The Canadian journal of cardiology
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Reporting of ischemic heart disease (IHD) prevalence in Canada has been based on self-report or patients presenting to hospital. However, IHD often presents and can be managed in the outpatient setting. ⋯ A combination of physician billing and hospital discharge abstracts can be used to identify patients with IHD. Population prevalence of IHD can be measured using administrative data.
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Multicenter Study Comparative Study
Evaluating the views of paramedics, cardiologists, emergency department physicians and nurses on advanced prehospital management of acute ST elevation myocardial infarction.
Although advanced prehospital management (PHM) in ST elevation myocardial infarction (STEMI) reduces reperfusion delay and improves patient outcomes, its use in North America remains uncommon. Understanding perceived barriers to and facilitators of PHM implementation may support the expansion of programs, with associated patient benefit. ⋯ Focus group discussions provided key insights into potential barriers to and facilitators of PHM in STEMI. Although all groups were supportive of the concept and its benefits, concerns were expressed and potential barriers identified. This novel body of knowledge will help elucidate future educational programs and protocol development, and identify future challenges to ensure successful PHM of STEMI, thereby reducing reperfusion delay and improving patient outcomes.
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Multicenter Study
The use of amiodarone for in-hospital cardiac arrest at two tertiary care centres.
Although amiodarone significantly increases survival to hospital admission when used in resuscitation of out-of-hospital pulseless ventricular tachycardia and fibrillation, there are limited data on its utility for in-hospital arrests. ⋯ Following two years' experience with the introduction of intravenous amiodarone for resuscitation in the institutions, use was less than 50% and no clinically observable survival benefit could be documented. Possible explanations for the difference between this experience and that found in out-of-hospital resuscitation trials include differing patient populations and operator bias during resuscitation. These results should provoke other institutions to question whether amiodarone has improved survival of cardiac arrest under the conditions prevailing in their hospitals. A patient registry or prospective, randomized trial will be required to assess what parameters affect the success of intravenous amiodarone for resuscitation in-hospital.
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Multicenter Study Comparative Study
Impact of guidelines on health care use for the management of dyslipidemia in two Canadian provinces, Alberta and Nova Scotia, from 1990 to 2001.
Guidelines for the treatment of hyperlipidemia aim at improving the management of people at a higher risk of developing cardiovascular disease. ⋯ Despite some limitations, these data show a discrepancy between guideline development and practice, leaving a high number of at-risk individuals undiagnosed and untreated. Mechanisms need to be put in place to ensure better classification and follow-up of people with hyperlipidemia at risk for cardiovascular disease.
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Multicenter Study Comparative Study
Characterization of ventricular tachycardias based on time and frequency domain analyses of cycle length variability in patients with implantable cardioverter defibrillator.
To discriminate between monomorphic (MVT) and polymorphic (PVT) ventricular tachycardias in humans using cycle length variability (CLV), and to characterize the onset of MVT and PVT using power spectral analysis of the CLV during sinus rhythm and the number of ventricular extrasystoles before onset of arrhythmia. ⋯ Discrimination between MVT and PVT episodes was possible based on CLV analysis. The onset of PVT was characterized by a greater number of preceding extrasystoles compared with the control. During sinus rhythm, the NHF spectral power activity decreased at the onset of both types of arrhythmic episodes compared with control, although statistical significance was marginal.