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The Journal of Bone and Joint Surgery.... Feb 2023Orthostatic intolerance (OI)-type events following hip and knee arthroplasty increase the risk of falls, hospital length of stay, and health-care costs. There is a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Orthostatic intolerance (OI)-type events following hip and knee arthroplasty increase the risk of falls, hospital length of stay, and health-care costs. There is a limited understanding of the incidence of and risk factors for OI-type events in patients during the acute hospital stay. Our aim was to systematically review the incidence of and risk factors for OI-type events during the acute hospital stay following hip and knee arthroplasty.
METHODS
A systematic review and meta-analysis of studies that investigated the incidence of and risk factors for OI-type events was undertaken. A comprehensive search was performed in MEDLINE, Embase, and CINAHL from their inception to October 2021. The methodological quality of identified studies was assessed using the modified version of the Quality in Prognosis Studies (QUIPS) tool.
RESULTS
Twenty-one studies (14,055 patients) were included. The incidence was 2% to 52% for an OI event, 1% to 46% for orthostatic hypotension, and 0% to 18% for syncope/vasovagal events. Two studies reported female sex, high peak pain levels (>5 out of 10) during mobilization, postoperative use of gabapentin, and the absence of postoperative intravenous dexamethasone as risk factors. There was no consensus on the definition and assessment of an OI-type event.
CONCLUSIONS
OI-type events are common during the acute hospital stay following hip and knee arthroplasty, and 4 risk factors have been reported for OI-type events. High-quality prospective cohort studies are required to systematically and reliably determine the incidence of and risk factors for OI-type events.
LEVEL OF EVIDENCE
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Female; Orthostatic Intolerance; Prospective Studies; Arthroplasty, Replacement, Knee; Arthroplasty, Replacement, Hip; Prognosis
PubMed: 36723468
DOI: 10.2106/JBJS.22.00600 -
Clinical Autonomic Research : Official... Jun 2022Orthostatic syncope (transient loss of conscious when standing-fainting) is common and negatively impacts quality of life. Many patients with syncope report experiencing... (Review)
Review
BACKGROUND
Orthostatic syncope (transient loss of conscious when standing-fainting) is common and negatively impacts quality of life. Many patients with syncope report experiencing fatigue, sometimes with "brain fog", which may further impact their quality of life, but the incidence and severity of fatigue in patients with syncope remain unclear. In this systematic review, we report evidence on the associations between fatigue and conditions of orthostatic syncope.
METHODS
We performed a comprehensive literature search of four academic databases to identify articles that evaluated the association between orthostatic syncope [postural orthostatic tachycardia syndrome (POTS), vasovagal syncope (VVS), orthostatic hypotension (OH)] and fatigue. Studies were independently screened using a multi-stage approach by two researchers to maintain consistency and limit bias.
RESULTS
Our initial search identified 2797 articles, of which 13 met our inclusion criteria (POTS n = 10; VVS n = 1; OH n = 1; VVS and POTS n = 1). Fatigue scores were significantly higher in patients with orthostatic syncope than healthy controls, and were particularly severe in those with POTS. Fatigue associated with orthostatic syncope disorders spanned multiple domains, with each dimension contributing equally to increased fatigue. "Brain fog" was an important symptom of POTS, negatively affecting productivity and cognition. Finally, fatigue was negatively associated with mental health in patients with POTS.
CONCLUSION
In conditions of orthostatic syncope, fatigue is prevalent and debilitating, especially in patients with POTS. The consideration of fatigue in patients with orthostatic disorders is essential to improve diagnosis and management of symptoms, thus improving quality of life for affected individuals.
Topics: Fatigue; Humans; Hypotension, Orthostatic; Postural Orthostatic Tachycardia Syndrome; Quality of Life; Syncope; Syncope, Vasovagal; Tilt-Table Test
PubMed: 35689118
DOI: 10.1007/s10286-022-00868-z -
American Journal of TherapeuticsOrthostatic hypotension (OH) is a potentially debilitating condition caused by dysfunction of the autonomic nervous system, which is essential for the physiologic...
