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Yildirim D, Akman O, Ozturk S, Yakin O. The correlation between death anxiety, loneliness and hope levels in patients treated in the cardiac intensive care unit. Nurs Crit Care 2024; 29:486-492. [PMID: 37969040 DOI: 10.1111/nicc.13007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND A sense of hope plays an important role in relieving stress and psychological distress of cardiology patients, as well as improving their physical well-being. AIM The aim of this study is to investigate the correlation between death anxiety, loneliness and hope levels in patients receiving treatment in a cardiac intensive care unit (ICU). DESIGN This is a prospective, descriptive and correlational study. METHODS The study was completed with 150 cardiac ICU patients in Istanbul, Turkey. The data were collected using a Patient Information Form, the Templer Death Anxiety Scale (TDAS), the Herth Hope Index (HHI) and the UCLA Loneliness Scale (UCLA-LS). RESULTS The patients had a mean age of 63.56 ± 12.74 years. Most of the patients (82%) were treated in the ICU for heart failure. There was a statistically significant positive correlation between total scores of TDAS and UCLA-LS (r = .337; p < .001) and a statistically significant negative correlation between total scores of UCLA-LS and HHI (r = -.292; p < .001). Also, there was a statistically significant negative correlation between the scores of UCLA-LS and Positive Readiness and Expectancy Subscale (r = -.164; p = .044). The multiple linear regression indicated that the model was statistically significant (F = 7.177, p < .001). The variables of age and UCLA-LS among those included in the model were statistically significant predictors of the death anxiety scores of the patients (23.1%) (p < .05). CONCLUSIONS The cardiology patients who received treatment in the ICU had a high level of death anxiety and moderate levels of loneliness and hope. The age and loneliness level were statistically significant predictors of death anxiety. RELEVANCE TO CLINICAL PRACTICE It is recommended that individualized nursing care be planned and provided to conscious cardiology patients who are treated in the ICU, considering their age and loneliness levels and that nursing care be planned for individuals who are at risk of fear, anxiety, loneliness and hopelessness by periodically assessing their death anxiety, loneliness and hope levels.
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Affiliation(s)
- Dilek Yildirim
- Faculty of Health Sciences, Department of Nursing, Istanbul Aydın University, Istanbul, Turkey
| | - Ozlem Akman
- Faculty of Health Sciences, Istanbul Topkapı University, Istanbul, Turkey
| | - Serpil Ozturk
- Istanbul Provincial Health Directorate Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Yakin
- Istanbul Provincial Health Directorate Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Yılmaz AS, Kahraman F, Ersoy İ, Taylan G, Kaya EE, Aydın E, Karakayalı M, Öğütveren MM, Taşdelen AG, Kümet Ö, Gül M, Nurkoç SG, Atan Ş, Özgeyik M, Kılıç O, Toprak AM, Özbek M, Kertmen Ö, Şafak Ö, Mert GÖ, Demir M, Yavuz YE, Keleşoğlu Ş, Uçar M, Işık İB, Öncel CR, Cengil ME, Küçük U, Dindaş F, Altınsoy M, Akkaya F. Baseline Characteristics of a Patient Cohort and Predictors of In-hospital MORtality in CORonary Care Units (MORCOR-TURK) Trial in Türkiye. Turk Kardiyol Dern Ars 2024; 52:175-181. [PMID: 38573092 DOI: 10.5543/tkda.2023.67505] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The MORtality in CORonary Care Units in Türkiye (MORCOR-TURK) trial is a national registry evaluating predictors and rates of in-hospital mortality in coronary care unit (CCU) patients in Türkiye. This report describes the baseline demographic characteristics of patients recruited for the MORCOR-TURK trial. METHODS The study is a multicenter, cross-sectional, prospective national registry that included 50 centers capable of 24-hour CCU service, selected from all seven geographic regions of Türkiye. All consecutive patients admitted to CCUs with cardiovascular emergencies between September 1-30, 2022, were prospectively enrolled. Baseline demographic characteristics, admission diagnoses, laboratory data, and cardiovascular risk factors were recorded. RESULTS A total of 3,157 patients with a mean age of 65 years (range: 56-73) and 2,087 (66.1%) males were included in the analysis. Patients with arterial hypertension [1,864 patients (59%)], diabetes mellitus (DM) [1,184 (37.5%)], hyperlipidemia [1,120 (35.5%)], and smoking [1,093 (34.6%)] were noted. Non-ST elevation myocardial infarction (NSTEMI) was the leading cause of admission [1,187 patients (37.6%)], followed by ST elevation myocardial infarction (STEMI) in 742 patients (23.5%). Other frequent diagnoses included decompensated heart failure (HF) [339 patients (10.7%)] and arrhythmia [272 patients (8.6%)], respectively. Atrial fibrillation (AF) was the most common pathological rhythm [442 patients (14%)], and chest pain was the most common primary complaint [2,173 patients (68.8%)]. CONCLUSION The most common admission diagnosis was acute coronary syndrome (ACS), particularly NSTEMI. Hypertension and DM were found to be the two leading risk factors, and AF was the most commonly seen pathological rhythm in all hospitalized patients. These findings may be useful in understanding the characteristics of patients admitted to CCUs and thus in taking precautions to decrease CCU admissions.
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Affiliation(s)
- Ahmet Seyda Yılmaz
- Recep Tayyip Erdogan University, Faculty of Medicine, Department of Cardiology, Rize, Turkiye
| | - Fatih Kahraman
- Kütahya Evliya Çelebi Training and Research Hospital, Department of Cardiology, Kütahya, Turkiye
| | - İbrahim Ersoy
- Afyonkarahisar Science of Health University, Department of Cardiology, Afyon, Turkiye
| | - Gökay Taylan
- Trakya University, Department of Cardiology, Tekirdağ, Turkiye
| | - Emin Erdem Kaya
- Ersin Arslan Training and Research Hospital, Department of Cardiology, Gaziantep, Turkiye
| | - Ertan Aydın
- Giresun University, Department of Cardiology, Giresun, Turkiye
| | - Muammer Karakayalı
- Kafkas University Training and Research Hospital, Department of Cardiology, Kars, Turkiye
| | | | | | - Ömer Kümet
- Van Training and Research Hospital, Department of Cardiology, Van, Turkiye
| | - Murat Gül
- Aksaray University, Department of Cardiology, Aksaray, Turkiye
| | | | - Şeyhmus Atan
- Ankara University, Faculty of Medicine, Department of Cardiology, Ankara, Turkiye
| | - Mehmet Özgeyik
- Eskişehir City Hospital, Department of Cardiology, Eskişehir, Turkiye
| | - Oğuz Kılıç
- Karaman Training and Research Hospital, Department of Cardiology, Karaman, Turkiye
| | - Aslıhan Merve Toprak
- Selçuk University, Faculty of Medicine, Department of Cardiology, Konya, Turkiye
| | - Mehmet Özbek
- Dicle University, Faculty of Medicine, Department of Cardiology, Diyarbakır, Turkiye
| | - Ömer Kertmen
- Amasya Training and Research Hospital, Department of Cardiology, Amasya, Turkiye
| | - Özgen Şafak
- Balıkesir University, Faculty of Medicine, Department of Cardiology, Balıkesir, Turkiye
| | - Gurbet Özge Mert
- Osmangazi University, Faculty of Medicine, Department of Cardiology, Eskişehir, Turkiye
| | - Mevlüt Demir
- Kütahya Evliya Çelebi Training and Research Hospital, Department of Cardiology, Kütahya, Turkiye
| | - Yunus Emre Yavuz
- Siirt Training and Research Hospital, Department of Cardiology, Siirt, Turkiye
| | - Şaban Keleşoğlu
- Erciyes University, Faculty of Medicine, Department of Cardiology, Kayseri, Turkiye
| | - Melisa Uçar
- Samsun Training and Research Hospital, Department of Cardiology, Samsun, Turkiye
| | | | - Can Ramazan Öncel
- Alanya Alaaddin Keykubat University, Department of Cardiology, Antalya, Turkiye
| | | | - Uğur Küçük
- Çanakkale 18 Mart University, Department of Cardiology, Çanakkale, Turkiye
| | - Ferhat Dindaş
- Uşak Training and Research Hospital, Department of Cardiology, Uşak, Turkiye
| | - Meltem Altınsoy
- Ankara Etlik City Hospital, Department of Cardiology, Ankara, Turkiye
| | - Fatih Akkaya
- Ordu University, Faculty of Medicine, Department of Cardiology, Ordu, Turkiye
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Bagheri H, Norouzi F, Maleki M, Rezaie S, Goli S, Ebrahimi H, Mardani A. The effect of increasing duration of family members' presence on sleep status in patients with acute coronary syndrome in cardiac care unit: A randomized controlled trial. Nurs Open 2024; 11:e2114. [PMID: 38424637 PMCID: PMC10904766 DOI: 10.1002/nop2.2114] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/27/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
AIM To investigate the effect of increasing duration of family members' presence on sleep status in patients with acute coronary syndrome (ACS) admitted to the cardiac care unit. DESIGN Randomized controlled trial. METHODS Ninety patients with ACS randomly assigned into two groups. No intervention was performed in control group. In the intervention group, the time of family members presence was changed from 1 h per day to 2 h per day from the second to the fourth day. Then, ST Mary's Hospital Sleep Questionnaire was completed by the patients every day during the study. RESULTS The patients in the intervention group had statistically significantly better sleep status during the course of intervention compared to the control group. PATIENT OR PUBLIC CONTRIBUTION The increasing duration of family members' presence can improve the sleep quality and quantity of ACS patients.
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Affiliation(s)
- Hossein Bagheri
- Department of Nursing, School of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
| | - Fatemeh Norouzi
- Student Research Committee, School of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
| | - Maryam Maleki
- Department of Pediatric and Neonatal Intensive Care Nursing Education, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Somayeh Rezaie
- Department of Nursing, School of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
| | - Shahrbanoo Goli
- Department of Epidemiology, School of Public HealthShahroud University of Medical SciencesShahroudIran
| | - Hossein Ebrahimi
- Center for Health Related Social and Behavioral Sciences ResearchShahroud University of Medical SciencesShahroudIran
| | - Abbas Mardani
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyZanjan University of Medical SciencesZanjanIran
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Liu A, Sun N, Gao F, Wang X, Zhu H, Pan D. The prognostic value of dynamic changes in SII for the patients with STEMI undergoing PPCI. BMC Cardiovasc Disord 2024; 24:67. [PMID: 38262934 PMCID: PMC10804790 DOI: 10.1186/s12872-023-03679-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Predicting the prognosis of primary percutaneous coronary intervention(PPCI) in ST-segment elevation myocardial infarction (STEMI) patients in the perioperative period is of great clinical significance. The inflammatory response during the perioperative period is also an important factor. This study aimed to investigate the dynamic changes in the systemic immune inflammatory index (SII) during the perioperative period of PPCI and evaluate its predictive value for in-hospital and out-of-hospital outcomes in patients with STEMI. METHODS This retrospective study included 324 consecutive patients with STEMI who were admitted to the cardiac care unit. Blood samples were collected before PPCI, 12 h (T1), 24 h, 48 h after PPCI, the last time before hospital discharge (T2), and 1 month after hospital discharge. The SII was calculated as (neutrophils×platelets)/lymphocytes. Based on whether the primary endpoint occurred, we divided the patients into event and non-event groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors that might influence the occurrence of the primary endpoint. Dynamic curves of SII were plotted, and receiver operating characteristic (ROC) curves were drawn for each node to calculate the optimal critical value, sensitivity, and specificity to assess their predictive ability for in-hospital and out-of-hospital courses. Kaplan-Meier curves were used to analyze the differences in survival rates at different SII inflammation levels. RESULTS High levels of SII were individually related to the occurrence of the in-hospital period and long-term outcomes during the post-operative follow-up of STEMI patients (in-hospital SII: T1:OR 1.001,95%CI 1.001-1.001, P < 0.001; SII following hospital discharge: T1M: OR 1.008,95%CI 1.006-1.010, P < 0.001). Patients with high SII levels had lower survival rates than those with low SII levels. The analysis showed that the SII 12 h after (T1) and SII 1 month (T1M) had excellent predictive values for the occurrence of in-hospital and out-of-hospital outcomes, respectively (AUC:0.896, P < 0.001; AUC:0.892, P < 0.001). CONCLUSION There is a significant relationship between the dynamic status of SII and prognosis in patients with STEMI. This study found that the 12 h and SII 1 month affected in-hospital and out-of-hospital outcomes, respectively. Consequently, we focused on the dynamic changes in the SII.
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Affiliation(s)
- Ailin Liu
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Na Sun
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Feiyu Gao
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xiaotong Wang
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hong Zhu
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
| | - Defeng Pan
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
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Donnelly S, Barnett CF, Bohula EA, Chaudhry SP, Chonde MD, Cooper HA, Daniels LB, Dodson MW, Gerber D, Goldfarb MJ, Guo J, Kontos MC, Liu S, Luk AC, Menon V, O'Brien CG, Papolos AI, Pisani BA, Potter BJ, Prasad R, Schnell G, Shah KS, Sridharan L, So DYF, Teuteberg JJ, Tymchak WJ, Zakaria S, Katz JN, Morrow DA, van Diepen S. Interhospital Variation in Admissions Managed With Critical Care Therapies or Invasive Hemodynamic Monitoring in Tertiary Cardiac Intensive Care Units: An Analysis From the Critical Care Cardiology Trials Network Registry. Circ Cardiovasc Qual Outcomes 2024; 17:e010092. [PMID: 38179787 DOI: 10.1161/circoutcomes.123.010092] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Wide interhospital variations exist in cardiovascular intensive care unit (CICU) admission practices and the use of critical care restricted therapies (CCRx), but little is known about the differences in patient acuity, CCRx utilization, and the associated outcomes within tertiary centers. METHODS The Critical Care Cardiology Trials Network is a multicenter registry of tertiary and academic CICUs in the United States and Canada that captured consecutive admissions in 2-month periods between 2017 and 2022. This analysis included 17 843 admissions across 34 sites and compared interhospital tertiles of CCRx (eg, mechanical ventilation, mechanical circulatory support, continuous renal replacement therapy) utilization and its adjusted association with in-hospital survival using logistic regression. The Pratt index was used to quantify patient-related and institutional factors associated with CCRx variability. RESULTS The median age of the study population was 66 (56-77) years and 37% were female. CCRx was provided to 62.2% (interhospital range of 21.3%-87.1%) of CICU patients. Admissions to CICUs with the highest tertile of CCRx utilization had a greater burden of comorbidities, had more diagnoses of ST-elevation myocardial infarction, cardiac arrest, or cardiogenic shock, and had higher Sequential Organ Failure Assessment scores. The unadjusted in-hospital mortality (median, 12.7%) was 9.6%, 11.1%, and 18.7% in low, intermediate, and high CCRx tertiles, respectively. No clinically meaningful differences in adjusted mortality were observed across tertiles when admissions were stratified by the provision of CCRx. Baseline patient-level variables and institutional differences accounted for 80% and 5.3% of the observed CCRx variability, respectively. CONCLUSIONS In a large registry of tertiary and academic CICUs, there was a >4-fold interhospital variation in the provision of CCRx that was primarily driven by differences in patient acuity compared with institutional differences. No differences were observed in adjusted mortality between low, intermediate, and high CCRx utilization sites.
