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Medicine Lodge, United States

Mahmoud K.D.,Mayo Medical School | Mahmoud K.D.,University of Groningen | Lennon R.J.,Mayo Medical School | Ting H.H.,Mayo Medical School | And 3 more authors.
JACC: Cardiovascular Interventions | Year: 2011

Objectives: We sought to determine the circadian, weekly, and seasonal variation of coronary stent thrombosis. Background: Other adverse cardiovascular events such as acute myocardial infarction are known to have higher incidences during the early morning hours, Mondays, and winter months. Methods: The Mayo Clinic Percutaneous Coronary Intervention Registry was searched for patients admitted to our center who underwent repeat percutaneous coronary intervention in a previously stented coronary artery segment. Stent thrombosis was confirmed by angiographic review, and date and time of symptom onset were obtained from medical records. Results: We identified 124 patients with definite stent thrombosis and known date and time of symptom onset. In these patients, onset of stent thrombosis was significantly associated with time of day (p = 0.006), with a peak incidence around 7:00 am. When patients were subdivided into early stent thrombosis (0 to 30 days; n = 49), late stent thrombosis (31 to 360 days; n = 30), and very late stent thrombosis (>360 days; n = 45), only early stent thrombosis remained significantly associated with time of day (p = 0.030). No association with the day of the week was found (p = 0.509); however, onset of stent thrombosis did follow a significant seasonal pattern, with higher occurrences in the summer (p = 0.036). Conclusions: Coronary stent thrombosis occurs more often in the early morning hours. Early stent thrombosis follows a circadian rhythm with a peak at 7:00 am. This pattern was not significant in late and very late stent thrombosis. Occurrences throughout the week were equally distributed, but stent thrombosis was more likely to occur in the summer months. © 2011 American College of Cardiology Foundation.

Jabre P.,Mayo Medical School | Jabre P.,University of Paris Descartes | Roger V.L.,Mayo Medical School | Murad M.H.,Knowledge and Encounter Research Unit | And 4 more authors.
Circulation | Year: 2011

Background-: Atrial fibrillation (AF) is a common finding in patients with myocardial infarction (MI). Atrial fibrillation is not generally perceived by clinicians as a critical event during the acute phase of MI; however, its prognostic influence in MI remains controversial. Furthermore, contradictory data exist concerning the risk of death according to AF timing. This article, a systematic review and first meta-analysis, aims to quantify the mortality risk associated with AF in MI patients and its timing. Methods and results-: A comprehensive search of several electronic databases (1970 to 2010; adults, any language) identified MI studies that evaluated mortality related to AF. Evidence was reviewed by 2 blinded reviewers with a formal assessment of the methodological quality of the studies. Adjusted odds ratios were pooled across studies using the random-effects model. The I statistic was used to assess heterogeneity. In the 43 included studies (278 854 subjects), the mortality odds ratio associated with AF was 1.46 (95% confidence interval, 1.35 to 1.58; I=76%; 23 studies). This worse prognosis persisted regardless of the timing of AF; the odds ratio of mortality for new AF with no prior history of AF was 1.37 (95% confidence interval, 1.26 to 1.49), I=28%, 9 studies), and for prior AF was 1.28 (95% confidence interval, 1.16 to 1.40; I=24%; 4 studies). The sensitivity analysis of new AF studies adjusting for confounding factors did not show a decrease in risk of death. Conclusions-: Atrial fibrillation is associated with increased risk of mortality in MI patients. New AF with no history of AF before MI remained associated with an increased risk of mortality even after adjustment for several important AF risk factors. These subsequent increases in mortality suggest that AF can no longer be considered a nonsevere event during MI. © 2011 American Heart Association, Inc.

