Pub Date : 2024-06-26DOI: 10.1016/j.hrtlng.2024.06.013
Feng Wang, Liangliang Jia
Background
Prior research has established a connection between depression and chronic obstructive pulmonary disease (COPD). However, the influence of age and BMI on this association remains unclear.
Objectives
We used the National Health and Nutrition Examination Survey (NHANES) database to explore the relationship between depression and COPD, and to investigate whether age and Body mass index (BMI) act as moderators in this relationship.
Methods
We analyzed data from 10,940 participants in the NHANES database. Depression served as the independent variable. COPD status served as the outcome variable. We employed multivariable logistic regression to examine the relationship between depression and COPD.
Results
Of the 10,940 respondents surveyed, about 3.9 % had COPD and 8.5 % had depression. The prevalence of depression in COPD patients was significantly greater than the prevalence of overall respondents (21.1 % VS.8.5 %). We found that the association between depression and COPD was mediated by BMI status. Controlling for other covariates, the association between depression and COPD increased significantly. For the underweight group, the impact of depression on the risk of COPD was lower compared to the normal BMI group.
Conclusion
This study confirms a significant association between depression and COPD, with BMI serving as a moderator. These findings enhance our understanding of the complex interplay between depression and COPD and underscore the importance of considering individual physical health characteristics in clinical assessments. The results have significant implications for clinical practice and public health policymaking.
{"title":"BMI moderates the relationship between depression and chronic obstructive pulmonary disease: A cross‑sectional survey","authors":"Feng Wang, Liangliang Jia","doi":"10.1016/j.hrtlng.2024.06.013","DOIUrl":"10.1016/j.hrtlng.2024.06.013","url":null,"abstract":"<div><h3>Background</h3><p>Prior research has established a connection between depression and chronic obstructive pulmonary disease (COPD). However, the influence of age and BMI on this association remains unclear.</p></div><div><h3>Objectives</h3><p>We used the National Health and Nutrition Examination Survey (NHANES) database to explore the relationship between depression and COPD, and to investigate whether age and Body mass index (BMI) act as moderators in this relationship.</p></div><div><h3>Methods</h3><p>We analyzed data from 10,940 participants in the NHANES database. Depression served as the independent variable. COPD status served as the outcome variable. We employed multivariable logistic regression to examine the relationship between depression and COPD.</p></div><div><h3>Results</h3><p>Of the 10,940 respondents surveyed, about 3.9 % had COPD and 8.5 % had depression. The prevalence of depression in COPD patients was significantly greater than the prevalence of overall respondents (21.1 % VS.8.5 %). We found that the association between depression and COPD was mediated by BMI status. Controlling for other covariates, the association between depression and COPD increased significantly. For the underweight group, the impact of depression on the risk of COPD was lower compared to the normal BMI group.</p></div><div><h3>Conclusion</h3><p>This study confirms a significant association between depression and COPD, with BMI serving as a moderator. These findings enhance our understanding of the complex interplay between depression and COPD and underscore the importance of considering individual physical health characteristics in clinical assessments. The results have significant implications for clinical practice and public health policymaking.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 68-73"},"PeriodicalIF":2.4,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472717","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 : 2024-06-25DOI: 10.1016/j.hrtlng.2024.06.012
Simone Britsch , Markward Britsch , Leonie Hahn , Harald Langer , Simon Lindner , Ibrahim Akin , Thomas Helbing , Daniel Duerschmied , Tobias Becher
Background
Cardiogenic shock (CS) is characterized by high mortality and requires accurate prognostic tools to predict outcomes and guide treatment. The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification indicates shock severity and can be used for outcome prediction.
Objective
Here, we compare the prognostic performance of SCAI shock classification determined on admission and during intensive care unit (ICU) stay.
Methods
We included all patients with CS or conditions associated with developing CS based on ICD codes. SCAI shock stages were determined on admission and during the first 5 days of ICU stay. Receiver operating curves were used to compare the prognostic performance of SCAI stages on admission, SCAI stages during ICU stay and CS evolution (absent, resolved, persistent and new onset) for in-hospital mortality.
Results
Between 01/2018 and 06/2022, 1303 patients were identified and 862 patients were included. On admission, 50.6 % patients had SCAI shock stage A, 3.9 % SCAI shock stage B, 17.7 % SCAI shock stage C, 7.0 % SCAI shock stage D and 20.8 % SCAI shock stage E. Shock stage distribution changed dynamically during ICU stay. Compared to SCAI stage on admission (AUC 0.80; 95 % CI 0.77–0.83), highest achieved SCAI stage during ICU (AUC 0.86, 95 % CI 0.83–0.89, p < 0.0001) and shock evolution (AUC 0.87, 95 % CI 0.85–0.90, p < 0.0001) yielded better prognostic performance.
Conclusions
SCAI shock stages changed dynamically during ICU stay, and prognostic performance can be improved by considering highest achieved SCAI shock stage as well as the evolution of CS compared to SCAI shock stage on admission.
