Raluca Ionescu-Ittu

University Medical Center Utrecht, Utrecht, Utrecht, Netherlands

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Publications (32)231.97 Total impact

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    ABSTRACT: Clinical guidelines recommend specialized care for adult congenital heart disease (ACHD) patients. In reality, few patients receive such dedicated care. We sought to examine the impact of specialized care on ACHD patient mortality. We examined referral rates to specialized-ACHD centers and ACHD patient mortality rates between 1990 and 2005 in the population-based Quebec Congenital Heart Disease (CHD) database (n=71,467). This period covers several years before and after publication of guidelines endorsing specialized care for ACHD patients. A time-series design, based on Joinpoint and Poisson regression analyses, was used to assess changes in annual referral and patient mortality rates. The association between specialized-ACHD care and all-cause mortality was assessed in both case-control and cohort studies. The time-series analysis demonstrated a significant increase in referral rates to specialized-ACHD centers in 1997 (Rate Ratio [RR] +7.4%; 95% CI +6.6% to +8.2%). In parallel, a significant reduction in expected ACHD patient mortality was observed after year 2000 (RR -5.0%;95% CI -10.8% to -0.8%). In exploratory post-hoc cohort and case-control analyses, specialized-ACHD care was independently associated with reduced mortality (Hazard Ratio (HR), 0.78;95% CI, 0.65-0.94) and a reduced odds of death (adjusted odds ratio: 0.82;95% CI 0.08-0.97), respectively. This effect was predominantly driven by patients with severe CHD (HR, 0.38;95% CI 0.22-0.67). A significant increase in referrals to specialized-ACHD centers followed the introduction of clinical guidelines. Moreover, referral to specialized-ACHD care was independently associated with a significant mortality reduction. Our findings support a model of specialized care for all ACHD patients.
    Circulation 03/2014; · 15.20 Impact Factor
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    ABSTRACT: The most common congenital anomaly in adults is secundum, which can be closed using a surgical or transcatheter approach. Despite the growing use of transcatheter ASD closure, few studies have examined the cost-effectiveness of this strategy. We sought to compare the long-term cost effectiveness of transcatheter and surgical closure of secundum in adults. A decision-analytic model was used with all clinical outcome parameter estimates obtained from the province-wide Québec Congenital Heart Disease Database. Costs were obtained from a single academic centre (Canadian dollars). A cost-effectiveness analysis using a discrete event Monte Carlo simulation model from the perspective of a single third party payer and multiple sensitivity analyses were performed. Patients were followed for a maximum of 5years after ASD closure. Between l998 and 2005, we identified 718 adults (n=335 transcatheter; n=383 surgical) who underwent ASD closure in Quebec. The 5-year cost of surgical closure was $15,304 SD $4581 versus $11,060 SD $5169 for the transcatheter alternative. At 5years, transcatheter closure was marginally more effective than surgery (4.683 SD 0.379 life-years versus 4.618 SD 0.638 life-years). Probabilistic sensitivity analyses demonstrated that transcatheter ASD closure was a dominant strategy with an 80% probability of cost savings and equal or greater efficacy compared to surgical treatment. Although definitive conclusions are limited given the observational nature of the primary data sources, transcatheter ASD closure appeared to be a cost-effective strategy associated with slightly improved clinical outcomes and reduced costs compared to surgical closure at 5-years follow-up.
