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McClenaghan L, Sandhu M, Caputo M, Brennan PF. An incidental finding of a right atrial myxoma with undiagnosed Ebstein anomaly: a case report. Eur Heart J Case Rep 2023; 7:ytad539. [PMID: 38025119 PMCID: PMC10660375 DOI: 10.1093/ehjcr/ytad539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 10/22/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023]
Abstract
Background Ebstein anomaly (EA) is a rare congenital abnormality of the tricuspid valve which can lead to progressive right heart dilatation and arrhythmias. While often seen in conjunction with other congenital cardiac lesions, such as atrial septal defects, it is not normally associated with atrial myxomas. Case summary We present a case report of an incidental finding of a right atrial myxoma in the context of undiagnosed EA, in a 16-year-old male who presented with appendicitis. Subtle cardiomegaly on routine chest X-ray prompted further investigation, which demonstrated characteristic findings of both conditions and culminated in surgical repair using the Cone procedure. At 4-month follow-up, the patient was asymptomatic, and transthoracic echocardiography demonstrated a mean gradient of 4.5 mmHg across the tricuspid valve with mild regurgitation. Discussion The combination of EA with right-sided myxoma is exceedingly rare, and, in this case, it may be that the apical displacement of the tricuspid valve was protective against right atrioventricular obstruction. We are reminded that although subtle abnormalities on routine investigations can be of limited significance, they can also indicate more serious underlying pathology and so consideration should be given to an appropriate cascade of further investigations to yield a timely diagnosis and enable prompt treatment.
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Affiliation(s)
- Lisa McClenaghan
- Department of Adult Congenital Heart Disease, Royal Victoria Hospital, 274 Grosvenor Road, Belfast BT12 6BA, UK
| | - Manraj Sandhu
- Department of Cardiothoracic Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Department of Cardiothoracic Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Paul F Brennan
- Department of Adult Congenital Heart Disease, Royal Victoria Hospital, 274 Grosvenor Road, Belfast BT12 6BA, UK
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Mailey JA, Moore JS, Brennan PF, Jing M, Awuah A, McLaughlin JAD, Nesbit MA, Moore TCB, Spence MS. Assessment of hemodynamic indices of conjunctival microvascular function in patients with coronary microvascular dysfunction. Microvasc Res 2023; 147:104480. [PMID: 36690270 DOI: 10.1016/j.mvr.2023.104480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/07/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Coronary microvascular dysfunction (CMD) is a cause of ischaemia with non-obstructive coronary arteries (INOCA). It is notoriously underdiagnosed due to the need for invasive microvascular function testing. We hypothesized that systemic microvascular dysfunction could be demonstrated non-invasively in the microcirculation of the bulbar conjunctiva in patients with CMD. METHODS Patients undergoing coronary angiography for the investigation of chest pain or dyspnoea, with physiologically insignificant epicardial disease (fractional flow reserve ≥0.80) were recruited. All patients underwent invasive coronary microvascular function testing. We compared a cohort of patients with evidence of CMD (IMR ≥25 or CFR <2.0); to a group of controls (IMR <25 and CFR ≥2.0). Conjunctival imaging was performed using a previously validated combination of a smartphone and slit-lamp biomicroscope. This technique allows measurement of vessel diameter and other indices of microvascular function by tracking erythrocyte motion. RESULTS A total of 111 patients were included (43 CMD and 68 controls). There were no differences in baseline demographics, co-morbidities or epicardial coronary disease severity. The mean number of vessel segments analysed per patient was 21.0 ± 12.8 (3.2 ± 3.5 arterioles and 14.8 ± 10.8 venules). In the CMD cohort, significant reductions were observed in axial/cross-sectional velocity, blood flow, wall shear rate and stress. CONCLUSION The changes in microvascular function linked to CMD can be observed non-invasively in the bulbar conjunctiva. Conjunctival vascular imaging may have utility as a non-invasive tool to both diagnose CMD and augment conventional cardiovascular risk assessment.
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Affiliation(s)
- Jonathan A Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom; Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom.
| | - Julie S Moore
- Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom; Integrated Diagnostic Laboratory, Northland House, Ulster University, Belfast, United Kingdom
| | - Paul F Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Min Jing
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, United Kingdom
| | - Agnes Awuah
- Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom; Integrated Diagnostic Laboratory, Northland House, Ulster University, Belfast, United Kingdom
| | - James A D McLaughlin
- Integrated Diagnostic Laboratory, Northland House, Ulster University, Belfast, United Kingdom; Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, United Kingdom
| | - M Andrew Nesbit
- Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom; Integrated Diagnostic Laboratory, Northland House, Ulster University, Belfast, United Kingdom
| | - Tara C B Moore
- Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom; Integrated Diagnostic Laboratory, Northland House, Ulster University, Belfast, United Kingdom
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom; Integrated Diagnostic Laboratory, Northland House, Ulster University, Belfast, United Kingdom
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Gatta F, Haqzad Y, Gradinariu G, Malvindi PG, Khalid Z, Suelo-Calanao RL, Moawad N, Bashir A, Rogers LJ, Lloyd C, Nguyen B, Booth K, Wang L, Al-Attar N, McDowall N, Watkins S, Sayeed R, Baghdadi S, D'Alessio A, Monteagudo-Vela M, Djordjevic J, Goricar M, Hoppe S, Bocking C, Hussain A, Evans B, Arif S, Malkin C, Field M, Sandhu K, Harky A, Torky A, Uddin M, Abdulhakeem M, Kenawy A, Massey J, Cartwright N, Tyson N, Nicou N, Baig K, Jones M, Aljanadi F, Owens CG, Oyebanji T, Doyle J, Spence MS, Brennan PF, Manoharan G, Ramadan T, Ohri S, Loubani M. Redo aortic valve replacement versus valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis. Monaldi Arch Chest Dis 2023; 94. [PMID: 37074089 DOI: 10.4081/monaldi.2023.2546] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/21/2023] [Indexed: 04/20/2023] Open
Abstract
This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicenter UK retrospective study of redo-AVR or valve-in-valve TAVI for patients referred for redo aortic valve intervention due to a degenerated aortic bioprosthesis. Propensity score matching was performed for confounding factors. From July 2005 to April 2021, 911 patients underwent redo-AVR and 411 patients underwent valve-in-valve TAVI. There were 125 pairs for analysis after propensity score matching. The mean age was 75.2±8.5 years. In-hospital mortality was 7.2% (n=9) for redo-AVR versus 0 for valve-in-valve TAVI, p=0.002. Surgical patients suffered more post-operative complications, including intra-aortic balloon pump support (p=0.02), early re-operation (p<0.001), arrhythmias (p<0.001), respiratory and neurological complications (p=0.02 and p=0.03) and multi-organ failure (p=0.01). The valve-in-valve TAVI group had a shorter intensive care unit and hospital stay (p<0.001 for both). However, moderate aortic regurgitation at discharge and higher post-procedural gradients were more common after valve-in-valve TAVI (p<0.001 for both). Survival probabilities in patients who were successfully discharged from the hospital were similar after valve-in-valve TAVI and redo-AVR over the 6-year follow-up (log-rank p=0.26). In elderly patients with a degenerated aortic bioprosthesis, valve-in-valve TAVI provides better early outcomes as opposed to redo-AVR, although there was no difference in mid-term survival in patients successfully discharged from the hospital.
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Affiliation(s)
- Francesca Gatta
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull; Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Yama Haqzad
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull.
| | - George Gradinariu
- Department of Cardiology and Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow.
| | | | - Zubair Khalid
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull.
| | - Rona L Suelo-Calanao
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull.
| | - Nader Moawad
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Aladdin Bashir
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Luke J Rogers
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Clinton Lloyd
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Bao Nguyen
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Karen Booth
- Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle.
| | - Lu Wang
- Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle.
| | - Nawwar Al-Attar
- Department of Cardiology and Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow.
| | - Neil McDowall
- Department of Cardiology and Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow.
| | - Stuart Watkins
- Department of Cardiology and Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow.
| | - Rana Sayeed
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Saleh Baghdadi
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Andrea D'Alessio
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Maria Monteagudo-Vela
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Jasmina Djordjevic
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Matej Goricar
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Solveig Hoppe
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Charlotte Bocking
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Azar Hussain
- Department of Cardiology and Cardiothoracic Surgery, Leeds General Infirmary.
| | - Betsy Evans
- Department of Cardiology and Cardiothoracic Surgery, Leeds General Infirmary.
| | - Salman Arif
- Department of Cardiology and Cardiothoracic Surgery, Leeds General Infirmary.
| | - Christopher Malkin
- Department of Cardiology and Cardiothoracic Surgery, Leeds General Infirmary.
| | - Mark Field
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Kully Sandhu
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Amer Harky
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Ahmed Torky
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Mauin Uddin
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Muhammad Abdulhakeem
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Ayman Kenawy
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - John Massey
- Department of Cardiology and Cardiothoracic Surgery, Northern General Hospital, Sheffield.
| | - Neil Cartwright
- Department of Cardiology and Cardiothoracic Surgery, Northern General Hospital, Sheffield.
| | - Nathan Tyson
- Department of Cardiology and Cardiothoracic Surgery, Nottingham City Hospital.
| | - Niki Nicou
- Department of Cardiology and Cardiothoracic Surgery, Nottingham City Hospital.
| | - Kamran Baig
- Department of Cardiology and Cardiothoracic Surgery, Nottingham City Hospital.
| | - Mark Jones
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Firas Aljanadi
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Colum G Owens
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Tunde Oyebanji
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Joseph Doyle
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Mark S Spence
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Paul F Brennan
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Ganesh Manoharan
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Taha Ramadan
- Department of Cardiology and Cardiothoracic Surgery, Southampton General Hospital.
| | - Sunil Ohri
- Department of Cardiology and Cardiothoracic Surgery, Southampton General Hospital.
| | - Mahmoud Loubani
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull.