背景：心源性休克（CS）的特点是死亡率高，需要准确的预后工具来预测预后和指导治疗。心血管造影和介入学会（SCAI）休克分级显示休克严重程度，可用于预后预测。目的：在此，我们比较了入院时和重症监护室（ICU）住院期间确定的 SCAI 休克分级的预后效果：我们根据 ICD 编码纳入了所有 CS 患者或与 CS 相关的患者。在入院时和入住重症监护病房的前 5 天确定 SCAI 休克分级。使用接收者操作曲线比较入院时的 SCAI 分期、入住 ICU 期间的 SCAI 分期和 CS 演变（无、缓解、持续和新发）对院内死亡率的预后影响：在2018年1月1日至2022年6月6日期间，共确定了1303名患者，纳入了862名患者。入院时，50.6%的患者处于SCAI休克A期，3.9%处于SCAI休克B期，17.7%处于SCAI休克C期，7.0%处于SCAI休克D期，20.8%处于SCAI休克E期。与入院时的SCAI分期（AUC 0.80; 95 % CI 0.77-0.83）相比，ICU期间达到的最高SCAI分期（AUC 0.86, 95 % CI 0.83-0.89, p < 0.0001）和休克演变（AUC 0.87, 95 % CI 0.85-0.90, p < 0.0001）具有更好的预后效果：结论：SCAI休克分期在ICU住院期间会发生动态变化，与入院时的SCAI休克分期相比，通过考虑达到的最高SCAI休克分期以及CS的演变情况可以改善预后效果。
{"title":"Prognostic performance of the SCAI shock classification at admission and during ICU treatment: A retrospective, observational cohort study","authors":"Simone Britsch , Markward Britsch , Leonie Hahn , Harald Langer , Simon Lindner , Ibrahim Akin , Thomas Helbing , Daniel Duerschmied , Tobias Becher","doi":"10.1016/j.hrtlng.2024.06.012","DOIUrl":"10.1016/j.hrtlng.2024.06.012","url":null,"abstract":"<div><h3>Background</h3><p>Cardiogenic shock (CS) is characterized by high mortality and requires accurate prognostic tools to predict outcomes and guide treatment. The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification indicates shock severity and can be used for outcome prediction.</p></div><div><h3>Objective</h3><p>Here, we compare the prognostic performance of SCAI shock classification determined on admission and during intensive care unit (ICU) stay.</p></div><div><h3>Methods</h3><p>We included all patients with CS or conditions associated with developing CS based on ICD codes. SCAI shock stages were determined on admission and during the first 5 days of ICU stay. Receiver operating curves were used to compare the prognostic performance of SCAI stages on admission, SCAI stages during ICU stay and CS evolution (absent, resolved, persistent and new onset) for in-hospital mortality.</p></div><div><h3>Results</h3><p>Between 01/2018 and 06/2022, 1303 patients were identified and 862 patients were included. On admission, 50.6 % patients had SCAI shock stage A, 3.9 % SCAI shock stage B, 17.7 % SCAI shock stage C, 7.0 % SCAI shock stage D and 20.8 % SCAI shock stage E. Shock stage distribution changed dynamically during ICU stay. Compared to SCAI stage on admission (AUC 0.80; 95 % CI 0.77–0.83), highest achieved SCAI stage during ICU (AUC 0.86, 95 % CI 0.83–0.89, <em>p</em> < 0.0001) and shock evolution (AUC 0.87, 95 % CI 0.85–0.90, <em>p</em> < 0.0001) yielded better prognostic performance.</p></div><div><h3>Conclusions</h3><p>SCAI shock stages changed dynamically during ICU stay, and prognostic performance can be improved by considering highest achieved SCAI shock stage as well as the evolution of CS compared to SCAI shock stage on admission.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 52-59"},"PeriodicalIF":2.4,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460828","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 : 2024-06-25DOI: 10.1016/j.hrtlng.2024.06.010
Anas Alsharawneh PhD, RN , Murad Sawalha PhD, RN , Nazih Abu Tabar PhD, RN , Rami A. Elshatarat PhD, RN , Abdulaziz Mofdy Almarwani PhD, RN , Zyad T. Saleh PhD, RN , Wesam T. Almagharbeh PhD, RN , Hekmat Y. Al-Akash PhD, RN , Nermen A. Mohamed PhD, RN , Mudathir M. Eltayeb PhD, RN
Background
Triage nurses' pivotal role in initial assessment makes their competence crucial. However, the specific impact on Acute Coronary Syndrome (ACS) recognition and outcomes remains unclear in Jordanian healthcare. Understanding this relationship could enhance ACS management and patient outcomes in Jordanian Emergency Departments (EDs).
Objective
To assess how triage nurses' recognition of ACS diagnosis affects patient outcomes in Jordan.
