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2-Week Benzinidazole Course Found Effective Against Chagas & Other NTD News
This news roundup is a collection of headlines and other items on neglected tropical diseases, and does not reflect the work or the views of the Neglected Tropical Diseases Support Center.
A study in Bolivia led by DNDi shows that the standard treatment for Chagas disease, which currently lasts 8 weeks, could be just as effective after only 2 weeks.
DNDi/YOUTUBE
Mapping of lymphatic filariasis in loiasis areas: A new strategy shows no evidence for Wuchereria bancrofti endemicity. . .
Sameul Wanji et al.
PLOS Neglected Tropical Diseases
Our study provides a simple day blood-based algorithm for [lymphatic filariasis, or] LF mapping in loiasis areas. The results indicate that many districts that were formerly classified as endemic for LF in Cameroon are non-endemic and do not require mass drug administration for elimination of LF.
Implementing a community vector collection strategy for monitoring vector-borne diseases in Ghana
Daniel A. Boakye et al.
Gates Open Research
The study revealed that use of community volunteers for the collection of mosquitoes for xenomonitoring purposes can be a viable strategy in the monitoring of vector-borne diseases. However, further development of the strategies and assessments of the costs involved will be required to make this a sustainable approach to monitoring vector-borne disease interventions and enhance community ownership of the programmes.
Preclinical development of an oral anti-Wolbachia macrolide drug for the treatment of lymphatic filariasis and onchocerciasis
Mark J. Taylor et al.
New drugs are urgently needed for treating the neglected tropical diseases, onchocerciasis and lymphatic filariasis. As part of the A·WOL consortium, Taylor et al. launched a drug discovery program that identified macrolide antibiotic molecules that were capable of eliminating the bacterial endosymbiont, Wolbachia, which is necessary for the viability and fertility of filarial worms. Two macrolide compounds cleared Wolbachia from filarial nematodes in animal models of lymphatic filariasis and onchocerciasis
Over 2 million Nigerian children receive treatment against parasitic worms
Charity Warigon
World Health Organization Nigeria
"My son had blood in his urine for almost a year and I didn't know what to do," says Rahab Haruna, a 45-year-old mother from Adamawa State. . . Like Rahab, very few parents know Schistosomiasis and that it can be treated despite the fact that the disease is rampant in their communities. In Nigeria 44 million children are at risk of being infected with Schistosomiasis - an acute and chronic disease caused by parasitic worms. . . Over the past three months, the World Health Organization's (WHO) Expanded Special Project for the Elimination of Neglected Tropical Diseases (ESPEN) has supported Nigeria to reach over 2 million children who have never had Schistosomiasis treatment before.
FIND extends Neglected Tropical Diseases portfolio to include Schistosomiasis
Sarah-Jane Loveday
The Foundation for Innovative New Diagnostics (FIND) announced today the launch of a new schistosomiasis programme within its neglected tropical diseases (NTD) portfolio. The programme focuses on developing rapid diagnostic tests (RDTs) for detection of circulating anodic antigen (CAA) in blood and/or urine, to support national control and/or elimination programmes in countries where schistosomiasis is regularly found. . . "Schistosomiasis is contracted from contaminated water, putting whole communities at risk," said Joseph Ndung'u, Head of Neglected Tropical Diseases at FIND. "The new diagnostic technologies will be a huge step forward, but to achieve real impact their use cannot be confined to labs. The RDT format will allow testing in community settings and enable essential surveillance and disease tracking."
One Health approach to schistosomiasis control in Africa - The CATTLES Project
London Centre for Neglected Tropical Disease Research
The new Control And Targeted Treatment of Livestock Emerging Schistosomiasis (CATTLES) project, led by Prof Joanne Webster, will build the evidence base for the development of sustainable schistosomiasis control programme for livestock in Africa. The project ultimately aims to improve the health and productivity of both humans and animals through the implementation of a One Health approach to schistosomiasis control. The research builds on some of the key finding produced by the earlier Schistosoma Hybridization Evolution, Ecology and Prevention (SHEEP) project, also led by Prof Joanne Webster. This ZELS funded research elucidated the complex transmission dynamics where host-spots of schistosomiasis transmission and sickness among both children and adults in West Africa are being driven not just by the human of form of the parasite as previously assumed, but rather through hybridized animal and human schistosome species.
In Vitro and In Vivo Studies of Spironolactone as an Antischistosomal Drug Capable of Clinical Repurposing
Rafael A. Guerra et al.
In this study, from a screening of 13 marketed diuretics, we identified that spironolactone, a potassium-sparing diuretic, had potent antischistosomal effects on Schistosoma mansoni in vitro and in vivo in a murine model of schistosomiasis. In vitro, spironolactone at low concentrations (<10 µM) is able to alter worm motor activity and the morphology of adult schistosomes, leading to parasitic death. In vivo, oral treatment with spironolactone at a single dose (400 mg/kg) or daily for five consecutive days (100 mg/kg/day) in mice harboring either patent or prepatent infections significantly reduced worm burden, egg production, and hepato- and splenomegaly (P < 0.05 to P < 0.001).
Pharmacokinetics of ascending doses of ivermectin in Trichuris trichiura-infected children aged 2–12 years
Jessica D Schulz et al.
Journal of Antimicrobial Chemotherapy
Ivermectin is marketed for humans ≥15 kg (>5 years of age) to treat onchocerciasis, strongyloidiasis and lymphatic filariasis. Owing to the lack of an effective treatment against T. trichiura and other parasitic diseases, ivermectin appears to be a promising drug candidate with its broad antiparasitic activity. . . Ivermectin shows a lower exposure profile in children than in adults, highlighting the need to study drug dosing carefully, in particular given the great interest in applying this drug for novel indications.
What mathematical models tells us about the impact of WASH on STH control and elimination
Anouk Gouvras
A recent study by Coffeng and team uses mathematical model simulations to predict the short-term and long-term impact of Water, Sanitation and Hygiene (WASH) interventions on soil-transmitted helminth control and elimination programmes. Their models demonstrate a clear added benefit of WASH interventions on sustaining the gains of preventative chemotherapy treatment (PCT), particularly after PCT is stopped, reducing the risk and speed of bounce-back of infections.
Strongyloides stercoralis infection: A systematic review of endemic cases in Spain
Maria Barroso et al.
With the data provided by this review it is likely that in Spain strongyloidiasis might have been underestimated. It is highly probable that the infection remains undiagnosed in many cases due to low clinical suspicion among Spanish population without recent travel history in which the contagion probably took place decades ago.
On Commonwealth Day - two years since visiting Malawi - HRH The Countess of Wessex congratulates the country on progress. . .
The Queen Elizabeth Diamond Jubilee Trust
The Countess of Wessex visited Malawi exactly two years ago to see the work of the Trust's Trachoma Initiative in action. Reflecting on the visit, The Countess said, "When I visited the country in 2017, the last few cases of trachoma were being located and treated. For the next two years, the country will carefully monitor and manage any new cases of trachoma. All being well, in 2020 the World Health Organisation will be able to certify that the disease is eliminated as a public health problem in Malawi. What an achievement that will be."
Health ministry tackles trachoma
Phyllis Mbanje
Zimbabwe Daily
The Health ministry has embarked on an aggressive drive to tackle trachoma, a leading cause of preventable blindness by conducting baseline surveys in districts most affected by the disease. . . "The country is going for a nationwide drive to push for a [World Health Organisation] WHO recommended planning and implementation strategy known as SAFE (Surgery, Antibiotics, Facial cleanliness and Environmental improvements) in targeted districts. As straightforward as the SAFE strategy sounds, a significant rollout of all components of SAFE is needed in communities suffering from trachoma," said [The Health ministry deputy director Isaac] Phiri.
Advancing the repurposing of ivermectin for malaria
Carlos Chaccour and N. Regina Rabinovich
Ivermectin lays the path for a whole new concept: drug-based vector control. Ivermectin, or indeed any effective endectocide, could be administered to eligible members of the at-risk community as a complementary tool for vector control. It could be administered alone or in combination with partner drugs to allow for integrated management of malaria or neglected tropical diseases, directly responding to residual transmission by targeting malaria and some lymphatic filariasis vectors, regardless of their feeding behaviour.