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Mailey J, Moore JS, Brennan PF, Jing M, Awuah A, McLaughlin JAD, Nesbit MA, Moore CBT, Spence MS. INOCA affects more than the coronaries. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Ischaemia with normal coronary arteries (INOCA) may result in disabling symptoms and has an association with adverse long-term prognosis. The diagnosis of INOCA necessitates invasive coronary angiography to perform a physiological evaluation of microvascular function.
The conjunctiva has a readily assessable microvascular network in which physiological parameters can be evaluated. We compared conjunctival haemodynamics in patients with and without coronary microvascular disease (MVD) to assess if systemic microvascular dysfunction was present in this coronary artery disease sub-group.
Methods
In this study, we recruited patients undergoing invasive coronary angiography for the investigation of angina or angina equivalent symptoms. All patients had physiologically insignificant epicardial disease (FFR≥0.80) and underwent a physiological evaluation of coronary microvascular function. We compared a group with evidence of coronary MVD (IMR≥25 or CFR<2.0); to a group of controls without MVD (IMR<25 and CFR≥2.0).
The conjunctival microvasculature was imaged using a previously validated combination of a smartphone and slit-lamp biomicroscope. The conjunctival vasculature was assessed using a semi-automated process of vessel diameter measurement and erythrocyte tracking to obtain haemodynamic parameters of microvascular function.
Results
A total of 111 patients were included (43 MVD and 68 controls). There were no differences in baseline demographics, co-morbidities, epicardial coronary disease severity or regular pharmacological therapies between the groups. Mean coronary flow reserve (CFR) was lower and mean index of microcirculatory resistance (IMR) higher in the MVD cohort (CFR 2.5±1.3 vs 5.2±2.5, p<0.001 and IMR 28.4±11.8 vs 13.7±5.0, p<0.001).
A total of 2295 conjunctival vessels were analysed. The mean number of vessels per patient was 21.0±12.8 (3.2±3.5 arterioles and 14.8±10.8 venules). Significant reductions in axial/cross-sectional velocity, wall shear rate and wall shear stress were observed in the MVD cohort. Table 1 demonstrates a comparison of conjunctival physiological parameters between the groups.
The most marked differences were observed in conjunctival arterioles. Due to the heterogenous size distribution of microvessels, arterioles were categorised into 2 diameter sub-groups (10–25 μm and 25–40 μm) for analysis (Table 2).
Conclusion
The reductions in microvascular blood flow velocity and rate that form the basis for the diagnosis of coronary microvascular dysfunction can be observed non-invasively in the bulbar conjunctiva microcirculation. Conjunctival vascular imaging may have utility as a non-invasive imaging modality to both diagnose microvascular dysfunction and augment conventional cardiovascular risk stratification.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Belfast Trust Heart Trust Fund and Northern Ireland Chest Heart and Stroke
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Affiliation(s)
- J Mailey
- Royal Victoria Hospital , Belfast , United Kingdom
| | - J S Moore
- University of Ulster , Belfast , United Kingdom
| | - P F Brennan
- Royal Victoria Hospital , Belfast , United Kingdom
| | - M Jing
- University of Ulster , Belfast , United Kingdom
| | - A Awuah
- University of Ulster , Belfast , United Kingdom
| | | | - M A Nesbit
- University of Ulster , Belfast , United Kingdom
| | - C B T Moore
- University of Ulster , Belfast , United Kingdom
| | - M S Spence
- Royal Victoria Hospital , Belfast , United Kingdom
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Mailey JA, Brennan PF, Kearney A, Hogg MC, McNeice AH, Jeganathan R, Manoharan G, Owens CG, Spence MS. Reframing Optimal Implantation of the Sapien 3 Transcatheter Heart Valve. J Invasive Cardiol 2022; 34:E380-E389. [PMID: 35394450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To define the optimal implantation of the Sapien 3 (Edwards Lifesciences) transcatheter heart valve (THV), this study systematically analyzed the predeployment fluoroscopic THV position and correlated this to clinical outcomes. METHODS This was an observational study of 279 patients treated with the Sapien 3 THV. Fluoroscopic imaging was used to categorize patients into low (n = 147), intermediate (n = 86), and high (n = 46) implantation zones. These zones were based on the relationship of the balloon marker and radiolucent line of the valve frame (line of lucency) to the annular plane at deployment. The primary outcome was the rate of permanent pacemaker implantation (PPI) at 30 days. The secondary outcomes were the rates of new left bundle-branch block (LBBB) in-hospital and all-cause mortality at 1 year. RESULTS In the high, intermediate, and low groups, 30-day PPI rates were 4.3%, 8.1%, and 8.8% (P=.62); in-hospital LBBB rates were 10.9%, 26.7%, and 32.0% (P=.02); and all-cause mortality rates at 1 year were 3.1%, 7.3%, and 12.5% (P=.14), respectively. No differences were observed with respect to procedural success/complications or THV performance between the groups. CONCLUSION This study demonstrates fewer conduction abnormalities for Sapien 3 valves positioned within a higher zone defined fluoroscopically by the line of lucency and balloon marker.
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Affiliation(s)
- Jonathan A Mailey
- Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA United Kingdom.
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Awuah A, Moore JS, Nesbit MA, Ruddock MW, Brennan PF, Mailey JA, McNeil AJ, Jing M, Finlay DD, Trucco E, Kurth MJ, Watt J, Lamont JV, Fitzgerald P, Spence MS, McLaughlin JAD, Moore TCB. A novel algorithm for cardiovascular screening using conjunctival microcirculatory parameters and blood biomarkers. Sci Rep 2022; 12:6545. [PMID: 35449196 PMCID: PMC9023476 DOI: 10.1038/s41598-022-10491-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022] Open
Abstract
Microvascular haemodynamic alterations are associated with coronary artery disease (CAD). The conjunctival microcirculation can easily be assessed non-invasively. However, the microcirculation of the conjunctiva has not been previously explored in clinical algorithms aimed at identifying patients with CAD. This case–control study involved 66 patients with post-myocardial infarction and 66 gender-matched healthy controls. Haemodynamic properties of the conjunctival microcirculation were assessed with a validated iPhone and slit lamp-based imaging tool. Haemodynamic properties were extracted with semi-automated software and compared between groups. Biomarkers implicated in the development of CAD were assessed in combination with conjunctival microcirculatory parameters. The conjunctival blood vessel parameters and biomarkers were used to derive an algorithm to aid in the screening of patients for CAD. Conjunctival blood velocity measured in combination with the blood biomarkers (N-terminal pro-brain natriuretic peptide and adiponectin) had an area under receiver operator characteristic curve (AUROC) of 0.967, sensitivity 93.0%, specificity 91.5% for CAD. This study demonstrated that the novel algorithm which included a combination of conjunctival blood vessel haemodynamic properties, and blood-based biomarkers could be used as a potential screening tool for CAD and should be validated for potential utility in asymptomatic individuals.
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Affiliation(s)
- Agnes Awuah
- Biomedical Sciences Research Institute, Ulster University, Cromore Road, Coleraine, BT52 1SA, UK
| | - Julie S Moore
- Biomedical Sciences Research Institute, Ulster University, Cromore Road, Coleraine, BT52 1SA, UK
| | - M Andrew Nesbit
- Biomedical Sciences Research Institute, Ulster University, Cromore Road, Coleraine, BT52 1SA, UK
| | - Mark W Ruddock
- Clinical Studies Group, Randox Laboratories Ltd, 55 Diamond Road, Crumlin, BT29 4QY, UK
| | - Paul F Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, 274 Grosvenor Road, Belfast, BT12 6BA, UK
| | - Jonathan A Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, 274 Grosvenor Road, Belfast, BT12 6BA, UK
| | - Andrew J McNeil
- VAMPIRE Project, Computing (SSEN), University of Dundee, Dundee, DD1 4HN, UK
| | - Min Jing
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, BT37 0QB, UK
| | - Dewar D Finlay
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, BT37 0QB, UK
| | - Emanuele Trucco
- VAMPIRE Project, Computing (SSEN), University of Dundee, Dundee, DD1 4HN, UK
| | - Mary Jo Kurth
- Clinical Studies Group, Randox Laboratories Ltd, 55 Diamond Road, Crumlin, BT29 4QY, UK
| | - Joanne Watt
- Clinical Studies Group, Randox Laboratories Ltd, 55 Diamond Road, Crumlin, BT29 4QY, UK
| | - John V Lamont
- Clinical Studies Group, Randox Laboratories Ltd, 55 Diamond Road, Crumlin, BT29 4QY, UK
| | - Peter Fitzgerald
- Clinical Studies Group, Randox Laboratories Ltd, 55 Diamond Road, Crumlin, BT29 4QY, UK
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, 274 Grosvenor Road, Belfast, BT12 6BA, UK
| | - James A D McLaughlin
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, BT37 0QB, UK
| | - Tara C B Moore
- Biomedical Sciences Research Institute, Ulster University, Cromore Road, Coleraine, BT52 1SA, UK.