Methods
This retrospective study examined records of 150 ACS patients admitted to the coronary care unit (CCU). Data extraction assessed triage nurses' accuracy in recognizing ACS symptoms and the timelines for diagnosis procedures (e.g., electrocardiogram [ECG]) and treatment provision (e.g., thrombolytic) based on triage decisions. It also evaluated the impact on treatment outcomes, including length of stay in the ED and hospital. Multiple linear regression analyses quantified the influence of under-triage on treatment outcomes.
Results
The sample comprised 150 patients. Most were female (78.7%), aged 45-59.9 years (37.3%). ACS classifications: unstable angina (52.0%), STEMI (38.0%), NSTEMI (10.0%). The study included a cohort of ACS patients, with findings indicating varying degrees of under-triage by triage nurses. Analysis of timelines revealed significant delays in diagnosis and treatment initiation for patients subjected to under-triage. Multiple linear regression analyses demonstrated a robust association between under-triage and prolonged time to essential treatment outcomes, including delays in physician assessment, ECG performance, thrombolytic administration, and extended ED length of stay.
Conclusion
Triage nurses' knowledge and competency are crucial determinants of accurate ACS recognition and subsequent clinical outcomes for patients presenting to the ED in Jordan. Investing in ongoing education and training programs for triage nurses may lead to improved ACS recognition rates and better patient outcomes in Jordanian healthcare settings.
{"title":"Impact of triage nurses' recognition of acute coronary syndrome on patients' clinical outcomes: A retrospective study","authors":"Anas Alsharawneh PhD, RN , Murad Sawalha PhD, RN , Nazih Abu Tabar PhD, RN , Rami A. Elshatarat PhD, RN , Abdulaziz Mofdy Almarwani PhD, RN , Zyad T. Saleh PhD, RN , Wesam T. Almagharbeh PhD, RN , Hekmat Y. Al-Akash PhD, RN , Nermen A. Mohamed PhD, RN , Mudathir M. Eltayeb PhD, RN","doi":"10.1016/j.hrtlng.2024.06.010","DOIUrl":"10.1016/j.hrtlng.2024.06.010","url":null,"abstract":"<div><h3>Background</h3><p>Triage nurses' pivotal role in initial assessment makes their competence crucial. However, the specific impact on Acute Coronary Syndrome (ACS) recognition and outcomes remains unclear in Jordanian healthcare. Understanding this relationship could enhance ACS management and patient outcomes in Jordanian Emergency Departments (EDs).</p></div><div><h3>Objective</h3><p>To assess how triage nurses' recognition of ACS diagnosis affects patient outcomes in Jordan.</p></div><div><h3>Methods</h3><p>This retrospective study examined records of 150 ACS patients admitted to the coronary care unit (CCU). Data extraction assessed triage nurses' accuracy in recognizing ACS symptoms and the timelines for diagnosis procedures (e.g., electrocardiogram [ECG]) and treatment provision (e.g., thrombolytic) based on triage decisions. It also evaluated the impact on treatment outcomes, including length of stay in the ED and hospital. Multiple linear regression analyses quantified the influence of under-triage on treatment outcomes.</p></div><div><h3>Results</h3><p>The sample comprised 150 patients. Most were female (78.7%), aged 45-59.9 years (37.3%). ACS classifications: unstable angina (52.0%), STEMI (38.0%), NSTEMI (10.0%). The study included a cohort of ACS patients, with findings indicating varying degrees of under-triage by triage nurses. Analysis of timelines revealed significant delays in diagnosis and treatment initiation for patients subjected to under-triage. Multiple linear regression analyses demonstrated a robust association between under-triage and prolonged time to essential treatment outcomes, including delays in physician assessment, ECG performance, thrombolytic administration, and extended ED length of stay.</p></div><div><h3>Conclusion</h3><p>Triage nurses' knowledge and competency are crucial determinants of accurate ACS recognition and subsequent clinical outcomes for patients presenting to the ED in Jordan. Investing in ongoing education and training programs for triage nurses may lead to improved ACS recognition rates and better patient outcomes in Jordanian healthcare settings.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 60-67"},"PeriodicalIF":2.4,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460827","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}
The pathophysiology of Takotsubo syndrome (TTS) remains incompletely understood. While coronary microvascular dysfunction (CMD) is a potential pathophysiologic mechanism, evidence is limited.
Objectives
We sought to evaluate CMD in patients with TTS.
Methods
Consecutive patients diagnosed with TTS were included and underwent coronary angiography with invasive microvascular function evaluation, including fractional flow reserve, Coronary Flow Reserve (CFR), Index of Microcirculatory Resistance (IMR), and Resistive Reserve Ratio (RRR). Patients had an echocardiography evaluation during their index admission and at approximately 6 weeks.
