The Canadian journal of cardiology
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Review
Combination Therapy for Pulmonary Arterial Hypertension: A Systematic Review and Meta-analysis.
Combination therapy (CT) for patients with pulmonary arterial hypertension (PAH) has been recommended for many years, despite weak evidence of efficacy over monotherapy (MT). A previous meta-analysis comparing CT vs MT with pulmonary vasodilators failed to demonstrate a clear reduction in clinical worsening events. ⋯ In this highly comprehensive meta-analysis, CT reduces the risk of CCW events in patients with PAH and brings physiological improvement.
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Advanced heart failure (HF) therapies are focused on extending life and improving function. In contrast, palliative care is a holistic approach that focuses on symptom alleviation and patients' physical, psychosocial, and spiritual needs. HF clinicians can integrate palliative care strategies by incorporating several important components of planning and decision-making for HF patients. ⋯ Such decisions also should include a discussion of palliative management, as an alternative to intervention and also as an option for managing symptoms or adverse events after intervention. Palliative care, including FCP and SDM, should be integrated into the course of all patients with advanced HF. Clinicians who provide HF care should acquire the skills necessary for conducting FCP and SDM discussions.
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Observational studies using propensity-score methods have been increasing in the cardiovascular literature because randomized controlled trials are not always feasible or ethical. However, propensity-score methods can be confusing, and the general audience may not fully understand the importance of this technique. The objectives of this review are to describe (1) the fundamentals of propensity score methods, (2) the techniques to assess for propensity-score model adequacy, (3) the 4 major methods for using the propensity score (matching, stratification, covariate adjustment, and inverse probability of treatment weighting [IPTW]) using examples from previously published cardiovascular studies, and (4) the strengths and weaknesses of these 4 techniques. Our review suggests that matching or IPTW using the propensity score have shown to be most effective in reducing bias of the treatment effect.
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Out-of-hospital cardiac arrest (OHCA) carries an enormous global burden of mortality and morbidity. The post-cardiac arrest syndrome consists of complex pathophysiological changes that result in hypoxic brain injury, myocardial and peripheral organ dysfunction, and the systemic ischemia-reperfusion response. ⋯ Similarly, early invasive coronary angiography is particularly beneficial when there is ST-elevation on the post-resuscitation electrocardiogram, but might be considered in the absence of ST-elevation if there is no noncardiac cause to explain the OHCA. However, there remain a large number of unanswered questions that require ongoing research.
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A cardiologist and respirologist examined the recent, neutral Prospective Randomized Placebo-Controlled Trial of Simvastatin in the Prevention of COPD Exacerbations (STATCOPE) for issues of relevance to cardiovascular risk reduction with statin medications. Although the potential benefit of the pleiotropic effects of statins on this inflammatory disease was not borne out, the effect over the longer term on total respiratory and cardiovascular morbidity and mortality remain unexplored. This study was unique as the only statin trial to date to use a national guideline (Adult Treatment Panel III) to exclude patients from the trial if at sufficient cardiovascular risk to warrant statin therapy. ⋯ The magnitude of this beneficial trend paralleled the magnitude of lowering of low-density lipoprotein cholesterol achieved in the active statin arm. Finally, the authors questioned whether the current standard of care adequately includes adherence to any national lipid guideline or adequate attention to the cardiovascular comorbidity of these patients. In conclusion, knowledge translation of the STATCOPE trial should at a minimum encourage assessment of cardiovascular risk in patients with chronic obstructive pulmonary disease, implementation of proven cardiovascular risk reduction therapies based on national guidelines, including statins, and plans to undertake a trial adequate in size and duration to address cardiovascular event reduction in patients not already eligible for evidence-based risk-reducing therapies.