mahshid givi

Survival and prognostic factors following stroke occurrence differ between world regions. Studies investigating stroke features in the Middle?east region are scarce. We aimed to investigate 1?year survival and related prognostic factors of stroke patients in Central Iran.

It is an observational analytical study conducted on patients registered in the Persian Registry of Cardiovascular Disease?Stroke  PROVE?Stroke) database. Records of 1703 patients admitted during  015–2016 with the primary diagnosis of stroke in all hospitals of Isfahan, Iran were reviewed. Information regarding sociodemographic  haracteristics, clinical presentations, medications, and comorbidities were recorded. The living status of patients after 1 year from stroke was considered as 1?year survival.

Among 1345 patients with the final diagnosis of stroke, 970 (72.1%) were alive at the 1 year follow?up and the mean survival time based on Kaplan–Meier procedure was estimated 277.33 days. The hemorrhagic and ischemic types of stroke were reported in 201 (15.0%) and 1141 (84.8%) patients, respectively. Age  hazard ratio [HR] = 1.07, 95% confidence interval [CI] =  .05–1.09), diabetes (HR = 1.49, 95% CI = 1.07–2.06), history of stroke or transient ischemic attack (HR = 1.81, 95% CI = 1.30–2.52), history of warfarin usage (HR = 1.73, 95% CI = 1.11–2.71), hospital complications of hemorrhage (HR = 3.89, 95% CI = 2.07–7.31), sepsis (HR = 1.78, 95% CI = 1.18–2.68), and hydrocephalus (HR = 3.43, 95% CI =  .34–8.79), and modified Rankin Scale (mRS) ?3 at the time of hospital dicharge (HR = 1.98, 95% CI = 1.27–3.07), were predictors of 1?year survival. 

conclusion:

 Predictors of 1?year survival can be categorized into  changeable ones, such as age, diabetes, previous stroke, and mRS. The changeable factors, such as hospital complications of infection and  emorrhage, guide physicians to pay greater attention to reduce the risk of mortality following stroke.

Numerous clinical trials have reported conflicting results regarding the benefit of digoxin in treating heart failure (HF) patients. This study was conducted with the aim to demonstrate the impact of added digoxin to beta-blocker and beta-blocker alone on all-cause mortality and rehospitalization among these patients.

We investigated the data of 1998 patients admitted with a primary diagnosis of decompensated HF in the prospective Persian Heart Failure Patients Registry in Iran. The outcomes of interest were time until death and time until first rehospitalization. Multivariate cox regression was used to compare the impact of beta-blocker plus digoxin and beta-blocker alone on 2.5-year survival and 90-day rehospitalization.

The mean age of the participants was 69.18 ± 13.26 years, and 38.1% of patients were women. The incidence rate of all-cause mortality in the total sample was 0.18 and 0.22 in patients on beta-blocker plus digoxin and beta-blocker alone, respectively [incidence rate ratio (IRR) = 1.25; 95% CI: 0.92-1.7]. The adjusted risk of all-cause mortality was significantly higher in women discharged with beta-blocker plus digoxin than beta-blocker groups [hazard ratio (HR) = 2.31; 95% CI: 1.27-4.19]. Rates of 90-day first rehospitalization were 0.10 and 0.12 in the beta-blocker plus digoxin and beta-blocker alone groups, respectively (IRR = 0.85; 95% CI: 0.53-1.35). After adjustment for covariates, beta-blocker plus digoxin therapy had no significant effect on increasing the risk of 90-day first rehospitalization in the total cohort (HR = 0.77; 95% CI: 0.48-1.23), in men (HR = 0.73; 95% CI: 0.40-1.35), and women (HR = 0.76; 95% CI: 0.36-1.65).

In patients hospitalized with decompensated HF, digoxin administration at discharge was associated with increased 30-month mortality risk in women.

Considering the high concentrations of pollutants in large cities of Iran and the high prevalence of heart failure (HF) among Iranians, especially with increasing life expectancy, this study investigated the relationship between airborne contaminants with a diameter < 2.5 µm or particulate matter 2.5 (PM2.5) and hospitalization and mortality in patients with HF in Isfahan, Iran, during 2011.