    International journal of cardiology 01/2014; · 7.08 Impact Factor
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    ABSTRACT: The American Heart Association guidelines for prevention of infective endocarditis (IE) in 2007 reduced the groups of congenital heart disease (CHD) patients for whom antibiotic prophylaxis was indicated. The evidence base in CHD patients is limited. We sought to determine the risk of IE in children with CHD. We performed a population-based analysis to determine the cumulative incidence and predictors of IE in children (0-18 years) with CHD by the use of the Quebec CHD Database from 1988 to 2010. In 47 518 children with CHD followed for 458 109 patient-years, 185 cases of IE were observed. Cumulative incidence of IE was estimated in the subset of 34 279 children with CHD followed since birth, in whom the risk of IE up to 18 years of age was 6.1/1000 children (95% confidence interval, 5.0-7.5). In a nested case-control analysis, the following CHD lesions were at highest risk of IE in comparison with atrial septal defects (adjusted rate ratio, 95% confidence interval): cyanotic CHD (6.44, 3.95-10.50), endocardial cushion defects (5.47, 2.89-10.36), and left-sided lesions (1.88, 1.01-3.49). Cardiac surgery within 6 months (5.34, 2.49-11.43) and an age of <3 years (3.53, 2.51-4.96; reference, ages 6-18) also conferred an elevated risk of IE. In a large population-based cohort of children with CHD, we documented the cumulative incidence of IE and associated factors. These findings help identify groups of patients who are at the highest risk of developing IE.
    Circulation 09/2013; 128(13):1412-9. · 15.20 Impact Factor
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    ABSTRACT: OBJECTIVES: To analyze sex differences in hospital mortality of adult CHD patients and to determine the impact of health services associated with pregnancy on outcomes in women. BACKGROUND: The determinants of sex differences in the demographic distribution of congenital heart disease (CHD) are poorly understood. METHODS: The Quebec CHD database and the Dutch CONCOR registry were used to identify CHD patients aged 18 to 65 hospitalized between 1996-2005. Regression analyses were used to compare 30-day in-hospital mortality in men vs. women and in women aged 18-45 with vs. without a pregnancy history, after adjustment for age, CHD severity, co-morbidities and admission diagnosis. RESULTS: Of 39,776 patients followed for 259,741 patient years, 19,099 patients (48%) had 54,195 admissions (62% among women). In those aged 18-45, 30-day in-hospital mortality was higher in men compared to women with non-pregnancy admissions (adjusted RR 1.36; 95% CI 1.02-1.81) The adjusted RR for 30-day in-hospital mortality in women with a pregnancy history compared to those without was 0.49; 95% CI 0.24-0.99. A history of pregnancy was not associated with an overall increase in medical encounters. CONCLUSIONS: We demonstrated a protective effect of sex on in-hospital mortality in women with CHD of reproductive age that did not correlate with increased medical surveillance. Future studies need to explore other mechanisms to account for our observations. Understanding the determinants of the sex distribution of adults with CHD is important for our ability to predict demographic changes in the CHD population.
    Journal of the American College of Cardiology 05/2013; · 14.09 Impact Factor
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    ABSTRACT: OBJECTIVES: The purpose of this study was to assess the comparative effectiveness and long-term safety of transcatheter versus surgical closure of secundum atrial septal defects (ASD) in adults. BACKGROUND: Transcatheter ASD closure has largely replaced surgery in most industrialized countries, but long-term data comparing the 2 techniques are limited. METHODS: We performed a retrospective population-based cohort study of all patients, ages 18 to 75 years, who had surgical or transcatheter ASD closure in Québec, Canada's second-largest province, using provincial administrative databases. Primary outcomes were long-term (5-year) reintervention and all-cause mortality. Secondary outcomes were short-term (1-year) onset of congestive heart failure, stroke, or transient ischemic attack, and markers of health service use. RESULTS: Of the 718 ASD closures performed between 1988 and 2005, 383 were surgical and 335 were transcatheter. The long-term reintervention rate was higher in patients with transcatheter ASD closure (7.9% vs. 0.3% at 5 years, p = 0.0038), but the majority of these reinterventions occurred in the first year. Long-term mortality with the transcatheter technique was not inferior to surgical ASD closure (5.3% vs. 6.3% at 5 years, p = 1.00). Secondary outcomes were similar in the 2 groups. CONCLUSIONS: Transcatheter ASD closure is associated with a higher long-term reintervention rate and long-term mortality that is not inferior to surgery. Overall, these data support the current practice of using transcatheter ASD closure in the majority of eligible patients and support the decision to intervene on ASD with significant shunts before symptoms become evident.
