Therapeutic Advances in Cardiovascular Disease最新文献

Background: Guideline-directed medical therapy (GDMT) prolongs survival in patients with heart failure with reduced ejection fraction (HFrEF). However, different countries implement GDMT differently, and many patients are still undertreated. Therefore, this study aimed to assess GDMT utilization in patients with chronic HFrEF at the adult cardiac clinics of three selected hospitals in Addis Ababa, Ethiopia.

Methods: An explanatory sequential mixed-methods (quantitative cross-sectional followed by qualitative phenomenological) study design was used to assess GDMT usage in patients with HFrEF at the study settings from September 25 to November 25, 2022. Simple random and purposive sampling techniques were used to select participants for the quantitative and qualitative studies, respectively. Adherence level was defined as good (adherence score = 1), moderate (0.5 < score <1), and poor (score ⩽0.5). Quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Logistic regression model was used to determine the association. Statistical significance was declared at p < 0.05. Qualitative data were analyzed with MAXQDA 2020.

Results: Three hundred forty-one patients were included in the quantitative study. Adherence to GDMT was good in 128 (37.5%) of the patients. Patient parameters, including female gender (adjusted odds ratio (AOR) = 0.55, 95% CI: 0.32-0.93), unable to read and write (AOR = 0.31, 95% CI: 0.11-0.86), primary education (AOR = 0.27, 95% CI: 0.12-0.63), were negatively associated with Physicians' good adherence. Hypertension was associated with lower odds of physicians' good adherence (AOR = 0.41, 95% CI: 0.21-0.78). Absence of comorbidities (other than hypertension; AOR = 2.65, 95% CI: 1.36-5.15) were positive predictors. System, patient, and physician-related factors were reported as barriers to intensifying GDMT.

Conclusion: Nearly one-fourth of eligible patients were on ⩽50% of guidelines-recommended drugs. Female gender, educational level, and comorbidities were the factors associated with adherence to GDMT. System, patient, and physician-related reasons for poor adherence were identified. Multipronged interventions are required to address those adherence barriers.

Background: Inflammation significantly impacts disease progression and prognosis in acute pulmonary embolism (APE); however, the optimal method to quantify this inflammation for prognostic purposes remains unclear.

Objectives: We aimed to identify the most effective blood-based inflammatory marker for predicting short-term mortality in patients with APE.

Methods: We retrospectively analyzed 301 patients with APE. We compared the predictive performance of nine inflammatory markers for 30-day mortality, focusing on the inflammatory burden index (IBI), and contrasted it with the standard clinical score (sPESI).

Results: After adjusting for potential confounders, a higher IBI was strongly and independently associated with an increased risk of 30-day mortality. IBI demonstrated superior predictive ability compared with all other inflammatory markers and the sPESI score. The relationship between IBI and mortality risk was linear; higher IBI values corresponded to greater mortality risk.

Conclusion: IBI is a robust and independent predictor of short-term survival in patients with APE. Calculated from routine blood tests (C-reactive protein, neutrophil, and lymphocyte counts), it offers a simple, rapid, and cost-effective tool that may enhance early risk stratification and guide personalized treatment decisions in clinical practice. Further validation in independent cohorts is required to confirm its prognostic utility.

This review aims to describe the sex differences in heart failure (HF) patients, with a particular emphasis on the effect of cardiovascular ageing. Additionally, it takes into consideration the sex-related variation in cardiovascular health and physiology and the role ageing plays in HF and its implications in drug therapy. The pharmacokinetics and pharmacodynamics of the common HF medications, classified according to the established sub-types, are summarised with respect to sex-specific documented findings. Despite numerous studies confirming significant differences in HF outcomes according to sex, there are no current guidelines that consider patients' sex in medical therapy of HF. Moreover, females are significantly under-represented in research trials, as well as under-treated in clinical practice, which hinders our understanding of HF in this demographic. Most of the current knowledge on sex-specific HF therapies is driven by secondary analyses of studies not primarily undertaking sex-specific analyses. Therefore, we propose a multi-faceted approach, including increased awareness among healthcare providers and more inclusive research to create a personalised care plan accounting for sex differences in HF management. Given the highlighted knowledge gaps, it is paramount for new research efforts to account for the different sex phenotypes in HF.

Background: Different accessible and low-cost biomarkers have been investigated to stratify patients with acute heart failure (AHF). One of them is the red cell distribution width (RDW), which proved to be a greater prognostic marker of mortality than other conventional markers.

Objective: Therefore, the objective of our study is to determine whether the anemic status modifies the magnitude of association between high RDW and 1-year mortality in patients with AHF.

Design: Observational, analytical, retrospective cohort study.

Methods: We included participants ⩾18 years old hospitalized with a diagnosis of AHF. As an association measure, a crude and adjusted generalized linear model of the Poisson family calculated the risk ratio (RR) with a 95% confidence interval (95% CI).

Results: In all, 709 participants with an average age of 73.48 years were included. At 1 year, the risk of dying was three times higher with high RDW (RR = 3.05, 95% CI: 1.39-6.66; p < 0.01). In anemic participants, the risk of dying at 1 year is two times greater with high RDW (RR = 2.18, 95% CI: 0.91-5.22; p = 0.07), while in non-anemic participants, the risk of dying increased almost seven times (RR = 6.95, 95% CI: 1.65-29.23; p < 0.01).

Conclusion: High RDW is a risk factor for mortality at 1 year in patients with AHF. A greater magnitude of association was found in non-anemic patients.

