ABSTRACT
BACKGROUND: Ejection fraction (EF) slightly declines with age in healthy control (HC) subjects. Yet, studies of heart failure with preserved ejection fraction (HFPEF) often report EF values which are surprisingly greater than those reported for HC of the same age. The goals of this study were to: (1) compare the EF, at rest, in subjects with HFPEF versus HC, and (2) compare how EF varies with age in HFPEF and HC. METHODS: A systematic review and meta-analysis of the literature was performed. Studies were identified in the PUBMED and EMBASE databases until August 2013. A study reporting EF at rest in HFPEF and HC was included regardless of the aim of the primary study. In most of the primary studies (25 of 28 studies, 89%) EF was not a primary endpoint. A summary measure was the standardized mean difference (SMD) of the EF in HFPEF vs. HC RESULTS: Twenty eight studies (1529 HFPEF and 1068 HC subjects) were included. SMD was 0.71 (95% CI: 0.31, 1.12, P<0.001) demonstrating a greater EF in HFPEF. Effect size of HFPEF on EF was moderate. A meta-regression showed a statistically non-significant trend of increased SMD with older age. CONCLUSIONS: This analysis showed that EF in HFPEF is on average "greater-than-normal". This phenomenon may be related to an underlying adaptive mechanism occurring in HFPEF. Further research is needed.
Subject(s)
Heart Failure/physiopathology , Stroke Volume/physiology , Case-Control Studies , HumansABSTRACT
OBJECTIVE: Information on the medical problems and diseases encountered by practicing Internists in the hospital environment is lacking. The aim of this study is to assess the prevalence of various diagnostic categories that present to internists in the hospital setting in Europe. DESIGN: A pan-European study used the Young Internists Research Network of the European Federation of Internal Medicine. RESULTS: Data on 1501 patients from 31 physicians in 18 European countries were included in the study. The patients carried an average of 2.75 (+/-2.22) chronic medical diagnoses, ranging from 0 to 18. The most common presenting complaint was shortness of breath, followed by chest pain and abdominal pain. A cardiac condition was most common, followed by infectious disease. The complexity of patients averaged 2.5 (+/-1.14). CONCLUSIONS: The results of this study will be useful for the development of a modern internal medicine curriculum, both at the graduate and postgraduate level, which reflects the competencies required for the delivery of comprehensive patient care in internal medicine wards.