This ecological study was carried out on a part of data from the CAPACITY study. A total of 275 patients with HF were randomly selected from 840 subjects with International Statistical Classification of Diseases, 10th Revision (ICD-10) diagnosis code I50 in the CAPACITY study. Patients’ records were evaluated and their clinical characteristics, disease history, and laboratory and echocardiographic findings were extracted. Air pollution and climatic data were extracted from the CAPACITY study. Poisson regression was used in crude and adjusted models to evaluate the association between PM2.5 and study outcomes. All analyses were performed using crude models and models adjusted for temperature, dew point, and wind speed.

54.9% (n = 151) were men with mean age of 70.4 ± 13.7 years. While most patients (85.8%) were discharged after recovery, 14.2% of the patients died in the hospital. Blood glucose, heart rate, and ejection fraction (EF) were significantly higher on unhealthy days than normal days. Regression analysis revealed no significant relationships between hospitalization and mortality rates and PM2.5 concentrations on healthy days, unhealthy days for sensitive people, and unhealthy days.

The model used in our study revealed no significant relationships between PM2.5 concentrations and hospital admission on healthy days, unhealthy days for sensitive people, and unhealthy days.

Heart failure (HF) resulted from ultimate pathway of many cardiovascular diseases (CVDs) or as a separate entity poses a considerable increasing prevalence and economic burden, but its registry for better management is less frequently done. In this study, we aimed to design and implement HF registry.

Persian Registry Of cardioVascular diseasE (PROVE) was initiated from March 2015 and continuously collected information of patients suffering from HF, ST-elevation myocardial infarction (STEMI), atrial fibrillation (AF), percutaneous coronary intervention (PCI), stroke, familial hypercholesterolemia (FH), congenital heart disease (CHD), chronic ischemic cardiovascular disease (CICD), and acute coronary syndrome (ACS) from 18 different cardiac centers. Data of patients with HF were collected from their medical forms and recorded in a registry system of PROVE/HF plus telephone follow-up survey of 1, 6, and 12 months after the date of HF attack.

Assessment of all related questions led to definition of a final questionnaire including 27 items regarding demographic information, underlying disorders and their complications, patients’ symptoms and signs, and laboratory and relevant para-clinic data at admission time, during hospitalization, and post discharge. Follow-up information was mostly based on patients’ general status and medication usage.

PROVE execution was a successful and hopeful project providing data of major CVDs in order to design appropriate preventive actions and better management and treatment strategies plus a valuable data center being utilized in multiple future comprehensive projects.

Obesity is a major risk factor for many diseases including cardiovascular diseases (CVDs). Recently, it has been shown that upper body obesity can predict CVDs per se. In this study, we aimed to determine the association between indicators of upper body obesity and echocardiographic indices. In this cross-sectional study conducted in Hajar Hospital in Shahrekord, Iran, from March to August 2014, 80 healthy adults were included. Participants’ neck circumference (NC), waist circumference (WC), body mass index (BMI), and blood pressure were measured. Echocardiography was performed for all participants, and echocardiographic indices such as early (E’) and late (A') diastolic tissue velocity, early (E) and late (A) transmitral flow velocity, E/E’ ratio, pulmonary arterial pressure (PAP), and left atrial volume (LAV) were recorded. The association between these indices were investigated using bivariate Pearson correlation coefficient. For men, NC had a significant correlation with LAV, systolic blood pressure (SBP), diastolic blood pressure (DBP), PAP, and A', and a negative correlation with E′. WC had a significant correlation with LAV, SBP, and PAP, and a negative correlation with E′, while BMI had a significant correlation with LAV, PAP, SBP, A, and A’. For women, NC had a significant positive correlation with LAV, A, ejection fraction (EF), SBP, PAP, and A’, and a negative correlation with E′ and E/E′. WC had a significant positive correlation with LAV, DBP, PAP, A, A’, and a negative correlation with E′, while BMI had a significant correlation with LAV, EF, SBP, PAP, E’, A, and A’. The positive correlation of NC with SBP, A, and A', as well as NC, WC, and BMI with LAV and PAP in both sexes, and the negative correlation of NC with E′ show the importance of these measures in estimation of metabolic and cardiovascular risk factors.

