Showing papers by "Jaap W. Deckers published in 1999"
01 Jan 1999
TL;DR: In the Rotterdam Study as mentioned in this paper, the authors determined the prevalence of heart failure and symptomatic as well as asymptomatic left ventricular systolic dysfunction in the general population by assessment of symptoms and signs (shortness of breath, ankle oedema and pulmonary crepitations).
Abstract: Aims To determine the prevalence of heart failure and symptomatic as well as asymptomatic left ventricular systolic dysfunction in the general population. Methods and Results In 5540 participants of the Rotterdam Study (age 68·9&8·7 years, 2251 men) aged 55‐95 years, the presence of heart failure was determined by assessment of symptoms and signs (shortness of breath, ankle oedema and pulmonary crepitations) and use of heart failure medication. In 2267 subjects (age 65·7&7·4 years, 1028 men) fractional shortening was measured. The overall prevalence of heart failure was 3·9% (95% CI 3·0&4·7) and did not diVer between men and women. The prevalence increased with age, with the exception of the highest age group in men. Fractional shortening was higher in women and did not decrease appreciably with age. The prevalence of left ventricular systolic dysfunction (fractional shortening < =25%) was approximately 2·5 times higher in men (5·5%, 95% CI 4·1‐7·0) than in women (2·2%, 95% CI 1·4‐3·2). Sixty percent of persons with left ventricular systolic dysfunction had no symptoms or signs of heart failure at all. Conclusions The prevalence of heart failure is appreciable and does not diVer between men and women. The majority of persons with left ventricular systolic dysfunction can be regarded as having asymptomatic left ventricular systolic dysfunction. (Eur Heart J 1999; 20: 447‐455)
640 citations
TL;DR: The prevalence of heart failure is appreciable and does not differ between men and women, and the majority of persons with left ventricular systolic dysfunction can be regarded as having asymptomatic left Ventricular syStolic dysfunction.
Abstract: Aims
To determine the prevalence of heart failure and symptomatic as well as asymptomatic left ventricular systolic dysfunction in the general population.
Methods and Results
In 5540 participants of the Rotterdam Study (age 68·9±8·7 years, 2251 men) aged 55–95 years, the presence of heart failure was determined by assessment of symptoms and signs (shortness of breath, ankle oedema and pulmonary crepitations) and use of heart failure medication. In 2267 subjects (age 65·7±7·4 years, 1028 men) fractional shortening was measured. The overall prevalence of heart failure was 3·9% (95% CI 3·0±4·7) and did not differ between men and women. The prevalence increased with age, with the exception of the highest age group in men. Fractional shortening was higher in women and did not decrease appreciably with age. The prevalence of left ventricular systolic dysfunction (fractional shortening <=25%) was approximately 2·5 times higher in men (5·5%, 95% CI 4·1–7·0) than in women (2·2%, 95% CI 1·4–3·2). Sixty percent of persons with left ventricular systolic dysfunction had no symptoms or signs of heart failure at all.
Conclusions
The prevalence of heart failure is appreciable and does not differ between men and women. The majority of persons with left ventricular systolic dysfunction can be regarded as having asymptomatic left ventricular systolic dysfunction.
632 citations
TL;DR: Thrombocytopenia was highly correlated with both bleeding and ischemic events, and the presence of this condition identified a more-at-risk patient population.
Abstract: Background—The significance of thrombocytopenia in patients experiencing an acute coronary syndrome (ACS) has not been examined systematically. We evaluated this condition in a large non–ST-elevation ACS clinical trial, with particular interest paid to its correlation with clinical outcomes. Methods and Results—Patients presenting without persistent ST elevation during an ACS were randomized to receive a double-blind infusion of the platelet glycoprotein (GP) IIb/IIIa inhibitor eptifibatide or placebo in addition to other standard therapies including heparin and aspirin. The primary end point was death/nonfatal myocardial infarction (MI) at 30 days, whereas bleeding and stroke were the main safety outcomes. Thrombocytopenia (nadir platelet count <100×109/L or <50% of baseline) occurred in 7.0% of enrolled patients. The time to onset was a median of 4 days in both treatment arms. Patients with thrombocytopenia were older, weighed less, were more likely nonwhite, and had more cardiac risk factors. These pat...
149 citations
TL;DR: The authors investigated the association between prior aspirin use and clinical outcomes in 9,461 patients with non-ST-elevation acute coronary syndromes enrolled in the Platelet IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial, before and after adjustment for baseline factors.
Abstract: Aspirin is beneficial in the prevention and treatment of cardiovascular events, but patients who have events while taking aspirin may have worse outcomes than those not on aspirin We investigated the association between prior aspirin use and clinical outcomes in 9,461 patients with non-ST-elevation acute coronary syndromes enrolled in the Platelet IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial, before and after adjustment for baseline factors We also examined whether eptifibatide has a differential treatment effect in prior aspirin users Prior aspirin users were less likely to have an enrollment myocardial infarction (MI) (vs unstable angina) (439% vs 488%, p = 0001) but more likely to have death or MI at 30 days (161% vs 130%, p = 0001) and at 6 months (199% vs 159%, p = 0001) After adjustment, prior aspirin users remained less likely to have an enrollment MI (odds ratio 088, 95% confidence interval 079 to 097) and more likely to have death or MI at 30 days (odds ratio 116, 95% confidence interval 100 to 133) but not at 6 months (odds ratio 114, 95% confidence interval 098 to 133) In a multivariable model, eptifibatide did not have a different treatment effect in prior aspirin users compared with nonusers (p = 0534) Prior aspirin users had fewer enrollment MIs but worse long-term outcomes than nonusers We found no evidence for a different treatment effect of eptifibatide in prior aspirin users
128 citations
TL;DR: Higher heart rate was the most important baseline clinical predictor of nonhemorrhagic stroke, followed by older age, prior anterior myocardial infarction, prior stroke or transient ischemic attack, and diabetes mellitus, and these factors were used to develop a simple scoring nomogram that can predict the risk ofNonhemor rhagic stroke.
Abstract: Background—The incidence of stroke in patients with acute coronary syndromes has not been clearly defined because few trials in this patient population have been large enough to provide stable estimates of stroke rates. Methods and Results—We studied the 10 948 patients with acute coronary syndromes without persistent ST-segment elevation who were randomly assigned to placebo or the platelet glycoprotein IIb/IIIa receptor inhibitor eptifibatide in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial to determine stroke rates, stroke types, clinical outcomes in patients with stroke, and independent baseline clinical predictors for nonhemorrhagic stroke. Stroke occurred in 79 (0.7%) patients, with 66 (0.6%) nonhemorrhagic, 6 intracranial hemorrhages, 3 cerebral infarctions with hemorrhagic conversion, and 4 of uncertain cause. There were no differences in stroke rates between patients who received placebo and those assigned high-dose eptifibati...
76 citations
TL;DR: The term ACS encompasses a spectrum of patients who present with chest discomfort or other symptoms caused by myocardial ischaemia, and the value of reperfusion therapy with coronary occlusion (evolving infarction) by thrombolytic therapy or direct angioplasty has been well established.
21 citations