Research to Practice: COUNTDOWN Findings lead to improved Community Awareness for Neglected Tropical Diseases in Nigeria
James Nuphi Yashiyi and Victoria Lebrun
COUNTDOWN research conducted in Ogun State, Nigeria indicates that understanding in relation to Neglected Tropical Diseases (NTDs) and associated awareness campaigns is limited in some areas. Consequently, the NTDs programme unit in the state recently organized an NTD awareness creation campaign across the 20 Local Government Areas (LGAs) of the State. The goal of such campaigns is to increase participation in the distribution of medicines to control diseases like onchocerciasis, schistosomiasis, and lymphatic filariasis and help people manage side effects if they encounter any after taking the medicine.
Treating parasite infections during pregnancy thought to boost babies' immune responses
Erin Digitale
[Desiree] LaBeaud and her colleagues previously found that when a mother is infected with parasites during pregnancy, her baby doesn't respond as effectively to these antibacterial vaccinations in infancy.. . . In the new study, the scientists monitored another group of 576 women who lived in rural Kenya and were pregnant between 2013 and 2015. The mothers were tested for eight different parasitic infections; 75 percent had at least one such infection during pregnancy, with malaria the most common. . . The babies in the new cohort had stronger immune responses to their infant vaccinations than babies in the earlier study.
Why fixing Africa's data gaps will lead to better health policies
Michelle Mbuthia
There are multiple sources of health data. These include household surveys, census, health facilities, disease surveillance, policy data and research studies. Datasets are increasingly spatially referenced and would be valuable in informing health programmes and monitoring performance. But they remain relatively under-used. It's important to find a way to bridge this gap and increase discovery and use of data.
How is implementation research applied to advance health in low-income and middle-income countries?
Olakunle Alonge et al.
BMJ Global Health
This paper examines the characteristics of implementation research (IR) efforts in low-income and middle-income countries (LMICs) by describing how key IR principles and concepts have been used in published health research in LMICs between 1998 and 2016, with focus on how to better apply these principles and concepts to support large-scale impact of health interventions in LMICs. There is a stark discrepancy between principles of IR and what has been published.
Study shows dramatically shorter treatment for Chagas disease could be just as effective, and significantly safer
Alessandra Vilas Boas
A two-week treatment course for adult patients with chronic Chagas disease showed, when compared to placebo, similar efficacy and significantly fewer side effects than the standard treatment duration of eight weeks, according to the results of a clinical trial in Bolivia led by the Drugs for Neglected Diseases initiative (DNDi). . . "We've shown that shorter treatment could be just as effective, and much safer. This could change the paradigm for Chagas treatment, by improving adherence and encouraging wider adoption by the medical community", said Dr Faustino Torrico, President of CEADES Foundation, Bolivia, and a principal investigator in the trial.
Novartis joins the Global Chagas Disease Coalition and also announces first multinational, prospective, randomized study. . .
Eric Althoff and Katerina Kontzalis
GlobeNewsire
At the Annual Meeting of the Global Chagas Disease Coalition in Barcelona, Spain, Novartis announced that it is joining the Coalition as a member contributor. In addition, the company announced its commitment to launch a multinational, prospective, randomized study with heart failure drug, Entresto® (sacubitril / valsartan), in people with chronic Chagas cardiomyopathy, one form of heart failure with reduced ejection fraction. This is the first definitive morbidity and mortality study to assess a potential therapy for cardiac disease in this underserved patient population.
Scaling up Malaria in Pregnancy Prevention at the Community Level
William Brieger
Tropical Health Matters
The World Health Organization (WHO) 2018 World Malaria Report revealed that of 33 countries where intermittent preventive treatment (with sulfadoxine-pyrimethamine/SP) is recommended for pregnant women, only 22% of eligible pregnant women received three doses of intermittent preventive treatment during pregnancy (IPTp3) with SP in 2017. Therefore, it is crucial that innovative interventions to scale up the provision of IPTp are needed to protect lives of mothers, fetuses and newborns. The Transforming Intermittent Preventive Treatment for Optimal Pregnancy (TIPTOP), a five-year project, is one such innovative effort that aims to contribute to reduced maternal and neonatal mortality in four countries: DRC, Madagascar, Mozambique, and Nigeria by expanding access to quality-assured (QA) SP.
Training surgeons through simulation: A BCBP-funded project
Emma McGuigan
The International Agency for the Prevention of Blindness
In some regions there is less than one ophthalmologist per one million people. So, when I learnt about one of the research projects [British Council for Prevention of Blindness, or] BCPB was funding in Sub Saharan Africa which is training eye surgeons quicker, more safely, more effectively, and to an acceptable level of competence to deal with the glaucoma and cataract backlog in the region, I got excited. . . There is still some way to go in proving whether this method of training is the most effective way to deal with the lack of surgeons in Sub Saharan Africa who can deal with glaucoma. However, the initial results from this trial are encouraging.
Marginalized groups – women, children, refugees, indigenous peoples, disabled people and many others – are often overlooked, and sometimes face discrimination, as they try to access and manage the safe water they need. This World Water Day, 22nd March, is about tackling the water crisis by addressing the reasons why so many people are being left behind.
22nd Meeting of the WHO Alliance for the Global Elimination of Trachoma by 2020 (GET2020)
April 9-11, 2019, Maputo, Mozambique
The purpose is to monitor progress towards elimination of trachoma at global level, exchange information and experience on SAFE (surgery, antibiotics, facial cleanliness, environmental improvement) strategy implementation, review partnership opportunities at global, regional and national levels, and discuss obstacles and barriers to the achievements of the elimination of trachoma as a public health problem by 2020.
Mobile to Multiplex: Accelerating Innovation in Global Diagnostics
April 11, 2019, Decatur, Georgia
Join experts from nongovernmental organizations, industry, and government as they examine how to meet the needs for diagnostics in global health in the absence of resources to develop these technologies. A panel of the world's leading diagnostic experts will examine this issue from multiple perspectives and offer solutions for accelerating innovation in this space.
Women Deliver 2019 Conference
June 3-6, 2019, Vancouver, Canada
The Women Deliver 2019 Conference – the world's largest gathering on the health, rights, and wellbeing of women and girls – will serve as a fueling station for advocates working to achieve a more gender equal world. In the summer of 2019, over 6,000 world leaders, influencers, advocates, academics, activists, and journalists will flock to Vancouver with dreams of accelerating progress girls and women everywhere.
WHO AFRO NTD Biennial Programme Managers Meeting
July 15-19, 2019, Location TBA
Please hold the week of July 15, 2019 as the World Health Organization Regional Office for Africa will be holding its Biennial NTD Programme Managers Meeting. This meeting will focus on Preventive Chemotherapy and Case Management diseases. We will be in touch soon to confirm the location and share all relevant documents.
11th European Congress on Tropical Medicine and International Health
September 16-20, 2019, Liverpool, UK
RSTMH is hosting the 11th ECTMIH in 2019, on behalf of the Federation of European Societies for Tropical Medicine and International Health (FESTMIH), at the ACC in Liverpool, UK. Every two years, ECTMIH 2019 brings together more than 1,500 scientists and experts from across the world. The Congress provides a platform for sharing research and innovation in the field of tropical medicine and global health.
The 10th NTD NGO Network (NNN) Conference
The chosen theme for the 2019 conference is 'Our vision beyond 2020: many partners, one voice'
6th International Symposium on One Health Research
September 18-19, 2019, Ulaanbaatar, Mongolia
An opportunity for foreign scientists to interact closely with high-ranking Mongolian leaders who specialize in human and animal research leading to numerous research collaborations and discoveries.
IAPB Council of Members 2019
October 5-8, 2019, Nairobi, Kenya
The next Council of Members will be held 5-8 October 2019 in Nairobi, alongside local partners Sightsavers.
ASTMH 68th Annual Meeting
November 20-24, 2019, National Harbor, Maryland
The ASTMH Annual Meeting draws tropical medicine and global health professionals representing academia, government, non-profits, philanthropy, NGOs, industry, military and private practice. The meeting is designed for researchers, professors, government and public health officials, military personnel, travel clinic physicians, practicing physicians in tropical medicine, students and all health care providers working in the fields of tropical medicine, hygiene and global health.
