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Statin Therapy For Elderly Patients Should Be Assessed For Each Individual, Raymond Gong 2016 Wayne State University School of Medicine

Statin Therapy For Elderly Patients Should Be Assessed For Each Individual, Raymond Gong

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002;360(9346):1623-30. doi:10.1016/S0140-6736(02)11600-X


Ultrasound-Guided Intralesional Bleomycin Injection (Ibi) For Treatment Of Cutaneous Hemangiomas And Vascular Malformations, Yousuf Memon, Nuzhat I. Malik, Naveed Anjum, S. Kamran Ahmed, Sadaf Saeed 2016 The Indus Hospital

Ultrasound-Guided Intralesional Bleomycin Injection (Ibi) For Treatment Of Cutaneous Hemangiomas And Vascular Malformations, Yousuf Memon, Nuzhat I. Malik, Naveed Anjum, S. Kamran Ahmed, Sadaf Saeed

The Journal of Global Radiology

Purpose: To report the therapeutic outcome of ultrasound-guided intralesional injection of bleomycin in the treatment of cutaneous hemangiomas and vascular malformations.

Material & Methods: The medical records of patients with cutaneous hemangiomas and vascular malformations treated with the intralesional injection of bleomycin under ultrasound guidance between August 2009 and June 2013 at the Indus Hospital, Karachi were reviewed retrospectively using a computerized medical record information management system. Data were extracted using a pre-coded performa that included patient demographics, type and location of lesion, number of treatments, presenting/pre- and post-treatment clinical symptoms (pain, swelling, heaviness, size, discoloration), ultrasound appearance and vascularity, and post-treatment side effects. The dose range of bleomycin was 0.5-1.0 mg/kg, but not exceeding 15 mg in a single session. A maximum of four treatments were given in any given patient except for one, who presented with recurrence after a year of complete resolution. Therapeutic outcome was determined using review of ultrasound images and recorded clinical assessment. Treatment response was categorized as: (i) complete resolution [more than 90% reduction]; (ii) substantial reduction [more than 50% reduction]; (iii) mild reduction [25% reduction]; or, (iv) no improvement [ < 10% reduction].

Results: A total of 30 patients (16 female, 14 male), ranging in age from 8 months to 48 years (mean age 10.2 years), were treated from 2009 to 2013. There were 23 hemangiomas. Seven were vascular malformations, of which five were lymphatic malformations and two were venous malformations. Twenty-eight lesions were located in the head and neck region, and two were ...


Physical Activity Among Older American Indians And Alaska Natives, David Hodgins, Linda Larkey, Barbara E. Ainsworth, Colleen Keller 2016 College of Nursing and Health Innovation, Arizona State University

Physical Activity Among Older American Indians And Alaska Natives, David Hodgins, Linda Larkey, Barbara E. Ainsworth, Colleen Keller

Journal of Health Disparities Research and Practice

Introduction: Life style behaviors contribute to poor health among older Americans Indians/Alaska Native (AI/AN) in the United States, with low levels of physical activity (PA) particularly tied to the chronic disease profile of this population. Searched reviews of physical activity among AI/ANs are limited in assessing prevalence and correlates to PA among older adults > 40 years.

Methods: A literature search of reported physical activity studies among older AI/AN was assessed for prevalence and predictive factors associated with levels of physical activity.

Results: Fourteen studies were included in this review that either specifically quantified the amount of ...


Clinical Outcomes Of Unprotected Left Main Coronary Artery Stenting In Nonsurgical Patients: A Single-Center Experience, John-Paul Pham, Abdelazim Hashim, Naoyo Mori, Mohamed Taha, Mohamed Djelmami-Hani, Joaquin Solis, Suhail Allaqaband, Tanvir Bajwa, Anjan Gupta 2016 Center for Urban Population Health, University of Wisconsin-Milwaukee

Clinical Outcomes Of Unprotected Left Main Coronary Artery Stenting In Nonsurgical Patients: A Single-Center Experience, John-Paul Pham, Abdelazim Hashim, Naoyo Mori, Mohamed Taha, Mohamed Djelmami-Hani, Joaquin Solis, Suhail Allaqaband, Tanvir Bajwa, Anjan Gupta

Mohamed Djelmami-Hani, MD

Purpose: Coronary artery bypass graft is the standard treatment for unprotected left main disease; however, some patients are poor surgical candidates due to comorbidities. We assessed the safety and clinical outcome of elective, unprotected left main coronary artery stenting in nonsurgical patients.

