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  • 1
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    Amiodarone in the New AHA Guidelines for Ventricular Tachyarrhythmias
    SAGE Publications ; 2001
    In:  Annals of Pharmacotherapy Vol. 35, No. 10 ( 2001-10), p. 1248-1254
    Details
    In: Annals of Pharmacotherapy, SAGE Publications, Vol. 35, No. 10 ( 2001-10), p. 1248-1254
    Abstract: To delineate amiodarone's role in the new American Heart Association guidelines for ventricular tachyarrhythmias, review the literature that supports the use of amiodarone in ventricular tachyarrhythmias, describe the pharmaceutical properties of amiodarone and elucidate their clinical implications, and discuss the dosing, preparation, and administration of amiodarone. DATA SOURCES: A search of MEDLINE (1966–October 2000) database and EMBASE Drugs and Pharmacology database (1980–October 2000) was performed. References from published articles and tertiary references were used to gather additional data. DATA EXTRACTION: All articles were screened, and pertinent studies were identified and evaluated. DATA SYNTHESIS: Recent trials have demonstrated amiodarone's usefulness in the setting of ventricular tachyarrhythmias. Based on these investigations and contrary to past guidelines, amiodarone is included in the 2000 advanced cardiovascular life support guidelines as a possible agent for hemodynamically stable monomorphic ventricular tachycardia (VT), non-QT prolonged polymorphic VT, and ventricular fibrillation (VF)/pulseless VT. Although not specifically evaluated in the setting of hemodynamically stable monomorphic VT and non-QT prolonged polymorphic VT, investigations by the Intravenous Amiodarone Multicenter Trial Group and other clinical trials make amiodarone an acceptable choice for these arrhythmia categories. The results of the ARREST (Resuscitation of Refractory Sustained Ventricular Tachyarrhythmias) trial prove amiodarone to be the antiarrhythmic of choice for VF/pulseless VT. CONCLUSIONS: Amiodarone is classified as a IIb therapeutic intervention for all three arrhythmia categories, which makes it an acceptable, safe, and useful agent with fair to good evidence to support its use. In addition, amiodarone requires careful preparation and delivery to achieve safe and effective outcomes.
    Type of Medium: Online Resource
    ISSN: 1060-0280 , 1542-6270
    URL: Article
    DOI: 10.1345/aph.10407
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2001
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  • 2
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    Effect of Prophylactic Amiodarone on Clinical and Economic Outcomes After Cardiothoracic Surgery: A Meta-Analysis
    SAGE Publications ; 2005
    In:  Annals of Pharmacotherapy Vol. 39, No. 9 ( 2005-09), p. 1409-1415
    Details
    In: Annals of Pharmacotherapy, SAGE Publications, Vol. 39, No. 9 ( 2005-09), p. 1409-1415
    Abstract: Two previous meta-analyses of amiodarone for prevention of postoperative atrial fibrillation (POAF) after cardiothoracic surgery did not evaluate total hospital cost, concluded that data on stroke are incomplete, and did not evaluate the effect of clinical heterogeneity between trials. OBJECTIVE: To conduct a meta-analysis examining amiodarone's prophylactic impact on cardiothoracic surgery POAF, length of stay (LOS), stroke, and total costs. METHODS: Three reviewers conducted a systematic literature search of MEDLINE, EMBASE, CINAHL, and the Cochrane Library (1966–September 2004%). Studies were included if they met the following criteria: (1%) randomized controlled trial versus placebo/routine treatment, (2%) coronary artery bypass graft and/or valvular surgery, (3%) Jadad score ≥3, (4%) reported data on incidence of POAF or stroke, LOS, or total costs, (5%) used electrocardiographic/Holter monitoring, and (6%) monitored subjects for ≥2 days. A random-effects model was utilized. Subgroup and sensitivity analyses were conducted. RESULTS: Fifteen trials were identified, including 1512 and 1429 patients in the amiodarone and control groups, respectively. Amiodarone reduced POAF (OR 0.50; 95% CI 0.42 to 0.60%) and decreased stroke (n = 8 studies), LOS (n = 10%), and total costs (n = 6%) (OR 0.47; 95% CI 0.23 to 0.96; −0.73 days, 95% CI −0.95 to −0.51; and –$1619, 95% CI −3395 to 156, respectively). Surgery type, β-blocker use, route of administration, use of a fixed-effects model, or exclusion of unblinded/unpublished studies did not affect the overall results. No statistical heterogeneity was observed for any endpoint evaluated (p 〉 0.22 for all comparisons). CONCLUSIONS: Prophylactic treatment with amiodarone decreases patients' risk of POAF and stroke while reducing LOS.
