CJC Open最新文献

{"title":"Late-Onset Mitral Valve Prosthesis Dehiscence With Severe Paravalvular Leak—Infectious Versus Noninfectious Etiology Dilemma: A Case Report","authors":"Nouhaila Lahmouch MD, Raid Faraj MD, Oualid Kerrouani MD, Asmae Bouamoud MD, Jamila Zarzur PhD, Mohamed Cherti PhD","doi":"10.1016/j.cjco.2024.07.009","DOIUrl":"10.1016/j.cjco.2024.07.009","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1255-1258"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, Predictors, and Outcomes of Acute Pericarditis in Patients with Inflammatory Bowel Disease: A 10-Year Nationwide Analysis","authors":"Ankit Agrawal MD ,&nbsp;Aqieda Bayat MD ,&nbsp;Umesh Bhagat MD ,&nbsp;Heba Wassif MD ,&nbsp;Allan Klein MD ,&nbsp;Michael Garshick MD ,&nbsp;Brittany Weber MD, PhD","doi":"10.1016/j.cjco.2024.08.004","DOIUrl":"10.1016/j.cjco.2024.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Inflammatory bowel disease (IBD) is a chronic condition characterized primarily by inflammation of the gastrointestinal tract. Pericarditis is a rare but important extraintestinal manifestation of IBD that is poorly understood yet is associated with significant morbidity. The objectives of this study were to identify the factors associated with pericarditis in IBD and associated complications.</div></div><div><h3>Methods</h3><div>Hospitalized adult patients (aged ≥ 18 years) with a diagnosis of acute pericarditis in the IBD cohort, 2011-2020, were identified from the National Inpatient Sample using codes from the International Classification of Diseases (revision 9 or 10). Multivariable logistic regression was performed to identify clinical factors associated with pericarditis among IBD patients and in-hospital complications.</div></div><div><h3>Results</h3><div>During the period 2011-2020, among 3,236,747 IBD patients, 9113 (0.28%) had pericarditis, with a mean patient age of 54.08 ± 0.48 years, and 53.1% females. Patients with IBD and coexisting diagnoses of systemic lupus erythematosus (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.03-2.15, <em>P</em> = 0.033), rheumatoid arthritis and/or collagen vascular disorders (OR 1.75, 95% CI [1.41-2.17], <em>P</em> &lt; 0.001), or postcardiotomy syndrome (OR 67.13, 95% CI [30.08-149.80], <em>P</em> &lt; 0.001), were each associated with a higher risk of pericarditis. Compared to IBD patients without pericarditis, patients with IBD and pericarditis had an increased associated incidence of inpatient mortality (OR 1.65, 95% CI [1.25-2.18], <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Pericarditis is an uncommon but important manifestation of IBD. The presence of a concomitant autoimmune condition led to a higher likelihood of developing pericarditis among IBD patients, and IBD patients who develop pericarditis had a higher incidence of inpatient mortality compared to IBD patients without pericarditis. Providers should be aware of the connection between IBD and pericarditis to identify individuals at risk of adverse complications.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1379-1385"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic Testing for Familial Hypercholesterolemia: The Current State of Its Implementation in Canada","authors":"Adam I. Kramer MD, MSc ,&nbsp;Susan Christian MSc, PhD ,&nbsp;Kirsten Bartels MSc ,&nbsp;Nicol Vaizman BS ,&nbsp;Robert A. Hegele MD ,&nbsp;Liam R. Brunham MD, PhD","doi":"10.1016/j.cjco.2024.08.005","DOIUrl":"10.1016/j.cjco.2024.08.005","url":null,"abstract":"<div><h3>Background</h3><div>Familial hypercholesterolemia (FH) is a common genetic disorder, yet it remains largely underdiagnosed in Canada. Multiple national and international guidelines recommend the use of clinical genetic testing for FH. However, the level of its accessibility and use within Canada is unclear. This study aims to describe the current state of clinical FH genetic testing in Canada and barriers to its implementation.