The ASCEND-HF trial aimed to assess the clinical effectiveness and safety of nesiritide compared to placebo for patients with acute decompensated heart failure. The randomized, double-blind, placebo-controlled trial enrolled over 7,000 patients across 30 countries. The co-primary endpoints were reduction in heart failure rehospitalization or mortality within 30 days and improvement in self-assessed dyspnea at 6 and 24 hours. Secondary outcomes included overall well-being, mortality, and safety. Baseline characteristics were well balanced between the nesiritide and placebo groups. Results of the trial could help definitively determine nesiritide's effects on important clinical outcomes in heart failure.
Treating Agitation and De to an Alphabet Soup of Potential Optionshospira2010
1) The MINDS trial compared haloperidol to placebo for treatment of delirium in mechanically ventilated ICU patients and found no difference in the number of delirium/coma-free days between the two groups.
2) Haloperidol treatment did not reduce the duration of delirium or coma compared to placebo.
3) There was no evidence from this randomized controlled trial that haloperidol is effective for treating delirium in critically ill patients.
Rivaroxaban was compared to warfarin for the prevention of stroke and embolism in atrial fibrillation patients. Over 14,000 patients were randomly assigned to once-daily rivaroxaban or warfarin with INR monitoring. The primary endpoint of stroke or embolism occurred less frequently with rivaroxaban compared to warfarin. Major bleeding occurred at similar rates while critical organ bleeding and death occurred less often with rivaroxaban.
This document summarizes a meta-analysis comparing first-generation and second-generation antipsychotic drugs for schizophrenia. The analysis found that some second-generation drugs were more effective than typical drugs, induced fewer motor side effects, but caused more weight gain and sedation. The meta-analysis provides data to help clinicians individualize treatment based on efficacy, side effects, and cost. However, some studies suggest first-generation mid-potency drugs may be appropriate to avoid motor side effects, sedation, and weight gain.
1. The patient is a 54-year-old woman who developed ICU delirium while intubated for influenza and pneumonia. She required high levels of sedation initially but was being weaned off.
2. On day 5, she tested positive for delirium on the CAM-ICU. Her risk factors included medications like benzodiazepines and opioids. Non-pharmacological and pharmacological interventions were considered to manage her delirium.
3. Studies show dexmedetomidine may be preferable to other sedatives like benzodiazepines and opioids for reducing delirium. Non-pharmacological steps like mobilization and cognitive
Ten Most Common Mistakes in Clinical Trial Interpretation - Slidecastclinicaltrialist
The document discusses two common cognitive optical illusions in clinical research: regression to the mean and survivor bias. Regression to the mean occurs when subgroups appear to benefit more from treatment due to natural fluctuations in disease severity over time. Survivor bias happens when a treatment appears harmful by the primary endpoint but beneficial when considering combined endpoints. The document provides examples and explanations of how these illusions can influence clinical trial results.
Ten Most Common Mistakes in Clinical Trial Interpretationclinicaltrialist
A document discusses several common cognitive optical illusions that can occur in clinical research trials. It provides examples of illusions related to regression to the mean, survivor bias, interpreting doses given to groups vs individuals, confusing proportional changes, overinterpreting p-values, making erroneous conclusions from post-hoc analyses, and incorrectly using surrogate endpoints rather than actual clinical outcomes. Researchers are encouraged to be aware of these potential illusions to avoid drawing incorrect conclusions from clinical trial data.
1) A clinical trial assessed whether chelation therapy improved quality of life outcomes in patients with stable coronary artery disease and a history of heart attack.
2) The trial found no consistent or sustained improvements in domains of health-related quality of life, including physical and mental functioning, with chelation therapy over 2 years of follow up.
3) A subgroup analysis found a potential benefit of chelation therapy for patients with angina symptoms at baseline, but no benefit was seen for patients with heart failure symptoms.
This document summarizes a program on residual renal function (RRF). The first presentation is by Thomas Golper on whether volume overloaded dialysis patients should be aggressively ultrafiltered to dry weight even if it causes RRF to decline. The second presentation is by Bernard Canaud on how RRF improves patient outcomes. The third presentation is by Isaac Teitelbaum on how to preserve RRF in dialysis patients. The program aims to discuss the tradeoffs between managing volume status and preserving RRF in dialysis care.
Treating Agitation and De to an Alphabet Soup of Potential Optionshospira2010
1) The MINDS trial compared haloperidol to placebo for treatment of delirium in mechanically ventilated ICU patients and found no difference in the number of delirium/coma-free days between the two groups.
2) Haloperidol treatment did not reduce the duration of delirium or coma compared to placebo.
3) There was no evidence from this randomized controlled trial that haloperidol is effective for treating delirium in critically ill patients.
Rivaroxaban was compared to warfarin for the prevention of stroke and embolism in atrial fibrillation patients. Over 14,000 patients were randomly assigned to once-daily rivaroxaban or warfarin with INR monitoring. The primary endpoint of stroke or embolism occurred less frequently with rivaroxaban compared to warfarin. Major bleeding occurred at similar rates while critical organ bleeding and death occurred less often with rivaroxaban.
This document summarizes a meta-analysis comparing first-generation and second-generation antipsychotic drugs for schizophrenia. The analysis found that some second-generation drugs were more effective than typical drugs, induced fewer motor side effects, but caused more weight gain and sedation. The meta-analysis provides data to help clinicians individualize treatment based on efficacy, side effects, and cost. However, some studies suggest first-generation mid-potency drugs may be appropriate to avoid motor side effects, sedation, and weight gain.
1. The patient is a 54-year-old woman who developed ICU delirium while intubated for influenza and pneumonia. She required high levels of sedation initially but was being weaned off.
2. On day 5, she tested positive for delirium on the CAM-ICU. Her risk factors included medications like benzodiazepines and opioids. Non-pharmacological and pharmacological interventions were considered to manage her delirium.
3. Studies show dexmedetomidine may be preferable to other sedatives like benzodiazepines and opioids for reducing delirium. Non-pharmacological steps like mobilization and cognitive
Ten Most Common Mistakes in Clinical Trial Interpretation - Slidecastclinicaltrialist
The document discusses two common cognitive optical illusions in clinical research: regression to the mean and survivor bias. Regression to the mean occurs when subgroups appear to benefit more from treatment due to natural fluctuations in disease severity over time. Survivor bias happens when a treatment appears harmful by the primary endpoint but beneficial when considering combined endpoints. The document provides examples and explanations of how these illusions can influence clinical trial results.
