Older hospital patients who participate in special care programs that include exercise may go home sooner and incur fewer medical costs than patients receiving standard care, according to a new review of evidence.
The positive effects are "small but significant" according to the review authors, led by Natalie de Morton of Monash University in Australia. However, "it is possible that the multidisciplinary intervention components other than exercise may explain improved hospital outcomes," they say. More studies are needed to determine if exercise is the key factor in producing the benefits.
Although the health benefits of physical activity are well known, senior citizens are not always encouraged to exercise during acute hospitalization. As a result, they may lose strength and mobility and require time in a rehabilitation center before returning home.
The new review is "visionary" in its exploration of "the dual burden of an acute medical condition compounded by inactivity," said Wojtek Chodzko-Zajko, Ph.D., an exercise physiologist at the University of Illinois at Urbana-Champaign.
Chodzko-Zajko, who was not involved with the review, believes hospitals should operate more like health spas, with staff focusing on "the overall health and well-being of their patients, in addition to programs that target whatever medical condition put them in the hospital."
The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Nine studies with a total of 4,223 patients age 65 and older were included in the review. The programs took place in the United States, Australia, the Netherlands and Sweden. Two of the review authors conducted one of the included studies.
Three studies compared exercise-only programs to standard hospital care, while six focused on multidisciplinary care programs that included physical activity. Each of the programs began within the first few days of hospitalization and was administered by medical, nursing or allied health staff.
Most of the fitness-oriented programs encouraged a regular walking regimen, and some also incorporated other exercises. All were designed to maintain or improve patients' ability to perform their normal activities of daily living, de Morton said.
There were no clear improvements among patients in the three exercise-only programs, which included fewer than 700 participants.
Patients receiving multidisciplinary care, however, went home one day earlier than those in standard care programs. In addition, six more patients out of 100 went directly home instead of to another health care facility such as a rehabilitation center.
The bill for each patient in the team-based programs was also nearly $300 lower. Since older adults account for almost half of U.S. hospital bed days, these figures could translate into substantial health care savings, according to the review.
There was no increase in mortality of patients participating in the exercise programs.
The authors acknowledge that factors other than physical activity such as increased attention from hospital staff or better coordination of care may have led to program benefits. Nevertheless, Chodzko-Zajko continues to promote hospital-based workouts.
Even if exercise doesn't speed recovery from a specific condition, he said, "It's still valuable to keep up a regular physical activity regimen just because of the known adverse health consequences of sedentary living."
David Buchner, M.D., of the U.S. Centers for Disease Control and Prevention, concurs. He urges older adults to discuss physical activity levels with their health care providers both during and after a hospital stay. "To the extent possible, they should avoid extremely low levels of physical activity whether in the hospital or not."
Further research on the benefits of exercise for hospitalized older adults is needed, say de Morton and colleagues. They call for larger studies with more detailed reporting on exercise type and intensity, negative effects such as falls and fractures and variability among patients.
If patients at greatest risk of functional decline could be identified upon admission to the hospital, health care services could be more effectively targeted at those in greatest need, they conclude.
de Morton NA, Keating JL, Jeffs K. Exercise for acutely hospitalised older medical patients. (Review). Cochrane Database of Systematic Reviews 2007, Issue 1.
The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit cochrane for more information.
Health Behavior News Service
Center for the Advancement of Health 2000 Florida Ave. NW, Ste 210
Washington, DC 20009
United States
hbns
понедельник, 30 мая 2011 г.
воскресенье, 29 мая 2011 г.
St. Jude Medical Announces Initiation Of A Study To Evaluate The Economic Impact Of FFR In Europe And Canada
St. Jude Medical, Inc. (NYSE:STJ), a global medical device company, announced today at EuroPCR it will evaluate the incremental cost-effectiveness of Fractional Flow Reserve (FFR)-guided treatment for patients with multivessel coronary artery disease in the UK, Germany, France, Italy, Switzerland, Belgium and Canada. The analysis will also determine FFR's potential health and budget impact for each of the seven countries.
FFR measurements indicate the severity of blood flow blockages in the coronary arteries. Using the PressureWire(TM) Aeris or PressureWire(TM) Certus, this physiological measurement helps physicians to better identify which specific lesion or lesions are responsible for a patient's ischemia, a deficiency of blood supply to the heart caused by blood restriction.
The detailed analysis will be based on the results of the FAME (Fractional Flow Reserve (FFR) vs. Angiography in Multivessel Evaluation) study, statistics from country-specific percutaneous coronary intervention (PCI) registries and from published literature.
The research will reveal for each country:
- Whether there is cost savings from using an FFR-guided approach to PCI
- Whether there is a cumulative savings for the health care system annually
- Whether there is an impact on health for the population undergoing PCI
The landmark FAME study, also sponsored by St. Jude Medical, compared treatment guided by FFR to standard angiography in more than 1,000 patients with multivessel coronary artery disease and found that in addition to superior clinical outcomes (which include a 34% reduction in death or heart attack), the FFR-guided intervention strategy reduced health care costs per patient by about $2,000, or 14% in the U.S.
The detailed analysis will be conducted by Professor Uwe Siebert, M.D., MSc, M.P.H., ScD and a FAME study investigator. Each country will also have local clinical advisors to help validate the data modeling.
"PressureWire FFR measurement technology represents a unique opportunity in medicine in which a product not only improves clinical outcomes, but also saves money," said Frank Callaghan, president of the St. Jude Medical's Cardiovascular Division. "St. Jude Medical will continue to conduct evaluations and sponsor research to better understand the broader economic and health care impact that FFR may have."
EuroPCR is the official congress of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), a leading international course for interventional cardiovascular specialists.
About the FAME Trial
The FAME study is a randomized, prospective, multi-center trial which enrolled 1,005 patients with multivessel coronary artery disease. The FAME study compared outcomes for patients whose treatment was guided by FFR to those whose treatment was guided only by angiography using St. Jude Medical's PressureWire Certus technology exclusively for FFR measurement. The 12-month results, published in the January 15, 2009 issue of the New England Journal of Medicine, demonstrated that instances of major adverse cardiovascular events (MACE), including death, myocardial infarction or repeat revascularization, were reduced by 28% for patients whose treatment was guided by FFR rather than by standard angiography alone.
Two-year results presented as a late-breaking trial during the 2009 Transcatheter Cardiovascular Therapeutics (TCT) Conference demonstrated that patients who received FFR-guided treatment continued to experience improved outcomes over time, including a 34% risk reduction in death or myocardial infarction (heart attack). FFR-guided treatment was also demonstrated to be cost-saving, with a difference per patient of about $2,000, or 14%, between total healthcare costs for the FFR-guided group and the group treated by angiography alone after a year. The reduced healthcare costs were a result of reduced procedural costs, reduced follow-up costs for major adverse cardiac events and shorter hospital stays.
Source
St. Jude Medical
FFR measurements indicate the severity of blood flow blockages in the coronary arteries. Using the PressureWire(TM) Aeris or PressureWire(TM) Certus, this physiological measurement helps physicians to better identify which specific lesion or lesions are responsible for a patient's ischemia, a deficiency of blood supply to the heart caused by blood restriction.
The detailed analysis will be based on the results of the FAME (Fractional Flow Reserve (FFR) vs. Angiography in Multivessel Evaluation) study, statistics from country-specific percutaneous coronary intervention (PCI) registries and from published literature.
