Pub Date : 2025-11-01Epub Date: 2025-08-10DOI: 10.1016/j.hrtlng.2025.08.002
Narat Srivali, Federica De Giacomi, Teng Moua, Jay H Ryu
Background: Patients with idiopathic pulmonary fibrosis (IPF) undergoing lung cancer surgery face a 4.4-20 % risk of acute exacerbation (AE-IPF) with mortality exceeding 50 %. The potential role of perioperative antifibrotic therapy in reducing surgical complications in this high-risk population remains unclear.
Objectives: To evaluate whether perioperative antifibrotic therapy (pirfenidone/nintedanib) reduces complications, particularly acute exacerbations and mortality, in IPF patients undergoing lung cancer surgery through systematic review and meta-analysis.
Methods: Following PRISMA guidelines, we conducted a systematic review and meta-analysis of observational studies examining perioperative antifibrotic therapy in IPF patients undergoing lung cancer surgery. Four studies comprising 261 patients (124 treated, 137 controls) from Japan and Italy (2016-2024) were analyzed. Pooled risk ratios were calculated using Review Manager 5.4. The study protocol was registered with PROSPERO (ID: CRD42025649005).
Results: Perioperative antifibrotic therapy achieved a 69 % reduction in AE-IPF risk (RR 0.31, 95 % CI 0.13-0.70) and an 81 % reduction in 90-day mortality (RR 0.19, 95 % CI 0.07-0.52). Additional benefits included significantly shorter hospital stays (5 vs 7 days, p = 0.029) and reduced complications, including decreased prolonged air leak rates (3.4 % vs 26.9 %). Adverse events were minimal, consisting primarily of mild nausea and photosensitivity.
Conclusions: Perioperative antifibrotic therapy significantly reduces acute exacerbations and mortality in IPF patients undergoing lung cancer surgery. However, findings are limited by small observational studies concentrated in specific geographic regions. Randomized controlled trials are needed to confirm efficacy and establish standardized treatment protocols.
背景：接受肺癌手术的特发性肺纤维化（IPF）患者面临4.4- 20%的急性加重（AE-IPF）风险，死亡率超过50%。围手术期抗纤维化治疗在减少这一高危人群手术并发症中的潜在作用尚不清楚。目的：通过系统回顾和荟萃分析，评估围手术期抗纤维化治疗（吡非尼酮/尼达尼布）是否能减少肺癌手术IPF患者的并发症，特别是急性加重和死亡率。方法：遵循PRISMA指南，我们对肺癌手术后IPF患者围手术期抗纤维化治疗的观察性研究进行了系统回顾和荟萃分析。分析了来自日本和意大利（2016-2024）的四项研究，包括261名患者（124名接受治疗，137名对照组）。使用Review Manager 5.4计算合并风险比。研究方案已在PROSPERO注册（ID: CRD42025649005）。结果：围手术期抗纤维化治疗使AE-IPF风险降低69% (RR 0.31, 95% CI 0.13-0.70)， 90天死亡率降低81% （RR 0.19, 95% CI 0.07-0.52）。其他益处包括显著缩短住院时间（5天vs 7天，p = 0.029）和减少并发症，包括减少延长的漏气率（3.4% vs 26.9%）。不良事件最小，主要包括轻度恶心和光敏。结论：围手术期抗纤维化治疗可显著降低肺癌手术IPF患者的急性加重和死亡率。然而，研究结果受到集中在特定地理区域的小型观察性研究的限制。需要随机对照试验来确认疗效并建立标准化的治疗方案。
{"title":"Perioperative antifibrotic therapy for patients with idiopathic pulmonary fibrosis undergoing lung cancer surgery: A systematic review and meta-analysis.","authors":"Narat Srivali, Federica De Giacomi, Teng Moua, Jay H Ryu","doi":"10.1016/j.hrtlng.2025.08.002","DOIUrl":"10.1016/j.hrtlng.2025.08.002","url":null,"abstract":"<p><strong>Background: </strong>Patients with idiopathic pulmonary fibrosis (IPF) undergoing lung cancer surgery face a 4.4-20 % risk of acute exacerbation (AE-IPF) with mortality exceeding 50 %. The potential role of perioperative antifibrotic therapy in reducing surgical complications in this high-risk population remains unclear.</p><p><strong>Objectives: </strong>To evaluate whether perioperative antifibrotic therapy (pirfenidone/nintedanib) reduces complications, particularly acute exacerbations and mortality, in IPF patients undergoing lung cancer surgery through systematic review and meta-analysis.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we conducted a systematic review and meta-analysis of observational studies examining perioperative antifibrotic therapy in IPF patients undergoing lung cancer surgery. Four studies comprising 261 patients (124 treated, 137 controls) from Japan and Italy (2016-2024) were analyzed. Pooled risk ratios were calculated using Review Manager 5.4. The study protocol was registered with PROSPERO (ID: CRD42025649005).</p><p><strong>Results: </strong>Perioperative antifibrotic therapy achieved a 69 % reduction in AE-IPF risk (RR 0.31, 95 % CI 0.13-0.70) and an 81 % reduction in 90-day mortality (RR 0.19, 95 % CI 0.07-0.52). Additional benefits included significantly shorter hospital stays (5 vs 7 days, p = 0.029) and reduced complications, including decreased prolonged air leak rates (3.4 % vs 26.9 %). Adverse events were minimal, consisting primarily of mild nausea and photosensitivity.</p><p><strong>Conclusions: </strong>Perioperative antifibrotic therapy significantly reduces acute exacerbations and mortality in IPF patients undergoing lung cancer surgery. However, findings are limited by small observational studies concentrated in specific geographic regions. Randomized controlled trials are needed to confirm efficacy and establish standardized treatment protocols.</p>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"74 ","pages":"266-275"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823268","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 : 2025-10-31DOI: 10.1016/j.hrtlng.2025.10.023
Aubree Bussa-Carlson , Timothy Joseph Sowicz
Background
Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease marked by progressive lung scarring of unknown cause. Diagnosis is complex, with an average delay of 2.1 years. While reasons for this delay are documented, less is known about the patient’s lived experience during the diagnostic process.
