| Physician-directed patient self-management of left atrial pressure in advanced chronic heart failure. | |
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MedLine Citation:
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PMID: 20176990 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Previous studies suggest that management of ambulatory hemodynamics may improve outcomes in chronic heart failure. We conducted a prospective, observational, first-in-human study of a physician-directed patient self-management system targeting left atrial pressure. METHODS AND RESULTS: Forty patients with reduced or preserved left ventricular ejection fraction and a history of New York Heart Association class III or IV heart failure and acute decompensation were implanted with an investigational left atrial pressure monitor, and readings were acquired twice daily. For the first 3 months, patients and clinicians were blinded as to these readings, and treatment continued per usual clinical assessment. Thereafter, left atrial pressure and individualized therapy instructions guided by these pressures were disclosed to the patient. Event-free survival was determined over a median follow-up of 25 months (range 3 to 38 months). Survival without decompensation was 61% at 3 years, and events tended to be less frequent after the first 3 months (hazard ratio 0.16 [95% confidence interval 0.04 to 0.68], P=0.012). Mean daily left atrial pressure fell from 17.6 mm Hg (95% confidence interval 15.8 to 19.4 mm Hg) in the first 3 months to 14.8 mm Hg (95% confidence interval 13.0 to 16.6 mm Hg; P=0.003) during pressure-guided therapy. The frequency of elevated readings (>25 mm Hg) was reduced by 67% (P<0.001). There were improvements in New York Heart Association class (-0.7+/-0.8, P<0.001) and left ventricular ejection fraction (7+/-10%, P<0.001). Doses of angiotensin-converting enzyme/angiotensin-receptor blockers and beta-blockers were uptitrated by 37% (P<0.001) and 40% (P<0.001), respectively, whereas doses of loop diuretics fell by 27% (P=0.15). CONCLUSIONS: Physician-directed patient self-management of left atrial pressure has the potential to improve hemodynamics, symptoms, and outcomes in advanced heart failure. Clinical Trial Registration Information- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00547729. |
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Authors:
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Jay Ritzema; Richard Troughton; Iain Melton; Ian Crozier; Robert Doughty; Henry Krum; Anthony Walton; Philip Adamson; Saibal Kar; Prediman K Shah; Mark Richards; Neal L Eigler; James S Whiting; Garrie J Haas; J Thomas Heywood; Christopher M Frampton; William T Abraham; |
Publication Detail:
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Type: Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2010-02-22 |
Journal Detail:
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Title: Circulation Volume: 121 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-03-09 Completed Date: 2010-03-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 1086-95 Citation Subset: AIM; IM |
Affiliation:
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University of Otago, Christchurch, New Zealand. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00547729 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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administration & dosage,
therapeutic use Aged Aged, 80 and over Angiotensin II Type 1 Receptor Blockers / administration & dosage, therapeutic use Angiotensin-Converting Enzyme Inhibitors / administration & dosage, therapeutic use Blood Pressure Monitoring, Ambulatory* / instrumentation, methods Combined Modality Therapy Double-Blind Method Electrodes, Implanted Equipment Design Female Heart Atria Heart Failure / drug therapy, mortality, physiopathology, therapy* Hemodynamics Humans Kaplan-Meiers Estimate Male Middle Aged Pacemaker, Artificial Prospective Studies Self Care* Sodium Potassium Chloride Symporter Inhibitors / administration & dosage, therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Sodium Potassium Chloride Symporter Inhibitors |
| Investigator | |
Investigator/Affiliation:
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J Aw / ; D Kaye / ; H Krum / ; T Waltoon / ; R Doughty / ; J Stewart / ; N Eigler / ; S Kar / ; R Makkar / ; P K Shah / ; R Siegel / ; J Whiting / ; I Crozier / ; J Lainchbury / ; I Melton / ; M Richards / ; J Ritzema-Carter / ; G Roper / ; R Troughton / ; W T Abraham / ; P Binkley / ; C Bush / ; G Cooke / ; D Feldman / ; D Hart / ; G Haas / ; A Hasan / ; M Houmsse / ; C Leir / ; C Love / ; R Magorien / ; R Mehta / ; B White / ; P Adamson / ; M Harvey / ; T Ahern / ; T Heywood / ; A Johnson / ; M Price / ; R Schatz / ; C Stinis / ; P Teirstein / ; B Greenberg / ; M Mehra / ; J McAnulty / ; M Klapholz / ; M Semigran / ; D Benditt / |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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