Aims The effect of atrial fibrillation catheter ablation on cardiovascular outcomes in heart failure is an important outstanding research question. We undertook a meta-analysis of randomized controlled trials comparing ablation to medical therapy in patients with AF and heart failure. Methods and results We systematically identified all trials comparing catheter ablation to medical therapy in patients with heart failure and atrial fibrillation. The pre-specified primary endpoint was all-cause mortality in trials with at least 2 years of follow-up. The secondary endpoint was heart failure hospitalization. Sensitivity analyses were performed for trials with any follow-up and trials deemed at low risk of bias. Eight trials (1390 patients) were included. Seven hundred and seven patients were randomized to catheter ablation and 683 to medical therapy. In the primary analysis (three trials, n = 977), catheter ablation reduced mortality compared with medical therapy [relative risk (RR): 0.61, 95% confidence interval (CI): 0.44 to 0.84, P = 0.003]. Catheter ablation also reduced heart failure hospitalizations compared with medical therapy (RR: 0.60, 95% CI: 0.49–0.74, P < 0.001). The effect on stroke was not statistically significant (RR: 0.62, 95% CI: 0.28–1.37, P = 0.237). There was low heterogeneity between studies. Sensitivity analyses were consistent with the primary analyses. Conclusion In patients with atrial fibrillation and heart failure, catheter ablation reduces mortality and the occurrence of heart failure hospitalizations.
Throughout pregnancy and the puerperium significant cardiovascular changes occur. Maternal heart 70 rate increases by approximately 20% from the pre-conception baseline to the third trimester of 71 pregnancy (1, 2), with a further increase during labour (3). Whilst these changes are well 72 understood, the changes in the postpartum period are less well defined. Studies show maternal 73 heart rate returns to baseline weeks to months post-delivery (4-7), yet the early postpartum period 74 remains poorly described. Knowledge of what constitutes normal during this period is clinically 75 pertinent to facilitate identification of sick women, and avoid inappropriate investigation of healthy 76 women. In some cases the cause of postpartum tachycardia is evident (haemorrhage, sepsis) (8)(9)(10)(11)(12). 77In other cases it is less obvious and should prompt further investigation for causes such as occult 78 bleeding, cardiac pathology or pulmonary embolism (3,(13)(14)(15). 79Modified Early Obstetric Warning Scores (MEOWS) are widely used. The parameters used vary (16, 80 17) and have often been developed from a non-pregnant population. Data derived from a 81 postpartum population would improve the pre-existing MEOWS scores validity; providing a platform 82 for further investigation into the relationship between postpartum heart rate and negative 83 outcomes and ultimately the creation of a postpartum specific clinical assessment tool. 84Study Aims 85 1. Describe the distribution of heart rate in the first 48 hours postpartum (at 6, 12, 24 and 48 86 hours post-delivery), in women with no evidence of sepsis, haemorrhage or anaemia. 87 2. Investigate the relationship between postpartum heart rate and other maternal factors 88(maternal BMI at booking, maternal age, method of delivery, puerperal blood loss, discharge 89 haemoglobin and length of hospital stay). 90 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 3 Gynaecologists' guidelines for major postpartum haemorrhage (19)) or whose discharge 111 haemoglobin was < 100 g/l (British Society of Haematology guidelines on maternal and postpartum 112 anaemia (20)). 113 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 4 Materials and Methods 91 Study Design Statistical Analyses 114Statistical analyses were performed using IBM® SPSS® Statistics 22 (The International Business 115 Machines Corporation®, New York, NY, USA). 116Central tendency for heart rate at each time period postpartum (6, 12, 24 and 48 hours) was 117 calculated using the mea μ . Spread as calculated usi g standard deviation (SD) and suggested 118 normal range upper thresholds were calculated using the me...
BACKGROUND Despite effective therapies, the economic burden of heart failure with reduced ejection fraction (HFrEF) is driven by frequent hospitalizations. Treatment optimization and admission avoidance rely on frequent symptom reviews and monitoring of vital signs. Remote monitoring (RM) aims to prevent admissions by facilitating early intervention, but the impact of noninvasive, smartphone-based RM of vital signs on secondary health care use and costs in the months after a new diagnosis of HFrEF is unknown. OBJECTIVE The purpose of this study is to conduct a secondary care health use and health-economic evaluation for patients with HFrEF using smartphone-based noninvasive RM and compare it with matched controls receiving usual care without RM. METHODS We conducted a retrospective study of 2 cohorts of newly diagnosed HFrEF patients, matched 1:1 for demographics, socioeconomic status, comorbidities, and HFrEF severity. They are (1) the RM group, with patients using the RM platform for >3 months and (2) the control group, with patients referred before RM was available who received usual heart failure care without RM. Emergency department (ED) attendance, hospital admissions, outpatient use, and the associated costs of this secondary care activity were extracted from the Discover data set for a 3-month period after diagnosis. Platform costs were added for the RM group. Secondary health care use and costs were analyzed using Kaplan-Meier event analysis and Cox proportional hazards modeling. RESULTS A total of 146 patients (mean age 63 years; 42/146, 29% female) were included (73 in each group). The groups were well-matched for all baseline characteristics except hypertension (<i>P</i>=.03). RM was associated with a lower hazard of ED attendance (hazard ratio [HR] 0.43; <i>P</i>=.02) and unplanned admissions (HR 0.26; <i>P</i>=.02). There were no differences in elective admissions (HR 1.03, <i>P</i>=.96) or outpatient use (HR 1.40; <i>P</i>=.18) between the 2 groups. These differences were sustained by a univariate model controlling for hypertension. Over a 3-month period, secondary health care costs were approximately 4-fold lower in the RM group than the control group, despite the additional cost of RM itself (mean cost per patient GBP £465, US $581 vs GBP £1850, US $2313, respectively; <i>P</i>=.04). CONCLUSIONS This retrospective cohort study shows that smartphone-based RM of vital signs is feasible for HFrEF. This type of RM was associated with an approximately 2-fold reduction in ED attendance and a 4-fold reduction in emergency admissions over just 3 months after a new diagnosis with HFrEF. Costs were significantly lower in the RM group without increasing outpatient demand. This type of RM could be adjunctive to standard care to reduce admissions, enabling other resources to help patients unable to use RM.
The Disability Discrimination Act (DDA 1995(DDA , amended 2005, Equality Act (2010), EU Disability Action Plan (2003Plan ( -2010 and EU Disability Strategy (2010-2020 were designed to make equal opportunities a 'reality'. As 16% of the EU population is statutorily disabled, there are considerable implications for beach management. Common research examples given of beach users include swimmers, anglers and water-sport enthusiasts -but rarely people with learning disabilities (LD). This paper assessed the viewpoints of a group of beach users with LD and considered their appreciation of three different coastal classifications in South Wales, UK. Because of the nature of their disabilities, the research applied a participatory photo-interpretation methodology (photovoice) at these three beach locations.The research then compared the LD ranking of beach issues with rankings provided by members of the general public at the same beaches. The results demonstrated some similarities between LD and general public coastal needs, but identified the need for specific
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