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Clyde W Yancy

Publications and source records attributed to Clyde W Yancy.

At least 37 records · Page 2Linked to original sources
PubMed2005

Routine computed tomography screening of the chest in high-risk cardiac transplant recipients may improve survival.

BACKGROUND: Multiple studies have demonstrated an increased incidence of lung cancer in the heart transplant population. We reviewed our cardiac transplantation experience with respect to the development of bronchogenic carcinoma and explored the role of routine chest computed tomography (CT) in its surveillance. METHODS: We performed a review of our cardiac transplantation experience, highlighting the incidence of lung cancer, and we analyzed our recent experience with screening chest CT in lung cancer surveillance in this patient group. RESULTS: Eighteen patients developed 20 cases of bronchogenic carcinoma for an incidence of 6.83%. In 10 cases, the patients underwent surgical resection; however, in the remaining cases, the patients were either treated with chemotherapy and/or radiation or they died before initiation of therapy. The actuarial 1-, 2- and 5-year overall survival rates were 49%, 29% and 13%, respectively. The median survival of patients who underwent surgical resection was 28 months (3 to 85 months), whereas the median survival of patients who were either ineligible for surgery or died before initiation of treatment was only 1 month (1 to 13 months). All patients diagnosed with lung cancer by chest CT underwent surgical resection; however, only 37.5% of patients diagnosed with lung cancer by chest X-ray were found at an appropriate stage for resection (p = 0.025). CONCLUSIONS: Cardiac transplant recipients have a significant risk of developing bronchogenic carcinoma. Routine chest CT screening in high-risk patients may enable clinicians to identify disease earlier, which is essential for the option of surgical resection and, therefore, prolonged survival.

Adolescent↗
PubMed2005

BiDil's impact.

Explore the source record for details and available documents.

Black or African American↗
PubMed2005

Comprehensive treatment of heart failure: state-of-the-art medical therapy.

Despite advances in therapy and better outcomes for heart failure, this disease remains burdensome in terms of hospitalization costs, quality of life, and mortality. Many treatment strategies are available for heart failure, including medical therapy with agents such as angiotensin-converting enzyme inhibitors, and b-blockers, and device therapy including implantable cardioverter-defibrillators and cardiac resynchronization. However, data now demonstrate that compliance with these evidence-based strategies is well below acceptable thresholds, negatively affecting quality of care. The implementation of guidelines such as those of the American College of Cardiology/American Heart Association and the application of dedicated disease management programs are two mechanisms aimed toward helping physicians construct and adhere to effective treatment regimens for their patients with heart failure.

Cardiology↗
PubMed2004

Safety and feasibility of using serial infusions of nesiritide for heart failure in an outpatient setting (from the FUSION I trial).

The Follow-Up Serial Infusions of Nesiritide pilot study was designed to assess the safety and tolerability of outpatient serial infusions of nesiritide in 210 patients with decompensated heart failure who were randomly assigned to usual care only or usual care plus weekly infusions of nesiritide at dosages of 0.005 or 0.01 microg/kg/min for 12 weeks. The mean age +/- SD of the entire population was 67 +/- 13 years; 70% were men, and 80% were white. Mean baseline serum creatinine levels were 1.8 +/- 0.7 mg/dl, and mean left ventricular ejection fraction was 0.28 +/- 0.15%. Diabetes mellitus was present in 106 patients (50%), and atrial arrhythmias were present in 100 patients (48%). A totalof 1,645 nesiritide infusions was administered; 11 (< 1%) were discontinued due to an adverse event. All treatment groups had a similar frequency of adverse events and experienced improvements in quality of life. Administration of nesiritide resulted in acute decreases in aldosterone and endothelin-1 concentrations. Although there were no statistically significant differences among groups by outcome, prospectively defined higher risk subgroups demonstrated significant decreases in cardiovascular events. These results demonstrate the safety and feasibility of administering nesiritide in an outpatient setting. Additional studies are needed to determine the effect of outpatient serial infusions of nesiritide on rates of morbidity and mortality in advanced heart failure.

Aged↗
PubMed2004

Special considerations for carvedilol use in heart failure.