The research will reveal for each country:
- Whether there is cost savings from using an FFR-guided approach to PCI
- Whether there is a cumulative savings for the health care system annually
- Whether there is an impact on health for the population undergoing PCI
The landmark FAME study, also sponsored by St. Jude Medical, compared treatment guided by FFR to standard angiography in more than 1,000 patients with multivessel coronary artery disease and found that in addition to superior clinical outcomes (which include a 34% reduction in death or heart attack), the FFR-guided intervention strategy reduced health care costs per patient by about $2,000, or 14% in the U.S.
The detailed analysis will be conducted by Professor Uwe Siebert, M.D., MSc, M.P.H., ScD and a FAME study investigator. Each country will also have local clinical advisors to help validate the data modeling.
"PressureWire FFR measurement technology represents a unique opportunity in medicine in which a product not only improves clinical outcomes, but also saves money," said Frank Callaghan, president of the St. Jude Medical's Cardiovascular Division. "St. Jude Medical will continue to conduct evaluations and sponsor research to better understand the broader economic and health care impact that FFR may have."
EuroPCR is the official congress of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), a leading international course for interventional cardiovascular specialists.
About the FAME Trial
The FAME study is a randomized, prospective, multi-center trial which enrolled 1,005 patients with multivessel coronary artery disease. The FAME study compared outcomes for patients whose treatment was guided by FFR to those whose treatment was guided only by angiography using St. Jude Medical's PressureWire Certus technology exclusively for FFR measurement. The 12-month results, published in the January 15, 2009 issue of the New England Journal of Medicine, demonstrated that instances of major adverse cardiovascular events (MACE), including death, myocardial infarction or repeat revascularization, were reduced by 28% for patients whose treatment was guided by FFR rather than by standard angiography alone.
Two-year results presented as a late-breaking trial during the 2009 Transcatheter Cardiovascular Therapeutics (TCT) Conference demonstrated that patients who received FFR-guided treatment continued to experience improved outcomes over time, including a 34% risk reduction in death or myocardial infarction (heart attack). FFR-guided treatment was also demonstrated to be cost-saving, with a difference per patient of about $2,000, or 14%, between total healthcare costs for the FFR-guided group and the group treated by angiography alone after a year. The reduced healthcare costs were a result of reduced procedural costs, reduced follow-up costs for major adverse cardiac events and shorter hospital stays.
Source
St. Jude Medical
суббота, 28 мая 2011 г.
Landmark ATHENA Study With Dronedarone (Multaq(R)) Shows 24% Reduction In Cardiovascular Hospitalisation Or Death In Patients With Atrial Fibrillation
Sanofi-aventis (EURONEXT: SAN and NYSE: SNY) announced that findings from the landmark ATHENA study showed dronedarone (Multaq®), a potential therapy for the treatment of patients with atrial fibrillation or atrial flutter, decreased the risk of cardiovascular hospitalisations or death from any cause by a statistically significant 24% (p=0.00000002), meeting the study primary endpoint. The ATHENA results will be presented at the late breaking clinical trial session of Heart Rhythm 2008, the Heart Rhythm Society's 29th Annual Scientific Sessions in San Francisco, USA.
For the first time in twenty years of clinical drug trials in atrial fibrillation, an investigational medicine, dronedarone, showed a significant decrease in the risk of cardiovascular death by 30% (p=0.03) on top of standard therapy, including rate control and antithrombotic drugs, in patients with atrial fibrillation or atrial flutter. Dronedarone also significantly decreased the risk for arrhythmic death by 45% (p=0.01) and there were numerically less deaths (16%) from any cause in the dronedarone group compared to placebo (p=0.17). First cardiovascular hospitalisation was reduced by 25% (p=0.000000009) in the dronedarone group.
"The ATHENA results have the potential to change the face of atrial fibrillation management. For atrial fibrillation patients, who together with their physicians struggle on a daily basis to manage the dramatic consequences of this complex disease, Multaq®carries hope for patients" said Marc Cluzel, sanofi-aventisSenior Vice President, R&D. "This milestone is indicative of sanofi-aventis' commitment to bringing innovative therapies to market, and of our ongoing commitment to provide patients, physicians and public health stakeholders with breakthrough medicines in those therapeutic areas where there are major healthcare needs and limited solutions".
Atrial fibrillation is a major cause of hospitalisation and mortality and affects about 2.5 million people in the United States, as well as 4.5 million people in the European Union and is emerging as a growing public health concern because of the aging of the population. Patients suffering from atrial fibrillation have twice the risk of death, an increased risk of stroke and cardiovascular complications, including congestive heart failure. Furthermore atrial fibrillation considerably impairs patients' lives, mainly because of their inability to perform normal daily activities due to complaints of palpitations, chest pain, dyspnoea, fatigue or light-headedness, without consideration of the cumbersome and sometime serious constraints imposed by current therapies of atrial fibrillation.
"In atrial fibrillation where treatment morbidity-mortality benefit still needed to be demonstrated, ATHENA is a unique trial using clinically relevant outcomes such as cardiovascular hospitalisation or death as the primary endpoint. In this regard, the trial has clearly achieved these safety and efficacy endpoints," said Dr Stefan H. Hohnloser, J.W. from the Goethe University, Division of Clinical Electrophysiology, Frankfurt, Germany, who served as co-principal investigator of the ATHENA study. "As a consequence, dronedarone is the first treatment for atrial fibrillation which has been demonstrated to reduce cardiovascular hospitalisation or mortality in patients with AF."
The most frequently reported adverse events of dronedarone vs placebo induced gastro-intestinal effect (26% vs 22%), skin disorder (10% vs 8%, mainly rash) and increased blood creatinine (4.7% vs 1%). The mechanism of blood creatinine increase (inhibition of creatinine secretion at the renal tubular level) is well defined. Compared to placebo, dronedarone showed low risk of pro-arrhythmia and no excess of hospitalisations for congestive heart failure. There was a similar rate of study drug discontinuation between the two study groups.
"ATHENA is truly a landmark trial, that marks a paradigm change for the management of atrial fibrillation," said Dr Christopher Cannon, a Senior Investigator in the TIMI Study Group at Brigham and Women's Hospital, who was not involved in the study. "Atrial fibrillation is a very common disease, and our prior treatment options have been focused only on symptom relief and a hope to not do harm, which has been the problem with prior antiarrhythmic drugs. Now, with a highly significant reduction in death or hospitalisation, as well as a 45% reduction in arrhythmic death or 30% cardiovascular death, dronedarone may become a first line treatment of atrial fibrillation".
ATHENA, the largest double blind randomised study in patients with atrial fibrillation, was conducted in more than 550 sites in 37 countries and enrolled a total of 4,628 patients. The ATHENA landmark trial is the first morbidity-mortality study as part of the dronedaronephase III clinical development program, which also included five other multinational clinical studies, an initial study in severe cardiac heart failure and a recent decompensationpatients ANDROMEDA, and a total of 4 international studies in atrial fibrillation: EURIDIS/ADONIS, ERATO, and the ongoing DIONYSOS trial.
Based upon this new clinical data, sanofi-aventis plans to submit a registration dossier to the European Medicines Agency (EMEA), and a new drug application (NDA) to the U.S. Food and Drug Administration (FDA) during the 3rd quarter of 2008.
About Atrial Fibrillation/Flutter
Atrial fibrillation is a major cause of hospitalisation and mortality and affects about 2.5 million people in the USA and 4.5 million people in the European Union. The Atrial Fibrillation Foundation expects the number of patients with AF to double in the next 20 years. Without appropriate management, atrial fibrillation can lead to serious complications, such as stroke and congestive heart failure.
