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Biomedical subjects

Tomasz M Rywik

Publications and source records attributed to Tomasz M Rywik.

4 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

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↗
PubMed2002

Role of nondiagnostic exercise-induced ST-segment abnormalities in predicting future coronary events in asymptomatic volunteers.

BACKGROUND: Whether exercise-induced ST-segment depression <1 mm is an independent predictor of future coronary events (CEs) in asymptomatic subjects is unknown. METHODS AND RESULTS: We performed maximal treadmill exercise tests on 1083 volunteers from the Baltimore Longitudinal Study of Aging who were free from clinical coronary heart disease. Exercise ST-segment changes were stratified by Minnesota code criteria: 11:1 (n=213), flat or downsloping ST depression > or =1 mm; 11:2 (n=66), flat or downsloping ST depression > or =0.5 mm and <1 mm; 11:4 (n=124), ST-J depression > or =1 mm with slowly rising ST segments; and 11:5 (n=69), minor ST depression (<0.5 mm) before exercise that worsened to flat or downsloping ST depression > or =1 mm during or after exercise. Risk of CE was compared with subjects with normal exercise ECG (n=611). Over a mean follow-up of 7.9 years, 76 subjects developed CEs (angina pectoris, myocardial infarction, or coronary death). On univariate analysis, age (relative risk [RR]=1.07/year, P<0.0001), male sex (RR=1.98, P=0.009), plasma cholesterol (RR=1.02/mg per dL, P<0.0001), hypertension (RR=2.23, P=0.002), duration of exercise (RR=0.71/min, P=0.0001), and systolic blood pressure at peak effort (RR=1.02/mm Hg, P=0.002) were associated with CE. By Cox proportional hazards analysis, age (RR=1.06/year, P<0.0001), male sex (RR=2.76, P=0.0002), plasma cholesterol (RR=1.02 per 1 mg/dL, P<0.0001), duration of exercise (RR=0.87/min, P=0.004), and ST-segment changes coded as either 11:1 (RR=2.70, P=0.0005) or 11:5 (RR=2.73, P=0.04) were independent predictors of CE. CONCLUSIONS: Both a classic ischemic ST-segment exercise response and intensification of minor preexercise ST-segment depression to levels > or =1 mm independently predicted future CE in this asymptomatic population. Neither slowly rising ST depression nor horizontal ST depression <1 mm was prognostic.

Age Distribution↗