    04/2013; · 1.07 Impact Factor
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    ABSTRACT: Abstract Introduction: This study compared progression, progression-free survival (PFS), overall survival (OS), and treatment changes among chronic myelogenous leukemia patients in chronic phase (CML-CP) receiving nilotinib or dasatinib as second-line therapy. Patients and Methods: Information on CML-CP patients switched from imatinib to nilotinib or dasatinib as second-line therapy was collected retrospectively from 122 U.S. hematologists and oncologists through an online medical chart review. Progression, PFS, and OS were compared using multivariate Cox proportional hazard models, and treatment changes using chi-square tests. Results: Of 597 imatinib-resistant or intolerantpatients, 301 initiated nilotinib and 296 dasatinib as second-line therapy. Nilotinib was associated with a lower risk of progression (hazard ratio [HR]=0.27; p=0.021) and longer PFS (HR=0.48; p=0.030) than dasatinib, with a median follow-up time of 11 months for nilotinib and 10 months for dasatinib. Nilotinib patients had a lower estimated hazard of mortality than dasatinib patients, though not statistically significant (HR=0.46; p=0.067). When treatment changes were classified by the physicians' justifications, fewer nilotinib patients had treatment changes due to ineffectiveness (2.0% vs. 5.1%, p=0.041) or drug holidays due to intolerance (0.0% vs. 1.7%, p=0.024) than dasatinib patients. Conclusions: Among CML-CP patients in this retrospective chart review who switched from imatinib to either nilotinib or dasatinib, nilotinib was associated with a significantly lower risk of progression and longer PFS than dasatinib. Nilotinib patients were also less likely than dasatinib patients to subsequently have treatment changes due to ineffectiveness or drug holidays due to intolerance. These findings could be subject to unobserved confounders.
    Current Medical Research and Opinion 03/2013; · 2.26 Impact Factor
  • Raluca Ionescu-Ittu, Louise Pilote
    Journal of comparative effectiveness research. 01/2013; 2(1):1-4.
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    ABSTRACT: Aortic coarctation (CoA) is reported to predispose to coronary artery disease (CAD). However, our clinical observations do not support this premise. Our objectives were to describe the prevalence of CAD among adults with CoA and to determine whether CoA is an independent predictor of CAD or premature CAD. The study population was derived from the Quebec Congenital Heart Disease Database. We compared patients with CoA and those with a ventricular septal defect, who are not known to be at increased risk of CAD. The prevalence of CAD in patients with CoA compared with those with ventricular septal defect was determined. We then used a nested case-control design to determine whether CoA independently predicted for the development of CAD. Of 756 patients with CoA who were alive in 2005, 37 had a history of CAD compared with 224 of 6481 patients with ventricular septal defect (4.9% versus 3.5%; P=0.04). Male sex (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.62-2.80), hypertension (OR, 1.95; 95% CI, 1.44-2.64), diabetes mellitus (OR, 1.68; 95% CI, 1.09-2.58), age (OR per 10-year increase, 2.28; 95% CI, 2.09-2.48), and hyperlipidemia (OR, 11.58; 95% CI, 5.75-23.3) all independently predicted for the development of CAD. CoA did not independently predict for the development of CAD (OR, 1.04; 95% CI, 0.68-1.57) or premature CAD (OR for CoA versus ventricular septal defect, 1.44; 95% CI, 0.79-2.64) after adjustment for other factors. Although traditional cardiovascular risk factors independently predicted for the development of CAD, the diagnosis of CoA alone did not. Our findings suggest that cardiovascular outcomes of these patients may be improved with tight risk factor control.
