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Zoltán Vokó

Publications and source records attributed to Zoltán Vokó.

9 recordsLinked to original sources
PubMed2006

The development of heart failure in patients with stable angina pectoris.

BACKGROUND: To describe the clinical characteristics of patients with stable angina pectoris who develop heart failure and the events preceding its onset. METHODS AND RESULTS: Of 7665 patients with stable angina in the ACTION trial, which compared long-acting nifedipine to placebo, 207 (2.7%) developed heart failure (HF) during a mean follow-up of 4.9 years. Those who developed HF were significantly (P<0.05) older, more often had diabetes, had a more extensive history of cardiovascular disease, lower ejection fractions, a higher serum creatinine and glucose, a lower haemoglobin, and were more often on blood pressure lowering drugs. A cardiac event or an intervention (n=155), a significant non-cardiac infection (n=19) or poor control of hypertension (n=12) preceded the development of HF in 186/207 cases (90%). There was no obvious precipitating factor in the remaining 21 patients (10%). Myocardial infarction increased the risk of the development of new HF within one week more than 100-fold. Nifedipine reduced the incidence of HF by 29% (P=0.015). CONCLUSIONS: The development of heart failure is uncommon in patients with stable angina, and even less so in the absence of an obvious precipitating factor.

Aged↗
PubMed2006

Safety of nifedipine GITS in stable angina: the ACTION trial.

AIM: We describe the safety profile of nifedipine GITS as assessed from adverse events reported in the ACTION trial in which 7,665 patients with stable, symptomatic coronary artery disease were randomly assigned nifedipine GITS or placebo and followed for a mean of 4.9 years. METHODS: All adverse events were coded using the COSTART coding dictionary. The incidence rate for each event was calculated as the number of patients with the event concerned divided by the total time 'at risk'. Hazard ratios comparing nifedipine with placebo and their 95% confidence intervals were obtained by Cox proportional-hazards analysis. RESULTS: As reported previously, nifedipine significantly reduced the incidence of cardiovascular events and procedures [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.83-0.95]. Apart from the known side effects of nifedipine, which include peripheral oedema, vasodilatation, hypotension, asthenia, constipation, leg cramps, non-specific respiratory complaints, impotence and polyuria, and which were reported more frequently in patients assigned nifedipine, the incidence rates of most other adverse events were similar. There were no differences in the occurrence of gastrointestinal haemorrhage, myocardial infarction and suicide. The rate of occurrence of death or new cancer excluding non-melanoma skin cancer for patients with no history of cancer at baseline was 2.53/100 patient years for patients assigned nifedipine and 2.37/100 patient years for patients assigned placebo (HR 1.06, 95% CI 0.93-1.22). CONCLUSION: Overall nifedipine GITS was well tolerated by patients with stable symptomatic angina.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

Relation between the socioeconomic status of the family and primary allergy prevention in infant feeding in Hajdu-Bihar County, Hungary.

BACKGROUND: The relationship between socioeconomic status and preventive care is an important issue in public health practice in Hungary. Our aim was to investigate the association between the socioeconomic status and the present practice of primary allergy prevention in infant feeding in Hajdú-Bihar County, Hungary. METHODS: A questionnaire-based cross-sectional survey was performed among 3076 infants aged 0-6 months. We studied how socioeconomic status, type of settlement, allergic background of the family and skin symptoms indicative for allergy were related to primary allergy prevention in infant feeding. Prevalence odds ratios (ORs) were calculated by multiple logistic regression. RESULTS: Independent determinants of breast feeding were age [OR corresponding to one month change 0.74; 95% confidence interval (CI) 0.70-0.77], the female gender (OR 1.24; 95% CI 1.06-1.46), the socioeconomic status of the family (OR comparing the worst with the best category 0.63; 95% CI 0.43-0.93), and birth weight (OR comparing <1500 g to >2500 g category 0.17; 95% CI 0.07-0.41). Among supplementary nutrient users independent determinants of the use of hydrolysed infant formulae were the socioeconomic status (OR comparing the worst with the best category 0.06; 95% CI 0.01-0.27), the type of settlement (OR comparing village with town 0.48; 95% CI 0.28-0.80), history of allergy in the family (OR 2.30; 95% CI 1.28-4.11), and skin symptoms indicative of allergy (OR 3.46; 95% CI 1.96-6.14). CONCLUSION: Socioeconomic status is related to the implementation of primary allergy prevention in infant feeding.

