Current Problems in Cardiology最新文献

Heart failure continues to pose a significant burden in terms of morbidity, mortality, and healthcare costs worldwide despite the implementation of guideline-directed medical therapy. Addressing this challenge and improving clinical outcomes for this patient population remains an urgent priority. Recognizing the limitations in current medical approaches and exploring strategies to overcome these limitations are crucial steps toward improving future outcomes. Various device-based interventions, such as Cardiac Resynchronization Therapy devices and Left Ventricular Assist Devices, have demonstrated notable benefits for individuals with heart failure. Our review is aimed at summarizing the ongoing research into new device therapies for heart failure, emphasizing their potential to overcome the current challenges in treatment. By utilizing Clinicaltrials.gov, an online repository, we conducted a comprehensive search for trials investigating emerging device therapies for patients dealing with heart failure.

Background

Patient education plays a crucial role in improving the quality of life for patients with heart failure. As artificial intelligence continues to advance, new chatbots are emerging as valuable tools across various aspects of life. One prominent example is ChatGPT, a widely used chatbot among the public. Our study aims to evaluate the readability of ChatGPT answers for common patients’ questions about heart failure.

Methods

We performed a comparative analysis between ChatGPT responses and existing heart failure educational materials from top US cardiology institutes. Validated readability calculators were employed to assess and compare the reading difficulty and grade level of the materials. Furthermore, blind assessment using The Patient Education Materials Assessment Tool (PEMAT) was done by four advanced heart failure attendings to evaluate the readability and actionability of each resource.

Results

Our study revealed that responses generated by ChatGPT were longer and more challenging to read compared to other materials. Additionally, these responses were written at a higher educational level (undergraduate and 9-10th grade), similar to those from the Heart Failure Society of America. Despite achieving a competitive PEMAT readability score (75 %), surpassing the American Heart Association score (68 %), ChatGPT's actionability score was the lowest (66.7 %) among all materials included in our study.

Conclusion

Despite its current limitations, artificial intelligence chatbots has the potential to revolutionize the field of patient education especially given theirs ongoing improvements. However, further research is necessary to ensure the integrity and reliability of these chatbots before endorsing them as reliable resources for patient education.

As the burden of rheumatic heart disease (RHD) increases in Ethiopia, there is a growing need for low-cost interventions to mitigate its impact. This study aimed to assess the effectiveness of chronic disease self-management education (CDSME) on clinical outcomes, depression, and anxiety among patients with RHD. A quasi-experimental study was deployed among 166 patients with RHD at Jimma Medical Center between April and July 2024. A multi-component CDSME was endured for four consecutive months. Data were analyzed using SPSS version 25.0. Systolic blood pressure decreased from 131.31 mmHg (SD±15.68) at pre-education to 113.77 mmHg (SD±20.98) at post-education (t- 12.251, p<0.001). Diastolic blood pressure decreased from 94.87 mmHg (SD±19.41) pre-education to 79.28 mmHg (SD±9.33) post-education (t-12.306, p<0.001). Hemoglobin level changed from 11.97 g/dl (SD±1.99) to 13.84 g/dl (SD±1.37) after the intervention (t -11.96, p < 0.001). Similarly, hospital depression subscale decreased from 11.93 (SD±3.43) to 9.48 (SD±3.67) (t - 8.37, p < 0.001) post intervention. Regarding the hospital anxiety subscale, the mean score before education program was 8.59 (SD±2.91) and decreased to 7.30 (SD±1.97) (t -6.44, p < 0.001) after education. This intervention is simple, cost-effective, and has the potential to be scaled up and implemented in the current healthcare system in Ethiopia.

Background

Studies exploring predictors of arrhythmias in the population primarily hospitalized for SARS-CoV-2 (COVID-19) are scarce. Understanding this is crucial for risk stratification and appropriate management.

Methods

Using the 2020 National Inpatient Sample (NIS) database, we identified primary admissions for COVID-19. A ‘greedy neighbor’ 1:1 propensity-score matching (PSM) accounted for baseline differences. Then, multivariable logistic regression models were employed to account for confounders and estimate the probability of arrhythmia.

Results

There were a total of 1,058,815 admissions for COVID-19 (mean age 64.3 years ±16.8), 47.2% female, 52.5% (107698) White, 18.5% (37973) Blacks, and 20.7% (42,447) Hispanics. Atrial fibrillation was the most prevalent arrhythmia, 15.1% (31,942). After PSM, 166,405 arrhythmia hospitalizations were matched to 166,405 hospitalizations without arrhythmia. Sick sinus syndrome 4.9 (4.4-5.5), dyslipidemia 1.2 (1.2–1.3), cardiac arrest 1.3 (1.1-1.4), invasive mechanical ventilation 1.9 (1.8-2.0) and obesity 1.3 (1.2-1.4), (p<0.0001, all) were all independent predictors of arrhythmias.

