Dr.Vad
01.10.2006, 00:28
Шкала прогноза выживаемости
US researchers have developed a risk score for elderly patients hospitalized with heart failure (HF), after finding significant heterogeneity in their survival.
Although median survival was approximately 2.5 years, a quarter of patients died within a year, while another quarter survived more than 5 years.
The researchers say that their risk score, based on factors readily available at the time of admission, "provides a reliable estimate of prognosis."
The Washington University School of Medicine team, based in St Louis, Missouri, developed the score after conducting extended follow-up of a randomized trial in multidisciplinary HF management conducted at their institution between 1990 and 1994.
Of the 282 HF patients included, all aged 70 years or over at the start of the study, 95% died in the 14 years after enrollment, with a median survival of 894 days.
Bao Huynh and co-workers identified seven variables that independently predicted shorter survival: older age (hazard ratio [HR]=1.14 per 5 years), serum sodium levels less than 135 mEq/l (HR=1.67), coronary artery disease (HR=1.51), dementia (HR=2.02), peripheral vascular disease (HR=1.74), systolic blood pressure (HR=0.95 per 10 mmHg), and serum urea nitrogen (HR=1.20 per 10 mg/dl).
One point was assigned to each risk factor, with the sum representing the risk score.
Mortality at 1 year was 9.0% in patients with a risk score of 0-1, 22.2% in those with a score of 2-3, and 73.0% in those with a score of four or more (p<0.001).
Reporting in the Archives of Internal Medicine, the researchers say that their risk score identified patients at low, medium, and high risk of mortality.
They conclude: "The identification of patients at high risk of death within 6 months may enable clinicians to better advise patients about prognosis, adjust management accordingly, and permit consideration of palliative care in those anticipated to have particularly poor short-term survival."
Arch Intern Med 2006; 166: 1892-1898
Еще одна точка приложения триметазидина (итальянцы являются еще одним контрибьютором по клиническому применению данного препарата, как правило все публикации позитивны...):
When added to conventional treatment, long-term treatment with trimetazidine, a partial free fatty acid oxidation inhibitor, can improve functional class and left ventricular (LV) function in patients with heart failure (HF), a small Italian trial indicates.
"We believe that our data suggest that the adjunct of targeted cardiac metabolic therapy opens a new therapeutic window in the treatment of HF," the investigators write in the Journal of the American College of Cardiology.
Trimetazidine is a ketoacyl-coenzyme A thiolase inhibitor that shifts the energy substrate metabolism away from fatty acid metabolism towards glucose metabolism.
Following positive results from small studies in patients with post-ischemic HF, Gabriele Fragasso and colleagues at the Istituto Scientifico-Universita Vita/Salute San Raffaele in Milan conducted an open-label trial in 55 patients at their institution.
The participants, who all had New York Heart Association (NYHA) functional class II to IV HF, were assigned to conventional therapy, with or without trimetazidine 20 mg three times daily.
During a mean follow-up of 13 months, NYHA class improved significantly more with trimetazidine than conventional therapy alone (p<0.0001). LV end-systolic volume decreased significantly with trimetazidine from 98 ml to 89 ml and, accordingly, ejection fraction increased from 34% to 41%. Improvements were also seen in exercise tolerance, which the team attributes to improvements in LV function.
In contrast, there were no significant changes in any of these measures in the conventional therapy group.
Based on their findings, the team concludes: "We believe that the time has come to evaluate the effects of partial fatty acid oxidation inhibition in patients with HF in a multicenter, randomized, placebo-controlled trial."
J Am Coll Cardiol 2006; 48: 992-998
CVN
US researchers have developed a risk score for elderly patients hospitalized with heart failure (HF), after finding significant heterogeneity in their survival.
Although median survival was approximately 2.5 years, a quarter of patients died within a year, while another quarter survived more than 5 years.
The researchers say that their risk score, based on factors readily available at the time of admission, "provides a reliable estimate of prognosis."
The Washington University School of Medicine team, based in St Louis, Missouri, developed the score after conducting extended follow-up of a randomized trial in multidisciplinary HF management conducted at their institution between 1990 and 1994.
Of the 282 HF patients included, all aged 70 years or over at the start of the study, 95% died in the 14 years after enrollment, with a median survival of 894 days.
Bao Huynh and co-workers identified seven variables that independently predicted shorter survival: older age (hazard ratio [HR]=1.14 per 5 years), serum sodium levels less than 135 mEq/l (HR=1.67), coronary artery disease (HR=1.51), dementia (HR=2.02), peripheral vascular disease (HR=1.74), systolic blood pressure (HR=0.95 per 10 mmHg), and serum urea nitrogen (HR=1.20 per 10 mg/dl).
One point was assigned to each risk factor, with the sum representing the risk score.
Mortality at 1 year was 9.0% in patients with a risk score of 0-1, 22.2% in those with a score of 2-3, and 73.0% in those with a score of four or more (p<0.001).
Reporting in the Archives of Internal Medicine, the researchers say that their risk score identified patients at low, medium, and high risk of mortality.
They conclude: "The identification of patients at high risk of death within 6 months may enable clinicians to better advise patients about prognosis, adjust management accordingly, and permit consideration of palliative care in those anticipated to have particularly poor short-term survival."
Arch Intern Med 2006; 166: 1892-1898
Еще одна точка приложения триметазидина (итальянцы являются еще одним контрибьютором по клиническому применению данного препарата, как правило все публикации позитивны...):
When added to conventional treatment, long-term treatment with trimetazidine, a partial free fatty acid oxidation inhibitor, can improve functional class and left ventricular (LV) function in patients with heart failure (HF), a small Italian trial indicates.
"We believe that our data suggest that the adjunct of targeted cardiac metabolic therapy opens a new therapeutic window in the treatment of HF," the investigators write in the Journal of the American College of Cardiology.
Trimetazidine is a ketoacyl-coenzyme A thiolase inhibitor that shifts the energy substrate metabolism away from fatty acid metabolism towards glucose metabolism.
Following positive results from small studies in patients with post-ischemic HF, Gabriele Fragasso and colleagues at the Istituto Scientifico-Universita Vita/Salute San Raffaele in Milan conducted an open-label trial in 55 patients at their institution.
The participants, who all had New York Heart Association (NYHA) functional class II to IV HF, were assigned to conventional therapy, with or without trimetazidine 20 mg three times daily.
During a mean follow-up of 13 months, NYHA class improved significantly more with trimetazidine than conventional therapy alone (p<0.0001). LV end-systolic volume decreased significantly with trimetazidine from 98 ml to 89 ml and, accordingly, ejection fraction increased from 34% to 41%. Improvements were also seen in exercise tolerance, which the team attributes to improvements in LV function.
In contrast, there were no significant changes in any of these measures in the conventional therapy group.
Based on their findings, the team concludes: "We believe that the time has come to evaluate the effects of partial fatty acid oxidation inhibition in patients with HF in a multicenter, randomized, placebo-controlled trial."
J Am Coll Cardiol 2006; 48: 992-998
CVN