AF is a condition in which the upper chambers of the heart beat in an uncoordinated and disorganised fashion, resulting in an irregular and fast heart rhythm (i.e. an irregular heartbeat). Atrial flutter is an abnormal fast heart rhythm that occurs in the atriaof the heart. This rhythm occurs often in individuals with other heart conditions (eg pericarditis, coronary artery disease, and cardiomyopathy). Atrial flutter frequently degenerates to atrial fibrillation. However, it may persist for months to years.
When blood is not completely pumped out of the heart's chambers, it can pool and clot. If a blood clot forms in the atria, it can exit the heart and block an artery in the brain, resulting in a stroke. Consequently, about 15 percent of all strokes result from atrial fibrillation.
The most common symptoms of atrial fibrillation include palpitations (a rapid, irregular, "flopping" movement or pounding sensation in the chest or neck), shortness of breath, dizziness and feeling of heaviness, or constriction in the chest. The disorder may even be more common than diagnosed, as patients may experience atrial fibrillation episodes that either do not cause symptoms or are not documented during their visits to the doctor.
About the ATHENA Study
The landmark ATHENA study is a randomised, placebo controlled, international metacentre study that evaluated for the first time a treatment on top of standard background therapy for the management of patients with atrial fibrillation in reducing morbidity and mortality by preventing cardiovascular hospitalisations or death from any cause. The study included 4,628 patients, which made it the largest ever outcome study of an anti-arrhythmic treatment for atrial fibrillation.
The ATHENA study objectives were to show a potential benefit of dronedarone on primary composite endpoint of all-cause mortality combined with cardiovascular hospitalisation as compared to placebo. The pre-specified secondary endpoints were death from any cause, cardiovascular death and hospitalisation for cardiovascular reasons. The pre-specified safety endpoint was the incidence of treatment emergent adverse events (time of observation for treatment emergent adverse events) including: all adverse events, serious adverse events, adverse events leading to study drug discontinuation.
The atrial fibrillation or atrial flutter patient population studied were either ?‰?75 years (with or without cardiovascular risk factor) or were 50 mm or left ventricular ejection fraction
For the first time in twenty years of clinical drug trials in atrial fibrillation, an investigational medicine, dronedarone, showed a significant decrease in the risk of cardiovascular death by 30% (p=0.03) on top of standard therapy, including rate control and antithrombotic drugs, in patients with atrial fibrillation or atrial flutter. Dronedarone also significantly decreased the risk for arrhythmic death by 45% (p=0.01) and there were numerically less deaths (16%) from any cause in the dronedarone group compared to placebo (p=0.17). First cardiovascular hospitalisation was reduced by 25% (p=0.000000009) in the dronedarone group.
"The ATHENA results have the potential to change the face of atrial fibrillation management. For atrial fibrillation patients, who together with their physicians struggle on a daily basis to manage the dramatic consequences of this complex disease, Multaq®carries hope for patients" said Marc Cluzel, sanofi-aventisSenior Vice President, R&D. "This milestone is indicative of sanofi-aventis' commitment to bringing innovative therapies to market, and of our ongoing commitment to provide patients, physicians and public health stakeholders with breakthrough medicines in those therapeutic areas where there are major healthcare needs and limited solutions".
Atrial fibrillation is a major cause of hospitalisation and mortality and affects about 2.5 million people in the United States, as well as 4.5 million people in the European Union and is emerging as a growing public health concern because of the aging of the population. Patients suffering from atrial fibrillation have twice the risk of death, an increased risk of stroke and cardiovascular complications, including congestive heart failure. Furthermore atrial fibrillation considerably impairs patients' lives, mainly because of their inability to perform normal daily activities due to complaints of palpitations, chest pain, dyspnoea, fatigue or light-headedness, without consideration of the cumbersome and sometime serious constraints imposed by current therapies of atrial fibrillation.
"In atrial fibrillation where treatment morbidity-mortality benefit still needed to be demonstrated, ATHENA is a unique trial using clinically relevant outcomes such as cardiovascular hospitalisation or death as the primary endpoint. In this regard, the trial has clearly achieved these safety and efficacy endpoints," said Dr Stefan H. Hohnloser, J.W. from the Goethe University, Division of Clinical Electrophysiology, Frankfurt, Germany, who served as co-principal investigator of the ATHENA study. "As a consequence, dronedarone is the first treatment for atrial fibrillation which has been demonstrated to reduce cardiovascular hospitalisation or mortality in patients with AF."
The most frequently reported adverse events of dronedarone vs placebo induced gastro-intestinal effect (26% vs 22%), skin disorder (10% vs 8%, mainly rash) and increased blood creatinine (4.7% vs 1%). The mechanism of blood creatinine increase (inhibition of creatinine secretion at the renal tubular level) is well defined. Compared to placebo, dronedarone showed low risk of pro-arrhythmia and no excess of hospitalisations for congestive heart failure. There was a similar rate of study drug discontinuation between the two study groups.
"ATHENA is truly a landmark trial, that marks a paradigm change for the management of atrial fibrillation," said Dr Christopher Cannon, a Senior Investigator in the TIMI Study Group at Brigham and Women's Hospital, who was not involved in the study. "Atrial fibrillation is a very common disease, and our prior treatment options have been focused only on symptom relief and a hope to not do harm, which has been the problem with prior antiarrhythmic drugs. Now, with a highly significant reduction in death or hospitalisation, as well as a 45% reduction in arrhythmic death or 30% cardiovascular death, dronedarone may become a first line treatment of atrial fibrillation".
ATHENA, the largest double blind randomised study in patients with atrial fibrillation, was conducted in more than 550 sites in 37 countries and enrolled a total of 4,628 patients. The ATHENA landmark trial is the first morbidity-mortality study as part of the dronedaronephase III clinical development program, which also included five other multinational clinical studies, an initial study in severe cardiac heart failure and a recent decompensationpatients ANDROMEDA, and a total of 4 international studies in atrial fibrillation: EURIDIS/ADONIS, ERATO, and the ongoing DIONYSOS trial.
Based upon this new clinical data, sanofi-aventis plans to submit a registration dossier to the European Medicines Agency (EMEA), and a new drug application (NDA) to the U.S. Food and Drug Administration (FDA) during the 3rd quarter of 2008.
About Atrial Fibrillation/Flutter
Atrial fibrillation is a major cause of hospitalisation and mortality and affects about 2.5 million people in the USA and 4.5 million people in the European Union. The Atrial Fibrillation Foundation expects the number of patients with AF to double in the next 20 years. Without appropriate management, atrial fibrillation can lead to serious complications, such as stroke and congestive heart failure.
AF is a condition in which the upper chambers of the heart beat in an uncoordinated and disorganised fashion, resulting in an irregular and fast heart rhythm (i.e. an irregular heartbeat). Atrial flutter is an abnormal fast heart rhythm that occurs in the atriaof the heart. This rhythm occurs often in individuals with other heart conditions (eg pericarditis, coronary artery disease, and cardiomyopathy). Atrial flutter frequently degenerates to atrial fibrillation. However, it may persist for months to years.
When blood is not completely pumped out of the heart's chambers, it can pool and clot. If a blood clot forms in the atria, it can exit the heart and block an artery in the brain, resulting in a stroke. Consequently, about 15 percent of all strokes result from atrial fibrillation.