Prehypertension is one of the cardiovascular disease predicators. Management of prehypertension is an appropriate objective for clinicians in a wide range of medical centers. Massage therapy is primarily nonpharmacological treatment that is used to control blood pressure (BP). This study intends to investigate the long‑term effect of massage therapy on BP in prehypertensive women.

This was a single‑blind clinical trial study conducted on 50 prehypertensive women who referred to Sedigheh Tahereh Cardiovascular Center, during 6 months in 2009. Participants were selected by simple random sampling and were divided into control and intervention groups. The test group (25 patients) received massage for 10–15 min, three times a week for 10 sessions, and the control group (25 patients) was relaxed in the same environment but with no massage. Their BP was measured before and after each session and 72 h and 2 weeks after finishing the massage therapy. Analyzing the data was done using descriptive and inferential statistical methods (Chi‑square, Mann–Whitney, paired t‑test, and Student’s t‑test) through SPSS software version 18 and a significant level was considered as P < 0.05.

The results indicated that the mean systolic BP (SBP) and diastolic BP (DBP) in the massage group were significantly lower in comparison with the control group (P < 0.001). Evaluation of durability of the massage effects on BP also indicated that 72 h after finishing the study, still there was a significant difference between the test and control groups in SBP and DBP (P < 0.001), but after 2 weeks, there was not a significant difference in SBP and DBP (P > 0.05) between the two groups.

Although massage therapy seems to be a safe, effective, applicable, and cost‑effective intervention to control BP of prehypertensive women, its effects do not persist for a long time.

Myocardial phosphodiesterase 5 (PDE5) inhibitors are documented for use in various disease states. The efficacy of PDE5 inhibitors is less determined in heart failure patients without pulmonary hypertension. The aim of the present study was to evaluate the efficacy of PDE5 inhibitors in heart failure patients without pulmonary hypertension. Seventy-six cases with heart failure were participated in this study. The ion criteria were systolic heart failure according to the New York Heart Association (NYHA) functional classifications I and IV, echocardiographically determined left ventricular ejection fraction less than 50%, and stability for at least 3 months. The participants were randomly divided into case and control groups. Both case and control groups received 50 mg of sildenafil and a placebo for 3 months, respectively. Transthoracic echocardiography (TTE) was performed using the Vingmed 800 CSF. All the ejection fraction measurements were done using the Simpson method. Before the initiation of the trial and then 3 months afterward, TTE was obtained the participants. Changes in the functional class and the left ventricular ejection fraction before and after the trial were assessed and the data were analyzed using SPSS, version 16. In the case group, the ejection fraction after the trial with an average of 41.53 ± 7.53 was considerably more significant than that before the trial with an average of 37.92 ± 6.92 (P

The Persian Registry of Cardiovascular disease/Heart Failure (PROVE/HF) aimed to studied the demographic, clinical, and diagnostic characteristics and treatment of patients hospitalized for heart failure (HF) and to follow them for short- and long-term outcomes. Its pilot phase started in 2015 in Isfahan aiming to evaluate its feasibility to be scaled up at the national level in later stages. This article describes the method and preliminary results of the first year registry. Information of hospitalized patients with preserved and low ejection fraction, were gathered. Patients were followed for 1, 6, and 12 months. During follow-up, information of the patients’ current status, medications used during hospitalization, and in case of death, the cause and place were assessed. PROVE/HF enrolled 787 patients in the first year. The mean age of patients was 70.74 ±12.01 years, and 60.7% of them were men. The most frequent risk factors for the development of HF in the recruited patients was ischemic heart disease (77.9%), and hypertension (63.7%), respectively. The re-admission rate for patients with HF was at least once in 16% and continued until the fifth to ninth re-admission over a one-year period. Among 787 registered patients, 30.9% died in the first year of follow-up, and the in-hospital mortality was 6.2%. The mean hospitalization period was 4.88 days, and 64.2% were hospitalized for >3 days. The annual rate of re-admission and mortality was high, and the use of medication was less than the recommended one inaccordance with the guidelines for the treatment of heart failure.