Ten Most Common Mistakes in Clinical Trial Interpretationclinicaltrialist
A document discusses several common cognitive optical illusions that can occur in clinical research trials. It provides examples of illusions related to regression to the mean, survivor bias, interpreting doses given to groups vs individuals, confusing proportional changes, overinterpreting p-values, making erroneous conclusions from post-hoc analyses, and incorrectly using surrogate endpoints rather than actual clinical outcomes. Researchers are encouraged to be aware of these potential illusions to avoid drawing incorrect conclusions from clinical trial data.
1) A clinical trial assessed whether chelation therapy improved quality of life outcomes in patients with stable coronary artery disease and a history of heart attack.
2) The trial found no consistent or sustained improvements in domains of health-related quality of life, including physical and mental functioning, with chelation therapy over 2 years of follow up.
3) A subgroup analysis found a potential benefit of chelation therapy for patients with angina symptoms at baseline, but no benefit was seen for patients with heart failure symptoms.
This document summarizes a program on residual renal function (RRF). The first presentation is by Thomas Golper on whether volume overloaded dialysis patients should be aggressively ultrafiltered to dry weight even if it causes RRF to decline. The second presentation is by Bernard Canaud on how RRF improves patient outcomes. The third presentation is by Isaac Teitelbaum on how to preserve RRF in dialysis patients. The program aims to discuss the tradeoffs between managing volume status and preserving RRF in dialysis care.
Resuscitation what works what doesnt and whats coming down the tube persoffRiver City Symposium
The document summarizes recent evidence on resuscitation techniques for cardiac arrest, finding that high quality chest compressions are essential but often lacking, and that delays in defibrillation, poor coordination of care, and excessive ventilation can reduce survival rates; it also reviews promising new approaches like continuous chest compressions and therapeutic hypothermia. Overall survival remains low but targeted improvements to the resuscitation process may help increase the percentage of patients who survive cardiac arrest with good neurological outcomes.
ZINPLAVA is a monoclonal antibody indicated to reduce recurrence of Clostridium difficile infection in patients receiving antibacterial treatment who are at high risk of recurrence. It binds to and neutralizes C. difficile toxin B. The recommended dosage is a single 10 mg/kg intravenous infusion over 60 minutes. Common adverse reactions include nausea, pyrexia, and headache. Heart failure occurred more often in patients with a history of congestive heart failure treated with ZINPLAVA.
Agm10 screening for depression in stroke (v4medium)Alex J Mitchell
This is a talk from a symposium on screening for depression in neurological disease. Topic is what screener works best in stroke given the communication and cognitive difficulties that may be present.
T Sornasse Elan Chi Accelerating Proof Of Concept 2010tsornasse
This document discusses opportunities and challenges for using biomarkers to accelerate proof-of-concept studies in neurodegenerative diseases. It highlights initiatives like ADNI that have advanced biomarkers for disease state and progression. These biomarkers allow for earlier patient enrichment, more sensitive endpoints, and smaller clinical trials. Biomarkers can also provide insights into drug-target engagement and pharmacodynamics/toxicodynamics. Integrating biomarkers throughout development could enable faster entry to Phase 3 and higher chances of success for disease-modifying therapies to address the growing burden of neurodegenerative diseases.
This document summarizes interim analysis results from a randomized phase 3 study of abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naïve patients with metastatic castration-resistant prostate cancer. The study showed a statistically significant improvement in radiographic progression-free survival with a median of not reached for abiraterone acetate versus 8.3 months for placebo. There was also a strong trend towards improved overall survival with a median of not reached for abiraterone acetate versus 27.2 months for placebo and a 25% reduction in risk of death. Benefits were seen across patient subgroups.
Montecucco Carlo Murizio Torino 13° Convegno Patologia Immune E Malattie Orfa...cmid
This document summarizes safety data from the LORHEN registry on anti-TNF-α treatments in rheumatoid arthritis patients. It found that 18.2% of patients discontinued treatment due to adverse events, with serious infections occurring in 6.9% of patients. Risk of discontinuation due to adverse events increased with age and higher corticosteroid doses. The risk of serious infections was highest for infliximab. The study provides valuable real-world safety data on anti-TNF-α treatments from a large observational registry.
This article examines the effects of gabapentin on uremic pruritus in hemodialysis patients. A double-blind clinical trial assigned patients to receive gabapentin 100 mg or a placebo after hemodialysis sessions. Patients receiving gabapentin experienced a significant reduction in pruritus compared to the placebo period, as measured by a visual analogue scale. No significant correlations were found between patient characteristics and response to gabapentin. The study concludes that gabapentin is an effective treatment for uremic pruritus.
MET vs TAU in 4 large multisite RCTs found:
1) No main effect on retention or substance use for outpatient treatment.
2) One study found a small effect on early retention but not substance use.
3) Studies of pregnant drug users and Spanish speakers also found no main effects of MET vs TAU.
The findings suggest MET may not produce meaningful improvements over TAU in typical substance abuse treatment settings based on these high quality trials.
wyeth Phase 2 Clinical Trial of Bapineuzumab, ICAD, July 2008finance12
This document summarizes the results of a Phase 2 clinical trial of Bapineuzumab (AAB-001), a humanized monoclonal antibody designed to target amyloid beta for the treatment of Alzheimer's disease. The trial involved 234 patients with mild to moderate AD randomized to receive either bapineuzumab or placebo in one of four dose cohorts. While the trial found bapineuzumab to be generally safe and well tolerated, with adverse events mostly mild to moderate, the prespecified primary efficacy endpoints of ADAS-cog and DAD did not achieve statistical significance. Post-hoc analyses found a possible treatment benefit in ApoE4 carriers on some endpoints but not others.
This document discusses new frontiers in viral hepatitis, specifically considerations for patients with HIV/HCV co-infection. It provides information on historical and current treatment approaches for hepatitis C, including cure rates of different treatment regimens. It also addresses factors to consider when making treatment decisions, such as genotype, duration of infection, and comorbidities. Upcoming interferon-free treatment options and drug-drug interactions with antiretrovirals are briefly touched upon.
Drupal Commerce / Wordpress Commerce - Les nouvelles alternatives...Core-Techs
Diaporama du Webinar Core-Techs du 11 octobre 2012, sur les nouvelles solutions CMS, Drupal Commerce et Wordpress Commerce. Réalisation d'un état des lieux des moyens qui étaient utilisés jusqu'à présent en matière de création et de développement de boutique en ligne, analyse comparative des deux nouveaux CMS ainsi que leurs présentations.
