BACKGROUND The impact of age on outcomes in cardiogenic shock(CS)is poorly described in the pre-hospital setting.We assessed the impact of age on outcomes of patients treated by emergency medical services(EMS).METHODS...BACKGROUND The impact of age on outcomes in cardiogenic shock(CS)is poorly described in the pre-hospital setting.We assessed the impact of age on outcomes of patients treated by emergency medical services(EMS).METHODS This population-based cohort study included consecutive adult patients with CS transported to hospital by EMS.Successfully linked patients were stratified into tertiles by age(18-63,64-77,and>77 years).Predictors of 30-day mortality were assessed through regression analyses.The primary outcome was 30-day all-cause mortality.RESULTS A total of 3523 patients with CS were successfully linked to state health records.The average age was 68±16 years and 1398(40%)were female.Older patients were more likely to have comorbidities including pre-existing coronary artery disease,hypertension,dyslipidemia,diabetes mellitus,and cerebrovascular disease.The incidence of CS was significantly greater with increasing age(incidence rate per 100,000 person years 6.47[95%CI:6.1-6.8]in age 18-63 years,34.34[32.4-36.4]in age 64-77 years,74.87[70.6-79.3]in age>77 years,P<0.001).There was a step-wise increase in the rate of 30-day mortality with increasing age tertile.After adjustment,compared to the lowest age tertile,patients aged>77 years had increased risk of 30-day mortality(adjusted hazard ratio=2.26[95%CI:1.96-2.60]).Older patients were less likely to receive inpatient coronary angiography.CONCLUSION Older patients with EMS-treated CS have significantly higher rates of short-term mortality.The reduced rates of invasive interventions in older patients underscore the need for further development of systems of care to improve outcomes for this patient group.展开更多
Rationale Haematoma growth is common early after intracerebral haemorrhage(ICH),and is a key determinant of outcome.Tranexamic acid,a widely available antifibrinolytic agent with an excellent safety profile,may reduce...Rationale Haematoma growth is common early after intracerebral haemorrhage(ICH),and is a key determinant of outcome.Tranexamic acid,a widely available antifibrinolytic agent with an excellent safety profile,may reduce haematoma growth.Methods and design Stopping intracerebral haemorrhage with tranexamic acid for hyperacute onset presentation including mobile stroke units(STOP-MSU)is a phase Ⅱ double-blind,randomised,placebo-controlled,multicentre,international investigator-led clinical trial,conducted within the estimand statistical framework.Hypothesis In patients with spontaneous ICH,treatment with tranexamic acid within 2 hours of onset will reduce haematoma expansion compared with placebo.Sample size estimates A sample size of 180 patients(90 in each arm)would be required to detect an absolute difference in the primary outcome of 20%(placebo 39%vs treatment 19%)under a two-tailed significance level of 0.05.An adaptive sample size re-estimation based on the outcomes of 144 patients will allow a possible increase to a prespecified maximum of 326 patients.Intervention Participants will receive 1 g intravenous tranexamic acid over 10 min,followed by 1 g intravenous tranexamic acid over 8 hours;or matching placebo.Primary efficacy measure The primary efficacy measure is the proportion of patients with haematoma growth by 24±6 hours,defined as either≥33%relative increase or≥6 mL absolute increase in haematoma volume between baseline and follow-up CT scan.Discussion We describe the rationale and protocol of STOP-MSU,a phase Ⅱ trial of tranexamic acid in patients with ICH within 2 hours from onset,based in participating mobile stroke units and emergency departments.展开更多
基金supported by National Heart Foundation(NHF)Fellowshipsupported by a National Health and Medical Research Council(NHMRC)+4 种基金a NHF Post Graduate Scholarshipssupported by a NHMRC Early Career Fellowshipa NHF Future Leader Fellowshipsupported by an NHMRC postgraduate scholarshipsupported by an NHMRC Senior Principal Research Fellowship。
文摘BACKGROUND The impact of age on outcomes in cardiogenic shock(CS)is poorly described in the pre-hospital setting.We assessed the impact of age on outcomes of patients treated by emergency medical services(EMS).METHODS This population-based cohort study included consecutive adult patients with CS transported to hospital by EMS.Successfully linked patients were stratified into tertiles by age(18-63,64-77,and>77 years).Predictors of 30-day mortality were assessed through regression analyses.The primary outcome was 30-day all-cause mortality.RESULTS A total of 3523 patients with CS were successfully linked to state health records.The average age was 68±16 years and 1398(40%)were female.Older patients were more likely to have comorbidities including pre-existing coronary artery disease,hypertension,dyslipidemia,diabetes mellitus,and cerebrovascular disease.The incidence of CS was significantly greater with increasing age(incidence rate per 100,000 person years 6.47[95%CI:6.1-6.8]in age 18-63 years,34.34[32.4-36.4]in age 64-77 years,74.87[70.6-79.3]in age>77 years,P<0.001).There was a step-wise increase in the rate of 30-day mortality with increasing age tertile.After adjustment,compared to the lowest age tertile,patients aged>77 years had increased risk of 30-day mortality(adjusted hazard ratio=2.26[95%CI:1.96-2.60]).Older patients were less likely to receive inpatient coronary angiography.CONCLUSION Older patients with EMS-treated CS have significantly higher rates of short-term mortality.The reduced rates of invasive interventions in older patients underscore the need for further development of systems of care to improve outcomes for this patient group.
基金Medical Research Future Fund,Australia(APP1152282).
文摘Rationale Haematoma growth is common early after intracerebral haemorrhage(ICH),and is a key determinant of outcome.Tranexamic acid,a widely available antifibrinolytic agent with an excellent safety profile,may reduce haematoma growth.Methods and design Stopping intracerebral haemorrhage with tranexamic acid for hyperacute onset presentation including mobile stroke units(STOP-MSU)is a phase Ⅱ double-blind,randomised,placebo-controlled,multicentre,international investigator-led clinical trial,conducted within the estimand statistical framework.Hypothesis In patients with spontaneous ICH,treatment with tranexamic acid within 2 hours of onset will reduce haematoma expansion compared with placebo.Sample size estimates A sample size of 180 patients(90 in each arm)would be required to detect an absolute difference in the primary outcome of 20%(placebo 39%vs treatment 19%)under a two-tailed significance level of 0.05.An adaptive sample size re-estimation based on the outcomes of 144 patients will allow a possible increase to a prespecified maximum of 326 patients.Intervention Participants will receive 1 g intravenous tranexamic acid over 10 min,followed by 1 g intravenous tranexamic acid over 8 hours;or matching placebo.Primary efficacy measure The primary efficacy measure is the proportion of patients with haematoma growth by 24±6 hours,defined as either≥33%relative increase or≥6 mL absolute increase in haematoma volume between baseline and follow-up CT scan.Discussion We describe the rationale and protocol of STOP-MSU,a phase Ⅱ trial of tranexamic acid in patients with ICH within 2 hours from onset,based in participating mobile stroke units and emergency departments.
