Subject(s)
Cardiology/standards , Clinical Competence/standards , Competency-Based Education/standards , Nurse Practitioners/standards , Physician Assistants/standards , Research Report/standards , Adult , Cardiology/education , Cardiology/methods , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Competency-Based Education/methods , Humans , Nurse Practitioners/education , Physician Assistants/education , United StatesSubject(s)
Cardiology/education , Fellowships and Scholarships , Nurse Practitioners , Patient Care Team/organization & administration , Physician Assistants , Professional Role , Academic Medical Centers , Cardiology/organization & administration , Delivery of Health Care/organization & administration , Humans , Interdisciplinary Placement , Physician's RoleABSTRACT
OBJECTIVES: We sought to determine whether hormone replacement therapy (HRT) is associated with an improved prognosis in women with advanced heart failure (HF) and systolic dysfunction. BACKGROUND: There are about two million postmenopausal women in the U.S. with HF. However, limited data are available to assess the effects of HRT on survival in this large group of patients. METHODS: A retrospective analysis of women age 50 years and over entered into the Beta-Blocker Evaluation of Survival Trial (BEST) was conducted using Cox regression analysis comparing survival in HRT users and non-users after correcting for baseline variables known to predict survival in women with HF and systolic dysfunction. RESULTS: In 493 women age 50 years and older, HRT was associated with a significant reduction in mortality-21% mortality in HRT users and 34% in non-users (p = 0.025). Multivariate analysis demonstrated a hazard ratio for mortality of 0.6 (95% confidence interval = 0.36 to 0.97) (p = 0.039) for HRT users. The benefits of HRT were noted only in women with a nonischemic etiology of HF (n = 237). CONCLUSIONS: Hormone replacement therapy is associated with a marked improvement in survival in postmenopausal women with advanced HF. A prospective, randomized trial of HRT should be performed in this large group of patients.
Subject(s)
Estrogen Replacement Therapy , Heart Failure/mortality , Heart Failure/prevention & control , Aged , Aged, 80 and over , Arizona , California , Colorado , Female , Humans , Louisiana , Maryland , Middle Aged , North Carolina , Ohio , Postmenopause , Prognosis , Propanolamines/administration & dosage , Proportional Hazards Models , Randomized Controlled Trials as Topic , Retrospective Studies , Survival Analysis , Systole , Texas , Ventricular Dysfunction, Left , Virginia , Women's HealthSubject(s)
Heart Diseases/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Thrombosis/prevention & control , Aspirin/therapeutic use , Blood Coagulation/drug effects , Blood Platelets/drug effects , Clopidogrel , Humans , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Ticlopidine/analogs & derivatives , Ticlopidine/therapeutic useABSTRACT
BACKGROUND: The relative anti-aggregatory effects of currently prescribed platelet glycoprotein IIb/IIIa receptor antagonists during and after percutaneous coronary intervention for acute coronary syndromes have not been established. METHODS AND RESULTS: We randomized 70 acute coronary syndrome patients undergoing percutaneous coronary intervention to receive abciximab, eptifibatide, or tirofiban at doses used in the Evaluation of Platelet IIb/IIIa Inhibitor for STENTing (EPISTENT), Platelet glycoprotein IIb/IIIa in Unstable angina Receptor Suppression Using Integrilin Therapy (PURSUIT), and Platelet Receptor Inhibition in ischemic Syndrome Management in Patients Limited by Unstable Signs and symptoms (PRISM-PLUS)/Randomized Efficacy Study of Tirofiban for Outcomes and Restenosis (RESTORE) trials, respectively. Platelet aggregation (PA) in response to 20 micro mol/L of adenosine diphosphate was measured with turbidimetric aggregometry in both D-phenylalanyl-L-prolyl-L-arginine chloromethylketone and citrate-anticoagulated blood early (15 and 30 minutes) and late (4, 12, and 18 to 24 hours) after drug initiation. At 15 and 30 minutes, PA was significantly less inhibited by the tirofiban-RESTORE regimen compared with abciximab (P=0.028) and eptifibatide regimens (P=0.0001). The abciximab regimen, however, showed increasingly varied anti-aggregatory effects during continued infusion for > or =4 hours. Citrate exaggerated ex vivo platelet inhibition after eptifibatide and tirofiban, but had the opposite effect on abciximab. Of all regimens evaluated, the eptifibatide regimen inhibited PA most consistently throughout both the early and late periods. CONCLUSIONS: Currently recommended drug regimens to inhibit the platelet glycoprotein IIb/IIIa receptor have distinct pharmacodynamic profiles that might affect their relative efficacy in acute coronary syndromes and percutaneous coronary intervention.
