Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Geriatrics
Published in: BMC Geriatrics 1/2015

Open Access 01-12-2015 | Study protocol

The protocol of the Oslo Study of Clonidine in Elderly Patients with Delirium; LUCID: a randomised placebo-controlled trial

Authors: Bjørn Erik Neerland, Karen Roksund Hov, Vegard Bruun Wyller, Eirik Qvigstad, Eva Skovlund, Alasdair MJ MacLullich, Torgeir Bruun Wyller

Published in: BMC Geriatrics | Issue 1/2015

Login to get access

Abstract

Background

Delirium affects 15% of hospitalised patients and is linked with poor outcomes, yet few pharmacological treatment options exist. One hypothesis is that delirium may in part result from exaggerated and/or prolonged stress responses. Dexmedetomidine, a parenterally-administered alpha2-adrenergic receptor agonist which attenuates sympathetic nervous system activity, shows promise as treatment in ICU delirium. Clonidine exhibits similar pharmacodynamic properties and can be administered orally. We therefore wish to explore possible effects of clonidine upon the duration and severity of delirium in general medical inpatients.

Methods/Design

The Oslo Study of Clonidine in Elderly Patients with Delirium (LUCID) is a randomised, placebo-controlled, double-blinded, parallel group study with 4-month prospective follow-up. We will recruit 100 older medical inpatients with delirium or subsyndromal delirium in the acute geriatric ward. Participants will be randomised to oral clonidine or placebo until delirium free for 2 days (Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria), or after a maximum of 7 days treatment. Assessment of haemodynamics (blood pressure, heart rate and electrocardiogram) and delirium will be performed daily until discharge or a maximum of 7 days after end of treatment. The primary endpoint is the trajectory of delirium over time (measured by Memorial Delirium Assessment Scale). Secondary endpoints include the duration of delirium, use of rescue medication for delirium, pharmacokinetics and pharmacodynamics of clonidine, cognitive function after 4 months, length of hospital stay and need for institutionalisation.

Discussion

LUCID will explore the efficacy and safety of clonidine for delirium in older medical inpatients.