Results
Thirty patients were included (mean age 74 ±9, 90 % female). Twenty-five patients (83 %) had at least one abnormal coronary microvascular function parameter. Abnormal parameters included CFR<2.5 in 20 patients (67 %), IMR>25 in 18 patients (60 %), and RRR<3.5 in 25 (83 %). Longer time from symptoms to angiography correlated with a higher CFR (r = 0.51, P<0.01), and had an area under the receiver operating characteristic curve of 0.793 (95 % CI 0.60-0.98) for pathologic CFR. Patients with emotional trigger had a lower rate of pathologic IMR compared with non-emotional trigger (36 % vs 81 %, p = 0.01). Follow up echocardiography performed at a median of 1.5 months (IQR 1.15-6) showed an improvement in left ventricular ejection fraction for all patients (from mean of 40 % to 57 %).
Conclusion
CMD was present in most patients with TTS. The role of microvascular function in TTS may vary according to the clinical presentation and RRR may be more sensitive for the diagnosis of CMD in TTS.
{"title":"Coronary microvascular dysfunction in patients with Takotsubo syndrome","authors":"Aviel Shetrit MD, Ophir Freund MD, Ariel Banai MD, Reut Amar Shamir MD, Ido Avivi MD, Lior Zornitzki MD, Jeremy Ben-Shoshan MD, Ph.D, Yishay Szekely MD, Yaron Arbel MD, Shmuel Bazan MD, Amir Halkin MD, Shmuel Banai MD, Maayan Konigstein MD, MBA","doi":"10.1016/j.hrtlng.2024.06.007","DOIUrl":"10.1016/j.hrtlng.2024.06.007","url":null,"abstract":"<div><h3>Background</h3><p>The pathophysiology of Takotsubo syndrome (TTS) remains incompletely understood. While coronary microvascular dysfunction (CMD) is a potential pathophysiologic mechanism, evidence is limited.</p></div><div><h3>Objectives</h3><p>We sought to evaluate CMD in patients with TTS.</p></div><div><h3>Methods</h3><p>Consecutive patients diagnosed with TTS were included and underwent coronary angiography with invasive microvascular function evaluation, including fractional flow reserve, Coronary Flow Reserve (CFR), Index of Microcirculatory Resistance (IMR), and Resistive Reserve Ratio (RRR). Patients had an echocardiography evaluation during their index admission and at approximately 6 weeks.</p></div><div><h3>Results</h3><p>Thirty patients were included (mean age 74 ±9, 90 % female). Twenty-five patients (83 %) had at least one abnormal coronary microvascular function parameter. Abnormal parameters included CFR<2.5 in 20 patients (67 %), IMR>25 in 18 patients (60 %), and RRR<3.5 in 25 (83 %). Longer time from symptoms to angiography correlated with a higher CFR (<em>r</em> = 0.51, P<0.01), and had an area under the receiver operating characteristic curve of 0.793 (95 % CI 0.60-0.98) for pathologic CFR. Patients with emotional trigger had a lower rate of pathologic IMR compared with non-emotional trigger (36 % vs 81 %, <em>p</em> = 0.01). Follow up echocardiography performed at a median of 1.5 months (IQR 1.15-6) showed an improvement in left ventricular ejection fraction for all patients (from mean of 40 % to 57 %).</p></div><div><h3>Conclusion</h3><p>CMD was present in most patients with TTS. The role of microvascular function in TTS may vary according to the clinical presentation and RRR may be more sensitive for the diagnosis of CMD in TTS.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 46-51"},"PeriodicalIF":2.4,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443784","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 : 2024-06-21DOI: 10.1016/j.hrtlng.2024.06.008
Yan Shen , Daishan Jiang , Xiaoyu Yuan , Youqin Xie , Bingbing Xie , Xiaoyang Cui , Sichao Gu , Qingyuan Zhan , Zhongwei Huang , Min Li
Background
Postoperative acute kidney injury (AKI) after lung transplantation (LTx) is an important factor affecting the short-term outcomes. The focus item of transplantation centers is how to improve the incidence of AKI through optimal management during the perioperative period.
Objective
The purpose of the study is to investigate the influence of perioperative volume in the development of early AKI following LTx.
Method
The study involved patients who had undergone LTx between October 2018 to December 2021 at China-Japan Friendship Hospital in Beijing. The patients were monitored for AKI occurring within 72 hours after LTx, as well as the renal outcomes within 30 days. The perioperative volumes were compared and analyzed to determine the impact on various clinical outcomes.
Results
248 patients were enrolled in the study ultimately, with almost half of them (49.6 %) experiencing AKI. 48.8 % of AKI patients received continuous renal replacement therapy (CRRT), with 57.7 % recovered by the end of the 30-day follow-up period. A J-shaped relationship was demonstrated between perioperative volume and AKI incidence. Moreover, maintaining a positive fluid balance would increase the 30-day mortality and lead to poor renal outcomes.
Conclusion
Perioperative volume is an independent risk factor of early AKI after LTx. Positive fluid balance increases the risk of AKI, 30-day mortality, and adverse renal prognosis. The LTx recipients may benefit from a relatively restrict fluid strategy during and after the lung transplantation.
