Subject(s)
Atrial Fibrillation/diagnosis , Electrocardiography, Ambulatory/instrumentation , Electrodes, Implanted , Heart Conduction System/physiopathology , Ischemic Stroke/etiology , Meta-Analysis as Topic , Atrial Fibrillation/complications , Atrial Fibrillation/physiopathology , Female , Humans , Male , Middle AgedSubject(s)
Atrial Fibrillation/drug therapy , Bioprosthesis , Factor Xa Inhibitors/therapeutic use , Heart Valve Prosthesis , Stroke/prevention & control , Thromboembolism/prevention & control , Warfarin/therapeutic use , Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Humans , Proportional Hazards Models , Stroke/etiology , Thromboembolism/etiologyABSTRACT
BACKGROUND: Sympathetic nervous system plays a central role in the development and persistence of essential hypertension. In recent years renal sympathetic denervation (RSD) has emerged as a promising option for the treatment of patients with hypertension. METHODS: We conducted a literature search of PubMed, EMBASE, Cochrane library and Clinicaltrials.gov from inception through April 20, 2020. Outcomes of interest were change in 24-hour ambulatory systolic (ASBP) or diastolic blood pressure (ADBP) and change in office systolic (OSBP) or diastolic blood pressure (ODBP). We pooled data from randomized controlled trials (RCTS) comparing RSD to sham procedures in the management of hypertension using the random effect model. RESULTS: A total of 1,363 patients from eight studies were included in the current meta-analysis. The mean age of the included patients was 56 ± 2.6 years, 29% were women and the median duration of maximum follow up was 6-month (range 3-12 month). There was more reduction favoring RSD in ASBP (Weighted mean difference [WMD] -3.55; 95% CI -4.91 - -2.19, p < .001, I2 = 0%), ADBP (WMD -1.87; 95% CI -3.07 - -0.66, p = .002, I2 = 43%), OSBP (WMD -5.5; 95% CI -7.59 - -3.40, p < .001, I2 = 7%) and ODBP (WMD -3.20; 95% CI -4.47 - -1.94, p < .001, I2 = 14%). CONCLUSION: The use of RSD for the management of hypertension resulted in effective reduction in the ambulatory and office blood pressure compared to sham procedure. Adequately powered RCTs of RSD are needed to confirm safety, reproducibility and assess the impact on clinical outcomes.
Subject(s)
Hypertension , Kidney , Blood Pressure , Female , Humans , Hypertension/diagnosis , Hypertension/surgery , Sympathectomy/adverse effects , Treatment OutcomeABSTRACT
BACKGROUND: Surgical myectomy (SM) and Alcohol septal ablation (ASA) are effective therapies for patients with hypertrophic cardiomyopathy who remain symptomatic despite medical therapy. A plethora of data has recently emerged on the long-term outcomes of these procedures. We hence sought to perform an updated meta-analysis comparing both procedures. METHODS: Studies reporting long-term (>3-years) outcomes of SM and/or ASA were included. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular mortality, sudden cardiac death (SCD), reintervention, and complications including death, pacemaker implantation, and stroke. RESULTS: Twenty-two ASA cohorts (n = 4213; follow-up = 6.6-years) and 23 SM cohorts (n = 4240; follow-up = 6.8-years) were included. Septal myectomy was associated with higher periprocedural mortality and stroke (2% vs 1.2%, P = 0.009 and 1.5% vs 0.8% P = 0.013, respectively), but ASA was associated with more need of pacemaker (10% vs 5%, P < 0.001). During long-term follow-up, all-cause mortality, cardiovascular mortality, and sudden cardiac death rates were 1.5%, 0.4%, and 0.3% per person-year in the ASA group and 1.1%, 0.5%, and 0.3% per person-year in the SM group (P = 0.21, P = 0.53, P = 0.43), respectively. Repeat septal reduction intervention(s) were more common after ASA (11% vs 1.5%, P < 0.001). CONCLUSION: Compared with SM, ASA is associated with lower periprocedural mortality and stroke but higher rates of pacemaker implantations and reintervention. However, there was no difference between ASA and SM with regards to long-term all-cause mortality, cardiovascular mortality, or SCD.
Subject(s)
Ablation Techniques/methods , Cardiac Surgical Procedures/methods , Cardiomyopathy, Hypertrophic/therapy , Ethanol/pharmacology , Heart Ventricles/surgery , Cause of Death/trends , Humans , Survival Rate/trends , Treatment OutcomeABSTRACT
BACKGROUND: Industry manufacturers are required by the Sunshine Act to disclose payments to physicians. These data recently became publicly available, but some manufacturers prereleased their data since 2009. We tested the hypotheses that there would be discrepancies between manufacturers' and physicians' disclosures. METHODS: The financial disclosures by authors of all 39 American College of Cardiology and American Heart Association guidelines between 2009 and 2012 were matched to the public disclosures of 15 pharmaceutical companies during that same period. Duplicate authors across guidelines were assessed independently. Per the guidelines, payments <$10,000 are modest and ≥$10,000 are significant. Agreement was determined using a κ statistic; Fisher's exact and Mann-Whitney tests were used to detect statistical significance. RESULTS: The overall agreement between author and company disclosure was poor (κ = 0.238). There was a significant difference in error rates of disclosure among companies and authors (P = .019). Of disclosures by authors, companies failed to match them with an error rate of 71.6%. Of disclosures by companies, authors failed to match them with an error rate of 54.7%. CONCLUSIONS: Our analysis shows a concerning level of disagreement between guideline authors' and pharmaceutical companies' disclosures. Without ability for physicians to challenge reports, it is unclear whether these discrepancies reflect undisclosed relationships with industry or errors in reporting, and caution should be advised in interpretation of data from the Sunshine Act.
