bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adherence to Antihypertensive Medication in Treatment‐Resistant Hypertension Undergoing Renal Denervation
Authors: Schmieder Roland E. , Ott Christian , Schmid Axel , Friedrich Stefanie , Kistner Iris , Ditting Tilmann , Veelken Roland , Uder Michael , Toennes Stefan W. 
Published: September 2018

Background

Adherence to medication has been repeatedly proposed to represent a major cause of treatment‐resistant hypertension (
TRH
); however, treatment decisions such as treating
TRH
with renal denervation depend on accurate judgment of adherence. We carefully analyzed adherence rates to medication before and after renal denervation and its effect on blood pressure (
BP
) control.

Methods and Results

Eighty patients with
TRH
were included in 2 prospective observational studies that assessed the difference of potential antihypertensive and nephroprotective effects of renal denervation. To compare prescribed with actual medication intake (representing a measure of adherence), we analyzed urine samples collected at baseline and at 6 months after renal denervation for antihypertensive compounds or metabolites (by liquid chromatography–mass spectrometry). In addition to office
BP
, 24‐hour ambulatory
BP
and central hemodynamics (central systolic pressure, central pulse pressure) were assessed. Informed consent for analyses of urine metabolites was obtained from 79 of 80 patients. Actual intake of all antihypertensive drugs was detected at baseline and at 6 months after renal denervation in 44 (56%) and 52 (66%) patients, respectively; 1 drug was missing in 22 (28%) and 17 (22%) patients, respectively, and ≥2 drugs were missing in 13 (16%) and 10 (13%) patients, respectively. At baseline, 24‐hour ambulatory BP (
P
=0.049) and central systolic
BP
(
P
=0.012) were higher in nonadherent patients. Adherence did not significantly change overall (McNemar‐Bowker test,
P
=0.362). An increase in adherence was observed in 21 patients, and a decrease was observed in 11 patients. The decrease in 24‐hour ambulatory
BP
was not different in those with stable adherence 6 months after renal denervation (n=41, −7±13 mm Hg) compared with those with increased adherence (n=21, −10±13 mm Hg) and decreased adherence (n=11, −7±14 mm Hg) (
P
>0.20). Our study is limited by the relatively small sample size and potentially by the specific health environment of our university center (Northern Bavaria, Germany).

Conclusions

Nonadherence to medication among patients with
TRH
was relatively low: ≈1 of 6 patients with
TRH
did not take ≥2 of the prescribed drugs. Adherence pattern did not change significantly after renal denervation and had no impact on the overall observed
BP
changes, supporting the concept that renal denervation is an effective treatment in patients with
TRH
.

Clinical Trial Registration

URL
:
https://www.clinicaltrials.gov
. Unique identifiers:
NCT
00888433,
NCT
01442883 and
NCT
01687725.
Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol
Authors: Garcia Santiago , Drexel Todd , Bekwelem Wobo , Raveendran Ganesh , Caldwell Emily , Hodgson Lucinda , Wang Qi , Adabag Selcuk , Mahoney Brian , Frascone Ralph , Helmer Gregory , Lick Charles , Conterato Marc , Baran Kenneth , Bart Bradley , Bachour Fouad , Roh Steven , Panetta Carmelo , Stark Randall , Haugland Mark , Mooney Michael , Wesley Keith , Yannopoulos Demetris 
Published: September 2018

Background
In 2013 the Minnesota Resuscitation Consortium developed an organized approach for the management of patients resuscitated from shockable rhythms to gain early access to the cardiac catheterization laboratory (CCL) in the metro area of Minneapolis‐St. Paul.

Methods and Results

Eleven hospitals with 24/7 percutaneous coronary intervention capabilities agreed to provide early (within 6 hours of arrival at the Emergency Department) access to the CCL with the intention to perform coronary revascularization for outpatients who were successfully resuscitated from ventricular fibrillation/ventricular tachycardia arrest. Other inclusion criteria were age >18 and <76 and presumed cardiac etiology. Patients with other rhythms, known do not resuscitate/do not intubate, noncardiac etiology, significant bleeding, and terminal disease were excluded. The primary outcome was survival to hospital discharge with favorable neurological outcome. Patients (315 out of 331) who were resuscitated from VT/VF and transferred alive to the Emergency Department had complete medical records. Of those, 231 (73.3%) were taken to the CCL per the Minnesota Resuscitation Consortium protocol while 84 (26.6%) were not taken to the CCL (protocol deviations). Overall, 197 (63%) patients survived to hospital discharge with good neurological outcome (cerebral performance category of 1 or 2). Of the patients who followed the Minnesota Resuscitation Consortium protocol, 121 (52%) underwent percutaneous coronary intervention, and 15 (7%) underwent coronary artery bypass graft. In this group, 151 (65%) survived with good neurological outcome, whereas in the group that did not follow the Minnesota Resuscitation Consortium protocol, 46 (55%) survived with good neurological outcome (adjusted odds ratio: 1.99; [1.07–3.72],
P
=0.03).

