American heart journal plus : cardiology research and practice最新文献_第4页

Medication optimization clinic decreases hospitalizations and mortality for patients with heart failure with reduced ejection fraction 优化用药诊所降低了射血分数降低型心力衰竭患者的住院率和死亡率

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-16 DOI: 10.1016/j.ahjo.2024.100470

James C. Coons , Jennifer Kliner , Michael A. Mathier , Suresh Mulukutla , Floyd Thoma , Ahmet Sezer , Mary Keebler

Study objective

To evaluate the impact of a medication optimization clinic (MOC) on GDMT and outcomes for patients with HFrEF versus usual care.

Design

Retrospective evaluation of a multi-site MOC was conducted.

Setting

Large health system with academic and community hospitals.

Participants

Patients with HFrEF referred to MOC by their cardiologist versus usual care.

Interventions

GDMT use managed by an advanced practice provider or clinical pharmacist through weekly telemedicine visits.

Main outcome measures

The primary outcome was HF hospitalization. Cardiovascular hospitalization and all-cause mortality were also assessed. Kaplan−Meier Curve, Cumulative Incidence Function, and competing risk analysis with regression models were conducted.

Results

1419 patients in MOC group were compared to 5116 control patients. GDMT use was significantly higher in MOC: quadruple therapy (49 % vs. 19 %; p < 0.0001), angiotensin-receptor neprilysin inhibitor (62 % vs. 45 %; p < 0.0001), beta blocker (92 % vs. 88 %; p < 0.0001), mineralocorticoid receptor antagonist (69 % vs. 45 %; p < 0.0001), and sodium glucose cotransporter-2 inhibitor (68 % vs. 35 %; p < 0.0001). Competing risk analyses showed that HF and CV hospitalizations were significantly lower at all times points (3, 6, and 12 months) for MOC vs. control (p < 0.001). All-cause mortality was significantly lower at 6 months (p = 0.006) and 12 months (p < 0.001), but did not differ at 3 months (p = 0.35), for MOC vs. control.

Conclusions

MOC was associated with improved GDMT and lower risks of hospitalizations due to HF and any cardiovascular cause, and all-cause mortality in patients with HFrEF.

研究目的评估药物优化门诊（MOC）与常规护理对高频低氧血症（HFrEF）患者GDMT和预后的影响.设计对一个多站点MOC进行了回顾性评估.设置由学术医院和社区医院组成的大型医疗系统.参与者由心脏病专家转诊至MOC的高频低氧血症（HFrEF）患者与常规护理.干预由高级医疗服务提供者或临床药剂师通过每周的远程医疗访问管理GDMT的使用.主要结果测量主要结果是高频住院。还评估了心血管疾病住院率和全因死亡率。结果1419名MOC组患者与5116名对照组患者进行了比较。在 MOC 组中，GDMT 的使用率明显更高：四联疗法（49 % vs. 19 %；p <；0.0001）、血管紧张素受体肾素抑制剂（62 % vs. 45 %；p <；0.0001）、β-受体阻滞剂（92 % vs. 88 %；p <；0.0001）。88%；p <；0.0001）、矿物质皮质激素受体拮抗剂（69% 对 45%；p <；0.0001）和钠葡萄糖共转运体-2 抑制剂（68% 对 35%；p <；0.0001）。竞争风险分析表明，在所有时间点（3、6 和 12 个月），MOC 与对照组相比，心房颤动和冠心病住院率均显著降低（p <0.001）。MOC与对照组相比，全因死亡率在6个月（p = 0.006）和12个月（p < 0.001）时明显降低，但在3个月（p = 0.35）时并无差异。

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引用次数: 0

The impact of door to extracorporeal cardiopulmonary resuscitation time on mortality and neurological outcomes among out-of-hospital cardiac arrest acute myocardial infarction patients treated by primary percutaneous coronary intervention 院外心脏骤停急性心肌梗死患者接受初诊经皮冠状动脉介入治疗后，体外心肺复苏门时间对死亡率和神经系统预后的影响

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-14 DOI: 10.1016/j.ahjo.2024.100473

Taro Takeuchi , Yasunori Ueda , Shumpei Kosugi , Kuniyasu Ikeoka , Haruya Yamane , Takuya Ohashi , Takashi Iehara , Kazuho Ukai , Kazuki Oozato , Satoshi Oosaki , Masayuki Nakamura , Tatsuhisa Ozaki , Tsuyoshi Mishima , Haruhiko Abe , Koichi Inoue , Yasushi Matsumura

Background

Few previous studies evaluated the impact of time from the hospital arrival to the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) (door to ECPR time) on outcomes among out-of-hospital cardiac arrest (OHCA) acute myocardial infarction (MI) patients.