This document discusses trends at academic medical centers. It notes that 7% of respondents work at academic medical centers, 55% of which plan to increase their IT budgets. Top priorities for technology purchases include PCs, data storage, and mobile devices. Ultrasound equipment is most likely to be upgraded or replaced among clinical imaging devices.
Support de présentation de l'openDay ecommerce qui s'est déroulé le 29 juin 2009 à la Cantine. Y sont présentés les solutions Joomla VirtueMart, Drupal Ubercart et Magento
Hospital Medicine Update, VA ACP Meeting 2015Jon Sweet
This document summarizes a presentation on papers that have changed the presenter's medical practice. It discusses several clinical cases and the evidence from recent studies on how to best manage them. For a patient with upper GI bleeding admitted after endoscopic treatment, intermittent PPI therapy is shown to be non-inferior to continuous infusion PPI based on multiple randomized trials. For heart failure patients under 75, BNP-guided treatment reduces mortality and hospitalizations compared to clinical guidance alone. Lower steroid doses are associated with better outcomes for COPD patients admitted to the ICU. MRCP or EUS are recommended for evaluating the CBD in patients at intermediate risk of retained stones.
Resuscitation what works what doesnt and whats coming down the tube persoffRiver City Symposium
The document summarizes recent evidence on resuscitation techniques for cardiac arrest, finding that high quality chest compressions are essential but often lacking, and that delays in defibrillation, poor coordination of care, and excessive ventilation can reduce survival rates; it also reviews promising new approaches like continuous chest compressions and therapeutic hypothermia. Overall survival remains low but targeted improvements to the resuscitation process may help increase the percentage of patients who survive cardiac arrest with good neurological outcomes.
ZINPLAVA is a monoclonal antibody indicated to reduce recurrence of Clostridium difficile infection in patients receiving antibacterial treatment who are at high risk of recurrence. It binds to and neutralizes C. difficile toxin B. The recommended dosage is a single 10 mg/kg intravenous infusion over 60 minutes. Common adverse reactions include nausea, pyrexia, and headache. Heart failure occurred more often in patients with a history of congestive heart failure treated with ZINPLAVA.
Agm10 screening for depression in stroke (v4medium)Alex J Mitchell
This is a talk from a symposium on screening for depression in neurological disease. Topic is what screener works best in stroke given the communication and cognitive difficulties that may be present.
T Sornasse Elan Chi Accelerating Proof Of Concept 2010tsornasse
This document discusses opportunities and challenges for using biomarkers to accelerate proof-of-concept studies in neurodegenerative diseases. It highlights initiatives like ADNI that have advanced biomarkers for disease state and progression. These biomarkers allow for earlier patient enrichment, more sensitive endpoints, and smaller clinical trials. Biomarkers can also provide insights into drug-target engagement and pharmacodynamics/toxicodynamics. Integrating biomarkers throughout development could enable faster entry to Phase 3 and higher chances of success for disease-modifying therapies to address the growing burden of neurodegenerative diseases.
This document summarizes interim analysis results from a randomized phase 3 study of abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naïve patients with metastatic castration-resistant prostate cancer. The study showed a statistically significant improvement in radiographic progression-free survival with a median of not reached for abiraterone acetate versus 8.3 months for placebo. There was also a strong trend towards improved overall survival with a median of not reached for abiraterone acetate versus 27.2 months for placebo and a 25% reduction in risk of death. Benefits were seen across patient subgroups.
Montecucco Carlo Murizio Torino 13° Convegno Patologia Immune E Malattie Orfa...cmid
This document summarizes safety data from the LORHEN registry on anti-TNF-α treatments in rheumatoid arthritis patients. It found that 18.2% of patients discontinued treatment due to adverse events, with serious infections occurring in 6.9% of patients. Risk of discontinuation due to adverse events increased with age and higher corticosteroid doses. The risk of serious infections was highest for infliximab. The study provides valuable real-world safety data on anti-TNF-α treatments from a large observational registry.
This article examines the effects of gabapentin on uremic pruritus in hemodialysis patients. A double-blind clinical trial assigned patients to receive gabapentin 100 mg or a placebo after hemodialysis sessions. Patients receiving gabapentin experienced a significant reduction in pruritus compared to the placebo period, as measured by a visual analogue scale. No significant correlations were found between patient characteristics and response to gabapentin. The study concludes that gabapentin is an effective treatment for uremic pruritus.
MET vs TAU in 4 large multisite RCTs found:
1) No main effect on retention or substance use for outpatient treatment.
2) One study found a small effect on early retention but not substance use.
3) Studies of pregnant drug users and Spanish speakers also found no main effects of MET vs TAU.
The findings suggest MET may not produce meaningful improvements over TAU in typical substance abuse treatment settings based on these high quality trials.
wyeth Phase 2 Clinical Trial of Bapineuzumab, ICAD, July 2008finance12
This document summarizes the results of a Phase 2 clinical trial of Bapineuzumab (AAB-001), a humanized monoclonal antibody designed to target amyloid beta for the treatment of Alzheimer's disease. The trial involved 234 patients with mild to moderate AD randomized to receive either bapineuzumab or placebo in one of four dose cohorts. While the trial found bapineuzumab to be generally safe and well tolerated, with adverse events mostly mild to moderate, the prespecified primary efficacy endpoints of ADAS-cog and DAD did not achieve statistical significance. Post-hoc analyses found a possible treatment benefit in ApoE4 carriers on some endpoints but not others.
This document discusses new frontiers in viral hepatitis, specifically considerations for patients with HIV/HCV co-infection. It provides information on historical and current treatment approaches for hepatitis C, including cure rates of different treatment regimens. It also addresses factors to consider when making treatment decisions, such as genotype, duration of infection, and comorbidities. Upcoming interferon-free treatment options and drug-drug interactions with antiretrovirals are briefly touched upon.
Drupal Commerce / Wordpress Commerce - Les nouvelles alternatives...Core-Techs
Diaporama du Webinar Core-Techs du 11 octobre 2012, sur les nouvelles solutions CMS, Drupal Commerce et Wordpress Commerce. Réalisation d'un état des lieux des moyens qui étaient utilisés jusqu'à présent en matière de création et de développement de boutique en ligne, analyse comparative des deux nouveaux CMS ainsi que leurs présentations.
This document discusses trends at academic medical centers. It notes that 7% of respondents work at academic medical centers, 55% of which plan to increase their IT budgets. Top priorities for technology purchases include PCs, data storage, and mobile devices. Ultrasound equipment is most likely to be upgraded or replaced among clinical imaging devices.