Our aim was to create and establish a database called “Persian Registry of Cardiovascular Disease (PROVE)” in order to be used for future research and in addition, as a tool to develop national guidelines for diagnosis, treatment, and prevention of cardiovascular disease (CVD). In this paper, the design and methodology of the PROVE pilot study will be discussed, launched in Isfahan, Iran, in 2015-2016.
Through establishing PROVE, patient's data were collected from hospitals and outpatient clinics prospectively or retrospectively and followed up for a maximum of three years based on the type of CVDs. The inclusion criteria were as patients with acute coronary syndrome (ACS), ST elevation myocardial infarction (STEMI), stroke, atrial fibrillation (AF), heart failure (HF), congenital heart disease (CHD), percutaneous coronary intervention (PCI), and chronic ischemic cardiovascular disease (CICD). Specific protocols, questionnaires, and glossaries were developed for each registry. In order to ensure the validation of the protocols, questionnaires, data collection, management, and analysis, a well-established quality control (QC) protocol was developed and implemented. Data confidentiality was considered.
In order to register patients with ACS, STEMI, stroke, HF, PCI, and CICD, the hospital recorded data were used, whereas, in case of AF and CHD registries, the data were collected from hospitals and outpatient clinics. During the pilot phase of the study in Isfahan, from March 2015 to September 2016, 9427 patients were registered as ACS including 809 as STEMI, 1195 patients with HF, 363 with AF, 761 with stroke, 1136 with CHD, 1200 with PCI, and 9 with CICD. Data collection and management were performed under the supervision of the QC group.
PROVE was developed and implemented in Isfahan as a pilot study, in order to be implemented at national level in future. It provides a valuable source of valid data that could be used for future research, re-evaluation of current CVD management and more specifically, gap analysis and as a tool for assessment of the type of CVDs, prevention, treatment, and control by health care decision makers.

Evidence suggests that the serum myeloperoxidase level has a diagnostic and predictive role in patients with chronic heart failure (CHF). We evaluated the association between the serum myeloperoxidase level and the severity and prognosis of CHF. Materials: In a prospective observational study, patients with CHF were evaluated. The myeloperoxidase serum level was measured at baseline by enzyme-linked immunosorbent assay. Transthoracic echocardiography was done at baseline and then after 6 months. History and duration of admission and also mortality were recorded during follow-up. Fifty patients at a mean age of 64.7±1.8 years (70% male) were evaluated. The mean ser into two groups of A and B with a serum myeloperoxidase level of less and more than 51 Heart Association functional class (NYHA III 20.5% vs. 27.3%; p value=0.456), left ventricular ejection fraction (30.3±10.0 vs. 29.8±10.1%; p value=0.873), systolic dysfunction (48.7% vs. 54.5%; p value=0.500), or diastolic dysfunction (38.5% vs. 63.6%; -up. The serum myeloperoxidase level was not associated with admission history or mortality. We found no significant association between the serum myeloperoxidase level and echocardiography parameters, admission history, or mortality in patients with CHF. Further studies with larger samples of patients are required in this regard.

Hypertension has become a major problem throughout the world, especially in developing countries like Iran. As it is a major risk factor for coronary heart disease, even small reductions in the prevalence can have potentially large public health benefits. Among the complementary methods, massage provides an effective means to lower the blood pressure. If nurses perceive the experiences of hypertensive patients receiving massage, they can use massage more effectively in their care plan. This is a descriptive phenomenological study. Deep interviews were conducted with nine prehypertensive women who received Swedish massage three times a week in a total of 10 sessions, with each session lasting 10-15 min. Then, the researcher conducted an interview using a ‘grand tour question (open ended question) and the participants were then encouraged to speak freely explaining their thoughts and feelings about the experience of massage therapy. Data analysis was done by Colaizzi’s method. Validity and reliability were obtained through measures such as real value, applicability, continuity, and authenticity. Women evaluated the massage therapy positively. The findings yielded six themes, including relaxation, sleeping better, reduction of anxiety and tension, reduction of fatigue, invigorating experience, improve connecting. This study demonstrates that a body‑centered intervention like massage can be valuable in a multidisciplinary approach to women with prehypertension. This method is easy to learn and relatively short (10-15 min) to administer as a suitable complement in nursing care for this group of patients.