Trial registration

ClinicalTrials.gov NCT01956604. EudraCT Number: 2013-000815-26
Literature
1.
Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22.PubMedCrossRef
2.
Young J, Murthy L, Westby M, Akunne A, O'Mahony R. Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ. 2010;341:c3704.PubMedCrossRef
3.
Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443–51.PubMedCrossRef
4.
Krogseth M, Wyller TB, Engedal K, Juliebo V. Delirium is an important predictor of incident dementia among elderly hip fracture patients. Dement Geriatr Cogn Disord. 2011;31(1):63–70.PubMedCrossRef
5.
Davis DH, Muniz TG, Keage H, Rahkonen T, Oinas M, Matthews FE, et al. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain. 2012;135(Pt 9):2809–16.PubMedPubMedCentralCrossRef
6.
Fong TG, Jones RN, Shi P, Marcantonio ER, Yap L, Rudolph JL, et al. Delirium accelerates cognitive decline in Alzheimer disease. Neurology. 2009;72(18):1570–5.PubMedPubMedCentralCrossRef
7.
Eeles EM, White SV, O'Mahony SM, Bayer AJ, Hubbard RE. The impact of frailty and delirium on mortality in older inpatients. Age Ageing. 2012;41(3):412–6.PubMedCrossRef
8.
Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing. 2006;35(4):350–64.PubMedCrossRef
9.
Ryan DJ, O'Regan NA, Caoimh Ríô, Clare J, O'Connor M, Leonard M, et al. Delirium in an adult acute hospital population: predictors, prevalence and detection. BMJ Open. 2013; 3(1).
10.
Korevaar JC, van Munster BC, de Rooij SE. Risk factors for delirium in acutely admitted elderly patients: a prospective cohort study. BMCGeriatr. 2005;5:6.
11.
Cole MG, Ciampi A, Belzile E, Dubuc-Sarrasin M: Subsyndromal delirium in older people: a systematic review of frequency, risk factors, course and outcomes. Int J Geriatr Psychiatry. 2012.
12.
van Gool WA, van de Beek D, Eikelenboom P. Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet. 2010;375(9716):773–5.PubMedCrossRef
13.
Maclullich AM, Ferguson KJ, Miller T, de Rooij SE, Cunningham C. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. JPsychosomRes. 2008;65(3):229–38.
14.
Cunningham C, Campion S, Lunnon K, Murray CL, Woods JF, Deacon RM, et al. Systemic inflammation induces acute behavioral and cognitive changes and accelerates neurodegenerative disease. BiolPsychiatry. 2009;65(4):304–12.
15.
Cerejeira J, Batista P, Nogueira V, Vaz-Serra A, Mukaetova-Ladinska EB. The stress response to surgery and postoperative delirium: evidence of hypothalamic-pituitary-adrenal axis hyperresponsiveness and decreased suppression of the GH/IGF-1 Axis. J Geriatr Psychiatry Neurol. 2013;26(3):185–94.PubMedCrossRef
16.
Breitbart W, Marotta R, Platt MM, Weisman H, Derevenco M, Grau C, et al. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry. 1996;153(2):231–7.PubMedCrossRef
17.
Kalisvaart KJ, de Jonghe JF, Bogaards MJ, Vreeswijk R, Egberts TC, Burger BJ, et al. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc. 2005;53(10):1658–66.PubMedCrossRef
18.
Skrobik YK, Bergeron N, Dumont M, Gottfried SB. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med. 2004;30(3):444–9.PubMedCrossRef
19.
Han CS, Kim YK. A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics. 2004;45(4):297–301.PubMedCrossRef
20.
Tahir TA, Eeles E, Karapareddy V, Muthuvelu P, Chapple S, Phillips B, et al. A randomized controlled trial of quetiapine versus placebo in the treatment of delirium. J Psychosom Res. 2010;69(5):485–90.PubMedCrossRef
21.
Lonergan E, Britton AM, Luxenberg J, Wyller T. Antipsychotics for delirium. Cochrane Batabase Syst Rev. 2007;2:CD005594.
22.
Grover S, Mattoo SK, Gupta N. Usefulness of atypical antipsychotics and choline esterase inhibitors in delirium: a review. Pharmacopsychiatry. 2011;44(2):43–54.PubMedCrossRef
23.
Murray-Thomas T, Jones ME, Patel D, Brunner E, Shatapathy CC, Motsko S, et al. Risk of mortality (including sudden cardiac death) and major cardiovascular events in atypical and typical antipsychotic users: a study with the general practice research database. Cardio Vascular Psychiatry Neurol. 2013;2013:247486.
24.
