scholarly journals The Impact of Catecholamines in Patients with or without Beta-Blockers on the Ventricular Fibrillation Cycle Length and Ventricular Fibrillation Cycle Length Variability

2005 ◽  
Vol 10 (3) ◽  
pp. 305-311 ◽  
Author(s):  
Bokyung Min ◽  
Jeffrey Kluger ◽  
James S. Kalus ◽  
Danette Guertin ◽  
Brian F. McBride ◽  
...  
Keyword(s):  
Ventricular Fibrillation ◽  
Cycle Length ◽  
Beta Blockers ◽  
The Impact

Abstract P116: VARIATION IN MEAN ARTERIAL PRESSURE (MAP) AND ITS HEMODYNAMIC COMPONENTS DURING 24-HOUR AMBULATORY PULSE WAVE ANALYSIS: IMPACT OF AGE, RACE, GENDER AND BODY SIZE

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Sagar Nagpal ◽  
Debduti Mukhopadhyay ◽  
Peter Osmond ◽  
Joseph E Schwartz ◽  
Joseph L Izzo
Keyword(s):  
Heart Rate ◽  
Pulse Wave ◽  
Beta Blockers ◽  
Demographic Characteristics ◽  
Pulse Wave Analysis ◽  
Clinical Implications ◽  
Wave Analysis ◽  
Contributing Factors ◽  
Clinical Associations ◽  
The Impact

BP is highly variable within and between individuals but the impact of variation in underlying hemodynamic components is unknown. We tested the feasibility and clinical associations of quantitated variances in MAP and its hemodynamic components [heart rate (HR), stroke volume (SV) and total vascular resistance (TVR)] obtained by 24-hr ambulatory pulse wave analysis (PWA, Mobil-O-Graph, IEM, Stolzberg, DE). BP and PWA were measured every 20 min for 24 hrs. Indexed to body surface area, MAP = HR*[SV index (SVI)]*[TVR index (TVRI)]; ln(MAP) = ln(HR) + ln(SVI) + ln(TVRI); and total MAP variability = var [ln(MAP)] = covariance (cov)[ln(HR), ln(MAP)] + cov[ln(SVI), ln(MAP)] + cov[ln(TVRI), ln(MAP)]. Relative contributions to var[ln(MAP)] for each hemodynamic component (as %) were calculated and associations with demographic characteristics were analyzed by correlations and t-tests. We studied 152 people (49% women, 23% black); mean(SD): # readings 57(11), age 59(16) yr, BMI 29.9(6.5) kg/m 2 , systolic BP 135(18) and MAP 106(14) mmHg. Mean(SD) 24-hr values were: ln(MAP) 4.64 (0.13), ln(HR) 4.20 (0.15), ln(SVI) -3.32 (0.15), and ln(TVRI) 3.75 (0.18). Relative contributions of hemodynamic components to total 24-hr ln(MAP) variation were: TVRI 54(36)%, HR 33(38)%, and SVI 13(40)%. The large SDs of these relative contributions led to analysis of potential contributing factors: TVRI contribution was correlated with 24-hr mean MAP (r=0.24, p=0.003) and was higher (>54%) in males (p=0.03) and blacks (p=0.04); HR contribution was inversely related to MAP (r=-0.26, p=0.001), age (r=-0.29, p=0.0003) and BMI (r=-0.173 p=0.05) and was lower (<33%) in blacks (p=0.008); SVI contribution was correlated with age (r=0.31, p<0.0001) and BMI (r=0.23, p=0.005) and was higher (>13%) in women (p=0.03). We conclude that 24-hr ambulatory PWA can identify components of MAP variation within individuals and their associations with demographic factors. The relative contributions of hemodynamic components (HR, SV, TVR) to 24-hr variability in ln(MAP) varies systematically with 24-hr mean MAP, age, race, gender, and BMI. Theoretical clinical implications may include therapeutic adjustments for extremes of variation in HR (beta-blockers), TVR (vasodilators) or SV (diuretics).

scholarly journals Long-Term Effect of Non-Selective Beta-Blockers in Patients With Rheumatoid Arthritis After Myocardial Infarction—A Nationwide Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Sheng-Fu Liu ◽  
Chih-Kuo Lee ◽  
Kuan-Chih Huang ◽  
Lian-Yu Lin ◽  
Mu-Yang Hsieh ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Protective Effect ◽  
Lower Risk ◽  
Beta Blockers ◽  
Term Survival ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
The Impact

