Out-of-hospital cardiac arrest (OHCA) remains a leading cause of mortality, with uncertain benefits of urgent coronary angiography (CAG) in non-ST-elevation myocardial infarction cases. Current guidelines lack clarity on the optimal timing of CAG for OHCA survivors. This study investigates the impact of CAG timing on in-hospital mortality and neurological outcomes in non-traumatic OHCA patients. It also identifies clinical predictors of poor prognosis.
Method
A retrospective cohort study was conducted at Fiona Stanley Hospital, Western Australia, analysing 223 non-traumatic OHCA patients admitted between February 2015 and December 2022. Patients were categorised into three CAG timing groups: immediate (<2 hours), intermediate (2–24 hours), and delayed (>24 hours). Multivariate logistic regression was used to assess independent predictors of mortality and neurological outcomes.
Results
Mortality was significantly higher in patients who received immediate or intermediate CAG compared to those who received delayed CAG. Delayed CAG was associated with better survival. Independent predictors of in-hospital mortality included lower pH, lower systolic blood pressure, lower Glasgow Coma Scale score on arrival, and diabetes.
Conclusions
Our findings do not support routine immediate CAG in non-ST-elevation myocardial infarction OHCA. A selective, delayed approach after hemodynamic stabilisation may improve survival. Clinicians should prioritise stabilisation before CAG, using pH, systolic blood pressure, and Glasgow Coma Scale as key prognostic indicators.
{"title":"Non-Traumatic Out-of-Hospital Cardiac Arrest at Fiona Stanley Hospital: In-Hospital Mortality Predictors and Timing of Coronary Angiography—A Retrospective Observational Cohort Study","authors":"Hendry Ramly MBBS , David Manners FRACP, MClinRes , Jenny Luong MBBS , Cian Murray MBBS , Christopher Judkins MBBS, MClinRes, PhD","doi":"10.1016/j.hlc.2025.06.007","DOIUrl":"10.1016/j.hlc.2025.06.007","url":null,"abstract":"<div><h3>Background & Aim</h3><div>Out-of-hospital cardiac arrest (OHCA) remains a leading cause of mortality, with uncertain benefits of urgent coronary angiography (CAG) in non-ST-elevation myocardial infarction cases. Current guidelines lack clarity on the optimal timing of CAG for OHCA survivors. This study investigates the impact of CAG timing on in-hospital mortality and neurological outcomes in non-traumatic OHCA patients. It also identifies clinical predictors of poor prognosis.</div></div><div><h3>Method</h3><div>A retrospective cohort study was conducted at Fiona Stanley Hospital, Western Australia, analysing 223 non-traumatic OHCA patients admitted between February 2015 and December 2022. Patients were categorised into three CAG timing groups: immediate (<2 hours), intermediate (2–24 hours), and delayed (>24 hours). Multivariate logistic regression was used to assess independent predictors of mortality and neurological outcomes.</div></div><div><h3>Results</h3><div>Mortality was significantly higher in patients who received immediate or intermediate CAG compared to those who received delayed CAG. Delayed CAG was associated with better survival. Independent predictors of in-hospital mortality included lower pH, lower systolic blood pressure, lower Glasgow Coma Scale score on arrival, and diabetes.</div></div><div><h3>Conclusions</h3><div>Our findings do not support routine immediate CAG in non-ST-elevation myocardial infarction OHCA. A selective, delayed approach after hemodynamic stabilisation may improve survival. Clinicians should prioritise stabilisation before CAG, using pH, systolic blood pressure, and Glasgow Coma Scale as key prognostic indicators.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 1","pages":"Pages 104-115"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.hlc.2025.09.014
Macit Kalçik MD, Ömer Burak Çelik MD, Mucahit Yetim MD
{"title":"Letter to the Editor “Reconsidering the Roles of Computed Tomography Coronary Angiography and Stress Echocardiography in Acute Chest Pain”","authors":"Macit Kalçik MD, Ömer Burak Çelik MD, Mucahit Yetim MD","doi":"10.1016/j.hlc.2025.09.014","DOIUrl":"10.1016/j.hlc.2025.09.014","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 1","pages":"Pages e9-e10"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.hlc.2025.12.012
C. Lac, H. Dimitri, J. Assad, J. Tan
{"title":"Corrigendum to: Abstract 290, Vol 34, Supplement 4, Page S289–S290 (2025) (Abstracts for the 73rd Annual Scientific Meeting of the Cardiac Society of Australia and New Zealand, 14–17 August 2025) entitled ‘Device-Detected Versus Questionnaire- Identified Obstructive Sleep Apnoea in Heart Failure Patients: A Comparative Study’","authors":"C. Lac, H. Dimitri, J. Assad, J. Tan","doi":"10.1016/j.hlc.2025.12.012","DOIUrl":"10.1016/j.hlc.2025.12.012","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 1","pages":"Page e16"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.hlc.2025.05.102
Hisato Takagi MD, PhD
{"title":"True Lumen Mural Thrombus in Type B Aortic Dissection","authors":"Hisato Takagi MD, PhD","doi":"10.1016/j.hlc.2025.05.102","DOIUrl":"10.1016/j.hlc.2025.05.102","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 1","pages":"Pages e1-e2"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145471037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.hlc.2025.06.1020
Anisha Haseeb MBBS , Zachary O’Brien MBBS , Rinaldo Bellomo PhD, FRACP, FICM , Julian A. Smith FRACS , Lavinia Tran PhD , Christopher M. Reid MD, PhD , Tim G. Coulson BM, PhD
Aim
To determine the prevalence of persistent critical illness (PerCI) after cardiac surgery, describe the characteristics, trajectory, and outcomes of these patients, identify risk factors, and develop predictive risk scores.
