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Valente A.M.,Harvard University | Landzberg M.J.,Harvard University | Gianola A.,Adult Congenital Heart Association | Harmon A.J.,Harvard University | And 14 more authors.
International Journal of Cardiology | Year: 2013

Objective The objective of this prospective multi-center study was to evaluate heart disease knowledge within the adult congenital heart disease (ACHD) population, pilot an educational intervention and assess interest in research participation among new patients at ACHD clinics. Background Many adults with congenital heart disease lack knowledge about their heart condition that may contribute to undesirable outcomes. Methods Patients ≥ 18 years of age were recruited upon their first presentation to an ACHD clinic and underwent an educational intervention consisting of creation of a personal health information 'passport' and an introduction to web-based resources. Subjects were asked to complete initial and follow-up surveys documenting their perceived knowledge. Results Nine hundred twenty-two subjects were recruited from 12 ACHD centers, and 520 (57%) completed follow-up surveys. Patients who completed the follow-up survey were more likely to be women, have more education, and have mild heart disease. At follow-up, the ability of the subjects to name their heart condition improved (78% to 83%, p = 0.002). Improvements were seen in mean Likert items regarding perceived knowledge of appropriate exercise (p < 0.0001), symptoms of heart rhythm problems or endocarditis (p < 0.0001), reasons for cardiac tests (p < 0.007), and birth control options and pregnancy safety (p < 0.0001). On follow-up, subjects reported a better understanding of medical research (p < 0.01), and higher interest in research participation (p < 0.003). Conclusion This joint clinician-patient pilot program will help inform future efforts toward patient education and participation in research with a focus on standardization of protocols for life-long longitudinal follow-up and continued multi-center collaboration in the ACHD population. © 2013 Elsevier Ireland Ltd.

Bentz B.A.,Penn State Hershey Heart and Vascular Institute
Journal of the American Association of Nurse Practitioners | Year: 2015

Purpose: In recent years, four nonvitamin K antagonist oral anticoagulants (NOACs) were approved to prevent stroke in patients with nonvalvular atrial fibrillation (AF) and to treat venous thromboembolism (VTE). Edoxaban, a direct factor Xa inhibitor, is the latest NOAC to be approved for use by the U.S. Food and Drug Administration. The other NOACs include two direct factor Xa inhibitors, apixaban and rivaroxaban, and one direct thrombin inhibitor, dabigatran. The purpose of this article is to introduce these agents to providers, discuss dosing, and offer insights into practical considerations for each NOAC. Data sources: PubMed was searched to identify randomized controlled trials and cost-effectiveness analyses evaluating NOACs. In addition, package inserts for the four NOACs provided pharmacologic data. Conclusions: All four NOACs are equivalent to or better than warfarin for the treatment of VTE and stroke prevention in AF, and may reduce the risk of bleeding complications, particularly intracranial bleeding. Implications for practice: NOACs may benefit some patients by avoiding the numerous food or drug interactions and frequent laboratory monitoring associated with warfarin. Adherence to proper dosing is critical for NOAC efficacy and safety. © 2015 American Association of Nurse Practitioners.

Griffith B.P.,University of Maryland, Baltimore | Anderson M.B.,Johnson University | Samuels L.E.,Lankenau Medical Science Hospital | Pae Jr. W.E.,Penn State Hershey Heart and Vascular Institute | And 2 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2013

Objectives: Cardiogenic shock after cardiac surgery is accompanied by a high mortality rate. Early institution of hemodynamic support with a versatile, easy to insert left ventricular assist device might help bridge patients to recovery or to the next therapy, and improve the outcomes. Methods: Patients developing cardiogenic shock or low cardiac output syndrome after being weaned off cardiopulmonary bypass were enrolled in a prospective single-arm feasibility study (RECOVER I). The primary safety endpoint was the frequency of major adverse events (death, stroke) at 30 days or discharge, whichever was longer. The primary efficacy endpoint was survival of the patient to implementation of the next therapy, which included recovery at 30 days after device removal and bridge-to-other-therapy. Results: Sixteen patients provided informed consent and were enrolled in the study. Hemodynamics improved immediately after the initiation of mechanical support: cardiac index, 1.65 versus 2.7 L/min/m 2 (P = .0001); mean arterial pressure, 71.4 versus 83.1 mm Hg (P = .01); and pulmonary artery diastolic pressure, 28.0 versus 19.8 mm Hg (P < .0001). The pump provided an average of 4.0 ± 0.6 L/min of flow for an average duration of 3.7 ± 2.9 days (range, 1.7-12.6). The primary safety endpoint occurred in 2 patients (13%; 1 stroke and 1 death). For the primary efficacy endpoint, recovery of the native heart function was obtained in 93% of the patients discharged, with bridge-to-other-therapy in 7%. Survival to 30 days, 3 months, and 1 year was 94%, 81%, and 75%, respectively. Conclusions: The use of the Impella 5.0/left direct device is safe and feasible in patients presenting with postcardiotomy cardiogenic shock. The device was rapidly inserted, enabled early support, and yielded favorable outcomes. Copyright © 2013 by The American Association for Thoracic Surgery.

