Author
Kim A. Eagle
Other affiliations: University of Wisconsin Hospital and Clinics, Spaulding Rehabilitation Hospital, Yale University ...read more
Bio: Kim A. Eagle is an academic researcher from University of Michigan. The author has contributed to research in topics: Aortic dissection & Myocardial infarction. The author has an hindex of 129, co-authored 823 publications receiving 75160 citations. Previous affiliations of Kim A. Eagle include University of Wisconsin Hospital and Clinics & Spaulding Rehabilitation Hospital.
Papers published on a yearly basis
Papers
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TL;DR: Atrial fibrillation is associated with a poor outcome among patients with ischemic stroke particularly among patients, who are not eligible to oral anticoagulant treatment.
Abstract: Background Atrial fibrillation is a major risk factor for ischemic stroke. However, the prognostic impact of atrial fibrillation among patients with stroke is not fully clarified. We compared patient characteristics, including severity of stroke and comorbidity, quality of in-hospital care and outcomes in a cohort of first-time ischemic stroke patients with and without atrial fibrillation. Methods Based on linkage of public medical databases, we did a population-based follow-up study among 3,849 stroke patients from the County of Aarhus, Denmark admitted in the period of 2003-2007 and prospectively registered in the Danish National Indicator Project. Results Atrial fibrillation was associated with an adverse prognostic profile but not with an overall poorer quality of in-hospital care. Patients with atrial fibrillation had a longer total length of stay (median: 15 vs 9 days), and were at increased risk of in-hospital medical complications (adjusted relative risk = 1.48, 95% CI: 1.23-1.79) and recurrent stroke (adjusted hazard ratio = 1.30, 95% CI: 0.93-1.82) when compared with patients without atrial fibrillation. The adjusted hazard ratios for 30 days and one year mortality were 1.55 (95% CI: 1.20-2.01) and 1.55 (95% CI: 1.30-1.85), respectively. Patients not eligible to oral anticoagulant treatment had an increased risk of recurrent stroke (adjusted hazard ratio = 1.92, 95% CI: 1.19-3.11). Conclusion Atrial fibrillation is associated with a poor outcome among patients with ischemic stroke particularly among patients, who are not eligible to oral anticoagulant treatment.
47 citations
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TL;DR: As the epidemic of cardiovascular disease continues to alter the demographics of disease in LMICs, healthcare providers with access to medical technology must investigate novel methods of easing the burden of those less fortunate.
Abstract: > Health of body and mind is so fundamental to the good life that if we believe men have any personal rights at all as human beings, they have an absolute right to such a measure of good health as society and society alone is able to give them.
>
> —Aristotle, 330 bc
For most of the industrialized world, the morbidity and mortality attributed to cardiovascular disease have declined in recent decades as a result of improvements in technology and a greater emphasis on primary and secondary preventative strategies.1 Unfortunately, this dramatic improvement in disease burden has not been witnessed in low- and middle-income countries (LMICs), defined by the World Bank as generating a gross national income per capita lower than US $9200.2 Currently, cardiovascular disease is the primary cause of mortality worldwide, accounting for 30% of all global deaths,3 and it has twice the mortality rate of HIV/AIDS, malaria, and tuberculosis combined.4 Secondary treatments are often limited because of a paucity of skilled healthcare providers and, more important, the inability of the patient to afford costly medical procedures.5
This great disparity in medical health care is clearly evident in the field of cardiac electrophysiology, specifically pacemaker implantation; this specialty is either severely underdeveloped or entirely nonexistent in many LMICs.6 As a result, many individuals with symptomatic bradycardia experience a decreased quality of life and/or decreased life expectancy because of a lack of resources (personal correspondence, University of Philippines–Philippine General Hospital [UP-PGH], November 15, 2008). As the epidemic of cardiovascular disease continues to alter the demographics of disease in LMICs, healthcare providers with access to medical technology must investigate novel methods of easing the burden of those less fortunate. The purpose of this article is to address the concept of postmortem pacemaker use for those in LMICs who otherwise …
47 citations
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TL;DR: What has been learned about the process of guideline implementation is reviewed, the major research questions that need to be addressed are laid out, and it is argued that professional societies play a critical role in moving from guideline development to application.