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Affiliation(s)
- Sarah Donnelly
- Division of General Internal Medicine, Department of Medicine (S.D.), University of Alberta, Edmonton, Canada
| | - Christopher F Barnett
- Division of Cardiology, Department of Medicine, University of California, San Francisco (C.F.B., C.G.O.)
| | - Erin A Bohula
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.B., J.G., D.A.M.)
| | - Sunit-Preet Chaudhry
- Division of Cardiology, Ascension St. Vincent Heart Center, Indianapolis, IN (S.-P.C.)
| | - Meshe D Chonde
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA (M.D.C.)
| | - Howard A Cooper
- Westchester Medical Center and New York Medical College, Valhalla (H.A.C.)
| | - Lori B Daniels
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla (L.B.D.)
| | - Mark W Dodson
- Department of Medicine, Intermountain Medical Center, Murray, UT (M.W.D.)
| | - Daniel Gerber
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, CA (D.G.)
| | - Michael J Goldfarb
- Division of Cardiology, Jewish General Hospital, Montreal, QC, Canada (M.J.G)
| | - Jianping Guo
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.B., J.G., D.A.M.)
| | - Michael C Kontos
- Division of Cardiology, Virginia Commonwealth University, Richmond (M.C.K.)
| | - Shuangbo Liu
- Max Rady College of Medicine, St. Boniface Hospital, Winnipeg, MB, Canada (S.L.)
| | - Adriana C Luk
- Peter Munk Cardiac Centre at Toronto General Hospital, Division of Cardiology and Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada (A.C.L.)
| | - Venu Menon
- Cardiovascular Medicine, Cleveland Clinic Foundation, OH (V.M.)
| | - Connor G O'Brien
- Division of Cardiology, Department of Medicine, University of California, San Francisco (C.F.B., C.G.O.)
| | - Alexander I Papolos
- Division of Cardiology, Department of Critical Care, MedStar Washington Hospital Center, DC (A.I.P.)
| | | | - Brian J Potter
- Centre Hospitalier de l'Université de Montréal Research Center and Cardiovascular Center, QC, Canada (B.J.P.)
| | | | - Gregory Schnell
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (G.S.)
| | - Kevin S Shah
- University of Utah Health Sciences Center, Salt Lake City (K.S.S.)
| | | | - Derek Y F So
- University of Ottawa Heart Institute, ON, Canada (D.Y.F.S.)
| | | | - Wayne J Tymchak
- Department of Critical Care Medicine (W.J.T.), University of Alberta, Edmonton, Canada
- Division of Cardiology, Department of Medicine (W.J.T.), University of Alberta, Edmonton, Canada
| | - Sammy Zakaria
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (S.Z.)
| | | | - David A Morrow
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.B., J.G., D.A.M.)
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Kaur G, Berg DD. The Changing Epidemiology of the Cardiac Intensive Care Unit. Crit Care Clin 2024; 40:1-13. [PMID: 37973347 DOI: 10.1016/j.ccc.2023.09.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Coronary care units (CCUs) were originally designed to monitor and treat peri-infarction ventricular arrhythmias but have evolved into highly specialized cardiac intensive care units (CICUs) that provide care to a patient population that is increasingly heterogeneous and complex. Paralleling broader epidemiologic trends, patients admitted to contemporary CICUs are older and have a greater burden of cardiovascular and non-cardiovascular comorbidities. Moreover, contemporary CICU patients have high illness severity and often present with acute noncardiac organ dysfunction. In addition to these shifting demographic patterns, there have been important epidemiologic changes in CICU technologies, multidisciplinary systems of care, and physician staffing and training.
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Affiliation(s)
- Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - David D Berg
- Department of Medicine, Levine Cardiac Intensive Care Unit, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, TIMI Study Group, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA.
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Pierce JB, Applefeld WN, Senman B, Loriaux DB, Lawler PR, Katz JN. Design and Execution of Clinical Trials in the Cardiac Intensive Care Unit. Crit Care Clin 2024; 40:193-209. [PMID: 37973354 DOI: 10.1016/j.ccc.2023.09.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Clinical practice in the contemporary cardiac intensive care unit (CICU) has evolved significantly over the last several decades. With more frequent multisystem organ failure, increasing use of advanced respiratory support, and the advent of new mechanical circulatory support platforms, clinicians in the CICU are increasingly managing patients with complex comorbid disease in addition to their high-acuity cardiovascular illnesses. Here, the authors discuss challenges associated with traditional trial design in the CICU setting and review novel clinical trial designs that may facilitate better evidence generation in the CICU.
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Affiliation(s)
- Jacob B Pierce
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Willard N Applefeld
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Balimkiz Senman
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Daniel B Loriaux
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Patrick R Lawler
- McGill University Health Centre, Montreal, Quebec, Canada; Peter Munk Cardiac Centre at University Health Network, Toronto, Canada
| | - Jason N Katz
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA
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Miller PE, Huber K, Bohula EA, Krychtiuk KA, Pöss J, Roswell RO, Tavazzi G, Solomon MA, Kristensen SD, Morrow DA. Research Priorities in Critical Care Cardiology: JACC Expert Panel. J Am Coll Cardiol 2023; 82:2329-2337. [PMID: 38057075 PMCID: PMC10752230 DOI: 10.1016/j.jacc.2023.09.828] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/15/2023] [Accepted: 09/20/2023] [Indexed: 12/08/2023]
Abstract
Over the last several decades, the cardiac intensive care unit (CICU) has seen a substantial evolution in the patient population, comorbidities, and diagnoses. However, the generation of high-quality evidence to manage these complex and critically ill patients has been slow. Given the scarcity of clinical trials focused on critical care cardiology (CCC), CICU clinicians are often left to extrapolate from studies that either exclude or poorly represent the patient population admitted to CICUs. The lack of high-quality evidence and limited guidance from society guidelines has led to significant variation in practice patterns for many of the most common CICU diagnoses. Several barriers, both common to critical care research and unique to CCC, have impeded progress. In this multinational perspective, we describe key areas of priority for CCC research, current challenges for investigation in the CICU, and essential elements of a path forward for the field.
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Affiliation(s)
- P Elliott Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Erin A Bohula
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Konstantin A Krychtiuk
- Department of Internal Medicine II, Division of Cardiology Medical University of Vienna, Vienna, Austria; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Janine Pöss
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Robert O Roswell
- Northwell Health, Zucker School of Medicine, Hempstead, New York, USA
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Intensive Care Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Michael A Solomon
- Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland, USA
| | | | - David A Morrow
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Jentzer JC, Van Diepen S, Patel PC, Henry TD, Morrow DA, Baran DA, Kashani KB. Serial Assessment of Shock Severity in Cardiac Intensive Care Unit Patients. J Am Heart Assoc 2023; 12:e032748. [PMID: 37930059 PMCID: PMC10727310 DOI: 10.1161/jaha.123.032748] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND One-time assessment of the Society for Cardiovascular Angiography and Interventions (SCAI) shock classification robustly predicts mortality in the cardiac intensive care unit (CICU). We sought to determine whether serial SCAI shock classification could improve risk stratification. METHODS AND RESULTS Unique admissions to a single academic level 1 CICU from 2015 to 2018 were included in this retrospective cohort study. Electronic health record data were used to assign the SCAI shock stage during 4-hour blocks of the first 24 hours of CICU admission. Shock was defined as hypoperfusion (SCAI shock stage C, D, or E). In-hospital death was evaluated using logistic regression. Among 2918 unique CICU patients, 1537 (52.7%) met criteria for shock during ≥1 block, and 266 (9.1%) died in the hospital. The SCAI shock stage on admission was: A, 37.6%; B, 31.5%; C, 25.9%; D, 1.8%; and E, 3.3%. Patients who met SCAI criteria for shock on admission (first 4 hours) and those with worsening SCAI shock stage after admission were at higher risk for in-hospital death. Each higher admission (adjusted odds ratio, 1.36 [95% CI, 1.18-1.56]; area under the receiver operating characteristic curve, 0.70), maximum (adjusted odds ratio, 1.59 [95% CI, 1.37-1.85]; area under the receiver operating characteristic curve, 0.73) and mean (adjusted odds ratio, 2.42 [95% CI, 1.99-2.95]; area under the receiver operating characteristic curve, 0.78) SCAI shock stage was incrementally associated with a higher in-hospital mortality rate. Discrimination was highest for the mean SCAI shock stage (P<0.05). Each additional 4-hour block meeting SCAI criteria for shock predicted a higher mortality rate (adjusted odds ratio, 1.15 [95% CI, 1.07-1.24]). CONCLUSIONS Dynamic assessment of shock using serial SCAI shock classification assignment can improve mortality risk stratification in CICU patients by quantifying the magnitude and duration of shock.
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Affiliation(s)
| | - Sean Van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of MedicineUniversity of Alberta HospitalEdmontonAlbertaCanada
| | - Parag C. Patel
- Department of Cardiovascular MedicineMayo Clinic FloridaJacksonvilleFLUSA
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital and The Christ Hospital Heart and Vascular InstituteCincinnatiOHUSA
| | - David A. Morrow
- TIMI Study Group, Cardiovascular DivisionBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | - David A. Baran
- Department of Cardiovascular MedicineCleveland Clinic FloridaWestonFLUSA
| | - Kianoush B. Kashani
- Division of Pulmonary and Critical Care Medicine, Division of Nephrology and Hypertension, Department of MedicineMayo Clinic RochesterRochesterMNUSA
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10
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Dusi V, De Ferrari GM, Vergara P, Gravinese C, Frea S, Nesti M, Valente S, Calvanese R, Gulizia MM, Gabrielli D, Oliva F, Colivicchi F. [Electrical storm management in the cardiac care unit]. G Ital Cardiol (Rome) 2023; 24:711-730. [PMID: 37642123 DOI: 10.1714/4084.40681] [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: 08/31/2023]
Abstract
Electrical storm (ES) is characterized by at least three separate episodes of ventricular arrhythmia (VA) over 24 h that require treatment or an incessant VA lasting >12 h. The incidence is higher in patients with implantable cardioverter-defibrillators (ICDs) in secondary prevention and the main manifestation is monomorphic VA. ES onset represents a major event in the history of patients with cardiomyopathies that significantly worsens prognosis. The management of ES is complex and requires a multidisciplinary approach including a comprehensive clinical assessment, resuscitation and sedation management skills, ICD reprogramming, ablation, and neuromodulation procedures. ES early recognition and prompt treatment initiation increase the chances of therapeutic success. Each one of these aspects will be properly discussed in the present decalogue. Notably, ES management remains a challenge, with only limited available evidence from small retrospective series and a substantial lack/limited number of randomized or prospective trials. The spectrum of available antiarrhythmic drugs is limited, as well as their efficacy. The future hope is that larger prospective studies will be able to answer important questions, concerning the most effective pharmacologic strategies, the timing for the invasive treatment, the indications for acute neuromodulation strategies and for the circulatory support tools.
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Affiliation(s)
- Veronica Dusi
- Divisione di Cardiologia, Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino - Dipartimento di Scienze Mediche, Università degli Studi, Torino
| | - Gaetano Maria De Ferrari
- Divisione di Cardiologia, Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino - Dipartimento di Scienze Mediche, Università degli Studi, Torino
| | - Pasquale Vergara
- Unità di Aritmologia e Elettrofisiologia Cardiaca, IRCCS San Raffaele, Milano
| | - Carol Gravinese
- Divisione di Cardiologia, Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino
| | - Simone Frea
- Divisione di Cardiologia, Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino
| | - Martina Nesti
- Dipartimento Cardiologico e Neurologico, Ospedale San Donato, Arezzo
| | - Serafina Valente
- Cardiologia Clinico-Chirurgica (UTIC), A.O.U. Senese, Ospedale Santa Maria alle Scotte, Siena
| | | | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento di Scienze Cardio-Toraco-Vascolari, A.O. San Camillo Forlanini, Roma - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Fabrizio Oliva
- Unità di Cure Intensive Cardiologiche, Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
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11
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Affiliation(s)
- Aaron S Case
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - P Elliott Miller
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT
| | - David N Hager
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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12
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Kahraman F, Yılmaz AS, Ersoy İ, Demir M, Orhan H. Predictive outcomes of APACHE II and expanded SAPS II mortality scoring systems in coronary care unit. Int J Cardiol 2023; 371:427-431. [PMID: 36181949 DOI: 10.1016/j.ijcard.2022.09.065] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/27/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We investigated the predictive values of the expanded Simplified Acute Physiology Score (SAPS) II and Acute Physiologic Score and Chronic Health Evaluation (APACHE) II score in predicting in-hospital mortality in coronary care unit (CCU) patients. METHODS In this study, expanded SAPS II and APACHE II scores were calculated in the CCU of a single-center tertiary hospital. Patients admitted to CCU with any cardivascular indication were included in the study. Both scores were calculated according to previously determined criteria. Calibration and discrimination abilities of the scores in predicting in-hospital mortality were tested with Hosmer-Lemeshow goodness-of-fit C chi-square and receiver operating characteristics (ROC) curve analyses. RESULTS A total of 871 patients were included in the analysis. The goodness-of-fit C chi-square test showed that both scores have a good performance in predicting survivors and nonsurvivors in CCU. Expanded SAPS II score has a sensitivity of 80% and a specificity of 91.8% with the cut-off value of 5.55, while APACHE II has a sensitivity of 75.9% and a specificity of 87.4% with the cut-off value of 16.5 in predicting mortality. CONCLUSION Expanded SAPS II and APACHE II scores have good ability to predict in-hospital mortality in CCU patients. Therefore, they can be used as a tool to predict short-term mortality in cardiovascular emergencies.