    Circulation 06/2012; 126(1):16-21. · 15.20 Impact Factor
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    ABSTRACT: Controversy continues concerning the choice of rhythm control vs rate control treatment strategies for atrial fibrillation (AF). A recent clinical trial showed no difference in 5-year mortality between the 2 treatments. We aimed to determine whether the 2 strategies have similar effectiveness when applied to a general population of patients with AF with longer follow-up. We used population-based administrative databases from Quebec, Canada, from 1999 to 2007 to select patients 66 years or older hospitalized with an AF diagnosis who did not have AF-related drug prescriptions in the year before the admission but received a prescription within 7 days of discharge. Patients were followed until death or administrative censoring. Mortality was analyzed by multivariable Cox regression. Among 26,130 patients followed for a mean (SD) period of 3.1 years (2.3 years), there were 13,237 deaths (49.5%). After adjusting for covariates, we found that the effect of rhythm vs rate control drugs changed over time: after a small increase in mortality for patients treated with rhythm control in the 6 months following treatment initiation (hazard ratio [HR], 1.07; 95% CI, 1.01-1.14), the mortality was similar between the 2 groups until year 4 but decreased steadily in the rhythm control group after year 5 (HR, 0.89; 95% CI, 0.81-0.96; and HR, 0.77; 95% CI, 0.62-0.95, after 5 and 8 years, respectively). In this population-based sample of patients with AF, we found little difference in mortality within 4 years of treatment initiation between patients with AF initiating rhythm control therapy vs those initiating rate control therapy. However, rhythm control therapy seems to be superior in the long-term.
    Archives of internal medicine 06/2012; 172(13):997-1004. · 11.46 Impact Factor
  • Raluca Ionescu-Ittu, Michal Abrahamowicz, Louise Pilote
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    ABSTRACT: The instrumental variable (IV) method can remove bias because of unobserved confounding, but it is unclear to what extent the choice of the IV may affect the results. We compared the estimates obtained with different provider-based IVs in a real-life observational comparative drug effectiveness study. We assessed the effectiveness of rhythm vs. rate control treatment in reducing 5-years mortality in a population-based cohort of patients with atrial fibrillation. We compared the IV treatment effect estimates obtained from two-stage least square regression models using nine alternative provider-based IVs defined at either hospital or physician level. All nine IVs reduced the covariate imbalance between the treatment groups. Yet, there were large variations in both the point estimates and the width of the confidence intervals obtained with alternative IVs. Relative to the physician-based IVs, the hospital-based IVs were stronger, had smaller variance, and produced less extreme point estimates. The IV estimates of treatment effect may vary considerably depending on the IV definition. Choosing the strongest IV could reduce the variance of the IV estimates.
    Journal of clinical epidemiology 02/2012; 65(2):155-62. · 2.96 Impact Factor
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    ABSTRACT: The study sought to measure the prevalence, disease burden, and determinants of mortality in geriatric adults with congenital heart disease (ACHD). The population of ACHD is increasing and aging. The geriatric ACHD population has yet to be characterized. Population-based cohort study using the Quebec Congenital Heart Disease Database of all patients with congenital heart disease coming into contact with the Quebec healthcare system between 1983 and 2005. Subjects with specific diagnoses of congenital heart disease and age 65 years at time of entry into the cohort were followed for up to 15 years. The primary outcome was all-cause mortality. The geriatric ACHD cohort consisted of 3,239 patients. From 1990 to 2005, the prevalence of ACHD in older adults remained constant from 3.8 to 3.7 per 1,000 indexed to the general population (prevalence odds ratio: 0.98; 95% confidence interval [CI]: 0.93 to 1.03). The age-stratified population prevalence of ACHD was similar in older and younger adults. The most common types of congenital heart disease lesions in older adults were shunt lesions (60%), followed by valvular lesions (37%) and severe congenital heart lesions (3%). Type of ACHD and ACHD-related complications had a minor impact on mortality, which was predominantly driven by acquired comorbid conditions. The most powerful predictors of mortality in the Cox proportional hazards model were: dementia (hazard ratio [HR]: 3.24; 95% CI: 1.53 to 6.85), gastrointestinal bleed (HR: 2.79; 95% CI: 1.66 to 4.69), and chronic kidney disease (HR: 2.50; 95% CI: 1.72 to 3.65). The prevalence of geriatric ACHD is substantial, although severe lesions remain uncommon. ACHD patients that live long enough acquire general medical comorbidities, which are the pre-eminent determinants of their mortality.