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7
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Cahill TJ, Raby J, Jewell PD, Brennan PF, Banning AP, Byrne J, Kharbanda RK, MacCarthy PA, Thornhill MH, Sandoe JAT, Spence MS, Ludman P, Hildick-Smith DJR, Redwood SR, Prendergast BD. Risk of infective endocarditis after surgical and transcatheter aortic valve replacement. Heart 2022; 108:639-647. [DOI: 10.1136/heartjnl-2021-320080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/20/2021] [Indexed: 01/22/2023] Open
Abstract
ObjectiveTo define the incidence and risk factors for infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).MethodsAll patients who underwent first SAVR or TAVI in England between 2007 and 2016 were identified from the NICOR databases. Hospital admissions with a primary diagnosis of IE were identified by linkage with the NHS Hospital Episode Statistics database. Approval was obtained from the NHS Research Ethics Committee.Results2057 of 91 962 patients undergoing SAVR developed IE over a median follow-up of 53.9 months—an overall incidence of 4.81 [95% CI 4.61 to 5.03] per 1000 person-years. Correspondingly, 140 of 14 195 patients undergoing TAVI developed IE over a median follow-up of 24.5 months—an overall incidence of 3.57 [95% CI 3.00 to 4.21] per 1000 person-years. The cumulative incidence of IE at 60 months was higher after SAVR than after TAVI (2.4% [95% CI 2.3 to 2.5] vs 1.5% [95% CI 1.3 to 1.8], HR 1.60, p<0.001). Across the entire cohort, SAVR remained an independent predictor of IE after multivariable adjustment. Risk factors for IE included younger age, male sex, atrial fibrillation, and dialysis.ConclusionsIE is a rare complication of SAVR and TAVI. In our population, the incidence of IE was higher after SAVR than after TAVI.
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Witberg G, Codner P, Landes U, Barbanti M, Valvo R, De Backer O, Ooms JF, Sievert K, El Sabbagh A, Jimenez-Quevedo P, Brennan PF, Sedaghat A, Masiero G, Werner P, Overtchouk P, Watanabe Y, Montorfano M, Bijjam VR, Hein M, Fiorina C, Arzamendi D, Rodriguez-Gabella T, Fernández-Vázquez F, Baz JA, Laperche C, Grasso C, Branca L, Estévez-Loureiro R, Benito-González T, Amat Santos IJ, Ruile P, Mylotte D, Buzzatti N, Piazza N, Andreas M, Tarantini G, Sinning JM, Spence MS, Nombela-Franco L, Guerrero M, Sievert H, Sondergaard L, Van Mieghem NM, Tchetche D, Webb JG, Kornowski R. Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry. JACC Cardiovasc Interv 2021; 13:2782-2791. [PMID: 33303117 DOI: 10.1016/j.jcin.2020.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/01/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit. BACKGROUND The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging. METHODS This was an international registry of 23 TAVR centers. RESULTS In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05). CONCLUSIONS For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Landes
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Abdallah El Sabbagh
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | | | - Paul F Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Paul Werner
- Division of Cardiac Surgery Medical University of Vienna, Vienna, Austria
| | - Pavel Overtchouk
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Matteo Montorfano
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan Italy
| | - Venu Reddy Bijjam
- Department of Cardiology, University Hospital, and National University of Ireland Galway, Galway, Ireland
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | | | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Clemence Laperche
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Carmelo Grasso
- Division of Cardiology, University of Catania, Catania, Italy
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | | | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Darren Mylotte
- Department of Cardiology, University Hospital, and National University of Ireland Galway, Galway, Ireland
| | - Nicola Buzzatti
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan Italy
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Martin Andreas
- Division of Cardiac Surgery Medical University of Vienna, Vienna, Austria
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | | | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Luis Nombela-Franco
- Cardiovascular Institute. Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom; University of California San Francisco, San Francisco, California, USA; Yunnan Hospital Fuwai, Kunming, China
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Didier Tchetche
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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9
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Brennan PF, McNeil AJ, Jing M, Awuah A, Moore JS, Mailey J, Finlay DD, Blighe K, McLaughlin JAD, Nesbit MA, Trucco E, Moore TCB, Spence MS. Assessment of the conjunctival microcirculation for patients presenting with acute myocardial infarction compared to healthy controls. Sci Rep 2021; 11:7660. [PMID: 33828174 PMCID: PMC8027463 DOI: 10.1038/s41598-021-87315-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/23/2021] [Indexed: 11/25/2022] Open
Abstract
Microcirculatory dysfunction occurs early in cardiovascular disease (CVD) development. Acute myocardial infarction (MI) is a late consequence of CVD. The conjunctival microcirculation is readily-accessible for quantitative assessment and has not previously been studied in MI patients. We compared the conjunctival microcirculation of acute MI patients and age/sex-matched healthy controls to determine if there were differences in microcirculatory parameters. We acquired images using an iPhone 6s and slit-lamp biomicroscope. Parameters measured included diameter, axial velocity, wall shear rate and blood volume flow. Results are for all vessels as they were not sub-classified into arterioles or venules. The conjunctival microcirculation was assessed in 56 controls and 59 inpatients with a presenting diagnosis of MI. Mean vessel diameter for the controls was 21.41 ± 7.57 μm compared to 22.32 ± 7.66 μm for the MI patients (p < 0.001). Axial velocity for the controls was 0.53 ± 0.15 mm/s compared to 0.49 ± 0.17 mm/s for the MI patients (p < 0.001). Wall shear rate was higher for controls than MI patients (162 ± 93 s-1 vs 145 ± 88 s-1, p < 0.001). Blood volume flow did not differ significantly for the controls and MI patients (153 ± 124 pl/s vs 154 ± 125 pl/s, p = 0.84). This pilot iPhone and slit-lamp assessment of the conjunctival microcirculation found lower axial velocity and wall shear rate in patients with acute MI. Further study is required to correlate these findings further and assess long-term outcomes in this patient group with a severe CVD phenotype.
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Affiliation(s)
- Paul F Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK.
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK.
| | - Andrew J McNeil
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Min Jing
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, UK
| | - Agnes Awuah
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Julie S Moore
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Jonathan Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Dewar D Finlay
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, UK
| | - Kevin Blighe
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - James A D McLaughlin
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, UK
| | - M Andrew Nesbit
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Emanuele Trucco
- VAMPIRE project, Computing (SSEN), University of Dundee, Dundee, UK
| | - Tara C B Moore
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
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10
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Dowling C, Firoozi S, Panoulas V, Dalby M, Kashyap MN, Kabir T, Kalogeras K, Buch MH, Levy R, Chowdhary S, Saraf S, Roberts D, More R, Wiper A, Abdelaziz HK, Neylon A, Mylotte D, Pisaniello AD, Fraser DGW, Anderson R, Cunnington MS, Malkin CJ, Blackman DJ, Brennan PF, Owens CG, Manoharan G, Spence MS, Brecker SJ. Initial experience of a self-expanding transcatheter aortic valve with an outer pericardial wrap: The United Kingdom and Ireland Implanters' registry. Catheter Cardiovasc Interv 2019; 95:1340-1346. [PMID: 31713325 DOI: 10.1002/ccd.28512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/12/2019] [Accepted: 09/16/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The United Kingdom and Ireland Implanters' registry is a multicenter registry which reports on real-world experience with new transcatheter heart valves. BACKGROUND The Evolut PRO (Medtronic, Minneapolis, MN) transcatheter aortic valve is a self-expanding transcatheter aortic valve with an outer pericardial wrap, designed to minimize paravalvular regurgitation. METHODS Between July 2017 and December 2018, clinical, procedural, and 30-day outcome data were prospectively collected from all patients receiving the Evolut PRO valve across nine participating centers in the United Kingdom and Ireland. The primary efficacy outcome was the Valve Academic Research Consortium-2 (VARC-2)-defined endpoint of device success. The primary safety outcome was the VARC-2-defined composite endpoint of early safety at 30 days. RESULTS A total of 317 patients underwent implantation. Mean age was 81.8 ± 6.4 years and Society of Thoracic Surgeons Predicted Risk of Mortality Score 5.5 ± 1.8%. Iliofemoral access was used in 99.1% of patients. Device success was 91.2%. Mean gradient was 7.6 ± 4.7 mmHg and effective orifice area 1.9 ± 0.7 cm2 . The incidence of moderate paravalvular regurgitation was 1.7% and there was no severe paravalvular regurgitation. A new permanent pacemaker was implanted in 17.8% of patients without a pacemaker at baseline. Early safety was demonstrated in 92.7%. At 30 days, all-cause mortality was 0.6%, stroke 3.8%, and major vascular complication 2.8%. CONCLUSIONS Real-world experience of the Evolut PRO transcatheter aortic valve demonstrated favorable procedural success, safety, valve function, and incidence of new permanent pacemaker implantation.