Lonergan E, Luxenberg J, Areosa SA, Wyller TB. Benzodiazepines for delirium. Cochrane Database Syst Rev. 2009;1:CD006379.PubMed
25.
van Eijk MM, Roes KC, Honing ML, Kuiper MA, Karakus A, van der Jagt M, et al. Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial. Lancet. 2010;376(9755):1829–37.PubMedCrossRef
26.
Overshott R, Karim S, Burns A. Cholinesterase inhibitors for delirium. Cochrane Database Syst Rev. 2008;1:CD005317.PubMed
27.
Overshott R, Vernon M, Morris J, Burns A. Rivastigmine in the treatment of delirium in older people: a pilot study. Int Psychogeriatr. 2010;22(5):812–8.PubMedCrossRef
28.
Khan ZP, Ferguson CN, Jones RM. alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. Anaesthesia. 1999;54(2):146–65.PubMedCrossRef
29.
Smith H, Elliott J. Alpha(2) receptors and agonists in pain management. Curr Opin Anaesthesiol. 2001;14(5):513–8.PubMedCrossRef
30.
Uyar AS, Yagmurdur H, Fidan Y, Topkaya C, Basar H. Dexmedetomidine attenuates the hemodynamic and neuroendocrinal responses to skull-pin head-holder application during craniotomy. J Neurosurg Anesthesiol. 2008;20(3):174–9.PubMedCrossRef
31.
Pichot C, Ghignone M, Quintin L. Dexmedetomidine and clonidine: from second- to first-line sedative agents in the critical care setting? J Intensive Care Med. 2012;27(4):219–37.PubMedCrossRef
32.
Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007;298(22):2644–53.PubMedCrossRef
33.
Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009;301(5):489–99.PubMedCrossRef
34.
Maldonado JR, Wysong A, van der Starre PJ, Block T, Miller C, Reitz BA. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics. 2009;50(3):206–17.PubMedCrossRef
35.
Shehabi Y, Grant P, Wolfenden H, Hammond N, Bass F, Campbell M, et al. Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology. 2009;111(5):1075–84.PubMedCrossRef
36.
Mo Y, Zimmermann AE. Role of dexmedetomidine for the prevention and treatment of delirium in intensive care unit patients. Ann Pharmacother. 2013;47(6):869–76.PubMedCrossRef
37.
Zhang H, Lu Y, Liu M, Zou Z, Wang L, Xu FY, et al. Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials. Crit Care. 2013;17(2):R47.PubMedPubMedCentralCrossRef
38.
39.
Cividjian A, Toader E, Wesseling KH, Karemaker JM, McAllen R, Quintin L. Effect of clonidine on cardiac baroreflex delay in humans and rats. Am J Physiol Regul Int Comp Physiol. 2011;300(4):R949–57.CrossRef
40.
Kim MH, Hahn TH. The effect of clonidine pretreatment on the perioperative proinflammatory cytokines, cortisol, and ACTH responses in patients undergoing total abdominal hysterectomy. Anesth Analg. 2000;90(6):1441–4.PubMedCrossRef
41.
Blaudszun G, Lysakowski C, Elia N, Tramer MR. Effect of perioperative systemic alpha2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012;116(6):1312–22.PubMedCrossRef
42.
Wright PM, Carabine UA, McClune S, Orr DA, Moore J. Preanaesthetic medication with clonidine. BrJ Anaesth. 1990;65(5):628–32.CrossRef
43.
Laurito CE, Baughman VL, Becker GL, DeSilva TW, Carranza CJ. The effectiveness of oral clonidine as a sedative/anxiolytic and as a drug to blunt the hemodynamic responses to laryngoscopy. J Clin Anesth. 1991;3(3):186–93.PubMedCrossRef
44.
Rubino AS, Onorati F, Caroleo S, Galato E, Nucera S, Amantea B, et al. Impact of clonidine administration on delirium and related respiratory weaning after surgical correction of acute type-A aortic dissection: results of a pilot study. Interact CardiovascThorac Surg. 2010;10(1):58–62.CrossRef
45.
Anavekar SN, Jarrott B, Toscano M, Louis WJ. Pharmacokinetic and pharmacodynamic studies of oral clonidine in normotensive subjects. EurJ ClinPharmacol. 1982;23(1):1–5.
46.
Mohr E, Schlegel J, Fabbrini G, et al. CLonidine treatment of alzheimer's disease. Arch Neurol. 1989;46(4):376–8.PubMedCrossRef
47.
Davidson M, Bierer LM, Kaminsky R, Ryan TM, Davis KL. Combined administration of physostigmine and clonidine to patients with dementia of the Alzheimer type: a pilot safety study. Alzheimer Dis Assoc Disord. 1989;3(4):224–7.PubMedCrossRef
48.
Riekkinen M, Jakala P, Kejonen K, Riekkinen Jr P. The alpha2 agonist, clonidine, improves spatial working performance in Parkinson's disease. Neuroscience. 1999;92(3):983–9.PubMedCrossRef
