2,697 publications from this institution
There was a significant longitudinal and causal relationship between neuroticism and AF. An integrated care including active mental health screening and management may benefit in high-risk populations.
There is a U-shaped relationship between initial blood pressure at ischaemic stroke presentation and the risk of subsequent SHS.
Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation (PG/05/036) Primary Care Research Network-Central England. Background Blood pressure (BP, mmHg) targets have been mainly determined based on the white ethnic group. Optimal BP levels have been less established in people of South Asian and African Caribbean origin. There is less data on how different office BP values influence the presence of cardiac target organ damage, left ventricular hypertrophy (LVH) and diastolic dysfunction (DD). Methods This study is based on the large prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES, South Asian and African-Caribbean origin, age ≥45 years). Echocardiography was used to diagnose LVH and DD following British Echocardiographic Society criteria. Optimal receiver operator curves (ROC) cut-off values for predicting LVH and DD were determined using the Leu method. Multivariable logistic regression, adjusted for age and sex, was used to determine the effects of different BP values for LVH and DD, using SBP 130-<140 and DBP 80-<90 as comparators (STATA 13). Results The study included 3200 South Asians (age 59±10, 52% women), of whom 1568 (49%) had LVH, and 1497 (47%) had diastolic dysfunction. Of people with LVH, 869 (55%) had SBP >140, and 372 (24%) had DBP >90. The optimal BP cut-off for ROC analysis was 139/80.5 for LVH and 139/80.5 for diastolic dysfunction. SBP <130 and DBP <80 were both associated with a 31% reduction in diastolic dysfunction (Table). BP ≥140/90 was strongly predictive of LVH and DD. The study included 1922 African Caribbeans (62±12 age, 55% women), of whom 1186 (62%) had LVH and 1124 (58%) had DD. Of people with LVH, 778 (66%) had SBP >140, and 333 (28%) had DBP >90. The optimal BP cut-off for ROC analysis were 139/81.5 for LVH and 138/80.5 for DD. DBP <80 mmHg 27% reduction in LVH and 24% in DD (Table). BP ≥140/90 was strongly predictive of LVH and DD. Conclusions People of South Asian origin may benefit from stricter SBP (<130) control, and both ethnic groups may benefit from stricter DBP (<80) control.
BACKGROUND: This retrospective cohort study evaluated whether long term outcome of atrial resynchronisation therapy using bi-atrial pacing (BiaP) to treat atrial fibrillation (AF) was effective in patients deemed unfit for left atrial (LA) ablation procedures. METHODS AND RESULTS: The patient population comprised 2 groups: those deemed suitable for left LA ablation (n=14) and those who were not (n = 17). Both groups underwent BiaP and outcomes were evaluated by comparing symptoms, AF duration, admissions and antiarrhythmic drugs (AAD) for an equal period of time pre and post implantation. Median follow-up was 24 months (range 8-66 months) for the unsuitable group and 31 months (range 7-84 months) for the suitable group. Efficacy in reduction of both AF and symptoms was similar (P = 0.44) in both groups (unsuitable group: 13/17; suitable group: 8/14). There was significant improvement in median AF episodes/week pre and post BiaP in both groups (unsuitable group AF reduction: 5 days/week, P = 0.001; suitable group AF reduction: 4.9 days/week, P = 0.03); the improvement was similar in both groups (P = 0.33). There was a significant reduction in the median number of admissions for AF in both groups (unsuitable group: P = 0.003; suitable group: P = 0.01) and this reduction was also similar (P = 0.70). The median number of AAD was also reduced to a similar degree (P = 0.83) in both groups (suitable group: P = 0.004; unsuitable group: P = 0.001). CONCLUSIONS: Atrial resynchronisation therapy is effective in the long term management of drug-resistant AF in patients unsuitable for LA ablation, leading to significant reductions in symptoms, AF duration, admissions and AAD.
