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J M Brophy

Publications and source records attributed to J M Brophy.

At least 37 records · Page 2Linked to original sources
PubMed1997

The epidemiology of acute myocardial infarction and ischemic heart disease in Canada: data from 1976 to 1991.

OBJECTIVE: To present national trends in mortality rates for myocardial infarction and cardiovascular disease. DESIGN: Observational study using mortality statistics and hospital separation data from Statistics Canada for the period 1976 to 1991. RESULTS: Despite ageing of the population, there has been a substantial decrease in the number of deaths attributed to ischemic heart disease, from 51,000 in 1976 to 44,000 in 1991, with most of the decrease due to fewer deaths from myocardial infarction. Although age-adjusted death rates remain higher for men, the observed mortality decline has been more pronounced in men than in women. Age-adjusted separation rates have also decreased, suggesting a decrease in the incidence of myocardial infarction, particularly in the 45 to 64 year age group. The duration of hospital stay has shortened dramatically. CONCLUSIONS: From 1976 to 1991, mortality rates for ischemic heart disease in Canada decreased sharply, suggesting that advancements observed in clinical trials are being translated to the population level. The decrease appears to be due to both preventive measures and improved hospital care, but further studies are necessary to define better the relative contribution of each factor. The extent of this progress over the past 15 years is similar to the American experience.

Aged↗
PubMed1996

The long term prognosis in patients following thrombolysis for acute myocardial infarction: a view from a community hospital.

Thrombolysis in patients with acute myocardial infarction has been established to improve hospital survival. Less information is available about the long term evolution of unselected patients seen in community hospitals. Consequently, consecutive patients treated with thrombolysis for acute myocardial infarction and surviving until hospital discharge (n = 129) were followed for an average of 22 months. Mortality, recurrent ischemic events, coronary angiography and re-vascularizations were recorded for all patients. Two-year total and cardiovascular survival rates of 95 and 98% respectively were obtained with a conservative approach to early re-vascularization (n = 17, 13%). A history of prior myocardial infarction and early recurrent myocardial ischemia were significant predictors of increased cardiac events, while thallium stress testing provided no incremental value. Angiography and re-vascularizations were more frequently performed in younger patients (under 65 years old), anterior vs. inferior infarction and those with early residual ischemia. Women received less aggressive investigation and therapy then men and this may represent a gender bias, unmeasured residual confounding or the play of chance in a small sample size. Further studies are needed to confirm or refute these findings.

Adult↗
PubMed1995

Placing trials in context using Bayesian analysis. GUSTO revisited by Reverend Bayes.

Standard statistical analyses of randomized clinical trials fail to provide a direct assessment of which treatment is superior or the probability of a clinically meaningful difference. A Bayesian analysis permits the calculation of the probability that a treatment is superior based on the observed data and prior beliefs. The subjectivity of prior beliefs in the Bayesian approach is not a liability, but rather explicitly allows different opinions to be formally expressed and evaluated. The usefulness of this approach is demonstrated using the results of the recent GUSTO study of various thrombolytic strategies in acute myocardial infarction. This analysis suggests that the clinical superiority of tissue-type plasminogen activator over streptokinase remains uncertain.

Bayes Theorem↗
PubMed1994

Long-term prognosis of patients presenting to the emergency room with decompensated congestive heart failure.

OBJECTIVES: This observational study was done to describe the long term prognosis of patients presenting to an emergency room with decompensated heart failure and to determine the factors that influence their survival. DESIGN: The routine clinical and laboratory characteristics of consecutive patients presenting to an emergency room with decompensated heart failure were documented and the patients followed for an average of 44 months (range 41 to 47). SETTING: One teaching hospital and one community-based hospital in Montreal, Quebec. PATIENTS: A prospective cohort of 153 consecutive patients presenting to the emergency room with decompensated heart failure. OUTCOME MEASURES: Total mortality was the main outcome. Survival status was validated by the government health insurance board. RESULTS: Survival was poor, with 61% dying within the 47-month follow-up. Univariate analysis revealed the following variables to be associated with decreased survival; low sodium (P < 0.001), decreased renal function (P < 0.001), prior hospitalization for decompensated heart failure (P < 0.001), intraventricular conduction defect (P < 0.002), failure despite prior use of angiotensin-converting enzyme (ACE) inhibitors (P < 0.005) and increased cardiac dimensions as determined by increased left ventricular end systolic diameter (P < 0.04). The multivariate analysis using the Cox proportional hazards model showed a prior admission for heart failure (relative risk [RR] 1.9 [P = 0.005], 95% confidence interval [CI] 1.2 to 2.9), hyponatremia (RR 2.1 [P = 0.005], 95% CI 1.2 to 3.5), presence of an intraventricular conduction delay (RR 1.9 [P = 0.003], 95% CI 1.2 to 2.9), and the cumulative required dose of intravenous furosemide (RR 1.7 [P = 0.03], 95% CI 1.1 to 2.8) to be associated with increased mortality. Patients with hyponatremia despite the use of ACE inhibitors were at greatest risk (RR 11.5 [P < 0.001], 95% CI 5.3 to 24.9). CONCLUSIONS: This prospective observational study confirms that the long term prognosis of patients needing hospitalization for congestive heart failure remains poor. Readily available acute-phase clinical variables may assist in predicting prognosis.

