Atrial fibrillation (AF) affects about 2% of the population, with the increasing prevalence with age. It is associated with poorer quality of life, effort intolerance, frequent hospitalizations, ...heart failure, and increased risk of systemic embolization, stroke, and mortality. Warfarin has been the only choice of chronic anticoagulant therapy for over 50 years. Its disadvantages are reflected by interaction with various foods, drugs, and alcohol, while its action is highly dependent on liver function, age, and genetic background. Administration of direct oral anticoagulants (DOACs) to patients with AF and acceptable bleeding risk reduces the risk of systemic thromboembolic complications and stroke; these drugs are superior or at least as effective as warfarin. Their use is safer than warfarin in terms of reduced risk of major bleeding. This is a group of drugs with wide clinical use, except in patients with severely impaired renal and hepatic function. Proper use is a guarantee of the safety of DOACs, which in the future will be even more pronounced with the advent of new antidotes, such as Praxbind.
The appearance of MI is more frequent during winter 1-6,14,20 . Because of acclimatization, people in cold regions (Finland) may not experience more winter excess mortality than those in mild regions ...(London) 21,22 . ...we would like to emphasize the need for decreasing the upper lawful limits of air pollutants as it increases the number of patients with MI.
...eGFR is a powerful predictor of outcome in patients with acute myocardial infarction (MI) and is more useful for this purpose than serum creatinine 3 .
Antibiotic prophylaxis (AP) of infective endocarditis (IE) in dental practice is a controversial topic. We evaluated the characteristics of the odontogenic IE and assessed the practice and sources of ...information pertaining to the topic utilized by the Croatian dentists. We conducted a retrospective review of consecutive medical charts of adult patients with IE, admitted to the University Hospital for Infectious Diseases in Zagreb, Croatia, between January 2007 and December 2017. In addition, a cross-sectional, self-reporting questionnaire survey was conducted with participation of 348 Croatian dentists. Of the 811 admissions for suspected IE (40.3% of all Croatian and 92.1% of all Zagreb hospitals), 386 patients were confirmed as definite IE: 68 with odontogenic IE and 318 with IE of other origin. Their first hospital admissions were analyzed. Definite odontogenic IE was defined as a positive echocardiographic result in conjunction with two separate positive blood cultures showing exclusive oral cavity pathogen or
Streptococcus viridans
associated with current or recent (< 1 month) dental, periodontal, or oral cavity infection. The annual number of new odontogenic IE patients appeared constant over time. In 91.2% of the cases, odontogenic IE was not preceded by a dental procedure; poor oral health was found in 51.5% of patients, and 47.1% had no cardiac condition that increases the IE risk. In-hospital mortality was 5.1% with conservative treatment and 4.5% with cardiac surgery and was much lower for odontogenic IE than in non-odontogenic IE (14.6% and 34.4%, respectively). An increasing number of admissions for non-odontogenic IE were observed in parallel with an increasing number of staphylococcal IE. Surveyed dentists (500 invited, 69.6% responded) were aware of the AP recommendations, but were largely reluctant to treat patients at risk. In people with poor oral health, AP should be considered regardless of cardiac risk factors. Improvement of oral health should be the cornerstone of odontogenic IE prevention.
Obesity is an important risk factor for the development of dyslipidemia, diabetes mellitus, hypertension, coronary artery disease, ventricular dysfunction, congestive heart failure (HF), stroke, and ...cardiac arrhythmias.
This meta-analysis brings comprehensive evaluation about still controversial association between the body mass index (BMI) and the outcomes of acute coronary syndrome.
PubMed/ScienceDirect databases were systematically searched for studies with baseline parameters, primary (HF, cardiogenic shock, cardiac arrest, reinfarction, stroke, death, total in-hospital complications) and secondary outcomes (reinfarction, stroke, death, total major adverse cardiovascular events MACE) in relation to BMI strictly classified into four groups (underweight <18.5 kg/m2, normal weight 18.5-24.9 kg/m2, overweight 25.0-29.9 kg/m2, and obese ≥30.0 kg/m2, grouped into mildly obese 30.0-34.9 kg/m2 and severely obese ≥35.0 kg/m2).