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Affiliation(s)
- Fatih Kahraman
- Cardiology Clinic, Kutahya Evliya Celebi Research and Training Hospital, Kutahya, Turkey.
| | | | - İbrahim Ersoy
- Department of Cardiology, Afyonkarahisar Health Sciences University, Afyon, Turkey
| | - Mevlüt Demir
- Department of Cardiology, Kutahya Health Sciences University, Kutahya, Turkey
| | - Hikmet Orhan
- Department of Medical Informatics and Biostatistics, Suleyman Demirel University, School of Medicine, Isparta, Turkey
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13
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Gulizia MM, Fabbri G, Lucci D, Di Pasquale G, Gabrielli D, Campodonico J, Mauro A, Inciardi R, Di Lorenzo E, Oliva F, Nardi F, Colivicchi F, De Luca L. Type of hospitalisations and in-hospital outcomes in the Italian coronary care unit network at the time of COVID-19 pandemic: the BLITZ-COVID19 Registry. BMJ Open 2022; 12:e062382. [PMID: 36446450 PMCID: PMC9709809 DOI: 10.1136/bmjopen-2022-062382] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The aim of the study was to describe the epidemiology and outcome of patients hospitalised during the COVID-19 pandemic in intensive cardiac care units (ICCs). DESIGN Non-interventional, retrospective and prospective, nationwide study. SETTING 109 private or public ICCs in Italy. PARTICIPANTS 6054 consecutive patients admitted to Italian ICCs during COVID-19 pandemic. PRIMARY AND SECONDARY OUTCOME MEASURES To obtain accurate and up-to-date information on epidemiology and outcome of patients admitted to ICCs during the COVID-19 pandemic, the impact that the COVID-19 infection may have determined on the organisational pathways and in-hospital management of the various clinical conditions being admitted to ICCs. RESULTS Acute coronary syndromes were the most frequent ICC discharge diagnoses followed by heart failure and hypokinetic arrhythmias. The prevalence of COVID-19 positivity was approximately 3%. Most patients with a COVID-19 diagnosis at discharge (52%) arrived to ICC from other wards, in particular 22% from non-cardiology ICCs. The overall mortality was 4.2% during ICC and 5.8% during hospital stay. The cause of in-hospital death was cardiac in 74.4% of the cases, non-cardiovascular in 13.5%, vascular in 5.8% and related to COVID-19 in 6.3% of the patients. CONCLUSIONS This study provides a unique nationwide picture of current ICC care during COVID-19 pandemic. TRIAL REGISTRATION NUMBER NCT04744415.
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Affiliation(s)
- Michele Massimo Gulizia
- Division of Cardiology, National Centre of Excellence Garibaldi-Nesima Hospital, Catania, Italy
- Heart Care Foundation, Firenze, Italy
| | - Gianna Fabbri
- ANMCO Research Center, Heart Care Foundation, Firenze, Italy
| | - Donata Lucci
- ANMCO Research Center, Heart Care Foundation, Firenze, Italy
| | - Giuseppe Di Pasquale
- Regional Authority for Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Domenico Gabrielli
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, A.O. San Camillo-Forlanini, Roma, Italy
| | - Jeness Campodonico
- Intensive Cardiac Care Unit, Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Andrea Mauro
- Division of Cardiology, San Gerardo Hospital, Monza, Italy
| | - Riccardo Inciardi
- Division of Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Fabrizio Oliva
- Division of Cardiology 1, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Federico Nardi
- Division of Cardiology, Santo Spirito Hospital, Casale Monferrato, Italy
| | - Furio Colivicchi
- Division of Clinical Cardiology, Presidio Ospedaliero San Filippo Neri, Roma, Italy
| | - Leonardo De Luca
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, A.O. San Camillo-Forlanini, Roma, Italy
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14
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Bagaswoto HP, Ardelia YP, Setianto BY. First 24-h Sardjito Cardiovascular Intensive Care (SCIENCE) admission risk score to predict mortality in cardiovascular intensive care unit (CICU). Indian Heart J 2022; 74:513-518. [PMID: 36370802 PMCID: PMC9773286 DOI: 10.1016/j.ihj.2022.11.002] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/05/2022] [Accepted: 11/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The application of prognostic scoring systems to identify risk of death within 24 h of CICU admission has significant consequences for clinical decision-making. Previous score of parameters collected after 24 h was considered too late to predict mortality. As a result, we attempted to develop a CICU admission risk score to predict hospital mortality using indicators collected within 24 h. METHODS Data were obtained from SCIENCE registry from January 1, 2021 to December 21, 2021. Outcomes of 657 patients (mean age 58.91 ± 12.8 years) were recorded retrospectively. Demography, risk factors, comorbidities, vital signs, laboratory and echocardiography data at 24-h of patient admitted to CICU were analysed by multivariate logistic regression to create two models of scoring system (probability and cut-off model) to predict in-hospital mortality of any cause. RESULTS From a total of 657 patients, the hospital mortality was 15%. The significant predictors of mortality were male, acute heart failure, hemodynamic instability, pneumonia, baseline creatinine ≥1.5 mg/dL, TAPSE <17 mm, and the use of mechanical ventilator within first 24-h of CICU admission. Based on Receiver Operating Characteristic (ROC) curve analysis a cut off of ≥3 is considered to be a high risk of in-hospital mortality (sensitivity 75% and specificity 65%). CONCLUSION The initial 24-h SCIENCE admission risk rating system can be used to predict in-hospital mortality in patients admitted to the CICU with a high degree of sensitivity and specificity.
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Affiliation(s)
- Hendry Purnasidha Bagaswoto
- Cardiologist at Cardiology and Vascular Medicine Department of Medical, Public Health, and Nursing Faculty Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.
| | - Yuwinda Prima Ardelia
- Resident of Cardiology and Vascular Medicine Department of Medical, Public Health, and Nursing Faculty Universitas Gadjah Mada, Indonesia.
| | - Budi Yuli Setianto
- Cardiologist at Cardiology and Vascular Medicine Department of Medical, Public Health, and Nursing Faculty Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.
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15
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Metkus TS, Baird-Zars VM, Alfonso CE, Alviar CL, Barnett CF, Barsness GW, Berg DD, Bertic M, Bohula EA, Burke J, Burstein B, Chaudhry SP, Cooper HA, Daniels LB, Fordyce CB, Ghafghazi S, Goldfarb M, Katz JN, Keeley EC, Keller NM, Kenigsberg B, Kontos MC, Kwon Y, Lawler PR, Leibner E, Liu S, Menon V, Miller PE, Newby LK, O'Brien CG, Papolos AI, Pierce MJ, Prasad R, Pisani B, Potter BJ, Roswell RO, Sinha SS, Shah KS, Smith TD, Snell RJ, So D, Solomon MA, Ternus BW, Teuteberg JJ, van Diepen S, Zakaria S, Morrow DA. Critical Care Cardiology Trials Network (CCCTN): a cohort profile. Eur Heart J Qual Care Clin Outcomes 2022; 8:703-708. [PMID: 36029517 PMCID: PMC9603535 DOI: 10.1093/ehjqcco/qcac055] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/12/2022]
Abstract
AIMS The aims of the Critical Care Cardiology Trials Network (CCCTN) are to develop a registry to investigate the epidemiology of cardiac critical illness and to establish a multicentre research network to conduct randomised clinical trials (RCTs) in patients with cardiac critical illness. METHODS AND RESULTS The CCCTN was founded in 2017 with 16 centres and has grown to a research network of over 40 academic and clinical centres in the United States and Canada. Each centre enters data for consecutive cardiac intensive care unit (CICU) admissions for at least 2 months of each calendar year. More than 20 000 unique CICU admissions are now included in the CCCTN Registry. To date, scientific observations from the CCCTN Registry include description of variations in care, the epidemiology and outcomes of all CICU patients, as well as subsets of patients with specific disease states, such as shock, heart failure, renal dysfunction, and respiratory failure. The CCCTN has also characterised utilization patterns, including use of mechanical circulatory support in response to changes in the heart transplantation allocation system, and the use and impact of multidisciplinary shock teams. Over years of multicentre collaboration, the CCCTN has established a robust research network to facilitate multicentre registry-based randomised trials in patients with cardiac critical illness. CONCLUSION The CCCTN is a large, prospective registry dedicated to describing processes-of-care and expanding clinical knowledge in cardiac critical illness. The CCCTN will serve as an investigational platform from which to conduct randomised controlled trials in this important patient population.
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Affiliation(s)
- Thomas S Metkus
- Divisions of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Vivian M Baird-Zars
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Carlos E Alfonso
- Division of Cardiology, Department of Medicine; University of Miami Hospital & Clinics, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Carlos L Alviar
- Leon H. Charney Division of Cardiology, NYU Langone Medical Center, New York 10016 NY, USA
| | - Christopher F Barnett
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - David D Berg
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Mia Bertic
- University of Toronto Etobicoke,Toronto ON, Canada
| | - Erin A Bohula
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - James Burke
- Lehigh Valley Heart Institute, Allentown, PA 18103, USA
| | | | | | - Howard A Cooper
- Westchester Medical Center and New York Medical College, Valhalla NY 10901, USA
| | - Lori B Daniels
- Division of Cardiovascular Medicine La Jolla, UCSD, San Diego, CA 92037, USA
| | - Christopher B Fordyce
- UBC Centre for Cardiovascular Innovation, Cardiovascular Health Program, UBC Centre for Health Evaluation & Outcomes Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shahab Ghafghazi
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Jason N Katz
- Division of Cardiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Ellen C Keeley
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Norma M Keller
- Department of Medicine at NYU Grossman School of Medicine, Bellevue Hospital, New York NY 10016, USA
| | - Benjamin Kenigsberg
- Departments of Cardiology and Critical Care Medicine, MedStar Washington Hospital Center, Washington DC, WA 20010, USA
| | - Michael C Kontos
- Division of Cardiology, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Younghoon Kwon
- Division of Cardiology, University of Washington, Seattle, WA 98104, USA
| | - Patrick R Lawler
- Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto ON, Canada
| | - Evan Leibner
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY 10029, USA
| | - Shuangbo Liu
- Max Rady College of Medicine St. Boniface Hospital Winnipeg, Manitoba, Canada
| | - Venu Menon
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - P Elliott Miller
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - L Kristin Newby
- Divison of Cardiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Connor G O'Brien
- Department of Medicine, Division of Cardiology, University of California-San Francisco School of Medicine, San Francisco, CA 94143, USA
| | - Alexander I Papolos
- Departments of Cardiology and Critical Care Medicine, MedStar Washington Hospital Center, Washington DC, WA 20010, USA
| | - Matthew J Pierce
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, Long Island, NY 11549, USA
| | - Rajnish Prasad
- Wellstar Cardiovascular Medicine, Marietta, GA 30060, USA
| | | | - Brian J Potter
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, VA 22042, USA
| | - Kevin S Shah
- University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
| | - Timothy D Smith
- The Christ Hospital and Lindner Institute for Research and Education Cincinnati, OH 45219, USA
| | | | - Derek So
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | - Bradley W Ternus
- Division of Cardiology, Department of Internal Medicine, University of Wisconsin, Madison, WI 53792, USA
| | - Jeffrey J Teuteberg
- Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, CA 94305, USA
| | - Sean van Diepen
- Division of Cardiology, Department of Critical Care Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sammy Zakaria
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - David A Morrow
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Abstract
Driven by evolving patient demographics and disease burdens over the past several decades, the demands placed on the cardiac intensive care unit have steadily increased. Originally born out of the need for post-infarction arrhythmia monitoring, the modern cardiac intensive care space is now encountering progressively more complex patients with multisystem organ failure and, increasingly, complex mechanical circulatory support. This complexity has fueled a demand for specifically trained cardiac intensivists, and many different training pathways have emerged nationwide. In this article, we provide an overview of the evolution, landscape, training, and future of the subspecialty of cardiac critical care.
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Affiliation(s)
- Ann Gage
- Centennial Medical Center, Nashville, Tennessee, US
| | | | - Ran Lee
- Cleveland Clinic, Cleveland, Ohio, US
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17
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Brueske BS, Sidhu MS, Chang IY, Wiley BM, Murphy JG, Bennett CE, Barsness GW, Jentzer JC. Braden Skin Score Subdomains Predict Mortality Among Cardiac Intensive Care Patients. Am J Med 2022; 135:730-736.e5. [PMID: 35202570 DOI: 10.1016/j.amjmed.2022.01.046] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/01/2022] [Accepted: 01/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Braden Skin Score (BSS) is a bedside nursing assessment that may be a measure of frailty and predicts mortality among patients in the cardiac intensive care unit (CICU). We examined the association between each of the 6 individual BSS subscores with hospital mortality in patients in the CICU. We hypothesized that BSS subscores reflecting patient frailty would have a stronger association with outcomes. METHODS Retrospective cohort study of unique adult patients admitted to the Mayo Clinic CICU from 2007 to 2018 with BSS documented on admission. Primary outcome was all-cause hospital mortality. Odds ratios (ORs) were determined using multivariable logistic regression. RESULTS The 11,954 included patients had a mean age of 67.4 ± 15.2 years (37.8% women). Each individual BSS subscore was lower among patients who died in the hospital (all P < .001). The total BSS was inversely associated with in-hospital mortality across admission diagnoses and among patients with coma or mechanical ventilation; each individual subscore was inversely associated with in-hospital mortality. On multivariable regression, all subscores were inversely associated with hospital mortality after full adjustment. Shear had the strongest association (adjusted OR 0.59), followed by nutrition (adjusted OR 0.67), skin moisture (adjusted OR 0.76), mobility (adjusted OR 0.76), sensory perception (adjusted OR 0.82), and activity level (adjusted OR 0.85). CONCLUSION BSS can serve as a rapid noninvasive screening tool for identifying poor outcomes in patients in the CICU. BSS subdomains that are more strongly associated with mortality appear to reflect physical frailty. Insofar as the BSS and its subscores measure frailty, a low BSS may identify frail patients.