背景肺移植（LTx）术后急性肾损伤（AKI）是影响短期疗效的重要因素。如何通过围手术期的优化管理来提高 AKI 的发生率是移植中心关注的焦点项目。研究旨在探讨围手术期容量对肺移植术后早期 AKI 发生的影响。对患者在LTx术后72小时内发生的AKI以及30天内的肾功能结果进行监测。对围手术期的容量进行了比较和分析，以确定其对各种临床结果的影响。结果 最终有248名患者参与了研究，其中近一半（49.6%）的患者出现了AKI。48.8% 的 AKI 患者接受了持续肾脏替代治疗 (CRRT)，其中 57.7% 的患者在 30 天随访期结束时痊愈。围手术期容量与 AKI 发生率之间呈 J 型关系。结论 围手术期容量是导致LTx术后早期AKI的独立风险因素。液体正平衡会增加发生 AKI、30 天死亡率和不良肾脏预后的风险。肺移植受者在肺移植期间和之后可能会从相对限制的液体策略中获益。
{"title":"Perioperative fluid balance and early acute kidney injury after lung transplantation","authors":"Yan Shen , Daishan Jiang , Xiaoyu Yuan , Youqin Xie , Bingbing Xie , Xiaoyang Cui , Sichao Gu , Qingyuan Zhan , Zhongwei Huang , Min Li","doi":"10.1016/j.hrtlng.2024.06.008","DOIUrl":"https://doi.org/10.1016/j.hrtlng.2024.06.008","url":null,"abstract":"<div><h3>Background</h3><p>Postoperative acute kidney injury (AKI) after lung transplantation (LTx) is an important factor affecting the short-term outcomes. The focus item of transplantation centers is how to improve the incidence of AKI through optimal management during the perioperative period.</p></div><div><h3>Objective</h3><p>The purpose of the study is to investigate the influence of perioperative volume in the development of early AKI following LTx.</p></div><div><h3>Method</h3><p>The study involved patients who had undergone LTx between October 2018 to December 2021 at China-Japan Friendship Hospital in Beijing. The patients were monitored for AKI occurring within 72 hours after LTx, as well as the renal outcomes within 30 days. The perioperative volumes were compared and analyzed to determine the impact on various clinical outcomes.</p></div><div><h3>Results</h3><p>248 patients were enrolled in the study ultimately, with almost half of them (49.6 %) experiencing AKI. 48.8 % of AKI patients received continuous renal replacement therapy (CRRT), with 57.7 % recovered by the end of the 30-day follow-up period. A J-shaped relationship was demonstrated between perioperative volume and AKI incidence. Moreover, maintaining a positive fluid balance would increase the 30-day mortality and lead to poor renal outcomes.</p></div><div><h3>Conclusion</h3><p>Perioperative volume is an independent risk factor of early AKI after LTx. Positive fluid balance increases the risk of AKI, 30-day mortality, and adverse renal prognosis. The LTx recipients may benefit from a relatively restrict fluid strategy during and after the lung transplantation.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 37-45"},"PeriodicalIF":2.4,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141439012","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 : 2024-06-19DOI: 10.1016/j.hrtlng.2024.05.013
Laura Tycon Moreines MSN, FNP-BC, ACHPN , Daniel David PhD RN , Komal Patel Murali PhD, RN, ACNP-BC , Victoria Vaughn Dickson PhD, RN, FAHA, FHFSA, FAAN , Abraham Brody FAAN PhD RN
Background
Aortic Stenosis (AS) is a common syndrome in older adults wherein the narrowing of the aortic valve impedes blood flow, resulting in advanced heart failure.1 AS is associated with a high mortality rate (50 % at 6 months if left untreated), substantial symptom burden, and reduced quality of life.1, 2, 3 Transcatheter aortic valve replacement (TAVR) was approved in 2012 as a less invasive alternative to surgical valve repair, offering a treatment for older frail patients. Although objective outcomes have been widely reported,4 the perspectives of older adults undergoing the TAVR process have never been synthesized.
Objectives
To contextualize the perspectives and experiences of older adults undergoing TAVR.
Methods
An integrative review was conducted using Whittemore and Knafl's five-stage methodology.5 Four electronic databases were searched in April 2023. Articles were included if a qualitative methodology was used to assess the perceptions of older adults (>65 years old) undergoing or recovering from TAVR.
Results
Out of 4619 articles screened, 12 articles met the criteria, representing 353 individuals from 10 countries. Relevant themes included the need for an individualized care plan, caregiver and family support, communication and education, persistent psychosocial and physical symptoms, and the unique recovery journey.
Conclusion
Older adults with AS undergoing TAVR generally perceive their procedure positively. Improved interdisciplinary and holistic management, open communication, symptom assessment, support, and education is needed.
