Ochsner Medical Center

About: Ochsner Medical Center is a healthcare organization based out in New Orleans, Louisiana, United States. It is known for research contribution in the topics: Population & Heart failure. The organization has 980 authors who have published 1159 publications receiving 49961 citations. The organization is also known as: Ochsner Hospital & Ochsner Foundation Hospital.

The 1987 Comprehensive Blood Bank Survey of the College of American Pathologists.

Abstract: The 1987 Comprehensive Blood Bank Survey consisted of four shipments of samples Each presented graded challenges in ABO and D typing, crossmatching, and antibody detection and identification and ungraded challenges for antigen typing and ungraded serum samples for educational purposes Practice patterns were elicited through supplemental questions, generally about issues raised by the survey samples Two of the surveys showed significant problems Set J-C included serum with anti-Lea, which was not detected by some participants Anti-Dia was one of two antibodies in the J-D graded sample, and this additional antibody was not detected by a significant number of participants Although minor problems were encountered in other challenges, in general performance was good

Prasugrel use and clinical outcomes by age among patients undergoing PCI for acute coronary syndrome: from the PROMETHEUS study.

Abstract: Prasugrel is a potent thienopyridine that may be preferentially used in younger patients with lower bleeding risk. We compared prasugrel use and outcomes by age from the PROMETHEUS study. We also assessed age-related trends in treatment effects with prasugrel versus clopidogrel. PROMETHEUS was a multicenter acute coronary syndrome (ACS) percutaneous coronary intervention (PCI) registry. We compared patients in age tertiles (T1 70 years). Major adverse cardiac events (MACE) were a composite of death, myocardial infarction, stroke or unplanned revascularization. Data were adjusted using multivariable Cox regression for age-related risks and propensity score stratification for thienopyridine effects. The study included 19,914 patients: 7045 (35.0%) in T1, 6489 (33.0%) in T2 and 6380 (32.0%) in T3. Prasugrel use decreased from T1 to T3 (29.2% vs. 23.5% vs. 7.5%, p < 0.001). Crude 1-year MACE rates were highest in T3 (17.4% vs. 16.8% vs. 22.7%, p < 0.001), but adjusted risk was similar between the groups (p-trend 0.52). Conversely, crude incidence (2.8% vs. 3.8% vs. 6.9%, p < 0.001) and adjusted bleeding risk were highest in T3 (HR 1.24, 95% CI 0.99–1.55 in T2; HR 1.83, 95% CI 1.46–2.30 in T3; p-trend < 0.001; reference = T1). Treatment effects with prasugrel versus clopidogrel did not demonstrate age-related trends for MACE (p-trend = 0.91) or bleeding (p-trend = 0.28). Age is a strong determinant of clinical risk as well as prasugrel prescription in ACS PCI with much lower use among older patients. Prasugrel did not have a differential treatment effect by age for MACE or bleeding. Frequency of prasugrel use and age-related temporal risks of all-cause death and bleeding after ACS PCI.

Exercise training and heart failure in older adults-dismal failure or not enough exercise?

Abstract: Cardiovascular (CV) disease continues to be a major threat to the health of older patients. Despite marked advances in the detection and treatment of most CV diseases, heart failure (HF) continues to produce a heavy burden of CV morbidity and mortality, especially in the elderly population. In 2006 in the United States, HF accounted for nearly 750,000 emergency department visits, 1 million hospital admissions, and an estimated cost of nearly $30 billion, with much of this being attributed to the elderly population. Cardiopulmonary fitness (CF) and exercise are known to predict prognosis and functional capacity in patients with a variety of CV disorders, including HF. We have recently reviewed the marked benefits of CF and exercise training (ET), especially with formal cardiac rehabilitation and ET (CRET) programs in patients with a variety of CV disorders. Although many of these benefits have been noted in younger patients with CV disease, the benefits of ET have been noted in elderly patients, including in cohorts well over the age of 70 (Table 1). Although in most of these studies, the benefits of ET were assessed according to estimated exercise capacity (in metabolic equivalents (METs)), substantial improvements in precisely measured exercise capacity (peak oxygen consumption (peak VO2)), including in 57 adults with a mean age of 78 (Table 2) who had a 13% improvement in peak VO2, were also demonstrated. In another large study of 260 older adults with a mean age of 75, although a less impressive, but significant, 7% improvement in peak VO2 after CRET (Po.001) was noted, this was associated with marked improvements in CV risk factors, as well as reductions in the prevalence of depression ( 67%; Po.001), hostility ( 50%; Po.05), and anxiety ( 31%; Po.01), which may affect prognosis. The benefits of ET in patients with advanced HF continues to be controversial and has recently been reviewed. A review of 81 studies with 2,383 patients of ET in HF found an average increase in peak VO2 of nearly 17%. 13 This meta-analysis demonstrated a trend toward lower mortality with ET ( 29%; P 5.06). In Exercise Training Meta-Analysis of Trials in Patients with Chronic Heart Failure, which assessed 801 patients from nine studies, ET was associated with 35% lower mortality (P 5.02) and 28% fewer hospital admissions (P 5.01). A major randomized control trial (RCT) of ET in HF, A Randomized Control Trial Investigating Outcomes of Exercise Training (HF-ACTION), is a landmark trial that randomly assigned 2,331 patients with HF to 3 months of supervised ET (3 supervised sessions weekly for 36 ET sessions at 60–70% of the heart rate reserve; patients were instructed to exercise 5 times weekly) followed by unsupervised ET versus usual care. Although the primary endpoint was not significantly affected, after preplanned adjustment for confounding factors (baseline peak VO2, ejection fraction, Beck Depression Inventory, and history of atrial fibrillation or flutter), there was a significant 11% reduction in all-cause mortality and a 15% reduction in CV mortality or hospitalizations. Unfortunately, peak VO2 increased significantly, although by less than 5% (Po.001), possibly because the ET group did not perform the volume of exercise that was initially anticipated, thus resulting in much smaller increases in peak VO2 than the greater than 15% improvement anticipated and reported in the metaanalyses. Nevertheless, this study confirmed the safety and efficacy of ET in advanced HF in patients receiving vigorous contemporary HF management. If patients had been more adherent to their exercise prescription (e.g., ET for closer to 150 h/wk as opposed to only half this amount), it is likely that greater improvements in peak VO2 would have been noted, along with greater reductions in major CV events and mortality. In the study by Brubaker et al. in this issue of the journal, the data were ‘‘revived’’ nearly a decade after the study was completed. Presumably, presentation and publication of HF-ACTION has stimulated renewed interest in the study of ET in HF. As the authors point out, the mean age of their population was aged 70 and older, compared with only 59 in HF-ACTION, although their study included only 23 patients with baseline and post-ET data, and they included only three weekly supervised ET sessions, with no comment on other nonsupervised ET performed by their cohort. Unfortunately, there was no improvement in mean peak VO2 in their patients after ET, although the authors noted that, in six of 23 (26%), peak VO2 increased by 10% or more, and in nine of 23 (39%), there was 0% to 9.9% improvement. Therefore, the median change in peak VO2 would be much more meaningful and is clearly in the 0% to 9.9% range in this cohort. It was recently demonstrated that only small improvements in peak VO2 (0–10%) are required to produce improvements in depression and depression-related mortality in a large cohort with coronary heart disease, and greater improvements in peak VO2 ( 10%) produced no additional improvements in prognosis. Because it has been reported that depression has considerable effect on morbidity and mortality in patients with advanced HF, it is possible that even these small DOI: 10.1111/j.1532-5415.2009.02520.x