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional survey of 23 genetic counsellors across 8 provinces, through the Canadian Association of Genetic Counsellors Cardiac Communities of Practice, to obtain information about the accessibility of genetic testing for FH and the use of genetic-counselling services.</div></div><div><h3>Results</h3><div>Responses were obtained from 12 genetic counsellors (52%). Of the 8 provinces surveyed, clinical FH genetic testing is available in 7, with British Columbia being the exception. The Simplified Canadian Definition for FH is the diagnostic criterion most commonly utilized to determine genetic-testing eligibility, and it is used in 5 of the 8 provinces. Notably, the referral rate to genetic counsellors typically is low, with most genetic-counselling programs receiving ≤ three referrals per site per month. Quebec is the only province to report a higher rate of genetic-counsellor referrals for FH.</div></div><div><h3>Conclusions</h3><div>Clinical FH genetic testing is not available widely in Canada and its implementation varies significantly by province; this includes the eligibility criteria to qualify for testing as well as the utilization of genetic counsellors. A harmonized national approach to FH diagnosis could improve the rates of diagnosis and treatment.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1395-1402"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Essentials for AI Research in Cardiology: Challenges and Mitigations","authors":"Biyanka Jaltotage MBBS, MSc ,&nbsp;Girish Dwivedi MD, PhD","doi":"10.1016/j.cjco.2024.07.015","DOIUrl":"10.1016/j.cjco.2024.07.015","url":null,"abstract":"<div><div>Technology using artificial intelligence (AI) is flourishing; the same advancements can be seen in health care. Cardiology in particular is well placed to take advantage of AI because of the data-intensive nature of the field and the current strain on existing resources in the management of cardiovascular disease. With AI nearing the stage of routine implementation into clinical care, considerations need to be made to ensure the software is effective and safe. The benefits of AI are well established, but the challenges and ethical considerations are less well understood. As a result, there is currently a lack of consensus on what the essential components are in an AI study. In this review we aim to assess and provide greater clarity on the challenges encountered in conducting AI studies and explore potential mitigations that could facilitate the successful integration of AI in the management of cardiovascular disease.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1334-1341"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Interplay of Type 2 Diabetes Status, Cardiorespiratory Fitness Level, and Sudden Cardiac Death: A Prospective Cohort Study","authors":"Setor K. Kunutsor MD, PhD ,&nbsp;Sudhir Kurl MD, PhD ,&nbsp;Sae Young Jae PhD ,&nbsp;Davinder S. Jassal MD ,&nbsp;Kai Savonen PhD ,&nbsp;Jari A. Laukkanen MD, PhD","doi":"10.1016/j.cjco.2024.08.007","DOIUrl":"10.1016/j.cjco.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate the individual and joint effects of type 2 diabetes (T2D) status and cardiorespiratory fitness (CRF) level with sudden cardiac death (SCD) risk.</div></div><div><h3>Methods</h3><div>Prevalent T2D was defined based on guideline recommendations, and CRF level was assessed using a respiratory gas-exchange analyzer during exercise testing at baseline, in 2308 men aged 42-61 years. T2D status was classified as either “Yes” or “No,” and CRF level was classified as low, medium, or high. Cox regression analysis was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for SCD.</div></div><div><h3>Results</h3><div>A total of 264 SCDs occurred during a median follow-up of 28.1 years. Comparing Yes vs No history of T2D, the multivariable-adjusted HR (95% CI) for SCD was 1.79 (1.19-2.72). Comparing low vs high CRF levels, the corresponding adjusted HR (95% CI) for SCD was 1.77 (1.21-2.58). The HRs persisted when T2D status was further adjusted for CRF level, and vice versa. Compared with No-T2D &amp; medium-high CRF level, men with No-T2D &amp; low CRF and those with Yes-T2D &amp; low CRF had an increased SCD risk: (HR = 1.87, 95% CI, 1.38-2.55) and (HR = 3.34, 95% CI, 2.00-5.57), respectively. No significant association occurred between men with Yes-T2D &amp; medium-high CRF and SCD risk (HR = 1.46, 95% CI, 0.46-4.65). Modest evidence indicated the presence of additive and multiplicative interactions between T2D status and CRF level, in relation to SCD.