Objective
This qualitative descriptive study aimed to explore how individuals with IPF describe their diagnostic journey.
Methods
Individual interviews were conducted with people living with IPF. Transcripts were analyzed using qualitative content analysis, identifying meaning units, condensing them, and developing codes. Codes were defined in a codebook and organized into subcategories, which were then grouped into categories to develop a unifying theme.
Results
The sample included 11 individuals with IPF. Analysis generated 119 codes, organized into four categories: 1) Symptom recognition; 2) Explanation of diagnosis from providers; 3) Recognizing and reacting to ignorance about diagnosis; and 4) Deciding to disclose or not. These categories supported a central theme: being diagnosed with IPF is a nuanced, extended, and multifaceted experience. The process begins with symptom recognition and continues through obtaining diagnostic clarity, often requiring self-advocacy and persistence. This journey marks the transition into life with IPF. Diagnosis should thus be understood not as a discrete event, but as a dynamic, ongoing process.
Conclusion
Findings suggest that receiving an IPF diagnosis is not a singular event, but a dynamic and evolving journey, highlighting the need for greater awareness of the patient experience during diagnosis.
{"title":"A journey without a map: Qualitative insights into the diagnosis of idiopathic pulmonary fibrosis","authors":"Aubree Bussa-Carlson , Timothy Joseph Sowicz","doi":"10.1016/j.hrtlng.2025.10.023","DOIUrl":"10.1016/j.hrtlng.2025.10.023","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease marked by progressive lung scarring of unknown cause. Diagnosis is complex, with an average delay of 2.1 years. While reasons for this delay are documented, less is known about the patient’s lived experience during the diagnostic process.</div></div><div><h3>Objective</h3><div>This qualitative descriptive study aimed to explore how individuals with IPF describe their diagnostic journey.</div></div><div><h3>Methods</h3><div>Individual interviews were conducted with people living with IPF. Transcripts were analyzed using qualitative content analysis, identifying meaning units, condensing them, and developing codes. Codes were defined in a codebook and organized into subcategories, which were then grouped into categories to develop a unifying theme.</div></div><div><h3>Results</h3><div>The sample included 11 individuals with IPF. Analysis generated 119 codes, organized into four categories: 1) Symptom recognition; 2) Explanation of diagnosis from providers; 3) Recognizing and reacting to ignorance about diagnosis; and 4) Deciding to disclose or not. These categories supported a central theme: being diagnosed with IPF is a nuanced, extended, and multifaceted experience. The process begins with symptom recognition and continues through obtaining diagnostic clarity, often requiring self-advocacy and persistence. This journey marks the transition into life with IPF. Diagnosis should thus be understood not as a discrete event, but as a dynamic, ongoing process.</div></div><div><h3>Conclusion</h3><div>Findings suggest that receiving an IPF diagnosis is not a singular event, but a dynamic and evolving journey, highlighting the need for greater awareness of the patient experience during diagnosis.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 347-351"},"PeriodicalIF":2.6,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416334","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 : 2025-10-30DOI: 10.1016/j.hrtlng.2025.10.009
Ahmed Emara MD , Mohamed Emara MD , Mohamed A. Aldemerdash MD , Lina Hemmeda , Ahmed Farid Gadelmawla MD , Alhassan Saber MD , Mohamed Ellebedy , Magdi Zordok MD , Kevin M. Harris MD , Vinayak N. Bapat MD , Erik Beckmann MD , Emmanouil S. Brilakis MD PHD , Michael Megaly MD MS
Background
Aortic root abscess (ARA) is a severe and life-threatening complication of infective endocarditis (IE), often requiring urgent surgical intervention. However, data on surgical outcomes and predictors of mortality in this population are limited.
Objectives
We conducted a systematic review and meta-analysis to evaluate postoperative outcomes and identify predictors of in-hospital mortality in patients with IE complicated by ARA.
Methods
A comprehensive search of PubMed, Web of Science, Scopus, and Embase was performed through February 2025 for studies comparing surgical outcomes in patients with IE with versus without ARA. Risk ratios (RR) were used for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95 % confidence intervals (CI).
Results
Eight observational studies comprising 2266 patients (637 with ARA, 1629 without ARA) were included. ARA was significantly associated with higher in-hospital mortality (15.7 % vs. 12.8 %; RR 1.65, 95 % CI 1.28–2.13, P = 0.0001), late mortality (21.4 % vs. 20.2 %; RR 1.44, 95 % CI 1.16–1.79, P = 0.001), and IE recurrence (10.6 % vs. 4.8 %; RR 2.15, 95 % CI 1.29–3.59, P = 0.003). No significant difference in heart failure incidence was found (RR 1.02, 95 % CI 0.86–1.21, P = 0.82). Renal failure (OR 3.22, 95 % CI 1.37–7.60) and Staphylococcus aureus infection (OR 3.30, 95 % CI 1.50–7.26) were independently associated with higher in-hospital mortality.