Conclusions
Early access to the CCL after cardiac arrest due to a shockable rhythm in a selected group of patients is feasible in a large metropolitan area in the United States and is associated with a 65% survival rate to hospital discharge with a good neurological outcome.
Primary Prevention Implantable Cardioverter Defibrillator (ICD) Therapy in Women—Data From a Multicenter French Registry
Authors: Providência Rui , Marijon Eloi , Lambiase Pier D. , Bouzeman Abdeslam , Defaye Pascal , Klug Didier , Amet Denis , Perier Marie‐Cécile , Gras Daniel , Algalarrondo Vincent , Deharo Jean‐Claude , Leclercq Christophe , Fauchier Laurent , Babuty Dominique , Bordachar Pierre , Sadoul Nicolas , Piot Olivier , Boveda Serge , Providencia Rui , Beganton Frankie , Perier Marie‐Cecile 
Published: September 2018

Background
There are limited data describing sex specificities regarding implantable cardioverter defibrillators (ICDs) in the real‐world European setting.

Methods and Results

Using a large multicenter cohort of consecutive patients referred for ICD implantation for primary prevention (2002–2012), in ischemic and nonischemic cardiomyopathy, we examined the sex differences in subjects' characteristics and outcomes. Of 5539 patients, only 837 (15.1%) were women and 53.8% received cardiac resynchronization therapy. Compared to men, women presented a significantly higher proportion of nonischemic cardiomyopathy (60.2% versus 36.2%,
P
<0.001), wider QRS complex width (QRS >120 ms: 74.6% versus 68.5%,
P
=0.003), higher New York Heart Association functional class (≥III in 54.2%♀ versus 47.8%♂,
P
=0.014), and lower prevalence of atrial fibrillation (18.7% versus 24.9%,
P
<0.001). During a 16 786 patient‐years follow‐up, overall, fewer appropriate therapies were observed in women (hazard ratio=0.59, 95% CI 0.45–0.76;
P
<0.001). By contrast, no sex‐specific interaction was observed for inappropriate shocks (odds ratio ♀=0.84, 95% CI 0.50–1.39,
P
=0.492), early complications (odds ratio=1.00, 95% CI 0.75–1.32,
P
=0.992), and all‐cause mortality (hazard ratio=0.87 95% CI 0.66–1.15,
P
=0.324). Analysis of sex‐by‐ cardiac resynchronization therapy interaction shows than female cardiac resynchronization therapy recipients experienced fewer appropriate therapies than men (hazard ratio=0.62, 95% CI 0.50–0.77;
P
<0.001) and lower mortality (hazard ratio=0.68, 95% CI 0.47–0.97;
P
=0.034).

Conclusions
In our real‐life registry, women account for the minority of ICD recipients and presented with a different clinical profile. Whereas female cardiac resynchronization therapy recipients had a lower incidence of appropriate ICD therapies and all‐cause death than their male counterparts, the observed rates of inappropriate shocks and early complications in all ICD recipients were comparable.

Clinical Trial Registration

URL:
https://www.clinicaltrials.gov/
. Unique identifier: NCT01992458.
Chronic Kidney Disease and Health Status Outcomes Following Acute Myocardial Infarction
Authors: Navarro Mark A. , Gosch Kensey L. , Spertus John A. , Rumsfeld John S. , Ho P. Michael 
Published: September 2018

Background

The association between chronic kidney disease (
CKD
) and health status outcomes after acute myocardial infarction (
AMI
) is unknown.

