Influence of Clinical Characteristics and Shock Occurrence on ICD Patient Outcome: A Multicenter Report

Data on 1,281 patients from the Bilitch impIantabje cardioverter defibrillator (ICD) registry were reviewed to evaluate ICD patient characteristics and survival, and the impact of ICD shock occurrence on outcome. The mean ejection fraction was 34.3%; 78% had coronary disease, 471 patients had at least one shock thought to be appropriate, and 231 patients died. Causes of death included: arrhythmic (41%), nonarrhythmic cardiac (37%), and noncardiac (22%). Cumulative survival from all-cause mortality at 1, 3, and 5 years was 89%, 76%, and 64%; survival from all-cause cardiac death was 93%, 90%, and 76%; survival from arrhythmic death was 96%, 92%, and 87%. Patients who had received a shock had a trend towards a worse long-term prognosis. Shock patients also had a small increase in the prevalence of coronary disease and a somewhat lower ejection fraction than the remainder of the population.     

Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on short-term patency

Summary.  Background:  Approximately one in four patients with acute proximal deep vein thrombosis (DVT) given anticoagulation and compression therapy develop post-thrombotic syndrome (PTS). Accelerated removal of thrombus by thrombolytic agents may increase patency and prevent PTS. Objectives:  To assess short-term efficacy of additional catheter-directed thrombolysis (CDT) compared with standard treatment alone. Patients and methods:  Open, multicenter, randomized, controlled trial. Patients (18–75 years) with iliofemoral DVT and symptoms < 21 days were randomized to receive additional CDT or standard treatment alone. After 6 months, iliofemoral patency was investigated using duplex ultrasound and air-plethysmography assessed by an investigator blinded to previous treatment. Results:  One hundred and three patients (64 men, mean age 52 years) were allocated additional CDT ( n  = 50) or standard treatment alone ( n  = 53). After CDT, grade III (complete) lysis was achieved in 24 and grade II (50%–90%) lysis in 20 patients. One patient suffered major bleeding and two had clinically relevant bleeding related to the CDT procedure. After 6 months, iliofemoral patency was found in 32 (64.0%) in the CDT group vs. 19 (35.8%) controls, corresponding to an absolute risk reduction (RR) of 28.2% (95% CI: 9.7%–46.7%; P  = 0.004). Venous obstruction was found in 10 (20.0%) in the CDT group vs. 26 (49.1%) controls; absolute RR 29.1% (95% CI: 20.0%–38.0%; P  = 0.004). Femoral venous insufficiency did not differ between the two groups. Conclusions:  After 6 months, additional CDT increased iliofemoral patency from 36% to 64%. The ongoing long-term follow-up of this study will document whether patency is related to improved functional outcome.     

How frequent are invasive therapies required in patients receiving tamsulosin for benign prostatic hyperplasia? A retrospective long‐term study

Three hundred Japanese patients with benign prostatic hyperplasia (BPH) who started an alpha1-adrenoceptor blocker, tamsulosin, between 1993 and 1996 were followed for 3.0+/-3.3 years (mean+/-SD) to determine whether an association existed between the disease severities measured prior to the tamsulosin treatment and the timing at which the invasive therapy was implemented. Patients with a lower quality of life (QOL) index or maximum urinary flow rate (Qmax) were transferred for invasive therapy earlier than those with less severe BPH. The International Prostate Symptom Score (I-PSS) was also associated, but apparently to a lesser extent, with the timing of the invasive therapy. Finally, the overall severity evaluated using all of the above three indices, I-PSS, QOL index, and Qmax, in accordance with the 'Severity Criteria for BPH' issued by the Japanese Urological Association, was found to be a good measure for predicting the prognosis of patients with BPH treated with tamsulosin.     

Meeting Report: Ninth and Tenth Workshops of the European Paediatric Network for Haemophilia Management (PedNet)

This meeting report presents an overview of the discussions at the ninth and tenth workshops of the European Paediatric Network for Haemophilia Management (PedNet) that occurred in 2005 and 2006. Among numerous topics, a major theme of these workshops was the formation of inhibitors to replacement factor.     