Methods

50 patients with OHCA who received both ECPR and percutaneous coronary intervention (PCI) at Cardiovascular Division, NHO Osaka National Hospital were analyzed. Patients were divided into 2 groups according to the median of door to ECPR time. The primary outcome was all-cause death. Survival analyses were conducted to compare all-cause mortality at 90 days between 2 groups. Neurological outcome at 30 days was also compared between 2 groups using the Cerebral Performance Category (CPC).

Results

The multivariable Cox proportional-hazards model showed that all-cause mortality at 90 days was significantly higher among patients with door to ECPR time ≥ 25 min compared with those with door to ECPR time < 25 min (adjusted hazard ratio [HR]: 3.14; 95 % confidence interval [CI]: 1.21–8.18). The proportion of patients with CPC at 30 days ≤ 2 was significantly higher among patients with shorter door to ECPR time (P = 0.048).

Conclusion

Among patients with OHCA due to acute MI who received ECPR and PCI, the shorter door to ECPR time was associated with the lower mortality and favorable neurological outcomes.

背景以前很少有研究评估从到达医院到实施体外心肺复苏（ECPR）的时间（从入院到实施 ECPR 的时间）对院外心脏骤停（OHCA）急性心肌梗死（MI）患者预后的影响。方法分析了 50 名在 NHO 大阪国立医院心血管科接受 ECPR 和经皮冠状动脉介入治疗（PCI）的 OHCA 患者。根据从入院到 ECPR 时间的中位数将患者分为两组。主要结果为全因死亡。对两组患者 90 天的全因死亡率进行了生存分析比较。结果多变量 Cox 比例危险模型显示，与门到 ECPR 时间 < 25 分钟的患者相比，门到 ECPR 时间≥ 25 分钟的患者在 90 天内的全因死亡率明显更高（调整后危险比 [HR]：3.14；95 % 置信区间 [CI]：1.21-8.18）。结论在急性心肌梗死导致的 OHCA 患者中，接受 ECPR 和 PCI 的患者中，门到 ECPR 时间越短，死亡率越低，神经系统预后越好。

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引用次数: 0

The interplay of climate change and physical activity: Implications for cardiovascular health 气候变化与体育锻炼的相互作用：对心血管健康的影响

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-14 DOI: 10.1016/j.ahjo.2024.100474

Eloise J. Thompson , Sarah E. Alexander , Kegan Moneghetti, Erin J. Howden

Cardiovascular disease (CVD) is one of the top contributors to global disease burden. Meeting the physical activity guidelines can effectively control and prevent several CVD risk factors, including obesity, hypertension and diabetes mellitus. The effects of climate change are multifactorial and have direct impacts on cardiovascular health. Increasing ambient temperatures, worsening air and water quality and urbanisation and loss of greenspace will also have indirect effects of cardiovascular health by impacting the ability and opportunity to participate in physical activity. A changing climate also has implications for large scale sporting events and policies regarding risk mitigation during exercise in hot climates. This review will discuss the impact of a changing climate on cardiovascular health and physical activity and the implications for the future of organised sport.

心血管疾病（CVD）是造成全球疾病负担的首要因素之一。符合体育锻炼指南可以有效控制和预防多种心血管疾病风险因素，包括肥胖、高血压和糖尿病。气候变化的影响是多因素的，对心血管健康有直接影响。环境温度的升高、空气和水质的恶化以及城市化和绿地的减少也会影响人们参加体育活动的能力和机会，从而对心血管健康产生间接影响。不断变化的气候也会对大型体育赛事以及在炎热气候条件下降低运动风险的政策产生影响。本综述将讨论不断变化的气候对心血管健康和体育活动的影响，以及对未来有组织体育运动的影响。

引用次数: 0

Subsequent pregnancies in peripartum cardiomyopathy: Patient-level differences and decision-making 围产期心肌病患者的后续妊娠：患者层面的差异和决策

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-11 DOI: 10.1016/j.ahjo.2024.100472

Olga Corazón Irizarry , Jennifer Lewey , Camille McCallister , Nathanael C. Koelper , Zoltan Arany , Lisa D. Levine

Study objective

To evaluate patient-level differences and decision making surrounding subsequent pregnancies (SSP) after peripartum cardiomyopathy (PPCM).

