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EFFECT OF PERIODIC STAFF EDUCATION ON PERFORMANCE IMPROVEMENT IN ASSESSMENT AND EDUCATION OF HEART FAILURE PATIENTS [Meeting Abstract]

Khurana, Dheeraj; Kukar, Nina; Gashi, Nora; Chen, Jennifer; Sagiv, Ofer; Mangla, Aditya; Vukelic, Sasha; Osahan, Deepinder; Gibson, Kyle; Bierzynski, Adam; Sillar, Jennifer; Panagopoulos, Georgia; Messineo, Frank; Coplan, Neil L.
ISI:000333695300156
ISSN: 1081-5589
CID: 5268412

Screening for asymptomatic atrial fibrillation while monitoring the blood pressure at home: trial of regular versus irregular pulse for prevention of stroke (TRIPPS 2.0)

Wiesel, Joseph; Abraham, Saji; Messineo, Frank C
Asymptomatic atrial fibrillation (AF) is a common cause of strokes. Physician screening for AF has been recommended. Home screening for AF may increase the likelihood of detecting asymptomatic AF in patients at risk for stroke because of AF. The aim of this study was to assess the feasibility and accuracy of screening for AF when taking home blood pressure (BP) measurements using an automatic AF-detecting BP monitor. Subjects aged >64 years or those with hypertension, diabetes, congestive heart failure, or previous stroke were enrolled by their primary physicians and given the AF-BP monitor and an electrocardiographic event monitor to use at home for 30 days. The AF-BP monitor reading was compared with the electrocardiographic reading to calculate the sensitivity and specificity of the device for detecting AF. A total of 160 subjects were enrolled, with 10 withdrawing, 1 excluded, and 10 with no AF-BP monitor logs or electrocardiographic recordings. Of the 139 subjects included, 14 had known AF. There was a total of 3,316 days with AF-BP monitor readings and electrocardiographic readings. On the basis of the initial daily AF-BP monitor readings, the AF-BP monitor demonstrated sensitivity of 99.2% and specificity of 92.9% for detecting AF. Two subjects with no histories of AF had AF-BP monitor readings of AF that were confirmed by the electrocardiographic monitor. One of these subjects was started on warfarin. In conclusion, home screening for asymptomatic AF while taking BP measurements can be performed accurately. This can be used to detect new AF, allowing treatment with anticoagulation to reduce the future risk for stroke.
PMID: 23499278
ISSN: 0002-9149
CID: 513212

Risk Factors for All-Cause Readmission after Heart Failure Admission in Patients with Preserved or Reduced Ejection Fraction [Meeting Abstract]

Siegfried, Jonathan S.; Sagiv, Ofer; Berkowitz, Eric; Takhalov, Yuri; Eltom, Alaeldin; Patel, Suhash; Benjamin, Ralph; Alemu, Benyam; Osahan, Deepinder; Siller, Jennifer; Ullman, Jennifer; Panagopoulos, Georgia; Messineo, Frank; Coplan, Neil L.
ISI:000315462800021
ISSN: 1081-5589
CID: 5268402

RISK FACTORS FOR HEART FAILURE READMISSION [Meeting Abstract]

Siegfried, J. S.; Sagiv, O.; Berkowitz, E.; Patel, S.; Eltom, A.; Takhalov, Y.; Benjamin, R.; Alemu, B.; Osahan, D.; Siller, J.; Ullman, J.; Panagopoulos, G.; Messineo, F.; Coplan, N. L.
ISI:000314156100322
ISSN: 1081-5589
CID: 5333272

Aldosterone receptor antagonists in cardiovascular disease: a review of the recent literature and insight into potential future indications

