates to those on inotropes but lower costs, also dominant. Compared with the worst case scenario the mean lifetime ICER for VADs was pound49,384 per QALY. In a range of sensitivity analyses this ranged from pound35,121 if the device cost was zero to pound49,384. Since neither inotrope-dependent transplant candidates nor the worst case scenario were considered fair controls the assumption was investigated that, without VAD technology, there would be a mixture of these situations. For mixtures considered the ICER for VADs ranged from pound79,212 per QALY to the non-VAD group being both cheaper and more effective.
CONCLUSIONS: There are insufficient data from either published studies or the current study to construct a fair comparison group for VADs. Overall survival of 52% is an excellent clinical achievement for those young patients with rapidly failing hearts. However, if the worst case scenario were plausible, and one could reliably extrapolate results to the lifetime of the patients, VADs would not be cost-effective at traditional thresholds. Further randomised controlled trials are required, using current second generation devices or subsequent devices and conducted in the UK.