    Journal of the American College of Cardiology 09/2011; 58(14):1509-15. · 14.09 Impact Factor
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    ABSTRACT: Instrumental variable (IV) methods based on the physician's prescribing preference may remove bias due to unobserved confounding in pharmacoepidemiologic studies. However, IV estimates, originally defined as the treatment prescribed for a single previous patient of a given physician, show important variance inflation. The authors proposed and validated in simulations a new method to reduce the variance of IV estimates even when physicians' preferences change over time. First, a potential "change-time," after which the physician's preference has changed, was estimated for each physician. Next, all patients of a given physician were divided into 2 homogeneous subsets: those treated before the change-time versus those treated after the change-time. The new IV was defined as the proportion of all previous patients in a corresponding homogeneous subset who were prescribed a specific drug. In simulations, all alternative IV estimators avoided strong bias of the conventional estimates. The change-time method reduced the standard deviation of the estimates by approximately 30% relative to the original previous patient-based IV. In an empirical example, the proposed IV correlated better with the actual treatment and yielded smaller standard errors than alternative IV estimators. Therefore, the new method improved the overall accuracy of IV estimates in studies with unobserved confounding and time-varying prescribing preferences.
    American journal of epidemiology 08/2011; 174(4):494-502. · 5.59 Impact Factor
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    ABSTRACT: The aim of this study was to assess the impact of the diagnosis of pulmonary hypertension (PH) on mortality, morbidity, and health services utilization (HSU) in an adult congenital heart disease (CHD) population. Although PH is a well-recognized complication of CHD, population-based studies of its significance on the survival and functional capacity of patients are uncommon. A retrospective longitudinal cohort study was conducted in an adult CHD population with 23 years of follow-up, from 1983 to 2005. The prevalence of PH was measured in 2005. Mortality, morbidity, and HSU outcomes were compared between patients with and without diagnoses of PH using multivariate Cox (mortality and morbidity) and Poisson (HSU) regression models within a subcohort matched for age and CHD lesion type. Of 38,430 adults alive with CHD in 2005, 2,212 (5.8%) had diagnoses of PH (median age 67 years, 59% women). The diagnosis of PH increased the all-cause mortality rate of adults with CHD more than 2-fold compared with patients without PH (hazard ratio [HR]: 2.69; 95% confidence interval [CI]: 2.41 to 2.99). Morbid complications including heart failure and arrhythmia occurred with a 3-fold higher risk compared with patients without PH (HR: 3.01; 95% CI: 2.80 to 3.22). The utilization of inpatient and outpatient services was increased, especially cardiac catheterization, excluding the index diagnostic study (rate ratio: 5.04; 95% CI: 4.27 to 5.93) and coronary and intensive care hospitalizations (rate ratio: 5.03; 95% CI: 4.86 to 5.20). A diagnosis of PH in adults with CHD is associated with a more than 2-fold higher risk for all-cause mortality and 3-fold higher rates of HSU, reflecting high morbidity.
    Journal of the American College of Cardiology 07/2011; 58(5):538-46. · 14.09 Impact Factor
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2011; 57(14).
