Biomedical subjects

Ryan A Meverden

Publications and source records attributed to Ryan A Meverden.

9 recordsLinked to original sources

PubMed2006

Systolic and diastolic heart failure in the community.

CONTEXT: The heart failure (HF) syndrome is heterogeneous. While it can be defined by ejection fraction (EF) and diastolic function, data on the characteristics of HF in the community are scarce, as most studies are retrospective, hospital-based, and rely on clinically indicated tests. Further, diastolic function is seldom systematically assessed based on standardized techniques. OBJECTIVE: To prospectively measure EF, diastolic function, and brain natriuretic peptide (BNP) in community residents with HF. MAIN OUTCOME MEASURES: Echocardiographic measures of EF and diastolic function, measurement of blood levels of BNP, and 6-month mortality. DESIGN, SETTING, AND PARTICIPANTS: Olmsted County residents with incident or prevalent HF (inpatients or outpatients) between September 10, 2003, and October 27, 2005, were prospectively recruited to undergo assessment of EF and diastolic function by echocardiography and measurement of BNP. RESULTS: A total of 556 study participants underwent echocardiography at HF diagnosis. Preserved EF (> or =50%) was present in 308 (55%) and was associated with older age, female sex, and no history of myocardial infarction (all P<.001). Isolated diastolic dysfunction (diastolic dysfunction with preserved EF) was present in 242 (44%) patients. For patients with reduced EF, moderate or severe diastolic dysfunction was more common than when EF was preserved (odds ratio, 1.67; 95% confidence interval [CI], 1.11-2.51; P = .01). Both low EF and diastolic dysfunction were independently related to higher levels of BNP. At 6 months, mortality was 16% for both preserved and reduced EF (age- and sex-adjusted hazard ratio, 0.85; 95% CI, 0.61-1.19; P = .33 for preserved vs reduced EF). CONCLUSIONS: In the community, more than half of patients with HF have preserved EF, and isolated diastolic dysfunction is present in more than 40% of cases. Ejection fraction and diastolic dysfunction are independently related to higher levels of BNP. Heart failure with preserved EF is associated with a high mortality rate, comparable to that of patients with reduced EF.

Aged↗

PubMed2006

Ventricular arrhythmias after acute myocardial infarction: a 20-year community study.

BACKGROUND: Although myocardial infarction (MI) severity is declining, the occurrence of ventricular arrhythmia (VA) after MI and its effect on outcome is unknown. This study was undertaken to examine the frequency and timing of VA and the effect of VA on mortality after MI. METHODS: Myocardial infarctions recorded between 1979 and 1998 were validated. Baseline characteristics, occurrence of VA, and survival were determined. Ventricular arrhythmias were categorized as primary ventricular fibrillation (VF), nonprimary VF, and ventricular tachycardia (VT). Logistic regression was used to analyze associations between VA and baseline characteristics. Temporal trends were assessed with the Mantel-Haenszel chi2. Survival was analyzed with the Kaplan-Meier method. Proportional hazards regression was used to examine the association between death and occurrence of VA. RESULTS: Among 2317 persons with incident MI, 7.5% experienced VA (3.6% nonprimary VF, 2.1% primary VF, 1.8% VT). Ventricular arrhythmia-associated factors were younger age, female sex, higher Killip class, ST elevation, and atrial fibrillation. Ventricular arrhythmias were associated with increased risk of death at 30 days. CONCLUSION: Ventricular arrhythmias after MI are relatively common, particularly among persons with more severe MI and no prior history of coronary disease. Over time, the incidence of VF declined, whereas VT did not change. Ventricular arrhythmia after MI was associated with a 6-fold increase in morality. Thus, identification of high-risk MI survivors and prevention of VA could markedly improve outcomes. Further studies are needed to determine the cause of the shift in distribution of VA subtype.

Aged↗

PubMed2006

Ischemic stroke after heart failure: a community-based study.

BACKGROUND: Although studies have examined the incidence of stroke in heart failure (HF), their findings are inconsistent and difficult to interpret because of heterogeneity in study design and population. Although HF remains a highly fatal disease, the excess mortality imparted from stroke is unknown. METHODS: A random sample of cases of HF from 1979 to 1999 was identified and validated according to Framingham criteria. Strokes were identified by screening medical diagnoses and subsequent physician validation. Stroke risk in HF was compared with the risk in the general population with standardized morbidity ratios. Associations between selected characteristics and stroke were examined using proportional hazards regression. RESULTS: The study cohort included 630 persons with incident HF. During a median of 4.3 years of follow-up, 102 (16%) experienced an ischemic stroke. Heart failure was associated with a 17.4-fold increased risk for stroke compared with the general population in the first 30 days after HF diagnosis and remained elevated during 5 years of follow-up. Older persons with prior stroke or diabetes were more likely to experience stroke after HF diagnosis. Persons with stroke after HF were 2.31 times more likely to die compared with persons without stroke. CONCLUSIONS: In the community, persons with HF have a large increase in the risk for ischemic stroke compared with the general population. Stroke results in a >2-fold increase in mortality. Thus, prevention of stroke has the potential to improve survival among patients with HF, particularly among the elderly and those with diabetes or prior stroke.