Objectives: Rheumatoid arthritis (RA) is an independent nontraditional risk factor for incidence of myocardial infarction (MI) and post-MI outcome is impaired in the RA population. Use of beta-blockers improves the long-term survival after MI in the general population while the protective effect of beta-blockers in RA patients is not clear. We investigate the impact of beta-blockers on the long-term outcome of MI among RA patients.Methods: We identified RA subjects from the registries for catastrophic illness and myocardial infarction from 2003 to 2013. The enrolled subjects were divided into three groups according to the prescription of beta-blockers (non-user, non-selective, and β1-selective beta-blockers). The primary endpoint was all-cause mortality. We adjusted clinical variables and utilized propensity scores to balance confounding bias. Cox proportional hazards regression models were used to estimate the incidence of mortality in different groups.Results: A total of 1,292 RA patients with myocardial infarction were enrolled, where 424 (32.8%), 281 (21.7%), and 587 (45.5%) subjects used non-user, non-selective, and β1-selective beta-blockers, respectively. Use of beta-blockers was associated with lower risk of all-cause mortality after adjustment with comorbidities, medications (adjusted hazard ratio [HR] 0.871; 95% confidence interval [CI] 0.727–0.978), and propensity score (HR 0.882; 95% CI 0.724–0.982). Compared with β1-selective beta-blockers, treatment with non-selective beta-blockers (HR 0.856; 95% CI 0.702–0.984) was significantly related to lower risk of mortality. The protective effect of non-selective beta-blockers remained in different subgroups including sex and different anti-inflammatory drugs.Conclusion: Use of beta-blockers improved prognosis in post-MI patients with RA. Treatment with non-selective beta-blockers was significantly associated with reduced risk of mortality in RA patients after MI rather than β1-selective beta-blockers.

scholarly journals The Impact of the COVID-19 Pandemic on Women’s Reproductive Health

2021 ◽  
Vol 12 ◽  
Author(s):  
Phelan Niamh ◽  
Lucy Ann Behan ◽  
Lisa Owens
Keyword(s):  
Reproductive Health ◽  
Cycle Length ◽  
Home Schooling ◽  
Hormonal Contraception ◽  
Median Number ◽  
Reproductive Age ◽  
Poor Sleep ◽  
Women’S Reproductive Health ◽  
Women's Reproductive Health ◽  
The Impact

BackgroundThe COVID-19 pandemic has profoundly affected the lives of the global population. It is known that periods of stress and psychological distress can affect women’s menstrual cycles. We therefore performed an observational study of women’s reproductive health over the course of the pandemic thus far.Materials and MethodsAn anonymous digital survey was shared by the authors via social media in September 2020. All women of reproductive age were invited to complete the survey.Results1031 women completed the survey. Mean age was 36.7 ± 6.6 years (range, 15–54). 693/70% reported recording their cycles using an app or diary. 233/23% were using hormonal contraception. 441/46% reported a change in their menstrual cycle since the beginning of the pandemic. 483/53% reported worsening premenstrual symptoms, 100/18% reported new menorrhagia (p = 0.003) and 173/30% new dysmenorrhea (p &lt; 0.0001) compared to before the pandemic. 72/9% reported missed periods who not previously missed periods (p = 0.003) and the median number of missed periods was 2 (1–3). 17/21% of those who “occasionally” missed periods pre-pandemic missed periods “often” during pandemic. 467/45% reported a reduced libido. There was no change in the median cycle length (28 days) or days of bleeding (5) but there was a wider variability of cycle length (p = 0.01) and a 1 day median decrease in the minimum (p &lt; 0.0001) and maximum (p = 0.009) cycle length. Women reported a median 2 kg increase in self-reported weight and a 30-min increase in median weekly exercise. 517/50% of women stated that their diet was worse and 232/23% that it was better than before the pandemic. 407/40% reported working more and 169/16% were working less. Women related a significant increase in low mood (p &lt; 0.0001), poor appetite (p &lt; 0.0001), binge eating (p &lt; 0.0001), poor concentration (p &lt; 0.0001), anxiety (p &lt; 0.0001), poor sleep (p &lt; 0.0001), loneliness (p &lt; 0.0001) and excess alcohol use (p &lt; 0.0001). Specific stressors reported included work stress (499/48%), difficulty accessing healthcare (254/25%), change in financial (201/19%) situation, difficulties with home schooling (191/19%) or childcare (99/10%), family or partner conflict (170/16%), family illness or bereavement (156/15%).ConclusionsThe COVID-19 pandemic has significantly impacted the reproductive health of women. The long term health implications of this are yet to be determined and future studies should address this.