49.
Serrano-Duenas M. Treatment of sialorrhea in Parkinson's disease patients with clonidine. Double-blind, comparative study with placebo. Neurologia (Barcelona Spain. 2003;18(1):2–6.
50.
Almenrader N, Larsson P, Passariello M, Haiberger R, Pietropaoli P, Lonnqvist PA, et al. Absorption pharmacokinetics of clonidine nasal drops in children. Paediatr Anaesth. 2009;19(3):257–61.PubMedCrossRef
51.
Hogan MJ, Wallin JD, Chu LC. Plasma clonidine concentration and pharmacologic effect. Clin Pharmacol Ther. 1981;30(6):729–34.PubMedCrossRef
52.
Keranen A, Nykanen S, Taskinen J. Pharmacokinetics and side-effects of clonidine. Eur J Clin Pharmacol. 1978;13(2):97–101.PubMedCrossRef
53.
Davies DS, Wing AM, Reid JL, Neill DM, Tippett P, Dollery CT. Pharmacokinetics and concentration-effect relationships of intervenous and oral clonidine. Clin Pharmacol Ther. 1977;21(5):593–601.PubMedCrossRef
54.
Frisk-Holmberg M, Edlund PO, Paalzow L. Pharmacokinetics of clonidine and its relation to the hypotensive effect in patients. Br J Clin Pharmacol. 1978;6(3):227–32.PubMedPubMedCentralCrossRef
55.
Sulheim D, Fagermoen E, Winger A, Andersen AM, Godang K, Muller F, et al. Disease mechanisms and clonidine treatment in adolescent chronic fatigue syndrome: a combined cross-sectional and randomized clinical trial. JAMA pediatrics. 2014;168(4):351–60.PubMedCrossRef
56.
Fagermoen E, Sulheim D, Winger A, Andersen AM, Vethe NT, Saul JP, et al. Clonidine in the treatment of adolescent chronic fatigue syndrome: a pilot study for the NorCAPITAL trial. BMC Res Notes. 2012;5:418.PubMedPubMedCentralCrossRef
57.
Anavekar SN, Howes LG, Jarrott B, Syrjanen M, Conway EL, Louis WJ. Pharmacokinetics and antihypertensive effects of low dose clonidine during chronic therapy. J Clin Pharmacol. 1989;29(4):321–6.PubMedCrossRef
58.
Breitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S. The memorial delirium assessment scale. J Pain Symptom Manag. 1997;13(3):128–37.CrossRef
59.
Association AP. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington DC: American Psychiatric Association; 2013.CrossRef
60.
Sands MB, Dantoc BP, Hartshorn A, Ryan CJ, Lujic S. Single question in delirium (SQiD): testing its efficacy against psychiatrist interview, the confusion assessment method and the memorial delirium assessment scale. Palliat Med. 2010;24(6):561–5.PubMedCrossRef
61.
Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338–44.PubMedCrossRef
62.
Tieges Z, McGrath A, Hall RJ, Maclullich AM. Abnormal level of arousal as a predictor of delirium and inattention: an exploratory study. Am J Geriatric Psychiatry Off J Am Assoc Ger Psychiatry. 2013;21(12):1244–53.CrossRef
63.
64.
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. AnnIntern Med. 1990;113(12):941–8.
65.
Holt R, Siddiqi N, Young J. The ethics of consent in delirium studies. J Psychosom Res. 2008;65(3):283–7.PubMedCrossRef
66.
Adamis D, Treloar A, Martin FC, Macdonald AJ. Ethical research in delirium: arguments for including decisionally incapacitated subjects. Sci Eng Ethics. 2010;16(1):169–74.PubMedCrossRef
67.
Wyller TB, Watne LO, Torbergsen A, Engedal K, Frihagen F, Juliebo V, et al. The effect of a pre- and post-operative orthogeriatric service on cognitive function in patients with hip fracture. The protocol of the Oslo Orthogeriatrics Trial. BMC Geriatr. 2012;12(1):36.PubMedPubMedCentralCrossRef
68.
Andreasen NC, Pressler M, Nopoulos P, Miller D, Ho BC. Antipsychotic dose equivalents and dose-years: a standardized method for comparing exposure to different drugs. Biol Psychiatry. 2010;67(3):255–62.PubMedCrossRef
69.
Mahoney FI, Barthel DW. Functional evaluation: the barthel index. Maryland State Med J. 1965;14:61–5.
70.
Lincoln NB, Gladman JR. The extended activities of daily living scale: a further validation. Disabil Rehabil. 1992;14(1):41–3.PubMedCrossRef
71.
Jorm AF. A short form of the informant questionnaire on cognitive decline in the elderly (IQCODE): development and cross-validation. Psychol Med. 1994;24(1):145–53.PubMedCrossRef
