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Vera H M Deneer

Publications and source records attributed to Vera H M Deneer.

4 recordsLinked to original sources
PubMed2007

Angiotensin-converting enzyme inhibitor use and protection against pneumonia in patients with diabetes.

OBJECTIVES: Because of the high risk of pneumonia in patients with diabetes, we aimed to assess the effect of angiotensin-converting enzyme (ACE) inhibitor use on the occurrence of pneumonia in a general population of patients with diabetes. METHODS: The study population comprised all patients in the UK General Practice Research Database who had a diagnosis of diabetes (both type 1 and type 2) between 1987 and 2001. Cases were defined as patients with a first diagnosis of pneumonia. For each case, up to four controls were matched by age, gender, practice, and index date. Patients were classified as current ACE inhibitor user when the index date was between the start and end date of ACE inhibitor therapy. Conditional logistic regression analysis was used to estimate the strength of the association between ACE inhibitor use and pneumonia risk. RESULTS: ACE inhibitors were used in 12.7% of 4719 cases and in 13.7% of 15,322 matched controls [crude odds ratio (OR)=0.92, 95% confidence interval (CI)=0.82-1.01]. After adjusting for confounding, ACE inhibitor therapy was associated with a significant reduction in pneumonia risk (adjusted OR=0.72, 95% CI=0.64-0.80). The protective association was consistent across different relevant subgroups with the strongest association in patients with a history of stroke. There was a significant dose-effect relationship (P for trend < 0.001). CONCLUSIONS: The use of ACE inhibitors is associated with a significant reduction in pneumonia risk and, apart from blood pressure-lowering properties, may be useful in the prevention of pneumonia in patients with diabetes.

Aged↗
PubMed2006

Prior outpatient antibacterial therapy as prognostic factor for mortality in hospitalized pneumonia patients.

STUDY OBJECTIVES: To assess whether prior outpatient treatment is associated with outcome in patients hospitalized for community-acquired pneumonia (CAP). PATIENTS AND METHODS: All patients with a first hospital admission for CAP between 1995 and 2000 were selected. Patients were divided into two groups, one of patients with use of antibacterial agents prior to hospitalization and one of patients treated as inpatient directly. The main outcome measures were duration of hospital stay and in-hospital mortality. RESULTS: The two patient groups comprised 296 and 794 patients, respectively. The median duration of hospital stay was 10 days and was similar for both groups. In patients with respiratory diseases or heart failure, the median duration of hospital stay was 12 and 14 days, respectively. The overall in-hospital mortality was 7.2% and did not largely differ between both groups. In patients with congestive heart failure, the mortality was 9.8% for controls and 23.3% for patients hospitalized after initial outpatient treatment (adjusted OR 2.78, 95% CI 1.01-7.81). CONCLUSIONS: Prior outpatient antibacterial therapy is not associated with outcome in hospitalized pneumonia patients. In patients with underlying chronic heart failure, prior outpatient antibiotic is associated with a significant increased mortality.

Adult↗
PubMed2004

Oral antiarrhythmic drugs in converting recent onset atrial fibrillation.

AIM: This article reviews clinical studies on oral antiarrhythmic drugs in converting recent onset atrial fibrillation. An oral loading dose of an antiarrhythmic drug for cardioversion of atrial fibrillation could be an option, due to its simplicity, both for patients admitted to outpatient departments and for episodic treatment by self administration outside the hospital. The latter treatment strategy has recently been pointed out by the American College of Cardiology, the American Heart Association and the European Society of Cardiology as the 'pill in the pocket approach'. METHODS: Articles were identified by Medline 1966 to November 2001 and Embase 1966 to November 2001. Randomized studies of oral antiarrhythmic drugs versus placebo or comparative treatment, which are written in the English language, were selected. Non-randomized or non-comparative studies were selected if the results of an analysis to identify predictors for successful conversion are described. The review of clinical trials is followed by a description of pharmacokinetic parameters of the antiarrhythmic drugs. RESULTS: Studies meeting the inclusion criteria were on propafenone, flecainide, sotalol, amiodarone, quinidine, digoxin and verapamil. Conversion rates of a single oral loading dose of 600 mg propafenone varied between 37% and 41% at 4 h after ingestion. Propafenone was more effective than quinidine, amiodarone and placebo. A single oral dose of 300 mg flecainide restored sinus rhythm in 59% and 68% of patients at 3 h. Flecainide was more effective than amiodarone and placebo. Oral sotalol, digoxin and verapamil were not effective in converting atrial fibrillation to sinus rhythm. CONCLUSION: Propafenone and flecainide are effective in converting recent onset atrial fibrillation. No serious ventricular arrhythmia, other serious proarrhythmic effects or serious non cardiac adverse events were observed. Regular supraventricular tachyarrhythmias with 1:1 AV conduction were rare and were also observed in placebo treated patients. Propafenone and flecainide are more effective in patients with atrial fibrillation of less than 24 h. The association between cardioversion and patient characteristics are not consistent between studies. The pharmacokinetics of flecainide, with lower interindividual variability of absorption kinetics, no genetically determined formation of an active metabolite and a more rapid distribution to myocardial tissue, are more favourable for episodic treatment as compared to propafenone. Both flecainide and propafenone are safe in hospitalized patients. Out of hospital self administration of antiarrhythmic drugs, also described as the 'pill in the pocket approach', could be an option for selected patients, after the treatment has proven to be safe in hospital.

Administration, Oral↗