We included 24 studies, with 585,919 participants (55.5% males), aged 66.8 years. Underweight was negatively associated with hypertension, hyperlipidemia and diabetes, and positively with primary outcomes {HF (odds ratio OR = 1.37, confidence interval CI 1.15-1.63), cardiogenic shock (OR = 1.43, CI 1.04-1.98), stroke (OR = 1.21, CI 1.05-1.40), overall death (OR = 1.64, CI 1.20-2.26), total in-hospital complications (OR = 1.39, CI 1.24-1.56)} and secondary outcomes during 34-month follow-up {cardiovascular/overall death (OR = 3.78, CI 1.69-8.49/OR = 2.82, CI 2.29-3.49), respectively, total MACE (OR = 2.77, CI 2.30-3.34)} (for all p < 0.05). Obesity had positive association with hypertension, hyperlipidemia, diabetes and smoking, and negative with primary outcomes {reinfarction (OR = 0.83, CI 0.76-0.91), stroke (OR = 0.67, CI 0.54-0.85), overall death (OR = 0.55, CI 0.49-0.63), total in-hospital complications (OR = 0.81, CI 0.70-0.93)} and secondary outcomes {cardiovascular/overall death (OR = 0.77, CI 0.66-0.88/OR = 0.62, CI 0.53-0.72), respectively, total MACE (OR = 0.63, CI 0.60-0.77)} (for all p < 0.05). This negative association with several primary outcomes (cardiogenic shock, overall death, total in-hospital complications) and secondary outcomes (cardiovascular/overall death, total MACE) was more pronounced in mild obesity (p < 0.05). These results give an "obesity paradox" with a bimodal pattern (slightly U-shaped).
Obesity is positively associated with traditional cardiovascular risk factors and negatively with primary and secondary outcomes, which confirms the persistence of overall "obesity paradox."
Sedentary lifestyle and obesity increase the risk of coronary disease (CAD). The aims of this prospective study were to estimate the trends in physical activity (PA) level, accuracy of the ...Baecke’s/LRC-PA questionnaires, and trends in obesity parameters (body mass index-BMI/waist-to-hip ratio-WHR) in patients with acute coronary syndrome (ACS) in the last two decades. We grouped 209 patients with ACS (UAP-unstable angina, STEMI-ST-elevation myocardial infarction, NSTEMI-non STEMI) by year of admission (Group 2002-05/Group 2017) and compared them by the levels of PA (Baecke’s/LRC-PA questionnaires) and obesity parameters (BMI, WHR). Group 2017 had higher WHR (1.02 vs. 0.97) and leisure PA index (LI) (3.00 vs. 2.50), as well as less high and very low activity patients (P<0.05). Patients with UAP/STEMI had higher WHR in 2017 (1.02 vs. 0.96, 1.02 vs. 0.99, respectively) (P<0.05) and had lower LI in 2002-05 (2.50 vs. 3.25, 2.75 vs. 3.50, respectively) (P<0.05). In conclusion, leisure PA and WHR was increased in the study period both in patients with ACS and in the general population. We emphasize the usage of more precise methods for evaluation of PA and obesity (Baecke’s/Four-point LRC-PA questionnaires, WHR), and that only increased PA with dietary changes leads to reduction of central obesity and risk of ACS.
Objective. Acute pulmonary embolism is a life-threatening form of venous thromboembolism often causing stress hyperglycaemia. The aim of this study was to determine the prognostic value of stress ...hyperglycaemia in acute pulmonary embolism, providing new insights into the presumed embolus size and localization, clinical parameters (Pulmonary Embolism Severity Index, PESI), and in-hospital mortality. Design and Methods. Among a total of 95,454 patients referred to the Emergency Department of the Sestre Milosrdnice University Hospital Centre between 2014 and 2016, all patients with acute pulmonary embolism were included into this observational cohort study. The study group consisted of 190 patients aged 25–96. Relevant patient history, clinical data, and laboratory findings were collected during the entire hospitalization period. Data were analyzed for the entire group of patients, as well as separately for patients without diabetes, using the Fisher exact test and logistic regression. Results. Analysis of embolus localization as an indirect parameter of embolus size showed that patients with stress hyperglycaemia more often had emboli located in proximal parts of the pulmonary circulation (i.e., main artery or lobar branches) (p<0.05). Furthermore, stress hyperglycaemia correlated with PESI score and diabetes (p<0.05) in the entire patient group. Stress hyperglycaemia showed independent association with in-hospital mortality in patients (p<0.05). Conclusion. Stress hyperglycaemia in patients with acute pulmonary embolism is associated with embolus localization in larger arteries of the pulmonary circulation and higher PESI score and therefore could serve as an independent in-hospital mortality predictor.
Chronic obstructive pulmonary disease (COPD) and heart failure (HF) both are global epidemics with substantial burden on morbidity and mortality. They present major challenges to healthcare providers ...and often coexsist. Multiple interactions exist between these conditions. COPD is often responsible for delayed diagnosis of HF and vice versa, since both conditions have similar symptoms such as dyspnea and poor exercise tolerance based on the skeletal myopathic response rather than the primary organ failure. Patients with COPD also have an increased risk of developing HF and higher hospitalization and death rates compared with HF patients without COPD. Echocardiography and pulmonary function tests along with natriuretic peptides should be performed and carefully interpreted. Diagnostic assessment of both conditions present in the same patient is often difficult, but therapeutic approach is also often non-adherent to current guidelines. For example, patients with coexisting COPD and HF receive beta-blockers at disappointingly low rates below 20%. Closer collaboration between cardiologists and pulmonologists is required for better identification and management of concurrent COPD and HF.
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