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Affiliation(s)
- Cameron Dowling
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's Hospital, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's Hospital, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Miles Dalby
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Mavin N Kashyap
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Tito Kabir
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Konstantinos Kalogeras
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Mamta H Buch
- North West Cardiac Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Levy
- North West Cardiac Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Saqib Chowdhary
- North West Cardiac Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Smriti Saraf
- North West Cardiac Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David Roberts
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Ranjit More
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Andrew Wiper
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Hesham K Abdelaziz
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.,Cardiovascular Department, Ain Shams University, Cairo, Egypt
| | - Antoinette Neylon
- Department of Cardiology, University Hospital Galway, Galway University Hospitals, Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway University Hospitals, Galway, Ireland
| | - Anthony D Pisaniello
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Douglas G W Fraser
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Michael S Cunnington
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Christopher J Malkin
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Daniel J Blackman
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul F Brennan
- Belfast Heart Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Colum G Owens
- Belfast Heart Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Ganesh Manoharan
- Belfast Heart Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Mark S Spence
- Belfast Heart Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's Hospital, St. George's University Hospitals NHS Foundation Trust, London, UK
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11
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Cahill TJ, Raby J, Jewell PD, Brennan PF, Banning AP, Byrne J, Kharbanda RK, MacCarthy PA, Thornhill MH, Sandoe JAT, Spence MS, Hildick-Smith D, Redwood S, Prendergast BD. 3326Infective endocarditis after transcatheter aortic valve implantation: findings from a UK nationwide linkage study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Infective endocarditis (IE) is a potentially fatal complication of prosthetic valve replacement and increasing use of transcatheter aortic valve implantation (TAVI) has resulted in a new elderly and frail population at increased risk of IE. The incidence of IE after TAVI and factors that influence the risk and subsequent outcome are relatively unknown.
Purpose
To describe the incidence, predictors, echocardiographic findings, microbiology and clinical outcomes of IE following TAVI in the United Kingdom (UK).
Methods
Patients who underwent TAVI between Jan 1 2007 and Dec 31 2016 were identified from the UK TAVI database held by the National Institute for Cardiovascular Outcomes Research. For this cohort, all hospital admissions with a primary diagnosis of IE were identified by linkage with the NHS Hospital Episode Statistics Admitted Patient Care database, or by contact with regional TAVI centres. Additional information concerning clinical presentation, imaging findings, microbiology, management and patient outcome were obtained where possible from the treating physician.
Results
A total of 16,014 patients underwent TAVI, of whom 157 developed IE over a median follow-up of 23.8 (IQR 7.8–52.4) months - an overall incidence of 0.98% (0.53% at one year post-TAVI). The mean age of patients with IE was 79.2±7.8 years, and 69% were male. The median time to IE following TAVI was 10.0 (IQR 4.0–22.3) months.
On multivariate analysis, IE was significantly more common in men (HR 2.05, 95% CI 1.35–3.11, p=0.001) and in patients receiving mechanically-expandable (HR 2.15, 95% CI 1.16–4.01, p=0.015) or balloon-expandable valves (HR 1.60, 95% CI 1.01–2.52, p=0.045) compared to self-expanding valves. IE was also more common in those with an aortic valve peak gradient following TAVI deployment greater than median (HR 1.81, 95% CI 1.23–2.67, p=0.003).
The most common presenting symptom was fever (present in 67.1%). The most frequent causal organisms were enterococci (25.9%), followed by oral streptococci (16.4%) and Staphylococcus aureus (11.8%). Transoesophageal echocardiography demonstrated vegetations in 72.5% of patients, most commonly on the TAVI valve leaflets (58.8%). Only 8.24% of patients underwent surgical valve intervention.
Survival rates at hospital discharge and one year follow up were 61.4% and 54.4%, respectively. Specific factors associated with one-year mortality were cardiogenic shock (HR 4.6, 95% CI 2.1–10.3, p=0.0002), septic shock (HR 3.4, 95% CI 1.4–8.3, p=0.006) and stroke (HR 4.9, 95% CI 1.46–16.7, p=0.01).
Conclusions
The incidence of IE one year after TAVI was 0.53% and greater risk was associated with male sex, mechanically-expandable and balloon-expandable valves, and elevated post-deployment valve gradient. Enterococci were the most common causative organism. Overall survival at one year was 54.4%, with adverse outcome predicted by cardiogenic shock, septic shock or stroke.
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Affiliation(s)
- T J Cahill
- John Radcliffe Hospital, Department of Cardiology, Oxford, United Kingdom
| | - J Raby
- John Radcliffe Hospital, Department of Cardiology, Oxford, United Kingdom
| | - P D Jewell
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - P F Brennan
- Belfast Health and Social Care Trust, Department of Cardiology, Belfast, United Kingdom
| | - A P Banning
- John Radcliffe Hospital, Department of Cardiology, Oxford, United Kingdom
| | - J Byrne
- Kings College Hospital, Department of Cardiology, London, United Kingdom
| | - R K Kharbanda
- John Radcliffe Hospital, Department of Cardiology, Oxford, United Kingdom
| | - P A MacCarthy
- Kings College Hospital, Department of Cardiology, London, United Kingdom
| | - M H Thornhill
- University of Sheffield, Unit of Oral & Maxillofacial Medicine Surgery & Pathology, School of Clinical Dentistry,, Sheffield, United Kingdom
| | - J A T Sandoe
- Leeds Teaching Hospitals NHS Trust, Department of Microbiology, Leeds, United Kingdom
| | - M S Spence
- Belfast Health and Social Care Trust, Department of Cardiology, Belfast, United Kingdom
| | | | - S Redwood
- St Thomas' Hospital, Department of Cardiology, London, United Kingdom
| | - B D Prendergast
- St Thomas' Hospital, Department of Cardiology, London, United Kingdom
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12
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Brennan PF, Wilson SJ, Alkhalil M, Santos A, McNiece A, Johnston NG, Jeganathan R, Owens CG, Manoharan G, Spence MS. P184511 years of transcatheter aortic valve implantation in a single centre and outcomes for all 1004 patient cases completed. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Long-term outcome data after TAVI is of key importance as indications have extended from high risk patients to intermediate risk alongside contemporary study of low risk patients.
Purpose
We report our complete 11 y experience of TAVI.
Methods
All patients (n=1004) treated with TAVI in our institution between Feb 2008 & Nov 2018 were included. Data was collected prospectively and all death certificates were reviewed. Independent predictors of mortality were determined by multivariable cox proportional hazard modelling. Annular sizing was performed via echocardiography +/or angiography until Aug 2012 after which time cardiac CT was used.
Results
Patients were 53% female & had mean age 81.9±6.6 y, logistic EuroScore 18.5%. 89% were NYHA >2, and 26.7% had a left ventricular ejection fraction (LVEF) of <50%. TAVI was performed for severe degenerative aortic valve disease (93.5%), while valve-in-valve (2.4%) bicuspid (2.1%) & rheumatic (2%) made up the remainder. Self-expanding valves were implanted in 73% cases. 98% cases were performed under local anaesthesia. A percutaneous transfemoral approach was used in 92% cases. For the first 6 y 19% procedures were performed for urgent inpatients, rising to 42% over the last 5 y. The mean time to discharge was 5.5 d, overall, & 60% cases were discharged within 72 h in the last 5 y. Mortality, for those at risk, was 3.2%, 12.8%, 53% & 88% at 30 d, 1 y, 5 y & 10 y. The median time to death was 2.6 y. Non-cardiac death accounted for 62% deaths, with sepsis being the main cause (55%). The main cause of cardiac death was heart failure (HF (53%)). Independent clinical predictors of death were increased age, atrial fibrillation, pulmonary disease & LVEF <50%. Use of a 2nd generation valve was associated with better survival at 5 y (p<0.001).
30 d new permanent pacemaker and stroke incidence were 13.7% and 2% respectively. 30 d readmission occurred in 13% patients. Independent clinical predictors of 1 y HF (7%) readmission were NYHA Class >2 and LVEF <50%. Endocarditis was seen in 1.6% during a mean follow-up 2,593 patient y. Mean aortic gradients at 1 y, 5 y & 10 y were 9.7mmHg, 8.4mmHg & 10.53mmHg. One patient had severe trans-aortic regurgitation during the follow-up. A 2nd TAVI procedure was performed in 5 patients with clinically significant paravalvular regurgitation, all within 30 d.
Figure 1. A. Survival. B. Predictors death
Conclusion
This comprehensive evaluation of all patients treated with this innovative technology provides reassurance regarding the long-term clinical efficacy of TAVI & gives insight into the evolution of our programme with time.
