Cardiovascular disease is one of the main causes of morbidity and mortality worldwide. Despite the availability of highly effective treatments, the contemporary burden of disease remains huge. ...Digital health interventions hold promise to improve further the quality and experience of cardiovascular care. This position paper provides a brief overview of currently existing digital health applications in different cardiovascular disease settings. It provides the reader with the most relevant challenges for their large-scale deployment in Europe. The potential role of different stakeholders and related challenges are identified, and the key points suggestions on how to proceed are given. This position paper was developed by the European Society of Cardiology (ESC) e-Cardiology working group, in close collaboration with the ESC Digital Health Committee, the European Association of Preventive Cardiology, the European Heart Rhythm Association, the Heart Failure Association, the European Association of Cardiovascular Imaging, the Acute Cardiovascular Care Association, the European Association of Percutaneous Cardiovascular Interventions, the Association of Cardiovascular Nursing and Allied Professions and the Council on Hypertension. It relates to the ESC's action plan and mission to play a pro-active role in all aspects of the e-health agenda in support of cardiovascular health in Europe and aims to be used as guiding document for cardiologists and other relevant stakeholders in the field of digital health.
To estimate the effectiveness and cost-effectiveness of a high-sensitivity troponin I (hsTnI) guided cardiovascular risk assessment program in women in Croatia.
An observational study of a voluntary ...program for cardiovascular disease (CVD) risk assessment in women aged above 45 years with no specific symptoms, no confirmed or known coronary artery disease was conducted (WHP). Participants were stratified into three categories according to their hsTnI level. Subjects in the moderate or high-risk class were referred to cardiac work-up and invasive cardiovascular investigation as appropriate. Study information were applied to a discrete-event simulation model to estimate the cost-effectiveness of WHP against current practice. The number of CVD events and deaths, costs, and quality-adjusted life years (QALY) were assessed over 10 years from a societal perspective.
Of 1034 women who participated in the program, 921 (89.1%), 100 (9.7%), and 13 (1.3%) subjects fall into the low, moderate, and high-risk class. Of 26 women referred for angiography, significant coronary artery disease (CAD) was diagnosed in 12 women (46.1%). WHP gained 15.8 (95%CI 12.8; 17.2) QALYs per 1000 subjects, increased costs by 490€ (95%CI 487; 500), decreased CVD-related mortality by 40%. At a willingness-to-pay threshold of 45,000 €/QALY, WHP was cost-effective with a probability of 90%. Model results were most sensitive to utility weights and cost of medical prevention.
Assessing the cardiovascular risk in asymptomatic women with hsTnI and guiding those at higher risk to further cardiac testing, identified individuals with CAD, could reduce CVD related burden, and would be cost-effective.
•Elevated high-sensitivity troponin I (hsTnI) values are associated with higher rates of incident cardiovascular (CV) events.•A hsTnI guided risk assessment program for apparently healthy women can identify CV disease and guide those at high risk towards prevention.•This strategy can help reduce CV disease related burden and mortality and is likely to be cost-effective in Croatia.
Introduction: Diseases of prevertebral spaces are uncommon but can result in significant morbidity. Case report: This is a case report of acute prevertebral abscess in a 40year-old man. After being ...transferred to our hospital the patient was initially diagnosed with lower back pain and with high-grade fever. Magnetic resonance imaging (MRI) suggested prevertebral abscess from Th11-L1. Blood test indicated a bacterial inflammation. Antibiotics were administered. The patient's condition consequently improved. He was discharged with normal neurological status and without any symptoms with a complete regression of the abscess on check-up MRI. Discussion: Magnetic resonance imaging remains the gold standard for the radiological demonstration of spine abscess. Antibiotic therapy is a pillar of treatment for spine abscess and should be a part of the treatment in all cases. Conclusion: In conclusion, our aim is to stress the importance of considering a prevertebral abscess in the differential diagnosis in patient with low back pain.
Background
Pancreatic fistula after pancreaticoduodenectomy is one of the most severe complications with mortality rates as high as 45%, and the prediction of most severe form of fistula (grade C) is ...crucial for successful management of patients who are to undergo cephalic pancreatoduodenectomy. It has been found that the amount of abdominal fat may predict grade C postoperative pancreatic fistula. In this study, we analysed the value of retrorenal fat thickness in the prediction of grade C pancreatic fistula.
Methods
A total of 140 patients who underwent pancreaticoduodenectomy were retrospectively analysed. Retrorenal fat thickness and intra‐abdominal fat, expressed as total fat area, visceral fat area and subcutaneous fat area, were determined from computed tomography slices using the known range of attenuation values (−190 to −30). Blood loss, operating time, pancreatic texture and main pancreatic duct diameter as well as body mass index were also analysed.
Results
Retrorenal fat thickness (P = 0.0004), duct diameter (P = 0.0008), subcutaneous fat area (P = 0.023) and total fat area (P = 0.014) were found to be significant predictors of grade C pancreatic fistula.