Background: Rapid interpretation of electrocardiography (ECGs) is essential for reducing patient mortality and morbidity associated with heart conditions. Despite its significance, many healthcare providers struggle to achieve proficiency in ECG interpretation.

Objective: This study assessed nurses' knowledge, practices, and associated factors regarding ECG interpretation in the emergency and intensive care units of selected public hospitals in Addis Ababa, Ethiopia.

Methods: A cross-sectional study was conducted to evaluate nurses' knowledge, practices, and factors related to ECG interpretation in selected public hospitals of emergency and intensive care units in Addis Ababa, Ethiopia. Data were collected using structured, self-administered questionnaires and analyzed using SPSS version 26. Binary logistic regression models were employed to identify associations between the dependent and independent variables.

Results: Among 255 of the study participants, only 60 (23.5%) and 69 (27.1%) of them demonstrated good knowledge and practice in ECG strip interpretation, respectively. The most frequently recognized ECG strip was asystole. Factors associated with good knowledge and practice encompassed holding a master's degree, receiving ECG training, and working in intensive care units.

Conclusion: This study identified the lack of knowledge and practice among nurses in ECG interpretation. The findings highlight the need for training programs and experience-sharing initiatives to enhance nurses' proficiency in ECG interpretation which might ultimately improve patient outcomes.

Background: It is crucial to timely recognize individuals presenting high-risk characteristics indicative of acute myocardial infarction.

Objectives: Our study aimed to analyze the significance of evaluating ST-segment depression in patients with acute inferior myocardial infarction (MI). We assessed precordial ST-T changes as an indicator of ongoing ischemia, examined their correlation with the extent of coronary artery involvement, and potential association with both early and late cardiac outcomes.

Methods: We enrolled 200 hospitalized patients with acute inferior MI who displayed ST depression in their precordial leads and underwent angiography. Individuals were divided into three groups based on the location of ST depression (V1-V3, V4-V6, and V1-V6). Demographic and echocardiographic data were extracted, and cardiac outcomes were assessed during hospitalization and follow-ups.

Results: The findings revealed significant associations between ST depression in leads V1-V6 and V4-V6 with left ventricular systolic dysfunction, mitral regurgitation severity, and the extent of coronary artery stenosis in comparison with ST depression in V1-V3 (p < 0.05). Furthermore, a notable connection was found between the involved vessels and the degree of ST depression in precordial leads (p < 0.05). Moreover, individuals with prominent ST depression in V1-V6 and V1-V3 exhibited poorer outcomes (p < 0.05).

Conclusion: Greater ST-segment depression in V1-V6 and V4-V6 in comparison with V1-V3 may signal multivessel disease, severe ischemia. Adverse outcomes like heart failure showed in V1-V6 especially V1-V3 versus V4-V6. This ST depression in acute inferior MI patients could indicate simultaneous ischemia or necrosis in other left ventricle regions, worsening cardiac function and prognosis. Thus, timely interventions are crucial.

Carotid blowout syndrome (CBS) is a potentially fatal condition requiring prompt diagnosis and intervention. CBS primarily affects patients with a history of surgery or irradiation for head and neck malignancies. In this report, we describe a case of CBS in which the carotid artery ruptured 2 months after carotid artery stenting in a patient with a previous history of surgery and irradiation for pharyngeal cancer. Although the distance between the orifice of the common carotid artery and the ruptured site was short, the "no-touch" technique-using the Newton-shaped stiff inner catheter (Newton-T^®, Medikit) during the guiding catheter navigation-and snare fixation enabled a stable procedure. Two self-expanding covered stents (GORE^® VIABAHN^®, Gore) covered the ruptured site. Despite adverse conditions, the combination of these techniques led to effective management of impending CBS, a potentially fatal disease. This case report highlights the feasibility of covered stents for CBS and the techniques used for guiding catheter navigation and stabilization throughout the procedure.

Background: Patients post-coronary artery bypass graft (CABG) can re-present with acute coronary syndrome (ACS); however, culprit lesion identification, as well as revascularization, is often challenging. Furthermore, the impact of revascularization in this patient group is relatively unknown.

Objectives: The purpose of our study was to evaluate the efficacy of percutaneous coronary intervention (PCI) in patients with previous CABG surgery presenting with ACS.

Methods: Using data from the Manitoba Center for Health Policy, we identified patients treated with CABG between April 1979 and March 2018, who subsequently presented with the primary diagnosis of ACS. Patients were divided into four groups: (1) managed medically and not investigated by cardiac catheterization and (2) investigated by cardiac catheterization and treated (2a) medically, (2b) with PCI, and (2c) with redo-CABG. Inverse probability treatment-weighted survival analyses were performed. Ethical approval was obtained from the local research board.

Results: Nearly 20% of patients treated with CABG presented with ACS at a median of 7.2 years (age at the time of CABG: 66 years (interquartile range: 58-73 years); 75.6% male). Patients treated with PCI (N = 929) demonstrated improved survival compared to the patients investigated by catheterization but treated medically (N = 952; hazard ratio 0.87, 95% confidence interval 0.77-0.97, p = 0.02). Patients who underwent redo CABG (N = 171) experienced 13% mortality within the first year, but subsequently, demonstrated a trend toward improved survival.

Conclusion: ACS is not uncommon following CABG. Revascularization is associated with prognostic improvement; however, such could be accounted for by inherent group differences, including comorbidities and coronary anatomy These findings should be validated in a prospective randomized study.