Mann D.M.,Mount Sinai School of Medicine | Ponieman D.,Mount Sinai School of Medicine | Montori V.M.,Knowledge and Encounter Research Unit | Arciniega J.,Mount Sinai School of Medicine | McGinn T.,Mount Sinai School of Medicine
Patient Education and Counseling | Year: 2010

Objective: To assess the impact of a decision aid on perceived risk of heart attacks and medication adherence among urban primary care patients with diabetes. Methods: We randomly allocated 150 patients with diabetes to participate in a usual primary care visit either with or without the Statin Choice tool. Participants completed a questionnaire at baseline and telephone follow-up at 3 and 6 months. Results: Intervention patients were more likely to accurately perceive their underlying risk for a heart attack without taking a statin (OR: 1.9, CI: 1.0-3.8) and with taking a statin (OR: 1.4, CI: 0.7-2.8); a decline in risk overestimation among patients receiving the decision aid accounts for this finding. There was no difference in statin adherence at 3 or 6 months. Conclusion: A decision aid about using statins to reduce coronary risk among patients with diabetes improved risk communication, beliefs, and decisional conflict, but did not improve adherence to statins. Practice implications: Decision aid enhanced communication about the risks and benefits of statins improved patient risk perceptions but did not alter adherence among patients with diabetes. © 2009 Elsevier Ireland Ltd.

Gallacher K.,University of Glasgow | May C.R.,University of Southampton | Montori V.M.,Knowledge and Encounter Research Unit | Mair F.S.,University of Glasgow
Annals of Family Medicine | Year: 2011

PURPOSE Our goal was to assess the burden associated with treatment among patients living with chronic heart failure and to determine whether Normalization Process Theory (NPT) is a useful framework to help describe the components of treatment burden in these patients. METHODS We performed a secondary analysis of qualitative interview data, using framework analysis, informed by NPT, to determine the components of patient "work." Participants were 47 patients with chronic heart failure managed in primary care in the United Kingdom who had participated in an earlier qualitative study about living with this condition. We identified and examined data that fell outside of the coding frame to determine if important concepts or ideas were being missed by using the chosen theoretical framework. RESULTS We were able to identify and describe components of treatment burden as distinct from illness burden using the framework. Treatment burden in chronic heart failure includes the work of developing an understanding of treatments, interacting with others to organize care, attending appointments, taking medications, enacting lifestyle measures, and appraising treatments. Factors that patients reported as increasing treatment burden included too many medications and appointments, barriers to accessing services, fragmented and poorly organized care, lack of continuity, and inadequate communication between health professionals. Patient "work" that fell outside of the coding frame was exclusively emotional or spiritual in nature. CONCLUSIONS We identified core components of treatment burden as reported by patients with chronic heart failure. The findings suggest that NPT is a theoretical framework that facilitates understanding of experiences of health care work at the individual, as well as the organizational, level. Although further exploration and patient endorsement are necessary, our findings lay the foundation for a new target for treatment and quality improvement efforts toward patientcentered care.

Caples S.M.,Center for Sleep Medicine | Rowley J.A.,Harper University Hospital | Pallanch J.F.,Mayo Medical School | Elamin M.B.,Knowledge and Encounter Research Unit | Harwick J.D.,University of Florida
Sleep | Year: 2010

A substantial portion of patients with obstructive sleep apnea (OSA) seek alternatives to positive airway pressure (PAP), the usual first-line treatment for the disorder. One option is upper airway surgery. As an adjunct to the American Academy of Sleep Medicine (AASM) Standards of Practice paper, we conducted a systematic review and meta-analysis of literature reporting outcomes following various upper airway surgeries for the treatment of OSA in adults, including maxillomandibular advancement (MMA), pharyngeal surgeries such as uvulopharyngopalatoplasty (UPPP), laser assisted uvulopalatoplasty (LAUP), and radiofrequency ablation (RFA), as well as multi-level and multi-phased procedures. We found that the published literature is comprised primarily of case series, with few controlled trials and varying approaches to pre-operative evaluation and post-operative follow-up. We include surgical morbidity and adverse events where reported but these were not systematically analyzed. Utilizing the ratio of means method, we used the change in the apnea-hypopnea index (AHI) as the primary measure of efficacy. Substantial and consistent reductions in the AHI were observed following MMA; adverse events were uncommonly reported. Outcomes following pharyngeal surgeries were less consistent; adverse events were reported more commonly. Papers describing positive outcomes associated with newer pharyngeal techniques and multi-level procedures performed in small samples of patients appear promising. Further research is needed to better clarify patient selection, as well as efficacy and safety of upper airway surgery in those with OSA.

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