Support de présentation de l'openDay ecommerce qui s'est déroulé le 29 juin 2009 à la Cantine. Y sont présentés les solutions Joomla VirtueMart, Drupal Ubercart et Magento
Hospital Medicine Update, VA ACP Meeting 2015Jon Sweet
This document summarizes a presentation on papers that have changed the presenter's medical practice. It discusses several clinical cases and the evidence from recent studies on how to best manage them. For a patient with upper GI bleeding admitted after endoscopic treatment, intermittent PPI therapy is shown to be non-inferior to continuous infusion PPI based on multiple randomized trials. For heart failure patients under 75, BNP-guided treatment reduces mortality and hospitalizations compared to clinical guidance alone. Lower steroid doses are associated with better outcomes for COPD patients admitted to the ICU. MRCP or EUS are recommended for evaluating the CBD in patients at intermediate risk of retained stones.
The document summarizes key information about acute heart failure, including epidemiology, pathophysiology, treatment approaches, and trial data. It describes the ASCEND-HF trial which investigated the effects of nesiritide vs placebo on outcomes in over 7,000 patients hospitalized for acute decompensated heart failure. The trial found no significant differences between nesiritide and placebo for its co-primary endpoints of 30-day mortality or heart failure rehospitalization and dyspnea relief at 6 and 24 hours.
The document discusses agitation, sedation, delirium, and pain management in critically ill patients. It describes the Richmond Agitation and Sedation Scale (RASS) used to assess sedation levels in the ICU. Light sedation is preferred to deep sedation. Spontaneous awakening and breathing trials should occur daily. Propofol and dexmedetomidine are preferred sedatives over benzodiazepines. Delirium is common in ICU patients and associated with poor outcomes. The Confusion Assessment Method for the ICU (CAM-ICU) is used to assess for delirium. A stepwise approach including identifying and eliminating contributing factors, implementing non-pharmacologic therapies, and pharmacologic management
The African-American Heart Failure Trial (A-HeFT) studied the effects of adding a fixed dose of isosorbide dinitrate and hydralazine to standard heart failure therapies in Black patients with advanced heart failure. The trial found that combination therapy reduced all-cause mortality by 43%, reduced the risk of first hospitalization for heart failure by 33%, and improved patient quality of life compared to standard therapy alone in under 3 sentences.
Trial of decompressive craniectomy for traumatic intracranial hypertension1Dr fakhir Raza
The New England Journal of Medicine, Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension, Extended Glasgow Outcome Scale (GOS-E), vegetative state, lower severe disability, traumatic brain injury, RESCUEicp,
A 9-year old male presented to the PICU with hypertension crisis due to a suspected pheochromocytoma. Physical exam revealed elevated blood pressure of 225/140 mmHg and symptoms of headache, blurred vision, palpitations, and sweating. Diagnostic tests confirmed elevated catecholamine levels in plasma and urine and imaging showed an adrenal tumor. The patient was started on antihypertensive medications, close monitoring, and nursing care to control symptoms and educate family. Surgical removal of the adrenal tumor was recommended as definitive treatment.
This document summarizes a journal club discussion of a randomized trial comparing outcomes of intracranial pressure monitoring versus clinical examination alone for patients with severe traumatic brain injury. Key points included that the trial found similar outcomes between the two groups in composite endpoints and mortality. However, the intracranial pressure monitoring group received more aggressive treatments such as barbiturates. There was skepticism around applying the results to clinical practice in the US due to differences in pre-hospital care, rehabilitation standards, and treatment protocols between the study locations and the US.
This document discusses managing hypertensive emergencies in the emergency department. It defines hypertension and hypertensive urgency versus emergency. For hypertensive urgency, when BP is markedly elevated but there are no symptoms, treatment is usually not required in the ED and patients can be referred for outpatient follow up. For hypertensive emergency, when there are progressive symptoms of end organ damage, treatment in the ED is warranted to lower BP by about 25% aiming to avoid hypotension. Goals of treatment and commonly used oral and IV antihypertensive agents are reviewed.
This study aimed to determine if early antihypertensive therapy in patients with acute ischemic stroke leads to different outcomes in those with and without a history of hypertension. Over 4 years, 4,071 patients were randomly assigned to either strict blood pressure control or usual care. Strict control led to greater reductions in blood pressure over 24 hours, 7 days and 14 days, with no differences in short-term death or disability regardless of hypertension history. However, early blood pressure reduction was associated with a lower rate of recurrent stroke in patients with a history of hypertension.
Hot Topics in Critical Care - March 2017Steve Mathieu
This document summarizes several recent randomized controlled trials in critical care medicine:
1. A trial comparing high-flow nasal cannula to standard oxygen therapy in patients post-abdominal surgery found no difference in rates of hypoxemia or other outcomes.
2. A trial of intravenous iron in anemic critically ill patients found higher hemoglobin levels at discharge but no difference in transfusion requirements.
3. A trial of dexmedetomidine in elderly surgery patients reduced delirium rates compared to placebo.
Hospital Medicine Pearls, VA ACP Meeting 2014Jon Sweet
This document summarizes recent evidence from studies on various topics in hospital medicine:
1. For patients with atherosclerotic renal artery stenosis, renal artery stenting provides no benefit over optimal medical therapy alone and should not be performed.
2. For COPD exacerbations, a 5-day course of prednisone is as effective as the typical 14-day course with fewer steroid-related side effects.
3. Restrictive transfusion strategies (transfusing at Hb <7 g/dL) reduce mortality, rebleeding and complications compared to liberal strategies in patients with upper GI bleeding and acute MI.
4. For overt hepatic encephalopathy, rifaximin added to lactulose
Vericiguat is a novel oral soluble guanylate cyclase stimulator being studied for the treatment of heart failure. The VICTORIA trial investigated vericiguat for reducing cardiovascular death or heart failure hospitalization in patients with recent worsening of chronic heart failure. The trial found that vericiguat reduced the primary composite outcome compared to placebo with an absolute risk reduction of 4.2 events per 100 patient-years. Vericiguat was well-tolerated overall but increased risks of hypotension and syncope compared to placebo. The results suggest vericiguat may be an effective additional treatment for reducing heart failure hospitalizations and cardiovascular death in patients with recent heart failure decompensation.
The recent definition, concept and terminologies of septic shock, surviving sepsis campaign, management techniques, SOFA score. Also includes antibiotics and supportive modalities.