Methods: Between October 2004 and June 2006, 50 consecutive patients underwent elective, unprotected left main coronary artery stenting at our institution. Patients were followed for a median of 16 and 96 months and clinical outcomes monitored.

Results: Median logistic euroSCORE was 28.6 (interquartile range: 14.6-43.4). Median baseline left ventricular ejection fraction (LVEF) was 50%. Procedural ...


Feasibility Of Atrial Delivery And Tracking Of Stem Cells In A Porcine Model, Nina Garlie, Timothy Hacker, Eric G. Schmuck, Jill Koch, Jayant Khitha, Amish Raval, Indrajit Choudhuri 2016 Regenerative Medicine Center, Aurora Research Institute, Aurora Health Care

Feasibility Of Atrial Delivery And Tracking Of Stem Cells In A Porcine Model, Nina Garlie, Timothy Hacker, Eric G. Schmuck, Jill Koch, Jayant Khitha, Amish Raval, Indrajit Choudhuri

Indrajit Choudhuri

Background: Many patients undergoing open heart surgery have sinus node dysfunction and atrial fibrillation, leading to adverse outcomes. Mesenchymal stem cells (MSC) delivered at the time of surgery may have a reparative effect on atrial tissue, thereby improving sinus node function and reducing or preventing atrial fibrillation. Stem cell delivery to the atrium is entirely unstudied. This is a significant gap in medical research, as atrial disease contributes significantly to health care costs. Purpose: The purpose of this pilot study is to establish a technique to deliver MSC to the atria through an open-chest model, to assess the safety of ...


Echocardiographic Predictors Of Admission Among Patients With Heart Failure With Reduced Ejection Fraction, Chi C. Cho, Yang Shi, Robyn Shearer, Nasir Z. Sulemanjee, Dianne L. Zwicke, T. Edward Hastings, Omar M. Cheema, Vinay Thohan 2016 Aurora Research Institute, Aurora Health Care

Echocardiographic Predictors Of Admission Among Patients With Heart Failure With Reduced Ejection Fraction, Chi C. Cho, Yang Shi, Robyn Shearer, Nasir Z. Sulemanjee, Dianne L. Zwicke, T. Edward Hastings, Omar M. Cheema, Vinay Thohan

Omar Cheema

Background: Congestive heart failure afflicts 5.7 million people in the United States with annual incidence of 600,000 and mortality of 280,000. Heart failure accounts for greater than 1 million hospitalizations annually and the single largest inpatient Medicare expense. As the U.S. population ages and greater emphasis is placed on population health as a means to bend projected health care expenditures, large health care organizations will need to develop algorithms to identify patients at high risk with heart failure and possibly preempt hospitalizations. Doppler echocardiography is routinely performed in clinical assessment of severe heart failure.

Purpose: We ...


Lead Burden As A Factor For Higher Complication Rate In Patients With Implantable Cardiac Devices, Christopher Kolibash, Naoyo Mori, Jasbir Sra, Masood Akhtar, M. Eyman Mortada 2016 Aurora Sinai/Aurora St. Luke’s Medical Centers, Aurora Health Care

Lead Burden As A Factor For Higher Complication Rate In Patients With Implantable Cardiac Devices, Christopher Kolibash, Naoyo Mori, Jasbir Sra, Masood Akhtar, M. Eyman Mortada

Masood Akhtar

Purpose

Lead revisions have increased over the last decade. Patients who do not undergo lead extraction face an increased lead burden. Consequences of increased lead burden have not been fully defined. We sought to characterize the complication rate and outcomes in patients with sterile redundant leads.

Methods

We retrospectively reviewed 242 consecutive patients [mean age 74 ± 12 years; 66.9% male] who underwent lead revision that resulted in an abandoned lead from January 2005 to June 2010. Patients were placed in a cohort based on number of leads after last recorded procedure (Group A: ≤2 [n=58]; Group B: 3-4 ...