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Affiliation(s)
- P F Brennan
- Royal Victoria Hospital, Belfast, United Kingdom
| | - S J Wilson
- Royal Victoria Hospital, Belfast, United Kingdom
| | - M Alkhalil
- Royal Victoria Hospital, Belfast, United Kingdom
| | - A Santos
- Royal Victoria Hospital, Belfast, United Kingdom
| | - A McNiece
- Royal Victoria Hospital, Belfast, United Kingdom
| | - N G Johnston
- Royal Victoria Hospital, Belfast, United Kingdom
| | - R Jeganathan
- Royal Victoria Hospital, Belfast, United Kingdom
| | - C G Owens
- Royal Victoria Hospital, Belfast, United Kingdom
| | - G Manoharan
- Royal Victoria Hospital, Belfast, United Kingdom
| | - M S Spence
- Royal Victoria Hospital, Belfast, United Kingdom
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13
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Brennan PF, Jeganathan R, Spence MS. Considering the optimal procedural Heart Team in TAVI: back to the future? EUROINTERVENTION 2019; 14:e1802-e1805. [PMID: 30956177 DOI: 10.4244/eijv14i18a315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Paul F Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
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14
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Abstract
Transcatheter aortic valve implantation (TAVI) is now an established treatment option for both high and intermediate operative risk patients with severe symptomatic aortic stenosis. The number of patients undergoing TAVI has increased over the last decade warranting continued technological improvements in transcatheter heart valve (THV) systems. The novel CENTERA self-expanding THV (Edwards Lifesciences, CA, USA) received CE approval this year. It is deliverable through a 14Fr sheath and has a unique motorized delivery system. The CENTERA-2 study results demonstrated a favorable survival rate at 30 days (99%), as well as a low need for new permanent pacemaker implantation (4.9%). 1-year outcomes reported a low incidence of >moderate paravalvular leak (0.6%) and consistently favorable THV hemodynamics making this a competitive THV for patients with severe aortic stenosis.
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Affiliation(s)
- Paul F Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, Country Antrim, Northern Ireland, BT12 6BA
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, Country Antrim, Northern Ireland, BT12 6BA
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15
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Brennan PF, King O, Spence MS. Forty-year-old man with dyspnoea, haemoptysis and night sweats. Heart 2019; 105:919-925. [PMID: 30772824 DOI: 10.1136/heartjnl-2018-314511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 11/04/2022] Open
Abstract
CLINICAL INTRODUCTION A 40-year-old man presented with a 1-month history of night sweats, haemoptysis, dyspnoea and weight loss. He had never smoked. Physical examination was unremarkable. He was haemodynamically stable. He was anaemic with a haemoglobin of 10 g/L and his D-dimer was elevated at 1.32 µg/mL.A 12 lead ECG showed sinus rhythm with no abnormalities. A chest radiograph (CXR) was performed (figure 1A). Transthoracic echocardiography revealed normal right ventricular size and systolic function with a step-up, distally, in pulmonary arterial (PA) velocity from 0.7 m/s to 3.2 m/s.heartjnl;105/12/919/F1F1F1Figure 1Case image panelA CT pulmonary angiogram (CTPA) (figure 1B,C) was subsequently performed. The findings of the CTPA prompted further assessment with a positron emission tomography (PET)-CT (figure 1D). QUESTION What is the likely diagnosis? Right upper lobe bronchopneumonia.Submassive pulmonary embolism.Right upper lobe squamous cell carcinoma.Primary pulmonary artery angiosarcoma.Giant cell pulmonary arteritis.
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Affiliation(s)
- Paul F Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Oonagh King
- Department of Pathology, Royal Victoria Hospital, Belfast, UK
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
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Dowling C, Firoozi S, Doyle N, Blackman DJ, Malkin CJ, Cunnington MS, Saraf S, Buch MH, Levy R, Chowdhary S, Spence MS, Manoharan G, Owens CG, Brennan PF, Roberts D, More R, Wiper A, Abdelaziz HK, Mylotte D, Neylon A, Martin N, Mercanti F, Dorman S, Panoulas V, Dalby M, Kashyap MN, Kabir T, Kovac J, Kontoprias K, Malik IS, Ghada MW, Sen S, Ruparelia N, Demir OM, Frame A, Uren NG, Anderson R, Rajathurai T, Tapp L, Deegan L, Grech E, Hall I, Neville M, Rampat R, Hildick-Smith D, Mullen M, Kennon S, Chandrala P, Doshi S, Brecker SJ. Initial experience of a large, self-expanding, and fully recapturable transcatheter aortic valve: The UK & Ireland Implanters' registry. Catheter Cardiovasc Interv 2018; 93:751-757. [PMID: 30394657 DOI: 10.1002/ccd.27934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/04/2018] [Accepted: 09/23/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The UK & Ireland Implanters' registry is a multicenter registry which reports on real-world experience with novel transcatheter heart valves. BACKGROUND The 34 mm Evolut R transcatheter aortic valve is a self-expanding and fully recapturable transcatheter aortic valve, designed to treat patients with a large aortic annulus. METHODS Between January 2017 and April 2018, clinical, procedural and 30-day outcome data were prospectively collected from all patients receiving the 34 mm Evolut R valve across 17 participating centers in the United Kingdom and Ireland. The primary efficacy outcome was the Valve Academic Research Consortium-2(VARC-2)-defined endpoint of device success. The primary safety outcome was the VARC-2-defined composite endpoint of early safety at 30 days. RESULTS A total of 217 patients underwent attempted implant. Mean age was 79.5 ± 8.8 years and Society of Thoracic Surgeons Predicted Risk of Mortality Score 5.2% ± 3.4%. Iliofemoral access was used in 91.2% of patients. Device success was 79.7%. Mean gradient was 7.0 ± 4.6 mmHg and effective orifice area 2.0 ± 0.6 cm2 . Paravalvular regurgitation was more than mild in 7.2%. A new permanent pacemaker was implanted in 15.7%. Early safety was demonstrated in 91.2%. At 30 days, all-cause mortality was 3.2%, stroke 3.7%, and major vascular complication 2.3%. CONCLUSIONS Real-world experience of the 34 mm Evolut R transcatheter aortic valve demonstrated acceptable procedural success, safety, valve function, and incidence of new permanent pacemaker implantation.
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Affiliation(s)
- Cameron Dowling
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Niamh Doyle
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Daniel J Blackman
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | | | | | - Smriti Saraf
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom.,Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mamta H Buch
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Richard Levy
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Saqib Chowdhary
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mark S Spence
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - Ganesh Manoharan
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - Colum G Owens
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - Paul F Brennan
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - David Roberts
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Ranjit More
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Andrew Wiper
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Hesham K Abdelaziz
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom.,Cardiovascular Department, Ain Shams University, Cairo, Egypt
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Antoinette Neylon
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Niamh Martin
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Federico Mercanti
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Stephen Dorman
- Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom
| | | | - Miles Dalby
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Mavin N Kashyap
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Tito Kabir
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Jan Kovac
- Biomedical Research Unit, University of Leicester, Leicester, United Kingdom
| | - Kosmas Kontoprias
- Biomedical Research Unit, University of Leicester, Leicester, United Kingdom
| | - Iqbal S Malik
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mikhail W Ghada
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sayan Sen
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Ruparelia
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ozan M Demir
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Angela Frame
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neal G Uren
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | | | - Luke Tapp
- Department of Cardiology, University Hospital, Coventry, United Kingdom
| | - Lauren Deegan
- Department of Cardiology, University Hospital, Coventry, United Kingdom
| | - Ever Grech
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
| | - Ian Hall
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
| | - Melanie Neville
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
| | - Rajiv Rampat
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - David Hildick-Smith
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Michael Mullen
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Simon Kennon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Pavan Chandrala
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Sagar Doshi
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
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Brennan PF, McMullan R, Johnston NG, Owens C, Jeganathan R, Manoharan G, Spence MS. P4580Infective endocarditis following transcatheter aortic valve implantation; a single centre experience out to 10 years. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P F Brennan
- Royal Victoria Hospital, Cardiology, Belfast, United Kingdom
| | - R McMullan
- Royal Victoria Hospital, Cardiology, Belfast, United Kingdom
| | - N G Johnston
- Royal Victoria Hospital, Cardiology, Belfast, United Kingdom
| | - C Owens
- Royal Victoria Hospital, Cardiology, Belfast, United Kingdom
| | - R Jeganathan
- Royal Victoria Hospital, Cardiology, Belfast, United Kingdom
| | - G Manoharan
- Royal Victoria Hospital, Cardiology, Belfast, United Kingdom
| | - M S Spence
- Royal Victoria Hospital, Cardiology, Belfast, United Kingdom
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Johnson KA, Valdez RS, Casper GR, Kossman SP, Carayon P, Or CKL, Burke LJ, Brennan PF. Experiences of technology integration in home care nursing. AMIA Annu Symp Proc 2008; 2008:389-393. [PMID: 18999245 PMCID: PMC2656057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 07/14/2008] [Indexed: 05/27/2023]
Abstract
The infusion of health care technologies into the home leads to substantial changes in the nature of work for home care nurses and their patients. Nurses and nursing practice must change to capitalize on these innovations. As part of a randomized field experiment evaluating web-based support for home care of patients with chronic heart disease, we engaged nine nurses in a dialogue about their experience integrating this modification of care delivery into their practice. They shared their perceptions of the work they needed to do and their perceptions and expectations for patients and themselves in using technologies to promote and manage self-care. We document three overarching themes that identify preexisting factors that influenced integration or represent the consequences of technology integration into home care: doing tasks differently, making accommodations in the home for devices and computers, and being mindful of existing expectations and skills of both nurses and patients.