    Type of Medium: Online Resource
    ISSN: 1060-0280 , 1542-6270
    URL: Article
    DOI: 10.1345/aph.1E592
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2005
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  • 3
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    Hemodynamic and Electrocardiographic Effects of Short-Term Ginkgo Biloba
    SAGE Publications ; 2003
    In:  Annals of Pharmacotherapy Vol. 37, No. 3 ( 2003-03), p. 345-349
    Details
    In: Annals of Pharmacotherapy, SAGE Publications, Vol. 37, No. 3 ( 2003-03), p. 345-349
    Abstract: To evaluate the immediate and short-term hemodynamic and electrocardiographic effects of Ginkgo biloba (ginkgo). METHODS: Healthy volunteers were randomized to receive ginkgo 120 mg or placebo twice daily for 7 days in this prospective, double blind trial. After at least a 7-day washout period, subjects were crossed over to an additional 7 days of alternate therapy. Blood pressure, heart rate, and 12-lead electrocardiograms were evaluated immediately before (baseline), and at 1, 3, and 5 hours after observed ingestion of study drug on days 1 and 7 of therapy. Electrocardiographic parameters (P wave and QRS complex duration; PR, QT, and QTc intervals) were measured in lead II by a blinded investigator. RESULTS: Ginkgo had no effect on any of the evaluated electrocardiographic parameters at any time point on days 1 or 7. Additionally, no changes in heart rate or systolic and diastolic blood pressure were found between the groups at any time point on any evaluative day. CONCLUSIONS: Commonly used doses of Ginkgo biloba do not have any immediate or short-term effects on blood pressure, heart rate, or electrocardiographic variables in young, healthy volunteers.
    Type of Medium: Online Resource
    ISSN: 1060-0280 , 1542-6270
    URL: Article
    DOI: 10.1345/aph.1C254
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2003
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  • 4
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    Efficacy and Cost Analysis of Ibutilide
    SAGE Publications ; 2000
    In:  Annals of Pharmacotherapy Vol. 34, No. 11 ( 2000-11), p. 1233-1237
    Details
    In: Annals of Pharmacotherapy, SAGE Publications, Vol. 34, No. 11 ( 2000-11), p. 1233-1237
    Abstract: To determine the efficacy and safety of ibutilide in atrial fibrillation (AF) and atrial flutter (AFl) in a clinical setting and to compare the cost of first-line ibutilide with that of projected first-line electrical cardioversion (EC) from a hospital and third-party payer perspective. METHODS: Medical records of all patients (n = 60) who received ibutilide from August 1996 to March 1998 were reviewed. Efficacy was defined as successful conversion to sinus rhythm within 60 minutes of the end of the infusion, and the maintenance of sinus rhythm until hospital discharge. Safety was evaluated by determining the incidence of torsade de pointes. Charges for EC and drug administration were obtained from the hospital database and converted to costs using cost/charge ratios. Hospital costs included drug, drug administration, cardiac intensive care laboratory fee, and the cost of managing torsade de pointes. The third-party payer calculation included all of the above plus the cardiologist and anesthesiologist fees. RESULTS: Fifty percent of patients with AF or AFl were successfully converted with ibutilide; 67% of these remained in sinus rhythm at hospital discharge. Three patients experienced nonsustained torsade de pointes; all resolved with pharmacologic management. From a hospital perspective, the cost of first-line ibutilide was greater than the cost of first-line EC ($280 vs. $138 per patient). However, from a third-party payer perspective, the use of ibutilide saved approximately $324 per patient ($718 vs. $1042). CONCLUSIONS: The efficacy and safety of ibutilide in the clinical setting are consistent with data reported in clinical trials. In contrast to a previous decision analysis, ibutilide was not associated with cost savings from a hospital perspective, but was from a payer perspective.