The most common symptoms of atrial fibrillation include palpitations (a rapid, irregular, "flopping" movement or pounding sensation in the chest or neck), shortness of breath, dizziness and feeling of heaviness, or constriction in the chest. The disorder may even be more common than diagnosed, as patients may experience atrial fibrillation episodes that either do not cause symptoms or are not documented during their visits to the doctor.
About the ATHENA Study
The landmark ATHENA study is a randomised, placebo controlled, international metacentre study that evaluated for the first time a treatment on top of standard background therapy for the management of patients with atrial fibrillation in reducing morbidity and mortality by preventing cardiovascular hospitalisations or death from any cause. The study included 4,628 patients, which made it the largest ever outcome study of an anti-arrhythmic treatment for atrial fibrillation.
The ATHENA study objectives were to show a potential benefit of dronedarone on primary composite endpoint of all-cause mortality combined with cardiovascular hospitalisation as compared to placebo. The pre-specified secondary endpoints were death from any cause, cardiovascular death and hospitalisation for cardiovascular reasons. The pre-specified safety endpoint was the incidence of treatment emergent adverse events (time of observation for treatment emergent adverse events) including: all adverse events, serious adverse events, adverse events leading to study drug discontinuation.
The atrial fibrillation or atrial flutter patient population studied were either ?‰?75 years (with or without cardiovascular risk factor) or were 50 mm or left ventricular ejection fraction
пятница, 27 мая 2011 г.
Woman Who Regularly Fainted While Eating Sandwiches Or Fizzy Drinks - Case Explored
The unusual case of a woman who regularly fainted while eating sandwiches or fizzy drinks is explored in a Case Report in this week's edition of The Lancet, written by Dr Christopher J Boos, and Dr Howard Marshall, Department of Cardiology, University Hospital Birmingham, UK, and colleagues.
The 25-year-old woman was seen at the hospital in January this year. She presented with episodes, typically lasting 10 second or less, of feeling suddenly and alarmingly light headed, and nauseous. She had collapsed on more than one occasion, but had no movements typical of epilepsy. Sometimes she would have several episodes a week. The problem first began when she was 15 and remained unexplained despite hospital admissions between 2001 and 2007. A full battery of blood and other tests had, more than once, revealed everything to be normal. However, an electrocardiogram (ECG) test had shown a pause of 2.5 seconds. She then had external-loop ECG tests, in which she was asked to press a button to record 1-2 minutes of the ECG each time she felt faint. At times of light-headedness, she was found to have complete atrioventricular block (a slowing of intracardiac conduction), with beat-to-beat pauses lasting up to 2.5 seconds.
On questioning, the patient revealed no history of note - she did not smoke, drank little alcohol and had never used illicit drugs. Her episodes tended to occur when she ate certain types of food, particularly sandwiches and fizzy drinks - and she had last collapsed when eating a sandwich while driving (in stationary traffic). Despite weighing only 46.5 kg, she had no symptoms of anorexia and her pulse rate and blood pressure were normal. Dr Boos and colleagues offered the woman a sandwich, which caused rapid onset of atrioventricular block and an associated 'heart pause' lasting two seconds - causing her to feel light headed again. She was diagnosed with 'swallow syncope'. This is a condition caused by alterations in the vagal nervous reflex arc - whereby the action of swallowing leads to vagal hyperstimulation and abnormal feedback along these nerves causing the heart to stop temporarily, leading to light-headedness or fainting. The woman was fitted with a pacemaker to overcome this, and, when last seen in June 2008, was free of fainting.
The authors conclude: "Cardiac pacing, when necessary, has been shown to be effective in an increasing number of case reports??¦Patients with swallow syncope can languish for years because the diagnosis is little known - although a case report on it was published in The Lancet, 50 years ago."
Dr Christopher J Boos, Department of Cardiology, University Hospital Birmingham, UK
Dr Howard Marshall, Department of Cardiology, University Hospital Birmingham, bham.ac.uk
Full Case Report: press.thelancet/sandwichesfinal.pdf
The 25-year-old woman was seen at the hospital in January this year. She presented with episodes, typically lasting 10 second or less, of feeling suddenly and alarmingly light headed, and nauseous. She had collapsed on more than one occasion, but had no movements typical of epilepsy. Sometimes she would have several episodes a week. The problem first began when she was 15 and remained unexplained despite hospital admissions between 2001 and 2007. A full battery of blood and other tests had, more than once, revealed everything to be normal. However, an electrocardiogram (ECG) test had shown a pause of 2.5 seconds. She then had external-loop ECG tests, in which she was asked to press a button to record 1-2 minutes of the ECG each time she felt faint. At times of light-headedness, she was found to have complete atrioventricular block (a slowing of intracardiac conduction), with beat-to-beat pauses lasting up to 2.5 seconds.
On questioning, the patient revealed no history of note - she did not smoke, drank little alcohol and had never used illicit drugs. Her episodes tended to occur when she ate certain types of food, particularly sandwiches and fizzy drinks - and she had last collapsed when eating a sandwich while driving (in stationary traffic). Despite weighing only 46.5 kg, she had no symptoms of anorexia and her pulse rate and blood pressure were normal. Dr Boos and colleagues offered the woman a sandwich, which caused rapid onset of atrioventricular block and an associated 'heart pause' lasting two seconds - causing her to feel light headed again. She was diagnosed with 'swallow syncope'. This is a condition caused by alterations in the vagal nervous reflex arc - whereby the action of swallowing leads to vagal hyperstimulation and abnormal feedback along these nerves causing the heart to stop temporarily, leading to light-headedness or fainting. The woman was fitted with a pacemaker to overcome this, and, when last seen in June 2008, was free of fainting.
The authors conclude: "Cardiac pacing, when necessary, has been shown to be effective in an increasing number of case reports??¦Patients with swallow syncope can languish for years because the diagnosis is little known - although a case report on it was published in The Lancet, 50 years ago."
Dr Christopher J Boos, Department of Cardiology, University Hospital Birmingham, UK
Dr Howard Marshall, Department of Cardiology, University Hospital Birmingham, bham.ac.uk
Full Case Report: press.thelancet/sandwichesfinal.pdf
четверг, 26 мая 2011 г.
Roche Diagnostics Announces Successful Resolution Of Urgent Medical Device Correction Of CoaguChek PT Test Strips Used In Anticoagulation Monitoring
Roche Diagnostics, in cooperation
with the U.S. Food and Drug Administration, announced today that the Urgent
Medical Device Correction issued for CoaguChek PT test strips (UMDC
06-266), used in anticoagulation monitoring, has been addressed and
duplicate testing is no longer required for CoaguChek PT Test Strips, lot
numbers 560A and higher (e.g., 561A, 562A, ...).
The potential for erroneous prothrombin time (PT) test results that
prompted the UMDC was a result of insufficient active ingredient
(thromboplastin) on selected test strips. Fully tested and validated
changes have been implemented within the manufacturing process to address
this concern. Every test strip is inspected to ensure that it contains the
correct amount of thromboplastin before being packaged and shipped.
All healthcare professionals performing duplicate testing to confirm
results can return to a single test using CoaguChek PT Test Strips (only
from lot numbers 560A and higher) to monitor patients on warfarin
(anticoagulation) therapy. All patients previously performing patient
self-testing may now resume monitoring with CoaguChek PT Test Strips (only
from lot numbers 560A and higher).