Conclusions
ARA in patients undergoing surgery for IE is associated with worse outcomes, including higher in-hospital and late mortality and greater IE recurrence. Renal failure and S. aureus infection are significant mortality predictors.
主动脉根脓肿（ARA）是感染性心内膜炎（IE）的一种严重且危及生命的并发症，通常需要紧急手术干预。然而，这一人群的手术结果和死亡率预测因素的数据是有限的。目的：我们进行了一项系统回顾和荟萃分析，以评估IE合并ARA患者的术后结局和确定住院死亡率的预测因素。方法综合检索PubMed、Web of Science、Scopus和Embase，检索到2025年2月，比较有ARA和没有ARA的IE患者手术结果的研究。风险比（RR）用于二分类结局，平均差异（MD）用于连续结局，均为95%置信区间（CI）。结果共纳入8项观察性研究，共2266例患者（637例ARA， 1629例非ARA）。ARA与较高的住院死亡率（15.7%比12.8%;RR 1.65, 95% CI 1.28-2.13, P = 0.0001）、晚期死亡率（21.4%比20.2%;RR 1.44, 95% CI 1.16-1.79, P = 0.001）和IE复发率（10.6%比4.8%;RR 2.15, 95% CI 1.29-3.59, P = 0.003）显著相关。两组心力衰竭发生率无显著差异（RR 1.02, 95% CI 0.86 ~ 1.21, P = 0.82）。肾功能衰竭（OR 3.22, 95% CI 1.37-7.60）和金黄色葡萄球菌感染（OR 3.30, 95% CI 1.50-7.26）与较高的住院死亡率独立相关。结论IE手术患者的sara与较差的预后相关，包括较高的住院死亡率和晚期死亡率以及较高的IE复发率。肾衰竭和金黄色葡萄球菌感染是重要的死亡率预测因子。
{"title":"Impact of aortic root abscess on outcomes in infective endocarditis and predictors of in-hospital mortality: A meta-analysis","authors":"Ahmed Emara MD , Mohamed Emara MD , Mohamed A. Aldemerdash MD , Lina Hemmeda , Ahmed Farid Gadelmawla MD , Alhassan Saber MD , Mohamed Ellebedy , Magdi Zordok MD , Kevin M. Harris MD , Vinayak N. Bapat MD , Erik Beckmann MD , Emmanouil S. Brilakis MD PHD , Michael Megaly MD MS","doi":"10.1016/j.hrtlng.2025.10.009","DOIUrl":"10.1016/j.hrtlng.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Aortic root abscess (ARA) is a severe and life-threatening complication of infective endocarditis (IE), often requiring urgent surgical intervention. However, data on surgical outcomes and predictors of mortality in this population are limited.</div></div><div><h3>Objectives</h3><div>We conducted a systematic review and meta-analysis to evaluate postoperative outcomes and identify predictors of in-hospital mortality in patients with IE complicated by ARA.</div></div><div><h3>Methods</h3><div>A comprehensive search of PubMed, Web of Science, Scopus, and Embase was performed through February 2025 for studies comparing surgical outcomes in patients with IE with versus without ARA. Risk ratios (RR) were used for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>Eight observational studies comprising 2266 patients (637 with ARA, 1629 without ARA) were included. ARA was significantly associated with higher in-hospital mortality (15.7 % vs. 12.8 %; RR 1.65, 95 % CI 1.28–2.13, P = 0.0001), late mortality (21.4 % vs. 20.2 %; RR 1.44, 95 % CI 1.16–1.79, P = 0.001), and IE recurrence (10.6 % vs. 4.8 %; RR 2.15, 95 % CI 1.29–3.59, P = 0.003). No significant difference in heart failure incidence was found (RR 1.02, 95 % CI 0.86–1.21, P = 0.82). Renal failure (OR 3.22, 95 % CI 1.37–7.60) and <em>Staphylococcus aureus</em> infection (OR 3.30, 95 % CI 1.50–7.26) were independently associated with higher in-hospital mortality.</div></div><div><h3>Conclusions</h3><div>ARA in patients undergoing surgery for IE is associated with worse outcomes, including higher in-hospital and late mortality and greater IE recurrence. Renal failure and <em>S. aureus</em> infection are significant mortality predictors.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 337-346"},"PeriodicalIF":2.6,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416336","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 : 2025-10-30DOI: 10.1016/j.hrtlng.2025.10.016
Alessandro Belletti , Vladimir Boboshko , Enrica Piazza , Martina Carmela Crusi , Luisa Zaraca , Krisztina Tóth , Özgün Ömer Asiller , Giovanni Landoni , Fabrizio Monaco , Alberto Zangrillo , Vladimir Lomivorotov , ICARUS Study Group Collaborators
Background
Intravenous calcium is frequently administered in cardiac surgery patients to improve hemodynamics.
Objectives
To assess safety and efficacy of intravenous calcium administration in this population.
Methods
We conducted a systematic review (with meta-analysis of hemodynamic data) and searched PubMed and Scopus up to March 15th, 2025. All studies investigating intravenous calcium administration in patients undergoing cardiac surgery were considered. Animal studies and studies investigating oral calcium administration were excluded. We abstracted data on study design, sample size, setting, calcium formulation, dose and timing of administration. Primary outcome was all-cause mortality. Secondary outcomes included rate of myocardial ischemia, postoperative release of cardiac necrosis biomarkers, adverse events, and hemodynamic data. Only data from randomized controlled trials (RCTs) were included in the quantitative analysis.
