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Publications (3)17.39 Total impact

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    ABSTRACT: There are currently no guidelines advising long-term surveillance of patients following an acute pulmonary embolism (PE), because long-term outcome studies are rare. We investigated the long-term cardiovascular and all-cause mortality of a large patient cohort with confirmed PE in relation to baseline cardiovascular disease (CVD). Clinical details of all patients presenting with acute PE to a tertiary hospital were retrieved from medical records, and their survival tracked from a statewide death registry. There were 1023 (45% males) patients admitted with confirmed PE from 2000 to 2007. During a mean follow-up of 3.8±2.6 years, 363 patients died (35.5%), of whom only 31 (3.0%) died in-hospital during the index PE admission. The 3-month, 6-month, 1-year, 3-year, and 5-year cumulative mortality rates were 8.3%, 11.1%, 16.3%, 26.7%, and 31.6% respectively. Annual mortality did not improve over the 7-year period. The postdischarge mortality of 8.5%/patient-year was 2.5-fold that of an age- and sex-matched general population, being 12.6-fold in the youngest quintile (<55 years) and 1.9-fold in the oldest quintile (≥83 years). Patients with known CVD at baseline had 2.2-fold greater all-cause mortality than those without CVD, and this effect, although at a lower level of risk, remained significant after multivariate analysis. Of the 332 deaths occurring postdischarge, 40% were attributed to cardiovascular causes. In a contemporary adult population, PE is associated with a substantially increased long-term mortality, of which nearly half is cardiovascular. Our study highlights the urgent need to develop long-term surveillance strategies in this population.
    Circulation Cardiovascular Quality and Outcomes 01/2011; 4(1):122-8. · 5.04 Impact Factor
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    ABSTRACT: Ischemic and non-ischemic cardiomyopathy (ICM and NICM) both cause heart failure, but the different etiologies may result in differences in management and outcome, which were explored in this study. Cohort study of 168 consecutive patients (90 ICM, 78 NICM) recruited from a tertiary referral heart failure clinic followed for 40+/-19 months. Patients with ICM were older than NICM with worse NYHA functional state but similar left ventricular ejection fraction (LVEF) and dimensions at baseline. Similar proportions (>80%) in both groups were on a beta-blocker and angiotensin-converting-enzyme inhibitor and/or angiotensin-II-receptor blocker (ACE inhibitor+/-ARB) by end of study. Mean LVEF improved in both groups over time (27.3+/-11.9% vs. 33.1+/-12.6%, p<0.05). Overall 40-month mortality was 17%. In univariate analysis of patients <80 years old, ICM, NYHA class, serum creatinine, ACE inhibitor+/-ARB, and amiodarone use were predictors of mortality, but only serum creatinine was significant in multivariate analysis, with a 2.9-fold relative risk of death (95%CI, 1.34-6.42, p<0.01) for creatinine >/=120 micromol/L compared to <120 micromol/L. Mortality of patients with cardiomyopathy remains high and is strongly related to serum creatinine. NICM patients were younger and showed greater improvement in symptoms and left ventricular function in long-term follow-up.
    International journal of cardiology 08/2007; 129(2):198-204. · 6.18 Impact Factor
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    ABSTRACT: Understanding the influence of gender in heart failure allows for better treatment. This study described the gender differences in heart failure patients and their response to therapy. Consecutive patients (116 men vs. 52 women) from 1997 to 2002 were recruited from a single heart failure unit. Mean follow-up was 40+/-19 months. Mean age was 68+/-12 years; left ventricular ejection fraction (LVEF) 27+/-12%. Women had higher mean LVEF, left ventricular end-diastolic diameter, and worse New York Heart Association (NYHA) functional class at baseline compared to men, while age, body mass index, blood pressure, estimated glomerular filtration rate and other co-morbidities did not differ significantly. Fewer women remained on angiotensin-converting-enzyme inhibitors while angiotensin-II-receptor blockers use increased significantly. By the end of the study, both genders exhibited similar magnitude of improvements in LVEF, cardiac dimensions, hemodynamics and mean NYHA functional class. In multivariate analysis, NYHA functional class was the strongest predictor of mortality: patients with NYHA class III/IV at baseline had 2.4-fold increased mortality risk compared to those in NYHA class I/II (95% CI 1.09-5.51, p=0.03). For men, functional class at baseline was the strongest predictor of mortality while for women, it was age at baseline. In a contemporary tertiary referral heart failure clinic, women were observed to have better LVEF, but worse NYHA functional class than men. Both genders exhibited functional and hemodynamic improvements with only minor differences in their medical therapies. Predictors of mortality differed between the genders.
    International journal of cardiology 05/2007; 117(2):214-21. · 6.18 Impact Factor