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Affiliation(s)
- K A Johnson
- University of Wisconsin Madison, Madison, Wisconsin, USA
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19
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Kwiatkowski K, Brennan PF. Linking personal and public health information: a vision for community-centered health information systems. Stud Health Technol Inform 2002; 84:33-7. [PMID: 11604701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
As health care in the U.S. and worldwide has shifted from a centralized, institution-based model to a distributed process occurring largely in the communities, Integrated Advanced Information Management Systems (IAIMS) initiatives must also move toward addressing the challenges of integrating health information at the community level. The Wisconsin IAIMS initiative strives to create such a solution, anchoring its efforts in a regional health information technology architecture by partnering with Wisconsin-area communities as the foundation that will ensure the establishment of the appropriate collaborations to gain adequate investment and generate sustainable solutions for health information integration.
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Affiliation(s)
- K Kwiatkowski
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA.
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20
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Shiffman RN, Spooner SA, Kwiatkowski K, Brennan PF. Information technology for children's health and health care: report on the Information Technology in Children's Health Care Expert Meeting, September 21-22, 2000. J Am Med Inform Assoc 2001; 8:546-51. [PMID: 11687562 PMCID: PMC130065 DOI: 10.1136/jamia.2001.0080546] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In September 2000, the Agency for Healthcare Quality and Research and the American Academy of Pediatrics Center for Child Health Research sponsored a meeting of experts and knowledgeable stakeholders to identify 1) the special information needs of pediatric care and 2) health service research questions related to the use of information technology in children's health care. Technologies that support the care of children must address issues related to growth and development, children's changing physiology, and the unique diseases of children and interventions of pediatric care. Connectivity and data integration are particular concerns for child health care workers. Consumer health information needs for this population extend beyond the needs of one individual to the needs of the family. Recommendations of the attendees include rapid implementation of features in electronic health information systems that support pediatric care and involvement of child health experts in policy making, standards setting, education, and advocacy. A proposed research agenda should address both effectiveness and costs of information technology, with special consideration for the needs of children, the development and evaluation of clinical decision support in pediatric settings, understanding of the epidemiology of iatrogenic injury in childhood, supplementation of vocabulary standards with pediatrics-specific terminology, and improvement in health care access for children, using telemedicine.
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Affiliation(s)
- R N Shiffman
- Yale Center for Medical Informatics, Yale University School of Medicine, New Haven, Connecticut 06520-8009, USA.
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Brennan PF, Menighan TE, Herzlinger RE. 1Q[3a]. What area of the Internet holds the most promise? Hosp Health Netw 2001; 75:32. [PMID: 11771515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Abstract
STUDY OBJECTIVES Patients experiencing prolonged periods of in-hospital mechanical ventilation have been described as long-term ventilator (LTV) patients. The purpose of this study was to document the incidence of hospital readmission and to identify risk factors for readmission for LTV patients up to 6 months after hospital discharge. DESIGN This study was part of a larger prospective longitudinal descriptive study of posthospital outcomes for LTV patients. SETTING AND PARTICIPANTS One hundred ninety-nine ICU patients admitted to a university medical center, Veterans Administration hospital, or small community hospital who required > 96 h of continuous in-hospital mechanical ventilation were enrolled. MEASUREMENTS AND RESULTS Descriptive statistics, logistic regression, and survival analytic techniques were used. The 6-month hospital readmission rate was 38%. Readmission occurred most often within days 1 to 60 days (mean, 39.2 days) posthospital discharge. Predictive variables for readmission were the following: length of the index hospital stay; length of the index mechanical ventilation; and the need for oxygen at hospital discharge. Using survival analysis, the age category of 66 to 71 years was statistically significant for the relative risk of readmission within the first 30 days of the index hospital discharge. CONCLUSIONS LTV patients should be considered at risk for hospital readmission. Further study examining the impact of closer follow-up in the first 60 days posthospital discharge is necessary in order to determine whether there is a more effective way of reducing the risk of readmission for LTV patients.
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Affiliation(s)
- S L Douglas
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106-4904, USA.
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23
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Brennan PF, Moore SM, Bjornsdottir G, Jones J, Visovsky C, Rogers M. HeartCare: an Internet-based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery. J Adv Nurs 2001; 35:699-708. [PMID: 11529972 DOI: 10.1046/j.1365-2648.2001.01902.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
HeartCare is an Internet-based information and support service for patients recovering at home from coronary artery bypass graft (CABG) surgery. The system is designed to meet the nursing challenges in health information to support needs of CABG patients. HeartCare (a) provides information and support, tailored to patients' individual and changing recovery needs during CABG recovery, (b) makes recovery information more accessible for timely use by patients, and (c) extends the scope of nursing services to CABG patients from hospital through home. An ongoing randomized controlled study is underway to evaluate the clinical outcomes of patients' use of the HeartCare system and to examine its acceptance as a usable resource for postCABG patients who have limited previous computer experience.
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Affiliation(s)
- P F Brennan
- Moehlman Bascan Professor of Nursing and Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA.
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Abstract
The track entitled "Consumer Informatics Supporting Patients as Co-Producers of Quality" at the AMIA Spring 2000 Congress was devoted to examining the new field of consumer health informatics. This area is developing rapidly, as worldwide changes are occurring in the organization and delivery of health care and in the traditional roles of patient and provider. This paper describes the key themes of the track; implications of the growing area of consumer health informatics; and recommendations for informatics research, design, and policy. Key themes that emerged from the panels and discussions involved changes in roles of consumers and providers; supporting a patient-provider-information technology partnership; virtual, not physical, structure for health care and health care information delivery; and health care as an integrated part of one's life. Panelists and participants at the Congress developed recommendations for informatics research, design, and policy, with an overarching focus on how to support the patient-provider-information technology partnership to provide more patient-centered health care. They recommended that AMIA take an active leadership role in consumer health informatics. Specific recommendations were made concerning research, new patient record systems, provider support, information access and evaluation, and policy and regulation.
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Affiliation(s)
- B Kaplan
- Yale University, New Haven, Connecticut, USA.
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25
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Kaplan B, Brennan PF, Dowling AF, Friedman CP, Peel V. Toward an informatics research agenda: key people and organizational issues. J Am Med Inform Assoc 2001; 8:235-41. [PMID: 11320068 PMCID: PMC131031 DOI: 10.1136/jamia.2001.0080235] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2000] [Accepted: 01/22/2001] [Indexed: 11/04/2022] Open
Abstract
As we have advanced in medical informatics and created many impressive innovations, we also have learned that technologic developments are not sufficient to bring the value of computer and information technologies to health care systems. This paper proposes a model for improving how we develop and deploy information technology. The authors focus on trends in people, organizational, and social issues (POI/OSI), which are becoming more complex as both health care institutions and information technologies are changing rapidly. They outline key issues and suggest high-priority research areas. One dimension of the model concerns different organizational levels at which informatics applications are used. The other dimension draws on social science disciplines for their approaches to studying implications of POI/OSI in informatics. By drawing on a wide variety of research approaches and asking questions based in social science disciplines, the authors propose a research agenda for high-priority issues, so that the challenges they see ahead for informatics may be met better.
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Affiliation(s)
- B Kaplan
- Yale University School of Medicine, New Haven, Connecticut, USA.
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26
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Abstract
The relationship between empathy and caregiving appraisal and outcomes was examined among 140 informal caregivers of older adults. Caregivers with high cognitive empathy appraised the caregiving situation as less stressful and less threatening, were less depressed, and reported higher life satisfaction than did caregivers with low cognitive empathy. The caregivers' appraisal, along with educational levels and total household income, significantly predicted individual differences in caregiver depression, life satisfaction, and perceived physical health. Emotional empathy was negatively related to life satisfaction. There appeared to be distinct roles for emotional and cognitive empathy in informal caregiving outcomes. The study supported the important role of caregiving appraisal and resources in caregiving outcomes.
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Affiliation(s)
- H S Lee
- Pusan National University, College of Medicine, Department of Nursing, 10 Ami 1 Ga, Suh-Gu, Pusan 602-739, South Korea
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Pioro MH, Landefeld CS, Brennan PF, Daly B, Fortinsky RH, Kim U, Rosenthal GE. Outcomes-based trial of an inpatient nurse practitioner service for general medical patients. J Eval Clin Pract 2001; 7:21-33. [PMID: 11240837 DOI: 10.1046/j.1365-2753.2001.00276.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although teaching hospitals are increasingly using nurse practitioners (NPs) to provide inpatient care, few studies have compared care delivered by NPs and housestaff or the ability of NPs to admit and manage unselected general medical patients. In a Midwest academic teaching hospital 381 patients were randomized to general medical wards staffed either by NPs and a medical director or medical housestaff. Data were obtained from medical records, interviews and hospital databases. Outcomes were compared on both an intention to treat (i.e. wards to which patients were randomized) and actual treatment (i.e. wards to which patients were admitted) basis. At admission, patients assigned randomly to NP-based care (n = 193) and housestaff care (n= 188) were similar with respect to demographics, comorbidity, severity of illness and functional parameters. Outcomes at discharge and at 6 weeks after discharge were similar (P>0.10) in the two groups, including: length of stay; charges; costs; consultations; complications; transfers to intensive care; 30-day mortality; patient assessments of care; and changes in activities of daily living, SF-36 scores and symptom severity. However, after randomization, 90 of 193 patients (47%) assigned to the NP ward were actually admitted to housestaff wards, largely because of attending physicians and NP requests. None the less, outcomes of patients admitted to NP and housestaff wards were similar (P>0.1). NP-based care can be implemented successfully in teaching hospitals and, compared to housestaff care, may be associated with similar costs and clinical and functional outcomes. However, there may be important obstacles to increasing the number of patients cared for by NPs, including physician concerns about NPs' capabilities and NPs' limited flexibility in managing varying numbers of patients and accepting off-hours admissions.