BACKGROUND
Orthostatic hypotension (OH) is a potentially debilitating condition caused by dysfunction of the autonomic nervous system, which is essential for the physiologic response to orthostatic posture. In addition to OH, autonomic dysfunction may also be associated with the development of concurrent supine hypertension (SH).
AREAS OF UNCERTAINTY
This paradoxical effect speaks to the complexity of the pathogenesis of autonomic disease and greatly complicates management of these patients. Clinicians are faced with a dilemma because aggressive treatment of orthostatic intolerance can worsen supine hypertension and attempts to control supine hypertension can worsen orthostatic intolerance.
DATA SOURCES
Systematic review of the published literature.
PREVENTION OF SUPINE HYPERTENSION
Patients should aim to avoid known stressors, perform physical maneuvers (eg, slowly getting up from bed, sleeping with head of bed elevated), manage underlying related conditions (eg, diabetes mellitus), and exercise.
MANAGEMENT OF SUPINE HYPERTENSION
With failure of conservative management, patients may advance to pharmacologic therapy. It is important to understand the underlying suspected etiology of the syndrome of supine hypertension and OH (SH-OH) to select promising pharmacologic agents. This article reviews medical treatment options to work toward achieving a better quality of life for patients afflicted with this disease. Although clonidine and beta-blockers can be used to treat hypertension without causing significant hypotension, midodrine, pyridostigmine, and droxidopa may be helpful in preventing OH.
CONCLUSION
The etiology and severity of autonomic dysfunction vary widely between patients, suggesting a need for an individualized treatment approach. Achieving perfect blood pressure control is not a realistic goal. Rather, treatment should be aimed at improving the patient's quality of life and decreasing their risk of injury and organ damage.
Topics: Droxidopa; Humans; Hypertension; Hypotension, Orthostatic; Midodrine; Quality of Life
PubMed: 31524637
DOI: 10.1097/MJT.0000000000001054 -
Clinical Parkinsonism & Related... 2021Frailty and Parkinson's disease (PD) are common conditions that increase with age. Independently, frailty and PD lead to increased morbidity and mortality for patients.... (Review)
Review
INTRODUCTION
Frailty and Parkinson's disease (PD) are common conditions that increase with age. Independently, frailty and PD lead to increased morbidity and mortality for patients. Few studies report on frailty in patients with PD. We performed a systematic review and -analysis of the prevalence, associations and outcomes of frailty in persons with PD.
METHODS
We searched four electronic databases and grey literature from inception to May 19, 2020, for articles which reported the prevalence, associations and outcomes of frailty in persons with PD.
RESULTS
One-thousand and sixty-three citations were identified, of which 127 articles were reviewed. Thirty studies were included. Twenty-eight studies were observational and the settings varied including 25 community and 5 inpatient studies.The most common frailty screening measures were the frailty phenotype and clinical frailty scale. The prevalence of frailty in PD using the FP was 0.38 (0.24-0.55) with I = 92.6% (p < 0.01). Frailty was associated with recurrent falls, cognitive impairment, dementia, orthostatic hypotension, fatigue, hallucinations, nursing home placement, dependency in activities of daily living and in-patient mortality. PD disease duration, motor impairment, non-tremor dominant PD (postural instability/gait difficulty dominant phenotype) and total daily levodopa dose were associated with frailty.
CONCLUSION
Frailty is common in PD. There is no agreed upon tool for identifying frailty, however, the importance of its identification is apparent given the high prevalence and the association between frailty and adverse outcomes in persons with PD. Future studies are required to guide clinicians in how best to identify and manage frail patients with PD.