Epidemics7: International Conference on Infectious Disease Dynamics
December 3-6, 2019, Charleston, SC
Join us for the Seventh International Conference on Infectious Disease Dynamics to share another three days of intense dialogue on our ideas, data, insight, models and methods. This conference regularly attracts over 400 scientists, with representatives from many of the major research groups in this area worldwide. If you want to meet many of your peers in this field, this is the place to go.
11th IAPB General Assembly
October 12-14, 2020, Singapore
The General Assembly will mark the end of the VISION 2020: The Right to Sight period. It will present a great opportunity to take stock, celebrate successes and make plans for the future. A key focus will be on the WHO's World Report on Vision and its framework for the future. The event will have three co-chairs leading on three streams: "Excellence", "Eye Health in the West Pacific" and "Sustainability".
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MMA fighter sells Parkland property for $1.35 million
By Lisa J. Huriash
The Parkland home of mixed martial arts fighter Vitor Belfort sold Monday for $1.35 million.
The 1997 estate, which sits on more than 1 acre, has six bedrooms, four bathrooms, a wine glass wall, summer kitchen area in the back patio and pool. It also has a gym that Belfort extended to accommodate for his training, according to Michael Citron, Belfort's agent at Citron Real Estate Group at Re/Max ParkCreek, who handled the sale.
Belfort is a former light heavyweight Ultimate Fighting Championship champion and a former Cage Rage World Light Heavyweight Champion. He retired in May after losing in a knockout in the second round.
The home he shared with his wife, former model Joana Prado, three children, two dogs and a parrot is at 8649 NW 60th Court in Tall Pines, a gated community of luxury homes on spacious home sites. County property records show the house has more than 6,400 square feet.
"Every time I walked into the home, you could get a sense of the hard work and determination of Belfort through his positive reinforcement images and inspirational and motivational quotes throughout the home," Citron said. "You could feel the way people who saw the home were mesmerized by the size of the home and its many features."
But it was "the massiveness and celebrity factor [that] certainly enticed buyers to the home," he added.
Belfort, who owns the Belfort Fitness Lifestyle gym in Coconut Creek, and his family have since moved to east Broward County, according to his real estate agent.
View unique real estate properties and celebrity homes at SunSentinel.com/PrimeProperty.
Ex-Formula 1 driver lists $7 million condo on exclusive Fisher Island
Mansion used for McCain, Bachmann fundraisers hits the market for just under $8 million
One of the most expensive homes in U.S. is in Hillsboro Beach
DJ Khaled buys $25.9 million Miami Beach mansion

redpajama_set_name: RedPajamaCommonCrawl


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Dutch outcome in implantable cardioverter-defibrillator therapy (DO-IT): registry design and baseline characteristics of a prospective observational cohort study to predict appropriate indication for implantable cardioverter-defibrillator | mijn-bsl Skip to main content
Open Access 07-08-2017 | Original Article
Dutch outcome in implantable cardioverter-defibrillator therapy (DO-IT): registry design and baseline characteristics of a prospective observational cohort study to predict appropriate indication for implantable cardioverter-defibrillator
Auteurs: M. van Barreveld, M. G. W. Dijkgraaf, M. Hulleman, L. V. A. Boersma, P. P. H. M. Delnoy, M. Meine, A. E. Tuinenburg, D. A. M. J. Theuns, P. H. van der Voort, G. P. Kimman, E. Buskens, J. P. G. Tijssen, N. Bruinsma, T. E. Verstraelen, A. H. Zwinderman, P. H. F. M. van Dessel, A. A. M. Wilde, on behalf of the DO-IT investigators
Gepubliceerd in: Netherlands Heart Journal | Uitgave 10/2017
Design and study population
Baseline and follow-up data
Data and adverse event management
Sample size/power
Research aim 1: prediction rules
Research aim 2: economic evaluation
Zoek in dit artikel
Implantable cardioverter-defibrillators (ICDs) are widely used for the prevention of sudden cardiac death. At present, both clinical benefit and cost-effectiveness of ICD therapy in primary prevention patients are topics of discussion, as only a minority of these patients will eventually receive appropriate ICD therapy.
The DO-IT Registry is a nationwide prospective cohort with a target enrolment of 1,500 primary prevention ICD patients with reduced left ventricular function in a setting of structural heart disease. The primary outcome measures are death and appropriate ICD therapy for ventricular tachyarrhythmias. Secondary outcome measures are inappropriate ICD therapy, death of any cause, hospitalisation for ICD related complications and for cardiovascular reasons. As of December 2016, data on demographic, clinical, and ICD characteristics of 1,468 patients have been collected. Follow-up will continue up to 24 months after inclusion of the last patient. During follow-up, clinical and ICD data are collected based on the normal follow-up of these patients, assuming ICD interrogations take place every six months and clinical follow-up is once a year. At baseline, the mean age was 66 (standard deviation [SD] 10) years and 27% were women.
The DO-IT Registry represents a real-world nationwide cohort of patients receiving ICDs for primary prevention of sudden cardiac death with reduced left ventricular function in a setting of structural heart disease. The registry investigates the efficacy of the current practice and aims to develop prediction rules to identify subgroups who will not (sufficiently) benefit from ICD implantation and to provide results regarding costs and budget impact of targeted supply of primary preventions ICDs.
The author's affiliations and complete list of investigators is provided in the online supplementary material. In addition, more detailed infomation is given regarding the collected parameters and planned data analysis for the economic evaluation
The online version of this article (doi: 10.1007/s12471-017-1016-x) contains supplementary material, which is available to authorized users.
A complete list of investigators in the DO-IT Registry is provided in the online supplementary material.
Since its introduction in 1980, the implantable cardioverter-defibrillator (ICD) has become a generally accepted therapy for the prevention of sudden cardiac death (SCD) [ 1 ]. Its efficacy was demonstrated in both primary and secondary prevention settings [ 2 ‐ 8 ]. Current international guidelines consider primary prevention ICD implantation as a class I indication in patients with New York Heart Association (NYHA) class II or III heart failure with ischaemic or non-ischaemic aetiology and left ventricular dysfunction (left ventricular ejection fraction (LVEF) of ≤35%). A class I indication is also recommended for patients with an LVEF ≤ 30% and NYHA I functional capacity [ 9 , 10 ].
At present, both clinical benefit and cost-effectiveness of ICD therapy in patients with a primary prevention indication of SCD are being discussed. During mid-term follow-up, approximately two thirds of primary prevention ICD patients will never receive appropriate therapy for ventricular arrhythmias [ 3 , 11 ‐ 13 ]. They remain at risk of inappropriate shocks and device complications [ 14 ‐ 16 ], which may impair recipients' quality of life [ 17 ]. Furthermore, primary prevention randomised control trials (RCTs) were designed and started enrolling patients in the late nineties of the previous century. Both treatment of acute myocardial infarction (primary percutaneous intervention as opposed to thrombolysis) and treatment of heart failure have changed considerably. Today, the question arises whether primary prevention patients will be subject to the same number of appropriate shocks and will experience a similar relative risk reduction as patients in these 'older' RCTs.
Additionally, there is the ongoing debate whether LVEF values and NYHA functional classes are sufficiently accurate selection criteria for prognostic stratification of SCD risk. Consequently, there is a strong need to improve the current selection criteria for primary prevention ICD treatment in this setting [ 18 ‐ 23 ]. In Europe alone, two prospectively designed cohort studies for improved risk stratification are ongoing [ 24 , 25 ].
Cost-effectiveness studies show a wide variation in benefit, raising doubt about the efficiency, also regarding costs, of ICD therapy. ICD therapy appears to be only cost-effective in selected patient groups and seems to be related to the number of risk factors present for SCD [ 22 , 26 ‐ 31 ]. Risk stratification before ICD implantation is important from both a medical and an economic standpoint.
