10 results on '"Iain Squire"'
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2. Does home oxygen therapy (HOT) in addition to standard care reduce disease severity and improve symptoms in people with chronic heart failure? A randomised trial of home oxygen therapy for patients with chronic heart failure
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Andrew L Clark, Miriam Johnson, Caroline Fairhurst, David Torgerson, Sarah Cockayne, Sara Rodgers, Susan Griffin, Victoria Allgar, Lesley Jones, Samantha Nabb, Ian Harvey, Iain Squire, Jerry Murphy, and Michael Greenstone
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heart failure ,home oxygen therapy ,health-related quality of life ,minnesota living with heart failure questionnaire ,Medical technology ,R855-855.5 - Abstract
Background: Home oxygen therapy (HOT) is commonly used for patients with severe chronic heart failure (CHF) who have intractable breathlessness. There is no trial evidence to support its use. Objectives: To detect whether or not there was a quality-of-life benefit from HOT given as long-term oxygen therapy (LTOT) for at least 15 hours per day in the home, including overnight hours, compared with best medical therapy (BMT) in patients with severely symptomatic CHF. Design: A pragmatic, two-arm, randomised controlled trial recruiting patients with severe CHF. It included a linked qualitative substudy to assess the views of patients using home oxygen, and a free-standing substudy to assess the haemodynamic effects of acute oxygen administration. Setting: Heart failure outpatient clinics in hospital or the community, in a range of urban and rural settings. Participants: Patients had to have heart failure from any aetiology, New York Heart Association (NYHA) class III/IV symptoms, at least moderate left ventricular systolic dysfunction, and be receiving maximally tolerated medical management. Patients were excluded if they had had a cardiac resynchronisation therapy device implanted within the past 3 months, chronic obstructive pulmonary disease fulfilling the criteria for LTOT or malignant disease that would impair survival or were using a device or medication that would impede their ability to use LTOT. Interventions: Patients received BMT and were randomised (unblinded) to open-label LTOT, prescribed for 15 hours per day including overnight hours, or no oxygen therapy. Main outcome measures: The primary end point was quality of life as measured by the Minnesota Living with Heart Failure (MLwHF) questionnaire score at 6 months. Secondary outcomes included assessing the effect of LTOT on patient symptoms and disease severity, and assessing its acceptability to patients and carers. Results: Between April 2012 and February 2014, 114 patients were randomised to receive either LTOT or BMT. The mean age was 72.3 years [standard deviation (SD) 11.3 years] and 70% were male. Ischaemic heart disease was the cause of heart failure in 84%; 95% were in NYHA class III; the mean left ventricular ejection fraction was 27.8%; and the median N-terminal pro-B-type natriuretic hormone was 2203 ng/l. The primary analysis used a covariance pattern mixed model which included patients only if they provided data for all baseline covariates adjusted for in the model and outcome data for at least one post-randomisation time point (n = 102: intervention, n = 51; control, n = 51). There was no difference in the MLwHF questionnaire score at 6 months between the two arms [at baseline the mean score was 54.0 (SD 18.4) for LTOT and 54.0 (SD 17.9) for BMT; at 6 months the mean score was 48.1 (SD 18.5) for LTOT and 49.0 (SD 20.2) for BMT; adjusted mean difference –0.10, 95% confidence interval (CI) –6.88 to 6.69; p = 0.98]. At 3 months, the adjusted mean MLwHF questionnaire score was lower in the LTOT group (–5.47, 95% CI –10.54 to –0.41; p = 0.03) and breathlessness scores improved, although the effect did not persist to 6 months. There was no effect of LTOT on any secondary measure. There was a greater number of deaths in the BMT arm (n = 12 vs. n = 6). Adherence was poor, with only 11% of patients reporting using the oxygen as prescribed. Conclusions: Although the study was significantly underpowered, HOT prescribed for 15 hours per day and subsequently used for a mean of 5.4 hours per day has no impact on quality of life as measured by the MLwHF questionnaire score at 6 months. Suggestions for future research include (1) a trial of patients with severe heart failure randomised to have emergency oxygen supply in the house, supplied by cylinders rather than an oxygen concentrator, powered to detect a reduction in admissions to hospital, and (2) a study of bed-bound patients with heart failure who are in the last few weeks of life, powered to detect changes in symptom severity. Trial registration: Current Controlled Trials ISRCTN60260702. Funding: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 75. See the NIHR Journals Library website for further project information.