Results
Twenty-two studies were selected (nine RCTs, eight pediatric studies, ten including a control group), with a total sample size of 1278 patients (809 receiving calcium). The most common formulation was calcium chloride. Most studies followed up patients for <60 min. Only one non-RCT study with a control group reported mortality data (4/66 [6.1 %] calcium group vs 8/69 [11.6 %] control group). Intravenous calcium transiently increases mean arterial pressure (MAP) and reduces heart rate, with effects fading within 10-20 min. Calcium administration may blunt hemodynamic response to catecholamines
Conclusions
There is no data on the effects of intravenous calcium on major clinical outcomes in patients undergoing cardiac surgery. Calcium may transiently improve MAP and reduce heart rate. Large RCTs are needed to assess the effects of calcium on clinically relevant endpoints. Review Registration: International Prospective Register of Systematic Reviews (PROSPERO), n. CRD420250282624
{"title":"Clinical and hemodynamic effect of intravenous calcium administration in cardiac surgery: A systematic review","authors":"Alessandro Belletti , Vladimir Boboshko , Enrica Piazza , Martina Carmela Crusi , Luisa Zaraca , Krisztina Tóth , Özgün Ömer Asiller , Giovanni Landoni , Fabrizio Monaco , Alberto Zangrillo , Vladimir Lomivorotov , ICARUS Study Group Collaborators","doi":"10.1016/j.hrtlng.2025.10.016","DOIUrl":"10.1016/j.hrtlng.2025.10.016","url":null,"abstract":"<div><h3>Background</h3><div>Intravenous calcium is frequently administered in cardiac surgery patients to improve hemodynamics.</div></div><div><h3>Objectives</h3><div>To assess safety and efficacy of intravenous calcium administration in this population.</div></div><div><h3>Methods</h3><div>We conducted a systematic review (with meta-analysis of hemodynamic data) and searched PubMed and Scopus up to March 15th, 2025. All studies investigating intravenous calcium administration in patients undergoing cardiac surgery were considered. Animal studies and studies investigating oral calcium administration were excluded. We abstracted data on study design, sample size, setting, calcium formulation, dose and timing of administration. Primary outcome was all-cause mortality. Secondary outcomes included rate of myocardial ischemia, postoperative release of cardiac necrosis biomarkers, adverse events, and hemodynamic data. Only data from randomized controlled trials (RCTs) were included in the quantitative analysis.</div></div><div><h3>Results</h3><div>Twenty-two studies were selected (nine RCTs, eight pediatric studies, ten including a control group), with a total sample size of 1278 patients (809 receiving calcium). The most common formulation was calcium chloride. Most studies followed up patients for <60 min. Only one non-RCT study with a control group reported mortality data (4/66 [6.1 %] calcium group vs 8/69 [11.6 %] control group). Intravenous calcium transiently increases mean arterial pressure (MAP) and reduces heart rate, with effects fading within 10-20 min. Calcium administration may blunt hemodynamic response to catecholamines</div></div><div><h3>Conclusions</h3><div>There is no data on the effects of intravenous calcium on major clinical outcomes in patients undergoing cardiac surgery. Calcium may transiently improve MAP and reduce heart rate. Large RCTs are needed to assess the effects of calcium on clinically relevant endpoints. Review Registration: International Prospective Register of Systematic Reviews (PROSPERO), n. CRD420250282624</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 329-336"},"PeriodicalIF":2.6,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416335","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 : 2025-10-29DOI: 10.1016/j.hrtlng.2025.10.024
Lauren East , Joanna Joly , Preston Nicely , Laura Kukuc , Marie Wilson , Margaret Blood , Elizabeth Baker , Lucia Juarez , Jose Tallaj , William Holman , Nicole Lohr , Yolanda Hall , Stephen Clarkson
Background
As longevity with left ventricular assist devices (LVAD) and their potential to improve health-related quality of life (HRQOL) increase, it is important to examine factors that may limit HRQOL in patients receiving LVADs.
Objectives
This study explores the relationship between adverse social determinants of heath (SDOH) and HRQOL post-LVAD, contextualizing individual and community-level characteristics associated with HRQOL outcomes.
Methods
This was a retrospective cohort study utilizing EHR based chart review. All HM3 LVAD recipients at an academic center in the Southeast United States were included. HRQOL was estimated by EuroQol-5D visual analog scale (VAS) and Kansas City Cardiomyopathy Questionnaire-12 (KCCQ) score. Impact of adverse SDOH on HRQOL and self-reported satisfaction with LVAD was evaluated using linear mixed models at 6 months, 1 year, 1.5 years, and 2 years.
Results
A total of 111 patients with HM3 LVAD (mean age 50, SD 13) were included. VAS and KCCQ scores significantly increased compared to pre-implant. Community-level characteristics showed no relationship with VAS or KCCQ score, but education attainment was associated with higher absolute KCCQ scores at 2 years post LVAD (college- n = 11, mean 62.9, SD 20.3; no college- n = 11, mean 39.2, SD 21.5; p-value 0.018). Satisfaction results demonstrated that those with more education had higher satisfaction (chi square= 8, p = 0.018).