The DO-IT Registry aims to prospectively register the efficacy of implantation of primary prevention ICDs in order to develop prediction rules to identify subgroups who will not, or not yet, sufficiently or not at all, benefit from ICD implantation for primary prevention of SCD within two years of follow-up. What constitutes 'sufficiently' will be defined in a joint effort with a Dutch convenience sample of ethicists, patient representatives, cardiologists, health care insurers, health care policymakers, and key opinion leaders. Additionally, we aim to assess the costs and budget impact of targeted supply of ICD implantation in primary prevention patients. This article provides an overview of the DO-IT Registry design, a cohort description and describes the planned statistical analyses.
Since September 2014, the DO-IT Registry documents the current nationwide practice of ICD implantation in the primary prevention of SCD with reduced left ventricular function in a setting of structural heart disease. We planned to collect data on demographic, clinical, and ICD characteristics of 1,500 consecutively recruited patients in all 28 ICD implanting centres in the Netherlands. Currently, we are collecting follow-up data up to 24 months after inclusion of the last patient. The inclusion and exclusion criteria are shown in Tab. 1. The inclusion criteria are based on current guidelines (e. g. before 2014) for primary prevention ICD implantation [ 9 , 10 ]. The LVEF assessment method was at the discretion of the local centre. The registry has been approved by the institutional review boards of all participating hospitals.
Inclusion and Exclusion Criteria
ICD implantation for primary prevention of sudden cardiac death
LVEF ≤35% and NYHA ≤ III or LVEF ≤30% and NYHA I
Life expectancy ≥1 year
≥40 days after myocardial infarction
≥90 days after revascularisation procedure
Optimal pharmacological heart failure treatment
Secondary prevention
ICD generator replacement
Inability or unwillingness to provide valid informed consent
ICD implantable cardioverter-defibrillator, LVEF left ventricular ejection fraction, NYHA New York Heart Association
Cardiologists, electrophysiologists, biostatisticians and health economists have jointly defined the relevant data set, in view of existing literature on possible predictors for SCD. Electronic case report forms (e-CRFs) were generated using an open source web-based software platform OpenClinica [ 32 ] in compliance with good clinical practice. By randomly generating a unique identification number, the anonymity of the patient is maintained. Data of the patient are collected from medical records and entered into the eCRF. All participating sites access the registry via a personal password protected login procedure and can only access the records of the patients of their own centre. We provided the participating centres with a sequential set of instructions for data entry and offered a training, if needed.
We collected baseline data on demographics, medical history and diagnostics, as well as implantation and device data. We collected clinical and ICD follow-up data, based on the normal follow-up of these patients assuming ICD interrogations take place every six months and clinical follow-up is once a year. Every six months, we register occurrence of ventricular arrhythmias and data regarding ICD therapies. ICD therapy is defined as anti-tachycardia pacing (ATP) and defibrillator shocks. During clinical follow-up, medical history, functional status, cardiovascular hospitalisations and performed procedures and diagnostics of the past year are entered into the registry. In addition, the participating hospitals report adverse events, defined as ICD related complications and deaths of any cause. Events such as death, arrhythmias, cardiovascular hospitalisations, cardiac interventions, diagnostic procedures and laboratory parameters between last follow-up visit and death are documented. Medical documentation around the time of death and ICD interrogations are collected, whenever possible. A more detailed list of the collected parameters is provided in the online supplementary material.
Verification rules and edit checks have been built into the system to validate completeness, accuracy and consistency of the dataset. Data quality is also maintained by online and on-site monitoring and continuous assessment of data quality during the export of datasets to statistical packages for subsequent analysis. A monitor plan is used which describes whether outcomes and variables need to be monitored entirely. This decision depends on the expected role of the variable in the prediction models, expected frequency of mistakes and the time needed to monitor the variable. The site investigator is required to maintain adequate records to ensure the manner in which the registry is conducted is well documented. The investigator should keep the records on file for a period of time specified by local law for the preservation of hospital documents. If requested, the investigator supplies the monitor with any required data.
A steering committee, represented by cardiologists of the participating hospitals, is responsible for the scientific integrity and the way that the study is conducted and advises the registry coordinating centre, when needed. A clinical event committee, consisting of independent cardiologists, assesses all ICD delivered therapies by analysing stored electrograms. The committee also determines whether deaths are of cardiac origin.
The primary outcome measures of the DO-IT Registry are death and appropriate ICD therapy for ventricular tachycardia (VT) or ventricular fibrillation. Secondary outcome measures are inappropriate ICD therapy, death of any cause, hospitalisation for ICD related complications and cardiovascular reasons.
The registry has a target enrolment of 1,500 patients with a follow-up of at least two years. Based on the latest RCT's and literature [ 3 , 8 ] we expect to observe 150 (10%) patients with appropriate shocks. In combination with 150 fatalities (5% per year), these are sufficient to develop prediction rules.
The incidence for the outcomes of appropriate ICD therapy and death are illustrated by Kaplan-Meier curves. Cox regression models with baseline characteristics of patients are developed to predict the outcomes of death or appropriate ICD therapy over time, considering the competing risk. The risk models will be developed according to the methods that have been used in the paper on the widely accepted 'MADIT-II risk score' for primary therapy with an ICD [ 33 ]. First, we will develop a model with important baseline characteristics, selected from previous publications on ICD mortality risk stratification and appropriate ICD therapy. We will consider age, gender, body mass index, LVEF, NYHA class, prior (<1-year) heart failure hospitalisation, history of atrial fibrillation and non-sustained VT, renal function, diabetes mellitus, smoking history, pulmonary disease and electrocardiographic parameters. Next, we will identify further factors, such as events during follow-up (complications and appropriate shock), that might improve prediction of the primary outcomes in exploratory analyses. The validity of the resulting predictor sets will be assessed by bootstrapping. A total of 200 bootstrap regression analyses will be performed for internal cross validation. The predictive values of the prediction models will be quantified using c‑statistics.
A cost-minimisation analysis and a budget impact of targeted supply of ICD implantation will be performed. This economic evaluation will compare targeted supply of ICD implantation based on new prediction rules with current practice as reflected in the DO-IT Registry. Targeted supply, however, is not registered; no ICD implantation is withheld from patients who meet the current guidelines. That is why we are not able to observe what would have happened to these patients had they not received an ICD. To circumvent the missing data, the economic evaluation will be conducted as a modelling study, and assuming that not performing unnecessary ICD implantations does not affect health outcomes, only costs, except for temporal implantation related complications. These assumptions are realistic, but depend on the quality of the prediction rules. That is why we will develop prediction rules which can be applied in a way that will minimise the number of false negative predictions. Further details regarding the cost-minimisation and budget impact analysis are provided in the online supplementary material.
Between September 10th, 2014 and May 13th, 2016, 1,619 patients were assessed for eligibility. A flowchart of the study participants is presented in Fig. 1. Sixty-nine patients refused to participate. Data of 1,550 patients were initially entered into the registry. However, 82 patients were excluded because they did not meet the inclusion criteria for various reasons. Although 153 patients did not fully meet the inclusion criteria, we decided that these patients should remain in the registry because they received their ICD in context of primary prevention with a reduced LVEF in a setting of structural heart disease and were assumed to be a clinical relevant subgroup. Therefore, 1,468 patients in total were included in the DO-IT Registry.
Flowchart of study participants
The baseline characteristics are presented in Tab. 2. Overall, 1,468 patients received their first ICD (single-chamber or dual-chamber), subcutaneous ICD (S-ICD) or cardiac resynchronisation therapy defibrillator (CRT-D) for primary prevention of SCD (32%, 16%, 9% and 43%, respectively). Seventy-three percent of patients were men and the mean age at implantation was 66 (SD 10) years. The mean LVEF was 26% and more than half of the patients (61%) experienced NYHA class II heart failure symptoms. Most patients, 56%, had ischaemic heart disease. The remaining 641 (44%) patients were considered non-ischaemic.