Methods and Results

Patients were enrolled between 2005 and 2008 in the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) registry, a prospective multicenter observational study of
AMI
outcomes. The Seattle Angina Questionnaire and Short Form‐12 were collected at baseline and at 1, 6, and 12 months following
AMI
.
CKD
was defined by an estimated glomerular filtration rate <60 mL/min, calculated during the
AMI
hospitalization. Linear repeated‐measures models assessed the association between
CKD
and health status after
AMI
, accounting for the propensity to have follow‐up heath status measures. Of 3617 patients, 576 (16%) had
CKD
and 3041 (84%) did not have
CKD
. Patients with
CKD
were older and had more comorbidity. Patients with
CKD
were more likely to have multivessel coronary disease and less likely to undergo revascularization. Among
AMI
survivors, patients with and without
CKD
had similar health‐related quality of life (adjusted difference of 0.24, 95%
CI
−1.46 to 1.95), angina frequency (adjusted difference of 1.27, 95%
CI
−0.05 to 2.58), and mental health (adjusted difference of −0.07, 95%
CI
−0.90 to 0.75). In contrast, patients with
CKD
had lower physical health (adjusted difference −1.61, 95%
CI
−2.49 to −0.74), which was not clinically significant, compared with patients without
CKD
.

Conclusions

Among
AMI
survivors, patients with
CKD
not only had more comorbidities but also, after adjusting for these patient differences, had similar health status compared with patients without
CKD
. Interventions aimed at improving health status after
AMI
should not focus on
CKD
status.
ABCA1‐Mediated Cholesterol Efflux Capacity to Cerebrospinal Fluid Is Reduced in Patients With Mild Cognitive Impairment and Alzheimer's Disease
Authors: Yassine Hussein N. , Feng Qingru , Chiang Jiarong , Petrosspour Larissa M. , Fonteh Alfred N. , Chui Helena C. , Harrington Michael G. 
Published: September 2018

Background
Animal and human studies indicate that ABCA1‐mediated cholesterol transport is important in Alzheimer's disease (AD). We hypothesized that the efficiency of cerebrospinal fluid (CSF) to facilitate ABCA1‐mediated cholesterol efflux would be reduced in participants with mild cognitive impairment (MCI) or AD compared with cognitively healthy participants.

Methods and Results

CSF was collected from a cross‐sectional study of cognitively healthy participants (n=47) and participants with MCI (n=35) or probable AD (n=26).The capacity of CSF to mediate cholesterol transport was assessed using a BHK cell line that can be induced to express the ABCA1 transporter. ABCA1‐mediated cholesterol efflux capacity was 30% less in participants with MCI or AD compared with cognitively healthy participants (
P
<0.001 for both). Cholesterol efflux capacity correlated with CSF cholesterol content (
r
=0.37,
P
<0.001). CSF phosphatidylcholine decreased in participants with MCI and AD compared with cognitively healthy participants (9% less in MCI and 27% less in AD compared with cognitively healthy participants,
P
=0.01) and correlated with CSF efflux capacity (
r
=0.3,
P
=0.001). CSF sphingomyelin also correlated with the efflux capacity (
r
=0.24,
P
=0.02). Concentrations of CSF apoA‐I and apoE did not significantly correlate with measures of efflux capacity.

Conclusions
In people with MCI and AD, the capacity of CSF to facilitate ABCA1‐mediated cholesterol efflux is impaired. This lesser cholesterol efflux in MCI supports a pathophysiological role for ABCA1‐mediated cholesterol transport in early neurodegeneration.
Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics
Authors: Korcarz Claudia E. , Benca Ruth , Barnet Jodi H. , Stein James H. 
Published: September 2018

Background

The cardiovascular effects of positive airway pressure (
PAP
) therapy in obstructive sleep apnea (
OSA
) patients are not clear because of confounding by comorbid conditions.

Methods and Results

Prospective interventional study of
PAP
therapy and withdrawal. Apnea Hypopnea Index (
AHI
; events/hour of sleep) was determined from polysomnography. Central aortic blood pressures (
BPs
), Aortic Augmentation Index (
AAI
x), and central (
PWV
c‐f
) and peripheral pulse wave (
PWV
c‐r
) velocities were determined by applanation tonometry. Echocardiography and brachial artery reactivity testing were performed at baseline, after 4 and 12 weeks of
PAP
therapy, and 1 week after
PAP
withdrawal. The 84 participants were mean (SD) 41.1 (7.6) years old and had 39.8 (24.5)
AHI
events/hour. After 4 weeks post‐
PAP
initiation and sustained after 12 weeks, subjects experienced decreases in central systolic
BP
(
P
=0.008), diastolic
BP
, mean
BP
,
AAI
x, and
PWV
c‐r
, and brachial artery dilation (all
P
<0.001), as well as improvements in left ventricular diastolic function and systemic and pulmonary vascular resistance. In adjusted models,
PAP
use (hours/night) predicted reductions in diastolic
BP
(β=−0.65 [SE, 0.32] mm Hg/hour;
P
=0.045),
AAI
x (β=−0.53 [0.27] %/hour;
P
=0.049) and
PWV
c‐r
(β=−0.13 [0.05] m·s
−1
/hour;
P
=0.007), and improved brachial artery flow‐mediated dilation (β=0.31 [0.14] %/hour use;
P
=0.015). After 1 week of
PAP
withdrawal, brachial diameter, diastolic
BP
, mean
BP
,
AAI
x, and heart rate increased (
P
≤0.05).