Remarkable improvements in morbidity and mortality caused by heart failure have been realized because of a greater understanding of the pathobiologic mechanisms of left ventricular dysfunction and the subsequent application of neurohormonal antagonism to the heart failure milieu. The median survival of patients with chronic heart failure has greatly increased with the use of effective medical therapy that includes angiotensin-converting enzyme inhibitors and beta-blockers, especially carvedilol. Still to be addressed is the issue of clinical trials that under represent special populations of patients who are affected with heart failure (eg, the elderly, women, and African Americans). Even though heart failure may be a somewhat different illness in etiology, epidemiology, or responsiveness to medical therapy for each of these groups, it is of utmost importance that patients affected by heart failure be treated with agents that have been shown to be of benefit in the major controlled clinical trials in heart failure.

Adrenergic beta-Antagonists↗
PubMed2004

Treatment with B-type natriuretic peptide for chronic decompensated heart failure: insights learned from the follow-up serial infusion of nesiritide (FUSION) trial.

Several evidence-based treatment regimens are modestly effective in patients with moderately severe to severe heart failure, but truly effective therapies that improve symptoms, reduce hospitalizations, and extend meaningful survival do not exist for these patients. Only ventricular replacement therapy, with either heart transplantation or left ventricular assist devices, has been shown to significantly improve outcomes. Nesiritide, a recombinant B-type natriuretic peptide, is associated with significant reductions in filling pressure, with corresponding relief of symptoms, and diminished neurohormonal levels and has no inotropic effects and no evidence of proarrhythmia when given to patients with decompensated acute heart failure. Results of the Follow-Up Serial Infusion of Nesiritide (FUSION) trial suggest that a regimen incorporating nesiritide can be accomplished with a reasonable assurance of safety and tolerability; pre-study concerns regarding hypotension were not realized. A qualified look at outcomes data within FUSION I suggests that further study of this paradigm is reasonable, especially if the studied patient population includes patients with a low left ventricular ejection fraction and New York Heart Association (NYHA) class III disease with renal insufficiency, or patients with low left ventricular ejection fraction and NYHA class IV heart failure. Therefore, FUSION II, a double-blind, placebo-controlled trial, will randomly assign approximately 900 such patients to treatment with usual care plus nesiritide or usual care plus placebo and will use mortality/cardiorenal hospitalization as a composite end point. If positive data emerge from FUSION II that either confirm or strengthen the data in FUSION I, a new therapeutic option may be available for patients with chronic decompensated heart failure.

Aged↗
PubMed2004

Quality of care and outcomes in acute decompensated heart failure: The ADHERE Registry.

Despite 1 million or more annual hospitalizations, the management of acute decompensated heart failure remains largely empiric. Data are lacking regarding patient characteristics, usual comorbidities, commonly used treatment strategies, clinical outcomes, and adherence to recently published quality indicators. The Acute Decompensated Heart Failure National Registry (ADHERE(R)) has been established to capture data regarding the presentation, management, and expected outcomes of acute decompensated heart failure. The size of the registry and its web-based platform allow for evaluation of compliance with quality indicators, assessment of mortality risk, and correlation of parenteral treatment strategies with clinical outcomes. More than 100,000 patient episodes have been recorded in the registry. These patient data have been reviewed and reveal important findings regarding acute decompensated heart failure and potential opportunities to improve the quality of care.

Acute Disease↗
PubMed2004

Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF): rationale and design.