</div></div><div><h3>Conclusions</h3><div>An interplay exists between T2D status, CRF level, and SCD risk in middle-aged and older men. Higher CRF levels may mitigate the increased SCD risk observed in men with T2D.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1403-1410"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Rehabilitation for Prediabetes and Metabolic Syndrome Remission: Impact of Ultraprocessed Food–Intake Reduction and Time-Restricted Eating in the DIABEPIC-1 Study","authors":"Josep Iglesies-Grau MD, PhD ,&nbsp;Valérie Dionne NP ,&nbsp;Élise Latour RD ,&nbsp;Mathieu Gayda PhD ,&nbsp;Florent Besnier PhD ,&nbsp;Daniel Gagnon PhD ,&nbsp;Amélie Debray PhD ,&nbsp;Christine Gagnon PhD ,&nbsp;Anne-Julie Tessier PhD ,&nbsp;Andréanne Paradis ,&nbsp;Chiheb Klai ,&nbsp;Nicolas Martin ,&nbsp;Véronique Pelletier MD ,&nbsp;François Simard MD ,&nbsp;Anil Nigam MD ,&nbsp;Philippe L. L’Allier MD ,&nbsp;Martin Juneau MD ,&nbsp;Nadia Bouabdallaoui MD, PhD ,&nbsp;Louis Bherer PhD","doi":"10.1016/j.cjco.2024.07.018","DOIUrl":"10.1016/j.cjco.2024.07.018","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac rehabilitation programs provide a valuable opportunity to promote the adoption of healthy lifestyle behaviors in patients with atherosclerotic cardiovascular diseases (ASCVDs) and metabolic comorbidities, including metabolic syndrome and prediabetes. However, strategies to reverse these conditions remain to be explored. The DIABEPIC-1 study aimed to assess the feasibility of an enhanced 6-month cardiac rehabilitation program for patients with ASCVD while investigating prediabetes and metabolic syndrome remission.</div></div><div><h3>Methods</h3><div>The study combined exercise training with a comprehensive nutritional intervention, emphasizing reduction in intake of ultraprocessed foods, adoption of a Mediterranean diet, and implementation of time-restricted eating. Baseline, 3-month, and 6-month assessments included segmental body-composition measurements, blood analysis, maximal exercise testing, nutritional diaries recorded with the Keenoa AI app, and lifestyle questionnaires. Remission criteria included a return to an HbA1c level of &lt; 5.7%, and &lt; 3 National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) criteria for prediabetes and metabolic syndrome, respectively.</div></div><div><h3>Results</h3><div>A total of 36 participants were recruited. The study demonstrated completion rates of 94.4% at 3 months, and 88.9% at 6 months, and a mean compliance rate of 92.5% for planned clinical appointments. Significant reductions in waist circumference (–9.2 cm, <em>P</em> &lt; 0.001) and weight (–8.0 kg, <em>P</em> &lt; 0.001) were observed. Improvement in glycemic and lipid profiles, insulin-resistance marker levels, and liver health were noted. Participants enhanced their cardiorespiratory fitness, reduced their consumption of ultraprocessed food, and increased their adherence to the Mediterranean diet and time-restricted eating. Notably, 50% achieved prediabetes remission, and 70% with metabolic syndrome at baseline achieved remission.</div></div><div><h3>Conclusions</h3><div>The study demonstrates the possibility of enhancing cardiac rehabilitation with an intensive nutritional intervention, yielding clinically significant outcomes, including remission of key risk factors in a substantial number of ASCVD patients.</div></div><div><h3>Clinical Trial Registration</h3><div>ClinicalTrials.gov, NCT05459987.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1411-1421"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Centre-Specific Variation in Atrial Fibrillation Ablation-Treatment Rates in a Universal Single-Payer Healthcare System","authors":"Christina Seo MASc ,&nbsp;Sameer Kushwaha MD ,&nbsp;Paul Angaran MD ,&nbsp;Peter Gozdyra MA ,&nbsp;Katherine S. Allan PhD ,&nbsp;Husam Abdel-Qadir MD, PhD ,&nbsp;Paul Dorian MD, MSc ,&nbsp;Timothy C.Y. Chan PhD","doi":"10.1016/j.cjco.2024.08.008","DOIUrl":"10.1016/j.cjco.2024.