Age Factors↗

PubMed2006

The impact of observer and patient factors on the occurrence of digit preference for zero in blood pressure measurement in a hypertension specialty clinic: evidence for the need of continued observation.

BACKGROUND: Many investigators have reported unconscious over-reporting of the terminal digit zero but little literature exists on observer or patient-related factors that may predict the occurrence. This study analyzes the occurrence of zero preference in 52,827 blood pressure (BP) measurements in 8513 patients by 11 hypertension nurse specialists in the Hypertension Division at Mayo Clinic, Rochester, Minnesota. METHODS: Data from the electronic database of the Hypertension Division from April 1997 to September 2001 were analyzed for the occurrence of zero preference. Nurse-specific zero preference was stratified on four variables: number of BPs performed, years as hypertension nurse specialist, time of day BP performed (fatigue), and nursing degree. Three patient-specific factors were analyzed: age at visit (stratified by decade), type of care (continuing versus short-term), and hypertension status. RESULTS: We found significantly increased frequency of zero preference for all BPs with mean frequency of 31% v 20% expected (P < .0001). Individual nurse zero preference varied widely, 22.0% to 53.6% for systolic BP and 22.2% to 40.8% for diastolic BP). Continuing care patients had a higher zero preference than did short-term care patients for both systolic BP (34.5% v 30.2%; P < .0001) and diastolic BP (34.7% v 33.3%; P = .006). Zero preference was also more common at higher categories of hypertension (P < .001). Time of day, nursing degree, patient age, the number of BPs performed, years of service did not affect the occurrence of digit preference. CONCLUSIONS: Digit preference was demonstrated and varied significantly among well-trained hypertension nurse specialists. Further studies in a larger number of observers are required.

Adult↗

PubMed2006

The incidence of stroke after myocardial infarction: a meta-analysis.

PURPOSE: While the risk of stroke after myocardial infarction (MI) is increased compared with the risk among those without MI, the magnitude of this risk remains unclear. Although numerous clinical trials have reported the incidence of stroke following MI, these are among selected populations. We reviewed cohort studies reporting the incidence of stroke after MI to better define the risk of ischemic stroke in an unselected population. METHODS: A computerized literature search (MEDLINE and PubMed) and manual review of reference lists of identified articles were conducted. Population-based studies published from 1978-2004 with at least 100 subjects that reported number or percent of ischemic strokes experienced by MI survivors were identified. Data were extracted using standardized forms, and study quality was assessed by 2 independent reviewers. Ischemic stroke rates were reported as number of events per 1000 MI with 95% confidence intervals (CI) calculated by Poisson distribution. A combined stroke rate was calculated for in-hospital, 30 days, and 1-year post-MI using weights of 1/variance. A random-effects model also was created to estimate in-hospital stroke rate. Variability in study designs and outcome definitions limit synthesis of available data. RESULTS: During hospitalization for the index MI, 11.1 ischemic strokes occurred per 1000 MI compared with 12.2 at 30 days and 21.4 at 1 year. Using a random-effects model, 14.5 strokes occurred per 1000 MI. Positive predictors of stroke after MI included: advanced age, diabetes, hypertension, history of prior stroke, anterior location of index MI, prior MI, atrial fibrillation, heart failure, and nonwhite race. CONCLUSIONS: The public health implications of stroke among MI survivors, as well as the large number of MI survivors, underscore the need to be aware of this devastating complication. Further research is needed to determine the optimal stroke prevention strategies for MI survivors.

Confidence Intervals↗

PubMed2005

Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation.

BACKGROUND: In case series, mitral regurgitation (MR) increased the risk of death after myocardial infarction (MI), yet the prevalence of MR, its incremental prognostic value over ejection fraction (EF), and its association with heart failure and death after MI in the community is not known. METHODS AND RESULTS: The prevalence of MR and its association with heart failure and death were examined among 1331 patients within a geographically defined MI incidence cohort between 1988 and 1998. Echocardiography was performed within 30 days after MI in 773 patients (58%), and MR was present in 50% of cases, mild in 38%, and moderate or severe in 12%. Among patients with MR, a murmur was inconsistently detected clinically. After 4.7+/-3.3 years of follow-up, 109 episodes of heart failure and 335 deaths occurred. There was a graded positive association between the presence and severity of MR and heart failure or death. Moderate or severe MR was associated with a large increase in the risk of heart failure (relative risk 3.44, 95% CI 1.74 to 6.82, P<0.001) and death (relative risk 1.55, 95% CI 1.08 to 2.22, P=0.019) among 30-day survivors independent of age, gender, EF, and Killip class. CONCLUSIONS: In the community, MR is frequent and often silent after MI. It carries information to predict heart failure or death among 30-day survivors independently of age, gender, EF, and Killip class. These findings, which are applicable to a large community-based MI cohort, suggest that the assessment of MR should be included in post-MI risk stratification.

Aged↗

PubMed2004

Cardiac rehabilitation after myocardial infarction in the community.