Abstract: Major opportunity exists to better align clinical science and clinical practice. To do so will require efforts not only to develop clinical practice guidelines, but to facilitate their application in practice. The American College of Cardiology operates a program to develop and assess the effectiveness of tools that facilitate the application of guidelines in practice. Here we review what we have learned about the process of guideline implementation, lay out the major research questions that need to be addressed, and argue that professional societies play a critical role in moving from guideline development to application.
46 citations
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TL;DR: Current standard practice at the University of Michigan, Ann Arbor for managing myocardial infarction is incorporated, and the benefit of long term treatment with β blockers in reducing the incidence of recurrent myocardian infarctions, sudden death, and all cause mortality is shown.
Abstract: Acute myocardial infarction affects hundreds of thousands of people each year. Around a quarter die, half of them before reaching a hospital. Survivors are at increased risk of recurrent myocardial infarctions or cardiac death, with a 10% death rate in the first year after discharge and a subsequent annual death rate of 5%—six times that in people of the same age who do not have coronary artery disease. Whereas aggressive management of the acute infarction has been enthusiastically adopted, far less attention has been given to preventive strategies. Though most doctors agree with the importance of secondary prevention, the results of studies suggest that many patients are currently not being given optimal preventive care. Since most patients after acute myocardial infarction are routinely followed up in primary care, general practitioners must be fully informed and participate in treatment strategies designed for the secondary prevention of coronary artery disease.
We conducted a Medline search for all articles on acute myocardial infarction dating from January 1980 to August 1997, with particular emphasis on secondary prevention in acute myocardial infarction. We scanned all of these reports, which numbered more than 3000. In this review we have also incorporated current standard practice at the University of Michigan, Ann Arbor, for managing myocardial infarction.
Several controlled trials in more than 35 000 survivors of myocardial infarction have shown the benefit of long term treatment with β blockers in reducing the incidence of recurrent myocardial infarction, sudden death, and all cause mortality (table 1).1-8 β Blockers reduce myocardial workload and oxygen consumption by reducing the heart rate, blood pressure, and contractility, and they increase the threshold for ventricular fibrillation. A meta-analysis of such treatment in patients who have had myocardial infarctions shows a 20% reduction in long term mortality and a 34% reduction in …
46 citations
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TL;DR: The epidemiologic aspects of perioperative myocardial infarction (MI) and cardiac death are described and various methods of risk stratification will be discussed, including exercise treadmill testing with and without adjunctive radionuclide imaging.
46 citations
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TL;DR: In those older than age 50, systolic blood pressure of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP, and hypertension will be controlled only if patients are motivated to stay on their treatment plan.
Abstract: The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.
14,975 citations
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University of Chicago1, University of Padua2, McGill University3, Johns Hopkins University4, French Institute of Health and Medical Research5, Uppsala University6, University of California, San Francisco7, MedStar Washington Hospital Center8, Katholieke Universiteit Leuven9, University of Liège10, Harvard University11, Ghent University Hospital12, University of Toronto13
TL;DR: This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases.
Abstract: The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.
11,568 citations
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TL;DR: In this article, Anderson et al. proposed a new FAHA Chair, Jeffrey L. Anderson, MD, FACC, FAHA, Chair-Elect, Alice K. Jacobs et al., this article and Biykem Bozkurt.
11,386 citations
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TL;DR: It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management, and management of diseases.
Abstract: PREAMBLE......e4
APPENDIX 1......e121
APPENDIX 2......e122
APPENDIX 3......e124
REFERENCES......e124
It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management,
8,362 citations
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TL;DR: Although considerable improvement has occurred in the process of care for patients with ST-elevation myocardial infarction (STEMI), room for improvement exists as discussed by the authors, and the purpose of the present guideline is to focus on the numerous advances in the diagnosis and management of patients
Abstract: Although considerable improvement has occurred in the process of care for patients with ST-elevation myocardial infarction (STEMI), room for improvement exists.[1–3][1][][2][][3] The purpose of the present guideline is to focus on the numerous advances in the diagnosis and management of patients
8,352 citations