Conclusions

Our analysis revealed a notable proportion of hospitalized COVID-19 patients with arrhythmias. Dyslipidemia, obesity, sick sinus syndrome, invasive mechanical ventilation, and cardiac arrest were independent predictors of arrhythmias.

Background

Acute coronary syndrome characterizes the spectrum of myocardial ischemia states, which include non-ST elevated myocardial infarction (MI), and angina.

Objective

The aim of the present study is to determine the effectiveness of foot massage on selected physiological parameters among patients with acute coronary syndrome.

Methods

A quasi- experimental study was conducted in Karbala center for cardiac diseases and surgery from December 25th, 2023, to May 7th, 2024. A nonprobability purposive sampling consisted of 60 patients with acute coronary syndrome in the intervention group were instructed to performed four-step foot massage similarly 5 min for each foot. While patients in the control group just received routine medical treatment. The physiological parameters were checked in the two groups before, after 5 min, and 10 min after the foot massage. The study instrument consisted of two main parts: part one included patient's socio demographics and clinical data, and the second part was used to assess the physiological parameters. Statistical tests were conducted using the software SPSS, version 24, with a level of significance of 5 % (p value <0.05).

Results

that are a significant statistical differences between the mean of the selected physiological parameters readings for the study group except reading of pulse pressure, while there is no significant statistical difference between the mean of the readings of the selected physiological parameters for the control group except the reading of heart rate.

Conclusion

The study found that the foot massage is effective for improving the blood pressure, heart rate, mean arterial pressure.

For several years, left ventricular non-compaction (LVNC) was considered as a true cardiomyopathy and several definitions have followed one another.

Particularly, LVNC was characterized by prominent left ventricular trabeculae separated from deep intertrabecular recesses. Several echocardiographic criteria and cardiac magnetic resonance imaging (CMR) criteria have been used to diagnose LVNC, leading to overestimate the diagnosis of LVNC in patients with other diseases and/or physiological conditions.

Left ventricular hypertrabeculation (LVH) can be present in several cardiac diseases and physiological conditions: heart failure with reduced ejection fraction, thalassemia and other hematological diseases, pregnancy, athlete's heart. Thus, the presence of LVH does not necessarily indicate the presence of an LVNC.

In addition, the great heterogeneity of clinical manifestations has raised concerns regarding the existence of a true LVNC as a cardiomyopathy. In fact, LVNC ranges from genetic to acquired and even transient conditions, isolated forms or forms associated with other cardiomyopathies, congenital heart diseases or syndromes with a very different prognosis.

Thus, considering LVH as a manifestation of various diseases and physiological conditions, the recent 2023 ESC guidelines on cardiomyopathies did not include LVNC among cardiomyopathies, but they suggested using the term “LVH” rather than LVNC, to describe this phenotype especially when it is transient or of adult-onset.

In this review, we aimed to make an excursion on LVNC, from its initial description to the present day, to understand why current guidelines decided to consider LVH as a phenotypic trait rather than a distinct cardiomyopathy.

Cardiogenic shock (CS) is a serious complication of heart attack and constitutes one of its main causes of death. To date, there is no data on its treatment and evolution in Latin America.

Objectives

To know the clinical characteristics, treatment strategies, evolution and in-hospital mortality of CS in Latin America.

Materials and methods

This is a prospective, multicenter registry of patients hospitalized with CS in the context of acute coronary syndromes (ACS) with and without ST segment elevation for 24 months.

Results

41 Latin American centers participated incorporating patients during the period between October 2021 and September 2023. 278 patients were included. Age: 66 (59-75) years, 70.1 % men. 74.8 % of the cases correspond to ACS with ST elevation, 14.4 % to ACS without ST elevation, 5.7 % to right ventricular infarction and 5.1 % to mechanical complications. CS was present from admission in 60 % of cases. Revascularization: 81.3 %, inotropic use: 97.8 %, ARM: 52.5 %, Swan Ganz: 17 %, intra-aortic balloon pump: 22.2 %. Overall in-hospital mortality was 52.7 %, with no differences between ACS with or without ST.

Conclusions

Morbidity and mortality is very high despite the high reperfusion used.