Description des effets de l’ajout de l’amiodarone sur les patients souffrant d’insuffisance cardiaque selon le choix du bêta-bloquant
Bibliographic record
Abstract
Resume Introduction : Il existe des interactions medicamenteuses entre l’amiodarone et certains beta-bloquants. Une augmentation trop rapide des concentrations plasmatiques de beta-bloquants peut provoquer une decompensation de l’insuffisance cardiaque ou des bradycardies. Ces evenements peuvent forcer la diminution des doses de betabloquants prouvees pour etre efficaces pour reduire la mortalite parmi les insuffisants cardiaques. Objectif : L’objectif de cette etude est de decrire l’effet de l’ajout de l’amiodarone aux doses de betabloquants sur la survenue d’effets secondaires et sur les parametres relatifs au stade d’insuffisance cardiaque pour les patients de la clinique d’insuffisance cardiaque de l’Institut universitaire de cardiologie et de pneumologie de Quebec. Methodologie : Les dossiers de tous les patients actifs et inactifs de cette clinique ont ete verifies afin d’inclure ceux ayant commence a prendre de l’amiodarone alors qu’ils recevaient deja une dose stable de beta-bloquant. Pendant les six mois qui ont suivi le debut de l’administration de l’amiodarone, les hospitalisations, les episodes de bradycardies, de blocs cardiaques et les modifications de doses de betabloquants ont ete verifiees retrospectivement. Resultats : Les patients recevant du metoprolol comptent pour 11 des 15 hospitalisations, 18 des 21 episodes de bradycardie, 7 des 12 blocs cardiaques et 11 des 17 diminutions de doses du betabloquant. Une diminution de frequence cardiaque superieure a ete notee chez ces patients, comparativement a ceux recevant d’autres beta-bloquants. Une amelioration de la fraction d’ejection et de la valeur de BNP (peptide natriuretique de type B) a ete notee, peu importe le beta-bloquant recu. Conclusion : L’ajout de l’amiodarone entraine plus de consequences pour les patients recevant du metoprolol. Le CYP2D6, metabolisant le metoprolol et dont l’activite est inhibee par l’amiodarone, est un candidat probable pour expliquer ce phenomene. Abstract Introduction: Drug interactions exist between amiodarone and certain beta-blockers. A rapid increase in plasma concentrations of beta-blockers can lead to decompensated heart failure or bradycardia. This can cause a decrease in the doses of beta-blockers, which are known to be effective in reducing mortality in heart failure. Objective: The purpose of this study is to describe the impact of adding amiodarone to beta-blockers on the occurrence of side effects and parameters related to heart failure stages in patients at the heart failure clinic of the Institut universitaire de cardiologie et de pneumologie de Quebec. Methods: Medical charts of all active and inactive patients of this clinic were reviewed to include patients who started to take amiodarone when already on a stable dose of a beta-blocker. For the six months following the initiation of amiodarone, number of hospitalizations, bradycardic episodes, heart blocks, and modifications to doses of beta-blockers were retrospectively reviewed. Results: Patients receiving metoprolol accounted for 11 of 15 hospitalizations, 18 of 21 episodes of bradycardia, 7 of 12 heart blocks, and 11 of 17 decreases in the dose of a beta-blocker. The decrease in heart rate was greater in these patients, compared to those having received other beta-blockers. Improvement in ejection fraction and BNP value was observed (Btype natriuretic peptide), regardless of the type of beta-blocker received. Conclusion: Adding amiodarone has more consequences for patients that are receiving metoprolol. This phenomenon is probably explained by CYP2D6 because it metabolizes metoprolol and its activity is inhibited by amiodarone.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".