Comparison of patient characteristics of DO-IT Registry (date) with ICD arms of MADIT II and SCD-HeFT Trial
Patient characteristics
DO-IT (n = 1,461a)
DO-IT (n = 1,308, 153 patients excluded)
SCD-HeFT
(n = 829)
MADIT II
Median (IQR)
(68) (60–73)
Men (%)
LVEF
NYHA
I (%)
II (%)
III (%)
Unknown (%)
Ischaemic cardiomyopathy (%)
Diabetes (%)
Hypertension (%)
Atrial fibrillation (%)
Data are presented as mean (standard deviation) or median (25th–75th percentiles)
DO-IT Dutch Outcome in ICD therapy,ICD implantable cardioverter-defibrillator, SCD-HeFT Sudden Cardiac Death in Heart Failure Trial, MADIT II Multicentre Automatic Defibrillator Implantation Trial-II, IQR interquartile range, LVEF left ventricular ejection fraction, NYHA New York Heart Association
aPreliminary data as of February 13, 2017.
In this article, we describe the design, cohort and planned analysis of the DO-IT Registry. This nationwide prospective registry aims to identify patients who will benefit most, or who will benefit the least, from ICD implantation. It further aims to assess the costs and budget impact of targeted supply of primary prevention ICDs. This is one of the largest prospective cohorts of primary prevention ICD patients, with a nationwide participation of all ICD implanting centres in the Netherlands. This research reflects current clinical practice and will provide real-world outcomes in the general population.
There are some differences between the baseline characteristics of the DO-IT patients and the patients included in the largest RCTs, MADIT II [ 8 ] and SCD-HEFT [ 3 ] (Tab. 2). Overall, DO-IT patients are older, more often female, and have higher LVEF. More patients have NYHA II symptomatic heart failure compared with MADIT II patients.
We enrolled 153 patients who did not fully meet the ACC/AHA/ESC Class I indication for primary prevention ICD implantation. The DO-IT Registry was designed to capture all primary prevention ICD patients. If the reason for ICD implantation was primary prevention for reduced LVEF in the setting of structural heart disease, patients were not excluded from the registry. Prior analyses of other primary prevention ICD registries also show that a proportion of patients do not meet trial inclusion criteria [ 34 , 35 ]. Further analyses of these patients could clarify the event rate in this group, and might elucidate common risk factors that led to the decision to implant an ICD without a clear Class I indication.
As expected, the registry has limitations [ 36 , 37 ]. First, there is no control group with eligible patients who did not receive an ICD. However, the findings can be evaluated within the context of the previous RCTs or other registries. Second, there is a possibility of underreporting or misreporting, because data in registries are often collected more passively and monitored less strictly compared with RCTs. Third, patients should be included consecutively. However, the inclusion of patients was not controlled. For instance, sites may have been unable to enrol all eligible patients or simply have forgotten to register one. In addition, physicians may have been more likely to exclude patients with uncertain benefit of ICD implantation, which results in selection bias. However, we built in quality and control checks and online and on-site monitoring to ensure that the data is representative and of adequate quality.
Some recent articles are not discussed in the content of this paper because they were published later than the setup of the DO-IT Registry [ 38 ‐ 40 ]. However, these studies also emphasise the need for improved selection of patients for primary ICD therapy since most patients do not experience benefit.
Although the DO-IT Registry is designed and funded for an initial follow-up duration of two years after inclusion of the last patient, other studies show that patients might benefit from primary prevention ICD therapy with follow-up longer than two years [ 11 , 41 ]. However, additional post cohort projections and hypothetical modelling are anticipated. Moreover, the DO-IT Registry intends to extend the observation period if cooperation of the participating hospitals and additional funding can be arranged.
At present, the indication for primary prevention defibrillators may not be optimal. Many patients do not receive appropriate ICD therapy, but are at risk of inappropriate shocks, device complications, or die without ever needing their ICD. The DO-IT Registry is a large nationwide cohort, consisting of patients receiving ICDs for primary prevention of SCD. Despite the limitations, we expect that the DO-IT Registry will identify subgroups of patients who will not, or not yet, sufficiently benefit from ICD implantation for primary prevention. We also expect that the registry will provide results regarding the costs and budget impact of targeted supply of primary preventions ICDs. Because of real-life data, the findings of this study should be representative and are likely to affect the current risk stratification of SCD.
This work was supported by ZONMW 837004009; Zorginstituut Nederland.
M. van Barreveld, M.G.W. Dijkgraaf, M. Hulleman, L.V.A. Boersma, P.P.H.M. Delnoy, M. Meine, A.E. Tuinenburg, D.A.M.J. Theuns, P.H. van der Voort, G.P. Kimman, E. Buskens, J.P.G. Tijssen, N. Bruinsma, T.E. Verstraelen, A.H. Zwinderman, P.H.F.M. van Dessel and A.A.M. Wilde declare that they have no competing interests.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
vorige artikel Current practice of Dutch cardiologists in detecting and diagnosing atrial fibrillation: results of an online case vignette study
volgende artikel Trends in service time of pacemakers in the Netherlands: a long-term nationwide follow-up study
Caption Electronic Supplementary Material
go back to reference Mirowski M, Reid PR, Mower MM, et al. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med. 1980;303:322–4. CrossRefPubMed Mirowski M, Reid PR, Mower MM, et al. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med. 1980;303:322–4. CrossRefPubMed
go back to reference The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. 1997;337:1576–83. CrossRef The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. 1997;337:1576–83. CrossRef
go back to reference Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:225–37. CrossRefPubMed Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:225–37. CrossRefPubMed
go back to reference Connolly SJ, Gent M, Roberts RS, et al. Canadian implantable defibrillator study (CIDS): a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation. 2000;101:1297–302. CrossRefPubMed Connolly SJ, Gent M, Roberts RS, et al. Canadian implantable defibrillator study (CIDS): a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation. 2000;101:1297–302. CrossRefPubMed
go back to reference Kadish A, Dyer A, Daubert JP, et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med. 2004;350:2151–8. CrossRefPubMed Kadish A, Dyer A, Daubert JP, et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med. 2004;350:2151–8. CrossRefPubMed
go back to reference Kuck KH, Cappato R, Siebels J, Ruppel R. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: the Cardiac Arrest Study Hamburg (CASH). Circulation. 2000;102:748–54. CrossRefPubMed Kuck KH, Cappato R, Siebels J, Ruppel R. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: the Cardiac Arrest Study Hamburg (CASH). Circulation. 2000;102:748–54. CrossRefPubMed
go back to reference Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med. 1996;335:1933–40. CrossRefPubMed Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med. 1996;335:1933–40. CrossRefPubMed
go back to reference Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877–83. CrossRefPubMed Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877–83. CrossRefPubMed
go back to reference McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33:1787–847. CrossRefPubMed McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33:1787–847. CrossRefPubMed
go back to reference Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147–239. CrossRefPubMed Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147–239. CrossRefPubMed
go back to reference Koller MT, Schaer B, Wolbers M, et al. Death without prior appropriate implantable cardioverter-defibrillator therapy: a competing risk study. Circulation. 2008;117:1918–26. CrossRefPubMed Koller MT, Schaer B, Wolbers M, et al. Death without prior appropriate implantable cardioverter-defibrillator therapy: a competing risk study. Circulation. 2008;117:1918–26. CrossRefPubMed