Heart failure (HF) affects >5 million patients in the United States, and its prevalence is increasing every year. Despite the compelling scientific evidence that angiotensin-converting enzyme inhibitors and beta-blockers reduce hospitalizations and mortality rates in patients with HF, these lifesaving therapies continue to be underused. Several studies in a variety of clinical settings have documented that a significant proportion of eligible patients with HF are not receiving treatment with these guideline-recommended, evidence-based therapies. In patients hospitalized with HF, who are at particularly high risk for re-hospitalization and death, the initiation of beta-blockers is often delayed because of concern that early initiation of these agents may exacerbate HF. Recent studies suggest that beta-blockers can be safely and effectively initiated in patients with HF before hospital discharge and that clinical outcomes are improved. The Initiation Management Predischarge Process for Assessment of Carvedilol Therapy for Heart Failure (IMPACT-HF) trial demonstrated that pre-discharge initiation of carvedilol was associated with a higher rate of beta-blocker use after hospital discharge, with no increase in hospital length of stay. In addition, there was no increase in the risk of worsening of HF. Studies of hospital-based management systems that rely on early (pre-discharge) initiation of evidence-based therapies for patients with cardiovascular disease have also found increases in post-discharge use of therapy and a reduction in the rates of mortality and hospitalization. On the basis of these pivotal studies, the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) program is designed to improve medical care and education of hospitalized patients with HF and accelerate the initiation of evidence-based HF guideline recommended therapies by administering them before hospital discharge. A registry component, planned as the most comprehensive database of the hospitalized HF population focusing on admission to discharge and 60- to 90-day follow-up, is designed to evaluate the demographic, pathophysiologic, clinical, treatment, and outcome characteristics of patients hospitalized with HF. The ultimate aim of this program is to improve the standard of HF care in the hospital and outpatient settings and increase the use of evidence-based therapeutic strategies to save lives.

Adrenergic beta-Antagonists↗
PubMed2004

Effects of diabetes mellitus and ischemic heart disease on the progression from asymptomatic left ventricular dysfunction to symptomatic heart failure: a retrospective analysis from the Studies of Left Ventricular Dysfunction (SOLVD) Prevention trial.

BACKGROUND: Emerging data suggest that diabetes mellitus is a risk factor for the progression of established heart failure only in those patients with ischemic cardiomyopathy. Whether diabetes mellitus is a risk factor for the progression from asymptomatic left ventricular systolic dysfunction to symptomatic heart failure in patients with left ventricular dysfunction of an ischemic cause is not known. METHODS: We performed a retrospective analysis of 2821 patients with asymptomatic left ventricular systolic dysfunction from the Studies of Left Ventricular Dysfunction (SOLVD) Prevention trial. We used adjusted survival analysis to examine the effects of ischemic heart disease and diabetes mellitus on 3 prespecified study end points: (1) development of heart failure (HF) symptoms, (2) HF hospitalization, and (3) death or development of symptoms. RESULTS: There is a statistically significant interaction between the cause of left ventricular systolic dysfunction and diabetes mellitus on the risk of development of heart failure symptoms (P = .020). Patients with ischemic cardiomyopathy and diabetes had an increased risk of progression to symptomatic heart failure (HR = 1.56, P < .001), hospitalization for heart failure (HR = 2.16, P < .001), and death or development of symptoms (HR = 1.50, P < .001), compared with patients with ischemic cardiomyopathy without diabetes. In contrast, diabetes was not associated with an increased risk of reaching these end points in patients with nonischemic cardiomyopathy. CONCLUSIONS: Diabetes mellitus is a risk factor for the progression from asymptomatic left ventricular systolic dysfunction to symptomatic heart failure, but this risk appears to be confined to those patients with ischemic cardiomyopathy.

Analysis of Variance↗
PubMed2004

Beta-blocker therapy in patients with heart failure in the urban setting: moving beyond clinical trials.

BACKGROUND: Despite their known benefits, beta-blockers (BBL) are not yet widely prescribed for heart failure, especially in the primary care setting. We wanted to identify patient characteristics that could guide primary care physicians in deciding whether they or a cardiologist should initiate BBL. A second objective was to determine the tolerability of BBL in clinical practice. METHODS: A retrospective chart review was conducted on a consecutive series of 551 patients with systolic dysfunction referred to a heart failure clinic in an urban public hospital. Patient responses to BBL were stratified into three categories: favorable (improvement of left ventricular ejection fraction by serial echocardiography), unfavorable (development of decompensated heart failure), or neither. Tolerability of BBL was assessed by the need to permanently discontinue BBL. RESULTS: Of 551 patients, 363 (66%) tolerated BBL. Among patients who had BBL initiated in the clinic, 48 had a favorable response, 34 had an unfavorable response, and 57 had neither a favorable or unfavorable response, as defined. A lower systolic blood pressure and higher diuretic dose were associated with development of decompensated heart failure as compared to improvement of ejection fraction. CONCLUSIONS: A majority of patients with heart failure in an urban public hospital can tolerate BBL. Easily measurable characteristics such as lower systolic blood pressure and higher diuretic dose may assist primary care physicians in triaging patients for referral to cardiologists for beta-blocker initiation.