Zeriouh M.,Royal Brompton and Harefield NHS Foundation Trust | Zeriouh M.,University of Cologne | Mohite P.N.,Royal Brompton and Harefield NHS Foundation Trust | Sabashnikov A.,University of Cologne | And 13 more authors.
Clinical Transplantation | Year: 2015

Objectives: Lung transplantation (LTx) remains the definitive treatment for end-stage lung failure, whereas chronic obstructive pulmonary disease (COPD) represents one of the main diagnoses leading to the indication for a transplant. We sought to assess long-term outcomes after LTx in patients diagnosed with COPD and analyze factors influencing outcome in this frequent patient cohort. Methods: Between January 2007 and November 2013, a total of 88 LTx were performed in patients with COPD in our institution. Patients with emphysema associated with alpha1-antitrypsin deficiency were excluded from this observation. The study design was a retrospective review of the prospectively collected data. A large number of pre-, intra-, and postoperative variables were analyzed including long-term survival and freedom from bronchiolitis obliterans syndrome (BOS). Furthermore, impact of different variables on survival was analyzed. Results: Preoperative donor data indicated a large proportion of marginal donors. While the overall cumulative survival after six yr was 57.4%, the results in terms of BOS-free survival in long-term follow-up were 39.7% after six yr. Patients with COPD were also associated with a low incidence (2.3%) of the need for postoperative extracorporeal life support (ECLS). Conclusions: Long-term results after LTx in patients with COPD are acceptable with excellent survival, freedom from BOS, and low use of ECLS postoperatively despite permanently increasing proportion of marginal organs used. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Goldsmit A.,Sanatorio Guemes | Kiemeneij F.,Heart Center | Gilchrist I.C.,Penn State Hershey Heart and Vascular Institute | Kantor P.,Sanatorio de la Providencia | And 6 more authors.
Catheterization and Cardiovascular Interventions | Year: 2014

Objectives To report the incidence and predictors of moderate/severe radial artery spasm (RAS) in patients undergoing cardiovascular percutaneous procedures through a transradial approach (TRA) in centers with TRA expertise. Background Data regarding the actual rate of clinically meaningful RAS are limited due to difference in study designs and operator expertise. Methods The RAS registry, an international (14 centers from Argentina, Chile, India, Indonesia, Macedonia, The Netherlands and United States of America) registry that included 1,868 patients undergoing TRA cardiovascular procedures (63.5% diagnostic and 56.5% therapeutic).All selected centers used TRA as default strategy in the cardiac catheterization laboratory. Throughout 2012, each center included all consecutive TRA cases (during a 2-month period) into a dedicated database covering clinical characteristics as well as procedural topics related to TRA patterns and RAS occurrence. Results The incidence of moderate/severe RAS was 2.7%. Only 0.7% of patients required crossover (8 to transfemoral and 5 to contralateral TRA). Patients with moderately/severe spasm were more frequently females, had a history of dyslipidemia, received more often a 7F sheath and more puncture attempts than patients without spasm. By multivariate analysis, the need for more than one attempt and the use of a 7 F sheath were independent predictors of the development of moderate/severe RAS. Conclusions The incidence of moderate/severe RAS is low in centers with a default TRA. Its development appears to be strongly related to the numbers of puncture attempts and the use of large sheaths. © 2013 Wiley Periodicals, Inc. Copyright © 2013 Wiley Periodicals, Inc.

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