User login
Pulmonary embolism in COPD exacerbations
Clinical question: How frequent is pulmonary embolism (PE) in patients with unexplained acute chronic obstructive pulmonary disease (COPD) exacerbation?
Study design: Systematic review.
Setting: U.S. hospitals and EDs.
Synopsis: PE prevalence was 16.1% (95% CI, 8.3%-25.8%) in patients with unexplained COPD exacerbations. Thirty-two percent were subsegmental, 35% affected one of the main pulmonary arteries, and 32% were located in the lobar and interlobar arteries. Heterogeneity between the included studies was high. In-hospital and 1-year mortality were increased in patients with PE and COPD exacerbations in one study but not in another.
Signs of cardiac failure, hypotension, and syncope were more frequently found in patients with COPD exacerbation and PE, compared with patients with COPD exacerbation without PE.
Bottom line: PE is a common occurrence in patients with unexplained COPD exacerbations; two-thirds of those emboli involved segmental circulation and therefore were clinically relevant.
Citation: Aleva FE, Voets LW, Simons SO, de Mast Q, van der Ven A, Heijdra YF. Prevalence and localization of pulmonary embolism in unexplained acute exacerbations of COPD: a systematic review and meta-analysis [published online ahead of print Aug. 11, 2016]. Chest. doi: 10.1016/j.chest.2016.07.034.
Clinical question: How frequent is pulmonary embolism (PE) in patients with unexplained acute chronic obstructive pulmonary disease (COPD) exacerbation?
Study design: Systematic review.
Setting: U.S. hospitals and EDs.
Synopsis: PE prevalence was 16.1% (95% CI, 8.3%-25.8%) in patients with unexplained COPD exacerbations. Thirty-two percent were subsegmental, 35% affected one of the main pulmonary arteries, and 32% were located in the lobar and interlobar arteries. Heterogeneity between the included studies was high. In-hospital and 1-year mortality were increased in patients with PE and COPD exacerbations in one study but not in another.
Signs of cardiac failure, hypotension, and syncope were more frequently found in patients with COPD exacerbation and PE, compared with patients with COPD exacerbation without PE.
Bottom line: PE is a common occurrence in patients with unexplained COPD exacerbations; two-thirds of those emboli involved segmental circulation and therefore were clinically relevant.
Citation: Aleva FE, Voets LW, Simons SO, de Mast Q, van der Ven A, Heijdra YF. Prevalence and localization of pulmonary embolism in unexplained acute exacerbations of COPD: a systematic review and meta-analysis [published online ahead of print Aug. 11, 2016]. Chest. doi: 10.1016/j.chest.2016.07.034.
Clinical question: How frequent is pulmonary embolism (PE) in patients with unexplained acute chronic obstructive pulmonary disease (COPD) exacerbation?
Study design: Systematic review.
Setting: U.S. hospitals and EDs.
Synopsis: PE prevalence was 16.1% (95% CI, 8.3%-25.8%) in patients with unexplained COPD exacerbations. Thirty-two percent were subsegmental, 35% affected one of the main pulmonary arteries, and 32% were located in the lobar and interlobar arteries. Heterogeneity between the included studies was high. In-hospital and 1-year mortality were increased in patients with PE and COPD exacerbations in one study but not in another.
Signs of cardiac failure, hypotension, and syncope were more frequently found in patients with COPD exacerbation and PE, compared with patients with COPD exacerbation without PE.
Bottom line: PE is a common occurrence in patients with unexplained COPD exacerbations; two-thirds of those emboli involved segmental circulation and therefore were clinically relevant.
Citation: Aleva FE, Voets LW, Simons SO, de Mast Q, van der Ven A, Heijdra YF. Prevalence and localization of pulmonary embolism in unexplained acute exacerbations of COPD: a systematic review and meta-analysis [published online ahead of print Aug. 11, 2016]. Chest. doi: 10.1016/j.chest.2016.07.034.
Nonischemic cardiomyopathy does not benefit from prophylactic ICDs
Clinical question: Do prophylactic implantable cardioverter defibrillators (ICDs) reduce long-term mortality in patients with symptomatic nonischemic systolic heart failure (NISHF)?
Study design: Multicenter, nonblinded, randomized controlled prospective trial.
Setting: Danish ICD centers.
Synopsis: A total of 1,116 patients with symptomatic NISHF (left ventricular ejection fraction of less than 35%) were randomized to either receive an ICD or usual clinical care. The primary outcome, death from any cause, occurred in 120 patients (21.6%) in the ICD group (4.4 events/100 person-years) and in 131 patients (23.4%) in the control group. The hazard ratio for death from any cause in the ICD group, as compared with the control group, was 0.87 (95% CI , 0.68-1.12; P = .28). The HR for death from any cause in the ICD group, as compared with the control group, was 0.87 (95% CI, 0.68-1.12; P = .28)
Bottom line: Prophylactic ICD implantation in patients with symptomatic NISHF does not reduce long-term mortality.
Citation: Kober L, Thune JJ, Nielsen JC, et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med. 2016;375:1221-1230.
Clinical question: Do prophylactic implantable cardioverter defibrillators (ICDs) reduce long-term mortality in patients with symptomatic nonischemic systolic heart failure (NISHF)?
Study design: Multicenter, nonblinded, randomized controlled prospective trial.
Setting: Danish ICD centers.
Synopsis: A total of 1,116 patients with symptomatic NISHF (left ventricular ejection fraction of less than 35%) were randomized to either receive an ICD or usual clinical care. The primary outcome, death from any cause, occurred in 120 patients (21.6%) in the ICD group (4.4 events/100 person-years) and in 131 patients (23.4%) in the control group. The hazard ratio for death from any cause in the ICD group, as compared with the control group, was 0.87 (95% CI , 0.68-1.12; P = .28). The HR for death from any cause in the ICD group, as compared with the control group, was 0.87 (95% CI, 0.68-1.12; P = .28)
Bottom line: Prophylactic ICD implantation in patients with symptomatic NISHF does not reduce long-term mortality.
Citation: Kober L, Thune JJ, Nielsen JC, et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med. 2016;375:1221-1230.
Clinical question: Do prophylactic implantable cardioverter defibrillators (ICDs) reduce long-term mortality in patients with symptomatic nonischemic systolic heart failure (NISHF)?
Study design: Multicenter, nonblinded, randomized controlled prospective trial.
Setting: Danish ICD centers.
Synopsis: A total of 1,116 patients with symptomatic NISHF (left ventricular ejection fraction of less than 35%) were randomized to either receive an ICD or usual clinical care. The primary outcome, death from any cause, occurred in 120 patients (21.6%) in the ICD group (4.4 events/100 person-years) and in 131 patients (23.4%) in the control group. The hazard ratio for death from any cause in the ICD group, as compared with the control group, was 0.87 (95% CI , 0.68-1.12; P = .28). The HR for death from any cause in the ICD group, as compared with the control group, was 0.87 (95% CI, 0.68-1.12; P = .28)
Bottom line: Prophylactic ICD implantation in patients with symptomatic NISHF does not reduce long-term mortality.
Citation: Kober L, Thune JJ, Nielsen JC, et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med. 2016;375:1221-1230.