Conclusions

PAP
therapy reduces arterial tone and improves endothelial and diastolic function in young to middle‐aged adults. This positive effect is observed after 4 weeks and depends on hours of use, but reverts quickly with
PAP
withdrawal.

Clinical Trial Registration

URL:
https://clinicaltrials.gov/
. Unique identifier:
NCT
01317329.
Cost‐Effectiveness of Ivabradine for Heart Failure in the United States
Authors: Kansal Anuraag R. , Cowie Martin R. , Kielhorn Adrian , Krotneva Stanimira , Tafazzoli Ali , Zheng Ying , Yurgin Nicole 
Published: September 2018

Background
Ivabradine is a heart rate–lowering agent approved to reduce the risk of hospitalization for worsening heart failure. This study assessed the cost‐effectiveness of adding ivabradine to background therapy in the United States from the perspective of a commercial or Medicare Advantage payer.

Methods and Results

A cost‐effectiveness, cohort‐based Markov model using a state transition approach tracked a cohort of heart failure patients with heart rate ≥70 beats per minute in sinus rhythm who were treated with ivabradine+background therapy or background therapy alone. Model inputs, including adjusted hazard ratios, rates of hospitalization and mortality, adverse events, and utility‐regression equations, were derived from a large
US
claims database and
SHIFT
(Systolic Heart failure treatment with the I
f
inhibitor ivabradine Trial). In the commercial population, ivabradine+background therapy was associated with a cost savings of $8594 versus the cost of background therapy alone over a 10‐year time horizon, primarily because of reduced hospitalization. Ivabradine was associated with an incremental benefit of 0.24 quality‐adjusted life years over a 10‐year time horizon. In the Medicare Advantage population, the incremental cost‐effectiveness ratio for ivabradine was estimated to be $24 920/quality‐adjusted life years.

Conclusions
The cost‐effectiveness model suggests that for a commercial population, the addition of ivabradine to background therapy was associated with cost savings and improved clinical outcomes. For a Medicare Advantage population, the analysis indicates that the clinical benefit of ivabradine can be achieved at a reasonable cost.
Association Between Changes in Hemoglobin Concentration and Cardiovascular Risks and All‐Cause Mortality Among Young Women
Authors: Lee Gyeongsil , Choi Seulggie , Kim Kyuwoong , Yun Jae‐Moon , Son Joung Sik , Jeong Su‐Min , Kim Sung Min , Kim Yeon‐Yong , Park Seong Yong , Koh Youngil , Hwang Seung‐sik , Park Sang Min 
Published: September 2018

Background

Anemia is considered to increase the risk of mortality in high‐risk populations, but its effect has not been examined among young populations. This study aimed to determine the effect of hemoglobin (Hb) concentration and its changes on the risk of acute myocardial infarction (
AMI
), stroke, cerebrovascular disease and all‐cause mortality among young women.

Methods and Results

We analyzed data from the Korean National Health Information Database on 808 143 women aged 20 to 39 years without any cardiocerebrovascular disease. A 1‐time Hb concentration and changes in Hb over a 2‐year period were calculated as exposures. Participants were followed for a median of 10 years to determine the risk of
AMI
, stroke, cerebrovascular disease, and all‐cause mortality. There were U‐ or J‐shaped associations between Hb concentration or change in Hb and
AMI
, stroke, cerebrovascular disease, and all‐cause mortality. Increasing the Hb concentration from normal to high increased the risk for
AMI
(hazard ratio [95% confidence interval]: 1.49 [1.08‐2.04]). With regard to the risk for stroke, increasing the Hb concentration from a normal to a high range increased the risk (hazard ratio [95% confidence interval]: 1.10 [1.02‐1.35]), and decreasing the Hb concentration from a high to a normal range decreased this risk (hazard ratio [95% confidence interval]: 0.80 [0.60‐0.97]). Improving anemia to the normal Hb range decreased all‐cause mortality (hazard ratio [95% confidence interval]: 0.81 [0.69‐0.94]); however, overcorrection of Hb concentration (Hb≥14.0 g/dL) was not significant.

