Heart, Lung and Circulation最新文献

Aim: Prevention and management of cardiovascular disease (CVD) in cancer survivors is crucial to reduce the burden of comorbid CVD; however, little is known about preferred models of care to address CVD risks. This study examined Australian cancer survivors' and health care professionals' (HCPs) views on managing CVD risk in cancer survivors, exploring challenges, needs, and preferences for implementing a model of care.

Method: Qualitative semi-structured interviews and focus groups were conducted with survivors, HCPs, and non-government organisation representatives, and analysed using reflexive thematic analysis.

Results: Four themes were developed: awareness and communication of CVD risk; models of care; relative priority of CVD risk; and need for self-management support. Despite identifying the need for a model of care including self-management support, participants identified several barriers to CVD management in cancer, including limited survivor awareness of CVD risk in cancer; information overwhelm; focus on cancer treatment and immediate side effects; limitations experienced by HCPs (e.g., time, expertise); and limitations in accessing specialist/allied health services. Improvement in care was deemed to require coordination, multidisciplinary involvement, and capacity building, including leveraging existing services. Potential for a nurse-led clinical pathway was emphasised.

Conclusions: Managing CVD risk in cancer survivors represents an important unmet need; meeting this need requires multilevel strategies for capacity-building and self-management support. Future research exploring the utility of models of care is warranted.

Background: This study investigates factors preventing the emergence of pulmonary regurgitation (PR) after transannular patch (TAP) repair for tetralogy of Fallot (TOF) with a small pulmonary valve annulus (PVA) in the long term.

Methods: Seventy-seven patients who underwent intracardiac repairs (ICR) with TAP using a monocusp for right ventricular outflow tract reconstruction for TOF at three institutions (2008-2023) were enrolled. Reconstructed PVA size was calculated using the formula: (width of TAP [mm] + native PVA [mm] ∗ 3.14) / 3.14. PR ≥ moderate on echocardiography was considered significant. Factors influencing PR emergence post-ICR were analysed using Cox proportional hazard analysis.

Results: No deaths occurred post-ICR. The median age and weight at ICR were 239 days and 7.3 kg, respectively. The median preoperative native PVA Z score was -3.0 (IQR: -4.5 to -2.0), and the reconstructed PVA Z score was 0.6 (IQR: -0.3 to 1.6). Patients whose reconstructed PVA Z scores increased by ≥4 from preoperative values had a significantly higher cumulative PR ratio (57.6%) compared to those with an increase of <4 from preoperative values (30.1%) (p=0.03). Extensive TAP (reconstructed PVA Z scores ≥+4 from preoperative values) was identified as a risk factor for progressive PR in the multivariable analysis.

Conclusions: Extensive TAP was a significant risk factor for progressive PR in the long-term. Patients whose reconstructed PVA Z scores increased by less than 4 from preoperative values demonstrated better cumulative PR ratios after ICR.

Background & aims: Destination ventricular assist device (VAD) is a newly approved upfront therapy for advanced heart failure in Australia, presenting a therapeutic option for patients who are unsuitable candidates for cardiac transplantation. This study investigated the mortality and morbidity of patients who underwent VAD implantation for advanced heart failure and subsequently determined destination therapy (DT) in the Australian healthcare context.

Method: We conducted a retrospective analysis of VAD recipients at a statewide advanced heart failure centre between 2012 and 2024. Patient and VAD characteristics, right-sided heart catheter indices, quality of life, and survival outcome data were collected for analysis.

Results: A total of 18 patients were included in the study. The median Interagency Registry for Mechanically Assisted Circulatory Support profile was 2 (interquartile range [IQR] 1.25-3). The median survival from discharge was 5.9 years (IQR 4.1-8.3). Symptoms improved at 6 months (p=0.00016), and Kansas City Heart Failure Questionnaire, EuroQol-5 Dimensions-5 Levels, and Depression in the Medically Ill screening scores improved through to 12 months (p=0.0042, 0.01 and 0.017, respectively) after implantation. The 6-minute walk distance improved from 247.7±149.8 m to 526.9±165.5 m at 12 months after implantation (p=0.003). Right-sided heart catheter indices also improved: mean pulmonary artery pressure (36.6±10.8 to 26.1±14.4 mmHg; p=0.04), pulmonary capillary wedge pressure (25.3±7.6 to 14.1±9.1 mmHg; p=0.02), and cardiac output (3.5±1.3 to 5.5±1.2 L/min; p=0.0005). The median time to confirm DT strategy was 621 days (IQR 314-916); transplant ineligibility was attributed to a range of biopsychosocial factors.