Pre‑hypertension is considered as a cardiovascular disease predicator. Management of pre‑hypertension is an appropriate objective for clinicians in a wide range of medical centers. Treatment of pre‑hypertension is primarily non‑pharmacological, one of which is massage therapy that is used to control the BP. This study aimed to evaluate the survival effect of Swedish massage (face, neck, shoulders, and chest) on BP of the women with pre‑hypertension. This was a single‑blind clinical trial study. Fifty pre‑hypertensive women selected by simple random sampling which divided into control and test groups. The test group (25 patients) received Swedish massage 10‑15 min, 3 times a week for 10 sessions and the control groups (25 patients) also were relaxed at the same environment with receiving no massage. Their BP was measured before and after each session and 72 h after finishing the massage therapy. Analyzing the data was done using descriptive and inferential statistical methods (Chi‑ square, Mann‑Whitney, paired t‑test and Student t‑test) through SPSS software. The results indicated that mean systolic and diastolic BP in the massage group was significantly lower in comparison with the control group (P < 0.001). Evaluation of durability of the massage effects on BP also indicated that 72 h after finishing the study, still there was a significant difference between the test and control groups in systolic and diastolic BP (P < 0.001). Findings of the study indicated that massage therapy was a safe, effective, applicable and cost‑effective intervention in controlling BP of the pre‑hypertension women and it can be used in the health care centers and even at home.

The Immense cost of cancer treatment is one of the main challenges of health care systems all over the world including Iran. The aim of this study was to analyze the direct treatment costs of colorectal cancer patients in Isfahan, Iran. In this cross sectional study, the medical records of colorectal cancer (CRC) patients admitted to the Seyyed‑al‑Shohada Hospital “SSH” from 2005-2010 were reviewed. The profiles of 452 patients were examined. However based on inclusion, exclusion criteria a total number of 432 profiles were analyzed. All records including age, sex, treatment processes and treatment costs were extracted from the patients’ profiles and analyzed using Kruskal‑Wallis test. The results showed that 56.1% of CRC patients were male. The mean age of patients suffering from CRC was 56 ± 13.4. More than Thirty‑six percent of the patients were in stages 1‑3 of CRC and more than half of them (64.4%) were in the 4th stage. The higher the stage of the cancer the higher the percentage of treatments used. 5-Fluorouracil and Leucovorin (5FU/LV) was the most common used chemical treatment protocol. The mean treatment cost for stage one was 10715 (±4927), for stage two 15920 (±3440), stage three 16452 (±2828) and for stage four was 16723 (±2555) US Dollars. The cost of drug treatment was the first cost driven between the medical services. CRC in Iranian population starts in younger age than people in western countries. This imposed considerable direct and indirect economic cost to the society. The direct medical cost of colorectal cancer in Iran is very higher than 38 million $. Screening programs could reduce the economic cost of CRC significantly.

Prehypertension is considered as a cardiovascular disease predicator. Management of prehypertension is an appropriate objective for clinicians in a wide range of medical centers. Treatment of prehypertension is primarily nonpharmacological, one of which is massage therapy that is used to control the blood pressure. This study aimed to evaluate the effect of Swedish massage (face, neck, shoulders and chest) on blood pressure (BP) of the women with prehypertension. This was a single-blind clinical trial study. Fifty prehypertensive women selected by simple random sampling which divided into control and test groups. The test group (25 patients) received Swedish massage 10-15 min, three times aweek for 10 sessions and the control groups (25 patients) also were relaxed at the same environment with receiving no massage. Their BP was measured before and after each session. Analyzing the data was done using descriptive and inferential statistical methods (chi square, Mann-Whitney, paired t-test and student t-test) through SPSS software. The results indicated that mean systolic and diastolic blood pressure in the massage group was significantly lower in comparison with the control group (p < 0.001). Findings of the study indicated that massage therapy was a safe, effective, applicable and cost-effective intervention in controlling BP of the prehypertension women and it can be used in the health care centers and even athome.