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- 2015
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3. Developing a core outcome set for patient-reported symptom monitoring to reduce hospital admissions for patients with heart failure
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Claire A Lawson, Carolyn Lam, Tiny Jaarsma, Umesh Kadam, Anna Stromberg, Mohammad Ali, Wan Ting Tay, Louise Clayton, Kamlesh Khunti, Iain Squire, and Cardiovascular Centre (CVC)
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Advanced and Specialized Nursing ,Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi ,RISK ,HEALTH-STATUS ,Consensus ,Delphi Technique ,MORTALITY ,Heart failure ,Health Care Service and Management, Health Policy and Services and Health Economy ,CARE ,DEPRESSION ,DIAGNOSIS ,Hospitals ,Hospitalization ,PROGNOSTIC VALUE ,Medical–Surgical Nursing ,Patient-reported outcomes measures ,Outcome Assessment, Health Care ,Humans ,ANXIETY ,Patient Reported Outcome Measures ,Cardiology and Cardiovascular Medicine ,BURDEN - Abstract
Aims In patients with heart failure (HF), hospitalization rates are increasing, particularly for non-HF causes and over half may be avoidable. Self-monitoring of symptoms plays a key part in the early identification of deterioration. Our objective was to develop expert consensus for a core outcome set (COS) of symptoms to be monitored by patients, using validated single-item patient-reported outcome measures (PROMs), focused on the key priority of reducing admissions in HF. Methods and results A rigorous COS development process incorporating systematic review, modified e-Delphi and nominal group technique (NGT) methods. Participants included 24 HF patients, 4 carers, 29 HF nurses, and 9 doctors. In three Delphi and NGT rounds, participants rated potential outcomes on their importance before a HF or a non-HF admission using a 5-point Likert scale. Opinion change between rounds was assessed and a two-thirds threshold was used for outcome selection. Item generation using systematic review identified 100 validated single-item PROMs covering 34 symptoms or signs, relevant to admission for people with HF. De-duplication and formal consensus processes, resulted in a COS comprising eight symptoms and signs; shortness of breath, arm or leg swelling, abdomen bloating, palpitations, weight gain, chest pain, anxiety, and overall health. In the NGT, a numerical rating scale was selected as the optimal approach to symptom monitoring. Conclusion Recognition of a range of HF-specific and general symptoms, alongside comorbidities, is an important consideration for admission prevention. Further work is needed to validate and integrate the COS in routine care with the aim of facilitating faster identification of clinical deterioration.
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- 2022
4. NT-proBNP Response to Sacubitril/Valsartan in Hospitalized Heart Failure Patients With Reduced Ejection Fraction
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Domingo Pascual-Figal, Rolf Wachter, Michele Senni, Weibin Bao, Adele Noè, Heike Schwende, Dmytro Butylin, Margaret F. Prescott, Jacek Gniot, Maria Mozheiko, Malgorzata Lelonek, Antonio Reyes Dominguez, Thomas Horacek, Enrique Garcia del Rio, Zhanna Kobalava, Christian Eugen Mueller, Yuksel Cavusoglu, Ewa Straburzynska-Migaj, Miroslav Slanina, Juergen vom Dahl, Alisdair Ryding, Andrew Moriarty, Manuel Beltran Robles, Julio Nunez Villota, Antonio Garcia Quintana, Thorsten Nitschke, Jose Manuel Garcia Pinilla, Luis Almenar Bonet, Said Chaaban, Samia Filali zaatari, Jindrich Spinar, Wlodzimierz Musial, Khaled Abdelbaki, Jan Belohlavek, Wolfgang Fehske, Michael Carlos Bott, Geir Hoegalmen, Marisa Crespo Leiro, Ismail Turkay Ozcan, Wilfried Mullens, Radim Kryza, Riadh Al-Ani, Krystyna Loboz-Grudzien, Lyudmila Ermoshkina, Silvia Hojerova, Alberto Alfredo Fernandez, Lenka Spinarova, Harald Lapp, Efraim Bulut, Filipa Almeida, Alexander Vishnevsky, Margita Belicova, Domingo Pascual, Klaus Witte, Kenneth Wong, Walter Droogne, Marc Delforge, Martin Peterka, Hans-Georg Olbrich, Stefano Carugo, Jadwiga Nessler, Thao Huynh McGill, Burkhard Huegl, Ibrahim Akin, Ilidio Moreira, Andrey Baglikov, Jeetendra Thambyrajah, Chris Hayes, Marcelo Raul Barrionuevo, Zerrin Yigit, Hakki Kaya, Zdenek Klimsa, Martin Radvan, Christoph Kadel, Ulf Landmesser, Giuseppe Di Tano, Malgorzata Buksinska Lisik, Candida Fonseca, Luis Oliveira, Irene Marques, Luis Miguel Santos, Egon Lenner, Peter Letavay, Manuel Gomez Bueno, Paula Mota, Aaron Wong, Kristian Bailey, Paul Foley, Eduardo Hasbani, Sean Virani, Tony Abdel Massih, Shukri Al-Saif, Milos Taborsky, Marta Kaislerova, Zuzana Motovska, Aron Ariel Cohen, Damien Logeart, Dierk Endemann, Daniel Ferreira, Dulce Brito, Peter Kycina, Entela Bollano, Enrique Galve Basilio, Lorenzo Facila Rubio, Marcos Garcia Aguado, Lilia Beatriz Schiavi, Daniel Francisco Zivano, Eva Lonn, Ali El Sayed, Anne-Catherine Pouleur, Alex Heyse, Alexandr Schee, Rostislav Polasek, Marek Houra, Christophe Tribouilloy, Marie France Seronde, Michel Galinier, Michel Noutsias, Peter Schwimmbeck, Ingo Voigt, Dirk Westermann, Giovanni Pulignano, Johnny Vegsundvaag, Jose Alexandre Da Silva Antunes, Pedro Monteiro, Jan Stevlik, Eva Goncalvesova, Beata Hulkoova, Antonio Juan Castro Fernandez, Ceri Davies, Iain Squire, Philippe Meyer, Richard Sheppard, Tayfun Sahin, Karel Sochor, Guillaume De Geeter, Alexander Schmeisser, Joachim Weil, Ana Oliveira Soares, Olga Bulashova Vasilevna, Andrey Oshurkov, Shahid Junejo Sunderland, Jason Glover, Tomas Exequiel, Eric Decoulx, Sven Meyer, Thomas Muenzel, Fernando Frioes, Georgy Arbolishvili, Anna Tokarcikova, Patric Karlstrom, Joan Carles Trullas Vila, Gonzalo Pena Perez, Rajiv Sankaranarayanan, Thuraia Nageh, Diego Cristian Alasia, Marwan Refaat, Burcu Demirkan, Jehad Al-Buraiki, and Shadi Karabsheh
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medicine.medical_specialty ,Ejection fraction ,Acute decompensated heart failure ,business.industry ,medicine.drug_class ,030204 cardiovascular system & hematology ,medicine.disease ,Sacubitril ,03 medical and health sciences ,0302 clinical medicine ,Valsartan ,Heart failure ,Internal medicine ,Natriuretic peptide ,Cardiology ,Medicine ,Decompensation ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,hormones, hormone substitutes, and hormone antagonists ,Sacubitril, Valsartan ,medicine.drug - Abstract
Objectives This study examined the effects of sacubitril/valsartan on N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels and determined patient characteristics associated with favorable NT-proBNP reduction response. Background NT-proBNP levels reflect cardiac wall stress and predict event risk in patients with acute decompensated heart failure (ADHF). Methods Post-hoc analysis of the TRANSITION (Comparison of Pre- and Post-discharge Initiation of Sacubitril/Valsartan Therapy in HFrEF Patients After an Acute Decompensation Event) study, including stabilized ADHF patients with reduced ejection fraction, randomized to open-label sacubitril/valsartan initiation in-hospital (pre-discharge) versus post-discharge. NT-proBNP was measured at randomization (baseline), discharge, and 4 and 10 weeks post-randomization. A favorable NT-proBNP response was defined as reduction to ≤1,000 pg/ml or >30% from baseline. Results In patients receiving sacubitril/valsartan in-hospital, NT-proBNP was reduced by 28% at discharge, with 46% of patients obtaining favorable NT-proBNP reduction response compared with a 4% reduction and 18% favorable response rate in patients initiated post-discharge (p Conclusions In-hospital initiation of sacubitril/valsartan produced rapid reductions in NT-proBNP, statistically significant at discharge. A favorable NT-proBNP response over time was associated with a better prognosis and predicted by higher starting dose and predisposing clinical profile. (Comparison of Pre- and Post-discharge Initiation of LCZ696 Therapy in HFrEF Patients After an Acute Decompensation Event [TRANSITION]; NCT02661217)
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- 2020
5. Empagliflozin in heart failure with a preserved ejection fraction
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Bela Merkely, Nikolaus Marx, Subodh Verma, Michele Senni, Eduardo Chuquiure-Valenzuela, James L. Januzzi, Vijay K. Chopra, Dong-Ju Choi, Stefan D. Anker, Stefano Taddei, Ileana L. Piña, Juan Esteban Gomez-Mesa, Jose R Gonzalez-Juanatey, Dragos Vinereanu, Sergio V. Perrone, Faiez Zannad, Jian Zhang, Carolyn Su Ping Lam, Stuart J. Pocock, Stefan Janssens, Iain Squire, Waheed Jamal, Hans-Peter Brunner-La Rocca, Peter E. Carson, Javed Butler, David K.L. Sim, EMPEROR-Preserved Trial Investigators, Stephen J. Nicholls, Hiroyuki Tsutsui, Janet Schnee, Martina Brueckmann, João Pedro Ferreira, Piotr Ponikowski, Naveed Sattar, Gerasimos Filippatos, Sven Schnaidt, Edimar Bocchi, Michael Böhm, Jindrich Spinar, Cordula Zeller, Nadia Giannetti, Milton Packer, Anker, S, Butler, J, Filippatos, G, Ferreira, J, Bocchi, E, Böhm, M, Brunner-La Rocca, H, Choi, D, Chopra, V, Chuquiure-Valenzuela, E, Giannetti, N, Gomez-Mesa, J, Janssens, S, Januzzi, J, Gonzalez-Juanatey, J, Merkely, B, Nicholls, S, Perrone, S, Piña, I, Ponikowski, P, Senni, M, Sim, D, Spinar, J, Squire, I, Taddei, S, Tsutsui, H, Verma, S, Vinereanu, D, Zhang, J, Carson, P, Lam, C, Marx, N, Zeller, C, Sattar, N, Jamal, W, Schnaidt, S, Schnee, J, Brueckmann, M, Pocock, S, Zannad, F, Packer, M, EMPEROR-Preserved Trial, I, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), and RS: Carim - H02 Cardiomyopathy
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Adult ,Male ,medicine.medical_specialty ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Empagliflozin ,Preserved Ejection Fraction ,Placebo ,chemistry.chemical_compound ,All institutes and research themes of the Radboud University Medical Center ,Double-Blind Method ,Glucosides ,Diabetes mellitus ,Internal medicine ,medicine ,Humans ,Benzhydryl Compounds ,Sodium-Glucose Transporter 2 Inhibitors ,Heart Failure ,Ejection fraction ,business.industry ,Hazard ratio ,Stroke Volume ,General Medicine ,Stroke volume ,medicine.disease ,SPIRONOLACTONE ,Hospitalization ,chemistry ,Cardiovascular Diseases ,Heart failure ,Chronic Disease ,Cardiology ,Spironolactone ,Female ,business - Abstract
Item does not contain fulltext BACKGROUND: Sodium-glucose cotransporter 2 inhibitors reduce the risk of hospitalization for heart failure in patients with heart failure and a reduced ejection fraction, but their effects in patients with heart failure and a preserved ejection fraction are uncertain. METHODS: In this double-blind trial, we randomly assigned 5988 patients with class II-IV heart failure and an ejection fraction of more than 40% to receive empagliflozin (10 mg once daily) or placebo, in addition to usual therapy. The primary outcome was a composite of cardiovascular death or hospitalization for heart failure. RESULTS: Over a median of 26.2 months, a primary outcome event occurred in 415 of 2997 patients (13.8%) in the empagliflozin group and in 511 of 2991 patients (17.1%) in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.69 to 0.90; P
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- 2021
6. Evidence-based drug treatment of chronic heart failure
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Iain Squire
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Drug ,medicine.medical_specialty ,Evidence-based practice ,business.industry ,media_common.quotation_subject ,Pharmacology (nursing) ,medicine.disease ,Drug treatment ,Heart failure ,Internal medicine ,medicine ,Cardiology ,Pharmacology (medical) ,Intensive care medicine ,business ,media_common - Abstract
A wide range of drugs to treat heart failure is available, and an evidence-based approach to management is now possible. Our Drug review discusses the properties and side-effects of the various drug groups, followed by sources of further information. Copyright © 2009 Wiley Interface Ltd
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- 2009
7. Comparing LCZ696 with enalapril according to baseline risk using the MAGGIC and EMPHASIS-HF risk scores: an analysis of mortality and morbidity in PARADIGM-HF
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Joanne, Simpson, Pardeep S, Jhund, Jose, Silva Cardoso, Felipe, Martinez, Arend, Mosterd, Felix, Ramires, Adel R, Rizkala, Michele, Senni, Iain, Squire, Jianjian, Gong, Martin P, Lefkowitz, Victor C, Shi, Akshay S, Desai, Jean L, Rouleau, Karl, Swedberg, Michael R, Zile, John J V, McMurray, Milton, Packer, and Scott D, Solomon
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Adult ,Aged, 80 and over ,Heart Failure ,Male ,Adolescent ,Aminobutyrates ,Biphenyl Compounds ,Tetrazoles ,Angiotensin-Converting Enzyme Inhibitors ,Middle Aged ,Global Health ,Prognosis ,Risk Assessment ,Survival Rate ,Angiotensin Receptor Antagonists ,Drug Combinations ,Young Adult ,Enalapril ,Humans ,Valsartan ,Female ,Neprilysin ,Prospective Studies ,Morbidity ,Aged - Abstract
Although most patients in the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial had mild symptoms, there is a poor correlation between reported functional limitation and prognosis in heart failure.The aim of this study was to examine the spectrum of risk in PARADIGM-HF and the effect of LCZ696 across that spectrum.This study analyzed rates of the primary composite outcome of cardiovascular death or heart failure hospitalization, its components, and all-cause mortality using the MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) and EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure) risk scores to categorize patients. The authors determined whether risk, on the basis of these scores, modified the treatment effect of LCZ696.The complete MAGGIC risk score was available for 8,375 of the 8,399 patients in PARADIGM-HF. The median MAGGIC score was 20 (IQR: 16 to 24). An increase of 1 point was associated with a 6% increased risk for the primary endpoint (p 0.001) and a 7% increased risk for cardiovascular death (p 0.001). The benefit of LCZ696 over enalapril for the primary endpoint was similar across the spectrum of risk (p = 0.159). Treating 100 patients for 2 years with LCZ696 instead of enalapril led to 7 fewer patients in the highest quintile of risk experiencing primary outcomes, compared with 3 in the lowest quintile. Analyses using the EMPHASIS-HF risk score gave similar findings.Although most PARADIGM-HF patients had mild symptoms, many were at high risk for adverse outcomes and obtained a large absolute benefit from LCZ696, compared with enalapril, over a relatively short treatment period. LCZ696's benefit was consistent across the spectrum of risk. (PARADIGM-HF trial [Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure]; NCT01035255).
