Cardiorespiratory training in a outpatient service is a suitable option for patients with PAH in WHO FC II/III thanks to improved exercise capacity and QoL, which may allow them to achieve better outcomes.
According to Ernst Cassirer, the transition from the concept of substance to that of mathematical function as a guide of knowledge coincided with the end of ancient and the beginning of modern theoretical thought. In the first part of this article we argue that a similar transition has also taken place in the practical sphere, where mathem- atical function occurs in one of its specific forms, which is that of the algorithm concept. In the second part we argue that with the rise of modernity the idea of substance and the related concepts of category and classification, which are deeply embedded in western culture, have not been totally supplanted by that of function. The intertwining of the concepts of substance and function has generated contra- dictory hybrids. These hybrids are used as a key for the understanding of the differ- ent repercussions of algorithmic logic on society in terms of social integration
Purpose
Numerous studies on thromboembolic prevention for non-valvular atrial fibrillation (NVAF) have shown either equal or better efficacy and safety of non-vitamin K oral anticoagulants (NOACs) compared to warfarin, even for patients aged ≥75 years. Data on elderly patients, in particular, octogenarians, are lacking. Paradoxically, this population is the one with the highest risk of bleeding and stroke with a worse prognosis. This study aims to describe safety and effectiveness of NOACs in an elderly comorbid population.
Patients and methods
REGIstry of patients on Non-vitamin K oral Anticoagulants (REGINA) is a prospective observational study enrolling consecutive NVAF patients started on NOACs and followed up to 1 year (at 1, 6, 12 months). The primary endpoint was the incidence rate of major bleeding (MB) and clinically relevant non-major bleeding (CRNMB). The secondary endpoints were the incidence of 1) stroke or systemic embolism, 2) hospitalization, 3) death, and 4) drug-related adverse events.
Results
We enrolled 227 patients aged 81.6±6.1 years (range 67–95 years; ≥80 years in 59.4%). The median CHA
2
DS
2
-VASc was 5 (IQR 4–5) and HAS-BLED was 4 (IQR 3–5). The estimated glomerular filtration rate was 59.27±24.12 mL/min. During follow-up, only 10 MB and 23 CRNMB occurred, with a total incidence of 4.4% (95% CI: 1.7%–7.17%) and 5.7% (95% CI: 2.68%–8.72%), respectively. There were 2 cerebral ischemic events, with a total incidence of 0.88% (95% CI: 0.84%–0.92%), 23 NOAC-related hospitalizations, no NOAC-related deaths, and 4 minor drug-related adverse effects.
Conclusion
In a population of aged and clinically complex patients, mainly octogenarians, NOACs were safe and effective.
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