"Patient safety is Roche Diagnostics' first priority. We are now using
an innovative detection system, combined with other measures, to improve
our test strip manufacturing process," said Randy Pritchard, Director of
Product Marketing, Near Patient Testing, Roche Diagnostics. "We are
confident that the potential for erroneous results from inadequate levels
of thromboplastin has been addressed, and we are pleased to continue
providing healthcare professionals with CoaguChek PT Test Strips and other
products that meet the highest standards of quality and patient safety."
About CoaguChek products
Physicians have been using CoaguChek instruments for PT/INR testing at
the point of care (POC) since 1994. Today, in the U.S., four out of five
POC PT/INR tests are performed using a CoaguChek system (1). The new
CoaguChek XS system represents the third generation of point-of-care
anticoagulation monitoring devices from Roche Diagnostics.
About Roche
Headquartered in Basel, Switzerland, Roche is one of the world's
leading research-focused healthcare groups in the fields of pharmaceuticals
and diagnostics. As the world's biggest biotech company and an innovator of
products and services for the early detection, prevention, diagnosis and
treatment of diseases, the Group contributes on a broad range of fronts to
improving people's health and quality of life. Roche is the world leader in
in-vitro diagnostics and drugs for cancer and transplantation, a market
leader in virology and active in other major therapeutic areas such as
autoimmune diseases, inflammation, metabolism and central nervous system.
In 2006, sales by the Pharmaceuticals Division totaled 33.3 billion Swiss
francs, and the Diagnostics Division posted sales of 8.7 billion Swiss
francs. Roche employs roughly 75,000 worldwide and has R&D agreements and
strategic alliances with numerous partners, including majority ownership
interests in Genentech and Chugai. Roche's Diagnostics Division offers a
uniquely broad product portfolio and supplies a wide array of innovative
testing products and services to researchers, physicians, patients,
hospitals and laboratories world-wide. For further information, please
visit our websites at roche-diagnostics.us and roche.
All trademarks used or mentioned in this release are legally protected
by law.
Healthcare Professional/Patient Questions: 1-800-820-0995
(1) Third quarter 2006 total market share of projected distributor unit
sales of the Point of Care Testing Coagulation Reagents and Kits product
class by HPIS Market Intelligence, a division of GHX Global Healthcare
Exchange. Total Market includes all market sectors as defined by HPIS:
Physician, Long Term Care, Treatment Centers, Clinical Laboratory,
Hospital, Home Healthcare and Other/Unspecified. Data on file.
Roche Diagnostics
roche
View drug information on Warfarin Sodium tablets.
with the U.S. Food and Drug Administration, announced today that the Urgent
Medical Device Correction issued for CoaguChek PT test strips (UMDC
06-266), used in anticoagulation monitoring, has been addressed and
duplicate testing is no longer required for CoaguChek PT Test Strips, lot
numbers 560A and higher (e.g., 561A, 562A, ...).
The potential for erroneous prothrombin time (PT) test results that
prompted the UMDC was a result of insufficient active ingredient
(thromboplastin) on selected test strips. Fully tested and validated
changes have been implemented within the manufacturing process to address
this concern. Every test strip is inspected to ensure that it contains the
correct amount of thromboplastin before being packaged and shipped.
All healthcare professionals performing duplicate testing to confirm
results can return to a single test using CoaguChek PT Test Strips (only
from lot numbers 560A and higher) to monitor patients on warfarin
(anticoagulation) therapy. All patients previously performing patient
self-testing may now resume monitoring with CoaguChek PT Test Strips (only
from lot numbers 560A and higher).
"Patient safety is Roche Diagnostics' first priority. We are now using
an innovative detection system, combined with other measures, to improve
our test strip manufacturing process," said Randy Pritchard, Director of
Product Marketing, Near Patient Testing, Roche Diagnostics. "We are
confident that the potential for erroneous results from inadequate levels
of thromboplastin has been addressed, and we are pleased to continue
providing healthcare professionals with CoaguChek PT Test Strips and other
products that meet the highest standards of quality and patient safety."
About CoaguChek products
Physicians have been using CoaguChek instruments for PT/INR testing at
the point of care (POC) since 1994. Today, in the U.S., four out of five
POC PT/INR tests are performed using a CoaguChek system (1). The new
CoaguChek XS system represents the third generation of point-of-care
anticoagulation monitoring devices from Roche Diagnostics.
About Roche
Headquartered in Basel, Switzerland, Roche is one of the world's
leading research-focused healthcare groups in the fields of pharmaceuticals
and diagnostics. As the world's biggest biotech company and an innovator of
products and services for the early detection, prevention, diagnosis and
treatment of diseases, the Group contributes on a broad range of fronts to
improving people's health and quality of life. Roche is the world leader in
in-vitro diagnostics and drugs for cancer and transplantation, a market
leader in virology and active in other major therapeutic areas such as
autoimmune diseases, inflammation, metabolism and central nervous system.
In 2006, sales by the Pharmaceuticals Division totaled 33.3 billion Swiss
francs, and the Diagnostics Division posted sales of 8.7 billion Swiss
francs. Roche employs roughly 75,000 worldwide and has R&D agreements and
strategic alliances with numerous partners, including majority ownership
interests in Genentech and Chugai. Roche's Diagnostics Division offers a
uniquely broad product portfolio and supplies a wide array of innovative
testing products and services to researchers, physicians, patients,
hospitals and laboratories world-wide. For further information, please
visit our websites at roche-diagnostics.us and roche.
All trademarks used or mentioned in this release are legally protected
by law.
Healthcare Professional/Patient Questions: 1-800-820-0995
(1) Third quarter 2006 total market share of projected distributor unit
sales of the Point of Care Testing Coagulation Reagents and Kits product
class by HPIS Market Intelligence, a division of GHX Global Healthcare
Exchange. Total Market includes all market sectors as defined by HPIS:
Physician, Long Term Care, Treatment Centers, Clinical Laboratory,
Hospital, Home Healthcare and Other/Unspecified. Data on file.
Roche Diagnostics
roche
View drug information on Warfarin Sodium tablets.
среда, 25 мая 2011 г.
NIH Genomic Mapping Study Finds Largest Set Of Genes Related To Major Risk Factor For Heart Disease
Scanning the genomes of more than 100,000 people from all over the world, scientists report the largest set of genes discovered underlying high cholesterol and high triglycerides - the major risk factors for coronary heart disease, the nation's number one killer. Taken together, the gene variants explain between a quarter and a third of the inherited portions of cholesterol and triglyceride measured in the blood. The research, representing scientists from 17 countries, appears in two papers in the Aug. 5 issue of Nature.
The National Institutes of Health's National Heart, Lung, and Blood Institute (NHLBI) is the lead funder of the research, with additional support from the National Human Genome Research Institute (NHGRI), the National Institute on Aging (NIA), and several other NIH components. Genome-wide association studies, or GWAS, analyze DNA across populations to pinpoint hard-to-find genetic hotspots for common diseases that are thought to have many causes, both genetic and environmental. Previous gene-scanning approaches have turned up hints about the nature of inherited heart disease risk. The new results take science well beyond what was previously known, and pinpoint research directions to elucidate the molecular and cellular mechanisms by which genetic variants contribute to disease.
"Genetic studies that survey a wide variety of human populations are a powerful tool for identifying hereditary factors in health and disease," said study co-author and NIH Director Francis S. Collins, M.D., Ph.D. "These results help refine our course for preventing and treating heart disease, a health problem that affects millions of Americans and many more people worldwide."