{"title":"The perspectives of older adults related to transcatheter aortic valve replacement: An integrative review","authors":"Laura Tycon Moreines MSN, FNP-BC, ACHPN , Daniel David PhD RN , Komal Patel Murali PhD, RN, ACNP-BC , Victoria Vaughn Dickson PhD, RN, FAHA, FHFSA, FAAN , Abraham Brody FAAN PhD RN","doi":"10.1016/j.hrtlng.2024.05.013","DOIUrl":"https://doi.org/10.1016/j.hrtlng.2024.05.013","url":null,"abstract":"<div><h3>Background</h3><p>Aortic Stenosis (AS) is a common syndrome in older adults wherein the narrowing of the aortic valve impedes blood flow, resulting in advanced heart failure.<span><sup>1</sup></span> AS is associated with a high mortality rate (50 % at 6 months if left untreated), substantial symptom burden, and reduced quality of life.<span>1</span>, <span>2</span>, <span>3</span> Transcatheter aortic valve replacement (TAVR) was approved in 2012 as a less invasive alternative to surgical valve repair, offering a treatment for older frail patients. Although objective outcomes have been widely reported,<span><sup>4</sup></span> the perspectives of older adults undergoing the TAVR process have never been synthesized.</p></div><div><h3>Objectives</h3><p>To contextualize the perspectives and experiences of older adults undergoing TAVR.</p></div><div><h3>Methods</h3><p>An integrative review was conducted using Whittemore and Knafl's five-stage methodology.<span><sup>5</sup></span> Four electronic databases were searched in April 2023. Articles were included if a qualitative methodology was used to assess the perceptions of older adults (>65 years old) undergoing or recovering from TAVR.</p></div><div><h3>Results</h3><p>Out of 4619 articles screened, 12 articles met the criteria, representing 353 individuals from 10 countries. Relevant themes included the need for an individualized care plan, caregiver and family support, communication and education, persistent psychosocial and physical symptoms, and the unique recovery journey.</p></div><div><h3>Conclusion</h3><p>Older adults with AS undergoing TAVR generally perceive their procedure positively. Improved interdisciplinary and holistic management, open communication, symptom assessment, support, and education is needed.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 23-36"},"PeriodicalIF":2.8,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141429036","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 : 2024-06-13DOI: 10.1016/j.hrtlng.2024.06.002
Seog-Kyun Mun M.D., Ph.D. , Munyoung Chang M.D., Ph.D. , Beom Seuk Hwang Ph.D. , Seong Jun Hong B.S. , Sei Young Lee M.D., Ph.D. , Sung Joon Park M.D. , Hyun-Jin Lee M.D.
Background
Non-pharmaceutical interventions have been implemented globally to control the COVID-19 pandemic and have been shown to alleviate both allergies and respiratory infections. Although mask-wearing is an accepted non-pharmaceutical intervention, the effects of social distancing have not been thoroughly evaluated.
Objectives
To evaluate the effects of social distancing on asthma trends in Seoul, South Korea.
Methods
This study included data from the National Health Insurance Service of South Korea, covering approximately 10 million people in Seoul. Daily and monthly data of patients with asthma from 2018 to 2021 were examined, and the degree of social distancing performance was measured using the number of subway users as an index. Pearson's correlation coefficient was used to determine the relationship between the two indices. The change-point detection technique, cross-correlation, and Granger causality method were used to assess the temporal causality between social distancing and asthma.
Results
The number of patients with asthma decreased by 42.4 % from 2019 to 2020, while that of subway users decreased by 26.3 % during this period. Pearson's correlation analysis revealed significant positive correlations. Asthma and subway users showed a significant change in incidence following the implementation of social distancing; subway users showed a causal relationship with patients with asthma.
Conclusion
Our results showed that the number of subway users decreased after the implementation of strict social distancing, coinciding with a decrease in the number of patients with asthma. These findings suggest that social distancing measures implemented to control COVID-19 may reduce the incidence and exacerbation of asthma.
{"title":"Social distancing during the COVID-19 pandemic: Potential impact and correlation with asthma","authors":"Seog-Kyun Mun M.D., Ph.D. , Munyoung Chang M.D., Ph.D. , Beom Seuk Hwang Ph.D. , Seong Jun Hong B.S. , Sei Young Lee M.D., Ph.D. , Sung Joon Park M.D. , Hyun-Jin Lee M.D.","doi":"10.1016/j.hrtlng.2024.06.002","DOIUrl":"10.1016/j.hrtlng.2024.06.002","url":null,"abstract":"<div><h3>Background</h3><p>Non-pharmaceutical interventions have been implemented globally to control the COVID-19 pandemic and have been shown to alleviate both allergies and respiratory infections. Although mask-wearing is an accepted non-pharmaceutical intervention, the effects of social distancing have not been thoroughly evaluated.</p></div><div><h3>Objectives</h3><p>To evaluate the effects of social distancing on asthma trends in Seoul, South Korea.</p></div><div><h3>Methods</h3><p>This study included data from the National Health Insurance Service of South Korea, covering approximately 10 million people in Seoul. Daily and monthly data of patients with asthma from 2018 to 2021 were examined, and the degree of social distancing performance was measured using the number of subway users as an index. Pearson's correlation coefficient was used to determine the relationship between the two indices. The change-point detection technique, cross-correlation, and Granger causality method were used to assess the temporal causality between social distancing and asthma.</p></div><div><h3>Results</h3><p>The number of patients with asthma decreased by 42.4 % from 2019 to 2020, while that of subway users decreased by 26.3 % during this period. Pearson's correlation analysis revealed significant positive correlations. Asthma and subway users showed a significant change in incidence following the implementation of social distancing; subway users showed a causal relationship with patients with asthma.</p></div><div><h3>Conclusion</h3><p>Our results showed that the number of subway users decreased after the implementation of strict social distancing, coinciding with a decrease in the number of patients with asthma. These findings suggest that social distancing measures implemented to control COVID-19 may reduce the incidence and exacerbation of asthma.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 18-22"},"PeriodicalIF":2.8,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321965","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 : 2024-06-11DOI: 10.1016/j.hrtlng.2024.06.003
Xuannian Li , Bowen Zhou , Fei Xu , Huaman Liu , Xinhua Jia
Background
A key component of idiopathic pulmonary fibrosis (IPF) is the involvement of immune cells. However, the causal interaction between different immune cell signatures and IPF remain inconclusive.