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- 2015
8. Is heart rate a risk marker in patients with chronic heart failure and concomitant atrial fibrillation? Results from the MAGGIC meta-analysis
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Joanne, Simpson, Davide, Castagno, Rob N, Doughty, Katrina K, Poppe, Nikki, Earle, Iain, Squire, Mark, Richards, Bert, Andersson, Justin A, Ezekowitz, Michel, Komajda, Mark C, Petrie, Finlay A, McAlister, Greg D, Gamble, Gillian A, Whalley, John J V, McMurray, and F, Gude
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Male ,Adrenergic beta-Antagonists ,Statistics as Topic ,heart failure ,Stroke Volume ,preserved ejection fraction ,Atrial fibrillation ,Heart failure ,Heart rate ,Preserved ejection fraction ,Prognosis ,Cardiology and Cardiovascular Medicine ,Risk Factors ,Cause of Death ,Hypertension ,heart rate ,Humans ,Female ,atrial fibrillation ,prognosis ,Aged ,Proportional Hazards Models - Abstract
Aim: To investigate the relationship between heart rate and survival in patients with heart failure (HF) and coexisting atrial fibrillation (AF). Methods and Results: Patients with AF included in the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) meta-analysis were the main focus of this analysis (3259 patients from 17 studies). The outcome was all-cause mortality at 3 years. Heart rate was analysed as a categorical (tertiles; T1 ≤77 b.p.m., T2 78–98 b.p.m., T3 ≥98 b.p.m.) and continuous variable. Cox proportional hazard models were used to compare the risk of all-cause death between tertiles of baseline heart rate. Patients in the highest tertile were more often female, less likely to have an ischaemic aetiology or diabetes, had a lower ejection fraction but higher blood pressure and New York Heart Association (NYHA) class. Higher heart rate was associated with higher mortality in patients with sinus rhythm (SR) but not in those in AF. In patients with heart failure and reduced ejection fraction (HF-REF) and AF, death rates per 100 patient years were lowest in the highest heart rate tertile (T1 18.9 vs. T3 15.9) but this difference was not statistically significant (P = 0.10). In patients with heart failure and preserved ejection fraction (HF-PEF), death rates per 100 patient years were highest in the highest heart rate tertile (T1 14.6 vs. T3 16.0, P = 0.014). However, after adjustment for other important prognostic variables, higher heart rate was no longer associated with higher mortality in HF-PEF (or HF-REF). Conclusions: In this meta-analysis of patients with HF, heart rate does not have the same prognostic significance in patients in AF as it does in those in SR, irrespective of ejection fraction or treatment with beta-blocker.
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- 2015
9. Current drug management of chronic heart failure
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Iain Squire
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Drug ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,medicine.medical_treatment ,Pharmacology (nursing) ,medicine.disease ,Internal medicine ,Heart failure ,ACE inhibitor ,medicine ,Cardiology ,Pharmacology (medical) ,Diuretic ,Intensive care medicine ,business ,media_common ,medicine.drug - Abstract
For most patients with heart failure, treatment will now include a diuretic, an ACE inhibitor or angiotensin-II inhibitor and a beta-blocker. Our Drug review discusses the properties and side-effects of the wide range of drugs available, followed by sources of further information and the Datafile. Copyright © 2006 Wiley Interface Ltd
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- 2006
10. Chapter 1 Aetiology and epidemiology of chronic heart failure
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Iain Squire
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medicine.medical_specialty ,business.industry ,Heart failure ,Epidemiology ,Etiology ,medicine ,Intensive care medicine ,medicine.disease ,business - Published
- 2008
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