    Type of Medium: Online Resource
    ISSN: 1060-0280 , 1542-6270
    URL: Article
    DOI: 10.1345/aph.10003
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2000
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  • 5
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    Effect of Magnesium L-Lactate on Blood Pressure in Patients with an Implantable Cardioverter Defibrillator
    SAGE Publications ; 2009
    In:  Annals of Pharmacotherapy Vol. 43, No. 4 ( 2009-04), p. 559-576
    Details
    In: Annals of Pharmacotherapy, SAGE Publications, Vol. 43, No. 4 ( 2009-04), p. 559-576
    Abstract: Previous studies have evaluated the impact of oral magnesium on blood pressure; however, they used magnesium salts with low bioavailability, had methodological issues, and showed differing results. Objective: To evaluate the long-term blood pressure–lowering ability of oral magnesium L-lactate versus placebo in patients with implanted cardioverter defibrillators (ICDs). Methods: In this double-blind, 24-week trial, 50 patients with ICDs were randomized to receive magnesium L-lactate (6 tablets daily, supplying a total of 504 mg of elemental magnesium daily) or matching placebo for at least 12 weeks. Baseline intracellular and serum magnesium concentrations were determined. The primary efficacy endpoint was the mean sitting systolic blood pressure at 24 weeks. Results: In 50 patients who completed at least 12 weeks of follow-up, 86% of patients, regardless of randomization, had a baseline intracellular magnesium deficiency, but no patients had a serum magnesium deficiency. At 12 weeks, magnesium L-lactate significantly reduced systolic blood pressure compared with placebo (117.7 ± 11.8 vs 126.3 ± 16.7 mm Hg, respectively; p = 0.04). In the 45 patients who continued in the study through the 24-week time period, the systolic blood pressure reduction was maintained, but statistical significance was lost (118.1 ± 14.1 vs 125.5 ± 17.2 mm Hg, respectively; p = 0.13). Magnesium L-lactate did not impact diastolic blood pressure at either time period (p ≥ 0.75 for both). Patients with a documented history of hypertension at baseline showed similar qualitative results to the primary analysis. Conclusions: A large number of subjects with ICDs have an intracellular magnesium deficiency not captured through serum magnesium determination. The use of magnesium L-lactate in patients with an ICD results in significant improvement in systolic blood pressure at 12 weeks, which may be maintained through 24 weeks.
    Type of Medium: Online Resource
    ISSN: 1060-0280 , 1542-6270
    URL: Article
    DOI: 10.1345/aph.1L640
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
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  • 6
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    Electrocardiographic and Hemodynamic Effects of Panax Ginseng
    SAGE Publications ; 2002
    In:  Annals of Pharmacotherapy Vol. 36, No. 5 ( 2002-05), p. 758-763
    Details
    In: Annals of Pharmacotherapy, SAGE Publications, Vol. 36, No. 5 ( 2002-05), p. 758-763
    Abstract: To determine whether Panax ginseng ingestion can acutely or chronically alter electrocardiographic parameters: PR, QRS, QT, QTc, and RR intervals, and QT and QTc interval dispersion. Effects of P. ginseng on blood pressure and heart rate also were evaluated. METHODS: This is a prospective, randomized, double-blind, placebo-controlled study of healthy adults at the University of Connecticut. Thirty subjects were randomly allocated to receive 28 days of therapy with either P. ginseng extract 200 mg or placebo. Baseline 12-lead electrocardiograms (ECGs) were obtained. Subsequent ECGs were performed following study drug ingestion at 50 minutes, 2 hours, and 5 hours on days 1 and 28. Blood pressure readings were taken with each ECG. RESULTS: P. ginseng ingestion increased the QTc interval by 0.015 seconds on day 1 at 2 hours compared with the placebo group (p = 0.03). It also reduced diastolic blood pressure from 75 ± 5 mm Hg at baseline to 70 ± 6 mm Hg at the same time point (p = 0.02). The observed effects are not believed to be clinically significant. No other statistically significant changes were found in electrocardiographic or hemodynamic variables on days 1 or 28. CONCLUSIONS: P. ginseng, at doses of 200 mg of the extract daily, increases the QTc interval and decreases diastolic blood pressure 2 hours after ingestion in healthy adults on the first day of therapy.