Adherence To Evidence-Based Secondary Prevention Pharmacotherapy In Patients After An Acute Coronary Syndrome: A Systematic Review, Han-Yang Chen, Jane S. Saczynski, Kate L. Lapane, Catarina I. Kiefe, Robert J. Goldberg 2016 University of Massachusetts Medical School

Adherence To Evidence-Based Secondary Prevention Pharmacotherapy In Patients After An Acute Coronary Syndrome: A Systematic Review, Han-Yang Chen, Jane S. Saczynski, Kate L. Lapane, Catarina I. Kiefe, Robert J. Goldberg

Robert J. Goldberg

OBJECTIVE: To synthesize current evidence on medication adherence rates and associated risk factors in patients after an acute coronary syndrome (ACS).

METHODS: A systematic review was conducted. Five electronic databases and article bibliographies were searched for publications from 1990 to 2013 which assessed adherence to secondary prevention pharmacotherapy in adults after hospital discharge for an ACS. Identified studies were screened using pre-defined criteria for eligibility. A standardized form was used for data abstraction. Methodological quality was assessed using modified criteria for quantitative studies.

RESULTS: Sixteen studies met our inclusion criteria. Post-discharge medication adherence rates at 1-year ranged between 54% and ...


A 35-Year Perspective (1975 To 2009) Into The Long-Term Prognosis And Hospital Management Of Patients Discharged From The Hospital After A First Acute Myocardial Infarction, Han-Yang Chen, Joel Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Jerry H. Gurwitz, Catarina I. Kiefe, Robert J. Goldberg 2016 University of Massachusetts Medical School

A 35-Year Perspective (1975 To 2009) Into The Long-Term Prognosis And Hospital Management Of Patients Discharged From The Hospital After A First Acute Myocardial Infarction, Han-Yang Chen, Joel Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Jerry H. Gurwitz, Catarina I. Kiefe, Robert J. Goldberg

Robert J. Goldberg

There are limited population-based data available describing trends in the long-term prognosis of patients discharged from the hospital after an initial acute myocardial infarction (AMI). Our objectives were to describe multidecade trends in post-discharge mortality and their association with hospital management practices in patients discharged from all medical centers in Central Massachusetts after a first AMI. Residents of the Worcester, Massachusetts, metropolitan area discharged from all hospitals in Central Massachusetts after a first AMI from 1975 to 2009 comprised the study population (n = 8,728). Multivariable-adjusted logistic regression analyses were used to examine the association between year of hospitalization and ...


Ethnicity Matters: Implications For Understanding And Acting Upon Disparities In Health Affecting Black Men In The United States, Helen V. S. Cole 2016 Graduate Center, City University of New York

Ethnicity Matters: Implications For Understanding And Acting Upon Disparities In Health Affecting Black Men In The United States, Helen V. S. Cole

All Graduate Works by Year: Dissertations, Theses, and Capstone Projects

Compared to non-Hispanic whites, non-Hispanic blacks have higher rates of mortality from heart disease, cancer, cardiovascular disease, and HIV/AIDS. Black men have a life expectancy approximately 4.7 years than the life expectancy of non-Hispanic white men, due in part to higher prevalence of chronic disease among black men. Many factors are hypothesized to contribute to disparities in health between races, including differences in socioeconomic status; culturally-linked behaviors such as diet, substance use, and physical activity; access to quality healthcare and other resources; and experiences of racism, both institutional and interpersonal. However, in public health research, race is usually ...


Priming Cardiovascular Stem Cells For Transplantation Using Short-Term Hypoxia, Ivan Hernandez 2016 California State University - San Bernardino

Priming Cardiovascular Stem Cells For Transplantation Using Short-Term Hypoxia, Ivan Hernandez

Electronic Theses, Projects, and Dissertations

Conventional medical treatments fail to address the underlying problems associated with the damage inflicted by a coronary event. Thus, the long-term prognosis of patients admitted for heart failure is disheartening, with reported survival rates of 25 percent. Recent advances in stem cell research highlight the potential benefits of autologous stem cell transplantation for stimulating repair in heart tissue. However, a majority of those suffering from cardiovascular diseases are older adults whose autologous cells no longer possess optimum functional capacity. Additional work is needed to identify the optimal cell types or conditions that will promote cardiovascular regeneration across all age groups ...