Markowitz, Mindy; Messineo, Frank; Coplan, Neil L
Randomized controlled trials demonstrate the efficacy of aldosterone receptor antagonists (spironolactone and eplerenone) as a useful pharmacologic intervention specifically in patients with New York Heart Association (NYHA) class III and IV heart failure, in patients with an ejection fraction <40% after myocardial infarction, and most recently in patients with mildly symptomatic heart failure. However, aldosterone receptor antagonists may be beneficial in a broader patient population. Aldosterone receptor antagonists can potentially serve as an antiarrhythmic pharmacologic agent for atrial and ventricular arrhythmias, an anti-ischemic medication in coronary artery disease through prevention of myocardial fibrosis and vascular damage, and as an agent in people with asymptomatic and mild heart failure (NYHA classes I and II) and diastolic heart failure. However, many clinicians remain reluctant to prescribe this highly efficacious pharmacologic therapy for a variety of reasons, including concerns about polypharmacy and hyperkalemia. Recent observational analysis demonstrates that less than one-third of eligible patients hospitalized with heart failure actually received aldosterone antagonist therapy. This article will review the current and potential future uses of aldosterone receptor antagonists across the entire spectrum of cardiovascular disease. The authors have no funding, financial relationships, or conflicts of interest to disclose.
PMID: 22778046
ISSN: 0160-9289
CID: 513182

Apical ballooning syndrome associated with isolated severe hyponatremia: case report and suggested pathophysiology [Case Report]

Sagiv, Ofer; Vukelic, Sasa; Czak, Steve; Messineo, Frank; Coplan, Neil L
An 82-year-old woman who presented to her primary care physician for preoperative evaluation was incidentally found to have severe hyponatremia (sodium = 118 mmol/L). The patient was then admitted for workup and treatment of hyponatremia. On day 2 of the admission, the patient was found to have new T-wave inversions on a telemetry monitor. Further workup, including an electrocardiogram, cardiac markers, echocardiogram, and a cardiac catheterization were consistent with the diagnosis of apical ballooning syndrome (ABS). Mechanisms of how severe hyponatremia may lead to ABS are discussed as well as a possible approach to the management of severe hyponatremia in postmenopausal women.
PMID: 23470689
ISSN: 1530-6550
CID: 513202

UTILIZATION RATE OF AUTOMATED IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS (AICDS) FOR PRIMARY PREVENTION: AN ANALYSIS OF ADHERENCE TO GUIDELINESV-A RETROSPECTIVE CHART REVIEW [Meeting Abstract]

Moretta, A.; Novella, J. A.; Messineo, F.; Suri, R.; Panagopoulos, G.; Mohammad, A.; Yehuda, M.; Shah, M.; Berkowitz, E.; Takhalov, Y.; Alemu, B.; Eltom, A.; Vukelic, S.; Coplan, N.
ISI:000298634402084
ISSN: 1081-5589
CID: 5333262

Detection of atrial fibrillation using a modified microlife blood pressure monitor

Wiesel, Joseph; Fitzig, Lorenzo; Herschman, Yehuda; Messineo, Frank C
BACKGROUND: Hypertension is a major risk factor for the development of atrial fibrillation (AF) and for stroke due to AF. Asymptomatic AF can result in a stroke, in patients with risk factors, if it is not detected and treated appropriately. This study evaluated the sensitivity and specificity of an automatic oscillometric sphygmomanometer designed to detect AF. METHODS: The sphygmomanometer incorporates an algorithm for detecting AF while reducing false positive readings due to premature beats. A total of 405 unselected outpatients seen in two cardiology offices were evaluated by taking three sequential device readings and one electrocardiogram (EKG) on each patient. RESULTS: For detecting AF, the sensitivity was 95% and the specificity 86% with a positive predictive value of 68% and a negative predictive value of 98% for single device readings. For the three sequential device readings grouped together, the sensitivity was 97% and the specificity was 89%. The device correctly categorized most of the non-AF, abnormal rhythms. The specificity for those in sinus rhythm was 97%. CONCLUSIONS: This device is able to detect AF with high sensitivity and specificity. Use of this device by patients who monitor their blood pressure at home may help detect asymptomatic AF and allow for treatment prior to the development of a stroke.
PMID: 19478793
ISSN: 0895-7061
CID: 513122