Activated factor XII type A predicts long‐term mortality in patients admitted with chest pain1

Summary. Background: We assessed the relation between admission levels of activated factor XII type A (XIIaA), and long‐term all‐cause and cardiac mortality and recurrent troponin T (TnT) positive cardiovascular events in a consecutive cohort of 870 patients admitted with a clinically strongly suspected acute coronary syndrome (ACS). Methods and results: After a 24‐month follow‐up period, 138 patients (15.8%) had died and 155 (17.8%) had suffered from a recurrent TnT positive (TnT > 0.05 ng mL^?1) event. XIIaA levels were significantly lower in long‐term survivors than in patients who died (22.9 (17.7–32.1) vs. 27.2 (20.0–39.7) pmol L^?1 [median, 25 and 75% percentiles], P < 0.001). The unadjusted hazard ratio for death within 2 years in patients with XIIaA in the highest quartile was 2.49 (95% confidence interval (CI), 1.52–4.06) as compared with patients with XIIaA in the lowest quartile. In a stepwise Cox regression model for death within 2 years, XIIaA added prognostic information for all‐cause mortality (HR 2.05; 95% CI, 1.21–3.47) above and beyond age, a history of heart failure, ST‐segment elevation, TnT and B‐type natriuretic peptide (BNP). In the subgroup of patients with an admission TnT ≤ 0.05 ng mL^?1, XIIaA provided independent prognostic information for all‐cause mortality (HR 3.88; 95% CI, 1.66–9.08) and for the combined endpoint of death or recurrent TnT positive event (HR 2.46; 95% CI, 1.34–4.50). Conclusion: XIIaA, a recently identified in vivo form of activated factor XII is an independent indicator of long‐term all‐cause mortality in patients admitted with chest pain, providing prognostic information above and beyond conventional risk factors.     

Using a revised asthma morbidity index to identify varying patterns of morbidity in U.K. general practices

Both in terms of morbidity and mortality, the therapeutic and organizational management of asthma pose a considerable and continuing challenge to healthcare delivery. One element in attempts to meet this challenge is the recognition of appropriate outcome measures to assess progress in tackling the burden of this disease. This study therefore aimed to assess pragmatically the effectiveness of a revised asthma morbidity index in identifying varying patterns of morbidity in U.K. general practices. A postal survey was conducted of 2,762 patients believed to have or have had asthma from the lists of 12 general practices within the Eden Valley in Cumbria, using a questionnaire which combined the revised Jones morbidity index with questions on age, medication and perception of current asthma. Prescribing data were also recovered for 11 of the practices for the quarter within which the postal survey was conducted. Responses were obtained from 2,123 subjects (77%), of whom 1,474 (70%) believed themselves to be currently asthmatic. In this group, 18% reported low morbidity 34% medium morbidity and 48% high morbidity Age and inhaled steroid use were both positively and significantly associated with high morbidity. Those taking inhaled steroids were 1.4 times more likely to report high morbidity than those nottaking steroids. The prescribed corticosteroid/bronchodilator ratio for cost was both negatively and significantly associated with high morbidity. The revised morbidity index is a simple tool of use in the surveillance of asthma in primary care. It identifies spectra of morbidity which vary between practices, which may be of use in assessing the quality of asthma care provided in the community.     

Merging universal and indicated prevention programs : The fast track model

Fast Track is a multisite, multicomponent preventive intervention for young children at high risk for long-term antisocial behavior. Based on a comprehensive developmental model, this intervention includes a universal-level classroom program plus social-skill training, academic tutoring, parent training, and home visiting to improve competencies and reduce problems in a high-risk group of children selected in kindergarten. The theoretical principles and clinical strategies utilized in the Fast Track Project are described to illustrate the interplay between basic developmental research, the understanding of risk and protective factors, and a research-based model of preventive intervention that integrates universal and indicated models of prevention.