OBJECTIVES: The aim of this study was to examine participation in cardiac rehabilitation after myocardial infarction (MI) by age and gender and the association of participation with survival. BACKGROUND: Lesser participation in cardiac rehabilitation has been reported for women and the elderly. METHODS: All incident MIs in Olmsted County were validated. Baseline characteristics and outcomes were ascertained from the medical record. Logistic regression examined the association between participation, age, and gender. Propensity scores were used to examine the association between participation and outcome. RESULTS: Among 1,821 persons with incident MI (58% men, 46% age >70 years), 55% participated in cardiac rehabilitation. Participants were more likely to be men, younger, and have fewer comorbidities (p < 0.01 for all comparisons). After adjustment, women were 55% less likely to participate than men (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.34 to 0.60), and persons 70 years or older were 77% less likely to participate than persons younger than 60 (OR 0.23, 95% CI 0.16 to 0.33). Participants had a lower risk of death and recurrent MI at three years (p < 0.001 and p = 0.049, respectively). The survival benefit associated with participation was stronger in more recent years (relative risk [RR] for 1998 vs. 1982 0.28, 95% CI 0.18 to 0.43; RR for 1990 vs. 1982 0.41, 95% CI 0.33 to 0.52). CONCLUSIONS: Approximately half of the patients participated in cardiac rehabilitation after MI. Participation did not increase over time. Women and elderly persons were less likely to participate, independently of other characteristics. Participation in rehabilitation was independently associated with decreased mortality and recurrent MI, and its protective effect was stronger in more recent years.

Age Factors↗

PubMed2004

Prevalence and secular trends of excess body weight and impact on outcomes after myocardial infarction in the community.

OBJECTIVES: To determine the trends in the prevalence of overweight and obese individuals among patients with myocardial infarction (MI), and to assess the association between weight and outcomes after MI. DESIGN: Population-based cohort study. METHODS: MIs occurring in Olmsted County, MN, between 1979 and 1998 were validated using standardized criteria. Clinical characteristics and outcomes were ascertained from community medical records. The prevalence and trends of excess weight and its association with outcomes were analyzed. RESULTS: Sixty-four percent of the 2,277 subjects with incident MI were overweight or obese. The prevalence of overweight/obese patients increased from 58% in the period from 1979 to 1983, to 72% in the period from 1994 to 1998 (p < 0.001), while the prevalence of class 3 obesity (body mass index >or= 40) increased from 0.6 to 4.4%. Overweight and obese patients were more likely to have diabetes, hypertension, familial coronary disease, and hyperlipidemia than persons with normal weight but less likely to have comorbidities (obstructive lung disease, heart failure, cancer, renal failure, and stroke) [all p values < 0.05]. When compared to patients with normal weight, after adjusting for age and other confounders, overweight and obese patients had a lower mortality (risk ratio [RR], 0.84; 95% confidence interval [CI], 0.73 to 0.96 for overweight; and RR, 0.85; 95% CI, 0.72 to 1.02 for obese) and a similar risk of cardiac events. CONCLUSION: The prevalence of overweight and obese individuals among patients with MI is high and increased over time. Despite a higher prevalence of other cardiovascular risk factors among patients with excess weight, these patients did not experience worse outcomes, underscoring the need to further study the paradoxical relation between weight and post-MI outcomes.

Aged↗

PubMed2003

Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation.

BACKGROUND: Mortality after out-of-hospital cardiac arrest from ventricular fibrillation is high. Programs focusing on early defibrillation have improved the rate of survival to hospital discharge. We conducted a population-based analysis of the long-term outcome and quality of life of survivors. METHODS: All patients who had an out-of-hospital cardiac arrest between November 1990 and January 2001 who received early defibrillation for ventricular fibrillation in Olmsted County, Minnesota, were included. The survival rate was compared with that of an age-, sex-, and disease-matched (2:1) control population of residents who had not had an out-of-hospital cardiac arrest and with that of age- and sex-matched controls from the general U.S. population. The quality of life was assessed with use of the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and compared with U.S. population norms. RESULTS: Of 200 patients who presented with an out-of-hospital cardiac arrest with ventricular fibrillation, 145 (72 percent) survived to hospital admission (7 died in the emergency department) and 79 (40 percent) were neurologically intact (good overall capability or moderate overall disability) at discharge. The mean (+/-SD) length of follow-up was 4.8+/-3.0 years. Nineteen patients died after discharge from the hospital. The expected five-year survival rate (79 percent) was identical to that among age-, sex-, and disease-matched controls (P=0.68) but lower than that among the age- and sex-matched U.S. population (86 percent, P=0.02). Fifty patients completed SF-36 surveys at the end of follow-up, and the majority had a nearly normal quality of life, with the exception of reduced vitality. CONCLUSIONS: Long-term survival among patients who have undergone rapid defibrillation after out-of-hospital cardiac arrest is similar to that among age-, sex-, and disease-matched patients who did not have out-of-hospital cardiac arrest. The quality of life among the majority of survivors is similar to that of the general population.

Aged↗