A 32-year-old man presented with fatigue, decreased urine output, and shortness of breath. He had a recent hypertension diagnosis and a history of analgesic abuse. Examinations found elevated blood pressure and diminished lung sounds. Tests showed acute kidney injury, hyperkalemia, and pleural effusions. He was treated with hemodialysis, antibiotics, steroids, and antihypertensives. Over time his renal function and other markers improved, though remained abnormal. A renal biopsy was planned to determine the cause of his kidney disease.
Does it matter how congestion is relieveddrucsamal
1. The document discusses different treatments for relieving congestion in acute heart failure, including diuretics, vasodilators, inotropes, and ultrafiltration.
2. A clinical trial found that higher versus lower doses of intravenous diuretics resulted in similar outcomes for patients with acute heart failure.
3. Nitrates have not been shown to definitively reduce mortality or rehospitalization when used to treat acute heart failure.
4. More aggressive decongestion as measured by hemoconcentration, albumin, and total protein levels was associated with improved outcomes, suggesting the importance of fully relieving congestion.
Effect of hydrocortisone on development of shock amongDr fakhir Raza
effects of hydrocortisone on development of shock among patients with severe sepsis the HYPRESS Randomized Clinical Trial American Medical Association caring for the critically ill patients Surviving sepsis campaign, to determine weather hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock
This randomized controlled trial compared outcomes for patients with traumatic brain injury (TBI) and intracranial hypertension who received therapeutic hypothermia (32-35°C) plus standard care versus standard care alone. The trial was stopped early due to higher mortality in the hypothermia group. At 6 months, functional outcomes as measured by the GOSE were worse in the hypothermia group. While hypothermia successfully controlled intracranial pressure, it did not result in improved outcomes compared to standard care alone and was associated with higher mortality.
Metabolic encephalopathy diagnosis and managementRobert Robinson
Overview of the diagnosis and management of metabolic encephalopathy for third year medical students in the Personalized Education Program portion of the third year curriculum at SIU Medicine
Rivaroxaban was compared to warfarin for the prevention of stroke and embolism in atrial fibrillation patients. Over 14,000 patients were randomly assigned to once-daily rivaroxaban or warfarin with INR monitoring. The primary endpoint of stroke or embolism occurred less frequently with rivaroxaban compared to warfarin. Major bleeding occurred at similar rates while critical organ bleeding and death occurred less often with rivaroxaban.
This document summarizes research on prion diseases like Creutzfeldt-Jakob disease (CJD). It discusses the causes of prion diseases including genetic mutations and spontaneous misfolding. The document outlines the clinical diagnosis and tests used to diagnose CJD. It also describes recent investigational treatments for CJD like quinacrine, pentosan polysulfate, and doxycycline. Finally, it provides an overview of resources for patients and their families dealing with prion diseases.
This document provides a summary of 6 late-breaking sessions to attend at the Heart Rhythm Society Scientific Sessions in Boston from May 13-16, 2015. The sessions include: (1) a study on the impact of remote monitoring on clinical events and healthcare utilization; (2) a randomized global trial comparing uninterrupted rivaroxaban to vitamin K antagonists in patients undergoing catheter ablation; and (3) a study comparing cryoballoon versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation. The other sessions include: (4) first-in-human experience with a miniaturized transcatheter pacing system; (5) results from the Canadian Registry of Card
This document provides details on the top 5 sessions to attend at the HIMSS.15 conference. The sessions cover topics like structured cardiology procedure reporting, connected heart health using American Heart Association resources, using BI and analytics to reduce sepsis and heart failure readmissions, how health information exchanges can support population health through New York's Million Hearts initiative, and a session on transforming data into information and driving transformation. Speakers include doctors, public health experts, and data analysts.
This document provides details on the top 5 sessions to attend at the HIMSS.15 conference. The sessions cover topics like structured cardiology procedure reporting, connected heart health using American Heart Association resources, using BI and analytics to reduce sepsis and heart failure readmissions, how health information exchanges can support population health through New York's Million Hearts initiative, and a session on transforming data into actionable information. The sessions will take place between April 13-16, 2015 and include speakers such as doctors, healthcare executives, and data analysts.
This document summarizes 7 innovative technologies that will be on display at ACC.15:
1) Medtronic's CoreValve transcatheter aortic valve replacement system provides a minimally invasive alternative to open heart surgery for replacing diseased heart valves.
2) St. Jude Medical's CardioMEMS heart failure monitoring system allows clinicians to monitor pulmonary pressures and manage treatment in patients with heart failure.
3) Toshiba's dose-tracking system measures radiation skin dose during interventional procedures to help clinicians monitor patient radiation exposure.
4) Merge Cardio provides a centralized web-based system for physicians to manage multiple aspects of patients' integrated cardiovascular records.
The document summarizes several imaging sessions at the upcoming American College of Cardiology's Annual Scientific Session & Expo on March 14-16 in San Diego. Key sessions include:
1) Results from the PROMISE trial comparing diagnostic testing for chest pain will be presented on Saturday, and costs will be discussed on Sunday.
2) A joint multimodality imaging symposium with several societies will discuss imaging high risk patients, techniques for difficult diagnoses, and radiation safety.
3) An international perspective on cardiac imaging will be provided including a discussion of using CT on Egyptian mummies to study heart disease over millennia.
If you want to avoid damaging litigation, concentrate on dialogue and details. Cardiologists who fail to maintain detailed, two-way conversations with patients and thoroughly assess diagnostic data are at risk of negligence lawsuits, a study shows.
The 2014 RSNA conference in Chicago saw over 56,000 attendees, up 5% from the previous year, with more than 2,000 additional professional registrations. Although exhibitor attendance dipped slightly by 2%, the conference floor was packed with 636 exhibits occupying over 426,000 square feet. The conference featured special exhibits celebrating RSNA's 100th anniversary and highlighting the organization's contributions to advances in medical imaging over the past century.
Aos 213 01 nelson rivaroxaban effectiveness and safety in nvaf finalTrimed Media Group
This study compared the real-world effectiveness and safety of rivaroxaban versus warfarin for stroke prevention in nonvalvular atrial fibrillation patients using claims data. The study found:
1) Rivaroxaban and warfarin had similar risks of major bleeding, stroke, systemic embolism, and venous thromboembolism.
2) Rivaroxaban was associated with a higher risk of gastrointestinal bleeding compared to warfarin.
3) Patients were less likely to discontinue rivaroxaban treatment compared to warfarin, suggesting better treatment persistence with rivaroxaban.
