Browsing by Author "Lai, Chao-Lun"

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Agreement Between Automated and Human Measurements of Heart Rate in Patients With Atrial Fibrillation
(2018-09-01)
Lin, Ting-Tse
;
Wang, Chia-Ling
;
Liao, Min-Tsun
;
Lai, Chao-Lun
;
分子醫學與生物工程研究所
Background: The accuracy of heart rate (HR) measurement by automated blood pressure monitors in patients with atrial fibrillation (AF) remains unclear. The authors investigate the agreement between HR measurements by 2 automated devices and human counting in patients with AF. Methods: In 47 patients with persistent AF, HR was recorded using 2 automated blood pressure monitors: Omron M5-I and Microlife BPA100 Plus. Human counting of HR by a stethoscope was used as the reference. For each method, 3 readings were made and the mean was calculated for comparison. In addition to Wilcoxon signed rank test, the correlation between HR measurements by automated devices and human counting was determined using Spearman's rank correlation coefficient (r), and the agreement between HR measurements by both devices and human counting was validated by the Bland-Altman plot and intraclass correlation coefficient (ICC). Results: Overall, we found no significant difference in HR measurements between devices and human counting (Omron vs human counting, 81.1 +/- 11.1 vs 80.2 +/- 10.8 beats per minute [bpm]; P = .21, r = 0.911; ICC, 0.954; Microlife vs human counting, 81.3 +/- 10.8 vs 80.2 +/- 10.8 bpm; P = .22, r = 0.842; ICC, 0.912). However, in patients with HR greater than 80 bpm, the HR measured by the Microlife device was significantly higher than that measured by human counting (91.1 +/- 5.2 vs 87.1 +/- 8.6 bpm, P = .034). Conclusion: There was a high agreement between HR measurements by 2 automated devices and human counting, but the Microlife device may overestimate HR in AF patients with HR greater than 80 bpm.
Single and dual antiplatelet therapy in elderly patients of medically managed myocardial infarction
(2018-04-05)
Lin, Ting-Tse
;
Lai, Hsiu-Yun
;
Chan, K. Arnold
;
Yang, Yen-Yun
;
Lai, Chao-Lun
Backgrounds: To examine the comparative effectiveness between dual and single antiplatelet therapies in real-world, medically managed elderly patients with acute myocardial infarction (AMI). Methods: This retrospective study identified very elderly (> 85 years) patients, who were medically managed, with their first AMI from the Taiwan National Health Insurance claims database from 2007 to 2010. Patients were classified as dual antiplatelet therapy (DAPT) group, aspirin only group and clopidogrel only group. Study outcomes included all-cause death, cardiovascular death and gastrointestinal bleeding. Treating DAPT group as the reference, we employed a multivariable Cox regression model to compare the relative risks of outcomes between 3 groups using pairwise comparison approach. Results: Among 1469 patients with incident ST-elevation myocardial infarction (STEMI, 14%) or non-STEMI (86%), 390 patients were prescribed DAPT, 549 aspirin only, and 530 clopidogrel only. After 9 months of follow-up, aspirin only group had similar risks of all-cause death (adjusted HR 1.21, 95% CI 0.77-1.89, p = 0.41), cardiovascular death (adjusted HR 1.16, 95% CI 0.66-2.04, p = 0.60) and gastrointestinal bleeding (adjusted HR 1.66, 95% CI 0.77-3.57, p = 0.20) in comparison with DAPT group. Clopidogrel users had a higher risk of all-cause death (adjusted HR 1.50, 95% CI 1.00-2.25, p = 0.049) but similar risks of cardiovascular death and gastrointestinal bleeding when compared with DAPT. Conclusions: Among very elderly patients who were medically managed after AMI, single antiplatelet therapy had comparable protective effect as DAPT. But clopidogrel only strategy was associated with a higher risk of all-cause death.