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Affiliation(s)
- Benjamin S Brueske
- Columbia University Irving Medical Center, New York, NY; Albany Medical College, Albany, NY
| | - Mandeep S Sidhu
- Albany Medical College, Albany, NY; Division of Cardiology, Albany Medical Center, Albany, NY.
| | | | - Brandon M Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Joseph G Murphy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | | | | | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
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18
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Fagundes A, Berg DD, Bohula EA, Baird-Zars VM, Barnett CF, Carnicelli AP, Chaudhry SP, Guo J, Keeley EC, Kenigsberg BB, Menon V, Miller PE, Newby LK, van Diepen S, Morrow DA, Katz JN. End-of-life care in the cardiac intensive care unit: a contemporary view from the Critical Care Cardiology Trials Network (CCCTN) Registry. Eur Heart J Acute Cardiovasc Care 2022; 11:190-197. [PMID: 34986236 DOI: 10.1093/ehjacc/zuab121] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
AIMS Increases in life expectancy, comorbidities, and survival with complex cardiovascular conditions have changed the clinical profile of the patients in cardiac intensive care units (CICUs). In this environment, palliative care (PC) services are increasingly important. However, scarce information is available about the delivery of PC in CICUs. METHODS AND RESULTS The Critical Care Cardiology Trials Network (CCCTN) Registry is a network of tertiary care CICUs in North America. Between 2017 and 2020, up to 26 centres contributed an annual 2-month snapshot of all consecutive medical CICU admissions. We captured code status at admission and the decision for comfort measures only (CMO) before all deaths in the CICU. Of 13 422 patients, 10% died in the CICU and 2.6% were discharged to palliative hospice. Of patients who died in the CICU, 68% were CMO at death. In the CMO group, only 13% were do not resuscitate/do not intubate at admission. The median time from CICU admission to CMO decision was 3.4 days (25th-75th percentiles: 1.2-7.7) and ≥7 days in 27%. Time from CMO decision to death was <24 h in 88%, with a median of 3.8 h (25th-75th 1.0-10.3). Before a CMO decision, 78% received mechanical ventilation and 26% mechanical circulatory support. A PC provider team participated in the care of 41% of patients who died. CONCLUSIONS In a contemporary CICU registry, comfort measures preceded death in two-thirds of cases, frequently without PC involvement. The high utilization of advanced intensive care unit therapies and lengthy times to a CMO decision highlight a potential opportunity for early engagement of PC teams in CICU.
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Affiliation(s)
- Antonio Fagundes
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - David D Berg
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Erin A Bohula
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Vivian M Baird-Zars
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Christopher F Barnett
- Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, Washington, DC, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Anthony P Carnicelli
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Jianping Guo
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Ellen C Keeley
- Division of Cardiology, University of Florida, Gainesville, FL, USA
| | - Benjamin B Kenigsberg
- Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, Washington, DC, USA
| | - Venu Menon
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - P Elliott Miller
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - L Kristin Newby
- Divison of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Sean van Diepen
- Division of Cardiology, Department of Critical Care Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - David A Morrow
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Jason N Katz
- Divison of Cardiology, Duke University School of Medicine, Durham, NC, USA
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19
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Yan J, Li X, Long W, Yuan T, Xian S. Association Between Obesity and Lower Short- and Long-Term Mortality in Coronary Care Unit Patients: A Cohort Study of the MIMIC-III Database. Front Endocrinol (Lausanne) 2022; 13:855650. [PMID: 35444615 PMCID: PMC9013888 DOI: 10.3389/fendo.2022.855650] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Obesity has long been considered an independent risk factor for cardiovascular diseases (CVD), even in the COVID-19 pandemic. However, recent studies have found that a certain degree of obesity may be beneficial for patients who have already suffered from CVD, which is called the "obesity paradox". Our objective was to investigate whether the obesity paradox existed in coronary care unit (CCU) patients and the relationship between body mass index (BMI) and short- and long-term mortality. METHODS We performed a cohort analysis of 3,502 adult CCU patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The patients were divided into four groups according to the WHO BMI categories. Both multivariable logistic regression and Cox regression were used to reveal the relation between BMI and mortality. Subgroup analyses were performed based on Simplified Acute Physiology Score (SAPS) and age. RESULTS After adjusting for confounders, obese patients had 33% and 30% lower mortality risk at 30-day and 1-year (OR 0.67, 95% CI 0.51 to 0.89; HR 0.70, 95% CI 0.59 to 0.83; respectively) compared with normal-weight patients, while the underweight group were opposite, with 141% and 81% higher in short- and long-term (OR 2.41, 95% CI 1.37 to 4.12; HR 1.81, 95% CI 1.34 to 2.46; respectively). Overweight patients did not have a significant survival advantage at 30-day (OR 0.91, 95% CI 0.70 to 1.17), but did have a 22% lower mortality risk at 1-year (HR 0.78; 95% CI 0.67 to 0.91). The results were consistent after being stratified by SAPS and age. CONCLUSION Our study supports that obesity improved survival at both 30-day and 1-year after CCU admission, and the obesity paradox existed in CCU patients.
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Affiliation(s)
- Junlue Yan
- The First Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinyuan Li
- Department of Community Health, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Wenjie Long
- Geriatrics Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tianhui Yuan
- Geriatrics Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Shaoxiang Xian, ; Tianhui Yuan,
| | - Shaoxiang Xian
- Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
- Cardiovascular Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Shaoxiang Xian, ; Tianhui Yuan,
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20
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Campanile A, Verdecchia P, Ravera A, Coiro S, Mattei C, Scavelli F, Bearzot L, Cutolo A, Centola M, Carugo S, De Rosa S, Guerra F, Marini M, Perna GP, Indolfi C, Cavallini C. Intensive cardiac care unit admission trends during the COVID-19 outbreak in Italy: a multi-center study. Intern Emerg Med 2021; 16:2077-2086. [PMID: 33768468 PMCID: PMC7993896 DOI: 10.1007/s11739-021-02718-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023]
Abstract
A significant decline in the admission to intensive cardiac care unit (ICCU) has been noted in Italy during the COVID-19 outbreak. Previous studies have provided data on clinical features and outcome of these patients, but information is still incomplete. In this multicenter study conducted in six ICCUs, we enrolled consecutive adult patients admitted to ICCU in three specific time intervals: from February 8 to March 9, 2020 [before national lockdown (pre-LD)], from March 10 to April 9, 2020 [during the first period of national lockdown (in-LD)] and from May 18 to June 17, 2020 [soon after the end of all containment measures (after-LD)]. Compared to pre-LD, in-LD was associated with a significant drop in the admission to ICCU for all causes (- 35%) and acute coronary syndrome (ACS; - 49%), with a rebound soon after-LD. The in-LD reduction was greater for women (- 49%) and NSTEMI (- 61%) compared to men (- 28%) and STEMI (- 33%). Length-of-stay, and in-hospital mortality did not show any significant change from to pre-LD to in-LD in the whole population as well as in the ACS group. This study confirms a notable reduction in the admissions to ICCUs from pre-LD to in-LD followed by an increment in the admission rates after-LD. These data strongly suggest that people, particularly women and patients with NSTEMI, are reluctant to seek medical care during lockdown, possibly due to the fear of viral infection. Such a phenomenon, however, was not associated with a rise in mortality among patients who get hospitalization.
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Affiliation(s)
- Alfonso Campanile
- Cardiology Department, Intensive Cardiac Care Unit, S. Giovanni Di Dio E Ruggi D'Aragona Hospital, Via San Leonardo 1, 84131, Salerno, Italy.
| | - Paolo Verdecchia
- Fondazione Umbra Cuore E Ipertensione-ONLUS', Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Amelia Ravera
- Cardiology Department, Intensive Cardiac Care Unit, S. Giovanni Di Dio E Ruggi D'Aragona Hospital, Via San Leonardo 1, 84131, Salerno, Italy
| | - Stefano Coiro
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Cristian Mattei
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Francesca Scavelli
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Luca Bearzot
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Ada Cutolo
- Cardiology Department, Intensive Cardiac Care Unit, Dell'Angelo Hospital, Mestre, Italy
| | - Marco Centola
- Department of Cardio-Respiratory Disease, University of Milan, Division of Cardiology, ASST Santi Paolo E Carlo, Milano, Italy
| | - Stefano Carugo
- Department of Cardio-Respiratory Disease, University of Milan, Division of Cardiology, ASST Santi Paolo E Carlo, Milano, Italy
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
- Cardiovascular Research Center, "Magna Graecia" University, Catanzaro, Italy
| | - Federico Guerra
- Cardiology Department, University Hospital 'Umberto I - Lancisi - Salesi', Ancona, Italy
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Marco Marini
- Cardiology Department, University Hospital 'Umberto I - Lancisi - Salesi', Ancona, Italy
| | - Gian Piero Perna
- Cardiology Department, University Hospital 'Umberto I - Lancisi - Salesi', Ancona, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
- Cardiovascular Research Center, "Magna Graecia" University, Catanzaro, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Claudio Cavallini
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
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21
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Nandiwada S, Islam S, Jentzer JC, Miller PE, Fordyce CB, Lawler P, Alviar CL, Sun LY, Dover DC, Lopes RD, Kaul P, van Diepen S. The association between cardiac intensive care unit mechanical ventilation volumes and in-hospital mortality. Eur Heart J Acute Cardiovasc Care 2021; 10:797-805. [PMID: 34318875 PMCID: PMC9067446 DOI: 10.1093/ehjacc/zuab055] [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] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/04/2021] [Indexed: 12/23/2022]
Abstract
AIMS The incidence of respiratory failure and use of invasive or non-invasive mechanical ventilation (MV) in the cardiac intensive care units (CICUs) is increasing. While institutional MV volumes are associated with reduced mortality in medical and surgical ICUs, this volume-mortality relationship has not been characterized in the CICU. METHODS AND RESULTS National population-based data were used to identify patients admitted to CICUs (2005-2015) requiring MV in Canada. CICUs were categorized into low (≤100), intermediate (101-300), and high (>300) volume centres based on spline knots identified in the association between annual MV volume and mortality. Outcomes of interest included all-cause in-hospital mortality, the proportion of patients requiring prolonged MV (>96 h) and CICU length of stay (LOS). Among 47 173 CICU admissions requiring MV, 89.5% (42 200) required invasive MV. The median annual CICU MV volume was 43 (inter-hospital range 1-490). Compared to low-volume centres (35.9%), in-hospital mortality was lower in intermediate [29.2%, adjusted odds ratio (aOR) 0.84, 95% confidence interval (CI) 0.72-0.97, P = 0.019] and high-volume (18.2%; aOR 0.82, 95% CI 0.66-1.02, P = 0.076) centres. Prolonged MV was higher in low-volume (29.2%) compared to high-volume (14.8%, aOR 0.70, 95% CI 0.55-0.89, P = 0.003) and intermediate-volume (23.0%, aOR 0.85, 95% CI 0.68-1.06, P = 0.14] centres. Mortality and prolonged MV were lower in percutaneous coronary intervention (PCI)-capable and academic centres, but a shorter CICU LOS was observed only in subgroup of PCI-capable intermediate- and high-volume hospitals. CONCLUSIONS In a national dataset, we observed that higher CICU MV volumes were associated with lower incidence of in-hospital mortality, prolonged MV, and CICU LOS. Our data highlight the need for minimum MV volume benchmarks for CICUs caring for patients with respiratory failure.
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Affiliation(s)
- Shiva Nandiwada
- Division of General Internal Medicine, Department of Medicine, Edmonton, Alberta, Canada
| | - Sunjidatul Islam
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - P Elliott Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Christopher B Fordyce
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick Lawler
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carlos L Alviar
- The Leon H. Charney Division of Cardiovascular Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Louise Y Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Douglas C Dover
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | | | - Padma Kaul
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sean van Diepen
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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22
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Adie SK, Ketcham SW, Abdul-Aziz AA, Thomas MP, Konerman MC. Characteristics of Heart Failure Patients With or Without Hypotension When Transitioning From Nitroprusside to Sacubitril-Valsartan. J Cardiovasc Pharmacol 2021; 78:403-406. [PMID: 34173810 DOI: 10.1097/fjc.0000000000001091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 04/30/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor indicated for the treatment of patients with symptomatic heart failure with reduced ejection fraction (HFrEF). Little is known about outcomes of HFrEF patients transitioned from sodium nitroprusside (SNP) to sacubitril-valsartan during an admission for acute decompensated heart failure. We sought to describe characteristics of patients initiated on sacubitril-valsartan while receiving SNP and, in particular, those patients who did and did not experience hypotension requiring interruption or discontinuation of sacubitril-valsartan. METHODS We performed a retrospective case series of adult patients (>18 years) with HFrEF (left ventricular ejection fraction ≤40%) admitted to the University of Michigan cardiac intensive care unit between July 2018 to September 2020 who received sacubitril-valsartan while on SNP. RESULTS A total of 15 patients with acute decompensated heart failure were initiated on sacubitril-valsartan while on SNP. The mean age was 57 ± 15.9 years. Seven (46.7%) patients experienced hypotension. The patients in the cohort who experienced hypotension were numerically older (60 ± 17 vs. 55 ± 15.5), and the majority were white (86%). Patients with hypotension had a numerically lower left ventricular ejection fraction (13 ± 4.2 vs. 18 ± 8.2) and higher serum creatinine (1.4 ± 0.54 vs. 0.88 ± 0.25). Seven (100%) patients received a diuretic on the day of sacubitril-valsartan initiation in those who experienced hypotension compared with 2 (25%) in those who did not experience hypotension. CONCLUSIONS In almost half of patients admitted to the cardiac intensive care unit with acutely decompensated HFrEF, significant hypotension was seen when initiating sacubitril-valsartan while on SNP. Future studies should evaluate appropriate patients for this transition and delineate appropriate titration parameters.
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Affiliation(s)
| | | | - Ahmad A Abdul-Aziz
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Michael P Thomas
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Matthew C Konerman
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, MI
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23
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Kanda M, Tateishi K, Nakagomi A, Iwahana T, Okada S, Kuwabara H, Kobayashi Y, Inoue T. Association between early intensive care or coronary care unit admission and post-discharge performance of activities of daily living in patients with acute decompensated heart failure. PLoS One 2021; 16:e0251505. [PMID: 33970971 PMCID: PMC8109822 DOI: 10.1371/journal.pone.0251505] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/27/2021] [Indexed: 01/16/2023] Open
Abstract
The management of acute decompensated heart failure often requires intensive care. However, the effects of early intensive care unit/coronary care unit admission on activities of daily living (ADL) in acute decompensated heart failure patients have not been precisely evaluated. Thus, we retrospectively assessed the association between early intensive care unit admission and post-discharge ADL performance in these patients. Acute decompensated heart failure patients (New York Heart Association I–III) admitted on emergency between April 1, 2014, and December 31, 2018, were selected from the Diagnosis Procedure Combination database and divided into intensive care unit/coronary care unit (ICU) and general ward (GW) groups according to the hospitalization type on admission day 1. The propensity score was calculated to create matched cohorts where admission style (intensive care unit/coronary care unit admission) was independent of measured baseline confounding factors, including ADL at admission. The primary outcome was ADL performance level at discharge (post-ADL) defined according to the Barthel index. Secondary outcomes included length of stay and total hospitalization cost (expense). Overall, 12231 patients were eligible, and propensity score matching created 2985 pairs. After matching, post-ADL was significantly higher in the ICU group than in the GW group [mean (standard deviation), GW vs. ICU: 71.5 (35.3) vs. 78.2 (31.2) points, P<0.001; mean difference: 6.7 (95% confidence interval, 5.1–8.4) points]. After matching, length of stay was significantly shorter and expenses were significantly higher in the ICU group than in the GW group. Stratified analysis showed that the patients with low ADL at admission (Barthel index score <60) were the most benefited from early intensive care unit/coronary care unit admission. Thus, early intensive care unit/coronary care unit admission was associated with improved post-ADL in patients with emergency acute decompensated heart failure admission.