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Affiliation(s)
- M H Pioro
- Division of General Internal Medicine and Institute for Health Care Research, VA Medical Center, Cleveland, USA
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28
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Abstract
Existing public databases may help nurse administrators better understand the rapidly changing and increasingly complex healthcare environment. The authors discuss the availability of public healthcare databases and demonstrate through a hypothetical query how nurse administrators can use these databases during their decision-making efforts.
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Affiliation(s)
- D C Vahey
- University of Pennsylvania, Center for Health Outcomes and Policy Research, USA.
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Abstract
Nursing Practice Models (NPMs) represent the structural and contextual features that exist within any group practice of nursing. Currently, measurement of NPMs relies on costly and nonreproducible global judgments by experts. Quantitative measurement techniques are needed to provide a useful evaluation of nursing practice. Guided by Multi-Attribute Utility theory (MAU theory), an expert panel identified 24 factors representative of N PMs. The factors became elements in a computational index that, when summed, assigns a score to a given nursing unit reflecting the extent to which that unit's nursing practice model achieves the nursing professional ideal. Initial validation of the index and its elements consisted of comparing assessments of 40 nursing units generated by the index with a global evaluation provided by each of the expert panelists who proposed the model factors. Pearson correlations between the index-generated scores and the global assigned scores provided evidence supporting the preliminary validation of the index.
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Bachman JA, Brennan PF, Patrick TB, Cole M. A World Wide Web-based health resource. Survey of Missouri school nurses to determine priority health information resources for SchoolhealthLink. J Sch Nurs 2000; 16:28-33. [PMID: 11033674 DOI: 10.1177/105984050001600105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Two hundred ninety-two school nurses in Missouri participated in a mailed survey to aid in the design of SchoolhealthLink, a World Wide Web (WWW)-based information service for Missouri school nurses and children. The nurses identified specific health information resources likely to benefit school nurses and school children and prioritized these resources. The school nurses assigned high priority to 11 types of health information resources: individualized health care plans, emergency care plans, communicable disease control plans, acute illness, injuries, communicable diseases, hotline numbers, medications in schools, immunization protocols and standards, community-based health care resources, and Department of Elementary and Secondary Education regulations that affect school nurse practice. The four most common health problems school nurses identified were asthma, attention deficit disorder, diabetes, and head lice. SchoolhealthLink will provide a one-stop WWW-based resource for school nurses and school children.
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Affiliation(s)
- J A Bachman
- Barnes College of Nursing, University of Missouri, St. Louis, USA
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Kwiatkowski K, Brennan PF, DeMets D, Dahlen K, Buchanan J. University of Wisconsin IAIMS planning: organizational challenges within a faculty governance model. Proc AMIA Symp 2000:448-52. [PMID: 11079923 PMCID: PMC2243931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
The University of Wisconsin-Madison Health Sciences Schools are currently in the planning stage of developing an Integrated Advanced Information Management System (IAIMS). The planning phase of this project attends to the unique opportunities that are found at the flagship campus of a large state university system. Statewide teaching and research initiatives and accelerated campus-level capital development challenge the planners to create an IAIMS plan that anticipates an emerging health science environment. Additionally, UW-Madison has an organizational culture with a strong tradition of faculty governance, which provides a very desirable and flexible decision-making environment for a cross-discipline collaborative information management initiative. Development of a shared IAIMS vision conflicts with a governance model that most directly supports intradepartmental decision-making. The challenge presented here for an IAIMS initiative has less to do with hard wiring a technical infrastructure and more to do with increased stakeholder cooperation in a highly decentralized organization with autonomous information systems.
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Masys DR, Brennan PF, Ozbolt JG, Corn M, Shortliffe EH. Are medical informatics and nursing informatics distinct disciplines? The 1999 ACMI debate. J Am Med Inform Assoc 2000; 7:304-12. [PMID: 10833168 PMCID: PMC61434 DOI: 10.1136/jamia.2000.0070304] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The 1999 debate of the American College of Medical Informatics focused on the proposition that medical informatics and nursing informatics are distinctive disciplines that require their own core curricula, training programs, and professional identities. Proponents of this position emphasized that informatics training, technology applications, and professional identities are closely tied to the activities of the health professionals they serve and that, as nursing and medicine differ, so do the corresponding efforts in information science and technology. Opponents of the proposition asserted that informatics is built on a re-usable and widely applicable set of methods that are common to all health science disciplines, and that "medical informatics" continues to be a useful name for a composite core discipline that should be studied by all students, regardless of their health profession orientation.
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Affiliation(s)
- D R Masys
- University of California-San Diego, La Jolla 92093-0602, USA.
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Brennan PF. Health informatics and community health: support for patients as collaborators in care. Methods Inf Med 1999; 38:274-8. [PMID: 10805012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Health informatics has much to offer community health care. Computer networks and telecommunications provide particular support that can enhance the collaboration among clinicians, care providers and patients. Special-purpose computer tools referred to as Consumer Health Informatics (CHI) represent the application of computer and information technologies specifically to support the health information and communication needs of patients and lay persons. Research projects like ComputerLink and CHESS demonstrate that CHI is acceptable to patients and promotes self-care and disease management. Three grand challenges must be faced to insure realization of the promise of health informatics to community health care: development of knowledge management and information discovery tools for patients, insurance of health information literacy for all persons, and re-engineering clinical practice to capitalize on patients as full partners in health care.
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Affiliation(s)
- P F Brennan
- School of Nursing, University of Wisconsin-Madison, USA.
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Brennan PF, Zielstorff RD, Ozbolt JG, Strombom I. Setting a national research agenda in nursing informatics. Stud Health Technol Inform 1999; 52 Pt 2:1188-91. [PMID: 10384647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
An active program of research assures the development and evaluation of nursing informatics solutions to the challenges of contemporary patient care. Experts in nursing informatics research participated in a two-part electronic mail survey of research priorities. Priorities identified included formalization of nursing vocabularies, design and management of databases for nursing information, development of technologies to support nursing practice, use of telecommunications technology in nursing, patient use of information technology, identification of nurses' information needs, and systems modeling and evaluation. Many of these priorities are similar to those advanced in the 1993 US PHS NINR PEP Report on Nursing Informatics. Additionally, the findings suggest the need for greater emphasis on the application of emerging technology to nursing practice problems, and the expansion to consider patients as direct users of information systems.
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Affiliation(s)
- P F Brennan
- School of Nursing, University of Wisconsin, Madison, USA
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Affiliation(s)
- P F Brennan
- School of Nursing, University of Wisconsin-Madison, USA
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Gustafson DH, Robinson TN, Ansley D, Adler L, Brennan PF. Consumers and evaluation of interactive health communication applications. The Science Panel on Interactive Communication and Health. Am J Prev Med 1999; 16:23-9. [PMID: 9894551 DOI: 10.1016/s0749-3797(98)00104-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- D H Gustafson
- Department of Industrial Engineering and Preventive Medicine, University of Wisconsin-Madison 53705, USA
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Ehrenberger H, Brennan PF. Nursing informatics as a support function for oncology nursing research. Oncol Nurs Forum 1998; 25:21-6. [PMID: 9826848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE/OBJECTIVES To provide an overview of nursing informatics and examples of informatics research highlighting the potential for intersecting such research with oncology nursing research. DATA SOURCES Literature and online sources. DATA SYNTHESIS Nursing informatics may be discussed from technical, theoretical, or clinical perspectives. The interface between nursing practice and nursing informatics provides an opportunity to create new science and research to expand the boundaries of nursing knowledge. CONCLUSIONS It is time to evaluate the potential for intersecting informatics research with oncology nursing research. In an era of continuous healthcare change, nursing informatics has the potential to provide a unique contribution to oncology clinical practice and nursing research. IMPLICATIONS FOR NURSING PRACTICE By creatively applying nursing informatics, oncology nurse researchers may better capture the phenomena relevant to oncology nursing practice and further the discipline.
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Affiliation(s)
- H Ehrenberger
- College of Nursing, University of Tennessee, Knoxville
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Abstract
Nursing practice models (NPMs) describe the structural and contextual features of nursing practice environments. They offer direction in the design of information systems. Eleven factors describing NPMs emerged from a modified Delphi process: continuity of care, participation in management, collaboration, leadership, learning environment, nurse's role, staffing, communication, specialization, orientation of temporary staff, and group commitment. These factors provide nurse administrators with specific features of the clinical practice environment that IS applications should support.