Method
Retrospective observational study between 2008 and 2021. In keeping with the literature, PerCI was defined as an intensive care unit admission for longer than six consecutive days. Fifty-two (52) hospitals across Australia and New Zealand that submitted data to the Australia New Zealand Society of Cardiac and Thoracic Surgeons database. Participants were all patients who underwent cardiac surgery or thoracic surgery requiring cardiopulmonary bypass, in participating units.
Results
We analysed 155,819 patients, of which 14,940 (9.6%) met the criteria for PerCI. Prognostic prediction models with out-of-sample area under the curve ≥0.70 and 0.75 for preoperative and immediately postoperative time points, respectively, were developed for early identification of patients at risk of developing PerCI. Patients affected by comorbidity, salvage or emergent surgery, compromised cardiac function, and those requiring intra-aortic balloon pump were more likely to develop PerCI. Patients with PerCI had more postoperative complications and required more intensive care unit resources (extracorporeal membrane oxygenation, blood products, inotropes, haemofiltration). Patients with PerCI were less likely to die from cardiac causes (21.9% vs 36.5% of deaths; p<0.001) but had a higher in-hospital mortality (9.8% vs 1.3%; p<0.001) and mortality at 1 year (7.5% vs 1.9%; p<0.001), with no change in such rates over time.
Conclusions
Nearly one in every 10 patients undergoing cardiac surgery will develop PerCI, with frequent non-cardiac complications and death from non-cardiac causes. With prognostic prediction models, most patients at risk of developing PerCI can be identified early, thus enabling the use of targeted preventive interventions.
{"title":"Persistent Critical Illness After Cardiac Surgery: Prevalence, Characteristics, Trajectory, Outcomes, and Predictive Scores","authors":"Anisha Haseeb MBBS , Zachary O’Brien MBBS , Rinaldo Bellomo PhD, FRACP, FICM , Julian A. Smith FRACS , Lavinia Tran PhD , Christopher M. Reid MD, PhD , Tim G. Coulson BM, PhD","doi":"10.1016/j.hlc.2025.06.1020","DOIUrl":"10.1016/j.hlc.2025.06.1020","url":null,"abstract":"<div><h3>Aim</h3><div>To determine the prevalence of persistent critical illness (PerCI) after cardiac surgery, describe the characteristics, trajectory, and outcomes of these patients, identify risk factors, and develop predictive risk scores.</div></div><div><h3>Method</h3><div>Retrospective observational study between 2008 and 2021. In keeping with the literature, PerCI was defined as an intensive care unit admission for longer than six consecutive days. Fifty-two (52) hospitals across Australia and New Zealand that submitted data to the Australia New Zealand Society of Cardiac and Thoracic Surgeons database. Participants were all patients who underwent cardiac surgery or thoracic surgery requiring cardiopulmonary bypass, in participating units.</div></div><div><h3>Results</h3><div>We analysed 155,819 patients, of which 14,940 (9.6%) met the criteria for PerCI. Prognostic prediction models with out-of-sample area under the curve ≥0.70 and 0.75 for preoperative and immediately postoperative time points, respectively, were developed for early identification of patients at risk of developing PerCI. Patients affected by comorbidity, salvage or emergent surgery, compromised cardiac function, and those requiring intra-aortic balloon pump were more likely to develop PerCI. Patients with PerCI had more postoperative complications and required more intensive care unit resources (extracorporeal membrane oxygenation, blood products, inotropes, haemofiltration). Patients with PerCI were less likely to die from cardiac causes (21.9% vs 36.5% of deaths; p<0.001) but had a higher in-hospital mortality (9.8% vs 1.3%; p<0.001) and mortality at 1 year (7.5% vs 1.9%; p<0.001), with no change in such rates over time.</div></div><div><h3>Conclusions</h3><div>Nearly one in every 10 patients undergoing cardiac surgery will develop PerCI, with frequent non-cardiac complications and death from non-cardiac causes. With prognostic prediction models, most patients at risk of developing PerCI can be identified early, thus enabling the use of targeted preventive interventions.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 1","pages":"Pages 137-147"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.hlc.2025.07.012
Ralph G. Audehm MBBS, DipRACOG , Danny Liew MBBS, PhD, FRACP , Gerald F. Watts DSc, PhD, MD, FRACP , Charlotte Hespe PhD, MBBS, FRACGP , Meherin Rahman MPharm , Anna Williamson PhD , Catherine Sciascia MSc, MPharmSc , Ravi Santani MBBS, MD , Andrew M. Tonkin MD, FRACP
Aim
We sought to investigate the use of lipid-lowering therapy (LLT) and the attainment of low-density lipoprotein cholesterol (LDL-C) goals in patients with atherosclerotic cardiovascular disease (ASCVD) in Australian general practices. The study aimed to investigate the discrepancies between guideline recommendations and clinical practice.