This document summarizes a study examining the length of stay and economic implications of treating pulmonary embolism with rivaroxaban versus low molecular weight heparin-vitamin K antagonist (LMWH-VKA) in an emergency room setting. The study found that among patients in North America from the EINSTEIN PE trial, the median length of stay was 1 day shorter for those treated with rivaroxaban (3 days) compared to LMWH-VKA (4 days). This 1 day reduction in length of stay was associated with an estimated $2040 savings per patient for the rivaroxaban cohort based on average hospital costs. The study concluded that rivaroxaban was associated with a consistent
Shorr and bria innovation at the point-of-care rethinking the doctor-patient...Trimed Media Group
The document discusses innovations in doctor-patient interactions through technology. It proposes two solutions: 1) Creating a "story" of the patient's medical history and presenting issues for doctors to review before visits to improve care. This would be generated through automated document assembly. 2) Developing an "ad hoc" user interface optimized for point-of-care use, allowing doctors to take notes digitally in various formats like ink, checkboxes and dictation to focus on patient interaction instead of formal documentation. The goal is to enhance both the patient and provider experience through disruptive technology.
Kuperman Health Information Exchange & Care CoordinationTrimed Media Group
1) Care coordination requires improved information sharing both within care teams and across settings using health information exchange (HIE). However, current electronic health records (EHRs) were not designed for care coordination and do not adequately support sharing data and coordinating care.
2) NewYork-Presbyterian Hospital is working to enhance care coordination for patients with diabetes and depression by improving EHR tools, care team workflows, and data sharing across settings using its regional HIE. Key features include standardized screening and monitoring, patient and provider education, population health analytics, and secure messaging.
3) The success of care coordination interventions is being evaluated based on clinical outcomes like HbA1c and depression measures, as well as process measures
This document discusses the need for innovation in healthcare, particularly for the elderly population and their caregivers. It introduces the InfoSAGE project, which aims to create a "living laboratory" to study how technology can improve communication, coordination and collaboration between elderly patients and their families. InfoSAGE will connect various sources of health information and services through identity and content coordination to address the challenges of aging and caregiving. The goal is to develop tools that help address problems around care coordination, respecting patient preferences and reducing caregiver burnout, as electronic health records currently do not adequately meet the needs of elderly patients and their families.
[Hongsermeier] clinical decision support services amdis finalTrimed Media Group
1) Clinical Decision Support Services (CDSS) allow externalization of clinical knowledge and decision support logic from electronic health records (EHRs) to specialized CDSS providers.
2) The Clinical Decision Support Consortium (CDSC) is working on standards for knowledge management, specification, and sharing of CDS content and services.
3) Opportunities exist for EHR vendors to leverage external CDSS as curating all needed clinical knowledge internally is challenging, and most EHR CDS cannot support advanced inferencing required for personalized medicine. Challenges include ensuring appropriate implementation and use of external CDSS within EHR workflows.
This document discusses delivering clinical knowledge and guidance directly into healthcare workflows through clinical decision support (CDS). CDS aims to provide clinicians and patients with intelligently filtered, situation-specific information to enhance patient care. The goal is to repurpose existing clinical content from various sources and deliver the most precise and useful information for each workflow and information need. Physician information needs were analyzed from query data to develop an ontology of needs. Content is curated, indexed as discrete facts, and tailored for specific situations by matching it to patient data, workflows, and information needs. Knowledge delivery aims to integrate actionable tools and options directly into clinical systems like EHRs.
The document summarizes a presentation on providing collaborative and coordinated care for patients with complex illnesses. Some key points:
- To achieve the goals of improved health outcomes, quality of care, and reduced costs ("Triple Aim"), the healthcare system needs to focus on caring for patients with complex chronic conditions who account for a large portion of costs.
- Successful models involve interdisciplinary, team-based care coordinated across care settings. CareMore, a Medicare Advantage plan, achieves better outcomes and lower costs through intensive management of frail patients using nurse practitioners, protocols, home monitoring, and an electronic health record.
- Clinical IT can support collaborative care by enabling documentation, care planning, decision support, and information
This document discusses challenges with using electronic health records (EHRs) to support clinical knowledge management (KM) and continuous learning. It outlines several investments made by Lahey Health to address these challenges, including using an external collaboration platform to manage clinical decision support (CDS) content outside of the EHR. The document argues that EHRs are not designed for collaboration or learning, and that clinical KM 3.0 approaches are needed to help health systems and users continuously self-improve.
The document is from the Intelligent Health Lab and discusses several topics:
1. The Lab's director and its affiliation with Harvard.
2. The potential for an "App Store for Health" where innovators can create and distribute apps across EMR systems, similar to app stores for smartphones.
3. The vision of a "Learning Health System" where evidence is continuously generated from patient data to improve outcomes over time.
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The document discusses new ways to engage patients through open notes and social media. It describes initial findings from the OpenNotes project that showed patients found value in reading clinical notes. It also outlines how patients use social media to find health information and connect with others. The document argues that healthcare providers can leverage these technologies and concepts to reduce information asymmetry, educate patients, and learn from them to provide more engaging and effective care.
Crotty engaging patients in new ways from open notes to social media
Ascend hf-101115080858-phpapp01
1. Acute Study of Clinical Effectiveness
of Nesiritide in Decompensated
Heart Failure
Adrian F. Hernandez, MD
On behalf of the ASCEND-HF Committees,
Investigators and Study Coordinators
2. Disclosure Information
Adrian F. Hernandez, MD
ASCEND-HF Trial
FINANCIAL DISCLOSURE:
Trial Sponsor: Scios Inc
Research funding from Johnson & Johnson
Honorarium from Amgen, Corthera
Full listing of disclosures at dcri.org
UNLABELED or UNAPPROVED USE: None
3. Study organization
Sponsor Executive Committee Independent DSMB
Scios Inc. Chair: Rob Califf Chair: Sidney Goldstein
Chris O’Connor (Co-PI), Randy Starling (Co-PI) Salim Yusuf,
Paul Armstrong, Kenneth Dickstein, David DeMets,
Michel Komajda, Barry Massie, John McMurray, Milton Packer,
Markku Nieminen, Jean Rouleau, John Kjekshus
Karl Swedberg, Vic Hasselblad
Clinical Event
International Steering Committee Committee
Chair: John McMurray
ROW: Coordinating center: North America
Johnson & Johnson DCRI Academic Consortium:
Global Clinical Adrian Hernandez, (DCRI, C5, Jefferson,
Operations Craig Reist, Henry Ford, Canadian
Gretchen Heizer VIGOUR Centre)
>800 Investigators and Study Coordinators at 398 Sites
4. Background
Acute heart failure is a major health problem responsible for
several million hospitalizations worldwide each year.