Aged↗
PubMed1993

The hospital course and short term prognosis of patients presenting to the emergency room with decompensated congestive heart failure.

OBJECTIVES: This observational study was done to describe the characteristics, hospital course and short term prognosis of patients presenting to an emergency room with decompensated heart failure and to determine the parameters influencing the length of their hospital stay. DESIGN: The routine clinical and laboratory characteristics of consecutive patients presenting to an emergency room with decompensated heart failure were documented and the patients followed for six months. SETTING: One teaching hospital and one community-based hospital in Montreal, Quebec. PATIENTS: A prospective cohort of 153 consecutive patients presenting to the emergency room with decompensated heart failure. Follow-up was by clinic visit and telephone survey at one, three and six months. Follow-up was 100%. MEASURES OF OUTCOME: Length of hospital stay, in-hospital mortality, readmissions and after hospital discharge deaths were measured. RESULTS: The average length of hospital stay was 6.2 days with a skewed distribution ranging from one to 56 days. A multivariate analysis showed that the length of hospital stay was associated with increasing left atrial size (P < 0.05), an ischemic etiology of the heart failure (P < 0.03) and a slow response to diuretic therapy (P < 0.001). This mathematical model accounted for only a small amount of hospital stay variability (R2 = 0.22). Six month mortality and morbidity of these patients was high, with 23% dying and 30% readmitted for heart failure, but was independent of the duration of the initial hospitalization. CONCLUSIONS: This prospective study confirms that the hospital course for congestive heart failure is shortening. The six month prognosis of patients presenting to an emergency room for decompensated heart failure is poor and appears independent of the length of hospital stay.

Aged↗
PubMed1992

Epidemiology of congestive heart failure: Canadian data from 1970 to 1989.

OBJECTIVE: To assess mortality rates from congestive heart failure in Canada from 1970 to 1989. DESIGN: Observational, retrospective design using national population and mortality data. MAIN RESULTS: There is a definite age gradient for deaths from congestive heart failure which, combined with a general ageing of the Canadian population, has lead to an increase in the absolute number of deaths. However, Standardized Mortality Ratios, which account for shifting population distributions, have shown steadily decreasing values for both men and women since 1980. CONCLUSIONS: Recent improvements in cardiology care demonstrated in controlled clinical trials appear also to be present in epidemiological studies.

Adult↗
PubMed1990

Risk stratification in patients with non Q wave myocardial infarction: a role for thallium exercise testing.

The ability of maximal exercise thallium testing to stratify patients after non Q wave myocardial infarction was prospectively examined in 20 patients. Patients were enrolled in the study if there was no evidence of residual ischemia nor congestive heart failure during initial hospitalization. The thallium exercise test showed four patients to be at high risk, three of whom had successful revascularization. The remaining 16 patients were considered to be at low risk. There were no re-admissions for unstable angina, no myocardial infarctions and no deaths in the follow-up period (average 15 months). Thus patients with no evidence of early ischemia, no signs of left ventricular failure and a negative maximum thallium exercise test are at low risk following non Q wave myocardial infarction.

Adult↗
PubMed1976

Adhesion of platelets to artificial surfaces: effect of red cells.

Adhesion of platelets to several polymer- and protein-coated glass surfaces has been studied in vitro. The apparatus consists of a cylindrical probe rotating in a test tube containing the platelet medium and allows close control of fluid shear and mass transport. Suspensions of washed pig platelets constitute the basic platelet medium, and can be modified by adding back red cells and plasma proteins. Adhesion is measured via 51Cr-labeling of platelets. In the absence of red cells, identical low levels of adhesion were seen on all surfaces and saturation was reached within 2 min. In the presence of red cells, adhesion was greater. Saturation on all surfaces except fibrinogen and collagen again occurred within 2 min. The adhesion levels on polymer surfaces and glass were indistinguishable, while those on albumin were lower and those on fibrinogen were higher. Collagen was the most reactive surface. It did not equilibrate within 15 min., and kinetic data indicated a platelet diffusivity strongly dependent on hematocrit. These effects were attributed to rotational and translational motion of the red cells causing increased diffusion and surface-platelet collision energy.

Animals↗