Objectives
Based on publicly accessible data, our study utilized the Mendelian randomization (MR) approach to determine the causative relevance of complex immune cell phenotypes in IPF.
Methods
We deployed a two-sample Mendelian randomization approach to evaluate the causal interaction between immune cell markers and IPF. All data regarding 731 immune signatures and IPF were acquired from two genome-wide association studies (GWAS) that are accessible to the public. The original study adopted the inverse variance weighted (IVW) method, followed by sensitivity analyses aimed at eliminating heterogeneity and pleiotropy. Additionally, Multivariate Mendelian randomization (MVMR) was utilized to identify the independent risk factors in our study.
Results
The summary dataset for IPF was accessed from the Finnish Genetic Consortium R9, comprising 2018 patients and 373,064 controls. And the dataset for immune signatures was conducted in 3,757 Sardinian individuals. By conducting IVW and extensive sensitivity analyses, univariate Mendelian randomization (UVMR) identified one immunophenotype that remained causally associated with IPF after false discovery rate (FDR) correction: CD39 on CD39+ CD8+T cells (odd ratio [OR] = 0.850, 95 % confidence interval [CI] = 0.787–0.918, P = 3.68 × 10−5). The causal association with IPF was further validated using MVMR.
Conclusions
Based on rigorous MR analysis methods and FDR correction, our study demonstrated that CD39 on CD39+ CD8+T cells showed a protective effect against IPF, providing effective insights for preventing and diagnosing pulmonary fibrosis.
{"title":"Causal effect of immune cells on idiopathic pulmonary fibrosis: A mendelian randomization study","authors":"Xuannian Li , Bowen Zhou , Fei Xu , Huaman Liu , Xinhua Jia","doi":"10.1016/j.hrtlng.2024.06.003","DOIUrl":"https://doi.org/10.1016/j.hrtlng.2024.06.003","url":null,"abstract":"<div><h3>Background</h3><p>A key component of idiopathic pulmonary fibrosis (IPF) is the involvement of immune cells. However, the causal interaction between different immune cell signatures and IPF remain inconclusive.</p></div><div><h3>Objectives</h3><p>Based on publicly accessible data, our study utilized the Mendelian randomization (MR) approach to determine the causative relevance of complex immune cell phenotypes in IPF.</p></div><div><h3>Methods</h3><p>We deployed a two-sample Mendelian randomization approach to evaluate the causal interaction between immune cell markers and IPF. All data regarding 731 immune signatures and IPF were acquired from two genome-wide association studies (GWAS) that are accessible to the public. The original study adopted the inverse variance weighted (IVW) method, followed by sensitivity analyses aimed at eliminating heterogeneity and pleiotropy. Additionally, Multivariate Mendelian randomization (MVMR) was utilized to identify the independent risk factors in our study.</p></div><div><h3>Results</h3><p>The summary dataset for IPF was accessed from the Finnish Genetic Consortium R9, comprising 2018 patients and 373,064 controls. And the dataset for immune signatures was conducted in 3,757 Sardinian individuals. By conducting IVW and extensive sensitivity analyses, univariate Mendelian randomization (UVMR) identified one immunophenotype that remained causally associated with IPF after false discovery rate (FDR) correction: CD39 on CD39<sup>+</sup> CD8<sup>+</sup> <em>T</em> cells (odd ratio [OR] = 0.850, 95 % confidence interval [CI] = 0.787–0.918, P = 3.68 × 10<sup>−5</sup>). The causal association with IPF was further validated using MVMR.</p></div><div><h3>Conclusions</h3><p>Based on rigorous MR analysis methods and FDR correction, our study demonstrated that CD39 on CD39<sup>+</sup> CD8<sup>+</sup> <em>T</em> cells showed a protective effect against IPF, providing effective insights for preventing and diagnosing pulmonary fibrosis.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 9-17"},"PeriodicalIF":2.8,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307926","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 : 2024-06-10DOI: 10.1016/j.hrtlng.2024.05.012
Lin Li , Zhe Li , Li Li , Ying Wang , Haizhou Zhang
Background
Dynamic changes in the fQRS complex between the initial and follow-up ECG in patients with acute pulmonary embolism (APE) have rarely been studied.