Standard therapy has not changed since 1970s and includes
diuretics and variable use of vasodilators or inotropes.
In 2001, nesiritide was approved by the FDA to reduce PCWP
and improve dyspnea, based on efficacy at 3 hrs.
However, in 2005 two meta-analyses raised concerns regarding
the risks of mortality and renal injury.
Subsequently, an independent panel* was convened by Scios
Inc and recommended that a clinical trial be conducted to
definitively answer the question of nesiritide’s safety and
efficacy.
*chaired by Eugene Braunwald
5. Design of ASCEND-HF: Guiding principles
Independent framework
Pragmatic trial model
• Focused
• Efficient study design
• Streamlined procedures
• Simple follow-up
Permissive enrollment criteria for broad population
Meaningful outcomes
“Real world” treatment
6. Co-Primary objectives
To assess whether nesiritide vs placebo,
in addition to standard care provides:
• Reduction in rate of
HF rehospitalization 60
Markedly Better
Moderately Better
or all-cause mortality 40 Minimally Better
through Day 30
% Subjects
20 No Change
• Significant improvement
Minimally Worse
0
Moderately Worse
in self-assessed dyspnea 20
Markedly Worse
at 6 or 24 hrs 40
Placebo Nesiritide
using 7-point Likert scale
7. Secondary and safety objectives
Secondary endpoints:
• Overall well-being at 6 and 24 hours
• Persistent or worsening HF and all-cause mortality from
randomization through discharge
• Number of days alive and outside of the hospital
• Cardiovascular rehospitalization and cardiovascular mortality
Safety endpoints:
• All cause mortality
• Renal: 25% decrease in eGFR at any time from study drug
initiation through Day 30
• Hypotension: As reported by investigator as symptomatic or
asymptomatic
8. Study design and drug procedures
Nesiritide
Acute HF < 24 hrs
24–168 hrs Rx
from IV RX
Placebo
Co-primary Co-primary All-cause
endpoint: endpoint: mortality
Dyspnea relief 30-day death or at 180
at 6 and 24 hrs HF rehosp days
Double – blind placebo controlled
IV bolus (loading dose) of 2 µg/kg nesiritide or placebo
• Investigator’s discretion for bolus
• Followed by continuous IV infusion of nesiritide 0.01 µg/kg/min or placebo
for up to 7 days
Usual care per investigators including diuretics and/or other therapies as needed
Duration of treatment per investigator based on clinical improvement
9. Inclusion and exclusion criteria
Key inclusion criteria Key exclusion criteria
Hospitalized for ADHF <24 hrs from Hypotension at baseline
IV treatment (SBP <100 mm Hg or SBP<110
mm Hg with IV vasodilator)
Dyspnea at rest or with minimal
activity Significant lung disease that could
interfere with interpretation of
1 clinical sign: dyspnea
• Respiratory rate ≥ 20 breaths per
min Acute coronary syndrome
• Rales >1/3 bases Severe anemia or active bleeding
1 objective measure: Treatment with levosimendan or
• CXR with pulmonary edema milrinone
• BNP ≥400 pg/mL or Unstable doses of IV vasoactive
NT-proBNP≥1000 pg/mL
medication within 3 hours
• Prior EF <40% within 12 months
• PCWP > 20 mmHg
10. Statistical methods
Study population: modified intention-to-treat based on receiving study
drug
Primary analysis:
• Co-primary endpoints tested using Bonferroni approach
• Composite of HF rehospitalization and all-cause mortality tested at
0.045 significance level
• Dyspnea tested at 0.005 level using Hochberg method:
Significant if both 6- and 24-hr assessment P values ≤0.005; or
If either 6- or 24-hr assessment P values ≤0.0025
Sample size determination:
• Based on composite endpoint: 89% power with 7000 patients using
chi-square test, assuming a placebo event rate of 14% and a relative
risk reduction of 18.6%
11. Enrollment
7141 patients
30 Countries & 398 Sites
Western Europe = 7%
35 sites
North America = 45%
Central Europe = 14%
214 sites
48 sites
Asia-Pacific = 25%
62 sites
Latin America = 9%
39 sites
>800 Investigators and Study Coordinators
12. Study population
Randomized (n=7141)
Placebo (n=3577) Nesiritide (n=3564)
• Did not receive study drug (n=66) • Did not receive study drug (n=68)
Hypotension (n=28) Hypotension (n=26)
Exclusion criteria (n=8) Exclusion criteria identified (n=9)
Physician decision (n=6) Physician decision (n=6)
Participant withdrew consent (n=14) Participant withdrew consent (n=16)
Other reason (n=10) Other reason (n=11)
Placebo MITT=3511 Nesiritide MITT=3496
13. Baseline characteristics
Placebo (n=3511) Nesiritide (n=3496)
Age (yrs) 67 (56, 76) 67 (56, 76)
Female (%) 34.9 33.4
Black or African American 15.0 14.7
Systolic Blood Pressure (mmHg) 124 (110, 140) 123 (110, 140)
Heart rate (beats/min) 82 (72, 95) 82 (72, 95)
Respiratory rate (breaths/min) 24 (21,26) 23 (21, 26)
Medical History (%)
Ischemic heart disease 60.8 59.5
Hypertension 72.6 71.8
Atrial fibrillation 37.7 37.4
Chronic respiratory disease 16.6 16.3
Diabetes 42.9 42.3
Continuous variables as median (IQR 25th, 75th); MITT population
16. 30 day death/HF readmission subgroups
All Subjects N=6836
< 123 N=3346
Baseline SBP (mmHg)
≥ 123 N=3490
Baseline Ejection Fraction <40 N=4362
(%) ≥ 40 N=1187
