PubMed Health⌕ Search

Biomedical subjects

Jonathan Sackner-Bernstein

Publications and source records attributed to Jonathan Sackner-Bernstein.

8 recordsLinked to original sources
PubMed2006

Rationale and design of CASPER: compliance and quality of life study comparing once-daily carvedilol CR and twice-daily carvedilol IR in patients with heart failure.

Adherence to a complex medical regimen in patients with chronic heart failure is an important problem. In the Medicare population, patients with heart failure take an average of 7-8 distinct medications that require >11 separate doses on a daily basis. Nonadherence to these regimens accounts for a significant proportion of hospital admissions. Simplification of the medical regimen for patients with heart failure is likely to be associated with improved adherence and, in parallel, may lead to greater satisfaction and potentially improved outcomes. Therefore, the Compliance and Quality of Life Study Comparing Once-Daily Controlled-Release Carvedilol CR and Twice-Daily Immediate-Release Carvedilol IR in Patients with Heart Failure (CASPER) trial has been designed to rigorously test the hypothesis that a once-daily formulation of carvedilol will result in better compliance and increased patient satisfaction relative to the twice-daily formulation. The background, methods, and statistical approaches used in this trial are reviewed in this article.

Adrenergic beta-Antagonists↗
PubMed2005

Reducing the risks of sudden death and heart failure post myocardial infarction: utility of optimized pharmacotherapy.

Current guidelines define the standard of care for patients after myocardial infarction (MI), with particular focus on patients with significant ventricular dysfunction. Inherent in these recommendations are assumptions about the relative risks and benefits, as well as the costs, of the available options. This review will consider strategies to prevent sudden death and heart failure post-MI by utilization of pharmacologic therapies--angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), aldosterone antagonists, statins, and beta-blockers--in parallel with the approaches reviewed elsewhere in this supplement. A patient-centric approach necessitates that drugs in each class be compared for efficacy within this patient population. Clinical trials have demonstrated the efficacy of several drugs, such as ACE inhibitors, beta-blockers, and aldosterone antagonists, in patients post-MI, yet these benefits do not seem to be reflected in the epidemiologic data. This may reflect underutilization of these therapies or, alternatively, support the notion that efficacy in clinical trials does not assure effectiveness in clinical practice. The latter point is a subject of ongoing investigation, while the former is being addressed through quality-of-care initiatives. In clinical practice, aggressiveness is key, starting with patient education. If patients understand their risks better, compliance and adoption of a more ideal lifestyle seem more likely. However, even with educational programs, human nature teaches us that marked change in behavior is difficult and therefore, to minimize risks, particularly of sudden death and heart failure post infarction, an optimized pharmacologic regimen serves as a powerful tool.

Adrenergic beta-Antagonists↗
PubMed2003

Robotically assisted left ventricular epicardial lead implantation for biventricular pacing.

OBJECTIVES: Ventricular resynchronization might be achieved in a minimally invasive fashion using a robotically assisted, direct left ventricular (LV) epicardial approach. BACKGROUND: Approximately 10% of patients undergoing biventricular pacemaker insertion have a failure of coronary sinus (CS) cannulation. Rescue therapy for these patients currently is limited to standard open surgical techniques. METHODS: Ten patients with congestive heart failure (New York Heart Association class 3.4 +/- 0.5) and a widened QRS complex (184 +/- 31 ms) underwent robotic LV lead placement after failed CS cannulation. Mean patient age was 71 +/- 12 years, LV ejection fraction (EF) was 12 +/- 6%, and LV end-diastolic diameter was 7.1 +/- 1.3 cm. Three patients had previous cardiac surgery, and five patients had a prior device implanted. RESULTS: Nineteen epicardial leads were successfully placed on the posterobasal surface of the LV. Intraoperative lead threshold was 1.0 +/- 0.5 V at 0.5 ms, R-wave was 18.6 +/- 8.6 mV, and impedance was 1,143 +/- 261 ohms at 0.5 V. Complications included an intraoperative LV injury and a postoperative pneumonia. Improvements in exercise tolerance (8 of 10 patients), EF (19 +/- 13%, p = 0.04), and QRS duration (152 +/- 21 ms, p = 0.006) have been noted at three to six months follow-up. Lead thresholds have remained unchanged (2.1 +/- 1.4 V at 0.5 ms, p = NS), and a significant drop in impedance (310 +/- 59 ohms, p < 0.001) has been measured. CONCLUSIONS: Robotic LV lead placement is an effective and novel technique which can be used for ventricular resynchronization therapy in patients with no other minimally invasive options for biventricular pacing.

Aged↗
PubMed2003

New concepts in the clinical aspects of cardiovascular disease.

Many patients with HIV infection, as well as those without this disease, may have coronary heart disease (CHD) or be at high risk for this condition. The high prevalence of and risk of CHD among patients with HIV infection are generally caused by traditional risk factors that can be readily managed with currently available therapies. New tools are also available for functional imaging and establishing diagnoses and prognoses in patients who do experience coronary events. Management of these persons requires careful attention to patient characteristics that may influence therapeutic outcomes.

Adult↗