Abstract 299: Association of Chronic Lung Disease with Treatments and Outcomes of Acute Coronary Syndromes: Results from the NCDR®

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Jonathan R Enriquez ◽  
James A de Lemos ◽  
Ramin Farzaneh-Far ◽  
Anand Rohatgi ◽  
S. A Peng ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Lung Disease ◽  
Major Bleeding ◽  
Chronic Lung Disease ◽  
Beta Blockers ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Processes Of Care ◽  
Increased Risk ◽  
The Impact

Background: Previous reports are conflicting regarding outcomes, treatments, and processes of care after acute myocardial infarction (MI) for patients with chronic lung disease (CLD). Methods: Using the NCDR ACTION Registry ® -GWTG ™ (AR-G), demographics, clinical characteristics, treatments, processes of care, and in-hospital adverse events after NSTEMI and STEMI were compared between patients with (n= 22,624; 14.2%) and without (n= 136,266; 85.8%) CLD. CLD was defined by a history of COPD, chronic bronchitis, or emphysema. Multivariable adjustment using published AR-G in-hospital mortality and major bleeding risk adjustment models was performed to quantify the impact of CLD on treatments and outcomes. Results: CLD was present in 10.1% of STEMI patients and 17.0% of NSTEMI patients. In both STEMI and NSTEMI, CLD patients were older, more likely to be female, and had more comorbidities including diabetes, renal disease, prior MI and heart failure, compared to those without CLD. Although on admission CLD patients were more likely to be on cardiovascular medications, by discharge slightly fewer CLD patients received composite core measures (aspirin, beta-blockers, ACE-inhibitors, and statins) (table). In NSTEMI, CLD was also associated with less use of invasive procedures and with increased risk of both death and major bleeding. In STEMI, major bleeding but not mortality was increased. Conclusions: CLD is a common comorbidity and is independently associated with an increased risk for major bleeding after MI. In NSTEMI, CLD is also associated with receiving fewer evidence-based medications, less timely angiography and revascularization, and increased in-hospital mortality. Close attention should be given to this high-risk subgroup for the prevention and management of bleeding complications after MI, and further investigation is needed to determine the reasons for treatment and outcome disparities in NSTEMI.

Abstract 12820: Beta Blocker Use and Peri-operative Outcomes in Cancer Patients Receiving Immunotherapy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ohad Oren ◽  
Julian R Molina ◽  
Eric H Yang ◽  
Michal Oren ◽  
Kent Bailey ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Cancer Patients ◽  
Surgical Procedures ◽  
Beta Blocker ◽  
Wound Repair ◽  
Beta Blockers ◽  
Chi Square ◽  
Risk Of Death ◽  
Operative Outcomes ◽  
The Impact

Introduction: The impact of beta blocker use on surgical outcomes of cancer patients receiving immunotherapy is unknown. Hypothesis: Beta blocker use is associated with lower post-operative mortality in cancer patients on immunotherapy. Methods: We used an institutional Advanced Cohort Explorer to identify all patients who underwent any surgical procedure less than 90 days after receiving immunotherapy. Data on the procedure performed as well as the post-operative outcome were collected and analyzed per the pre-operative beta blocker use status. Results: A total of 233 patients underwent surgery between 09/2011-06/2019. Mean age was 64.7 years (range: 16-92). The most common cancer diagnoses were lung (48, 44.4%), melanoma (49, 45.4%) and kidney (11, 10.2%). Immunotherapy medications were pembrolizumab ( 127, 54.5%), nivolumab (51, 21.9%), ipilimumab (43, 18.5%), atezolizumab (11, 4.7%) and avelumab (1, 0.43%). Pre-operative beta blocker use was documented in 140 (60.1%) patients. Most common surgical procedures were skin resection (75, 32.1%), wound repair (47, 20.2%), vascular procedures (36, 15.5%), urethral procedures 16 (6.9%) and sentinel lymph node biopsies (10, 4.3%). The 30-day mortality rate was 10.3% (24 deaths). In a multi-variable logistic regression analysis, pre-operative use of beta blockers was associated with a lower risk of death within 30 days from surgery (OR 0.34, CI 0.13-0.87, P=0.024). 30-day mortality rates were higher in patients undergoing vascular (50%, 17 of 34) versus non-vascular (3.5%, 7 of 199) procedures (P<0.0001) in a Chi Square test. Conclusions: Beta blocker use is associated with a lower 30-day mortality rate after surgical procedures in cancer patients treated with immunotherapy. Further investigation is warranted.