PubMed: 34316672
DOI: 10.1016/j.prdoa.2021.100095 -
Ageing Research Reviews Jun 2023Autonomic dysfunction and frailty are two common and complex geriatric syndromes. Their prevalence increases with age and they have similar negative health outcomes. In... (Meta-Analysis)
Meta-Analysis Review
Autonomic dysfunction and frailty are two common and complex geriatric syndromes. Their prevalence increases with age and they have similar negative health outcomes. In PubMed and Web of Science we screened studies identifying a relationship between autonomic function (AF) and frailty in adults aged ≥ 65 years. Twenty-two studies of which two prospective and 20 cross-sectional were included (n = 8375). We performed a meta-analysis for the articles addressing orthostatic hypotension (OH). Frailty was associated with 1.6 higher odds of suffering from consensus OH (COH) {OR= 1.607 95%CI [1.15-2.24]; 7 studies; n = 3488}. When measured for each type of OH the largest trend was seen between initial OH (IOH) and frailty {OR= 3.08; 95%CI [1.50-6.36]; 2 studies; n = 497}. Fourteen studies reported other autonomic function alterations in frail older adults with 4-22% reduction in orthostatic heart rate increase, 6% reduction in systolic blood pressure recovery, 9-75% reduction in most common used heart rate variability (HRV) parameters. Frail older adults were more likely to have impaired AF. Diagnosis of frailty should promptly lead to orthostatic testing as OH implicates specific treatment modalities, which differ from frailty management. As IOH is most strongly correlated with frailty, continuous beat to beat blood pressure measurements should be performed when present at least until cut-off values for heart rate variability testing are defined.
Topics: Aged; Humans; Frail Elderly; Frailty; Prospective Studies; Cross-Sectional Studies; Hypotension, Orthostatic
PubMed: 37028604
DOI: 10.1016/j.arr.2023.101925 -
Cardiology 2023Space travel imposes significant gravitational and radiation stress on both cellular and systemic physiology, resulting in myriad cardiovascular changes that have not...
INTRODUCTION
Space travel imposes significant gravitational and radiation stress on both cellular and systemic physiology, resulting in myriad cardiovascular changes that have not been fully characterized.
METHODS
We conducted a systematic review of the cellular and clinical adaptations of the cardiovascular system after exposure to real or simulated space travel in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed and Cochrane databases were searched in June 2021 for all peer-reviewed articles published since 1950 related to the following search terms entered in separate pairs: "cardiology and space" and "cardiology and astronaut." Only cellular and clinical studies in English concerning the investigation of cardiology and space were included.
RESULTS
Eighteen studies were identified, comprising 14 clinical and 4 cellular investigations. On the genetic level, pluripotent stem cells in humans and cardiomyocytes in mice displayed increased beat irregularity, with clinical studies revealing a persistent increase in heart rate after space travel. Further cardiovascular adaptations included a higher frequency of orthostatic tachycardia but no evidence of orthostatic hypotension, after return to sea level. Hemoglobin concentration was also consistently decreased after return to Earth. No consistent change in systolic or diastolic blood pressure or any clinically significant arrhythmias were observed during or after space travel.
CONCLUSION
Changes in oxygen carrying capacity, blood pressure, and post-flight orthostatic tachycardia may serve as reasons to further screen for pre-existing anemic and hypotensive conditions among astronauts.
Topics: Humans; Animals; Mice; Space Flight; Astronauts; Heart; Blood Pressure; Tachycardia
PubMed: 37302388
DOI: 10.1159/000531466 -
British Journal of Neurosurgery Oct 2020Deep brain stimulation (DBS) is a treatment that may be suitable for patients with Parkinson's disease (PD) with severe motor fluctuations and/or dyskinesias despite...
Deep brain stimulation (DBS) is a treatment that may be suitable for patients with Parkinson's disease (PD) with severe motor fluctuations and/or dyskinesias despite optimised medical therapy. DBS has been associated with side effects including deterioration in cognition, verbal fluency and mood. Studies assessing the effect of DBS on orthostatic hypotension (OH) have produced variable results. The aim is to summarise peer-reviewed studies that have assessed the effect of DBS on systolic or diastolic BP in PD patients. The databases PubMed, EMBASE, Medline and Scopus were searched using the terms on 13 April 2017. Fourteen studies fulfilled the inclusion criteria. Ten studies involved subthalamic nucleus (STN) DBS, three studies globus pallidus interna (GPi) DBS and one study involved DBS of the pedunculopontine nuclei and motor thalamus. The majority of the studies found results indicating that DBS in PD does not worsen OH in PD. Small sample sizes and lack of blinding of outcome assessors means this result should be approached cautiously. Future research may further investigate the effect of GPi DBS on OH and should aim to address these methodological issues.
Topics: Deep Brain Stimulation; Globus Pallidus; Humans; Hypotension, Orthostatic; Parkinson Disease; Subthalamic Nucleus
PubMed: 31294612
DOI: 10.1080/02688697.2019.1639617 -
Neurological Sciences : Official... Apr 2023Cognitive impairment is a frequent disabling feature of Parkinson's disease (PD). Orthostatic hypotension (OH) is treatable and may be a risk factor for cognitive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cognitive impairment is a frequent disabling feature of Parkinson's disease (PD). Orthostatic hypotension (OH) is treatable and may be a risk factor for cognitive impairment.
OBJECTIVE
We conducted a systematic review and meta-analysis to examine the relationship between OH with PD-associated minimal cognitive impairment (PD-MCI) and dementia (PDD) and assess the mitigating effects of potential confounding factors.
METHODS
Observational studies published in English, Spanish, French, or Portuguese up to January 2022 were searched for in PubMed, EBSCO, and SciELO databases. The primary aim of this study was to revise the association between OH with PD-MCI and PDD. Alongside, we assessed OH as related to cognitive rating scales. Fixed and random models were fitted. Meta-regression was used to assess the mitigating effects of confounding variables.
RESULTS
We identified 18 studies that reported OH association with PDD or PD-MCI, 15 of them reporting OH association with cognitive rating scales. OH was significantly associated with PDD/PD-MCI (OR, 95% CI: 3.31, 2.16-5.08; k = 18, n = 2251; p < 0.01). OH association with PDD (4.64, 2.68-8.02; k = 13, n = 1194; p < 0.01) was stronger than with PD-MCI (1.82, 0.92-3.58; k = 5, n = 1056; p = NS). The association between OH and PD-MCI/PDD was stronger in studies with a higher proportion of women and in those with a lower frequency of supine hypertension. Global cognition rating scale scores were lower in patients with OH (SMD, 95% CI: - 0.55, - 0.83/ - 0.26; k = 12, n = 1427; p < 0.01).
CONCLUSIONS
Orthostatic hypotension shows as a significant risk factor for cognitive impairment in PD, especially in women and patients not suffering from hypertension.
Topics: Humans; Female; Parkinson Disease; Dementia; Hypotension, Orthostatic; Cognitive Dysfunction; Cognition; Neuropsychological Tests; Observational Studies as Topic
PubMed: 36542202
DOI: 10.1007/s10072-022-06537-3 -
The American Journal of Medicine Dec 2020Guidelines recommend increased salt intake as a first-line recommendation in the management of symptomatic orthostatic hypotension and recurrent syncope. There have been... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Guidelines recommend increased salt intake as a first-line recommendation in the management of symptomatic orthostatic hypotension and recurrent syncope. There have been no systematic reviews of this intervention. We sought to summarize the evidence for increased salt intake in patients with orthostatic intolerance syndromes.
METHODS
We conducted a systematic review and meta-analysis of studies in PubMed, EMBASE, and CINAHL. Interventional studies that increased salt intake in individuals with orthostatic intolerance syndromes were included. Primary outcome measures included incidence of falls and injuries, and rates of syncope and presyncope. Secondary outcome measures included other orthostatic intolerance symptoms, blood pressure, and heart rate.
RESULTS
A total of 14 studies were eligible, including participants with orthostatic hypotension, syncope, postural orthostatic tachycardia syndrome, and idiopathic orthostatic tachycardia (n = 391). Mean age was 35.6 (± 15) years. All studies were small and short-term (<60 mins-90 days). No study reported on the effect of increased salt intake on falls or injuries. Meta-analysis demonstrated that during head-up tilt, mean time to presyncope with salt intake increased by 1.57 minutes (95% confidence interval [CI], 1.26-1.88), mean systolic blood pressure increased by 12.27 mm Hg (95% CI, 10.86-13.68), and mean heart rate decreased by -3.97 beats per minute (95% CI, -4.08 to -3.86), compared with control. Increased salt increased supine blood pressure by 1.03 mm Hg (95% CI, 0.81 to 1.25). Increased salt intake resulted in an improvement or resolution of symptoms in 62.3% (95% CI, 51.6 to 72.6) of participants in short-term follow-up studies (mean follow-up of 44.3 days, 6 studies; n=91). Methodological quality of studies were low with high statistical heterogeneity in all meta-analyses.
CONCLUSIONS
Our meta-analysis provides low-quality evidence of a short-term improvement in orthostatic intolerance with increased salt intake. There were no clinical trials demonstrating the efficacy and safety of increased salt intake on long-term clinical outcomes. Overall, there is a paucity of clinical trial evidence to support a cornerstone recommendation in the management of orthostatic intolerance syndromes.
Topics: Adult; Humans; Middle Aged; Orthostatic Intolerance; Sodium Chloride, Dietary; Young Adult
PubMed: 32603788
DOI: 10.1016/j.amjmed.2020.05.028 -
Journal of the American Pharmacists... 2021Several systematic reviews (SRs) have summarized the potential effectiveness of medical cannabinoids, but it is unclear to what extent safety-related outcomes were... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several systematic reviews (SRs) have summarized the potential effectiveness of medical cannabinoids, but it is unclear to what extent safety-related outcomes were incorporated.
OBJECTIVE
The objective of this study was to evaluate the cardiovascular toxicity associated with medical use of cannabinoids.
METHODS
A 2-stage systematic review (SR) approach was undertaken to assess the current evidence on cannabinoid-associated cardiovascular events reported among randomized controlled trials (RCTs). First, we searched for SRs in multiple sources until June 2019. Second, RCTs identified from the SRs were included if they assessed medical cannabis and reported cardiovascular events. The outcomes of interest were all types of cardiovascular events. Data were extracted by 2 independent reviewers. Study quality was assessed using the Cochrane risk of bias. A statistical test of heterogeneity was performed. The summary risk ratios (RRs) and 95% CIs were calculated using a random-effects model.
RESULTS
A total of 47 studies involving 2800 patients were included. The median duration of cannabinoid use was 15.8 days (range 1 to 322), and 45% of the studies excluded patients with underlying cardiovascular diseases. Cannabinoid use was significantly associated with increased risks of orthostatic hypotension (RR 3.16 [95% CI 2.27-4.40], I = 2.3%) and hypotension (3.55 [1.45-8.71], I = 31.8%), with a trend of increased risk of tachycardia (1.94 [0.81-4.64], I = 48.6%). No study reported serious cardiovascular events.
CONCLUSIONS
Cannabinoid use was associated with tachycardia, hypotension, and orthostatic hypotension. There is a paucity of data for other cardiovascular events among medical cannabis users. More data, especially regarding long-term effects among patients with existing cardiovascular diseases, are needed.
Topics: Cannabinoids; Cardiovascular Diseases; Humans; Medical Marijuana; Randomized Controlled Trials as Topic
PubMed: 33952424
DOI: 10.1016/j.japh.2021.03.013