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Disparities in atrial fibrillation ablation rates have been studied previously, with a focus on either patient characteristics or systems factors, rather than geographic factors. The impact of electrophysiology (EP) centre practice patterns on ablation rates has not been well studied.</div></div><div><h3>Methods</h3><div>This population-based cohort study used linked administrative datasets covering physician billing codes, hospitalizations, prescriptions, and census data. The study population consisted of patients who visited an emergency department with a new diagnosis of atrial fibrillation, in the period 2007-2016, in Ontario, Canada. Patient characteristics, including age, sex, medical history, comorbidities, socioeconomic factors, closest EP centre within 20 km, and distance to the nearest centre, were used as predictors in multivariable logistic regression models to assess the relationship between living in a location around specific EP centres and ablation rates.</div></div><div><h3>Results</h3><div>The cohort included 134,820 patients, of whom 9267 had an ablation treatment during the study period. Patients undergoing ablation treatment were younger, had a lower <strong>C</strong>ongestive Heart Failure, <strong>H</strong>ypertension, <strong>A</strong>ge, <strong>D</strong>iabetes, <strong>S</strong>troke/Transient Ischemic Attack (CHADS₂) score, lived closer to EP centres, and had fewer comorbidities than those who did not receive ablation treatment. Wide variation occurred in ablation rates, with adjacent census divisions having ablation rates up to 2.6 times higher. Multivariate regression revealed significant differences in ablation rates for patients who lived in a location around certain EP centres. The odds ratios for living in a location closest to specific centres ranged from 0.78 (95% confidence interval: 0.68-0.89) to 1.60 (95% confidence interval:1.34-1.90).</div></div><div><h3>Conclusions</h3><div>Living near specific EP centres may significantly affect a patient’s likelihood of receiving ablation treatment, regardless of factors such as age, gender, socioeconomic status, prior medical history, and distance to EP centres.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1355-1362"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fractured and Entrapped Coronary Angioplasty Balloon Successfully Managed with Rotational Atherectomy","authors":"David Sá Couto MD ,&nbsp;André Dias-Frias MD ,&nbsp;Bruno Brochado MD ,&nbsp;André Alexandre MD ,&nbsp;Mariana Pereira Santos MD ,&nbsp;Diana Ribeiro MD ,&nbsp;Raquel Santos MD ,&nbsp;André Luz MD, PhD ,&nbsp;João Silveira MD ,&nbsp;Severo Torres MD","doi":"10.1016/j.cjco.2024.08.001","DOIUrl":"10.1016/j.cjco.2024.08.001","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1303-1306"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cost Analysis of Catheter Ablation for Atrial Fibrillation: A Canadian Pre-Post Study","authors":"Yousef N. Bolous MD ,&nbsp;Prosper Koto PhD ,&nbsp;John L. Sapp MD, FRCPC, FHRS ,&nbsp;Chris Gray MD, FRCPC ,&nbsp;David C. Lee MBChB ,&nbsp;Nicolas Berbenetz MD, FRCPC ,&nbsp;Amir AbdelWahab MBBCh ,&nbsp;Ratika Parkash MD, MS, FRCPC","doi":"10.1016/j.cjco.2024.07.016","DOIUrl":"10.1016/j.cjco.2024.07.016","url":null,"abstract":"<div><h3>Background</h3><div>There is a paucity of Canadian studies using patient-level data to analyze the costs of catheter ablation (CA) for atrial fibrillation (AF). We sought to identify the health care resource use, costs, and cost predictors of CA.