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- Swedberg, Karl, 1944, et al.
(author)
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Successful treatment of heart failure with devices requires collaboration
- 2008
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In: European Journal of Heart Failure. - : Wiley. - 1388-9842. ; 10:12, s. 1229-35
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Journal article (peer-reviewed)abstract
- Implanted biventricular pacemakers (cardiac resynchronisation therapy, CRT) with or without implantable cardioverter defibrillators (ICD) improve survival and morbidity in some patients with chronic heart failure (CHF) who are optimally treated with pharmacologic agents according to current guidelines. Correspondingly, ICDs improve survival. However, there is only limited evidence for device treatment in certain patient subgroups, such as the impact of ICD on outcomes in patients with reduced ejection fraction in New York Heart Association (NYHA) Class I or IV heart failure. Similarly, limited evidence exists for CRT in patients with only modest QRS prolongation or only modestly reduced ejection fraction. Despite evidence for a beneficial effect of device therapy in CHF, only a minority of eligible patients are currently offered these options. Multiple reasons contribute to the underuse of these potentially life-saving therapies. A lack of adherence to guidelines by health care professionals is an important barrier. Clearly, efforts should be made to improve the standard of care and to familiarise all physicians involved in managing CHF patients with the indications and potential efficacy of these devices. Increased collaboration between structured heart failure care and pacemaker clinics as well as between electrophysiologists, heart failure clinicians, and primary care physicians is required. Such team collaborations should lead to improved care with reduced mortality and morbidity and increased cost effectiveness. Treatment strategy should be based on a structured approach tailored to local practice and national priorities.
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- Both, C., et al.
(author)
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Pied Flycatchers Ficedula hypoleuca travelling from Africa to breed in Europe: differential effects of winter and migration conditions on breeding date
- 2006
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In: ARDEA. - 0373-2266 .- 2213-1175. ; 94:3, s. 511-525
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Journal article (peer-reviewed)abstract
- In most bird species there is only a short time window available for optimal breeding due to variation in ecological conditions in a seasonal environment. Long-distance migrants must travel before they start breeding, and conditions at the wintering grounds and during migration may affect travelling speed and hence arrival and breeding dates. These effects are to a large extent determined by climate variables such as rainfall and temperature, and need to be identified to predict how well species can adapt to climate change. In this paper we analyse effects of vegetation growth on the wintering grounds and sites en route on the annual timing of breeding of 17 populations of Pied Flycatchers Ficedula hypoleuca studied between 1982–2000. Timing of breeding was largely correlated with local spring temperatures, supplemented by striking effects of African vegetation and NAO. Populations differed in the effects of vegetation growth on the wintering grounds, and on their northern African staging grounds, as well as ecological conditions in Europe as measured by the winter NAO. In general, early breeding populations (low altitude, western European populations) bred earlier in years with more vegetation in the Northern Sahel zone, as well as in Northern Africa. In contrast, late breeding populations (high altitude and northern and eastern populations) advanced their breeding dates when circumstances in Europe were more advanced (high NAO). Thus, timing of breeding in most Pied Flycatcher populations not only depends upon local circumstances, but also on conditions encountered during travelling, and these effects differ across populations dependent on the timing of travelling and breeding.
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