Conclusions
In this Southern cohort, adverse community SDOH factors are not associated with HRQOL following LVAD, and post-LVAD, HRQOL improves. These data support the beneficial nature of this therapy for all. Education attainment, a potential surrogate for health literacy, may be a source for future intervention.
背景：随着左心室辅助装置（LVAD）的使用寿命及其改善健康相关生活质量（HRQOL）的潜力的增加，检查可能限制左心室辅助装置患者HRQOL的因素是很重要的。目的：本研究探讨了lvad后健康不良社会决定因素（SDOH）与HRQOL之间的关系，以及与HRQOL结果相关的个人和社区水平特征。方法：这是一项基于电子病历的回顾性队列研究。美国东南部一个学术中心的所有HM3 LVAD受者均被纳入研究。HRQOL采用EuroQol-5D视觉模拟量表（VAS）和Kansas City Cardiomyopathy Questionnaire-12 （KCCQ）评分进行评估。使用线性混合模型在6个月、1年、1.5年和2年评估不良SDOH对HRQOL和LVAD自我报告满意度的影响。结果：共纳入111例HM3 LVAD患者（平均年龄50岁，SD 13）。与植入前相比，VAS和KCCQ评分明显升高。社区水平特征与VAS或KCCQ评分没有关系，但教育程度与LVAD后2年较高的KCCQ绝对评分相关（大学- n = 11，平均62.9,SD 20.3；非大学- n = 11，平均39.2,SD 21.5； p值0.018）。满意度结果显示，受教育程度越高，满意度越高（卡方= 8,p = 0.018）。结论：在这个南方队列中，不良社区SDOH因素与LVAD后的HRQOL无关，LVAD后HRQOL有所改善。这些数据支持这种疗法对所有人都有益。教育程度作为健康素养的潜在替代指标，可能是未来干预的一个来源。
{"title":"Impact of adverse social determinants on quality of life and satisfaction after left ventricular assist device: A Southern single-center pilot experience","authors":"Lauren East , Joanna Joly , Preston Nicely , Laura Kukuc , Marie Wilson , Margaret Blood , Elizabeth Baker , Lucia Juarez , Jose Tallaj , William Holman , Nicole Lohr , Yolanda Hall , Stephen Clarkson","doi":"10.1016/j.hrtlng.2025.10.024","DOIUrl":"10.1016/j.hrtlng.2025.10.024","url":null,"abstract":"<div><h3>Background</h3><div>As longevity with left ventricular assist devices (LVAD) and their potential to improve health-related quality of life (HRQOL) increase, it is important to examine factors that may limit HRQOL in patients receiving LVADs.</div></div><div><h3>Objectives</h3><div>This study explores the relationship between adverse social determinants of heath (SDOH) and HRQOL post-LVAD, contextualizing individual and community-level characteristics associated with HRQOL outcomes.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study utilizing EHR based chart review. All HM3 LVAD recipients at an academic center in the Southeast United States were included. HRQOL was estimated by EuroQol-5D visual analog scale (VAS) and Kansas City Cardiomyopathy Questionnaire-12 (KCCQ) score. Impact of adverse SDOH on HRQOL and self-reported satisfaction with LVAD was evaluated using linear mixed models at 6 months, 1 year, 1.5 years, and 2 years.</div></div><div><h3>Results</h3><div>A total of 111 patients with HM3 LVAD (mean age 50, SD 13) were included. VAS and KCCQ scores significantly increased compared to pre-implant. Community-level characteristics showed no relationship with VAS or KCCQ score, but education attainment was associated with higher absolute KCCQ scores at 2 years post LVAD (college- <em>n</em> = 11, mean 62.9, SD 20.3; no college- <em>n</em> = 11, mean 39.2, SD 21.5; p-value 0.018). Satisfaction results demonstrated that those with more education had higher satisfaction (chi square= 8, <em>p</em> = 0.018).</div></div><div><h3>Conclusions</h3><div>In this Southern cohort, adverse community SDOH factors are not associated with HRQOL following LVAD, and post-LVAD, HRQOL improves. These data support the beneficial nature of this therapy for all. Education attainment, a potential surrogate for health literacy, may be a source for future intervention.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 321-328"},"PeriodicalIF":2.6,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410884","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}
Early identification of noninvasive ventilation (NIV) failure is essential to prevent clinical deterioration and guide timely escalation of care in acute and critical care settings.
Objectives
This study aimed to evaluate the diagnostic accuracy of right diaphragm excursion measured by point-of-care ultrasound (POCUS) in predicting NIV failure and to identify associated predictors.
Methods
We conducted a prospective diagnostic accuracy study in the emergency department of a tertiary care hospital between January and October 2024. Adult patients (≥18 years) with acute respiratory failure requiring NIV were included. Exclusion criteria included neuromuscular disease, hemodynamic instability, cardiac or respiratory arrest, or drug-induced respiratory depression. Prior to NIV initiation, right diaphragm excursion was assessed via M-mode POCUS in the subcostal view by five trained emergency medicine residents. NIV failure was defined as the need for intubation due to clinical deterioration or intolerance.
Results
Among 77 patients, 21 (27.3 %) experienced NIV failure. Diaphragm excursion <1.4 cm predicted NIV failure with an area under the curve (AUC) of 0.86 (95 % CI: 0.76–0.93), sensitivity 85.7 %, specificity 85.7 %, positive predictive value 66.7 %, negative predictive value 94.0 %, and accuracy 84.4 %. Right diaphragm excursion <1.4 cm was independently associated with NIV failure (OR: 42.12; 95 % CI: 6.79–261.12), along with older age (OR: 1.15; 95 % CI: 1.04–1.27) and lower base excess (OR: 0.85; 95 % CI: 0.74–0.98).