scholarly journals Intramural optical mapping of Vm and Cai2+ during long-duration ventricular fibrillation in canine hearts

2012 ◽  
Vol 302 (6) ◽  
pp. H1294-H1305 ◽  
Author(s):  
Wei Kong ◽  
Raymond E. Ideker ◽  
Vladimir G. Fast
Keyword(s):  
Ventricular Fibrillation ◽  
Action Potential ◽  
Short Duration ◽  
Action Potential Duration ◽  
Cycle Length ◽  
The Other ◽  
Membrane Voltage ◽  
Long Duration ◽  
Intracellular Ca ◽  
Rapid Pacing

Intramural gradients of intracellular Ca2+ (Cai2+) Cai2+ handling, Cai2+ oscillations, and Cai2+ transient (CaT) alternans may be important in long-duration ventricular fibrillation (LDVF). However, previous studies of Cai2+ handling have been limited to recordings from the heart surface during short-duration ventricular fibrillation. To examine whether abnormalities of intramural Cai2+ handling contribute to LDVF, we measured membrane voltage ( Vm) and Cai2+ during pacing and LDVF in six perfused canine hearts using five eight-fiber optrodes. Measurements were grouped into epicardial, midwall, and endocardial layers. We found that during pacing at 350-ms cycle length, CaT duration was slightly longer (by ≃10%) in endocardial layers than in epicardial layers, whereas action potential duration (APD) exhibited no difference. Rapid pacing at 150-ms cycle length caused alternans in both APD (APD-ALT) and CaT amplitude (CaA-ALT) without significant transmural differences. For 93% of optrode recordings, CaA-ALT was transmurally concordant, whereas APD-ALT was either concordant (36%) or discordant (54%), suggesting that APD-ALT was not caused by CaA-ALT. During LDVF, Vm and Cai2+ progressively desynchronized when not every action potential was followed by a CaT. Such desynchronization developed faster in the epicardium than in the other layers. In addition, CaT duration strongly increased (by ∼240% at 5 min of LDVF), whereas APD shortened (by ∼17%). CaT rises always followed Vm upstrokes during pacing and LDVF. In conclusion, the fact that Vm upstrokes always preceded CaTs indicates that spontaneous Cai2+ oscillations in the working myocardium were not likely the reason for LDVF maintenance. Strong Vm-Cai2+ desynchronization and the occurrence of long CaTs during LDVF indicate severely impaired Cai2+ handling and may potentially contribute to LDVF maintenance.

scholarly journals Timolol 0.1% in Glaucomatous Patients: Efficacy, Tolerance, and Quality of Life

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Letizia Negri ◽  
Antonio Ferreras ◽  
Michele Iester
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Beta Blockers ◽  
The Other ◽  
Visual Field Defects ◽  
Market Beta ◽  
Systemic Side Effects ◽  
The Impact ◽  
Preservative Free

Glaucoma is a progressive, chronic optic neuropathy characterized by a typical visual field defects. Four main classes of topical medication are actually available on the market: beta-blockers, prostaglandins, alpha2-agonists, and topical carbonic anhydrase inhibitor to treat intraocular pressure (IOP). The aim of this review is to outline the efficacy of timolol and to evaluate the impact of this treatment on patients’ quality of life. Among beta-blockers, timolol is most used at three different concentrations: 0.1%, 0.25%, and 0.5%. While the first one is a gel, the other two products are solution. Timolol has few topical side effects, while it has some important systemic side effects on the cardiac and respiratory systems. The balance between efficacy and safety is always the main aspect to care patients. Because of the less efficacy of timolol 0.1% solution, the possibility to use carbomers as vehicle in the gel drops helped timolol 0.1 to be used in clinics, extending the time contact between the active ingredient and the surface of the cornea. Using preservative-free timolol 0.1 for treatment, IOP was at the same level of the other beta-blockers at higher concentration, but it was better tolerated. Preservative-free treatment improved the quality of life reducing dry-eye like symptoms; furthermore, the presence of an artificial tear in the medication bottle could help adherence. The once daily dosing improves compliance.