go back to reference Moss AJ, Greenberg H, Case RB, et al. Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation. 2004;110:3760–5. CrossRefPubMed Moss AJ, Greenberg H, Case RB, et al. Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation. 2004;110:3760–5. CrossRefPubMed
go back to reference van Rees JB, Borleffs CJ, van Welsenes GH, et al. Clinical prediction model for death prior to appropriate therapy in primary prevention implantable cardioverter defibrillator patients with ischaemic heart disease: the FADES risk score. Heart. 2012;98:872–7. CrossRefPubMed van Rees JB, Borleffs CJ, van Welsenes GH, et al. Clinical prediction model for death prior to appropriate therapy in primary prevention implantable cardioverter defibrillator patients with ischaemic heart disease: the FADES risk score. Heart. 2012;98:872–7. CrossRefPubMed
go back to reference Brignole M. Are complications of implantable defibrillators under-estimated and benefits over-estimated? Europace. 2009;11:1129–33. CrossRefPubMed Brignole M. Are complications of implantable defibrillators under-estimated and benefits over-estimated? Europace. 2009;11:1129–33. CrossRefPubMed
go back to reference Poole JE, Johnson GW, Hellkamp AS, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008;359:1009–17. CrossRefPubMedPubMedCentral Poole JE, Johnson GW, Hellkamp AS, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008;359:1009–17. CrossRefPubMedPubMedCentral
go back to reference van Rees JB, Borleffs CJ, de Bie MK, et al. Inappropriate implantable cardioverter-defibrillator shocks: incidence, predictors, and impact on mortality. J Am Coll Cardiol. 2011;57:556–62. CrossRefPubMed van Rees JB, Borleffs CJ, de Bie MK, et al. Inappropriate implantable cardioverter-defibrillator shocks: incidence, predictors, and impact on mortality. J Am Coll Cardiol. 2011;57:556–62. CrossRefPubMed
go back to reference Groeneveld PW, Matta MA, Suh JJ, Heidenreich PA, Shea JA. Costs and quality-of-life effects of implantable cardioverter-defibrillators. Am J Cardiol. 2006;98:1409–15. CrossRefPubMed Groeneveld PW, Matta MA, Suh JJ, Heidenreich PA, Shea JA. Costs and quality-of-life effects of implantable cardioverter-defibrillators. Am J Cardiol. 2006;98:1409–15. CrossRefPubMed
go back to reference Bracke FA, Dekker LR, van der Voort PH, Meijer A. Primary prevention with the ICD in clinical practice: not as straightforward as the guidelines suggest? Neth Heart J. 2009;17:107–10. CrossRefPubMedPubMedCentral Bracke FA, Dekker LR, van der Voort PH, Meijer A. Primary prevention with the ICD in clinical practice: not as straightforward as the guidelines suggest? Neth Heart J. 2009;17:107–10. CrossRefPubMedPubMedCentral
go back to reference Buxton AE, Lee KL, Hafley GE, et al. Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: lessons from the MUSTT study. J Am Coll Cardiol. 2007;50:1150–7. CrossRefPubMed Buxton AE, Lee KL, Hafley GE, et al. Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: lessons from the MUSTT study. J Am Coll Cardiol. 2007;50:1150–7. CrossRefPubMed
go back to reference Disertori M, Quintarelli S, Mazzola S, et al. The need to modify patient selection to improve the benefits of implantable cardioverter-defibrillator for primary prevention of sudden death in non-ischaemic dilated cardiomyopathy. Europace. 2013;15:1693–701. CrossRefPubMed Disertori M, Quintarelli S, Mazzola S, et al. The need to modify patient selection to improve the benefits of implantable cardioverter-defibrillator for primary prevention of sudden death in non-ischaemic dilated cardiomyopathy. Europace. 2013;15:1693–701. CrossRefPubMed
go back to reference Stecker EC, Vickers C, Waltz J, et al. Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study. J Am Coll Cardiol. 2006;47:1161–6. CrossRefPubMed Stecker EC, Vickers C, Waltz J, et al. Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study. J Am Coll Cardiol. 2006;47:1161–6. CrossRefPubMed
go back to reference Tung R, Zimetbaum P, Josephson ME. A critical appraisal of implantable cardioverter-defibrillator therapy for the prevention of sudden cardiac death. J Am Coll Cardiol. 2008;52:1111–21. doi: 10.1016/j.jacc.2008.05.058. CrossRefPubMed Tung R, Zimetbaum P, Josephson ME. A critical appraisal of implantable cardioverter-defibrillator therapy for the prevention of sudden cardiac death. J Am Coll Cardiol. 2008;52:1111–21. doi: 10.1016/j.jacc.2008.05.058. CrossRefPubMed
go back to reference Yap YG, Duong T, Bland JM, et al. Optimising the dichotomy limit for left ventricular ejection fraction in selecting patients for defibrillator therapy after myocardial infarction. Heart. 2007;93:832–6. CrossRefPubMedPubMedCentral Yap YG, Duong T, Bland JM, et al. Optimising the dichotomy limit for left ventricular ejection fraction in selecting patients for defibrillator therapy after myocardial infarction. Heart. 2007;93:832–6. CrossRefPubMedPubMedCentral
go back to reference Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators in Europe (EU-CERT-ICD) [cited 2014 20 August]. Available from: https://clinicaltrials.gov/ct2/show/NCT02064192. Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators in Europe (EU-CERT-ICD) [cited 2014 20 August]. Available from: https://clinicaltrials.gov/ct2/show/NCT02064192.
go back to reference Efficacy of Implantable Cardioverter Defibrillator in Patients With Non-ischemic Systolic Heart Failure on Mortality (DANISH) [cited 2014 20 August]. Available from: https://clinicaltrials.gov/ct2/show/NCT00541268. Efficacy of Implantable Cardioverter Defibrillator in Patients With Non-ischemic Systolic Heart Failure on Mortality (DANISH) [cited 2014 20 August]. Available from: https://clinicaltrials.gov/ct2/show/NCT00541268.
go back to reference Cowie MR, Marshall D, Drummond M, et al. Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population. Europace. 2009;11:716–26. CrossRefPubMed Cowie MR, Marshall D, Drummond M, et al. Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population. Europace. 2009;11:716–26. CrossRefPubMed
go back to reference Mark DB, Nelson CL, Anstrom KJ, et al. Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). Circulation. 2006;114:135–42. CrossRefPubMed Mark DB, Nelson CL, Anstrom KJ, et al. Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). Circulation. 2006;114:135–42. CrossRefPubMed
go back to reference Sanders GD, Hlatky MA, Owens DK. Cost-effectiveness of implantable cardioverter-defibrillators. N Engl J Med. 2005;353:1471–80. CrossRefPubMed Sanders GD, Hlatky MA, Owens DK. Cost-effectiveness of implantable cardioverter-defibrillators. N Engl J Med. 2005;353:1471–80. CrossRefPubMed
go back to reference Sheldon R, O'Brien BJ, Blackhouse G, et al. Effect of clinical risk stratification on cost-effectiveness of the implantable cardioverter-defibrillator: the Canadian implantable defibrillator study. Circulation. 2001;104:1622–6. CrossRefPubMed Sheldon R, O'Brien BJ, Blackhouse G, et al. Effect of clinical risk stratification on cost-effectiveness of the implantable cardioverter-defibrillator: the Canadian implantable defibrillator study. Circulation. 2001;104:1622–6. CrossRefPubMed
go back to reference Smith T, Jordaens L, Theuns DA, et al. The cost-effectiveness of primary prophylactic implantable defibrillator therapy in patients with ischaemic or non-ischaemic heart disease: a European analysis. Eur Heart J. 2013;34:211–9. CrossRefPubMed Smith T, Jordaens L, Theuns DA, et al. The cost-effectiveness of primary prophylactic implantable defibrillator therapy in patients with ischaemic or non-ischaemic heart disease: a European analysis. Eur Heart J. 2013;34:211–9. CrossRefPubMed
go back to reference Zwanziger J, Hall WJ, Dick AW, et al. The cost effectiveness of implantable cardioverter-defibrillators: results from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. J Am Coll Cardiol. 2006;47:2310–8. CrossRefPubMed Zwanziger J, Hall WJ, Dick AW, et al. The cost effectiveness of implantable cardioverter-defibrillators: results from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. J Am Coll Cardiol. 2006;47:2310–8. CrossRefPubMed
go back to reference OpenClinica Open Source EDC n. d. Available from: https://www.openclinica.com/. Accessed 9 November 2016. OpenClinica Open Source EDC n. d. Available from: https://www.openclinica.com/. Accessed 9 November 2016.