Conclusion
Diaphragm excursion showed high diagnostic accuracy and independently predicted NIV failure. Its integration into early assessment in acute care may support informed decisions and improve outcomes.
{"title":"Diaphragm excursion as a predictor of noninvasive ventilation failure in the emergency department: A prospective study","authors":"Yunus Emre Sagmal , Merve Eksioglu , Burcu Azapoglu Kaymak , Tuba Cimilli Ozturk","doi":"10.1016/j.hrtlng.2025.10.021","DOIUrl":"10.1016/j.hrtlng.2025.10.021","url":null,"abstract":"<div><h3>Background</h3><div>Early identification of noninvasive ventilation (NIV) failure is essential to prevent clinical deterioration and guide timely escalation of care in acute and critical care settings.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate the diagnostic accuracy of right diaphragm excursion measured by point-of-care ultrasound (POCUS) in predicting NIV failure and to identify associated predictors.</div></div><div><h3>Methods</h3><div>We conducted a prospective diagnostic accuracy study in the emergency department of a tertiary care hospital between January and October 2024. Adult patients (≥18 years) with acute respiratory failure requiring NIV were included. Exclusion criteria included neuromuscular disease, hemodynamic instability, cardiac or respiratory arrest, or drug-induced respiratory depression. Prior to NIV initiation, right diaphragm excursion was assessed via M-mode POCUS in the subcostal view by five trained emergency medicine residents. NIV failure was defined as the need for intubation due to clinical deterioration or intolerance.</div></div><div><h3>Results</h3><div>Among 77 patients, 21 (27.3 %) experienced NIV failure. Diaphragm excursion <1.4 cm predicted NIV failure with an area under the curve (AUC) of 0.86 (95 % CI: 0.76–0.93), sensitivity 85.7 %, specificity 85.7 %, positive predictive value 66.7 %, negative predictive value 94.0 %, and accuracy 84.4 %. Right diaphragm excursion <1.4 cm was independently associated with NIV failure (OR: 42.12; 95 % CI: 6.79–261.12), along with older age (OR: 1.15; 95 % CI: 1.04–1.27) and lower base excess (OR: 0.85; 95 % CI: 0.74–0.98).</div></div><div><h3>Conclusion</h3><div>Diaphragm excursion showed high diagnostic accuracy and independently predicted NIV failure. Its integration into early assessment in acute care may support informed decisions and improve outcomes.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 313-320"},"PeriodicalIF":2.6,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410899","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 left ventricular assist device (LVAD), an invaluable technology that saves and prolongs lives, is associated with a variety of stressors for both device recipients and their caregivers. Particularly, given the demand for caregiving post-LVAD implantation, it appears that caregivers can experience overwhelming stress, which affects their quality of life as well as recipients’ outcomes. Although recipients and caregivers experience some similar stressors related to LVAD, important differences may exist between the two groups.
Objectives
Using the LVAD Stress Questionnaire (LVADSQ), the current study aimed to examine what aspects of LVAD caregivers and recipients perceive as most stressful and how LVAD caregivers’ and recipients’ level of stress differs.
Methods
This study involved 71 LVAD recipients who were an average of 24.29 months (SD = 22.91) post-LVAD implantation and 50 caregivers of these recipients. Mann-Whitney U tests were conducted to examine differences in ratings of 18 LVAD-related stressors between the LVAD caregivers and recipients.
Results
The results indicated that LVAD caregivers and recipients rated LVAD-related stressors significantly differently. Caregivers rated alarms, LVAD-related pain or discomfort, fear of device failure, and fear of stroke to be significantly more stressful than LVAD recipients. LVAD recipients rated showering with an LVAD and LVAD-related interference with pleasurable activities to be significantly more stressful than caregivers.
Conclusion
LVAD recipients and caregivers experience a myriad of stressors post-LVAD placement and the aspects they perceive as stressful differ. Awareness of these differing appraisals is important to maximize teaching and to provide targeted support to caregivers and recipients.