Conclusion: Destination therapy (DT) VAD for advanced heart failure is a feasible therapeutic option for transplant-ineligible patients in Australia, associated with substantial improvements in survival and quality of life. Future studies should focus on optimising remote monitoring and patient selection to further improve long-term outcomes in this complex cohort.

Background: Effective management of volume overload is essential for improving the prognosis of heart failure (HF), which is often complicated by exacerbations and rehospitalisations. Psychosocial and behavioural factors significantly influence volume status. However, studies directly linking these factors to volume overload in patients with HF remain limited.

Aim: This study aimed to model the direct and indirect influences of social support, cognition, self-efficacy, consideration of future outcomes, and self-care on volume overload in patients with HF to guide volume management interventions.

Method: A cross-sectional study was conducted among 233 consecutively hospitalised patients with HF from a tertiary hospital in Chongqing, China (January-July 2023). Bioelectrical impedance analysis measured volume status, and psychosocial and behavioural variables were assessed using validated scales, including the Lubben Social Network Scale, Mini-Cog, General Self-Efficacy Scale, Consideration of Future Consequences Scale, and Self-Care of Heart Failure Index, Version 6.2 Behaviour Scale. Data were analysed using IBM SPSS Statistics, Version 26.0 and AMOS 24.0.

Results: Among the patients (mean age=66.49±12.49 years; 43.35% women; 61.8% New York Heart Association stage III), 71% experienced volume overload. Path analysis showed that volume overload (oedema index) was directly and negatively associated with self-care maintenance (β=-0.263; p<0.001), cognition (β=-0.202; p<0.001), and self-efficacy (β=-0.199; p<0.01). Indirect negative effects were observed for social support (β=-0.203; p<0.001), self-care confidence (β=-0.090; p<0.001), and consideration of future outcomes (β=-0.057; p<0.001).

Conclusions: Factors such as social support, cognitive functioning, self-efficacy, future considerations, and self-care are significant contributors to the vulnerability of patients with HF to volume overload. This underscores the necessity for multifaceted interventions aimed at improving the prognosis of patients with HF.

Background: Sudden cardiac arrest (SCA) affects 26,000 Australians each year, with an approximately 90% fatality rate.

Method: Data from 2013 to 2023, inclusive for National Health and Medical Research Council (NHMRC) and 2020-2024 for National Heart Foundation (NHF) grant outcomes were obtained. Major causes of death were obtained from the Australian Institute of Health and Welfare (AIHW).

Results: From the NHMRC, 10,474 projects were assessed. Annual investment in research per death was low for SCA at AUD$887 compared to conditions such as breast cancer (AUD$4,673 per death) and renal failure (AUD$5,957 per death). From the NHF, 341 relevant funded projects were identified across 14 broad themes. Overall, 15 applications (4.4%) related to SCA, with AUD$3,302,498.00 (4.3% of total funding) awarded. Most NHF SCA funding was allocated to pre-hospital care (AUD$1.42 million, 43% of awarded funding), whereas most NHMRC funding was allocated to prevention (AUD$24.3 million, 60% of awarded funding). Over time, SCA funding increased for both NHMRC and NHF schemes (NHMRC: AUD$2.32 million in 2013/14 vs AUD$11.2 million in 2021/22, NHF: AUD$331,600 in 2019/20 vs AUD$1.2 million in 2023/24).

Conclusions: SCA is poorly captured as a leading cause of death in Australia. It is underfunded relative to other leading causes of mortality by up to a factor of 100. Investment in SCA research has increased over the last decade across Australian funding schemes, and this should be encouraged.