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    ABSTRACT: The congenital heart disease population is aging. We hypothesized that changes in rates of congenital, valvular, and noncongenital surgical operations in congenital heart patients varied with age and disease severity over the last two decades. We performed time trend analysis using a Quebec congenital heart disease database constructed from administrative data. We included congenital heart patients of all ages having cardiac surgical operations. Heart lesions were classified as "severe" and "other." Cardiac surgical operations were grouped as congenital, valvular (including aortic), and noncongenital (arrhythmia surgery, coronary artery bypass grafting, and cardiac transplants). An adapted Aristotle score was developed to classify procedures based on surgical risk. Yearly surgical rates were measured as surgical operations per 1,000 person-years and analyzed over time using Poisson regression models stratified by age, lesion severity, and cardiac surgery category. From 1988 to 2005 we followed 71,979 patients for 1,009,430 person-years. We identified 17,444 cardiac surgical operations. There was a 31% increase in volumes and a 5% increase in surgical rates over time. In children, congenital surgical operations remained constant, accounting for 80% of all surgical operations. In adults, valvular operations were the most common type of surgical operations, increasing from 42% to 63% of all procedures over time. Rates of valvular operations increased significantly in all adult subgroups and in children with severe lesions. The need for valvular interventions has increased in the last two decades in congenital heart disease patients. These findings should be taken into account when allocating resources that will optimize outcomes for this growing population.
    The Annals of thoracic surgery 11/2010; 90(5):1563-9. · 3.74 Impact Factor
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    ABSTRACT: This study sought to characterize temporal trends in all-cause mortality in patients with congenital heart disease (CHD). Historically, most deaths in patients with CHD occurred in early childhood. Notable advances have since been achieved that may impact on mortality trends. We conducted a population-based cohort study of patients with CHD in Quebec, Canada, from July 1987 to June 2005. A total of 8,561 deaths occurred in 71,686 patients with CHD followed for 982,363 patient-years. The proportion of infant and childhood deaths markedly declined from 1987 to 2005, with a reduction in mortality that exceeded that of the general population. Distribution of age at death transitioned from a bimodal to unimodal, albeit skewed, pattern, more closely approximating the general population. Overall, mortality decreased by 31% (mortality rate ratio: 0.69, 95% confidence interval [CI]: 0.61 to 0.79) in the last (2002 to 2005) relative to the first (1987 to 1990) period of observation. Mortality rates decreased in all age groups below 65 years, with the largest reduction in infants (mortality rate ratio: 0.23, 95% CI: 0.12 to 0.47). In adults 18 to 64 years, the mortality reduction (mortality rate ratio: 0.84, 95% CI: 0.73 to 0.97) paralleled the general population. Gains in survival were mostly driven by reduced mortality in severe forms of CHD, particularly in children (mortality rate ratio: 0.33, 95% CI: 0.19 to 0.60), and were consistent across most subtypes. Deaths in CHD have shifted away from infants and towards adults, with a steady increase in age at death and decreasing mortality.
    Journal of the American College of Cardiology 09/2010; 56(14):1149-57. · 14.09 Impact Factor
  • Circulation 01/2010; 121(12). · 15.20 Impact Factor
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    ABSTRACT: The goal of this study was to identify factors associated with decreased disability and lower pain scores 6 months after a multimodal treatment program for fibromyalgia (FM). Forty-six patients with FM were assessed after having participated in a 3-month outpatient program integrating physiotherapy, occupational therapy, nursing, and cognitive-behavior therapy. A physician examined the patients before treatment and patients who completed a battery of psychosocial questionnaires at baseline, during treatment, at the end of treatment, and 3 and 6 months after the end of treatment. Two separate multivariable linear regression models were built to identify predictors of improvements in disability and pain. Two predictors for improvement in disability were found: an increase in self-efficacy for pain during treatment and better general adherence during treatment. Similarly, one predictor for improvement in pain intensity was found: an increase in self-efficacy for pain during treatment. Self-efficacy and adherence are 2 modifiable factors that influence disability and pain intensity in FM. These psychosocial factors need to be addressed in FM treatment programs to assist patients in maintaining posttreatment improvements.