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Affiliation(s)
- Masato Kanda
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuya Tateishi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Atsushi Nakagomi
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Togo Iwahana
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sho Okada
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroyo Kuwabara
- Department of Healthcare Management Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takahiro Inoue
- Department of Healthcare Management Research Center, Chiba University Hospital, Chiba, Japan
- * E-mail:
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24
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Breen TJ, Brueske B, Sidhu MS, Kashani KB, Anavekar NS, Barsness GW, Jentzer JC. Abnormal serum chloride is associated with increased mortality among unselected cardiac intensive care unit patients. PLoS One 2021; 16:e0250292. [PMID: 33901227 PMCID: PMC8075550 DOI: 10.1371/journal.pone.0250292] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/01/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose We sought to describe the association between serum chloride levels and mortality among unselected cardiac intensive care unit (CICU) patients. Materials and methods We retrospectively reviewed adult patients admitted to our CICU from 2007 to 2015. The association of dyschloremia and hospital mortality was assessed in a multiple variable model including additional confounders, and the association of dyschloremia and post-discharge mortality were assessed using Cox proportional-hazards analysis. Results 9,426 patients with a mean age of 67±15 years (37% females) were included. Admission hypochloremia was present in 1,384 (15%) patients, and hyperchloremia was present in 1,606 (17%) patients. There was a U-shaped relationship between admission chloride and unadjusted hospital mortality, with increased hospital mortality among patients with hypochloremia (unadjusted OR 3.0, 95% CI 2.5–3.6, p<0.001) or hyperchloremia (unadjusted OR 1.9, 95% CI 1.6–2.3, p<0.001). After multivariate adjustment, hypochloremia remained associated with higher hospital mortality (adjusted OR 2.1, 95% CI 1.6–2.9, p <0.001). Post-discharge mortality among hospital survivors was higher among patients with admission hypochloremia (adjusted HR 1.3, 95% CI 1.1–1.6; p<0.001). Conclusion Abnormal serum chloride on admission to the CICU is associated with increased short- and long-term mortality, with hypochloremia being a strong independent predictor.
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Affiliation(s)
- Thomas J. Breen
- Department of Internal Medicine, Mayo Clinic, Rochester MN, United States of America
| | - Benjamin Brueske
- Division of Cardiology, Department of Medicine, Albany Medical Center and Albany Medical College, Albany, NY, United States of America
| | - Mandeep S. Sidhu
- Division of Cardiology, Department of Medicine, Albany Medical Center and Albany Medical College, Albany, NY, United States of America
| | - Kianoush B. Kashani
- Division of Nephrology & Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Nandan S. Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Gregory W. Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Jacob C. Jentzer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
- * E-mail:
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25
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De Bonis S, Salerno N, Bisignani A, Capristo A, Sosto G, Verta A, Borselli R, Capristo C, Bisignani G. Cardiology emergency management and telecardiology within territorial hospital network. Four years activity results. Am J Emerg Med 2021; 48:347-350. [PMID: 33526347 DOI: 10.1016/j.ajem.2021.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Silvana De Bonis
- Department of Cardiology, Ospedale "Ferrari", Castrovillari, CS, Italy
| | - Nadia Salerno
- Department of Cardiology, Ospedale "Ferrari", Castrovillari, CS, Italy
| | - Antonio Bisignani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Gennaro Sosto
- Direzione Generale ASL Napoli 3 - Coordinatore Area Innovazione e Tecnologie Sanitarie di Federsanità, Italy
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26
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Cortés-Beringola A, Vicent L, Martín-Asenjo R, Puerto E, Domínguez-Pérez L, Maruri R, Moreno G, Vidán MT, Bueno H. Diagnosis, prevention, and management of delirium in the intensive cardiac care unit. Am Heart J 2021; 232:164-176. [PMID: 33253676 DOI: 10.1016/j.ahj.2020.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Received: 08/22/2020] [Accepted: 11/16/2020] [Indexed: 12/01/2022]
Abstract
Delirium is a frequent complication in patients admitted to intensive cardiac care units (ICCU) with potentially severe consequences including increased risks of mortality, cognitive impairment and dependence at discharge, and longer times on mechanical ventilation and hospital stay. Delirium has been widely documented and studied in general intensive care units and in patients after cardiac surgery, but it has barely been studied in acute nonsurgical cardiac patients. Moreover, delirium (especially in its hypoactive form) is commonly misdiagnosed. We propose a protocol for delirium prevention and management in ICCUs. A daily comprehensive assessment to improve detection should be done using validated scales (ie, confusion assessment method). Preventive measures are particularly relevance and constitute the basis of treatment as well, acting on reversible risk factors, including environmental interventions, such as quiet time, sleep promotion, family support, communication, and adequate treatment of pain and dyspnea. Pharmacological prophylaxis is not indicated with the exception of patients at risk of withdrawal syndrome but should only be used in patients with confirmed delirium. Dexmedetomidine is the drug of choice in patients with severe agitation, and those weaning from invasive mechanical ventilation. As the complexity of ICCUs increases, clinical scenarios posing challenges for the management of delirium become more frequent. Efforts should be done to improve the identification of patients at risk during admission in order to establish preventive interventions to avoid this complication. Patient-centered protocols will increase the awareness of the healthcare professionals for better prevention and earlier diagnosis and will positively impact on prognosis.
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Affiliation(s)
- Alejandro Cortés-Beringola
- Intensive Cardiac Care Unit, Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Cardiology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Lourdes Vicent
- Intensive Cardiac Care Unit, Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Roberto Martín-Asenjo
- Intensive Cardiac Care Unit, Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Elena Puerto
- Intensive Cardiac Care Unit, Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Laura Domínguez-Pérez
- Intensive Cardiac Care Unit, Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Ramón Maruri
- Intensive Cardiac Care Unit, Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Guillermo Moreno
- Intensive Cardiac Care Unit, Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - María T Vidán
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Héctor Bueno
- Intensive Cardiac Care Unit, Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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Bernal-Sprekelsen M, Avilés-Jurado FX, Álvarez Escudero J, Aldecoa Álvarez-Santuyano C, de Haro López C, Díaz de Cerio Canduela P, Ferrandis Perepérez E, Ferrando Ortolá C, Ferrer Roca R, Hernández Tejedor A, López Álvarez F, Monedero Rodríguez P, Ortiz Suñer A, Parente Arias P, Planas Roca A, Plaza Mayor G, Rascado Sedes P, Sistiaga Suárez JA, Vera Ching C, Villalonga Vadell R, Martín Delgado MC. [Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection]. Acta Otorrinolaringol Esp (Engl Ed) 2020; 71:386-392. [PMID: 32513456 PMCID: PMC7211599 DOI: 10.1016/j.otorri.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/15/2022]
Abstract
The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.
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Affiliation(s)
- Manuel Bernal-Sprekelsen
- Vicepresidente de la SEORL-CCC; Servicio de Otorrinolaringología, Hospital Clínic i Provincial, Barcelona, España.
| | | | - Julián Álvarez Escudero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - César Aldecoa Álvarez-Santuyano
- Servicio de Anestesiología y Reanimación, Hospital Universitario del Río Hortega, Departamento de Cirugía, Universidad de Valladolid, Valladolid, España
| | - Candelaria de Haro López
- Àrea de Crítics, Hospital Universitari Parc Taulí, Sabadell, Barcelona; CIBERES Enfermedades Respiratorias, ISCIII, y Grupo de trabajo de Insuficiencia Respiratoria Aguda, SEMICYUC, Madrid, España
| | - Pedro Díaz de Cerio Canduela
- Presidente de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC; Área de Otorrinolaringología, Hospital San Pedro, Logroño, España
| | - Eduardo Ferrandis Perepérez
- Instituto Valenciano de Oncología (IVO); Vocal de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Valencia, España
| | - Carlos Ferrando Ortolá
- Servicio de Anestesiología y Reanimación, Instituto de Investigación Pi i Suñer, Hospital Clínic i Provincial de Barcelona, Barcelona; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - Ricard Ferrer Roca
- Presidente de SEMICYUC; Servicio de Medicina Intensiva, Grupo de Investigación SODIR-VHIR, Hospital Vall d'Hebron, Barcelona, España
| | - Alberto Hernández Tejedor
- Departamento de Operaciones, SAMUR-Protección Civil. Unidad de Cuidados Intensivos, Hospital COVID-19 IFEMA, Madrid, España
| | - Fernando López Álvarez
- Vocal de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC; Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Pablo Monedero Rodríguez
- Vicepresidente de la Sección de Cuidados Intensivos, SEDAR; Departamento de Anestesia y Cuidados Intensivos; Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - Andrea Ortiz Suñer
- Servicio de Medicina Intensiva, Hospital Comarcal, Vinaroz, Castellón, España; Grupo de Trabajo de Insuficiencia Respiratoria Aguda de la SEMICYUC
| | - Pablo Parente Arias
- Presidente de Relaciones Internacionales de la SEORL-CCC; Hospital Universitario Locus Augusti, Lugo, España
| | - Antonio Planas Roca
- Servicio de Anestesiología y Reanimación, Hospital Universitario de la Princesa, Madrid, España
| | - Guillermo Plaza Mayor
- Presidente de Congresos de la SEORL-CCC; Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
| | - Pedro Rascado Sedes
- Presidente de la Sociedad Gallega de Medicina Intensiva y Unidades Coronarias (SOGAMIUC); Vocal JD SEMICYUC; Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - Jon Alexander Sistiaga Suárez
- Vocal de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC; Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Claudia Vera Ching
- Grupo de Trabajo de Insuficiencia Respiratoria Aguda de SEMICYUC; Servicio de Medicina Intensiva, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - Rosa Villalonga Vadell
- Vicepresidenta de la Comisión Nacional de Anestesiologia, Reanimación y Terapéutica del Dolor; Presidenta de la Sociedad Catalana de Anestesiología, Reanimación y Terapéutica del Dolor (SCARTD)
| | - María Cruz Martín Delgado
- Servicio Medicina Intensiva, Hospital Universitario de Torrejón, Universidad Francisco de Vitoria, Torrejón de Ardoz, Madrid, España
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28
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Villalonga Vadell R, Martín Delgado MC, Avilés-Jurado FX, Álvarez Escudero J, Aldecoa Álvarez-Santuyano C, de Haro López C, Díaz de Cerio Canduela P, Ferrandis Perepérez E, Ferrando Ortolá C, Ferrer Roca R, Hernández Tejedor A, López Álvarez F, Monedero Rodríguez P, Ortiz Suñer A, Parente Arias P, Planas Roca A, Plaza Mayor G, Rascado Sedes P, Sistiaga Suárez JA, Vera Ching C, Villalonga Vadell R, Martín Delgado MC, Bernal-Sprekelsen M. Consensus Document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on Tracheotomy in Patients with COVID-19 Infection. Rev Esp Anestesiol Reanim 2020; 67:504-510. [PMID: 32532430 PMCID: PMC7283053 DOI: 10.1016/j.redar.2020.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 12/20/2022]
Abstract
The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.
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Affiliation(s)
- R Villalonga Vadell
- Vicepresidencia de la Comisión Nacional de Anestesiología, Reanimación y Terapéutica del Dolor; Presidencia de la Sociedad Catalana de Anestesiología, Reanimación y Terapéutica del Dolor (SCARTD).
| | - M C Martín Delgado
- Vicepresidencia de la Comisión Nacional de Anestesiología, Reanimación y Terapéutica del Dolor; Presidencia de la Sociedad Catalana de Anestesiología, Reanimación y Terapéutica del Dolor (SCARTD)
| | - F X Avilés-Jurado
- Servicio de Otorrinolaringología, Hospital Clínic i Provincial, Barcelona, España
| | - J Álvarez Escudero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - C Aldecoa Álvarez-Santuyano
- Servicio de Anestesiología y Reanimación, Hospital Universitario del Río Hortega, Departamento de Cirugía, Universidad de Valladolid, Valladolid, España
| | - C de Haro López
- Àrea de Crítics, Hospital Universitari Parc Taulí, Sabadell, Barcelona, CIBERES Enfermedades Respiratorias, ISCIII, y Grupo de trabajo de Insuficiencia Respiratoria Aguda, SEMICYUC, Madrid, España
| | - P Díaz de Cerio Canduela
- Presidencia de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Área de Otorrinolaringología, Hospital San Pedro, Logroño, España
| | - E Ferrandis Perepérez
- Instituto Valenciano de Oncología (IVO), Vocalía de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Valencia, España
| | - C Ferrando Ortolá
- Servicio de Anestesiología y Reanimación, Instituto de Investigación Pi i Suñer, Hospital Clínic i Provincial de Barcelona, Barcelona, CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - R Ferrer Roca
- Presidencia de SEMICYUC, Servicio de Medicina Intensiva, Grupo de Investigación SODIR-VHIR, Hospital Vall d'Hebron, Barcelona, España
| | - A Hernández Tejedor
- Departamento de Operaciones, SAMUR-Protección Civil. Unidad de Cuidados Intensivos, Hospital COVID-19 IFEMA, Madrid, España
| | - F López Álvarez
- Vocalía de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - P Monedero Rodríguez
- Vicepresidencia de la Sección de Cuidados Intensivos, SEDAR, Departamento de Anestesia y Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - A Ortiz Suñer
- Servicio de Medicina Intensiva, Hospital Comarcal, Vinaroz, Castellón, España, Grupo de Trabajo de Insuficiencia Respiratoria Aguda de la SEMICYUC
| | - P Parente Arias
- Presidencia de Relaciones Internacionales de la SEORL-CCC, Hospital Universitario Locus Augusti, Lugo, España
| | - A Planas Roca
- Servicio de Anestesiología y Reanimación, Hospital Universitario de la Princesa, Madrid, España
| | - G Plaza Mayor
- Presidencia de Congresos de la SEORL-CCC, Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
| | - P Rascado Sedes
- Presidencia de la Sociedad Gallega de Medicina Intensiva y Unidades Coronarias (SOGAMIUC), Vocalía JD SEMICYUC, Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - J A Sistiaga Suárez
- Vocalía de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC; Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - C Vera Ching
- Grupo de Trabajo de Insuficiencia Respiratoria Aguda de SEMICYUC, Servicio de Medicina Intensiva, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - R Villalonga Vadell
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Universidad Francisco de Vitoria, Torrejón de Ardoz, Madrid, España
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Universidad Francisco de Vitoria, Torrejón de Ardoz, Madrid, España
| | - M Bernal-Sprekelsen
- Vicepresidencia de la SEORL-CCC, Servicio de Otorrinolaringología, Hospital Clínic i Provincial, Barcelona, España
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Martín Delgado MC, Avilés-Jurado FX, Álvarez Escudero J, Aldecoa Álvarez-Santuyano C, de Haro López C, Díaz de Cerio Canduela P, Ferrandis Perepérez E, Ferrando Ortolá C, Ferrer Roca R, Hernández Tejedor A, López Álvarez F, Monedero Rodríguez P, Ortiz Suñer A, Parente Arias P, Planas Roca A, Plaza Mayor G, Rascado Sedes P, Sistiaga Suárez JA, Vera Ching C, Villalonga Vadell R, Bernal-Sprekelsen M. [Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection]. Med Intensiva 2020; 44:493-499. [PMID: 32466990 PMCID: PMC7205735 DOI: 10.1016/j.medin.2020.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 02/03/2023]
Abstract
The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.