go back to reference Goldenberg I, Vyas AK, Hall WJ, et al. Risk stratification for primary implantation of a cardioverter-defibrillator in patients with ischemic left ventricular dysfunction. J Am Coll Cardiol. 2008;51:288–96. CrossRefPubMed Goldenberg I, Vyas AK, Hall WJ, et al. Risk stratification for primary implantation of a cardioverter-defibrillator in patients with ischemic left ventricular dysfunction. J Am Coll Cardiol. 2008;51:288–96. CrossRefPubMed
go back to reference Al-Khatib SM, Hellkamp A, Curtis J, et al. Non-evidence-based ICD implantations in the United States. JAMA. 2011;305:43–9. CrossRefPubMedPubMedCentral Al-Khatib SM, Hellkamp A, Curtis J, et al. Non-evidence-based ICD implantations in the United States. JAMA. 2011;305:43–9. CrossRefPubMedPubMedCentral
go back to reference Lee DS, Birnie D, Cameron D, et al. Design and implementation of a population-based registry of Implantable Cardioverter Defibrillators (ICDs) in Ontario. Heart Rhythm. 2008;5:1250–6. CrossRefPubMed Lee DS, Birnie D, Cameron D, et al. Design and implementation of a population-based registry of Implantable Cardioverter Defibrillators (ICDs) in Ontario. Heart Rhythm. 2008;5:1250–6. CrossRefPubMed
go back to reference Krumholz HM. Registries and selectio bias. The need for accountability. Circ Cardiovasc Qual Outcomes. 2009;2(6):517–8. CrossRefPubMed Krumholz HM. Registries and selectio bias. The need for accountability. Circ Cardiovasc Qual Outcomes. 2009;2(6):517–8. CrossRefPubMed
go back to reference Roovers JP. Registries: what level of evidence do they provide? Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1119–20. CrossRefPubMedPubMedCentral Roovers JP. Registries: what level of evidence do they provide? Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1119–20. CrossRefPubMedPubMedCentral
go back to reference Lee DS, Hardy J, Yee R, et al. Clinical risk stratification for primary prevention Implantable Cardioverter Defibrillators. Circ Heart Fail. 2015;8:927–37. CrossRefPubMedPubMedCentral Lee DS, Hardy J, Yee R, et al. Clinical risk stratification for primary prevention Implantable Cardioverter Defibrillators. Circ Heart Fail. 2015;8:927–37. CrossRefPubMedPubMedCentral
go back to reference Sabbag A, Suleiman M, Laish-Farkash A, et al. Contemporary rates of appropriate shock therapy in patients who receive implantable device therapy in a real-world setting: From the Israeli ICD Registry. Heart Rhythm. 2015;12:2426–33. CrossRefPubMed Sabbag A, Suleiman M, Laish-Farkash A, et al. Contemporary rates of appropriate shock therapy in patients who receive implantable device therapy in a real-world setting: From the Israeli ICD Registry. Heart Rhythm. 2015;12:2426–33. CrossRefPubMed
go back to reference Kober L, Thune JJ, Nielsen JC, et al. Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. N Engl J Med. 2016;375:1221-30. Kober L, Thune JJ, Nielsen JC, et al. Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. N Engl J Med. 2016;375:1221-30.
go back to reference Goldenberg I, Gillespie J, Moss AJ, et al. Long-term benefit of primary prevention with an implantable cardioverter-defibrillator: an extended 8‑year follow-up study of the Multicenter Automatic Defibrillator Implantation Trial II. Circulation. 2010;122:1265–71. CrossRefPubMed Goldenberg I, Gillespie J, Moss AJ, et al. Long-term benefit of primary prevention with an implantable cardioverter-defibrillator: an extended 8‑year follow-up study of the Multicenter Automatic Defibrillator Implantation Trial II. Circulation. 2010;122:1265–71. CrossRefPubMed
M. van Barreveld
M. G. W. Dijkgraaf
M. Hulleman
L. V. A. Boersma
P. P. H. M. Delnoy
M. Meine
A. E. Tuinenburg
D. A. M. J. Theuns
P. H. van der Voort
G. P. Kimman
E. Buskens
J. P. G. Tijssen
N. Bruinsma
T. E. Verstraelen
A. H. Zwinderman
P. H. F. M. van Dessel
A. A. M. Wilde
on behalf of the DO-IT investigators
Netherlands Heart Journal / Uitgave 10/2017
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Original Article - E‑Learning
Real-life use of Rivaroxaban in the Netherlands: data from the Xarelto for Prevention of Stroke in Patients with Atrial Fibrillation (XANTUS) registry
A decade of atrial fibrillation ablation
Current practice of Dutch cardiologists in detecting and diagnosing atrial fibrillation: results of an online case vignette study


Come check out my live stream, Im streaming on PS4 playing BO3 Zombies, maybe some fortnite later! Dont forget to follow!
Reply with your PSN if you want to join!
Been watching you a while man, I would follow you but ain't got an account but still loved the stream. It's nice to see some old school zombies stream as you don't see a lot of it around these days.


I've never had such a day before, but this is amazing how a day can unfold.
I have to admit $258 of it didn't come from my site, but it's from one of my Instagram accounts.
I've built a Disney account that has over 106K followers and I finally closed a sponsorship deal yesterday for 2 posts on it.
The rest did come from my website and I even made $45 from a product I HIGHLY did NOT recommend and they still bought it!!
Grace you are the one to follow to make it in WA, I celebrate your success and I know if we keep putting in place everything that we have learned, we'll see what you are witnessing right now. Oh, I feel so happy for you because if we keep working hard that's what we can expect too. Congrats, you did it!
Thanks very much Eugene! Indeed you could look forward to days like that too!
Thank you, check out my latest results here too: Apr'18 Results: 358 Referrals Plus Many Milestones!
That is awesome Grace! congratulations and I wish you endless more days just like this and better. I hope that some day I will be able to report something similar.
Thanks for your well wishes and support!!
That's awesome. You tell them not to buy and they hand you $45 on a plate anyway.
That's great! I always love reading about your success Grace, you're such a great motivator.
Appreciate this, thanks very much!
Congratulations! I just had a look at your amazon store...it is lovely.
I thought only Disney can sell their own products. Didn't know its possible to sell on their behalf.
I'm sure you will achieve this too, just keep writing and using low hanging fruit keywords.
Great stuff Grace, makes it all worthwhile when you see results like this.
Thanks for sharing and congrats !!!!
Congratulations. When you are on a roll, you are on a roll. This shows accomplishments come from unforeseen places. Enjoy!
Awesome! Congrats. Keep it going!
Congratulations, well done. Sweet Mickey page. Wow over 106.000 fans, how long does it take to get so many followers?
You are going to have a good 2018 I see.
Thank you Stefan! My account is 2 years old in April.
This is great news, thanks for sharing!
Congratulations! Hope it's the first of many more to come!
Nice Grace. Thanks for sharing. Well done.
Way to go, Grace! That's awesome!
Well, got to get ready! use my site for reflection: rovingretirees.org!
Way to go!! You inspire me!!
Congratulations, Grace! That is another great stream of income to have.
Sound great Grace:) Up to more successful sales!
love this good news. Cheers!
Wow, this is amazing!! Congrats =) Could you share some Instagram tips?
Thank you Miren, sure I can I will PM you.
106k Instagram followers! - You're a true Instagram Influencer. With that kind of following you should be able to get more sponsorship deals like that, and ones that probably pay heaps more too.
Congratulations! You are doing an awesome job...keep it up!!
Congrats on the sponsorship and the sale.
Hey Grace, congrats AGAIN. You rock!
I love Disney & Mickey Mouse!!!
Congrats Grace, your bussiness ideas never sieze to amaze me.. keep moving forward and encouraging us.
That is awesome! I was just debating doing a review on a product I am not really happy with. This helps to decide to do that.
Congrats on your success, may it continue tenfold!
WOW! You are really on fire. Congratulations, and keep on going.
Thank you very much Delores. :) I do, I will keep working hard!
That's AWESOME Grace! So Happy for you!!!!
All your hard work is paying off, Keep up the great work and I wish you even greater success going forward every day!
Grace, Wow! It's time for another Celebration!!!
I shall break out the champagne! You go little mama!
You got it my dear! Lets keep it forward and positive!
We're celebrating with you, congratulations!
Way to go! Marching on!!!
Thanks Ronnie, did I beat your March 1 income? LOL. Probably not!
What a great start to your month!! Congratulations - and hope it continues like this for you. You deserve it!
Yes the fans are crazy and has high engagement!
Yeah I have Mickey Mouse on my Apple Watch and i used to go to Disney world as a child. Maybe I'll do Disney and royal Caribbean cruises . How did you build your webpage?
You mean how did I build my Instagram page? It's not a webpage. I just curate content from other IG users and I tag them in the photo to give them credit plus I also give them second credit in my caption.