Using Mathematical Modeling To Unmask The Concealed Nature Of Long Qt-3 Syndrome, Steven Poelzing, Amara Greer-Short, Seth H. Weinberg 2016 Virginia Tech

Using Mathematical Modeling To Unmask The Concealed Nature Of Long Qt-3 Syndrome, Steven Poelzing, Amara Greer-Short, Seth H. Weinberg

Biology and Medicine Through Mathematics Conference

No abstract provided.


Low Energy Defibrillation By Synchronization; 90 % Less Energy Compared To One Shock., Flavio H. Fenton, Yanyan Ji, Ilija Uzelac, Niels Otani, Elizabeth M. Cherry 2016 Georgia Institute of Technology

Low Energy Defibrillation By Synchronization; 90 % Less Energy Compared To One Shock., Flavio H. Fenton, Yanyan Ji, Ilija Uzelac, Niels Otani, Elizabeth M. Cherry

Biology and Medicine Through Mathematics Conference

No abstract provided.


The Effect Of Mobile Self-Monitoring On Self-Care Behaviors In Heart Failure And Copd Patients: A Feasibility Study, Elizabeth Chin, Kristen Sethares, Paul Fortier, Benjamin Viall 2016 University of Massachusetts Dartmouth

The Effect Of Mobile Self-Monitoring On Self-Care Behaviors In Heart Failure And Copd Patients: A Feasibility Study, Elizabeth Chin, Kristen Sethares, Paul Fortier, Benjamin Viall

UMass Center for Clinical and Translational Science Research Retreat

Exacerbations of heart failure (HF) and chronic obstructive lung disease (COPD) are among the most costly illnesses. Patient recognition of changes in symptoms cueing imminent exacerbation is poor. Innovative strategies to improve patient symptom recognition, self-care behaviors and treatment seeking are necessary to improve overall health outcomes.

The aim of this pilot study was to test the feasibility of a wireless health monitoring device and cell phone app in 10 patients (5 with COPD and 5 with HF). This collaborative multidisciplinary study is innovative in its inclusion of the patient as an active partner in the use of technology to ...


Herpes Zoster And Cardiovascular Events In Adults: A Systematic Review, Nathaniel A. Erskine, Hoang Tran, Len L. Levin, Christine M. Ulbricht, Joyce D. Fingeroth, Catarina I. Kiefe, Robert J. Goldberg 2016 University of Massachusetts Medical School

Herpes Zoster And Cardiovascular Events In Adults: A Systematic Review, Nathaniel A. Erskine, Hoang Tran, Len L. Levin, Christine M. Ulbricht, Joyce D. Fingeroth, Catarina I. Kiefe, Robert J. Goldberg

UMass Center for Clinical and Translational Science Research Retreat

Background: Stroke and myocardial infarction have been reported to occur after the development of herpes zoster (shingles), a common and preventable disease.

Purpose: To evaluate literature describing the association between herpes zoster and its subtypes with the occurrence of cardiovascular events.

Data Sources: PubMed, SCOPUS (Embase), OAIster, Google Scholar (searched in January 2016)

Study Selection: Studies published up to January 2016 examining the association between herpes zoster or subtype of herpes zoster with the occurrence of cardiovascular events, including stroke, transient ischemic attack, or an acute coronary event, were selected. Case reports, case studies, and studies of non-general adult populations ...


Burden Of Adverse Metabolic Factors Is Associated With Increased Left Ventricular Concentricity In Adults With Normal-Range Body Mass Index: The Framingham Heart Study, Philimon Gona, Jane Lee, Carol J. Salton, Christopher J. O'Donnell, Warren J. Manning, Michael L. Chuang 2016 University of Massachusetts Boston

Burden Of Adverse Metabolic Factors Is Associated With Increased Left Ventricular Concentricity In Adults With Normal-Range Body Mass Index: The Framingham Heart Study, Philimon Gona, Jane Lee, Carol J. Salton, Christopher J. O'Donnell, Warren J. Manning, Michael L. Chuang

