Biomedical subjects

Stefan L Rywik

Publications and source records attributed to Stefan L Rywik.

3 recordsLinked to original sources

PubMed2004

A survey of outpatient management of elderly heart failure patients in Poland-treatment patterns.

BACKGROUND: Despite the fact that heart failure constitutes a major health problem there are only limited data regarding pharmacotherapy along with characterization and prognosis of heart failure in the community. AIM: The aim of this study was to investigate treatment pattern in ambulatory patients with heart failure. METHODS: The study is a cross-country epidemiological survey, based on registration, by 417 participating physicians, 50 consecutive ambulatory patients aged >/=65 years seeking medical care for any cause. RESULTS: From a total of 19,877 individuals, 10,579 patients (3901 men and 6678 women, 53% of total) were diagnosed with HF. Therapy with angiotensin converting enzyme inhibitors was recommended in 68%, long acting nitrates in 62%, diuretics in 55%, cardiac glycosides in 31%, Ca blockers in 29% and beta blockers in 22% of all individuals with HF. The prevalence of particular groups of drugs administered in both genders was similar with the exception for calcium blockers, which were more frequently used in women (p<0.001), whereas long acting nitrates in men (p<0.001). In general, angiotensin converting enzyme inhibitors, long acting nitrates and cardiac glycosides use increased with age. On the contrary, beta blockers and calcium blockers were given mostly to younger patients. The most sick patients were more likely to receive angiotensin converting enzyme inhibitors, cardiac glycosides, long acting nitrates and diuretics, whereas less frequently beta blockers and calcium blockers. Combination therapy was used relatively rarely, with lowest percentage in NYHA IV. CONCLUSION: Compared to the other population studies, both angiotensin converting enzyme inhibitors and beta blockers were used relatively more frequently, although in the absolute terms the latter was clearly underused. The high rate of Ca blockers prescription is a matter of concern. More attention should be paid to optimising combination usage and introducing beta blockers early in all stable patients.

Adrenergic beta-Antagonists↗

PubMed2003

[Are fluctuations in health status related to socioeconomic factors among the Polish population?].

INTRODUCTION: Several studies indicated that prevalence of ischaemic heart disease (IHD) rose with increasing wealth of the population and previously higher IHD prevalence was observed in the higher social strata. Later, the IHD prevalence was higher in lower social class because the higher social class faster followed the recommendation connected with IHD prevention. Currently, in majority of wealthy countries the higher IHD prevalence is connected with lower social class. To assess the relationship between analyzed social factors (social background, education of father and subject himself and character of activity at work), marital status and self evaluation of the health status on the one hand and on the other hand classical IHD risk factors and death both total and cardiovascular. The basis of analyses constituted the results of examined in 1984, 1988 and 1993 independent 3 random samples of Warsaw population aged 35-64 years, the study conducted within the framework of the Pol-MONICA Warsaw Project. The screened population was followed up to 1998 from the death and its cause point of view. To the lower social class were included persons with peasant or blue collar worker social background, subjects, whose father's or himself had not finished the elementary education, and whose employment required very heavy physical work. Separately the analysis dealt with marital status and self assessment of health status. The lower social class was characterized by higher BMI and higher prevalence of obesity, higher heart frequency, higher level of systolic, diastolic and pulse pressure as well as prevalence of hypertension and higher HDL-C level. Higher social class was characterized by higher height and higher prevalence of cigarettes smoking. Married persons were characterized by higher weight and height as well as BMI. Persons who evaluated health status as bad or poor had lower height but higher systolic, diastolic and pulse pressure as well as prevalence of hypertension than the reference characteristics. Regardless that 18 characteristics (social factors and classical risk factors) were introduced previously into the regression model to evaluate the risk of death, in female population only lack of employment and poor assessments of health status out of social factors increased the overall risk of death; the risk of cardiovascular death increased with higher level of education, employment required heavy physical activity, not--maried status and poor or bad evaluation of health status, while compared with risk of reference characteristics. Among men the overall risk of death was connected with blue collar type of work, widow or divorced status, employment required heavy physical activity and poor or bad evaluation of health status. The risk of IHD death was connected with widow or not--married status, education at least college and poor or bad assessment of health status. One should conclude that currently in Poland the higher risk of death began to be transferred to lower social class.

Adult↗

PubMed2003

Is the decrease of cardiovascular mortality in Poland associated with the reduction of global cardiovascular risk related to changes in life style?

BACKGROUND: After an ascending trend of cardiovascular mortality, which was observed up to the sixties, there was a declining tendency in western countries thereafter. The decrease in mortality rates in Poland has been noticed since 1991. There is an uncertainty whether this improvement in prognosis was only due to the improvement in health care level or was accomplished, to some extent, by population life style changes. AIM: To assess whether the decrease in cardiovascular mortality in Poland was accompanied by a simultaneous reduction in global cardiovascular risk profile. METHODS: The study was based on screened random samples from the Warsaw population aged 35-64 years, who were examined in the years 1984 (2646 subjects), 1988 (1433 subjects), 1993 (1539 subjects) and 2001 (853 subjects). The group evaluated in 1984 was followed up for 10 years with all fatal events recorded (364 deaths were registered including 166 cardiovascular deaths). The model of 10 years probability of total and cardiovascular death was developed, which was based on 11 risk factors (age, smoking cigarettes, systolic blood pressure, pulse pressure, ratio of total cholesterol/HDL-cholesterol, triglyceride, symptoms of coronary heart disease or heart failure, death of mother before 65 or death of father before 55 years due to myocardial infarction or stroke, energy in daily food intake and percentage of energy derived from saturated fatty acids). This model was applied to assess the probability of deaths between years 1984 and 2001, utilising data from screenings. RESULTS: The probability of death (in %) decreased from 1984 to 2001 by 11% in men. However, it remained stable for women. On the other hand the probability of cardiovascular death decreased by 25% and 33%, respectively. The main role in global risk decrease was played by beneficial trends in mean systolic blood pressure (in both genders) and percentage of smokers in men. CONCLUSIONS: Modification of life style influencing risk factors profile decreased the probability of death in the Warsaw population, correlating with changes in mortality rates.

Adult↗