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Affiliation(s)
- M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Universidad Francisco de Vitoria, Torrejón de Ardoz, Madrid, España.
| | - F X Avilés-Jurado
- Servicio de Otorrinolaringología, Hospital Clínic i Provincial, Barcelona, España
| | - J Álvarez Escudero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - C Aldecoa Álvarez-Santuyano
- Servicio de Anestesiología y Reanimación, Hospital Universitario del Río Hortega, Departamento de Cirugía, Universidad de Valladolid, Valladolid, España
| | - C de Haro López
- Àrea de Crítics, Hospital Universitari Parc Taulí, Sabadell, Barcelona, CIBERES Enfermedades Respiratorias, ISCIII, y Grupo de trabajo de Insuficiencia Respiratoria Aguda, SEMICYUC, Madrid, España
| | - P Díaz de Cerio Canduela
- Presidencia de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Área de Otorrinolaringología, Hospital San Pedro, Logroño, España
| | - E Ferrandis Perepérez
- Instituto Valenciano de Oncología (IVO), Vocalía de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Valencia, España
| | - C Ferrando Ortolá
- Servicio de Anestesiología y Reanimación, Instituto de Investigación Pi i Suñer, Hospital Clínic i Provincial de Barcelona, Barcelona, CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - R Ferrer Roca
- Presidencia de SEMICYUC, Servicio de Medicina Intensiva, Grupo de Investigación SODIR-VHIR, Hospital Vall d'Hebron, Barcelona, España
| | - A Hernández Tejedor
- Departamento de Operaciones, SAMUR-Protección Civil. Unidad de Cuidados Intensivos, Hospital COVID-19 IFEMA, Madrid, España
| | - F López Álvarez
- Vocalía de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - P Monedero Rodríguez
- Vicepresidencia de la Sección de Cuidados Intensivos, SEDAR, Departamento de Anestesia y Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - A Ortiz Suñer
- Servicio de Medicina Intensiva, Hospital Comarcal, Vinaroz, Castellón, España, Grupo de Trabajo de Insuficiencia Respiratoria Aguda de la SEMICYUC
| | - P Parente Arias
- Presidencia de Relaciones Internacionales de la SEORL-CCC, Hospital Universitario Locus Augusti, Lugo, España
| | - A Planas Roca
- Servicio de Anestesiología y Reanimación, Hospital Universitario de la Princesa, Madrid, España
| | - G Plaza Mayor
- Presidencia de Congresos de la SEORL-CCC, Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
| | - P Rascado Sedes
- Presidencia de la Sociedad Gallega de Medicina Intensiva y Unidades Coronarias (SOGAMIUC), Vocalía JD SEMICYUC, Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - J A Sistiaga Suárez
- Vocalía de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC; Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - C Vera Ching
- Grupo de Trabajo de Insuficiencia Respiratoria Aguda de SEMICYUC, Servicio de Medicina Intensiva, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - R Villalonga Vadell
- Vicepresidencia de la Comisión Nacional de Anestesiologia, Reanimación y Terapéutica del Dolor; Presidencia de la Sociedad Catalana de Anestesiología, Reanimación y Terapéutica del Dolor (SCARTD)
| | - M Bernal-Sprekelsen
- Vicepresidencia de la SEORL-CCC, Servicio de Otorrinolaringología, Hospital Clínic i Provincial, Barcelona, España
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Alsinglawi B, Alnajjar F, Mubin O, Novoa M, Alorjani M, Karajeh O, Darwish O. Predicting Length of Stay for Cardiovascular Hospitalizations in the Intensive Care Unit: Machine Learning Approach. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:5442-5445. [PMID: 33019211 DOI: 10.1109/embc44109.2020.9175889] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Predicting Cardiovascular Length of stay based hospitalization at the time of patients' admitting to the coronary care unit (CCU) or (cardiac intensive care units CICU) is deemed as a challenging task to hospital management systems globally. Recently, few studies examined the length of stay (LOS) predictive analytics for cardiovascular inpatients in ICU. However, there are almost scarcely real attempts utilized machine learning models to predict the likelihood of heart failure patients length of stay in ICU hospitalization. This paper introduces a predictive research architecture to predict Length of Stay (LOS) for heart failure diagnoses from electronic medical records using the state-of-art- machine learning models, in particular, the ensembles regressors and deep learning regression models. Our results showed that the gradient boosting regressor (GBR) outweighed the other proposed models in this study. The GBR reported higher R-squared value followed by the proposed method in this study called Staking Regressor. Additionally, The Random forest Regressor (RFR) was the fastest model to train. Our outcomes suggested that deep learning-based regressor did not achieve better results than the traditional regression model in this study. This work contributes to the field of predictive modelling for electronic medical records for hospital management systems.
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Tateishi K, Nakagomi A, Saito Y, Kitahara H, Kanda M, Shiko Y, Kawasaki Y, Kuwabara H, Kobayashi Y, Inoue T. Feasibility of management of hemodynamically stable patients with acute myocardial infarction following primary percutaneous coronary intervention in the general ward settings. PLoS One 2020; 15:e0240364. [PMID: 33035270 PMCID: PMC7546471 DOI: 10.1371/journal.pone.0240364] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although current guidelines recommend admission to the intensive/coronary care unit (ICU/CCU) for patients with ST-segment elevation myocardial infarction (MI), routine use of the CCU in uncomplicated patients with acute MI remains controversial. We aimed to evaluate the safety of management in the general ward (GW) of hemodynamically stable patients with acute MI after primary percutaneous coronary intervention (PCI). METHODS Using a large nationwide administrative database, a cohort of 19426 patients diagnosed with acute MI in 52 hospitals where a CCU was available were retrospectively analyzed. Patients with mechanical cardiac support and Killip classification 4, and those without primary PCI on admission were excluded. A total of 5736 patients were included and divided into the CCU (n = 3488) and GW (n = 2248) groups according to the type of hospitalization room after primary PCI. Propensity score matching was performed, and 1644 pairs were matched. The primary endpoint was in-hospital mortality at 30 days. RESULTS The CCU group had a higher rate of Killip classification 3 and ambulance use than the GW group. There was no significant difference in the incidence of in-hospital mortality within 30 days among the matched subjects. Multivariable Cox proportional hazard model analysis among unmatched patients supported the findings (hazard ratio 1.12, 95% confidence interval 0.66-1.91, p = 0.67). CONCLUSIONS The use of the GW was not associated with higher in-hospital mortality in hemodynamically stable patients with acute MI after primary PCI. It may be feasible for the selected patients to be directly admitted to the GW after primary PCI.
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Affiliation(s)
- Kazuya Tateishi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Atsushi Nakagomi
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masato Kanda
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hiroyo Kuwabara
- Healthcare Management Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takahiro Inoue
- Healthcare Management Research Center, Chiba University Hospital, Chiba, Japan
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Dehghanrad F, Mosallanejad M, Momennasab M. Anxiety in Relatives of Patients Admitted to Cardiac Care Units and its Relationship with Spiritual Health and Religious Coping. Invest Educ Enferm 2020; 38:e10. [PMID: 33306900 PMCID: PMC7885539 DOI: 10.17533/udea.iee.v38n3e10] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This work sought to determine the level of anxiety in relatives of patients admitted to CCUs and its relationship with spiritual health and religious coping. METHODS This cross-sectional study was conducted on 300 relatives of Cardiac Care Units patients in Jahrom, Iran. Required data was collected using the Spielberger State-Trait Anxiety Inventory (STAI), the Paloutzian-Ellison Spiritual Well Being Scale (SWBS), and the Pargament Brief RCOPE questionnaire. RESULTS The results showed that both levels of state and trait anxiety were moderate and the level of total spiritual health was high. Anxiety score had an inverse relationship with spiritual health (r=-0.52) and a direct relationship with negative religious coping score (r=0.25). However, no significant relationship was found between total anxiety score and positive religious coping (p < 0.05). There was a direct relationship between spiritual health and positive religious coping (r=0.19), and an inverse relationship between spiritual health and negative religious coping (r=-0.36). CONCLUSIONS According to the findings of the study, it is suggested to paying attention to the reinforcement of spiritual attitudes, beliefs, and religious coping strategies to reduce their anxiety in CCU patients.
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Joubert LH, Herbst PG, Doubell AF, Pecoraro AJK. Clinical v. laboratory-based screening for COVID-19 in asymptomatic patients requiring acute cardiac care. S Afr Med J 2020; 110:13088. [PMID: 33403976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 06/12/2023] Open
Affiliation(s)
- L H Joubert
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
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Povar Marco J. Organizing the emergency care of patients with chest pain. Emergencias 2020; 31:371-372. [PMID: 31777205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Javier Povar Marco
- Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza, España
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Altay S, Gürdoğan M, Kaya Ç, Kardaş F, Zeybey U, Çakir B, Ebik M, Demir M. The etiology and age-related properties of patients with delirium in coronary intensive care unit and its effects on inhospital and follow up prognosis. Ideggyogy Sz 2020; 73:189-197. [PMID: 32579309 DOI: 10.18071/isz.73.0189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND PURPOSE Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. METHODS This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. RESULTS A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). CONCLUSION Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.
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Affiliation(s)
- Servet Altay
- Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey
| | - Muhammet Gürdoğan
- Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey
| | - Çağlar Kaya
- Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey
| | - Fatih Kardaş
- Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey
| | - Utku Zeybey
- Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey
| | - Burcu Çakir
- Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey
| | - Mustafa Ebik
- Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey
| | - Melik Demir
- Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey
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Suwita CS, Nasution SA, Muhadi M, Kurniawan J. Effects of Extracardiac Factors in Signal-Averaged Electrocardiography-measured Late Potentials from Early Anterior Myocardial Infarction in Intensive Cardiac Care Unit. Acta Med Indones 2020; 52:131-139. [PMID: 32778627] [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: 06/11/2023]
Abstract
BACKGROUND one modality that can predict ventricular arrhythmias after myocardial infarction (MI), particularly anterior MI, is signal-averaged electrocardiogram (SA-ECG), through the detection of late potentials (LP) which is a substrate for ventricular arrhythmias. Extracardiac factors, which are also risk factors for MI, such as hypertension, diabetes, dyslipidemia, and obesity, are apparently associated with post-MI ventricular arrhythmias, which in turn may be correlated with LP. This study aims to determine the effect of extracardiac risk factors on LP incidence in anterior MI patients treated in the intensive cardiac care unit (ICCU). METHODS this was a cross-sectional study in which 80 subjects with anterior MI during the period of December 2018-2019 underwent SA-ECG examination. The medical history and extracardiac risk factors were recapitulated, and then the SA-ECG data was taken from either direct examination or ICCU patients' database in that period. This study used multivariate analysis with logistic regression test. RESULTS the most common factors found were hypertension (70.00%), followed by dyslipidemia (56.25%), diabetes (46.25%), and obesity (38.75%). Obesity and dyslipidemia are extracardiac factors with the two biggest roles in the prevalence of LP. However, from additional analysis, we found that diabetes with acute hyperglycemia also had immense influence on the occurrence of LP. The OR for diabetes with acute hyperglycemia, obesity, and dyslipidemia were 4.806 (IK95% 0.522-44.232), 4.291 (IK95% 0.469-39.299), and 3.237 (IK95% 0.560-18.707). However, the association is not statistically significant. CONCLUSION patients with anterior MI who suffer from diabetes with hyperglycemia in admission, obesity, and dyslipidemia have a potentially higher LP prevalence, despite statistical insignificance. To increase the prognostic value of SA-ECG, serial examinations are needed during hospitalization.
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Rojas-Velázquez JM, Giralt-Herrera A, Torre Fonseca LMDL, Machín-Legón M, Cordero Menéndez SS. Gender differences in acute coronary syndrome. "Comandante Manuel Fajardo" Hospital, 2016-2017. Clin Investig Arterioscler 2020; 32:43-48. [PMID: 31964539 DOI: 10.1016/j.arteri.2019.08.001] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/30/2019] [Accepted: 08/22/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION There are both biological and sociocultural differences in patients with cardiovascular diseases. Inequalities in the prognosis between women and men are due to several variables, including specific risk factors for females, discrepancies in treatment strategies, and pathophysiological differences. OBJECTIVE To identify gender differences in patients with acute coronary syndrome. METHODS An observational, analytical, cross-sectional study was carried out on the gender differences in 170 patients with a diagnosis of acute coronary syndrome who were discharged from the Intensive Coronary Care Unit of the Comandante Manuel Fajardo Clinical-Surgical Hospital in 2016 and 2017. RESULTS Females had a statistically very significant association, with a higher mean age (68 vs. 62, P<.01) and with a history of arterial hypertension (91.2 vs. 72.3% P<.01). The smoking habit showed a statistically significant association with male individuals (50.5 vs. 30.4% P=.017). Males had a significantly higher median creatinine (90μmol/L vs. 80μmol/L, P<.01). Women showed an increased risk of haemodynamic complications (OR=3.11, 95% CI=1.20-8.04). CONCLUSIONS In women with acute coronary syndrome, being female is associated with older age, a history of arterial hypertension, and the appearance of haemodynamic complications during admission. Males are associated with smoking habits and higher concentrations of serum creatinine.