UMass Center for Clinical and Translational Science Research Retreat

Introduction: Persons with normal-range body mass index (BMI) but adverse metabolic characteristics associated with obesity have been described as metabolically-obese normal weight (MONW). We sought to determine whether adverse metabolic profile is associated with alterations in left ventricular (LV) structure or function among adults with normal BMI. Methods: From the 1794 Framingham Heart Study Offspring cohort adults who underwent cardiac magnetic resonance imaging (CMRI) , we identified 446 free of non-skin cancer and prevalent clinical cardiovascular disease (CVD) who had 18.5≤BMI<25.0 kg/m2 and complete covariates. We calculated a metabolic score (MS) where 1 point was assigned for each of: a) fasting glucose≥100 mg/dL or diabetes; b) SBP≥140 or DBP≥90 mmHg or antihypertensive treatment; c) TG≥150 or HDL_C <40(M)/<50(W) mg/dL or lipid treatment; d) HOMA-IR≥2.5; e) waist circumference ≥102/88cm for M/W. Participants were classified as MS0 (no points), MS1 (exactly 1 point), or MS2+ (≥2 points). LV mass (LVM), end-diastolic volume (EDV), ejection fraction (EF), and concentricity (LVM/EDV) were measured from breathhold cine SSFP CMR scans; we calculated LVM/BSA. Analysis of covariance (ANCOVA) was used to compare MS1 and MS2+ groups to the MS0 group. CMRI variables were adjusted for sex, age, heart rate (HR) and body size (BSA); LVM/BSA was adjusted for sex, age, HR only. We also tested for linear trend across metabolic groups. Results: LV concentricity increased with worsening metabolic status. This was driven by lower LV EDV, not increased LVM. LVM did not differ across (trend) or between MS-groups. LVEDV decreased across groups but only MS2 differed significantly from MS0. LVEF increased slightly but significantly across MS-groups. Conclusions: In a community-dwelling cohort, among participants who were free of cancer and clinical CVD and had normal BMI, worsening metabolic profile was associated with adverse remodeling of the left ventricle, reflected by greater LV concentricity.


Effect Of Left Atrial Function Index On Late Atrial Fibrillation Recurrence After Pulmonary Vein Isolation, Mayank Sardana, Owusu Asamoah, Glenn Stokken, Matthew Spring, Amir Y. Shaikh, Adedotun Ogunsua, Barinder Hansra, Deego Mohamud, Michael Gagnier, Summer Aldrugh, Nada Esa, Kevin C. Floyd, Clifford Browning, Cynthia Ennis, Kevin Donahue, Lawrence S. Rosenthal, Gerard P. Aurigemma, David D. McManus 2016 University of Massachusetts Medical School

Effect Of Left Atrial Function Index On Late Atrial Fibrillation Recurrence After Pulmonary Vein Isolation, Mayank Sardana, Owusu Asamoah, Glenn Stokken, Matthew Spring, Amir Y. Shaikh, Adedotun Ogunsua, Barinder Hansra, Deego Mohamud, Michael Gagnier, Summer Aldrugh, Nada Esa, Kevin C. Floyd, Clifford Browning, Cynthia Ennis, Kevin Donahue, Lawrence S. Rosenthal, Gerard P. Aurigemma, David D. Mcmanus

UMass Center for Clinical and Translational Science Research Retreat

Background: Although the rates of catheter ablation (CA) for atrial fibrillation (AF) are rapidly increasing, there are few predictors of outcome to help inform appropriate patient selection for this procedure. Traditional echocardiographic measures of atrial structure do not significantly reclassify risk of AF recurrence over and above the clinical risk factors. Left Atrial Function Index (LAFI) is a rhythm-independent measure of atrial function. We hypothesized that baseline LAFI would relate to AF recurrence after CA.

Methods: Pre-procedural echocardiograms from 170 participants, who underwent CA for AF and were enrolled in the UMMC AF Treatment Registry, were analyzed. LAFI was calculated ...


Sedentary Behavior And Cardiovascular Disease Risk Factors Among Latino Adults, Valerie J. Silfee, Stephenie C. Lemon, Vilma Lora, Milagros C. Rosal 2016 University of Massachusetts Medical School

Sedentary Behavior And Cardiovascular Disease Risk Factors Among Latino Adults, Valerie J. Silfee, Stephenie C. Lemon, Vilma Lora, Milagros C. Rosal

UMass Center for Clinical and Translational Science Research Retreat

Background: Compared to other racial/ethnic subgroups in the U.S., Latinos experience increased rates of cardiovascular disease (CVD) and CVD risk factors such as hypertension, inactivity, and diabetes. Sedentary behavior has also been defined as an additional risk factor for CVD, independent of physical activity participation. However, while sedentary behavior has been associated with increased risk for CVD among primarily White samples, previous studies in Latinos have shown mixed results.