Conclusion
Although retrorenal fat tissue thickness may seem robust, it is a simple measure that can be used to predict the most severe grade of pancreatic fistula after pancreaticoduodenectomy.
Prediction of the most severe form of postoperative pancreatic fistula is crucial for successful management of patients who are to undergo cephalic pancreatoduodenectomy. Measurement of retrorenal fat tissue thickness is a simple measure that may help to predict the most severe grade of pancreatic fistula after pancreaticoduodenectomy.
Postoperative pancreatic fistula (POPF) is one of the most severe complications after cephalic pancreaticoduodenectomy, with mortality as high as 30%. Risk scores may help predict the risk of POPF. ...Multiple external validations substantially improve generalized clinical acceptability of a scoring system.
The aim of this study was to externally validate previously described fistula risk score in the prediction of clinically relevant POPF.
All patients who underwent pancreaticoduodenectomy for any indication during a 5-year period were prospectively analyzed. A total of 132 patients were analyzed.
Of the 132 patients, 44 (33.3%) developed pancreatic fistula, including 12.9% biochemical leaks, 7.6% grade B fistula, and 12.9% grade C fistula. Cut-off point of 4.5 was determined to best separate patients who developed clinically relevant POPF with area under curve of 78% (p = .00003). Sensitivity and specificity for the prediction of clinically relevant POPF with the cut-off value of 4.5 was 70.4 and 74.3%, respectively. Positive predictive value with cut-off value 4.5 was 57.8%, and negative predictive value was 83.4%.
Fistula risk score identified low risk patients with false negative rate of 16.6%. Further external validation studies on large cohorts of patients and with wide case-mix may enable additional refinements of the score model.
Heart rate variability (HRV) gives information on the sympathetic-parasympathetic autonomic balance. The aim of the study was to analyze sympathovagal balance after acute spinal cord injury (SCI), ...demonstrated by linear measures in time and frequency domain of HRV and to analyze the effect of corticosteroids on HRV parameters in SCI. The study included 40 tetraplegic patients with acute SCI and 40 healthy subjects as control group. In the SCI group, 29 patients received and 11 patients did not receive corticosteroid therapy. All patients underwent 24-hour Holter monitoring for evaluation of HRV. Cardiac autonomic balance was evaluated by analysis of HRV in time and frequency domain. Sympathovagal balance (LF/HF) was significantly reduced in the groups of acute SCI patients, both with and without corticosteroid therapy, as compared with controls. However, there was no statistically significant difference between the two SCI groups (1.74 (0524) with and 1.75 (0534) without corticosteroid therapy). This study showed the sympathovagal balance to be altered in the acute phase of cervical spinal cord trauma. Finally, there was no effect of corticosteroid therapy on HRV parameters in SCI patients.
The following laboratory tests were normal; full blood count, haemoglobin, erythrocyte sedimentation rat (ESR), serology, serum electrolytes and blood urea, serum calcium, phosphorous and alkaline ...phosphatase blood glucose, liver and renal function tests, thyroxine hormone T4, an auto-antibody screen was negative and the following investigations were normal like chest radiograph and electrocardiogram (ECG). Hyperlipoproteinemia has been previously verified; cholesterol - CHOLwas 7,2 mmol/L and low density cholesterol- LDL was 5,2 mmol/L and significant creatine kinase (CK) elevation is observed on prescribed statins. Control cholesterol (CHOL) was 6,5 mmol/L and LDL was 4,3 mmol/L.
Sexual Activity in Patients with Cardiac Diseases Jelavic, Marko Mornar; Krstacic, Goran; Perencevic, Aleksandra ...
Acta clinica Croatica (Tisak),
03/2018, Letnik:
57, Številka:
1
Journal Article
Recenzirano
Odprti dostop
In this article, we outline the latest guidelines published by the American Heart Association on sexual activity in patients with coronary artery disease, heart failure, structural heart diseases, ...arrhythmias, implanted pacemakers or cardioverter defibrillators, as well as on treatment options of sexual dysfunction. Sexual activities are similar to mild/moderate physical activity during a short period. Most patients are recommended to involve in sexual activity after prior comprehensive evaluation of physical condition. Those with stable cardiac symptoms and good functional capacity are at a low risk of adverse cardiovascular events, and others require treatment or stabilization before involving in sexual activity. Stress testing is useful in evaluating safety of sexual activity in patients with questionable or undetermined risk. Treatment of sexual dysfunction includes counseling of patients and their sexual partners, and drug treatment with phosphodiesterase inhibitors (sildenafil, tadalafil, vardenafil) which have been demonstrated to be safe and effective, in men, and with serotonin reuptake inhibitors (flibanserin) and local vaginal estrogen administration in women. In conclusion, in routine clinical practice, patients should be approached individually and multidisciplinarily in order to detect and eliminate the factors that interfere with normal sexual activities and disturb the quality of life.
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