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Affiliation(s)
| | | | | | - Milagro Machín-Legón
- Facultad de Ciencias Médicas Manuel Fajardo, Universidad de Ciencias Médicas de La Habana, La Habana, Cuba
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Breen T, Brueske B, Sidhu MS, Murphree DH, Kashani KB, Barsness GW, Jentzer JC. Abnormal Serum Sodium is Associated With Increased Mortality Among Unselected Cardiac Intensive Care Unit Patients. J Am Heart Assoc 2020; 9:e014140. [PMID: 31914877 PMCID: PMC7033827 DOI: 10.1161/jaha.119.014140] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Abnormal serum sodium levels have been associated with higher mortality among patients with acute coronary syndromes and heart failure. We sought to describe the association between sodium levels and mortality among unselected cardiac intensive care unit (CICU) patients. Methods and Results We retrospectively reviewed consecutive adult patients admitted to our cardiac intensive care unit from 2007 to 2015. Hyponatremia and hypernatremia were defined as admission serum sodium <135 and >145 mEq/L, respectively. In‐hospital mortality was assessed by multivariable regression, and postdischarge mortality was evaluated by Cox proportional‐hazards analysis. We included 9676 patients with a mean age of 68±15 years (37.5% females). Hyponatremia occurred in 1706 (17.6%) patients, and hypernatremia occurred in 322 (3.3%) patients; these groups had higher illness severity and a greater number of comorbidities. Risk of hospital mortality was higher with hyponatremia (15.5% versus 7.5%; unadjusted odds ratio, 2.41; 95% CI, 2.06–2.82; P<0.001) or hypernatremia (17.7% versus 8.6%; unadjusted odds ratio, 2.82; 95% CI, 2.09–3.80; P<0.001), with a J‐shaped relationship between admission sodium and mortality. After multivariate adjustment, only hyponatremia was significantly associated with in‐hospital mortality (adjusted odds ratio, 1.42; 95% CI, 1.14–1.76; P=0.002). Among hospital survivors, risk of postdischarge mortality was higher in patients with hyponatremia (adjusted hazard ratio, 1.28; 95% CI, 1.17–1.41; P<0.001) or hypernatremia (adjusted hazard ratio, 1.36; 95% CI, 1.12–1.64; P=0.002). Conclusions Hyponatremia and hypernatremia on admission to the cardiac intensive care unit are associated with increased unadjusted short‐ and long‐term mortality. Further studies are needed to determine whether correcting abnormal sodium levels can improve outcomes in cardiac intensive care unit patients.
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Affiliation(s)
- Thomas Breen
- Department of Internal MedicineMayo ClinicRochesterMN
| | - Benjamin Brueske
- Division of CardiologyDepartment of MedicineAlbany Medical Center and Albany Medical CollegeAlbanyNY
| | - Mandeep S. Sidhu
- Division of CardiologyDepartment of MedicineAlbany Medical Center and Albany Medical CollegeAlbanyNY
| | | | - Kianoush B. Kashani
- Division of Nephrology and HypertensionDepartment of Internal MedicineMayo ClinicRochesterMN
- Division of Pulmonary and Critical Care MedicineDepartment of Internal MedicineMayo ClinicRochesterMN
| | | | - Jacob C. Jentzer
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Division of Pulmonary and Critical Care MedicineDepartment of Internal MedicineMayo ClinicRochesterMN
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Valentinuzzi ME, Hasbani E, Aguinaga L. Numerical Clinical Cardiology. IEEE Pulse 2020; 11:21-24. [PMID: 32175848 DOI: 10.1109/mpuls.2020.2972724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Numbers, numbers, they endessly fill out our life… weight, height and many other more hidden body attributes, too, like chronobiological parameters! Fat and thin woman, by Lyudmyla Kharlamova.
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Hao GW, Ma GG, Liu BF, Yang XM, Zhu DM, Liu L, Zhang Y, Liu H, Zhuang YM, Luo Z, Tu GW. Evaluation of two intensive care models in relation to successful extubation after cardiac surgery. Med Intensiva 2020; 44:27-35. [PMID: 30146128 DOI: 10.1016/j.medin.2018.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare outcomes between intensivist-directed and cardiac surgeon-directed care delivery models. DESIGN This retrospective, historical-control study was performed in a cohort of adult cardiac surgical patients at Zhongshan Hospital (Fudan University, China). During the first phase (March to August 2015), cardiac surgeons were in charge of postoperative care while intensivists were in charge during the second phase (September 2015-June 2016). Both phases were compared regarding successful extubation rate, intensive care unit (ICU) length of stay (LOS), and in-hospital mortality. SETTING Tertiary Zhongshan Hospital (Fudan University, China). PATIENTS Consecutive adult patients admitted to the cardiac surgical ICU (CSICU) after heart surgery. INTERVENTIONS Phase I patients treated by cardiac surgeons, and phase II patients treated by intensivists. MAIN VARIABLES OF INTEREST Successful extubation, ICU LOS and in-hospital mortality. RESULTS A total of 1792 (phase I) and 3007 patients (phase II) were enrolled. Most variables did not differ significantly between the two phases. However, patients in phase II had a higher successful extubation rate (99.17% vs. 98.55%; p=0.043) and a shorter median duration of mechanical ventilation (MV) (18 vs. 19h; p<0.001). In relation to patients with MV duration >48h, those in phase II had a comparatively higher successful extubation rate (p=0.033), shorter ICU LOS (p=0.038) and a significant decrease in in-hospital mortality (p=0.039). CONCLUSIONS The intensivist-directed care model showed improved rates of successful extubation and shorter MV durations after cardiac surgery.
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Affiliation(s)
- G-W Hao
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, PR China
| | - G-G Ma
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, PR China
| | - B-F Liu
- Department of Critical Care Medicine, The First People's Hospital of Zhangjiagang, Suzhou, China
| | - X-M Yang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, PR China
| | - D-M Zhu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, PR China
| | - L Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, PR China
| | - Y Zhang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, PR China
| | - H Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, PR China
| | - Y-M Zhuang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, PR China
| | - Z Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, PR China.
| | - G-W Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, PR China.
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Jentzer JC, Anavekar NS, Brenes-Salazar JA, Wiley B, Murphree DH, Bennett C, Murphy JG, Keegan MT, Barsness GW. Admission Braden Skin Score Independently Predicts Mortality in Cardiac Intensive Care Patients. Mayo Clin Proc 2019; 94:1994-2003. [PMID: 31585582 DOI: 10.1016/j.mayocp.2019.04.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Received: 10/26/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether a low Braden skin score (BSS), reflecting increased risk for skin pressure injury, would predict lower survival in cardiac intensive care unit (CICU) patients after adjustment for illness severity and comorbidities. PATIENTS AND METHODS This retrospective cohort study included consecutive unique adult patients admitted to a single tertiary care referral hospital CICU from January 1, 2007, through December 31, 2015, who had a BSS documented on CICU admission. The primary outcome was all-cause hospital mortality, using elastic net penalized logistic regression to determine predictors of hospital mortality. The secondary outcome was all-cause post-discharge mortality, using Cox proportional hazards models to determine predictors of post-discharge mortality. RESULTS The study included 9552 patients with a mean age of 67.4±15.2 years (3589 [37.6%] were females) and a hospital mortality rate of 8.3%. Admission BSS was inversely associated with hospital mortality (unadjusted odds ratio, 0.70; 95% CI, 0.68-0.72; P<.001; area under the receiver operator curve, 0.80; 95% CI, 0.78-0.82), with increased short-term mortality as a function of decreasing admission BSS. After adjustment for illness severity and comorbidities using multivariable analysis, admission BSS remained inversely associated with hospital mortality (adjusted odds ratio, 0.88; 95% CI, 0.85-0.92; P<.001). Among hospital survivors, admission BSS was inversely associated with post-discharge mortality after adjustment for illness severity and comorbidities (adjusted hazard ratio, 0.89; 95% CI, 0.88-0. 90; P<.001). CONCLUSION The admission BSS, a simple inexpensive bedside nursing assessment potentially reflecting frailty and overall illness acuity, was independently associated with hospital and post-discharge mortality when added to established multiparametric illness severity scores among contemporary CICU patients.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | | | | | - Brandon Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Courtney Bennett
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Joseph G Murphy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mark T Keegan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Abstract
OBJECTIVE To explore how health education received by patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM) influences patients' self-efficacy and self-management and changes in behaviour at, and following, hospital discharge. DESIGN This study used a convergent mixed methods design. PARTICIPANTS Twenty-one participants with completed surveys and interviews at discharge and home follow-up were included in the analysis. SETTING At a coronary care unit of a major hospital in Shanghai, China. RESULTS Most participants (n=17) did not perceive they had sufficient education or ability to manage both conditions. More concerning was that most participants (n=16) reported low self-efficacy in the management of ACS symptoms. Three major themes were identified: self-management of ACS and T2DM represents a complex interplay between individual self-efficacy, knowledge and skills, as individuals navigate shifting self-management priorities due to perceived condition severity; the social environment is integral to lifestyle and behaviour change and managing multiple health conditions requires body and mind systems' harmony. CONCLUSIONS The inpatient education received did not enhance participants' confidence to manage either condition on discharge. While an unhealthy lifestyle was embedded within social roles and norms, some social activities, such as square dancing, positively influenced health behaviour. Culturally appropriate education for Chinese people with diabetes and ACS should contain information on maintaining mind and body harmony. Family members should be involved in formal education.
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Affiliation(s)
- Xian-Liang Liu
- Shenzhen Nanshan People's Hospital, Shenzhen, China
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University (McAuley Campus), Brisbane, Queensland, Australia
- Tenth People's Hospital of Tongji University, Shanghai, China
- School of Nursing, Jinggangshan University, Ji'an, China
| | - Karen Willis
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Allied Health, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast (USC), Sippy Downs, Queensland, Australia
- Honorary Research Fellow, Royal Brisbane and Women's Hospital (RBWH), Herston, Queensland, Australia
- Honorary Research Fellow, Mater Medical Research Institute-University of Queensland (MMRI-UQ), Brisbane, Queensland, Australia
| | - Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University (McAuley Campus), Brisbane, Queensland, Australia
- Nursing Research & Practice Development Centre, The Prince Charles Hospital Metro North Health Service District, Brisbane, Queensland, Australia
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yan Shi
- Tenth People's Hospital of Tongji University, Shanghai, China
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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Sun H, Que J, Peng Y, Ye H, Xiang H, Han Y, Wang J, Ji K. The neutrophil-lymphocyte ratio: A promising predictor of mortality in coronary care unit patients - A cohort study. Int Immunopharmacol 2019; 74:105692. [PMID: 31228818 DOI: 10.1016/j.intimp.2019.105692] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Severe inflammation causes poor outcomes in coronary care unit (CCU) patients. The neutrophil-lymphocyte ratio (NLR), a biomarker used to monitor inflammation and the immune response, can predict a poor prognosis in various diseases. However, it remains unclear whether the NLR is associated with all-cause mortality in CCU patients. This study investigated the association between the NLR and CCU outcomes. METHODS Clinical data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database, which contains health data for over 50,000 patients. The primary outcome was 30-day mortality and the secondary outcome was 90-day mortality. Cox proportional hazard models were used to reveal the associations between NLR and outcomes. Multivariate analyses were used to control for confounders. RESULTS We enrolled 3563 CCU patients. For 30-day mortality, the hazard ratio (HR) (95% confidence interval [CI]) for the second (NLR 4.80-10.08) and the third (NLR ≥ 10.09) tertiles were 1.57 (1.24, 1.97) and 2.76 (2.23, 3.41), respectively, compared to the first tertile (NLR < 4.80). In the model adjusted for multiple confounders, the fifth quintile (NLR ≥ 14.17) showed a slightly lower mortality risk [HR (95% CI) 1.44 (1.07, 1.94)] compared to the fourth (NLR 8.82-14.16) [HR (95% CI) 1.55 (1.15, 2.10)]. A similar trend was observed for 90-day mortality. The interactions between the acute kidney injury, respiratory failure, and pneumonia subgroups and 30-day mortality were significant. CONCLUSIONS The NLR was an independent predictor of 30- and 90-day mortality for CCU patients. The NLR is a promising clinical biomarker as an integrated, readily available predictor of CCU mortality.
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Affiliation(s)
- Huankun Sun
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Jiaqun Que
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Yangpei Peng
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Haihao Ye
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China; Department of Cardiology, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, Zhejiang, China
| | - Huaqiang Xiang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Yueyuan Han
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Jie Wang
- Department of Endocrinology, Affiliated Hospital of Yanbian University, Yanji 133002, Jilin, China.
| | - Kangting Ji
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China.
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Brown SL. When the Doctor Becomes the Patient. JACC Heart Fail 2019; 7:527-530. [PMID: 31146876 DOI: 10.1016/j.jchf.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
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Lorente V, Ariza-Solé A, Jacob J, Formiga F, Marín F, Martínez-Sellés M, Viana-Tejedor A, Bardají A, Sionis A, Palau-Vendrell A, Díez-Villanueva P, Aboal J, González-Salvado V, Bueno H. Criteria for admitting elderly patients with acute coronary syndrome to critical care units from Spanish hospital emergency departments: a LONGEVO-SCA cohort study. Emergencias 2019; 31:154-160. [PMID: 31210446] [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: 06/09/2023]
Abstract
OBJECTIVES Information on criteria for admitting elderly patients with acute coronary syndrome (ACS) to intensive care units (ICUs) is scarce. We aimed to describe factors associated with ICU admission in unselected older patients with ACS in Spain. MATERIAL AND METHODS The prospective LONGEVO-SCA registry (Impact of Frailty and Other Geriatric Syndromes on the Management of and Mortality in Elderly Patients With Non-ST-segment Elevation Acute Coronary Syndrome) included unselected patients over the age of 80 years with non-ST-segment elevation SCA. A geriatric assessment of each patient was done in the hospital. Clinical outcomes at 6 months were analyzed. Bivariate logistic regression analysis was applied to identify ICU admission criteria. RESULTS Of 508 patients with a mean age of 84.3 years, 150 (29.5%) were admitted to the ICU. The admitted patients were younger and more often had acute heart failure, elevated troponin levels, and poor left ventricular function. They also scored higher on the Acute Coronary Treatment and Intervention Outcomes Network-ICU (ACTION-ICU) and Global Registry of Acute Coronary Events (GRACE) risk scales. These patients had higher functional status scores and a lower prevalence of frailty and had more often undergone coronary angiography (P < .001). No differences in hospital mortality or outcomes at 6 months were detected between patients admitted or not admitted to ICUs. The following variables were independent predictors of ICU admission: no history of a previous episode of heart failure, an elevated troponin level on arrival, left ventricular dysfunction, high GRACE score and high Charlson Comorbidity Index, and absence of frailty. CONCLUSION Around a third of elderly patients with non-ST-segment elevation ACS are admitted to an ICU. Admitted patients have a higher risk profile on arrival and a lower prevalence of geriatric syndromes.