Objective
The purpose of this study was to investigate the significance of dynamic changes in the fragmented QRS complex in APE patients.
Methods
APE patients (n = 222) were divided into three groups based on their ECG data to determine whether there were dynamic changes in the fQRS complex from admission to follow-up at one month: the fQRS shallower group (n = 49), fQRS deeper group (n = 25) and fQRS unchanged group (n = 148). Each patient was observed and followed for 12 months.
Results
Cox multivariate logistic regression analysis indicated that the dynamic deeper fQRS complex was an independent predictor of long-term mortality (HR: 5.563, 95 % CI: 1.079–28.678, P = 0.040) in patients with APE. Kaplan–Meier curve analysis revealed that the event-free survival of the fQRS shallower group significantly increased relative to that of the fQRS deeper group and that of the fQRS deeper group significantly decreased relative to that of the fQRS unchanged group and shallower group (P = 0.022, P = 0.041).
Conclusion
Compared with the deeper fQRS complex, the dynamic shallower fQRS complex was an indicator of a good prognosis in APE patients, while the dynamic deeper fQRS complex indicated a poor prognosis. Dynamical changes in fQRS may assist clinicians in risk stratification and individualized treatment for APE, as well as in predicting APE regression or progression.
背景：急性肺栓塞（APE）患者初始心电图和随访心电图之间fQRS复合体的动态变化很少被研究：本研究旨在探讨 APE 患者 QRS 波群片段动态变化的意义：根据心电图数据将APE患者（n = 222）分为三组，以确定从入院到随访一个月期间fQRS复合体是否发生动态变化：fQRS较浅组（n = 49）、fQRS较深组（n = 25）和fQRS不变组（n = 148）。每名患者均接受了 12 个月的观察和随访：Cox多变量逻辑回归分析表明，动态较深的fQRS复合体是APE患者长期死亡率的独立预测因子（HR：5.563，95 % CI：1.079-28.678，P = 0.040）。Kaplan-Meier曲线分析显示，fQRS较浅组的无事件生存率相对于fQRS较深组明显增加，而fQRS较深组的无事件生存率相对于fQRS不变组和较浅组明显降低（P = 0.022，P = 0.041）：结论：与较深的fQRS复合体相比，动态较浅的fQRS复合体是APE患者预后良好的指标，而动态较深的fQRS复合体则预示着预后不良。fQRS 的动态变化可能有助于临床医生对 APE 进行风险分层和个体化治疗，也有助于预测 APE 的消退或进展。
{"title":"Significance of dynamic changes in the fragmented QRS complex in acute pulmonary embolism","authors":"Lin Li , Zhe Li , Li Li , Ying Wang , Haizhou Zhang","doi":"10.1016/j.hrtlng.2024.05.012","DOIUrl":"10.1016/j.hrtlng.2024.05.012","url":null,"abstract":"<div><h3>Background</h3><p>Dynamic changes in the fQRS complex between the initial and follow-up ECG in patients with acute pulmonary embolism (APE) have rarely been studied.</p></div><div><h3>Objective</h3><p>The purpose of this study was to investigate the significance of dynamic changes in the fragmented QRS complex in APE patients.</p></div><div><h3>Methods</h3><p>APE patients (n = 222) were divided into three groups based on their ECG data to determine whether there were dynamic changes in the fQRS complex from admission to follow-up at one month: the fQRS shallower group (n = 49), fQRS deeper group (n = 25) and fQRS unchanged group (n = 148). Each patient was observed and followed for 12 months.</p></div><div><h3>Results</h3><p>Cox multivariate logistic regression analysis indicated that the dynamic deeper fQRS complex was an independent predictor of long-term mortality (HR: 5.563, 95 % CI: 1.079–28.678, <em>P</em> = 0.040) in patients with APE. Kaplan–Meier curve analysis revealed that the event-free survival of the fQRS shallower group significantly increased relative to that of the fQRS deeper group and that of the fQRS deeper group significantly decreased relative to that of the fQRS unchanged group and shallower group (P = 0.022, P = 0.041).</p></div><div><h3>Conclusion</h3><p>Compared with the deeper fQRS complex, the dynamic shallower fQRS complex was an indicator of a good prognosis in APE patients, while the dynamic deeper fQRS complex indicated a poor prognosis. Dynamical changes in fQRS may assist clinicians in risk stratification and individualized treatment for APE, as well as in predicting APE regression or progression.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 1-8"},"PeriodicalIF":2.8,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307468","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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