Renal function- MDRD GFR <60 N=3395
(mL/min/m2) ≥ 60 N=3093
No N=3092
History of CAD
Yes N=3742
No N=3923
History of Diabetes Mellitus
Yes N=2913
-10 -5 0 5 10
Risk Difference <0: Favors Nesiritide;
Risk Difference >0: Favors Placebo
Difference (%) and 95% Confidence Interval
17. 30 day death/HF readmission subgroups
All Subjects N=6836
Inotrope Use at No N=6556
Randomization Yes N=280
None N=5889
Any IV Vasodilators N=942
Vasodilators
No IV Nitroglycerin N=5943
IV Nitroglycerin N=892
Diuretic Use from No N=691
Hospitalization to
Rand Yes N=6145
No N=2609
Study Drug Bolus
Yes N=4227
Time from Hosp to <15.5 N=3426
Rand (hrs) ≥15.5 N=3410
-10 -5 0 5 10
Risk Difference <0: Favors Nesiritide;
Risk Difference >0: Favors Placebo
Difference (%) and 95% Confidence Interval
19. Dyspnea at 6 and 24 Hours
Odds for Marked-Moderate Improvement
6 hours 24 hours
All Subjects N=6860 N=6769
<123 N=3369 N=3314
SBP
≥123 N=3491 N=3455
<60 N=3494 N=3349
GFR
≥60 N=3121 N=3075
Ejection <40 N=4385 N=4335
Fraction ≥40 N=1186 N=1171
No N=3115 N=3082
CAD
Yes N=3743 N=3685
No N=3930 N=3887
Diabetes
Yes N=2930 N=2882
0 1 20 1 2
OR <1: Favors Placebo; OR >1: Favors Nesiritide;
Odds Ratio of Markedly/Moderately vs. Other
20. Dyspnea at 6 and 24 Hours
Odds for Marked-Moderate Improvement
6 hours 24 hours
All Subjects N=6860 N=6769
No N=6574 N=6481
Inotropes
Yes N=286 N=288
None N=5912 N=5835
Any IV Vaso N=943 N=929
Vasodilators
No IV Nitro N=5965 N=5886
IV Nitro N=894 N=882
No N=691 N=679
Diuretics
Yes N=6169 N=6090
Study
Medication No N=2612 N=2564
Bolus Yes N=4248 N=4205
Time from
<15.5 N=3428 N=3369
Hosp to
≥15.5 N=3432 N=3400
Rand
0 1 2 0 1 2
OR <1: Favors Placebo; OR >1: Favors Nesiritide;
Odds Ratio of Markedly/Moderately vs. Other
21. Secondary endpoints
Placebo Nesiritide Difference P-
(n=3511) (n=3496) (95% CI) value
Persistent or worsening HF or
4.8% 4.2% -0.5
all-cause mortality through 0.30
(165) (147) (-1.5 to 0.5)
discharge
Days alive and outside of 0.2
20.7 20.9 0.16
hospital through Day 30 (-0.13 to 0.53)
CV death or CV rehosp 11.8% 10.9% -0.9
0.24
through Day 30 (402) (372) (-2.4 to 0.6)
Placebo Nesiritide
P-value
(n=3511) (n=3496)
Well Being at 6 hours* 40.3% 41.4% 0.32
Well Being at 24 hours*
63.7% 65.7% 0.02
*Combined response for moderately/markedly better
22. Renal Safety
Placebo Nesiritide
Anytime Through Day 30 P-value Placebo Nesiritide
(n=3509) (n=3498)
>25% decrease eGFR 29.5% 31.4% 0.11
End of Treatment Creatinine Discharge or 10 day Creatinine
1.0 1.0
0.9 0.9
0.8 0.8
0.7 0.7
Cum Dist
Cum Dist
0.6 0.6
0.5 0.5
0.4 0.4
0.3 0.3
0.2 0.2
0.1 0.1
0 0
0 2 4 6 8 0 2 4 6 8
Creatinine (mg/dL) Creatinine (mg/dL)
23. Hypotension
Risk
Placebo Nesiritide P-
Difference
(n=3509) (n=3498) value
(95% CI)
Any hypotension 15.3% 26.6% 11.3
<.001
(Through Day 10/discharge) (538) (930) (9.4 to 13.1)
12.4% 21.4% 9.0
Asymptomatic Hypotension <.001
(436) (748) (7.2 to 10.7)
4.0% 7.1% 3.1
Symptomatic Hypotension <.001
(141) (250) (2.1 to 4.2)
25. Conclusions
Nesiritide did not reduce the rate of recurrent heart
failure hospitalization or death at 30 days.
Nesiritide reduced dyspnea to a modest degree,
consistent with previous findings but did not meet pre-
specified protocol criteria for statistical significance at 6
and 24 hours.
Nesiritide did not affect 30-day all cause mortality nor did
it worsen renal function as had been suggested by prior
meta-analyses of smaller studies.
26. Implications
Nesiritide can now be considered a safe therapy in
patients with acute heart failure.
Further analysis of ASCEND-HF is likely to permit better
understanding of acute heart failure and patient profiles
that may potentially benefit from nesiritide.
Our results from this large randomized trial emphasize
both the challenges of making therapeutic decisions on
inadequate evidence as well as the urgent need for
large, well-conducted trials capable of informing clinical
practice
27. Steering Committee
North America: Kirkwood F. Adams Jr MD; Javed Butler, MD;Maria Rosa
Costanzo, MD; Mark E. Dunlap, MD; Justin A. Ezekowitz, MBBCh, MSc; David
Feldman, MD, PhD; Gregg C. Fonarow, MD; Stephen S. Gottlieb, MD, MHS; James
A. Hill, MD, MS; Judd E. Hollander, MD; Jonathan G. Howlett, MD; Michael
Hudson, MD; Mariell L. Jessup, MD; Serge Lepage, MD; Wayne C. Levy, MD;
Naveen Pereira, MD; W.H. Wilson Tang, MD; John R. Teerlink, MD; Clyde W.
Yancy, MD
Europe: Stefan D. Anker, MD, PhD; Dan Atar, MD; Alexander Battler, MD; Ulf
Dahlstrom, MD, PhD; Aleksandras Laucevicius, MD; Marco Metra, MD; Alexander
Parkhomenko, MD; Piotr Ponikowski, MD, PhD; Jindrich Spinar, MD; Svetla
Torbova, MD; Filippos Triposkiadis, MD;Vyacheslav Mareev, MD; Adriaan A.
Voors, MD, PhD;David J. Whellan, MD, MHS; Clyde W. Yancy, MD; Faiez Zannad,
MD, PhD
Latin America: Rodrigo Botero, MD; Nadine Clausell, MD; Ramón Corbalán, MD;
Rafael Diaz, MD; Gustavo Méndez Machedo
Asia Pacific: Ping Chai, MD; Wen-Jone Chen, MD; Henry Krum, MBBS, PhD;
Sanjay Mittal, MD; Byung Hee Oh, MD; Supachai Tanomsup, MD; Richard W.
Troughton, MD, PhD; YueJin Yang, MD;