Thank you and glad I can remind you! :) It's definitely important.
Awesome Grace, and the month has only just started keep on charging.
Thanks so much Alex, I hope March will be an amazing one!
That's fantastic! I hope your month continues like this!
Great Job Grace! Keep on keeping on!!
Thank you Denis! I sure will.
Lol, that's great Zarina.. it's definitely exciting when you can build your business to a point like this! You can definitely do this too girl!
You are so right, be honest in your praise of a site or lack of praise and it will come back to reward you!
Hey Congrats on your MickeyLife and the rewards capped with your website Littlemama.
Hmmm... marching on and marching on and on...TRA la..la.
Yes! Looking for that Magical key Littlemama.
Magic key = Hard consistent work.
Way to go littlemama!!! Congratulations!
Congratulations! Inspiration for a newbie!
Thank you and so glad I can inspire! Check out my previous post about my Feb and 18 month progress: 18 Month & Feb '18 Update - Best Month Yet!
Nice! People are interesting, aren't they? They'll buy even if you don't recommend it. You never know what people will purchase. Congrats on the payday!
No no more using pics of members! LOL. thanks so much Wayne!
Well done Grace! No stopping you now.
Good for you and I like the fact that you are getting money from different sources. A very wise woman.
Genius idea to have a Disney Instagram account. Who doesn't love Disney.
Yes gotta have different sources even on your website, I have tons of other programs I promote but the main of course is here but those other programs will still make significant money when my site increases in even more traffic.
Wowee Grace, that's awesome!! Had such a giggle at the $45 you earned from a product you don't recommend. How cool is that? Super well done on the 108k followers on Instagram and sponsorship deal!
Now i want to go to Disneyland!!!


Although I am still young, I have a good idea of what I would like to do in the future. My plan is to pursue the career of journalism. Journalism is a fiercely competitive job, with many steps and strategies that can be taken to advance oneself. It does not seem easy yet the world of journalism is extremely exciting with many rewards.
There are a great deal of skills needed to become a successful journalist. First off, a sincere interest in current affairs is beneficial. Writing, reporting, and interviewing is all centered on what is happening in the world today. I will have to learn to accept traveling away from home for periods at a time to get information on future articles. Journalists often work long irregular hours. The criteria for their work is demanding, with strict deadlines. I would have to learn self discipline, and practice getting assignments completed on time.
Procrastinating will not be acceptable. Furthermore, successful journalists need to have extreme confidence, excellent communication skills, and a good command of the English language for their work has to be error free. I believe taking a public speaking class in college will help higher my confidence and communication skills, and taking a few English classes will help my grammar and mechanical writing.
WriteWork contributors. "Steps toward becoming a successful Journalist" WriteWork.com. WriteWork.com, 30 June, 2005. Web. 22 Apr. 2019.


text:
Posted inHealth
Insurers seek rate hikes for 2016 Obamacare plans, but expect members' health to stabilize
by Arielle Levin Becker May 7, 2015 @ 7:32 am Updated March 4, 2022 @ 10:38 pm
Insurance companies selling health plans through the state's health insurance exchange are seeking to raise rates next year, with average increases between 2 percent and nearly 14 percent.
But the companies' rate proposals, made public by the Connecticut Insurance Department Thursday, suggest that, although the companies anticipate higher expenses overall in 2016, they are also expecting the medical needs of those newly insured under the federal health law to stabilize.
Because Obamacare required that insurers cover anyone who wanted to buy a plan, regardless of medical history, insurers anticipated an influx of customers in 2014 who had been uninsured and would have "pent-up" medical needs that would require significant care — and expense — in their first year of coverage. The carriers indicated they don't expect those higher-than-usual needs to continue into 2016.
The health of those newly insured under the health law — and its impact on insurance costs — has been a major question since Obamacare passed. This is the first year that rate proposals have been based on the claims experience of plans sold through the exchanges to customers regardless of medical history, and the two largest exchange carriers proposed rate hikes lower than those they requested last year.
In addition, at least one company expects to gain younger members next year. ConnectiCare Benefits Inc. reported that its 2015 customers are younger than the year before, and anticipates a slightly younger population in 2016.
Despite that, the carriers projected increased costs, citing rising claims expenses and a planned reduction in protection against high-cost claims from a temporary federal program intended to provide stability for insurers during the initial years of the health law.
The rate filings are proposals, not actual changes. The insurance department will now analyze the proposals, accept public comments and issue decisions on whether the rate changes can go forward. The department could approve the rates as proposed, allow lower increases or deny any increase. Any changes allowed by the department would take effect in January 2016.
For people who buy plans through the state's exchange, Access Health CT, and use federal subsidies to discount their premiums, any rate changes won't be reflected directly in their bills. That's because the subsidies are set to ensure that people don't pay more than a certain percentage of their income for coverage. Although the prices people getting subsidies pay for coverage can vary from year to year for the same plan, those variations are not directly tied to rate changes in the specific plans.
ConnectiCare Benefits Inc., which has the most Access Health customers, requested the lowest average rate increase, 2 percent, although the actual rate change requested varies by plan. The company reported that it expects the overall health of its members to stabilize in 2016 compared to 2014, when previously uninsured people with pent-up medical needs joined the plans.
The highest average increase was requested by HealthyCT, which has some of the lowest rates on the exchange this year. HealthyCT, which began selling plans in 2014, began with some of the highest-cost plans in 2014, then lowered rates this year. For 2016, it requested an average increase of 13.96 percent for its plans sold on and off the exchange.
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Anthem Blue Cross and Blue Shield requested an average increase of 6.7 percent for all of its individual-market plans sold in Connecticut — those sold through Access Health and outside the exchange. The company cited an anticipated increase in medical claims costs in 2016, and mentioned the cost of Sovaldi and other costly Hepatitis C drugs. But the company also reported that it no longer expected higher medical costs from pent-up demand of newly insured customers.
UnitedHealthcare, which began offering plans through the exchange this year, requested an average increase of 12.4 percent. Unlike the other companies, its rates were not based on its post-Obamacare individual market experience in Connecticut, since it did not offer exchange plans to individuals in 2014.
Tagged: 2016 insurance rates, Access Health CT, Affordable Care Act, insurance
Arielle Levin Becker
alevinbecker@ctmirror.org
Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.
More by Arielle Levin Becker


Chemotherapy is the primary treatment for most mesothelioma patients. It is not an easy process by any means: common side effects include pain and severe nausea. People who are dealing with these symptoms rarely feel like eating, but good nutrition is a vital part of staying healthy enough to fight the disease. Researchers have developed some tips for cancer patients that could help them keep their weight up throughout treatment.
Protein is a dietary requirement, especially for people who are trying to keep their strength. It can be found in a variety of foods, including lean meats, nuts, eggs, and legumes.
Carbohydrates found in whole grains are a key source of energy. Try to eat pasta, whole wheat bread, rice, or hot cereal whenever possible.
There are a variety of canned shakes or drinks that contain high amounts of protein, vitamins, and minerals. They can be a good way to get the nutrition you need when you do not feel up to eating a meal.
Dehydration is a common problem for people suffering from nausea and vomiting, so be sure to drink plenty of fluids. It is not recommended that you drink a lot of fluids while eating a meal, as this can increase nausea. Instead, make sure you drink plenty of water or sports drinks throughout the day.
If you are having difficulty making yourself eat, try eating small snacks throughout the day instead of full meals. They will easier to finish and to keep down.
If you or a loved one is coping with mesothelioma due to asbestos exposure, contact the mesothelioma lawyers Williams Hart at 800-781-3955.


operator adds to the fun!
Fun moments to last a lifetime.
Your Photobooth should help make them.
You want the party festive & fun.
It can with the right photobooth.
They come once a year!
of the day with the right Photobooth.
You want it to be great!
Photobooth Association CRUSHES our Third Installment of The Photobooth Show!
This week the PBA crushed the 3rd Episode of the Photobooth Show. Presenting 9 online sessions chockful of great content to help boothers to build and grow their business. Videos will be online in the members only area very soon.
Photobooth Association set to rock the Photoboothshow!