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Affiliation(s)
- Victòria Lorente
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Francisco Marín
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Universidad de Murcia, Murcia, España
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense de Madrid, Madrid, España
| | - Ana Viana-Tejedor
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, España
| | - Alfredo Bardají
- Servicio de Cardiología, Hospital Joan XXIII, Tarragona, España
| | - Alessandro Sionis
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Jaime Aboal
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - Violeta González-Salvado
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - Héctor Bueno
- Servicio de Cardiología, Hospital 12 de Octubre, Madrid, España
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Berg DD, Bohula EA, van Diepen S, Katz JN, Alviar CL, Baird-Zars VM, Barnett CF, Barsness GW, Burke JA, Cremer PC, Cruz J, Daniels LB, DeFilippis AP, Haleem A, Hollenberg SM, Horowitz JM, Keller N, Kontos MC, Lawler PR, Menon V, Metkus TS, Ng J, Orgel R, Overgaard CB, Park JG, Phreaner N, Roswell RO, Schulman SP, Jeffrey Snell R, Solomon MA, Ternus B, Tymchak W, Vikram F, Morrow DA. Epidemiology of Shock in Contemporary Cardiac Intensive Care Units. Circ Cardiovasc Qual Outcomes 2019; 12:e005618. [PMID: 30879324 PMCID: PMC11032172 DOI: 10.1161/circoutcomes.119.005618] [Citation(s) in RCA: 200] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/25/2019] [Indexed: 01/01/2023]
Abstract
Background Clinical investigations of shock in cardiac intensive care units (CICUs) have primarily focused on acute myocardial infarction (AMI) complicated by cardiogenic shock (AMICS). Few studies have evaluated the full spectrum of shock in contemporary CICUs. Methods and Results The Critical Care Cardiology Trials Network is a multicenter network of advanced CICUs in North America. Anytime between September 2017 and September 2018, each center (n=16) contributed a 2-month snap-shot of all consecutive medical admissions to the CICU. Data were submitted to the central coordinating center (TIMI Study Group, Boston, MA). Shock was defined as sustained systolic blood pressure <90 mm Hg with end-organ dysfunction ascribed to the hypotension. Shock type was classified by site investigators as cardiogenic, distributive, hypovolemic, or mixed. Among 3049 CICU admissions, 677 (22%) met clinical criteria for shock. Shock type was varied, with 66% assessed as cardiogenic shock (CS), 7% as distributive, 3% as hypovolemic, 20% as mixed, and 4% as unknown. Among patients with CS (n=450), 30% had AMICS, 18% had ischemic cardiomyopathy without AMI, 28% had nonischemic cardiomyopathy, and 17% had a cardiac cause other than primary myocardial dysfunction. Patients with mixed shock had cardiovascular comorbidities similar to patients with CS. The median CICU stay was 4.0 days (interquartile range [IQR], 2.5-8.1 days) for AMICS, 4.3 days (IQR, 2.1-8.5 days) for CS not related to AMI, and 5.8 days (IQR, 2.9-10.0 days) for mixed shock versus 1.9 days (IQR, 1.0-3.6) for patients without shock ( P<0.01 for each). Median Sequential Organ Failure Assessment scores were higher in patients with mixed shock (10; IQR, 6-13) versus AMICS (8; IQR, 5-11) or CS without AMI (7; IQR, 5-11; each P<0.01). In-hospital mortality rates were 36% (95% CI, 28%-45%), 31% (95% CI, 26%-36%), and 39% (95% CI, 31%-48%) in AMICS, CS without AMI, and mixed shock, respectively. Conclusions The epidemiology of shock in contemporary advanced CICUs is varied, and AMICS now represents less than one-third of all CS. Despite advanced therapies, mortality in CS and mixed shock remains high. Investigation of management strategies and new therapies to treat shock in the CICU should take this epidemiology into account.
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Affiliation(s)
- David D Berg
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.D.B, E.A.B., V.M.B.-Z., J.-G.P., D.A.M.)
| | - Erin A Bohula
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.D.B, E.A.B., V.M.B.-Z., J.-G.P., D.A.M.)
| | - Sean van Diepen
- Department of Critical Care and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada (S.v.D., W.T.)
| | - Jason N Katz
- Divisions of Cardiology and Pulmonary and Critical Care Medicine, University of North Carolina, Center for Heart and Vascular Care Chapel Hill (J.N.K., R.O.)
| | | | - Vivian M Baird-Zars
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.D.B, E.A.B., V.M.B.-Z., J.-G.P., D.A.M.)
| | | | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (G.W.B., B.T.)
| | - James A Burke
- Lehigh Valley Health Network, Allentown, PA (J.A.B., A.H., F.V.)
| | - Paul C Cremer
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (P.C.C., V.M.)
| | - Jennifer Cruz
- Section of Cardiology, Cooper University Hospital, Camden, NJ (J.C., S.H.)
| | - Lori B Daniels
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla (L.B.D., N.P.)
| | - Andrew P DeFilippis
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, KY (A.D.)
| | - Affan Haleem
- Lehigh Valley Health Network, Allentown, PA (J.A.B., A.H., F.V.)
| | | | | | - Norma Keller
- New York University Langone Health (J.M.H., N.K., J.N., R.O.R.)
| | | | - Patrick R Lawler
- Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, ON, Canada (P.R.L., C.B.O.)
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (P.C.C., V.M.)
| | - Thomas S Metkus
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (T.S.M., S.P.S.)
| | - Jason Ng
- New York University Langone Health (J.M.H., N.K., J.N., R.O.R.)
| | - Ryan Orgel
- Divisions of Cardiology and Pulmonary and Critical Care Medicine, University of North Carolina, Center for Heart and Vascular Care Chapel Hill (J.N.K., R.O.)
| | - Christopher B Overgaard
- Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, ON, Canada (P.R.L., C.B.O.)
| | - Jeong-Gun Park
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.D.B, E.A.B., V.M.B.-Z., J.-G.P., D.A.M.)
| | - Nicholas Phreaner
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla (L.B.D., N.P.)
| | | | - Steven P Schulman
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (T.S.M., S.P.S.)
| | | | - Michael A Solomon
- Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute, of the National Institutes of Health, Bethesda, MD (M.A.S.)
| | - Bradley Ternus
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (G.W.B., B.T.)
| | - Wayne Tymchak
- Department of Critical Care and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada (S.v.D., W.T.)
| | - Fnu Vikram
- Lehigh Valley Health Network, Allentown, PA (J.A.B., A.H., F.V.)
| | - David A Morrow
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.D.B, E.A.B., V.M.B.-Z., J.-G.P., D.A.M.)
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Affiliation(s)
- William B Greenough
- Associate Medical Director, Specialty Hospital Programs, Clinical Chief, Ventilator Unit, Member of the Miller-Coulson Academy of Clinical Excellence, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD.
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Jogia PM, Kalkoff M, Sleigh JW, Bertinelli A, La Pine M, Richards AM, Devlin G. NT-Pro BNP Secretion and Clinical Endpoints in Cardiac Surgery Intensive Care Patients. Anaesth Intensive Care 2019; 35:363-9. [PMID: 17591129 DOI: 10.1177/0310057x0703500307] [Citation(s) in RCA: 10] [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] [Indexed: 11/17/2022]
Abstract
The primary objective of this study was to determine the pattern of N-Terminal pro brain natriuretic peptide (NT-pro BNP) secretion pre and post cardiac surgery and then to investigate the correlation between levels of serum NT-pro BNP and postoperative clinical and biochemical endpoints. This was a prospective observational study performed at a tertiary centre in New Zealand, examining 118 adult patients undergoing cardiac surgery. Interventions included blood samples for NT-Pro BNP and troponin-T taken 48 hours prior to operation and 12, 36 and 72 hours postoperatively. The plasma NT-pro BNP levels increased fourfold postoperatively, to plateau at 36 to 72 hours. Preoperative NT-pro BNP levels correlated with ventilation time (r=0.46), length of stay in intensive care unit (r=0.59), total perioperative noradrenaline dose (r=0.55), but not with postoperative atrial fibrillation or mortality. Using multivariate analysis, serum NT-pro BNP levels at 36 hours were associated with increased noradrenaline dose (P=0.001), decreased preoperative ejection fraction (EF) Group (P=0.013) and elevated preoperative NT-pro BNP (P <0.001). Factors not associated with NT-pro BNP levels at 36 hours include the operation type, bypass and cross-clamp times, use of milrinone and troponin-T. We conclude that NT-pro BNP levels increased markedly after cardiac surgery and that high preoperative NT-pro BNP levels are associated with a slow postoperative recovery, but do not predict the occurrence of postoperative atrial fibrillation or mortality. Myocardial ischaemia is an unlikely cause of the NT-pro BNP elevation, because no correlation existed between troponin-T and NT-pro BNP levels.
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Affiliation(s)
- P M Jogia
- Intensive Care Unit, Waikato Hospital, Hamilton, New Zealand
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49
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Meisel SR, Kleiner-Shochat M, Frimerman A, Levy Y, Abu Fanne R, Amsalem N, Bar El M, Hochman O, Ashkar J, Asif A, Mohsen J, Zidan A, Neiman E, Samara H, Kazatsker M, Blondheim DS, Shotan A. [DIRECT ADMISSION OF STEMI PATIENTS TO THE CARDIAC CARE UNIT VERSUS ADMISSION VIA THE EMERGENCY DEPARTMENT FOR PRIMARY CORONARY INTERVENTION IMPROVES SHORT AND LONG-TERM SURVIVAL]. Harefuah 2019; 158:35-40. [PMID: 30663291] [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: 06/09/2023]
Abstract
INTRODUCTION Shortening door-to-balloon time intervals in ST-elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI) is necessary in order to limit myocardial damage. Direct admission to the cardiac care unit (CCU) facilitates this goal. We compared characteristics and short- and long-term mortality of PPCI-treated STEMI patients admitted directly to the CCU with those admitted via the emergency department (ED). METHODS To compare 303 patients admitted directly to the CCU (42%) with 427 admitted via the ED (58%) included in the current registry comprising 730 consecutive PPCI-treated STEMI patients. RESULTS Groups were similar regarding demographics, medical history and risk factors. Pain-to-CCU time was 151±164 minutes (median-94) for patients admitted directly and 242±226 minutes (160) for those admitted via the ED, while door-to-balloon intervals were 69±42 minutes (61) and 133±102 minutes (111), respectively. LVEF evaluated during admission (48.3±13% [47.5%] vs. 47.7±13.7% [47.5%]) and mean CK level (893±1157 [527] vs. 891±1255 [507], p=0.45) were similar between groups. Mortality was 4.2% vs. 10.3% at 30-days (p<0.002), 7.6% and 14.3% at one-year (p<0.01), reaching 12.2% and 21.9% at 3.9±2.3 years (median-3.5, p<0.004) among directly-admitted patients vs. those admitted via the ED, respectively. Long-term mortality was 4.1%, 9.4%, 21.4%, and 16% for pain-to-balloon quartiles of <140 min, 141-207 min, 208-330 min, and >330 mins, respectively (p=0.026). CONCLUSIONS Direct admission of STEMI patients to the CCU for PPCI facilitated the attainment of guidelines-dictated door-to-balloon time intervals and yielded improved short- and long-term mortality. Longer pain-to-balloon time was associated with higher long-term mortality.
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Affiliation(s)
- Simcha R Meisel
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Michael Kleiner-Shochat
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Aaron Frimerman
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Yaniv Levy
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Rami Abu Fanne
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Naama Amsalem
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Maguli Bar El
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Ohad Hochman
- Hospital Management, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Jalal Ashkar
- Emergency Department, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Aya Asif
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Jameel Mohsen
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Adham Zidan
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Elena Neiman
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Hazem Samara
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Mark Kazatsker
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - David S Blondheim
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
| | - Avraham Shotan
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel
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50
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Davidson JA, Pfeifer Z, Frank B, Tong S, Urban TT, Wischmeyer PA, Mourani P, Landeck B, Christians U, Klawitter J. Metabolomic Fingerprinting of Infants Undergoing Cardiopulmonary Bypass: Changes in Metabolic Pathways and Association With Mortality and Cardiac Intensive Care Unit Length of Stay. J Am Heart Assoc 2018; 7:e010711. [PMID: 30561257 PMCID: PMC6405618 DOI: 10.1161/jaha.118.010711] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/08/2018] [Indexed: 12/30/2022]
Abstract
Background Mortality for infants undergoing complex cardiac surgery is >10% with a 30% to 40% risk of complications. Early identification and treatment of high-risk infants remains challenging. Metabolites are small molecules that determine the minute-to-minute cellular phenotype, making them ideal biomarkers for postsurgical monitoring and potential targets for intervention. Methods and Results We measured 165 serum metabolites by tandem mass spectroscopy in infants ≤120 days old undergoing cardiopulmonary bypass. Samples were collected prebypass, during rewarming, and 24 hours after surgery. Partial least squares-discriminant analysis, pathway analysis, and receiver operator characteristic curve analysis were used to evaluate changes in the metabolome, assess altered metabolic pathways, and discriminate between survivors/nonsurvivors as well as upper/lower 50% intensive care unit length of stay. Eighty-two infants had preoperative samples for analysis; 57 also had rewarming and 24-hour samples. Preoperation, the metabolic fingerprint of neonates differed from older infants ( R2=0.89, Q2=0.77; P<0.001). Cardiopulmonary bypass resulted in progressive, age-independent metabolic disturbance ( R2=0.92, Q2=0.83; P<0.001). Multiple pathways demonstrated changes, with arginine/proline ( P=1.2×10-35), glutathione ( P=3.3×10-39), and alanine/aspartate/glutamate ( P=1.4×10-26) metabolism most affected. Six subjects died. Nonsurvivors demonstrated altered aspartate ( P=0.007) and nicotinate/nicotinamide metabolism ( P=0.005). The combination of 24-hour aspartate and methylnicotinamide identified nonsurvivors versus survivors (area under the curve, 0.86; P<0.01), as well as upper/lower 50% intensive care unit length of stay (area under the curve, 0.89; P<0.01). Conclusions The preoperative metabolic fingerprint of neonates differed from older infants. Large metabolic shifts occurred after cardiopulmonary bypass, independent of age. Nonsurvivors and subjects requiring longer intensive care unit length of stay showed distinct changes in metabolism. Specific metabolites, including aspartate and methylnicotinamide, may differentiate sicker patients from those experiencing a more benign course.
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Affiliation(s)
- Jesse A. Davidson
- Department of PediatricsUniversity of Colorado/Children's Hospital ColoradoAuroraCO
| | | | - Benjamin Frank
- Department of PediatricsUniversity of Colorado/Children's Hospital ColoradoAuroraCO
| | - Suhong Tong
- Department of BiostatisticsUniversity of Colorado/Children's Hospital ColoradoAuroraCO
| | - Tracy T. Urban
- Department of Research InstituteChildren's Hospital ColoradoAuroraCO
| | | | - Peter Mourani
- Department of PediatricsUniversity of Colorado/Children's Hospital ColoradoAuroraCO
| | - Bruce Landeck
- Department of PediatricsUniversity of Colorado/Children's Hospital ColoradoAuroraCO
| | - Uwe Christians
- Department of AnesthesiologyUniversity of ColoradoAuroraCO
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