    Type of Medium: Online Resource
    ISSN: 1060-0280 , 1542-6270
    URL: Article
    DOI: 10.1345/aph.1A411
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2002
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  • 7
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    Antihypertensive medication and their impact on cancer incidence: a mixed treatment comparison meta-analysis of randomized controlled trials
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Journal of Hypertension Vol. 26, No. 4 ( 2008-04), p. 622-629
    Details
    In: Journal of Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 26, No. 4 ( 2008-04), p. 622-629
    Type of Medium: Online Resource
    ISSN: 0263-6352
    URL: Article
    DOI: 10.1097/HJH.0b013e3282f3ef5e
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
    detail.hit.zdb_id: 2017684-3
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  • 8
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    Oral amiodarone for prevention of atrial fibrillation after open heart surgery, the Atrial Fibrillation Suppression Trial (AFIST): a randomised placebo-controlled trial
    Elsevier BV ; 2001
    In:  The Lancet Vol. 357, No. 9259 ( 2001-03), p. 830-836
    Details
    In: The Lancet, Elsevier BV, Vol. 357, No. 9259 ( 2001-03), p. 830-836
    Type of Medium: Online Resource
    ISSN: 0140-6736
    URL: Article
    DOI: 10.1016/S0140-6736(00)04196-9
    RVK:
    XA 10000
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2001
    detail.hit.zdb_id: 2067452-1
    detail.hit.zdb_id: 3306-6
    detail.hit.zdb_id: 1476593-7
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  • 9
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    Systematic review: comparative effectiveness of adjunctive devices in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention of native vessels
    Springer Science and Business Media LLC ; 2011
    In:  BMC Cardiovascular Disorders Vol. 11, No. 1 ( 2011-12)
    Details
    In: BMC Cardiovascular Disorders, Springer Science and Business Media LLC, Vol. 11, No. 1 ( 2011-12)
    Abstract: During percutaneous coronary intervention (PCI), dislodgement of atherothrombotic material from coronary lesions can result in distal embolization, and may lead to increased major adverse cardiovascular events (MACE) and mortality. We sought to systematically review the comparative effectiveness of adjunctive devices to remove thrombi or protect against distal embolization in patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI of native vessels. Methods We conducted a systematic literature search of Medline, the Cochrane Database, and Web of Science (January 1996-March 2011), http://www.clinicaltrials.gov , abstracts from major cardiology meetings, TCTMD, and CardioSource Plus. Two investigators independently screened citations and extracted data from randomized controlled trials (RCTs) that compared the use of adjunctive devices plus PCI to PCI alone, evaluated patients with STEMI, enrolled a population with 95% of target lesion(s) in native vessels, and reported data on at least one pre-specified outcome. Quality was graded as good, fair or poor and the strength of evidence was rated as high, moderate, low or insufficient. Disagreement was resolved through consensus. Results 37 trials met inclusion criteria. At the maximal duration of follow-up, catheter aspiration devices plus PCI significantly decreased the risk of MACE by 27% compared to PCI alone. Catheter aspiration devices also significantly increased the achievement of ST-segment resolution by 49%, myocardial blush grade of 3 (MBG-3) by 39%, and thrombolysis in myocardial infarction (TIMI) 3 flow by 8%, while reducing the risk of distal embolization by 44%, no reflow by 48% and coronary dissection by 70% versus standard PCI alone. In a majority of trials, the use of catheter aspiration devices increased procedural time upon qualitative assessment. Distal