scholarly journals Importance and Assessment of Quality of Life in Symptomatic Permanent Atrial Fibrillation: Patient Focus Groups from the RATE-AF Trial

Cardiology ◽  
2020 ◽  
Vol 145 (10) ◽  
pp. 666-675 ◽  
Author(s):  
Jacqueline Jones ◽  
Mary Stanbury ◽  
Sandra Haynes ◽  
Karina V. Bunting ◽  
Trudie Lobban ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Focus Groups ◽  
Atrial Fibrillation Patient ◽  
Beta Blockers ◽  
Nyha Class ◽  
Symptom Burden ◽  
Routine Practice ◽  
The Impact

Aims: To establish the extent and impact of symptoms in patients with atrial fibrillation (AF), the importance of different aspects of quality of life (QoL), and how we should assess wellbeing. Methods: Focus groups of patients with symptomatic permanent AF in a trial of heart rate control; the RATE-AF trial randomised 160 patients aged ≥60 years with permanent AF and at least NYHA class II dyspnoea to either digoxin or beta-blockers. Patient and public representatives led the focus groups and performed all data acquisition and analysis, using thematic approaches to interpret patient views about QoL and its measurement. Results: Substantial impairment of health-related QoL was noted in 160 trial patients, with impact on all domains apart from mental health. Eight women and 11 men aged 61–87 years participated in the focus groups. Common themes were a lack of information from healthcare professionals about AF, a lack of focus on QoL in consultations, and a sense of frustration, isolation, and reduced confidence. There was marked variability in symptoms in individual patients, with some describing severe impact on activities of daily living, and profound interaction with comorbidities such as arthritis. Day-to-day variation in QoL and difficulty in attributing symptom burden to AF or other comorbidities led to challenges in questionnaire completion. Consensus was reached that collecting both general and AF-specific QoL would be useful in routine practice, along with participation in peer support, which was empowering for the patients. Conclusions: The impact of comorbidities is poorly appreciated in the context of AF, with considerable variability in QoL that requires both generic and AF-specific assessment. Improvement in QoL should direct the appraisal, and reappraisal, of treatment decisions for patients with permanent AF.

scholarly journals The Impact of Beta Blockers on Survival in Heart Transplant Recipients: Insights from the Zabrze HTx Registry

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Grzegorz M. Kubiak ◽  
Radosław Kwieciński ◽  
Agnieszka Ciarka ◽  
Andrzej Tukiendorf ◽  
Piotr Przybyłowski ◽  
...  
Keyword(s):  
Beta Blockers ◽  
Rank Test ◽  
Proportional Hazard ◽  
Transplant Recipients ◽  
Entire Cohort ◽  
Reactive Protein ◽  
Cox Proportional Hazard ◽  
Log Rank Test ◽  
Cox Proportional Hazard Regression ◽  
The Impact

Introduction. The data assessing the impact of beta blocker (BB) medication on survival in patients after heart transplantation (HTx) are scarce and unequivocal; therefore, we investigated this population. Methods. We retrospectively analyzed the HTx Zabrze Registry of 380 consecutive patients who survived the 30-day postoperative period. Results. The percentage of patients from the entire cohort taking BBs was as follows: atenolol 24 (17%), bisoprolol 67 (49%), carvedilol 11 (8%), metoprolol 28 (20%), and nebivolol 8 (6%). The patients receiving BBs were older (56.94 ± 14.68 years vs. 52.70 ± 15.35 years, p=0.008) and experienced an onset of HTx earlier in years (11.65 ± 7.04 vs. 7.24 ± 5.78 p≤0.001). They also had higher hematocrit (0.40 ± 0.05 vs. 0.39 ± 0.05, p=0.022) and red blood cells (4.63 (106/μl) ± 0.71 vs. 4.45 (106/μl) ± 0.68, p=0.015). Survival according to BB medication did not differ among the groups (p=0.655) (log-rank test). Univariate Cox proportional hazard regression analysis revealed that the following parameters were associated with unfavorable diagnosis: serum concentration of albumin (g/l) HR: 0.87, 95% CI (0.81–0.94), p=0.0004; fibrinogen (mg/dl) HR: 1.006, 95% CI (1.002–1.008), p=0.0017; and C-reactive protein (mg/l) HR: 1.014, 95% CI (1.004–1.023), p=0.0044. Conclusions. The use of BBs in our cohort of patients after HTx was not associated with survival benefits.

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