The research team found 95 genetic variants - arrangements of the nucleic acids in DNA that differ among people - which contribute to changes in blood cholesterol and triglyceride levels in women and men of many ethnic backgrounds. Abnormal levels of blood cholesterol and of triglycerides are powerful risk factors for heart disease. Because high blood cholesterol on its own does not cause symptoms, doctors routinely do blood tests to assess individual risk, but they do not know how much risk of developing cardiovascular disease is inherited.
Of the genetic variants, 59 had not been known and thus provide new clues for developing effective medicines to combat heart disease. A significant insight from this research is that many of the variants show up in the DNA of people of widely diverse backgrounds. That is because the scientists scoured the DNA from people participating in large, population-based heart disease studies, reflecting people of European, Eastern and Southern Asian, and African-American descent.
Together, research participants from NHLBI study populations contributed about half of the 100,000 genomes scanned. Among the NIH population-based studies involved in the research were the Framingham Heart Study; the Atherosclerosis Risk in Communities Study; the Cardiovascular Health Study; the SardiNIA Study; the Ages, Gene, Environment Study; the InCHIANTI Study; the Family Heart Study; the NHLBI Candidate Gene Association Resource Program; the NIH Pharmacogenetics Research Network; the deCODE MI Study; and the Women's Genome Health Study.
"The NHLBI is a leader in supporting long-term studies, including the decades-long Framingham Heart Study, that carefully track the health outcomes of large groups of people and generations of families." said NHLBI Acting Director Susan B. Shurin, M.D. "This genome-wide association study successfully demonstrates how cutting-edge genomics research can be leveraged by our past and current research investment in population-based studies assessing long-term health and disease."
The research team's other study probed deeply into one of the genetic variants identified in the accompanying GWAS analysis.
In the group's second study, the scientists had an unusual opportunity to follow up on the findings of the GWAS to determining how one unusual gene variant trips up cholesterol and triglyceride metabolism in mice. Previous studies had identified the same genetic variant in humans who were prone to deadly heart attacks: The variant is common in people of African American, Hispanic, Asian Indian, and Chinese ancestries. Having a genetically identical mouse model enables researchers to look further into the contribution of a particular genetic variant to inherited heart disease risk.
"The new findings point us to specific genetic signposts that allow us to understand more fully why many people from all walks of life have abnormal levels of cholesterol and other blood lipids that lead to heart disease," said Christopher J. O'Donnell, M.D., associate director of the Framingham Heart Study and senior advisor for genomics to the NHLBI acting director. "What's really exciting about this work is that we are moving from discovery to understanding brand-new information about how genes alter the lipids that contribute to heart disease."
In addition to the NHLBI, the NIA and the NHGRI, other NIH funding sources include the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke, the National Cancer Institute, the National Institute of General Medical Sciences, the National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Center for Research Resources.
The National Institutes of Health's National Heart, Lung, and Blood Institute (NHLBI) is the lead funder of the research, with additional support from the National Human Genome Research Institute (NHGRI), the National Institute on Aging (NIA), and several other NIH components. Genome-wide association studies, or GWAS, analyze DNA across populations to pinpoint hard-to-find genetic hotspots for common diseases that are thought to have many causes, both genetic and environmental. Previous gene-scanning approaches have turned up hints about the nature of inherited heart disease risk. The new results take science well beyond what was previously known, and pinpoint research directions to elucidate the molecular and cellular mechanisms by which genetic variants contribute to disease.
"Genetic studies that survey a wide variety of human populations are a powerful tool for identifying hereditary factors in health and disease," said study co-author and NIH Director Francis S. Collins, M.D., Ph.D. "These results help refine our course for preventing and treating heart disease, a health problem that affects millions of Americans and many more people worldwide."
The research team found 95 genetic variants - arrangements of the nucleic acids in DNA that differ among people - which contribute to changes in blood cholesterol and triglyceride levels in women and men of many ethnic backgrounds. Abnormal levels of blood cholesterol and of triglycerides are powerful risk factors for heart disease. Because high blood cholesterol on its own does not cause symptoms, doctors routinely do blood tests to assess individual risk, but they do not know how much risk of developing cardiovascular disease is inherited.
Of the genetic variants, 59 had not been known and thus provide new clues for developing effective medicines to combat heart disease. A significant insight from this research is that many of the variants show up in the DNA of people of widely diverse backgrounds. That is because the scientists scoured the DNA from people participating in large, population-based heart disease studies, reflecting people of European, Eastern and Southern Asian, and African-American descent.
Together, research participants from NHLBI study populations contributed about half of the 100,000 genomes scanned. Among the NIH population-based studies involved in the research were the Framingham Heart Study; the Atherosclerosis Risk in Communities Study; the Cardiovascular Health Study; the SardiNIA Study; the Ages, Gene, Environment Study; the InCHIANTI Study; the Family Heart Study; the NHLBI Candidate Gene Association Resource Program; the NIH Pharmacogenetics Research Network; the deCODE MI Study; and the Women's Genome Health Study.
"The NHLBI is a leader in supporting long-term studies, including the decades-long Framingham Heart Study, that carefully track the health outcomes of large groups of people and generations of families." said NHLBI Acting Director Susan B. Shurin, M.D. "This genome-wide association study successfully demonstrates how cutting-edge genomics research can be leveraged by our past and current research investment in population-based studies assessing long-term health and disease."
The research team's other study probed deeply into one of the genetic variants identified in the accompanying GWAS analysis.
In the group's second study, the scientists had an unusual opportunity to follow up on the findings of the GWAS to determining how one unusual gene variant trips up cholesterol and triglyceride metabolism in mice. Previous studies had identified the same genetic variant in humans who were prone to deadly heart attacks: The variant is common in people of African American, Hispanic, Asian Indian, and Chinese ancestries. Having a genetically identical mouse model enables researchers to look further into the contribution of a particular genetic variant to inherited heart disease risk.
"The new findings point us to specific genetic signposts that allow us to understand more fully why many people from all walks of life have abnormal levels of cholesterol and other blood lipids that lead to heart disease," said Christopher J. O'Donnell, M.D., associate director of the Framingham Heart Study and senior advisor for genomics to the NHLBI acting director. "What's really exciting about this work is that we are moving from discovery to understanding brand-new information about how genes alter the lipids that contribute to heart disease."
In addition to the NHLBI, the NIA and the NHGRI, other NIH funding sources include the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke, the National Cancer Institute, the National Institute of General Medical Sciences, the National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Center for Research Resources.
вторник, 24 мая 2011 г.
What Are Beta-Blockers? What Are Beta-Blockers For?
Beta-blockers, also known as beta-adrenergic blocking agents, beta-adrenergic antagonists, or beta antagonists, are a type of drug that block the action of the sympathetic nervous system of the heart, resulting in a relief of stress on the heart.
A beta-blocker blocks beta-adrenergic substances, for example adrenaline (apinephrine) in the involuntary nervous system (autononomic nervous system). Beta-blockers slow down the heart beat, reduce the force of the heart muscle's contractions, and decrease blood vessel contraction in the heart, brain, and the rest of the body.
Patients with cardiac arrhythmias (abnormal heart rhythms), tachycardias (accelerated heart rates), or irregular heart rhythms (atrial fibrillation), such as premature ventricular beats may be prescribed beta-blockers. They may also be useful in treating angina because they lower the heart muscle's demand for oxygen - angina pectoris occurs when the heart's demand for oxygen is greater than the supply.