Method
This retrospective study used electronic data from Australian general practitioners, extracted from IQVIA’s “general practice electronic medical record” data set, covering the period from January 2010 to June 2022. Descriptive statistics examined the relationships between demographics, clinical characteristics, treatment patterns, adherence to LLT, and the achievement of guideline-recommended LDL-C goals, with data stratified by gender, age, and LDL-C levels.
Results
Of 13,644 patients with ASCVD identified, 64% of the patients with ASCVD were men, and the overall mean age was 70 years (±13.5 standard deviation). Only 51.9% of patients had a recorded LDL-C test at their most recent general practice physician visit. Of those tested, 60.5% and 50.6% had increased LDL-C levels >1.8 mmol/L and >2.0 mmol/L, respectively. Statin therapy was prescribed to n=11,100 (81.3%) of patients during the study period, but this fell to n=8,918 (65.4%) by the last consult. Of those on treatment at their last review, statin monotherapy was the most common (n=7,861, 57.6%), with a low use of combination therapies (n=1,004, 7.36%). At 1 year, 80.1% of patients on statin monotherapy were adherent (proportion of days covered ≥0.8), but this fell to 47.9% at 5 years. The use of non–high-intensity statins were associated with the highest persistence, being 47.5% adherent at 5 years. There were no significant differences in persistence between females and males nor across age categories <44, 44–65, and>65 years old.
Conclusions
The study highlights gaps in the management of ASCVD in Australian general practice, including the lack of monitoring of LDL-C levels, under-prescription of proven LLT, and increasingly poor adherence and persistence with LLT over time.
{"title":"Attainment of Low-Density Lipoprotein Cholesterol Goals and Statin Use in Patients With Atherosclerotic Cardiovascular Disease in Australian General Practice: Are We Doing Enough?","authors":"Ralph G. Audehm MBBS, DipRACOG , Danny Liew MBBS, PhD, FRACP , Gerald F. Watts DSc, PhD, MD, FRACP , Charlotte Hespe PhD, MBBS, FRACGP , Meherin Rahman MPharm , Anna Williamson PhD , Catherine Sciascia MSc, MPharmSc , Ravi Santani MBBS, MD , Andrew M. Tonkin MD, FRACP","doi":"10.1016/j.hlc.2025.07.012","DOIUrl":"10.1016/j.hlc.2025.07.012","url":null,"abstract":"<div><h3>Aim</h3><div>We sought to investigate the use of lipid-lowering therapy (LLT) and the attainment of low-density lipoprotein cholesterol (LDL-C) goals in patients with atherosclerotic cardiovascular disease (ASCVD) in Australian general practices. The study aimed to investigate the discrepancies between guideline recommendations and clinical practice.</div></div><div><h3>Method</h3><div>This retrospective study used electronic data from Australian general practitioners, extracted from IQVIA’s “general practice electronic medical record” data set, covering the period from January 2010 to June 2022. Descriptive statistics examined the relationships between demographics, clinical characteristics, treatment patterns, adherence to LLT, and the achievement of guideline-recommended LDL-C goals, with data stratified by gender, age, and LDL-C levels.</div></div><div><h3>Results</h3><div>Of 13,644 patients with ASCVD identified, 64% of the patients with ASCVD were men, and the overall mean age was 70 years (±13.5 standard deviation). Only 51.9% of patients had a recorded LDL-C test at their most recent general practice physician visit. Of those tested, 60.5% and 50.6% had increased LDL-C levels >1.8 mmol/L and >2.0 mmol/L, respectively. Statin therapy was prescribed to n=11,100 (81.3%) of patients during the study period, but this fell to n=8,918 (65.4%) by the last consult. Of those on treatment at their last review, statin monotherapy was the most common (n=7,861, 57.6%), with a low use of combination therapies (n=1,004, 7.36%). At 1 year, 80.1% of patients on statin monotherapy were adherent (proportion of days covered ≥0.8), but this fell to 47.9% at 5 years. The use of non–high-intensity statins were associated with the highest persistence, being 47.5% adherent at 5 years. There were no significant differences in persistence between females and males nor across age categories <44, 44–65, and>65 years old.</div></div><div><h3>Conclusions</h3><div>The study highlights gaps in the management of ASCVD in Australian general practice, including the lack of monitoring of LDL-C levels, under-prescription of proven LLT, and increasingly poor adherence and persistence with LLT over time.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 1","pages":"Pages 82-95"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.hlc.2025.08.031
Fumu Wang MD, Haiming Wang MD
{"title":"Integrating Psychological Intervention into Multidisciplinary Management of Pulmonary Nodules: A Critical Need for Standardised Care","authors":"Fumu Wang MD, Haiming Wang MD","doi":"10.1016/j.hlc.2025.08.031","DOIUrl":"10.1016/j.hlc.2025.08.031","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 1","pages":"Page e4"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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