Life expectancy determination.

Expert opinion on life expectancy must make reasonable factual assumptions, which entails finding a proper group to which the individual being assessed will be compared, as well as use of appropriate and reliable technical methods. Reasonable judgment should be exercised in the selection of the studies employed. A schedule of mortality rates must be built on a fair assessment of the person's medical condition and of relevant peer-reviewed findings.

Results of a non-specific immunomodulation therapy in chronic heart failure (ACCLAIM trial): a placebo-controlled randomised trial.

Background: Evidence suggests that inflammatory mediators contribute to development and progression of chronic heart failure. We therefore tested the hypothesis that immunomodulation might counteract this pathophysiological mechanism in patients.

Methods: We did a double-blind, placebo-controlled study of a device-based non-specific immunomodulation therapy (IMT) in patients with New York Heart Association (NYHA) functional class II-IV chronic heart failure, left ventricular (LV) systolic dysfunction, and hospitalisation for heart failure or intravenous drug therapy in an outpatient setting within the past 12 months.

A study to assess the effects of a broad-spectrum immune modulatory therapy on mortality and morbidity in patients with chronic heart failure: the ACCLAIM trial rationale and design.

Background: Evidence has accumulated regarding the importance of inflammatory mediators in the development and progression of heart failure (HF). Although targeted anticytokine treatment strategies, specifically antitumour necrosis factor-alpha, have yielded disappointing results, this may simply reflect the redundancy of the cytokine cascade and the fact that antitumour necrosis factor-alpha therapies do not stimulate increased activity of the anti-inflammatory arm of the immune system. Ex vivo exposure of autologous blood to controlled oxidative stress and subsequent intramuscular administration is a device-based procedure shown in experimental studies to have a broad-spectrum effect on a number of immune mediators.

Aortic valve replacement and long-term prognosis.

Objective: We assessed the long-term risk of mortality associated with mechanical and biological aortic valve replacement (AVR).

Methods: We reviewed articles published during the last decade, with emphasis on large series reporting mortality data and follow up of 5 years or longer. The latest editions of textbooks on cardiology and cardiac surgery were also reviewed.

Broad modulation of tissue responses (immune activation) by celacade may favorably influence pathologic processes associated with heart failure progression.

Immune activation and inflammation contribute to the progression of chronic heart failure (CHF), but therapeutic approaches directed against these processes have been largely unsuccessful. This clinical study evaluated a novel, nonpharmacologic immune modulation therapy, shown experimentally to reduce inflammatory and increase anti-inflammatory cytokines. A total of 75 patients with New York Heart Association (NYHA) functional class III or IV CHF were randomized to receive either Celacade (immune modulation therapy) or placebo (n = 38 and n = 37, respectively) in a double-blind trial for 6 months, during which standard therapy for CHF was maintained.

Geographical variations in post myocardial infarction mortality and their impact on risk selection.

Objectives: The objective is to assess the impact of geographical variations in mortality on risk selection in patients after acute myocardial infarction.

Method: Mortality analysis is used with an actuarial methodology applied to follow-up studies based on data from randomized clinical trial and observational cohort studies of acute myocardial infarction patients from different geographic areas. Observed mortality was calculated as geometric average annual rate (q) and compared to the expected geometric average annual mortality (q') mortality calculated from different life tables.

Effects of a novel immune modulation therapy in patients with advanced chronic heart failure: results of a randomized, controlled, phase II trial.

Objective: We sought to determine whether a novel, non-pharmacological form of immune modulation therapy (IMT), shown experimentally to reduce inflammatory and increase anti-inflammatory cytokines, improved outcomes in patients with advanced heart failure (HF).

Background: Immune activation contributes to the progression of HF, but treatments directed against inflammation have been largely unsuccessful.

Methods: Seventy-five HF patients (New York Heart Association [NYHA] functional class III to IV) were randomized to receive either IMT (n = 38) or placebo (n = 37) in a double-blind trial for six months, with continuation of standard HF therapy.

Mortality analysis in patients with atrial fibrillation and implantable permanent pacemaker after ablation of the atrioventricular node.

Object: Atrial fibrillation is associated with excess mortality. This analysis was performed to determine the magnitude of the excess mortality risk.

Methods: Life table analysis of a published study of 350 patients undergoing radiofrequency ablation of the atrioventricular node and permanent pacemaker implantation for symptomatic paroxysmal or chronic atrial fibrillation.

Diabetes mellitus related morbidity, risk of hospitalization and disability.

Objective: To investigate the rates of complications, hospitalizations and disabilities attributable to type 1 and type 2 diabetes mellitus (DM) combined, unless otherwise noted.

Methodology: Risk assessment of DM-related morbidity, hospitalizations and disabilities using data from the medical literature and health statistics on the population. Calculation of morbidity, hospitalization, and disability ratios (MbR, HR, DR) will allow comparison of observed rates in people with DM to those reported in the nondiabetic population.