Conclusions

These findings suggest that regular Hb analysis may assist in identifying young women who are at risk of
AMI
, stroke, cerebrovascular disease, and all‐cause mortality.
Differential Effects of Levosimendan and Dobutamine on Glomerular Filtration Rate in Patients With Heart Failure and Renal Impairment:A Randomized Double‐Blind Controlled Trial
Authors: Lannemyr Lukas , Ricksten Sven‐Erik , Rundqvist Bengt , Andersson Bert , Bartfay Sven‐Erik , Ljungman Charlotta , Dahlberg Pia , Bergh Niklas , Hjalmarsson Clara , Gilljam Thomas , Bollano Entela , Karason Kristjan 
Published: September 2018

Background
The management of the cardiorenal syndrome in advanced heart failure is challenging, and the role of inotropic drugs has not been fully defined. Our aim was to compare the renal effects of levosimendan versus dobutamine in patients with heart failure and renal impairment.

Methods and Results

In a randomized double‐blind study, we assigned patients with chronic heart failure (left ventricular ejection fraction <40%) and impaired renal function (glomerular filtration rate <80 mL/min per 1.73 m
2
) to receive either levosimendan (loading dose 12 μg/kg+0.1 μg/kg per minute) or dobutamine (7.5 μg/kg per minute) for 75 minutes. A pulmonary artery catheter was used for measurements of systemic hemodynamics, and a renal vein catheter was used to measure renal plasma flow by the infusion clearance technique for PAH (para‐aminohippurate) corrected by renal extraction of
PAH
. Filtration fraction was measured by renal extraction of chromium ethylenediamine tetraacetic acid. A total of 32 patients completed the study. Following treatment, the levosimendan and dobutamine groups displayed similar increases in renal blood flow (22% and 26%, respectively) with no significant differences between groups. Glomerular filtration rate increased by 22% in the levosimendan group but remained unchanged in the dobutamine group (
P
=0.012). Filtration fraction was not affected by levosimendan but decreased by 17% with dobutamine (
P
=0.045).

Conclusions
In patients with chronic heart failure and renal impairment, levosimendan increases glomerular filtration rate to a greater extent than dobutamine and thus may be the preferred inotropic agent for treating patients with the cardiorenal syndrome.

Clinical Trial Registration

URL:
https://www.clinicaltrials.gov
. Unique identifier:
NCT
02133105.
Associations of Obesity With Incident Hospitalization Related to Peripheral Artery Disease and Critical Limb Ischemia in the ARIC Study
Authors: Hicks Caitlin W. , Yang Chao , Ndumele Chiadi E. , Folsom Aaron R. , Heiss Gerardo , Black James H. , Selvin Elizabeth , Matsushita Kunihiro 
Published: September 2018

Background

We conducted an analysis of data from the ARIC (Atherosclerosis Risk in Communities) study to assess the independent association of obesity with peripheral artery disease (
PAD
) and critical limb ischemia (
CLI
).

Methods and Results

All black and white
ARIC
participants without prevalent
PAD
at baseline (1987–1989) were included. We used Cox proportional hazards models adjusting for potential confounders and then potential mediators to quantify the association between body mass index (
BMI
) and incident hospitalizations related to
PAD
without
CLI
and with
CLI
through 2013. Our analysis included 13 988 men and women followed for a median of 24 years. Incident
PAD
without
CLI
and
PAD
with
CLI
occurred in 373 and 201 participants, respectively. After adjusting for potential confounders, higher
BMI
at baseline was associated with increased risk of
PAD
without
CLI
when
BMI
was modeled continuously (hazard ratio per 1‐
SD
increment in BMI: 1.23; 95% confidence interval, 1.11–1.37) and with
PAD
with
CLI
regardless of whether
BMI
was modeled categorically (
P
<0.05) or continuously (hazard ratio per 1‐
SD
increment in BMI: 1.51; 95% confidence interval, 1.34–1.69). The associations of
BMI
with
PAD
without
CLI
and with
CLI
were attenuated after further accounting for potential mediators but remained significant for
PAD
with
CLI
when
BMI
was linearly modeled (hazard ratio per 1‐
SD
increment in BMI: 1.19; 95% confidence interval, 1.04–1.36). The positive association between
BMI
and
PAD
with
CLI
was stronger than the association between
BMI
and
PAD
without
CLI
for all models (
P
<0.001).

Conclusions

In the general population,
BMI
is positively associated with incident hospitalized
PAD
after adjusting for potential confounders, particularly its most severe form of
CLI
. Maintaining an optimal weight, in addition to controlling other cardiovascular risk factors, may play a role in reducing risk of
PAD
with
CLI
.