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Affiliation(s)
- P F Brennan
- School of Nursing, University of Wisconsin, Madison, USA
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Brennan PF, Strombom I. Improving health care by understanding patient preferences: the role of computer technology. J Am Med Inform Assoc 1998; 5:257-62. [PMID: 9609495 PMCID: PMC61299 DOI: 10.1136/jamia.1998.0050257] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/1997] [Accepted: 01/20/1998] [Indexed: 11/03/2022] Open
Abstract
If nurses, physicians, and health care planners knew more about patients' health-related preferences, care would most likely be cheaper, more effective, and closer to the individuals' desires. In order for patient preferences to be effectively used in the delivery of health care, it is important that patients be able to formulate and express preferences, that these judgments be made known to the clinician at the time of care, and that these statements meaningfully inform care activities. Decision theory and health informatics offer promising strategies for eliciting subjective values and making them accessible in a clinical encounter in a manner that drives health choices. Computer-based elicitation and reporting tools are proving acceptable to patients and clinicians alike. It is time for the informatics community to turn their attention toward building computer-based applications that support clinicians in the complex cognitive process of integrating patient preferences with scientific knowledge, clinical practice guidelines, and the realities of contemporary health care.
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Affiliation(s)
- P F Brennan
- University of Wisconsin, Madison 53706, USA.
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Brennan PF, Daly BJ. Information requirements of advanced practice nurses. Adv Pract Nurs Q 1998; 2:54-7. [PMID: 9447090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To insure the availability of effective computer systems, advanced practice nurses (APNs) must first identify information required for practice. Fifteen APNs who worked in a local hospital participated in a focus group. The APNs included nurse practitioners and certified nurse midwives. All APNs carried individual caseloads and practiced collaboratively with both nurses and physicians. The most important information need expressed by the APNs was for current, clinical information about specific patients. Also desirable were computer tools that supported communication, documentation, and billing.
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Affiliation(s)
- P F Brennan
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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Abstract
ComputerLink was a computer support network for family caregivers of people with Alzheimer's disease. In a 12-month experiment, 102 caregivers were randomly assigned to an experimental group that had access to ComputerLink or to a control group that did not. This investigation examined whether caregivers in the experimental group had greater reductions in four types of care-related strain by the end of the 1-year study. ComputerLink reduced certain types of strain if caregivers also had larger informal support networks, were spouses, or did not live alone with their care receivers. More frequent use of the communication function was related to significantly reduced strain for caregivers who were initially more stressed and for non-spouse caregivers. Greater use of the information function was related to significantly lower strain among caregivers who lived alone with care receivers. Overall, ComputerLink appeared to be an effective tool for reducing strain for some caregivers.
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Brennan PF, Caldwell B, Moore SM, Sreenath N, Jones J. Designing HeartCare: custom computerized home care for patients recovering from CABG surgery. Proc AMIA Symp 1998:381-5. [PMID: 9929246 PMCID: PMC2232196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
With the current trend toward discharge of cardiac artery bypass graft (CABG) patients from the hospital after 5 days, clinicians must make effective use of existing computer technology to provide more efficiently the services once available during the patient's lengthier hospital stay. This paper describes the design of the HeartCare initiative, a computerized cardiac recovery service designed to provide home-care support for patients in the first three months following CABG surgery. Capitalizing on the expansion in health resources on the Internet, and building on the lessons from the ComputerLink projects, HeartCare will employ the World Wide Web platform in the generation of personalized in-home computerized access to recovery resources. Key implementation decisions include selection of WebTV/ as the home-based device, and application of Metadata to organizing health-related knowledge resources on the WWW.
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Brennan PF. Knowing what to do: international perspectives on the roles of clinical guidelines and patient preferences in patient care. J Am Med Inform Assoc 1998; 5:317-8. [PMID: 9609502 PMCID: PMC61306 DOI: 10.1136/jamia.1998.0050317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Choi CS, Brennan PF, Kalish C. Child health records: are they valid and useful to children and pediatric practitioners? Proc AMIA Symp 1998:453-6. [PMID: 9929260 PMCID: PMC2232094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Children are important consumers of health care, yet neither children nor their clinical practitioners have received much attention from the health informatics community. Child health needs differ from those of adults, and the purpose of health encounters for children focus to a greater extent on health promotion and evaluation of developmental milestones. The early childhood period is critical because it is during this time the children develop the expectations and attitudes about health care that they will carry with them throughout their lives. The primary purpose of this project is to examine the congruence in communication between children and pediatric practitioners. From this examination implications will be drawn for designing pediatric clinical records and developing strategies for determining the extent to which the record serve the child's health information needs and the clinician's health service delivery needs.
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Affiliation(s)
- C S Choi
- University of Wisconsin-Madison, USA
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Douglas SL, Daly BJ, Brennan PF, Harris S, Nochomovitz M, Dyer MA. Outcomes of long-term ventilator patients: a descriptive study. Am J Crit Care 1997; 6:99-105. [PMID: 9172858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Long-term ICU patients who require prolonged mechanical ventilation are a growing segment of the in-hospital population. Despite recognition that this population is costly to care for no systematic research has been done on the characteristics, outcomes, and disposition of these patients after they leave the hospital. OBJECTIVE To describe clinical and sociodemographic characteristics and outcomes of ICU patients who require long-term (5 days or more) mechanical ventilation while in the hospital. METHODS A prospective, longitudinal descriptive design was used to study 57 ICU patients who required 5 days or more of continuous mechanical ventilation while in the hospital. Clinical and sociodemographic data were collected at the time of enrollment. Patients were followed up for up to 6 months after discharge from the hospital to ascertain disposition and morality. RESULTS On average, patients had a hospital stay of almost 6 weeks and required mechanical ventilation for approximately 4 weeks; 43.9% of the patients died in the hospital. None of the patients discharged from the hospital were able to return home initially without assistance. By 6 months after discharge, more than 50% of the original sample and died, 9% resided in an institution, and 33% were living at home. CONCLUSIONS A large percentage of ICU patients who require 5 days or more of mechanical ventilation die in the hospital, and many of those who live spend considerable time in an extended-care facility before they are discharged to their homes. These likely outcomes of patients who require long-term ventilation should be discussed with patients and their families to assist them in making informed decisions.
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Affiliation(s)
- S L Douglas
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Abstract
BACKGROUND: Long-term ICU patients who require prolonged mechanical ventilation are a growing segment of the in-hospital population. Despite recognition that this population is costly to care for no systematic research has been done on the characteristics, outcomes, and disposition of these patients after they leave the hospital. OBJECTIVE: To describe clinical and sociodemographic characteristics and outcomes of ICU patients who require long-term (5 days or more) mechanical ventilation while in the hospital. METHODS: A prospective, longitudinal descriptive design was used to study 57 ICU patients who required 5 days or more of continuous mechanical ventilation while in the hospital. Clinical and sociodemographic data were collected at the time of enrollment. Patients were followed up for up to 6 months after discharge from the hospital to ascertain disposition and morality. RESULTS: On average, patients had a hospital stay of almost 6 weeks and required mechanical ventilation for approximately 4 weeks; 43.9% of the patients died in the hospital. None of the patients discharged from the hospital were able to return home initially without assistance. By 6 months after discharge, more than 50% of the original sample and died, 9% resided in an institution, and 33% were living at home. CONCLUSIONS: A large percentage of ICU patients who require 5 days or more of mechanical ventilation die in the hospital, and many of those who live spend considerable time in an extended-care facility before they are discharged to their homes. These likely outcomes of patients who require long-term ventilation should be discussed with patients and their families to assist them in making informed decisions.
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Brennan PF. The ComputerLink projects: a decade of experience. Stud Health Technol Inform 1997; 46:521-6. [PMID: 10175453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Telecommunications technology provides a pathway for nurses to reach patients and their family caregivers. The ComputerLink, an experimental computer network, enabled home-bound persons to access information, communications, and decision support services from their homes. Persons naive to computers can and will use telecommunications to maintain contact with peers and professionals. While participants in experimental networks used communication services most often, the access to relevant health information in a timely and convenient fashion may contribute more to the positive health benefits. Nursing interventions need to be tailored to capitalize on the unique features of computer network. The timing, cadence and content of interpersonal interactions must be modified to account for lags in the transmission of messages. Strategies for interpreting written text, which lacks the aural cues found in spoken speech, must be developed.
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Affiliation(s)
- P F Brennan
- School of Nursing and College of Engineering, University of Wisconsin-Madison, USA
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Ruland CM, Kresevic D, Brennan PF, Lorensen M. Decision support for assessing patient preferences for geriatric care. Stud Health Technol Inform 1996; 46:296-9. [PMID: 10175413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This paper describes a pilot study that tested the strategy and feasibility of a decision support system (DSS) that assists nurses in integrating patients' preferences for self-care functions in the assessment of elderly patients. 12 elderly clients and a clinical nurse specialist (CNS) participated in this study. The CNS reported the assessment strategy to be very helpful to learn about patients' strengths and weaknesses in self-care functioning. Clients reported that being asked about their preferences helped them clarify their goals, and created a shared understanding between nurse and patient. This pilot study also suggests that patients have a clear understanding of their predominant problems and can discriminate between their preferences. It further supports previous literature that there is a substantial difference in values patients place on clinical outcomes. This highlights the importance of an individual approach to patient care and the usefulness of DSS to assist nurses in eliciting patient preferences.
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Affiliation(s)
- C M Ruland
- FPB School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA
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