72.
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry J Mental Sci. 1982;140:566–72.CrossRef
73.
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.PubMedCrossRef
74.
Engedal K, Haugen P, Gilje K, Laake P. Efficacy of short mental tests in the detection of mental impairment in old age. Comp gerontol Section A Clin Lab Sci. 1988;2(2):87–93.
75.
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Use of the Cornell scale in nondemented patients. J Am Geriatr Soc. 1988;36(3):230–6.PubMedCrossRef
76.
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell scale for depression in dementia. Biol Psychiatry. 1988;23(3):271–84.PubMedCrossRef
77.
Salvi F, Miller MD, Grilli A, Giorgi R, Towers AL, Morichi V, et al. A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients. J Am Geriatr Soc. 2008;56(10):1926–31.PubMedCrossRef
78.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.PubMedCrossRef
79.
Feldt KS. The checklist of nonverbal pain indicators (CNPI). Pain Manage Nurs Off J Am Soc Pain Manage Nurs. 2000;1(1):13–21.CrossRef
80.
van Munster BC, Bisschop PH, Zwinderman AH, Korevaar JC, Endert E, Wiersinga WJ, et al. Cortisol, interleukins and S100B in delirium in the elderly. Brain Cogn. 2010;74(1):18–23.PubMedCrossRef
81.
Khan BA, Farber MO, Campbell N, Perkins A, Prasad NK, Hui SL, et al. S100 calcium binding protein B as a biomarker of delirium duration in the intensive care unit - an exploratory analysis. Int J Gene Med. 2013;6:855–61.CrossRef
82.
Osse RJ, Fekkes D, Tulen JH, Wierdsma AI, Bogers AJ, van der Mast RC, et al. High preoperative plasma neopterin predicts delirium after cardiac surgery in older adults. J Am Geriatr Soc. 2012;60(4):661–8.PubMedCrossRef
83.
84.
Girard TD, Ware LB, Bernard GR, Pandharipande PP, Thompson JL, Shintani AK, et al. Associations of markers of inflammation and coagulation with delirium during critical illness. Intensive Care Med. 2012;38(12):1965–73.PubMedPubMedCentralCrossRef
85.
Devlin JW, Al-Qadhee NS, Skrobik Y. Pharmacologic prevention and treatment of delirium in critically ill and non-critically ill hospitalised patients: A review of data from prospective, randomised studies. Best Pract Res Clin Anaesthesiol. 2012;26(3):289–309.PubMedCrossRef
86.
Trzepacz PT, Bourne R, Zhang S. Designing clinical trials for the treatment of delirium. J Psychosom Res. 2008;65(3):299–307.PubMedCrossRef
87.
88.
Adamis D. Statistical methods for analysing longitudinal data in delirium studies. Int Rev Psychiatry. 2009;21(1):74–85.PubMedCrossRef
89.
Tahir TA, Farewell D, Bisson J. Randomised control trials for delirium: current evidence and statistical methods. J Psychosom Res. 2012;72(1):84–5.PubMedCrossRef
Metadata
Title
The protocol of the Oslo Study of Clonidine in Elderly Patients with Delirium; LUCID: a randomised placebo-controlled trial
Authors
Bjørn Erik Neerland
Karen Roksund Hov
Vegard Bruun Wyller
Eirik Qvigstad
Eva Skovlund
Alasdair MJ MacLullich
Torgeir Bruun Wyller
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2015
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-015-0006-3

Other articles of this Issue 1/2015

BMC Geriatrics 1/2015 Go to the issue

Research article

Description of spatio-temporal gait parameters in elderly people and their association with history of falls: results of the population-based cross-sectional KORA-Age study

Research article

A comprehensive grid to evaluate case management’s expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study

Research article

Frailty still matters to health and survival in centenarians: the case of China

Study protocol

A cluster randomized controlled trial on the effects and costs of advance care planning in elderly care: study protocol

Research article

A retrospective, longitudinal study of factors associated with new antipsychotic medication use among recently admitted long-term care residents

Research article

Preliminary validation of the short physical performance battery in older adults with multiple sclerosis: secondary data analysis

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits