Pub Date : 2024-06-06DOI: 10.1016/j.hrtlng.2024.05.010
Ana Cecília Silva de Oliveira , Laíla Cândida Zacarias , Clarice Cristina Cunha de Souza , João Paulo da Silva Bezerra , Antônio Brazil Viana-Junior , Manoel Alves Sobreira-Neto , Camila Ferreira Leite
Background
Obstructive sleep apnoea (OSA) is a disabling health condition, and there is no disease-specific patient-reported outcome instrument to assess individuals with OSA.
Objectives
To evaluate the psychometric properties of the Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in individuals with OSA.
Methods
One hundred individuals with OSA responded to the WHODAS 2.0 version of 36 items, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the 12-item health survey (SF-12). Internal consistency, convergent and discriminative validity, and responsiveness to continuous positive airway pressure (CPAP) were the psychometric properties tested.
Results
Cronbach's α values indicate good internal consistency (0.91 – 0.73), except for the self-care domain (α = 0.52). Convergent validity indicated an excellent correlation (r = -0.80) between the domains of functioning and quality of life. Discriminative validity showed no association between OSA severity and functioning (p = 0.90). The responsiveness to CPAP treatment showed a large effect size (r = 0.82; p < 0.05)
Conclusions
The WHODAS 2.0 instrument is valid, reliable, and responsive for assessing individuals with OSA.
{"title":"Validity, reliability, and responsiveness of the Brazilian version of the instrument World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with obstructive sleep apnoea","authors":"Ana Cecília Silva de Oliveira , Laíla Cândida Zacarias , Clarice Cristina Cunha de Souza , João Paulo da Silva Bezerra , Antônio Brazil Viana-Junior , Manoel Alves Sobreira-Neto , Camila Ferreira Leite","doi":"10.1016/j.hrtlng.2024.05.010","DOIUrl":"https://doi.org/10.1016/j.hrtlng.2024.05.010","url":null,"abstract":"<div><h3>Background</h3><p>Obstructive sleep apnoea (OSA) is a disabling health condition, and there is no disease-specific patient-reported outcome instrument to assess individuals with OSA.</p></div><div><h3>Objectives</h3><p>To evaluate the psychometric properties of the Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in individuals with OSA.</p></div><div><h3>Methods</h3><p>One hundred individuals with OSA responded to the WHODAS 2.0 version of 36 items, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the 12-item health survey (SF-12). Internal consistency, convergent and discriminative validity, and responsiveness to continuous positive airway pressure (CPAP) were the psychometric properties tested.</p></div><div><h3>Results</h3><p>Cronbach's α values indicate good internal consistency (0.91 – 0.73), except for the self-care domain (α = 0.52). Convergent validity indicated an excellent correlation (<em>r</em> = -0.80) between the domains of functioning and quality of life. Discriminative validity showed no association between OSA severity and functioning (<em>p</em> = 0.90). The responsiveness to CPAP treatment showed a large effect size (<em>r</em> = 0.82; <em>p</em> < 0.05)</p></div><div><h3>Conclusions</h3><p>The WHODAS 2.0 instrument is valid, reliable, and responsive for assessing individuals with OSA.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"67 ","pages":"Pages 183-190"},"PeriodicalIF":2.8,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263872","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 : 2024-06-04DOI: 10.1016/j.hrtlng.2024.05.002
Thi Xuan Mai Tran PhD , Yoosoo Chang MD, PhD , Seungho Ryu MD, PhD , Boyoung Park MD, PhD
Background
There is a growing amount of evidence on the association between cardiovascular diseases (CVDs) and breast calcification. Thus, mammographic breast features have recently gained attention as CVD predictors.
Objective
This study assessed the association of mammographic features, including benign calcification, microcalcification, and breast density, with cardiovascular diseases.
Methods
This study comprised 6,878,686 women aged ≥40 who underwent mammographic screening between 2009 and 2012 with follow-up until 2020. The mammographic features included benign calcification, microcalcification, and breast density. The cardiovascular diseases associated with the mammographic features were assessed using logistic regression.
Results
The prevalence of benign calcification, microcalcification, and dense breasts were 9.6 %, 0.9 % and 47.3 % at baseline, respectively. Over a median follow-up of 10 years, benign calcification and microcalcification were positively associated with an increased risk of chronic ischaemic heart disease whereas breast density was inversely associated with it; the corresponding aOR (95 % CI) was 1.14 (1.10–1.17), 1.19 (1.03–1.15), and 0.88 (0.85–0.90), respectively. A significantly increased risk of chronic ischaemic heart disease (IHD) was observed among women with benign calcifications (aHR, 1.14; 95 % CI 1.10–1.17) and microcalcifications (aOR, 1.19; 95 % CI 1.06–1.33). Women with microcalcifications had a 1.16–fold (95 % CI 1.03–1.30) increased risk of heart failure.
Conclusions
Mammographic calcifications were associated with an increased risk of chronic ischaemic heart diseases, whereas dense breast was associated with a decreased risk of cardiovascular disease. Thus, the mammographic features identified on breast cancer screening may provide an opportunity for cardiovascular disease risk identification and prevention.
{"title":"Mammographic breast features and risk of cardiovascular diseases in korean women","authors":"Thi Xuan Mai Tran PhD , Yoosoo Chang MD, PhD , Seungho Ryu MD, PhD , Boyoung Park MD, PhD","doi":"10.1016/j.hrtlng.2024.05.002","DOIUrl":"https://doi.org/10.1016/j.hrtlng.2024.05.002","url":null,"abstract":"<div><h3>Background</h3><p>There is a growing amount of evidence on the association between cardiovascular diseases (CVDs) and breast calcification. Thus, mammographic breast features have recently gained attention as CVD predictors.</p></div><div><h3>Objective</h3><p>This study assessed the association of mammographic features, including benign calcification, microcalcification, and breast density, with cardiovascular diseases.</p></div><div><h3>Methods</h3><p>This study comprised 6,878,686 women aged ≥40 who underwent mammographic screening between 2009 and 2012 with follow-up until 2020. The mammographic features included benign calcification, microcalcification, and breast density. The cardiovascular diseases associated with the mammographic features were assessed using logistic regression.</p></div><div><h3>Results</h3><p>The prevalence of benign calcification, microcalcification, and dense breasts were 9.6 %, 0.9 % and 47.3 % at baseline, respectively. Over a median follow-up of 10 years, benign calcification and microcalcification were positively associated with an increased risk of chronic ischaemic heart disease whereas breast density was inversely associated with it; the corresponding aOR (95 % CI) was 1.14 (1.10–1.17), 1.19 (1.03–1.15), and 0.88 (0.85–0.90), respectively. A significantly increased risk of chronic ischaemic heart disease (IHD) was observed among women with benign calcifications (aHR, 1.14; 95 % CI 1.10–1.17) and microcalcifications (aOR, 1.19; 95 % CI 1.06–1.33). Women with microcalcifications had a 1.16–fold (95 % CI 1.03–1.30) increased risk of heart failure.</p></div><div><h3>Conclusions</h3><p>Mammographic calcifications were associated with an increased risk of chronic ischaemic heart diseases, whereas dense breast was associated with a decreased risk of cardiovascular disease. Thus, the mammographic features identified on breast cancer screening may provide an opportunity for cardiovascular disease risk identification and prevention.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"67 ","pages":"Pages 176-182"},"PeriodicalIF":2.8,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141242972","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 : 2024-05-28DOI: 10.1016/j.hrtlng.2024.05.009
Shelly Ashkenazy PhD, RN , Charles Weissman MD , Freda DeKeyser Ganz PhD, RN
Background
Pain is routinely measured on mechanically ventilated ICU patients. However, the tools used are not designed to discriminate between pain and non-pain discomfort, a distinction with therapeutic implications.
Objectives
To evaluate whether clinical measurement tools can discern both pain and non-pain discomfort.
Methods
A prospective observational cohort study was conducted in a General ICU at a tertiary Medical Center in Israel. The Behavior Pain Scale (BPS) and Visual Analog Scale (VAS) of Discomfort were simultaneously assessed by a researcher and bedside nurse on thirteen lightly sedated patients during 71 routine nursing interventions in lightly sedated, mechanically ventilated, adult patients. Patients were asked whether they were in pain due to these interventions.
Results
Statistically significant increases from baseline during interventions were observed [median change: 1.00 (-1–5), 1.5(-4–8.5), p < 0.001] as measured by BPS and VAS Discomfort Scale, respectively. BPS scores ranged between 4 and 6 when the majority (53 %) of the patients replied that they had no pain but were interpreted by the clinicians as discomfort. Endotracheal suctioning caused the greatest increase in BPS and VAS, with no statistically significant differences in BPS and VAS Discomfort Scale scores whether patients reported or did not report pain. A BPS>6 had a higher sensitivity and specificity to reported pain (accuracy of 76 %) compared to a BPS of 4–6.
Conclusions
Standard assessments are sensitive to pain caused by routine nursing care interventions. However, this study presents evidence that among lightly sedated ICU patients, moderate BPS scores could also measure non-pain discomfort. ICU nurses should be aware that signs of unpleasantness measured by a pain scale could reflect non-pain discomfort.
{"title":"Measuring pain or discomfort during routine nursing care in lightly sedated mechanically ventilated intensive care patients: A prospective preliminary cohort study","authors":"Shelly Ashkenazy PhD, RN , Charles Weissman MD , Freda DeKeyser Ganz PhD, RN","doi":"10.1016/j.hrtlng.2024.05.009","DOIUrl":"10.1016/j.hrtlng.2024.05.009","url":null,"abstract":"<div><h3>Background</h3><p>Pain is routinely measured on mechanically ventilated ICU patients. However, the tools used are not designed to discriminate between pain and non-pain discomfort, a distinction with therapeutic implications.</p></div><div><h3>Objectives</h3><p>To evaluate whether clinical measurement tools can discern both pain and non-pain discomfort.</p></div><div><h3>Methods</h3><p>A prospective observational cohort study was conducted in a General ICU at a tertiary Medical Center in Israel. The Behavior Pain Scale (BPS) and Visual Analog Scale (VAS) of Discomfort were simultaneously assessed by a researcher and bedside nurse on thirteen lightly sedated patients during 71 routine nursing interventions in lightly sedated, mechanically ventilated, adult patients. Patients were asked whether they were in pain due to these interventions.</p></div><div><h3>Results</h3><p>Statistically significant increases from baseline during interventions were observed [median change: 1.00 (-1–5), 1.5(-4–8.5), <em>p</em> < 0.001] as measured by BPS and VAS Discomfort Scale, respectively. BPS scores ranged between 4 and 6 when the majority (53 %) of the patients replied that they had no pain but were interpreted by the clinicians as discomfort. Endotracheal suctioning caused the greatest increase in BPS and VAS, with no statistically significant differences in BPS and VAS Discomfort Scale scores whether patients reported or did not report pain. A BPS>6 had a higher sensitivity and specificity to reported pain (accuracy of 76 %) compared to a BPS of 4–6.</p></div><div><h3>Conclusions</h3><p>Standard assessments are sensitive to pain caused by routine nursing care interventions. However, this study presents evidence that among lightly sedated ICU patients, moderate BPS scores could also measure non-pain discomfort. ICU nurses should be aware that signs of unpleasantness measured by a pain scale could reflect non-pain discomfort.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"67 ","pages":"Pages 169-175"},"PeriodicalIF":2.8,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141167897","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 : 2024-05-23DOI: 10.1016/j.hrtlng.2024.05.008
Deng Yifan , Fang Zhen , Ma Yue , Sun Xun , Gao Jiapei , Zhu Li , Zhang Jing
Background
Transcatheter aortic valve replacement (TAVR) is a preferred treatment for patients with highly critical aortic stenosis (AS), which is a difficult and complicated procedure, leaving a heavy economical burden on patients and national health insurance. Minimalist TAVR can simplify a part of the operation procedures, but the surgical efficacy and safety are still under debated.
Objectives
Explore the effectiveness and safety of minimalist TAVR in the treatment of patients with aortic stenosis.
Methods
A systematic search of PubMed, Web of Science, and Embase databases was conducted for studies involving application of minimalist TAVR in patients with severe aortic stenosis, two researchers independently screened the literature, extracted data and Meta-analysis was performed using STATA 16.0 software.
Results
Nine studies, involving a total of 3,148 AS patients, were included. Minimalist TAVR has similar surgical success rates compared to standardized TAVR, intraoperative fluoroscopy time, dosage of contrast agent, and total operative time were superior to standard TAVR. Regarding surgical complications, the incidence of permanent pacemaker placement and moderate to severe paravalvular leakage were similar for both TAVR, the risk of major vascular complications and major bleeding events in the minimalist TAVR was significantly lower than the standard TAVR. The risk of overall death, stroke, and cardiovascular-related readmission within 30 days was similar in both procedures.
Conclusion
Patients with severe aortic stenosis treated with minimalist TAVR have similar short-term efficacy as well as 30-day clinical outcomes to standard TAVR, while minimalist TAVR could reduce the risk of major vascular complications and bleeding complications.
背景经导管主动脉瓣置换术（TAVR）是高危主动脉瓣狭窄（AS）患者的首选治疗方法，其手术难度大、操作复杂，给患者和国家医疗保险带来沉重的经济负担。目的探讨极简TAVR治疗主动脉瓣狭窄患者的有效性和安全性。方法在PubMed、Web of Science和Embase数据库中系统检索涉及在重度主动脉瓣狭窄患者中应用极简TAVR的研究，由两名研究人员独立筛选文献、提取数据，并使用STATA 16.0软件进行Meta分析。结果共纳入9项研究，涉及3148名AS患者。与标准TAVR相比，极简TAVR的手术成功率相似，术中透视时间、造影剂用量和总手术时间均优于标准TAVR。在手术并发症方面，两种TAVR的永久起搏器安置和中重度瓣膜旁漏发生率相似，极简TAVR的主要血管并发症和大出血风险明显低于标准TAVR。结论采用极简TAVR治疗重度主动脉瓣狭窄患者的短期疗效和30天临床结果与标准TAVR相似，而极简TAVR可降低主要血管并发症和出血并发症的风险。
{"title":"Safety and efficacy of minimal transcatheter aortic valve replacement: A systematic review and meta-analysis","authors":"Deng Yifan , Fang Zhen , Ma Yue , Sun Xun , Gao Jiapei , Zhu Li , Zhang Jing","doi":"10.1016/j.hrtlng.2024.05.008","DOIUrl":"https://doi.org/10.1016/j.hrtlng.2024.05.008","url":null,"abstract":"<div><h3>Background</h3><p>Transcatheter aortic valve replacement (TAVR) is a preferred treatment for patients with highly critical aortic stenosis (AS), which is a difficult and complicated procedure, leaving a heavy economical burden on patients and national health insurance. Minimalist TAVR can simplify a part of the operation procedures, but the surgical efficacy and safety are still under debated.</p></div><div><h3>Objectives</h3><p>Explore the effectiveness and safety of minimalist TAVR in the treatment of patients with aortic stenosis.</p></div><div><h3>Methods</h3><p>A systematic search of PubMed, Web of Science, and Embase databases was conducted for studies involving application of minimalist TAVR in patients with severe aortic stenosis, two researchers independently screened the literature, extracted data and Meta-analysis was performed using STATA 16.0 software.</p></div><div><h3>Results</h3><p>Nine studies, involving a total of 3,148 AS patients, were included. Minimalist TAVR has similar surgical success rates compared to standardized TAVR, intraoperative fluoroscopy time, dosage of contrast agent, and total operative time were superior to standard TAVR. Regarding surgical complications, the incidence of permanent pacemaker placement and moderate to severe paravalvular leakage were similar for both TAVR, the risk of major vascular complications and major bleeding events in the minimalist TAVR was significantly lower than the standard TAVR. The risk of overall death, stroke, and cardiovascular-related readmission within 30 days was similar in both procedures.</p></div><div><h3>Conclusion</h3><p>Patients with severe aortic stenosis treated with minimalist TAVR have similar short-term efficacy as well as 30-day clinical outcomes to standard TAVR, while minimalist TAVR could reduce the risk of major vascular complications and bleeding complications.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"67 ","pages":"Pages 158-168"},"PeriodicalIF":2.8,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141090283","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 : 2024-05-19DOI: 10.1016/j.hrtlng.2024.05.005
Katie H. Sanders DClinSci , Kathryn Carver PhD , Elizabeth Eggleton MSc , Peter J. Pugh MD , Lucy Walker PhD , May Azzawi PhD
Background
Support groups for people with Implantable Cardioverter Defibrillators (ICDs) are widely used, however, it is not clear what people with ICDs gain from a support group or what format they should take.
Objectives
The aim of the present study is to define the perceived benefit of ICD support groups and develop practical recommendations for group format.
Methods
14 individuals with ICDs were interviewed using a semi-structured interview guide. Reflexive thematic analysis methods were utilised to code and analyse the transcripts before generating themes.
Results
Four themes were defined: confronting mortality, coping through sharing, coping through learning, and providing space. Making connections with other people with ICDs, reassurance, access to information, and advice from health care professionals were important perceived benefits of the support group.
Conclusion
People with ICDs may have to confront their own mortality and adapt to considerable life changes after implant. The findings from the present study have improved understanding of how support groups are perceived and how ICD indication and group format influence the experience. A blended format of in-person community meetings, online forums, HCP-led education and space for person-person interaction is recommended. Importantly, provision of support should not be time-limited to allow people to access it when it most likely to be of benefit to them.
{"title":"Perceived benefits of patient support groups and their format for people with an implantable cardioverter defibrillator","authors":"Katie H. Sanders DClinSci , Kathryn Carver PhD , Elizabeth Eggleton MSc , Peter J. Pugh MD , Lucy Walker PhD , May Azzawi PhD","doi":"10.1016/j.hrtlng.2024.05.005","DOIUrl":"10.1016/j.hrtlng.2024.05.005","url":null,"abstract":"<div><h3>Background</h3><p>Support groups for people with Implantable Cardioverter Defibrillators (ICDs) are widely used, however, it is not clear what people with ICDs gain from a support group or what format they should take.</p></div><div><h3>Objectives</h3><p>The aim of the present study is to define the perceived benefit of ICD support groups and develop practical recommendations for group format.</p></div><div><h3>Methods</h3><p>14 individuals with ICDs were interviewed using a semi-structured interview guide. Reflexive thematic analysis methods were utilised to code and analyse the transcripts before generating themes.</p></div><div><h3>Results</h3><p>Four themes were defined: confronting mortality, coping through sharing, coping through learning, and providing space. Making connections with other people with ICDs, reassurance, access to information, and advice from health care professionals were important perceived benefits of the support group.</p></div><div><h3>Conclusion</h3><p>People with ICDs may have to confront their own mortality and adapt to considerable life changes after implant. The findings from the present study have improved understanding of how support groups are perceived and how ICD indication and group format influence the experience. A blended format of in-person community meetings, online forums, HCP-led education and space for person-person interaction is recommended. Importantly, provision of support should not be time-limited to allow people to access it when it most likely to be of benefit to them.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"67 ","pages":"Pages 152-157"},"PeriodicalIF":2.8,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066252","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 : 2024-05-18DOI: 10.1016/j.hrtlng.2024.05.003
Frederick Berro Rivera MD , Sung Whoy Cha MD , Sonny C. Redula MD , Mara Bernadette O. Liston MD , Erika P. Ong Bsc , Nathan Ross B. Bantayan Bsc , Gurleen Kaur MD , Annabelle Santos Volgman MD, FACC, FAHA , Mamas A. Mamas MD, DPhil
Background
Despite comprising almost half of all patients undergoing valvular repair, data on transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (BAS) are limited.
Objective
We aimed to evaluate whether there are any sex differences in trends and outcomes of TAVR in this population.
Methods
We utilized the National Inpatient Sample from 2012 to 2020 to identify admissions with BAS who underwent TAVR and analyzed trends and outcomes. Our primary outcome was in-hospital mortality and secondary outcomes were in-hospital complications. We used two models to adjust for demographics (A) and interventions (B).
Results
Between 2012 to 2020, there were 76,540 hospitalizations for BAS patients who underwent AVR, among which 6,010 (7.9 %) underwent TAVR. There was an overall increasing trend in number of TAVR cases with a decreasing trend in mortality (2013: 8.7 %, 2020: 1.3 %). TAVR was performed more in males (61.1% vs 38.9 %). Despite the worse baseline characteristics in males, in-hospital mortality (2.4% vs. 1.5 %; OR: 1.584; 95 % CI: 0.621–4.038; p = 0.335) and secondary outcomes were similar across both sexes, even after adjusting for demographics and interventions.
Conclusion
TAVR in BAS has grown rapidly in the last decade. Males comprised the majority and had more comorbidities, but mortality and complications were similar in both sexes. Despite the increasing number of cases, a decreasing trend in mortality was observed for both sexes ultimately approaching that of SAVR, suggesting that TAVR may be a safe alternative among eligible males and females with bicuspid AS.
{"title":"Sex differences in transcatheter aortic valve replacement outcomes among patients with bicuspid aortic stenosis","authors":"Frederick Berro Rivera MD , Sung Whoy Cha MD , Sonny C. Redula MD , Mara Bernadette O. Liston MD , Erika P. Ong Bsc , Nathan Ross B. Bantayan Bsc , Gurleen Kaur MD , Annabelle Santos Volgman MD, FACC, FAHA , Mamas A. Mamas MD, DPhil","doi":"10.1016/j.hrtlng.2024.05.003","DOIUrl":"10.1016/j.hrtlng.2024.05.003","url":null,"abstract":"<div><h3>Background</h3><p>Despite comprising almost half of all patients undergoing valvular repair, data on transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (BAS) are limited.</p></div><div><h3>Objective</h3><p>We aimed to evaluate whether there are any sex differences in trends and outcomes of TAVR in this population.</p></div><div><h3>Methods</h3><p>We utilized the National Inpatient Sample from 2012 to 2020 to identify admissions with BAS who underwent TAVR and analyzed trends and outcomes. Our primary outcome was in-hospital mortality and secondary outcomes were in-hospital complications. We used two models to adjust for demographics (A) and interventions (B).</p></div><div><h3>Results</h3><p>Between 2012 to 2020, there were 76,540 hospitalizations for BAS patients who underwent AVR, among which 6,010 (7.9 %) underwent TAVR. There was an overall increasing trend in number of TAVR cases with a decreasing trend in mortality (2013: 8.7 %, 2020: 1.3 %). TAVR was performed more in males (61.1% vs 38.9 %). Despite the worse baseline characteristics in males, in-hospital mortality (2.4% vs. 1.5 %; OR: 1.584; 95 % CI: 0.621–4.038; <em>p</em> = 0.335) and secondary outcomes were similar across both sexes, even after adjusting for demographics and interventions.</p></div><div><h3>Conclusion</h3><p>TAVR in BAS has grown rapidly in the last decade. Males comprised the majority and had more comorbidities, but mortality and complications were similar in both sexes. Despite the increasing number of cases, a decreasing trend in mortality was observed for both sexes ultimately approaching that of SAVR, suggesting that TAVR may be a safe alternative among eligible males and females with bicuspid AS.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"67 ","pages":"Pages 144-151"},"PeriodicalIF":2.8,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066256","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 : 2024-05-16DOI: 10.1016/j.hrtlng.2024.05.004
Fernando Torres MD , Christine Shedd BS , Vaidehi Kaza MD , Srinivas Bollineni MD , Amit Banga MD , Manish R. Mohanka MD , Nicholas Ladikos PharmD , Marniker Wijesinha PhD , Luke D. Mahan MSN APRN , Adrian Lawrence MD , John Joerns MD , Lance Terada MD , Irina Timofte MD MS
Background
COVID patients continue to experience unremitting symptoms that extend far beyond the initial illness. While there is rapid accumulation of data on acute COVID treatment in hospitalized patients, little is known regarding post-COVID management.
Objectives
To describe our center's experience treating post-COVID sub-syndromes encountered in Post-COVID Lung Clinic.
Methods
We retrospectively reviewed data on 98 post-COVID patients evaluated in our clinic between 07/01/2020–12/31/2022. We encountered three distinct post-COVID subtypes: 1) respiratory complaints associated with increased O2 requirements and abnormal CT findings (post-COVID interstitial lung disease [ILD]), 2) respiratory complaints associated with tachycardia (post-COVID dyspnea-tachycardia syndrome [DTS]). Post-COVID ILD patients (n = 28) received steroids in combination with cell cycle inhibitor (mycophenolate mofetil-MMF). Post-COVID DTS patients (n = 16) were treated with metoprolol. 3) A third, undifferentiated group presented with mild respiratory complaints and normal spirometry (n = 17) and was followed in clinic without initiation of a specific treatment.
Results
In treated post-COVID ILD patients, mean oxygen requirements at rest (1.96 ± 1.79 L/NC) decreased to 0.89 ± 1.29 L/NC at 6 months follow-up, p = 0.005. In patients with post-COVID DTS, mean heart rate at rest decreased (98 ± 15 bpm to 79 ± 11 bpm) at 6 months follow-up, p = 0.023. 60 % of patients reported an improvement in exertional dyspnea.
Conclusions
Our descriptive study presents a single center outpatient COVID-19 clinic experience. We encountered 3 post-COVID sub-syndromes and describe their treatments: post-COVID interstitial lung disease [ILD] treated with a novel regimen of MMF and steroids, post COVID dyspnea-tachycardia syndrome [DTS] treated with metoprolol, and a third subgroup with mild undifferentiated symptoms without specific treatment.
{"title":"Outpatient management of Post-COVID syndrome – single center experience","authors":"Fernando Torres MD , Christine Shedd BS , Vaidehi Kaza MD , Srinivas Bollineni MD , Amit Banga MD , Manish R. Mohanka MD , Nicholas Ladikos PharmD , Marniker Wijesinha PhD , Luke D. Mahan MSN APRN , Adrian Lawrence MD , John Joerns MD , Lance Terada MD , Irina Timofte MD MS","doi":"10.1016/j.hrtlng.2024.05.004","DOIUrl":"https://doi.org/10.1016/j.hrtlng.2024.05.004","url":null,"abstract":"<div><h3>Background</h3><p>COVID patients continue to experience unremitting symptoms that extend far beyond the initial illness. While there is rapid accumulation of data on acute COVID treatment in hospitalized patients, little is known regarding post-COVID management.</p></div><div><h3>Objectives</h3><p>To describe our center's experience treating post-COVID sub-syndromes encountered in Post-COVID Lung Clinic.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed data on 98 post-COVID patients evaluated in our clinic between 07/01/2020–12/31/2022. We encountered three distinct post-COVID subtypes: 1) respiratory complaints associated with increased O2 requirements and abnormal CT findings (post-COVID interstitial lung disease [ILD]), 2) respiratory complaints associated with tachycardia (post-COVID dyspnea-tachycardia syndrome [DTS]). Post-COVID ILD patients (<em>n</em> = 28) received steroids in combination with cell cycle inhibitor (mycophenolate mofetil-MMF). Post-COVID DTS patients (<em>n</em> = 16) were treated with metoprolol. 3) A third, undifferentiated group presented with mild respiratory complaints and normal spirometry (<em>n</em> = 17) and was followed in clinic without initiation of a specific treatment.</p></div><div><h3>Results</h3><p>In treated post-COVID ILD patients, mean oxygen requirements at rest (1.96 ± 1.79 L/NC) decreased to 0.89 ± 1.29 L/NC at 6 months follow-up, <em>p</em> = 0.005. In patients with post-COVID DTS, mean heart rate at rest decreased (98 ± 15 bpm to 79 ± 11 bpm) at 6 months follow-up, <em>p</em> = 0.023. 60 % of patients reported an improvement in exertional dyspnea.</p></div><div><h3>Conclusions</h3><p>Our descriptive study presents a single center outpatient COVID-19 clinic experience. We encountered 3 post-COVID sub-syndromes and describe their treatments: post-COVID interstitial lung disease [ILD] treated with a novel regimen of MMF and steroids, post COVID dyspnea-tachycardia syndrome [DTS] treated with metoprolol, and a third subgroup with mild undifferentiated symptoms without specific treatment.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"67 ","pages":"Pages 137-143"},"PeriodicalIF":2.8,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140950392","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 : 2024-05-15DOI: 10.1016/j.hrtlng.2024.04.019
Maryam Mehrpooya , Mohammad Rafi Barakzehi , Mahdi Nikoobakhsh
Background
Since the introduction of direct oral anticoagulants (DOACs) and their comparison with vitamin K antagonists (VKAs), conflicting results have been reported regarding the optimal treatment for left ventricular thrombosis (LVT).
Objectives
In this meta-analysis, we intend to comprehensively evaluate the safety and efficacy of these treatments.
Methods
All clinical trials and cohorts that compared the efficacy or safety of VKAs with DOACs in the treatment of LVTs were systematically searched until April 15, 2023.
Results
The results of 32 studies with a pooled sample size of 4213 patients were extracted for meta-analysis. DOACs, especially rivaroxaban and apixaban, cause faster resolution, lower mortality, and fewer complications (SSE and bleeding events) than VKAs in the management of LVTs.
Conclusion
Compared with VKAs, DOACs result in significantly faster (only rivaroxaban) and safer resolution of left ventricular thrombosis.
{"title":"Evaluation of the safety and efficacy of direct oral anticoagulants compared with vitamin-k antagonists in the treatment of left ventricular thrombosis. A systematic review and meta-analysis","authors":"Maryam Mehrpooya , Mohammad Rafi Barakzehi , Mahdi Nikoobakhsh","doi":"10.1016/j.hrtlng.2024.04.019","DOIUrl":"https://doi.org/10.1016/j.hrtlng.2024.04.019","url":null,"abstract":"<div><h3>Background</h3><p>Since the introduction of direct oral anticoagulants (DOACs) and their comparison with vitamin K antagonists (VKAs), conflicting results have been reported regarding the optimal treatment for left ventricular thrombosis (LVT).</p></div><div><h3>Objectives</h3><p>In this meta-analysis, we intend to comprehensively evaluate the safety and efficacy of these treatments.</p></div><div><h3>Methods</h3><p>All clinical trials and cohorts that compared the efficacy or safety of VKAs with DOACs in the treatment of LVTs were systematically searched until April 15, 2023.</p></div><div><h3>Results</h3><p>The results of 32 studies with a pooled sample size of 4213 patients were extracted for meta-analysis. DOACs, especially rivaroxaban and apixaban, cause faster resolution, lower mortality, and fewer complications (SSE and bleeding events) than VKAs in the management of LVTs.</p></div><div><h3>Conclusion</h3><p>Compared with VKAs, DOACs result in significantly faster (only rivaroxaban) and safer resolution of left ventricular thrombosis.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"67 ","pages":"Pages 121-136"},"PeriodicalIF":2.8,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140948107","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 : 2024-05-14DOI: 10.1016/j.hrtlng.2024.05.006
Jinqi Zhu , Jing Cao , Sue Zhao
Background
Anthocyanins have anti-inflammatory and antioxidant properties. Several studies have demonstrated that anthocyanins are associated with many chronic diseases, but few studies have focused on the relationship between anthocyanins and chronic obstructive pulmonary disease (COPD).
Objectives
This survey aimed to explore the relationship between dietary anthocyanin intake and COPD in US adults over the age of 40.
Methods
A cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) 2017–2018 was conducted. We used univariate and multivariate logistic regression and restricted cubic spline (RCS) to analyze the relationship between dietary anthocyanins and COPD. Subgroup and interaction analyses were adopted to assess whether there were differences in the relationship between dietary anthocyanin intake and COPD in different groups.
Results
A total of 2862 participants aged ≥ 40 years were analyzed, of whom 213 were diagnosed with COPD. The highest tertile of dietary anthocyanin intake was negatively correlated with COPD compared to the lowest after adjusting potential confounders (Model 1, OR = 0.414; 95% CI: (0.245, 0.699), P-trend = 0.002; Model 2, OR = 0.363; 95% CI: (0.210, 0.627), P-trend = 0.002; Model 3, OR = 0.614; 95% CI: (0.383, 0.985), P-trend = 0.040). The RCS curve showed a significant inverse linear relationship between dietary anthocyanin intake and COPD (P non-linear = 0.734). In subgroup analyses, the negative correlation between dietary anthocyanin intake and COPD existed across different subgroups.
Conclusion
Our study indicated that higher dietary anthocyanins are a protective factor against the presence of COPD in the US aged over 40.
{"title":"Association between dietary anthocyanin intake and chronic obstructive pulmonary disease in US adults: A public database survey","authors":"Jinqi Zhu , Jing Cao , Sue Zhao","doi":"10.1016/j.hrtlng.2024.05.006","DOIUrl":"10.1016/j.hrtlng.2024.05.006","url":null,"abstract":"<div><h3>Background</h3><p>Anthocyanins have anti-inflammatory and antioxidant properties. Several studies have demonstrated that anthocyanins are associated with many chronic diseases, but few studies have focused on the relationship between anthocyanins and chronic obstructive pulmonary disease (COPD).</p></div><div><h3>Objectives</h3><p>This survey aimed to explore the relationship between dietary anthocyanin intake and COPD in US adults over the age of 40.</p></div><div><h3>Methods</h3><p>A cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) 2017–2018 was conducted. We used univariate and multivariate logistic regression and restricted cubic spline (RCS) to analyze the relationship between dietary anthocyanins and COPD. Subgroup and interaction analyses were adopted to assess whether there were differences in the relationship between dietary anthocyanin intake and COPD in different groups.</p></div><div><h3>Results</h3><p>A total of 2862 participants aged ≥ 40 years were analyzed, of whom 213 were diagnosed with COPD. The highest tertile of dietary anthocyanin intake was negatively correlated with COPD compared to the lowest after adjusting potential confounders (Model 1, OR = 0.414; 95% CI: (0.245, 0.699), <em>P</em>-trend = 0.002; Model 2, OR = 0.363; 95% CI: (0.210, 0.627), <em>P</em>-trend = 0.002; Model 3, OR = 0.614; 95% CI: (0.383, 0.985), <em>P</em>-trend = 0.040). The RCS curve showed a significant inverse linear relationship between dietary anthocyanin intake and COPD (<em>P</em> non-linear = 0.734). In subgroup analyses, the negative correlation between dietary anthocyanin intake and COPD existed across different subgroups.</p></div><div><h3>Conclusion</h3><p>Our study indicated that higher dietary anthocyanins are a protective factor against the presence of COPD in the US aged over 40.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"67 ","pages":"Pages 108-113"},"PeriodicalIF":2.8,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140937747","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 : 2024-05-14DOI: 10.1016/j.hrtlng.2024.05.001
Ophir Freund , Levi Elhadad , Boaz Tiran , Ariel Melloul , Eyal Kleinhendler , Tal Moshe Perluk , Evgeni Gershman , Avraham Unterman , Avishay Elis , Amir Bar-Shai
Background
Implementing standard of care therapy for chronic obstructive pulmonary disease (COPD) has barriers. Hospitalization with an acute exacerbation of COPD (AECOPD) is a major adverse event that could also be an opportunity to improve patients' long-term care.
Objectives
To evaluate which in-hospital interventions during AECOPD are associated with improved 30-day care.
Methods
This was a prospective study that included patients from 10 medical centers across Israel, hospitalized with AECOPD between 2017 and 2019. Patients were approached during hospitalization in internal medicine departments. A semi-structured follow-up call was performed 30 days after discharge, and six COPD areas of care were assessed. Multivariate analyses were used to analyze predictors for each area of care.
Results
234 patients were included (mean age 69 years and 34% females). A lower 30-day readmission rate was independently associated with smoking cessation and prescription of renin-angiotensin blockers. Initiating or continuing long acting bronchodilators (LABD) during admission was an independent predictor for their 30-day use. Among patients with prior LABD treatment, only 38% continued at 30-days if it was not prescribed during admission (OR 4, 95% CI 1.98-8.08, p<0.01). In-hospital daily respiratory physiotherapy was an independent predictor for smoking cessation (AOR 5.1, 95% CI 1.1-23, p=0.04), while smoking cessation recommendation was not (p=0.28). Initiating a smoking cessation program (5%) or pulmonary rehabilitation (1%) after discharge was performed only by patients with a written referral.
Conclusion
Routine procedures during hospitalization for AECOPD could impact patients' long-term care in areas with proven effects on disease outcomes.
{"title":"Routine in-hospital interventions during acute exacerbation of COPD are associated with improved 30-day care","authors":"Ophir Freund , Levi Elhadad , Boaz Tiran , Ariel Melloul , Eyal Kleinhendler , Tal Moshe Perluk , Evgeni Gershman , Avraham Unterman , Avishay Elis , Amir Bar-Shai","doi":"10.1016/j.hrtlng.2024.05.001","DOIUrl":"10.1016/j.hrtlng.2024.05.001","url":null,"abstract":"<div><h3>Background</h3><p>Implementing standard of care therapy for chronic obstructive pulmonary disease (COPD) has barriers. Hospitalization with an acute exacerbation of COPD (AECOPD) is a major adverse event that could also be an opportunity to improve patients' long-term care.</p></div><div><h3>Objectives</h3><p>To evaluate which in-hospital interventions during AECOPD are associated with improved 30-day care.</p></div><div><h3>Methods</h3><p>This was a prospective study that included patients from 10 medical centers across Israel, hospitalized with AECOPD between 2017 and 2019. Patients were approached during hospitalization in internal medicine departments. A semi-structured follow-up call was performed 30 days after discharge, and six COPD areas of care were assessed. Multivariate analyses were used to analyze predictors for each area of care.</p></div><div><h3>Results</h3><p>234 patients were included (mean age 69 years and 34% females). A lower 30-day readmission rate was independently associated with smoking cessation and prescription of renin-angiotensin blockers. Initiating or continuing long acting bronchodilators (LABD) during admission was an independent predictor for their 30-day use. Among patients with prior LABD treatment, only 38% continued at 30-days if it was not prescribed during admission (OR 4, 95% CI 1.98-8.08, p<0.01). In-hospital daily respiratory physiotherapy was an independent predictor for smoking cessation (AOR 5.1, 95% CI 1.1-23, p=0.04), while smoking cessation recommendation was not (p=0.28). Initiating a smoking cessation program (5%) or pulmonary rehabilitation (1%) after discharge was performed only by patients with a written referral.</p></div><div><h3>Conclusion</h3><p>Routine procedures during hospitalization for AECOPD could impact patients' long-term care in areas with proven effects on disease outcomes.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"67 ","pages":"Pages 114-120"},"PeriodicalIF":2.8,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946538","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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