{"title":"The left ventricular assist device experience: Recipient and caregiver perception of stress differs","authors":"Katy Martin-Fernandez Ph.D. , Yasmine M. Eshera M.S. , Qingqing Yin Ph.D. , Aurelie Merlo M.D. , Eileen Burker Ph.D., CRC","doi":"10.1016/j.hrtlng.2025.10.020","DOIUrl":"10.1016/j.hrtlng.2025.10.020","url":null,"abstract":"<div><h3>Background</h3><div>The left ventricular assist device (LVAD), an invaluable technology that saves and prolongs lives, is associated with a variety of stressors for both device recipients and their caregivers. Particularly, given the demand for caregiving post-LVAD implantation, it appears that caregivers can experience overwhelming stress, which affects their quality of life as well as recipients’ outcomes. Although recipients and caregivers experience some similar stressors related to LVAD, important differences may exist between the two groups.</div></div><div><h3>Objectives</h3><div>Using the LVAD Stress Questionnaire (LVADSQ), the current study aimed to examine what aspects of LVAD caregivers and recipients perceive as most stressful and how LVAD caregivers’ and recipients’ level of stress differs.</div></div><div><h3>Methods</h3><div>This study involved 71 LVAD recipients who were an average of 24.29 months (SD = 22.91) post-LVAD implantation and 50 caregivers of these recipients. Mann-Whitney U tests were conducted to examine differences in ratings of 18 LVAD-related stressors between the LVAD caregivers and recipients.</div></div><div><h3>Results</h3><div>The results indicated that LVAD caregivers and recipients rated LVAD-related stressors significantly differently. Caregivers rated alarms, LVAD-related pain or discomfort, fear of device failure, and fear of stroke to be significantly more stressful than LVAD recipients. LVAD recipients rated showering with an LVAD and LVAD-related interference with pleasurable activities to be significantly more stressful than caregivers.</div></div><div><h3>Conclusion</h3><div>LVAD recipients and caregivers experience a myriad of stressors post-LVAD placement and the aspects they perceive as stressful differ. Awareness of these differing appraisals is important to maximize teaching and to provide targeted support to caregivers and recipients.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 299-303"},"PeriodicalIF":2.6,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395194","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 : 2025-10-27DOI: 10.1016/j.hrtlng.2025.10.010
Feng Tian , Shiqi Chen , Xiaoyan Lan , Rong xiang Zhang , Chen yang Zhu , Yuan Chen
Background
Self-care is critical for patients with heart failure (HF) to reduce rehospitalization, improve survival, and enhance quality of life. However, adherence to self-care during recovery is often suboptimal and influenced by multiple determinants.
Objectives
To systematically identify the determinants of self-care behaviors in patients with HF and provide evidence to inform the development of tailored intervention strategies.
Methods
Five databases (PubMed, Web of Science, Cochrane Library, Embase, and CINAHL) were searched from inception to April 2025. Eligible studies were synthesized and analyzed using a convergent integrated approach.
Results
A total of 56 studies were included (34 quantitative, 19 qualitative, and 3 mixed-methods). Five major categories of determinants were identified: (1) sociodemographic factors, (2) health-related factors, (3) psychological and social factors, (4) personal health perceptions and decision-making in sociocultural context and (5) economic and knowledge-related factors.
Conclusions
Self-care behaviors among patients with HF are shaped by a complex interplay of multidimensional factors. The findings highlight the necessity for multifaceted, context-sensitive interventions that account for individual psychosocial profiles, cultural contexts, and resource accessibility to enhance self-management and adherence.
背景：自我护理对心力衰竭（HF）患者减少再住院、提高生存率和提高生活质量至关重要。然而，在康复期间坚持自我护理往往是次优的，并受到多种因素的影响。目的：系统地确定心衰患者自我保健行为的决定因素，并为制定针对性的干预策略提供证据。方法：检索5个数据库（PubMed、Web of Science、Cochrane Library、Embase和CINAHL），检索时间为建库至2025年4月。采用收敛综合方法对符合条件的研究进行综合和分析。结果：共纳入56项研究（定量方法34项，定性方法19项，混合方法3项）。确定了五大类决定因素：(1)社会人口因素；(2)健康相关因素；(3)心理和社会因素；(4)社会文化背景下的个人健康观念和决策；(5)经济和知识相关因素。结论：心衰患者的自我保健行为受多方面因素的复杂相互作用。研究结果强调，有必要采取多方面的、对环境敏感的干预措施，考虑到个人的社会心理状况、文化背景和资源可及性，以加强自我管理和依从性。
{"title":"Factors influencing self-care behaviours in patients with heart failure: A mixed-methods systematic review","authors":"Feng Tian , Shiqi Chen , Xiaoyan Lan , Rong xiang Zhang , Chen yang Zhu , Yuan Chen","doi":"10.1016/j.hrtlng.2025.10.010","DOIUrl":"10.1016/j.hrtlng.2025.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Self-care is critical for patients with heart failure (HF) to reduce rehospitalization, improve survival, and enhance quality of life. However, adherence to self-care during recovery is often suboptimal and influenced by multiple determinants.</div></div><div><h3>Objectives</h3><div>To systematically identify the determinants of self-care behaviors in patients with HF and provide evidence to inform the development of tailored intervention strategies.</div></div><div><h3>Methods</h3><div>Five databases (PubMed, Web of Science, Cochrane Library, Embase, and CINAHL) were searched from inception to April 2025. Eligible studies were synthesized and analyzed using a convergent integrated approach.</div></div><div><h3>Results</h3><div>A total of 56 studies were included (34 quantitative, 19 qualitative, and 3 mixed-methods). Five major categories of determinants were identified: (1) sociodemographic factors, (2) health-related factors, (3) psychological and social factors, (4) personal health perceptions and decision-making in sociocultural context and (5) economic and knowledge-related factors.</div></div><div><h3>Conclusions</h3><div>Self-care behaviors among patients with HF are shaped by a complex interplay of multidimensional factors. The findings highlight the necessity for multifaceted, context-sensitive interventions that account for individual psychosocial profiles, cultural contexts, and resource accessibility to enhance self-management and adherence.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 304-312"},"PeriodicalIF":2.6,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395120","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 : 2025-10-26DOI: 10.1016/j.hrtlng.2025.10.015
Miguel A. Samaniego-Laguna , Andrea Tripoli , Norma N. Gamarra-Valverde , Shivraj Selvam , Alejandro Barbagelata , Robert Mentz , Juliana Giorgi
Background
Cardiac myosin activators (CMAs) have been explored as a potential therapy to enhance cardiac contractility in patients with heart failure with reduced ejection fraction (HFrEF). However, their effect on clinical outcomes, including mortality, cardiovascular (CV) events, and heart failure (HF) symptoms, remains unclear.