filter embolic protection devices significantly increased the risk of target revascularization by 39% although the use of mechanical thrombectomy or embolic protection devices did not significantly impact other final health outcomes. Distal balloon or any embolic protection device increased the achievement of MBG-3 by 61% and 20% and TIMI3 flow by 11% and 6% but did not significantly impact other intermediate outcomes versus control. Upon qualitative analysis, all device categories, with exception of catheter aspiration devices, appear to significantly prolong procedure time compared to PCI alone while none appear to significantly impact ejection fraction. Many of the final health outcome and adverse event evaluations were underpowered and the safety of devices overall is unclear due to insufficient amounts of data. Conclusions In patients with STEMI, for most devices, few RCTs evaluated final health outcomes over a long period of follow-up. Due to insufficient data, the safety of these devices is unclear.
    Type of Medium: Online Resource
    ISSN: 1471-2261
    URL: Article
    DOI: 10.1186/1471-2261-11-74
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2011
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  • 10
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    Effect of Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers on the Frequency of Post-Cardiothoracic Surgery Atrial Fibrillation
    SAGE Publications ; 2007
    In:  Annals of Pharmacotherapy Vol. 41, No. 3 ( 2007-03), p. 433-437
    Details
    In: Annals of Pharmacotherapy, SAGE Publications, Vol. 41, No. 3 ( 2007-03), p. 433-437
    Abstract: A recent meta-analysis demonstrated that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduce the incidence of new-onset atrial fibrillation by nearly 50%. However, the ability of ACE inhibitors or ARBs to prevent post-cardiothoracic surgery (CTS) atrial fibrillation, when used postoperatively, has yet to be evaluated. Objective: To evaluate the impact of postoperative ACE inhibitor or ARB use on the incidence of post-CTS atrial fibrillation. Methods: We performed a retrospective cohort study of propensity score matched patients who underwent CTS at a single institution from January 2004 through December 2005. Patients who received either an ACE inhibitor or an ARB within 24 hours of surgery were propensity score matched for common predictors of post-CTS atrial fibrillation (age 〉 70 y, preoperative digoxin use, postoperative β-blocker or amiodarone use, β-blockor intolerance, valve surgery, male sex, and history of diabetes mellitus, smoking, chronic obstructive pulmonary disease, prior cardiothoracic surgery) in a 1:1 ratio with patients who did not receive an ACE inhibitor or an ARB. Multivariate logistic regression was used to generate adjusted odds ratios to minimize the impact of baseline confounders. Results: A total of 1469 patients underwent CTS during the study evaluation period. Postoperatively, 188 received an ACE inhibitor or an ARB and were matched to 188 control patients. Mean ± SD age of matched patients was 68.1 ± 11.8 years, 66% were men, 42% underwent valve surgery, and 69% and 35% received postoperative β-blockade and amiodarone, respectively. Patients who received an ACE inhibitor or an ARB did not experience a significant reduction in post-CTS atrial fibrillation compared with control patients (adjusted OR 0.95; 95% CI 0.57 to 1.56; p = 0.83). Conclusions: In this evaluation, postoperative ACE inhibitor or ARB use was not associated with a reduction in post-CTS atrial fibrillation. A study of preoperative, longer-term ACE inhibitor and/or ARB therapy is needed to determine the benefits of that strategy.
    Type of Medium: Online Resource
    ISSN: 1060-0280 , 1542-6270
    URL: Article
    DOI: 10.1345/aph.1H583
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2007
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