Breast Feeding↗
PubMed2005

Risk score for predicting death, myocardial infarction, and stroke in patients with stable angina, based on a large randomised trial cohort of patients.

OBJECTIVE: To derive a risk score for the combination of death from all causes, myocardial infarction, and disabling stroke in patients with stable symptomatic angina who require treatment for angina and have preserved left ventricular function. DESIGN: Multivariate Cox regression analysis of data from a large multicentre trial. SETTING: Outpatient cardiology clinics in western Europe, Israel, Canada, Australia, and New Zealand. PARTICIPANTS: 7311 patients with all required data available. MAIN OUTCOME MEASURE: Death from any cause or myocardial infarction or disabling stroke during a mean follow-up of 4.9 years. RESULTS: 1063 patients either died from any cause or sustained myocardial infarction or disabling stroke. The five year risk of this composite ranged from 4% for patients in the lowest tenth of risk to 35% for patients in the highest tenth. The risk score combines 16 routinely available clinical variables (in order of decreasing contribution): age, left ventricular ejection fraction, smoking, white blood cell count, diabetes, casual blood glucose concentration, creatinine concentration, previous stroke, at least one angina attack a week, coronary angiographic findings (if available), lipid lowering treatment, QT interval, systolic blood pressure > or = 155 mm Hg, number of drugs used for angina, previous myocardial infarction, and sex. Fitting the same model separately to all cause death, myocardial infarction, and stroke gave similar results. The risk score did not seem to predict the nature of the event (death in 39%, myocardial infarction in 46%, and disabling stroke in 15%) or the incidence of angiography or revascularisation, which occurred in 29% of patients. CONCLUSION: This risk score is an objective aid in deciding on further management of patients with stable angina with the aim of reducing serious outcome events. The score can also be used in planning future trials.

Adult↗
PubMed2005

A preliminary evaluation of a health monitoring programme in Hungary.

BACKGROUND: In 1998 a joint initiative of the Hungarian School of Public Health and the National Public Health Service created a network of sentinel stations based in primary care facilities in four Hungarian counties. The aim was to establish a system that will provide valid data on morbidity of selected diseases in Hungary. METHODS: Based on standardized protocols, the participating centres have continuously reported data on the prevalence of cardiovascular diseases, diabetes mellitus, liver cirrhosis, and some malignant diseases, as well as supplying denominator data. The four counties represent both eastern and western parts of Hungary, reflecting the known geographical disparities in health. Each county office enrolled general practitioners maintaining representation in terms of both geography and distribution of settlement size. RESULTS: A total of 73 general practitioners agreed to participate, providing care for 15.6% (138,088 people) of the population in the counties. The population registered with the practices were representative in terms of age and sex of both the participating counties and the entire country. The prevalence of hypertension, diabetes mellitus and liver cirrhosis is high in each county but varies considerably, with higher levels in the western counties, especially among older age groups of both sexes. CONCLUSIONS: The establishment of sentinel stations to collect morbidity data is feasible and sustainable in Hungarian primary care. The data that have been generated provide a valid and comprehensive picture of important aspects of the Hungarian population's health, with important implications for health policy and health service planning. In regions where low prevalence rates of diseases and high mortality rates simultaneously exist special attention is required to explore the background of this caveat. KEY POINTS: Till the end of 1998 no program operated in Hungary engaged with non-communicable disease morbidity data collection, except some hospital-based registries, which failed to produce reliable information. The establishment of sentinel stations to collect morbidity data is feasible and sustainable in Hungarian primary care, the valid morbidity data can be built into the decision making process in health service planning. Regular training, quality control and feedback are important contributors to the success of the program. The prevalence of hypertension, diabetes mellitus and liver cirrhosis is high in each county but varies considerably, with higher levels in the western counties, especially among older age groups of both sexes. More research needed to determine the possible contribution of unknown morbidity and health service utilisation to the different prevalence values in the two parts of Hungary.