Purpose: To explore the relationships between sedentary behavior and CVD risk factors, including BMI, waist circumference, blood pressure, physical activity, dyslipidemia, and diabetes, among a sample of Latino adults ...


Angina Characteristics As Predictors Of Trajectories Of Quality Of Life Following Acute Coronary Syndrome In The Transitions, Risks And Actions In Coronary Events-Center For Outcomes Research And Education Cohort (Trace-Core), Lisa Nobel, Jennifer Tjia, Jane S. Saczynski, Molly E. Waring, Milena D. Anatchkova, Arlene Ash, Catarina I. Kiefe, Jeroan Allison 2016 University of Massachusettts Medical School

Angina Characteristics As Predictors Of Trajectories Of Quality Of Life Following Acute Coronary Syndrome In The Transitions, Risks And Actions In Coronary Events-Center For Outcomes Research And Education Cohort (Trace-Core), Lisa Nobel, Jennifer Tjia, Jane S. Saczynski, Molly E. Waring, Milena D. Anatchkova, Arlene Ash, Catarina I. Kiefe, Jeroan Allison

UMass Center for Clinical and Translational Science Research Retreat

BACKGROUND: To describe longitudinal trajectories of health-related quality of life (HRQoL) after hospitalization with an acute coronary syndrome (ACS), their associations with baseline angina characteristics, and associations with anxiety, depression, and cognitive impairment.

METHODS: TRACE-CORE participants (N=1,613) completed the SF-36 during hospitalization for ACS and 1, 3, & 6 months post-discharge. Latent growth curves identified trajectories of physical and mental components of HRQOL (MCS and PCS) and sequential multiple logistic regression estimated associations between trajectories and angina characteristics.

RESULTS: Participants (N=1613) had mean age 63.3 (SD 11.4) years, 33.0% female, and 78.2% non-Hispanic white. We identified 2 MCS trajectories: AVERAGE and IMPAIRED HRQoL. The majority of participants (81.0%) had AVERAGE MCS at baseline (mean MCS 53.6) and slight improvement in scores over time. A minority (19.0%) had IMPAIRED HRQoL at baseline (mean MCS 36.7) and slight improvement in scores over time. We identified 2 similar PCS trajectories with similar patterns of scores over time: AVERAGE (71.1%) and IMPAIRED (28.9%) HRQoL at baseline. Adjusting for demographics & comorbidities, patients with less severe baseline angina were more likely to have AVERAGE MCS (odds ratio [OR]/10 unit change in severity 1.1) and PCS (OR 1.1) trajectories, and similarly for less frequent angina (MCS OR 1.2; PCS OR 1.3). The associations of MCS trajectory with severity and frequency lost significance after adjusting for psychosocial factors, whereas the PCS associations remained significant [All p < 0.05 unless noted].

CONCLUSIONS: About 1/3 of patients exhibited impaired 6-month HRQoL trajectories, which can be predicted by angina characteristics. Psychosocial factors may explain the ...


Impact Of Multimorbidity On Clinical Outcomes In Older Adults With Cardiovascular Disease, Mayra Tisminetsky, Robert J. Goldberg, Jerry H. Gurwitz 2016 University of Massachusetts Medical School

Impact Of Multimorbidity On Clinical Outcomes In Older Adults With Cardiovascular Disease, Mayra Tisminetsky, Robert J. Goldberg, Jerry H. Gurwitz

UMass Center for Clinical and Translational Science Research Retreat

Objective: To synthesize the current literature on the magnitude and impact of multiple chronic conditions on clinical outcomes, including total in-hospital and post discharge mortality and hospitalizations, in older patients with cardiovascular disease (CVD).

Methods: A systematic review was conducted. Four electronic databases and article bibliographies were searched for publications from 2005 to 2015 which assessed the impact of multimorbidity on clinical outcomes in the elderly with CVD. Identified studies were screened using pre-defined criteria for eligibility.

Results: Fifteen studies met our inclusion criteria. Multimorbidity was assessed by simple counting of morbidities and by the Charlson and Elixhauser indices. Case-fatality ...


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