Systematic review: comparing routine and selective invasive strategies for the acute coronary syndrome

Qayyum, Rehan; Khalid, M Rizwan; Adomaityte, Jurga; Papadakos, Stylianos P; Messineo, Frank C
BACKGROUND: Patients with non-ST-segment elevation acute coronary syndrome (ACS) are managed with either a routine invasive strategy, in which all patients receive coronary angiography, or a selective invasive strategy, in which only patients with refractory or inducible ischemia receive coronary angiography. PURPOSE: To evaluate whether a routine invasive strategy improves cardiovascular outcomes more than a selective invasive strategy in patients with non-ST-segment elevation ACS. DATA SOURCES: English-language publications in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from 1966 to 18 September 2007. STUDY SELECTION: Two investigators independently reviewed searches and selected trials that compared death or myocardial infarction outcomes among adults with non-ST-segment elevation ACS by randomly assigning patients to either a routine invasive strategy or a selective invasive strategy. DATA EXTRACTION: Three investigators independently abstracted data from trial reports by using standardized forms. DATA SYNTHESIS: 10 trials with a total of 10,648 patients (mean age, 62 years; 71% male; median follow-up, 16.5 months) were found. Trial participants had typical symptoms of unstable angina and frequently had a positive electrocardiogram or marker evidence of myocardial ischemia. Of the 5330 participants assigned to the routine invasive strategy group, 847 had the composite outcome of death or nonfatal myocardial infarction, compared with 928 of 5318 participants assigned to the selective invasive strategy group (relative risk, 0.90 [95% CI, 0.74 to 1.08]). Four hundred thirty-eight patients in the routine invasive strategy group and 463 in the selective invasive strategy group died (relative risk, 0.95 [CI, 0.80 to 1.14]). Four hundred ninety and 569 nonfatal myocardial infarctions, respectively, occurred in the 2 groups (relative risk, 0.86 [CI, 0.68 to 1.08]). LIMITATIONS: Methodology, protocols, and outcome definitions differed substantially among the trials. The lower bound of the CI for the pooled results did not rule out the superiority of the routine invasive strategy. CONCLUSION: Available trial evidence is heterogeneous and insufficient for comparing routine and selective invasive strategies. Therefore, in patients with non-ST-segment elevation ACS a routine invasive strategy cannot be proven to reduce deaths or nonfatal myocardial infarction.
PMID: 18252682
ISSN: 0003-4819
CID: 513112

Home monitoring with a modified automatic sphygmomanometer to detect recurrent atrial fibrillation

Wiesel, Joseph; Wiesel, David J; Messineo, Frank C
OBJECTIVES: Detecting asymptomatic atrial fibrillation would help identify patients who would benefit from anticoagulation. This study examined the application of a modified blood pressure monitor to screen for episodes of atrial fibrillation. METHODS: A modified sphygmomanometer was designed to detect atrial fibrillation. The device has a sensitivity near 100% and a specificity of up to 91%. Therefore, this device can be expected to detect all episodes of atrial fibrillation. However, the lower specificity may result in false-positive readings that could prompt unnecessary clinic visits for electrocardiogram confirmation of the rhythm. Outpatients in sinus rhythm with a history of atrial fibrillation were given the device to monitor their pulse regularity once daily to detect atrial fibrillation. Patients with irregular readings were evaluated with an electrocardiogram. RESULTS: Nineteen patients were monitored at home for a period ranging from 5 days to 5 months. Seven patients had recurrent atrial fibrillation identified by the monitor. Nine patients had no irregular readings for a mean of 82 +/- 40 days. Of 19 patients, 3 had false-positive irregular readings that were a result of sinus arrhythmia or ectopy. CONCLUSIONS: The device had an acceptably low false-positive rate allowing 16 of 19 patients to use it at home for long-term atrial fibrillation monitoring. This device may help prevent strokes by identifying patients with prolonged episodes of asymptomatic atrial fibrillation who are candidates for anticoagulation.
PMID: 17689385
ISSN: 1052-3057
CID: 513102