Adolescent↗
PubMed2003

[Establishment and preliminary evaluation of the General Practitioners' Morbidity Sentinel Stations Program in Hungary. Prevalence of hypertension, diabetes mellitus and liver cirrhosis].

STUDY OBJECTIVE: To develop, introduce and test a methodology, which provides valid data about the prevalence and incidence of chronic, non-communicable diseases of great public health importance. DESIGN: The School of Public Health, University of Debrecen, Hungary and the National Public Health and Medical Officer Service the first time launched a morbidity sentinel stations network of general practitioners in four counties in Hungary in May 1998. Within the framework of this program the participating general practitioners reported the prevalence data of cardiovascular diseases, diabetes mellitus, liver cirrhosis, and major malignant diseases at the beginning, and from than on continuously report the incidence of these diseases. The authors built quality assurance into the program at different levels in order to ensure high quality data. PATIENTS: The study population consists of people belonging to the participating general practitioners' practices at any time, selected in a way to represent the eastern and western part of the country as well as the participating practices in the counties (Gyór-Moson-Sopron, Hajdú-Bihar, Szabolcs-Szatmár-Bereg, Zala) would give a geographically and according to settlement size representative sample of general practitioners in those counties. Eighty general practitioners were approached in the four counties by the county offices and overall 73 of them, 1.4% of the total practices in Hungary (5212), agreed to participate in the study, therefore information can be collected on 1.37% of the Hungarian population's (138,088 people) morbidity status. MAIN RESULTS: The population of practices participating in the program gives a representative sample of the counties population by age and sex. The prevalence of hypertension, diabetes mellitus and liver cirrhosis is high in all the counties involved. In most of the selected diseases the authors have found differences in the prevalence between the eastern and western part of Hungary with higher values in the western counties. The differences were most apparent in the older age groups in both sexes. CONCLUSIONS: The development and sustainability of primary care based, sentinel stations type, euroconform morbidity data collection system is undoubtedly justified in Hungary. The collected and thoroughly analysed data provide not only a valid and comprehensive basis to describe some aspects of the health status of the Hungarian population but also gives an opportunity to continuously monitor the changes in morbidity of the selected diseases. Thus, the program serves an important basis for health care capacity building, priority setting and the evaluation of the effectiveness of public health interventions.

Adolescent↗
PubMed2003

Combining multiple outcome measures in a meta-analysis: an application.

In meta-analysis of clinical trials published in the medical literature it is customary to restrict oneself to standard univariate fixed or random effects models. If multiple endpoints are present, each endpoint is analysed separately. A few articles have been written in the statistical literature on multivariate methods for multiple outcome measures. However, these methods were not easy to apply in practice, because self-written programs had to be used, and the examples were only two-dimensional. In this paper we consider a meta-analysis on the effect on stroke-free survival of surgery compared to conservative treatment in patients with increased risk of stroke. Three summary measures per trial are available: short-term post-operative morbidity/mortality in the surgical group; long-term event rate in the surgical group, and the event rate in the conservative group. We analyse the three outcomes jointly with a general linear MIXED model, compare the results with the standard univariate approaches and discuss the many advantages of multivariate modelling. It turns out that the general linear MIXED model is a very convenient framework for multivariate meta-analysis. All analyses could be carried out in standard general linear MIXED model software.

Disease-Free Survival↗
PubMedDate not supplied

How do American stroke risk functions perform in a Western European population?

OBJECTIVES: We evaluated the predictive performance of the stroke risk functions from the Framingham and the Cardiovascular Health Study in a population-based study in The Netherlands. METHODS: We assessed how well the functions could estimate the number of strokes in the Rotterdam Study, and how well they could discriminate between high- and low-risk persons. RESULTS: Both functions predicted the number of stroke cases reasonably well, except in persons with a predicted 5-year risk higher than 5%, where they overestimated the risk. The area under the receiver operator characteristic curve was 0.75 (95% confidence interval, 0.71-0.78) for both functions. CONCLUSIONS: Stroke risk functions developed in US populations predict the number of strokes reasonably well in elderly Western European persons at low or modest risk for stroke. The functions can be a useful tool to discriminate between persons at high or low risk for stroke.

Aged↗