The safety and effectiveness of adenosine diphosphate receptor inhibitor pretreatment among acute myocardial infarction patients treated with percutaneous coronary intervention in community practice: Insights from the TRANSLATE-ACS study.

Abstract: Objectives: To understand the optimal timing of adenosine diphosphate (ADP) receptor inhibitor pretreatment prior to percutaneous coronary intervention (PCI) among acute myocardial infarction (MI) patients. Background: The role of ADP receptor inhibitor pretreatment in this population is unclear. Methods: A total of 9,251 ADP receptor inhibitor-naive MI patients undergoing PCI at 229 TRANSLATE-ACS sites were evaluated. Adjusted risks of in-hospital major adverse cardiovascular events (MACE) and major bleeding were compared among patients with and without pretreatment using inverse probability-weighted propensity adjustment. Results: Of 9,251 patients treated with either prasugrel or clopidogrel during the index MI hospitalization, 4,056 (44%) received pretreatment (ST-segment elevation MI [STEMI] 54.9%, non-STEMI 45.1%); pretreatment was used more commonly among those receiving clopidogrel than prasugrel (52% vs. 20%, P < 0.0001). MACE risks were not significantly different between patients with and without pretreatment (clopidogrel 2.1% vs. 2.2%, adjusted hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.70–1.43; prasugrel 2.1% vs. 2.3%, adjusted odds ratio [OR] 0.82, 95% CI 0.42–1.60). No differences in major bleeding were observed among those receiving versus not receiving pretreatment (clopidogrel 3.1% vs. 3.5%, adjusted HR 0.94, 95% CI 0.65–1.36; prasugrel 2.5% vs. 2.7%, adjusted OR 0.93, 95% CI 0.42–2.02); results were similar when stratified by MI type. Conclusions: ADP receptor inhibitor pretreatment (44%) is commonly used among acute MI patients undergoing PCI in contemporary practice, but no significant differences were found in in-hospital MACE and/or bleeding risks between patients receiving versus not receiving pretreatment, regardless of ADP receptor inhibitor type.

Fixed-Ratio Combination of Insulin and GLP-1 RA in Patients with Longstanding Type 2 Diabetes: A Subanalysis of LixiLan-L

Abstract: With longer duration and progression of type 2 diabetes (T2D), β-cell function deteriorates and insulin therapy often becomes necessary. Glucagon-like peptide-1 receptor agonists such as lixisenatide that do not rely only on β-cell function and glucagon suppression primarily, but also lower glucose by other (insulin-independent) mechanisms such as delayed gastric emptying, may be appropriate adjuvant therapy to basal insulin in patients with longstanding T2D. We assessed the efficacy and safety of insulin glargine (iGlar) versus iGlarLixi, a fixed-ratio combination of iGlar and lixisenatide, stratified by quartiles (Q) of T2D duration (≤ 7.305 [Q1], > 7.305 to ≤ 10.75 [Q2], > 10.75 to ≤ 15.67 [Q3], and > 15.67 years [Q4]) in the LixiLan-L trial (N = 736). Across all quartiles, the reduction in glycated haemoglobin was greater with iGlarLixi versus iGlar, and the difference was most pronounced in patients with the longest duration (Q4; least squares mean difference [standard error] − 0.62 [0.13], P < 0.0001). Additionally, hypoglycaemia rates were significantly lower with iGlarLixi versus iGlar in patients in Q4 (3.3 vs. 6.9 events/patient-year, P < 0.0001). iGlarLixi lowered glycated haemoglobin more versus iGlar regardless of T2D duration, with benefit retained even among patients with the longest T2D duration.