Beta-blockers are useful in the treatment of high blood pressure (hypertension) because their effects on blood vessels lowers blood pressure. They are also key drugs in improving survival rates for patients after a heart attack.
Beta-blockers are also used for preventing migraine headaches and some familial or hereditary tremors.
In other words, beta-blockers are known as beta- adrenoreceptor blocking agents and are used to treat:
Commonly
Angina
Heart failure
High blood pressure (hypertension)
irregular heart beat (atrial fibrillation)
Myocardial infarction (heart attack)
Less commonly
Prevention of migraine
Thyrotoxicosis (overactive thyroid)
Anxiety
Tremor
Glaucoma (as eye drops)
The first clinically useful beta adrenergic receptor antagonist was called Propranolol. It was invented by Sir James W. Black (born 1924), a Scottish doctor and pharmacologist. Sir James also synthesized Cimetidine (for the treatment of heartburn and peptic ulcers) and was awarded the Nobel Prize for Medicine in 1988. Propranolol revolutionized the medical management of angina pectoris - it is considered as one of the major contributions to clinical medicine and pharmacology of the 20th century.
According to Medilexicon's medical dictionary
A beta-adrenergic blocking agent is "a class of drugs that competes with ??-adrenergic agonists for available receptor sites; some compete for both Beta1 and Beta2 receptors (propranolol) whereas others are primarily either Beta1 (metoprolol) or Beta2 blockers; used in the treatment of a variety of cardiovascular diseases for which beta-adrenergic blockade is desirable."
Types of beta-blockers
There are various types of beta-blockers (beta-adrenoceptor blocking agents). Which one a patient has depends on his/her condition.
Below are some examples:
Acebutolol (Sectral)
Atenolol (Tenormin)
Betaxolol (Betoptic)
Bisoprolol (Cardicor, Emcor, Zebeta)
Carteolol (Teoptic)
Carvedilol (Coreg, Eucardic)
Celiprolol (Celectol)
Labetalol (Trandate)
Levobunolol (Betagan)
Metipranolol (Metipranolol Minims)
Metoprolol (Betaloc, Lopresor, Lopressor, Toprol XL)
Nadolol (Corgard)
Nebivolol (Bystolic, Nebilet)
Oxprenolol (Trasicor)
Pindolol (Visken)
Propranolol (Inderal LA)
Sotalol (Beta-Cardone, Sotacor)
Timolol (Betim, Nyogel, Timoptol)
What do beta-blockers do?
Beta-blockers block the release of noradrenalin in parts of the body. Noradrenalin is released by the nerves when they are stimulated - it is a chemical that conveys messages to other parts of the body, including muscles, blood vessels and the heart.
Heart problems - for a patient with heart problems beta-blockers can reduce the workload for the heart; so that it does not have to work so hard to supply all parts of the body with oxygen-rich blood. For people with angina, heart failure, or after a heart attack, reducing the heart's workload is crucial.
Beta-blockers can also block the stimulation of the heart form electrical impulses - they can control irregular heartbeats - thus lowering the activity of the heart and slowing down the heart rate.
Hypertension - beta-blockers lower blood pressure by slowing down the heart rate, as well as reducing the force of the heart. Blood still gets to all parts of the body, but at reduced pressure.
Glaucoma - pressure within the eyeball is reduced with beta-blocker eye drops. The medication lowers the production of fluid inside the eye ball (aqueous humor).
Things to bear in mind with beta-blockers
The following people should not take beta-blockers:
Patients with a history of asthma (unless the doctor says so)
Patients with a history of bronchospasm (unless the doctor says so)
Patients with second or third degree heart block
Patients with severe peripheral arterial disease (including Raynaud's syndrome)
Patients with worsening, unstable heart failure (can be used for stable heart failure)
For the following people, beta-blockers should be used with caution:
Patients with diabetes, especially those with regular episodes of low blood sugar (hypoglycemia)
Patients with MG (myasthenia gravis)
Patients with a slow heart rate (bradycardia)
Patients with low blood pressure (hypotension)
Patients with hypertension that results from an adrenal gland tumor (pheochromocytoma)
Patients with high blood acid levels (metabolic acidosis)
Patients with Prinzmetal angina
Pregnancy and breastfeeding - in some cases certain types of beta-blockers may be used.
Getting off beta-blockers - Patients must not stop taking beta-blockers suddenly without their doctor's advice and close supervision. Suddenly ceasing beta-blocker treatment may exacerbate the patient's condition, especially after a heart attack or for the treatment of angina.
What are the side effects of beta-blockers?
The most common side effects are:
Cold feet
Cold hands
Diarrhea
Fatigue
Nausea
Very slow heartbeat
The following less common side effects are also possible:
Sleeping difficulties and disturbances
Bad dreams (nightmares)
Erectile dysfunction (male inability to achieve or sustain an erection during sex)
Driving - some patients may experience dizziness or fatigue; in such cases they should not drive. However, this is rare.
Beta-blocker interactions with other drugs
Drug interaction is the extra effects two different medicines can have on the body when taken together - effects beyond their primary purposes. Beta-blockers can interact with the following medications:
Antipsychotics - these medications are commonly prescribed for patients with bipolar disorder or schizophrenia. When taken with some beta-blockers the risk of arrhythmias is greater.
Clonidine - a medication prescribed for either patients with hypertension (high blood pressure) or migraines. A patient who is taking both clonidine and beta-blockers and then suddenly stops taking clonidine has a greater risk of experiencing a sudden and sharp rise in blood pressure (rebound hypertension).
Digoxin - prescribed for patients with congestive heart failure and certain cardiac arrhythmias. When taken with beta-blockers there is a higher risk of slow heart rate (bradycardia).
Diltiazem - a medication that dilates blood vessels, prescribed for patients with angina pectoris or hypertension. When taken with beta-blockers there is a higher risk of slow heart rate (bradycardia).
Drugs to control high blood pressure (antihypertensives) - when taken with beta-blockers the patient may experience hypotension (a serious drop in blood pressure).
Drugs to control irregular heartbeats (anti-arrhythmics) - when taken with beta-blockers the risk of impaired function of the heart (myocardial depression) is greater, as is the risk of irregular heartbeats (arrhythmias).
Mefloquine - a drug for the treatment of malaria resistant to chloroquine phosphate. When taken with beta-blockers the result may be bradycardia.
Nifedipine - this drug reduces calcium ions available to heart and smooth muscle, used in the treatment of angina pectoris. When taken with beta-blockers there is a higher risk of hypotension (low blood pressure).
Nisoldipine - a calcium channel blocker used in the treatment of high blood pressure (hypertension). When taken with beta-blockers there is a higher risk of hypotension (low blood pressure).
Verapamil - used in the treatment of hypertension, angina pectoris, and certain cardiac arrhythmias. When taken with beta-blockers there is a higher risk of hypotension (low blood pressure).
Check with your pharmacist or doctor for a more comprehensive and up-to-date list of beta-blocker interactions.
View drug information on Cimetidine Hydrochloride Oral Solution; Pindolol.
A beta-blocker blocks beta-adrenergic substances, for example adrenaline (apinephrine) in the involuntary nervous system (autononomic nervous system). Beta-blockers slow down the heart beat, reduce the force of the heart muscle's contractions, and decrease blood vessel contraction in the heart, brain, and the rest of the body.