</div></div><div><h3>Methods</h3><div>A cost analysis was performed in a population of AF patients treated with CA in Central Zone Nova Scotia from 2010 to 2018. Costs were compared 2 years before ablation (pre-CA) with costs 2 years after (post-CA); the 3-month period post-CA was defined as the treatment window. Costs were also compared according to CA technology defined as before 2015 for patients treated with non-contact force sensing CA and after 2015 for patients treated with contact force sensing CA.</div></div><div><h3>Results</h3><div>Heart failure hospitalizations, AF-related emergency department visits, acute inpatient admissions, and cardioversions all decreased after ablation. The cost difference post-CA vs pre-CA was CAD$18,869 (95% confidence interval [CI], $15,570-$22,168). This increase in costs was driven by costs incurred during the treatment window, which was $21,439 (95% CI, $20,468-$22,409). After excluding treatment window costs, the mean year 1 post-CA cost was $11,223 (95% CI, $9113-$13,334) and year 2 post-CA cost was $4555 (95% CI, $3145-$5965); both were lower than the pre-CA costs. Costs remained stable over the time frame of the study period, with no influence from new technologies on cost. The post-CA cost difference between the post-2015 and pre-2015 groups was $2573 (95% CI, -$2336 to $7481).</div></div><div><h3>Conclusions</h3><div>We showed that although CA is expensive, it might be a cost-effective treatment modality for AF because of the associated reduction in costs and health care resource use.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1372-1378"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Need for Support: Facilitating Early Transfer of Cardiogenic Shock Patients to Advanced Heart Failure Centres","authors":"Vicki N. Wang MD ,&nbsp;Darshan H. Brahmbhatt MB BChir, MD(Res) ,&nbsp;Julie K.K. Vishram-Nielsen MD, PhD ,&nbsp;Fernando L. Scolari MD, PhD ,&nbsp;Nicole L. Fung ,&nbsp;Madison Otsuki ,&nbsp;Vesna Mihajlovic MD ,&nbsp;Narmin Ibrahimova ,&nbsp;Filio Billia MD, PhD ,&nbsp;Christopher B. Overgaard MD ,&nbsp;Adriana C. Luk MD, MSc","doi":"10.1016/j.cjco.2024.07.017","DOIUrl":"10.1016/j.cjco.2024.07.017","url":null,"abstract":"<div><h3>Background</h3><div>Cardiogenic shock (CS) is a complex, life-threatening condition that requires timely care of patients. The purpose of this study is to evaluate the characteristics and outcomes of patients transferred to a cardiac intensive-care unit from outside hospitals, compared to those of patients admitted directly to a CS centre.</div></div><div><h3>Methods</h3><div>Patients admitted with CS (January 1, 2014-December 31, 2019) were analyzed. Clinical characteristics and outcomes were recorded.</div></div><div><h3>Results</h3><div>A total of 916 patients were admitted with CS; 440 (48.0%) were transferred from outside hospitals, and 476 (52.0%) were admitted directly to our institution. Transferred patients were younger (56.5 ± 14.7 vs 63.3 ± 16.3 years, <em>P</em> &lt; 0.001), required vasopressor support more often (63.6% vs 14.9%, <em>P</em> &lt; 0.001), and required mechanical ventilation more often (40.6% vs 10.7%, <em>P</em> &lt; 0.001) upon transfer to the cardiac intensive-care unit. Transferred patients more frequently required extracorporeal life support (8.9% vs 3.0%, <em>P</em> &lt; 0.001), had a lower rate of requiring orthotopic heart transplantation (6.4% vs 14.6%, <em>P</em> &lt; 0.001), and had a lower incidence of all-cause mortality during follow-up (52.3% vs 62.8%, <em>P</em> = 0.001). With a multivariate analysis, patients transferred from outside were found to be less likely to reach the composite endpoint of durable ventricular assist device, orthotopic heart transplantation, or death (hazard ratio 0.75, 95% confidence interval 0.62-0.90, <em>P</em> = 0.003).</div></div><div><h3>Conclusions</h3><div>Marked differences are present in the characteristics and outcomes of patients transferred from outside institutions vs of those transferred from within our quaternary-care centre. Further studies are required to evaluate decision-making for transfer of CS patients and assess CS outcomes in the setting of standardized CS protocols and interventions.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1342-1350"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}