    The Clinical journal of pain 01/2010; 26(1):23-9. · 3.01 Impact Factor
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    ABSTRACT: Atrial arrhythmias increase disease burden in the general adult population. Adults with congenital heart lesions constitute a rapidly growing group of patients with cardiovascular disease. We hypothesized that atrial arrhythmias increase with age and impair health outcomes in this population. We conducted a population-based analysis of prevalence, lifetime risk, mortality, and morbidity associated with atrial arrhythmias in adults with congenital heart disease from l983 to 2005. In 38 428 adults with congenital heart disease in 2005, 5812 had atrial arrhythmias. Overall, the 20-year risk of developing atrial arrhythmia was 7% in a 20-year-old subject and 38% in a 50-year-old subject. More than 50% of patients with severe congenital heart disease reaching age 18 years developed atrial arrhythmias by age 65 years. In patients with congenital heart disease, the hazard ratio of any adverse event in those with atrial arrhythmias compared with those without was 2.50 (95% confidence interval, 2.38 to 2.62; P<0.0001), with a near 50% increase in mortality (hazard ratio, 1.47; 95% confidence interval, 1.37 to 1.58; P<0.001), more than double the risk of morbidity (stroke or heart failure) (hazard ratio, 2.21; 95% confidence interval, 2.07 to 2.36; P<0.001), and 3 times the risk of cardiac interventions (hazard ratio, 3.00; 95% confidence interval, 2.81 to 3.20; P<0.001). Atrial arrhythmias occurred in 15% of adults with congenital heart disease. The lifetime incidence increased steadily with age and was associated with a doubling of the risk of adverse events. An increase in resource allocation should be anticipated to deal with this increasing burden.
    Circulation 10/2009; 120(17):1679-86. · 15.20 Impact Factor
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    ABSTRACT: To evaluate whether a 12-week home-based exercise program is more effective than usual care for alleviating depressive symptomology in the postpartum. Eighty-eight women experiencing postpartum depressed mood were randomly assigned to a 12-week home-based exercise program or usual care. Outcomes assessed immediately post-treatment and 3-months post-treatment were the Hamilton Rating Scale for Depression (HAM-D) and Edinburgh Postnatal Depression Scale (EPDS). In the intention-to-treat analysis, the effect of the intervention on EPDS did not change from 3 to 6 months evaluations, but was modified by the baseline EPDS score, with subjects with greater depression at baseline (EPDS > 13) in the intervention group having a significantly lower postbaseline EPDS score compared with the usual care group (mean difference 4.06 points, 95%CI 1.51-6.61, p < 0.001). After adjusting for baseline HAM-D, subjects in the intervention group had a significantly lower HAM-D score at post-treatment compared with subjects in the usual care group (mean difference 1.83 points, 95%CI 0.24-3.41, p = 0.02). The difference in HAM-D became non-significant at 3-months post-treatment. Home-based exercise is a feasible nonpharmacological intervention with the potential to alleviate postpartum depressive symptoms, especially in women with higher initial depressed mood scores as measured by the EPDS. These findings may guide the design of future exercise clinical trials with postpartum depressed women.
    Journal of Psychosomatic Obstetrics & Gynecology 09/2009; 30(3):191-200. · 1.59 Impact Factor

Publication Stats

524 Citations
231.97 Total Impact Points


  • 2013
    • University Medical Center Utrecht
      Utrecht, Utrecht, Netherlands
  • 2007–2013
    • McGill University Health Centre
      • Epidemiology Clinic
      Montréal, Quebec, Canada
  • 2012
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2007–2012
    • McGill University
      • Department of Epidemiology, Biostatistics and Occupational Health
      Montréal, Quebec, Canada
  • 2010
    • Montreal Heart Institute
      Montréal, Quebec, Canada
  • 2006
    • Université de Montréal
      Montréal, Quebec, Canada