Patients with cardiac arrhythmias (abnormal heart rhythms), tachycardias (accelerated heart rates), or irregular heart rhythms (atrial fibrillation), such as premature ventricular beats may be prescribed beta-blockers. They may also be useful in treating angina because they lower the heart muscle's demand for oxygen - angina pectoris occurs when the heart's demand for oxygen is greater than the supply.
Beta-blockers are useful in the treatment of high blood pressure (hypertension) because their effects on blood vessels lowers blood pressure. They are also key drugs in improving survival rates for patients after a heart attack.
Beta-blockers are also used for preventing migraine headaches and some familial or hereditary tremors.
In other words, beta-blockers are known as beta- adrenoreceptor blocking agents and are used to treat:
Commonly
Angina
Heart failure
High blood pressure (hypertension)
irregular heart beat (atrial fibrillation)
Myocardial infarction (heart attack)
Less commonly
Prevention of migraine
Thyrotoxicosis (overactive thyroid)
Anxiety
Tremor
Glaucoma (as eye drops)
The first clinically useful beta adrenergic receptor antagonist was called Propranolol. It was invented by Sir James W. Black (born 1924), a Scottish doctor and pharmacologist. Sir James also synthesized Cimetidine (for the treatment of heartburn and peptic ulcers) and was awarded the Nobel Prize for Medicine in 1988. Propranolol revolutionized the medical management of angina pectoris - it is considered as one of the major contributions to clinical medicine and pharmacology of the 20th century.
According to Medilexicon's medical dictionary
A beta-adrenergic blocking agent is "a class of drugs that competes with ??-adrenergic agonists for available receptor sites; some compete for both Beta1 and Beta2 receptors (propranolol) whereas others are primarily either Beta1 (metoprolol) or Beta2 blockers; used in the treatment of a variety of cardiovascular diseases for which beta-adrenergic blockade is desirable."
Types of beta-blockers
There are various types of beta-blockers (beta-adrenoceptor blocking agents). Which one a patient has depends on his/her condition.
Below are some examples:
Acebutolol (Sectral)
Atenolol (Tenormin)
Betaxolol (Betoptic)
Bisoprolol (Cardicor, Emcor, Zebeta)
Carteolol (Teoptic)
Carvedilol (Coreg, Eucardic)
Celiprolol (Celectol)
Labetalol (Trandate)
Levobunolol (Betagan)
Metipranolol (Metipranolol Minims)
Metoprolol (Betaloc, Lopresor, Lopressor, Toprol XL)
Nadolol (Corgard)
Nebivolol (Bystolic, Nebilet)
Oxprenolol (Trasicor)
Pindolol (Visken)
Propranolol (Inderal LA)
Sotalol (Beta-Cardone, Sotacor)
Timolol (Betim, Nyogel, Timoptol)
What do beta-blockers do?
Beta-blockers block the release of noradrenalin in parts of the body. Noradrenalin is released by the nerves when they are stimulated - it is a chemical that conveys messages to other parts of the body, including muscles, blood vessels and the heart.
Heart problems - for a patient with heart problems beta-blockers can reduce the workload for the heart; so that it does not have to work so hard to supply all parts of the body with oxygen-rich blood. For people with angina, heart failure, or after a heart attack, reducing the heart's workload is crucial.
Beta-blockers can also block the stimulation of the heart form electrical impulses - they can control irregular heartbeats - thus lowering the activity of the heart and slowing down the heart rate.
Hypertension - beta-blockers lower blood pressure by slowing down the heart rate, as well as reducing the force of the heart. Blood still gets to all parts of the body, but at reduced pressure.
Glaucoma - pressure within the eyeball is reduced with beta-blocker eye drops. The medication lowers the production of fluid inside the eye ball (aqueous humor).
Things to bear in mind with beta-blockers
The following people should not take beta-blockers:
Patients with a history of asthma (unless the doctor says so)
Patients with a history of bronchospasm (unless the doctor says so)
Patients with second or third degree heart block
Patients with severe peripheral arterial disease (including Raynaud's syndrome)
Patients with worsening, unstable heart failure (can be used for stable heart failure)
For the following people, beta-blockers should be used with caution:
Patients with diabetes, especially those with regular episodes of low blood sugar (hypoglycemia)
Patients with MG (myasthenia gravis)
Patients with a slow heart rate (bradycardia)
Patients with low blood pressure (hypotension)
Patients with hypertension that results from an adrenal gland tumor (pheochromocytoma)
Patients with high blood acid levels (metabolic acidosis)
Patients with Prinzmetal angina
Pregnancy and breastfeeding - in some cases certain types of beta-blockers may be used.
Getting off beta-blockers - Patients must not stop taking beta-blockers suddenly without their doctor's advice and close supervision. Suddenly ceasing beta-blocker treatment may exacerbate the patient's condition, especially after a heart attack or for the treatment of angina.
What are the side effects of beta-blockers?
The most common side effects are:
Cold feet
Cold hands
Diarrhea
Fatigue
Nausea
Very slow heartbeat
The following less common side effects are also possible:
Sleeping difficulties and disturbances
Bad dreams (nightmares)
Erectile dysfunction (male inability to achieve or sustain an erection during sex)
Driving - some patients may experience dizziness or fatigue; in such cases they should not drive. However, this is rare.
Beta-blocker interactions with other drugs
Drug interaction is the extra effects two different medicines can have on the body when taken together - effects beyond their primary purposes. Beta-blockers can interact with the following medications:
Antipsychotics - these medications are commonly prescribed for patients with bipolar disorder or schizophrenia. When taken with some beta-blockers the risk of arrhythmias is greater.
Clonidine - a medication prescribed for either patients with hypertension (high blood pressure) or migraines. A patient who is taking both clonidine and beta-blockers and then suddenly stops taking clonidine has a greater risk of experiencing a sudden and sharp rise in blood pressure (rebound hypertension).
Digoxin - prescribed for patients with congestive heart failure and certain cardiac arrhythmias. When taken with beta-blockers there is a higher risk of slow heart rate (bradycardia).
Diltiazem - a medication that dilates blood vessels, prescribed for patients with angina pectoris or hypertension. When taken with beta-blockers there is a higher risk of slow heart rate (bradycardia).
Drugs to control high blood pressure (antihypertensives) - when taken with beta-blockers the patient may experience hypotension (a serious drop in blood pressure).
Drugs to control irregular heartbeats (anti-arrhythmics) - when taken with beta-blockers the risk of impaired function of the heart (myocardial depression) is greater, as is the risk of irregular heartbeats (arrhythmias).
Mefloquine - a drug for the treatment of malaria resistant to chloroquine phosphate. When taken with beta-blockers the result may be bradycardia.
Nifedipine - this drug reduces calcium ions available to heart and smooth muscle, used in the treatment of angina pectoris. When taken with beta-blockers there is a higher risk of hypotension (low blood pressure).
Nisoldipine - a calcium channel blocker used in the treatment of high blood pressure (hypertension). When taken with beta-blockers there is a higher risk of hypotension (low blood pressure).
Verapamil - used in the treatment of hypertension, angina pectoris, and certain cardiac arrhythmias. When taken with beta-blockers there is a higher risk of hypotension (low blood pressure).
Check with your pharmacist or doctor for a more comprehensive and up-to-date list of beta-blocker interactions.
View drug information on Cimetidine Hydrochloride Oral Solution; Pindolol.
Подписаться на:
Сообщения (Atom)