Objectives
This study aimed to evaluate the efficacy and safety of CMAs compared to placebo in patients with HFrEF through a systematic review and meta-analysis of randomized controlled trials.
Methods and results
A systematic search of PubMed, Cochrane, Embase, and Scopus identified randomized controlled trials comparing CMAs to placebo in HFrEF patients. Meta-analyses were performed using a random-effects model, including 10,019 patients from nine trials, with 5204 receiving CMAs. CMAs had no significant effect on CV death (risk ratio [RR]: 1.01; 95 % confidence interval [CI]: 0.92–1.10; p = 0.85), HF events (RR: 0.95; 95 % CI: 0.89–1.02; p = 0.15), or all-cause mortality (RR: 1.00; 95 % CI: 0.93–1.07; p = 0.95). However, CMAs significantly reduced the composite outcome of CV death, HF hospitalization, and urgent outpatient visits for HF (hazard ratio [HR]: 0.92; 95 % CI: 0.90–0.93; p < 0.00001) and lowered stroke risk compared to placebo (p = 0.006).
Conclusion
CMAs, particularly omecamtiv mecarbil, did not significantly impact all-cause mortality, cardiovascular death, or HF recurrence in patients with HFrEF. However, modest reductions were observed in composite outcomes and stroke. These findings should be interpreted cautiously, and further trials are needed to validate their clinical role.
背景：心肌肌球蛋白激活剂（CMAs）作为增强心力衰竭伴射血分数降低（HFrEF）患者心脏收缩力的潜在疗法已被探索。然而，它们对临床结果的影响，包括死亡率、心血管（CV）事件和心力衰竭（HF）症状仍不清楚。目的：本研究旨在通过随机对照试验的系统回顾和荟萃分析，评估CMAs与安慰剂相比在HFrEF患者中的疗效和安全性。方法和结果：对PubMed、Cochrane、Embase和Scopus进行系统检索，确定了比较cma和安慰剂在HFrEF患者中的随机对照试验。采用随机效应模型进行meta分析，包括来自9项试验的10019例患者，其中5204例接受cma治疗。cma对CV死亡（风险比[RR]: 1.01； 95%可信区间[CI]: 0.92-1.10; p = 0.85）、HF事件（RR: 0.95; 95% CI: 0.89-1.02; p = 0.15）或全因死亡率（RR: 1.00; 95% CI: 0.93-1.07; p = 0.95）无显著影响。然而，与安慰剂相比，CMAs显著降低了CV死亡、HF住院和HF紧急门诊就诊的综合结局（风险比[HR]: 0.92; 95% CI: 0.90-0.93; p < 0.00001），并降低了卒中风险（p = 0.006）。结论：cma，特别是欧米康替，对HFrEF患者的全因死亡率、心血管死亡或HF复发没有显著影响。然而，在综合结果和卒中中观察到适度的降低。这些发现应谨慎解释，并需要进一步的试验来验证其临床作用。
{"title":"Efficacy of cardiac myosin activators compared to placebo in patients with heart failure and reduced ejection fraction: A systematic review and meta-analysis of randomized controlled trials","authors":"Miguel A. Samaniego-Laguna , Andrea Tripoli , Norma N. Gamarra-Valverde , Shivraj Selvam , Alejandro Barbagelata , Robert Mentz , Juliana Giorgi","doi":"10.1016/j.hrtlng.2025.10.015","DOIUrl":"10.1016/j.hrtlng.2025.10.015","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac myosin activators (CMAs) have been explored as a potential therapy to enhance cardiac contractility in patients with heart failure with reduced ejection fraction (HFrEF). However, their effect on clinical outcomes, including mortality, cardiovascular (CV) events, and heart failure (HF) symptoms, remains unclear.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate the efficacy and safety of CMAs compared to placebo in patients with HFrEF through a systematic review and meta-analysis of randomized controlled trials.</div></div><div><h3>Methods and results</h3><div>A systematic search of PubMed, Cochrane, Embase, and Scopus identified randomized controlled trials comparing CMAs to placebo in HFrEF patients. Meta-analyses were performed using a random-effects model, including 10,019 patients from nine trials, with 5204 receiving CMAs. CMAs had no significant effect on CV death (risk ratio [RR]: 1.01; 95 % confidence interval [CI]: 0.92–1.10; <em>p</em> = 0.85), HF events (RR: 0.95; 95 % CI: 0.89–1.02; <em>p</em> = 0.15), or all-cause mortality (RR: 1.00; 95 % CI: 0.93–1.07; <em>p</em> = 0.95). However, CMAs significantly reduced the composite outcome of CV death, HF hospitalization, and urgent outpatient visits for HF (hazard ratio [HR]: 0.92; 95 % CI: 0.90–0.93; <em>p</em> < 0.00001) and lowered stroke risk compared to placebo (<em>p</em> = 0.006).</div></div><div><h3>Conclusion</h3><div>CMAs, particularly omecamtiv mecarbil, did not significantly impact all-cause mortality, cardiovascular death, or HF recurrence in patients with HFrEF. However, modest reductions were observed in composite outcomes and stroke. These findings should be interpreted cautiously, and further trials are needed to validate their clinical role.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 290-298"},"PeriodicalIF":2.6,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379890","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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