Adrenergic beta-Antagonists↗
PubMed2004

The prevention of heart failure in minority communities and discrepancies in health care delivery systems.

This article discusses risk factors for cardiovascular disease in the minority community, including hypertension, obesity, diabetes,and diet. The minority community exhibits important population differences regarding risk and outcomes for cardiovascular disease. The complete explanation for these differential outcomes is lacking and likely to be multifactorial in origin; however, disparities in health care (differences in the quality of health care that are not due to access-related factors or clinical needs, to preferences, or to the appropriateness of the intervention) may emanate from decisions made by the patient, provider, or health care system. Hypertension as a disease entity is strikingly pathologic in African Americans. Correspondingly, the incidence of cardiovascular mortality due to hypertensive heart disease is fourfold higher in African Americans than in non-Hispanic whites. Hypertension and heart failure can be treated effectively in the minority community with a regimen of agents not dissimilar from that used for the general population. Treatment regimens should be individualized based on the disease presentation, associated comorbidity, and disease severity and not on something as arbitrary as race.

Adrenergic beta-Antagonists↗
PubMed2004

Improving outcomes in the post-myocardial infarction setting.

Heart disease is the leading cause of death in the United States, with African-American men having the highest rate of cardiovascular mortality in the US population. Although the clustering of multiple cardiovascular risk factors is particularly apparent in this group, a key reason for the higher rate of cardiovascular mortality among African-American men compared with other ethnic groups may be related to underdiagnosis and undertreatment. Studies have shown that minority persons with myocardial infarction are less likely than non-minorities to be diagnosed, to receive appropriate drug therapy, or to undergo bypass surgery. However, there are no data that suggest established treatments and secondary prevention strategies are less effective in African Americans. Appropriate therapy for secondary prevention--including thrombolysis, antiplatelet strategies, angiotensin-converting enzyme inhibition, beta blockade, and lipid-lowering therapies--results in significant reductions in mortality for all patients.

Black or African American↗
PubMed2004

Heart failure therapy in special populations: the same or different?

Traditional clinical trials of heart failure therapy have focused on fairly homogeneous patient populations. Therefore, a pressing question is raised regarding whether it is appropriate to extrapolate findings from these trials to other groups, such as the elderly, women, and African Americans. Based on current knowledge, the differences among these groups should be acknowledged as subtle and represent a need for heightened clinical awareness and more vigorous investigation. These special populations, however, should receive medical therapy for heart failure that is consistent with the results from the major trials and is in accordance with published heart failure guidelines.

Aged↗
PubMed2003

Gender differences in advanced heart failure: insights from the BEST study.

OBJECTIVES: The goal of this study was to determine the influence of gender on baseline characteristics, response to treatment, and prognosis in patients with heart failure (HF) and impaired left ventricular ejection fraction (LVEF). BACKGROUND: Under-representation of women in HF clinical trials has limited our understanding of gender-related differences in patients with HF. METHODS: The impact of gender was assessed in the Beta-Blocker Evaluation of Survival Trial (BEST) which randomized 2,708 patients with New York Heart Association class III/IV and LVEF < or =0.35 to bucindolol versus placebo. Women (n = 593) were compared with men (n = 2,115). Mean follow-up period was two years. RESULTS: Significant differences in baseline clinical and laboratory characteristics were found. Women were younger, more likely to be black, had a higher prevalence of nonischemic etiology, higher right and left ventricular ejection fraction, higher heart rate, greater cardiothoracic ratio, higher prevalence of left bundle branch block, lower prevalence of atrial fibrillation, and lower plasma norepinephrine level. Ischemic etiology and measures of severity of HF were found to be predictors of prognosis in women and men. However, differences in the predictive values of various variables were noted; most notably, coronary artery disease and LVEF appear to be stronger predictors of prognosis in women. In the nonischemic patients, women had a significantly better survival rate compared with men. CONCLUSIONS: In HF patients with impaired LVEF, significant gender differences are present, and the prognostic predictive values of some variables vary in magnitude between women and men. The survival advantage of women is confined to patients with nonischemic etiology.

Adrenergic beta-Antagonists↗