Design

Mixed methods approach to evaluate quantitative demographic and clinical differences between patients with and without a SSP and to qualitatively describe the decision-making regarding a SSP with a survey component.

Setting/participants

220 PPCM cases within the University of Pennsylvania Health System.

Main outcome measures

Demographic, clinical and obstetrical outcomes.

Results

73 patients (33 %) had a SSP, 37 with a live birth. Those with a SSP were more likely to self-identify as Black (70 % vs. 52 %; p = 0.04), be nulliparous in index pregnancy (68 % vs. 45 %, p = 0.02), were younger at diagnosis (24.3 vs. 30.5 years; p < 0.01), and a higher left ventricular ejection fraction (LVEF) at diagnosis (35 % vs. 27.5 %; p = 0.03) compared to patients without a SSP. There was no difference in recovery rates of LVEF (62 % vs. 50 %, p = 0.17), or need for LVAD, transplant, or death. 22 patients completed the survey (representing 44 SSPs): 41 % of SSPs (n = 18) resulted in termination, 18 % (n = 8) in a first/s trimester loss, and 41 % (n = 18) in a live-born delivery. All patients who elected termination indicated risk of recurrence/worsening heart failure to be a motivating factor.

Conclusions

Less than 20 % of patients in this single-center, multi-racial cohort had a SSP and delivery after PPCM with fear of recurrence as a large driver in this decision. Patients with a SSP were younger with a higher EF at diagnosis but ultimately had similar cardiac outcomes as patients without a SSP.

研究目的评估围产期心肌病 (PPCM) 患者层面的差异以及围绕后续妊娠 (SSP) 的决策。设计采用混合方法评估有 SSP 和无 SSP 患者之间的人口统计学和临床差异，并通过调查对 SSP 的决策进行定性描述。与无 SSP 的患者相比，有 SSP 的患者更有可能自我认同为黑人（70% 对 52%；p = 0.04），在指数妊娠中为空腹（68% 对 45%，p = 0.02），诊断时更年轻（24.3 岁对 30.5 岁；p <0.01），诊断时左心室射血分数（LVEF）更高（35% 对 27.5%；p = 0.03）。在 LVEF 恢复率（62% 对 50%，p = 0.17）、LVAD 需求、移植或死亡方面没有差异。22 名患者完成了调查（代表 44 个 SSP）：41%的 SSP（n = 18）导致终止妊娠，18%（n = 8）导致前/后三个月流产，41%（n = 18）导致活产。所有选择终止妊娠的患者均表示，复发/心衰恶化的风险是促使其终止妊娠的一个因素。结论在这个单中心、多种族的队列中，不到 20% 的患者在 PPCM 后进行了 SSP 和分娩，害怕复发是促使其做出这一决定的主要原因。有 SSP 的患者更年轻，诊断时 EF 值更高，但最终的心脏预后与没有 SSP 的患者相似。

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引用次数: 0

The role of cholesterol crystals and ocular crystal emboli in retinal pathology 胆固醇晶体和眼晶体栓塞在视网膜病理学中的作用

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-11 DOI: 10.1016/j.ahjo.2024.100475

Nicholas G. Medawar , Tim F. Dorweiler , George S. Abela , Julia V. Busik , Maria B. Grant

Cholesterol crystals (CC) can be responsible for a range of clinical syndromes in the retina from asymptomatic plaques to retinal artery occlusion with clinical trials providing evidence for the efficacy in lipid lowering therapies in preventing ocular pathology. Much of the literature has focused on CC in retinal circulation as a marker of poor systemic health and have attempted to use them to categorize risk of mortality and stroke. More recently cholesterol accumulation and CC formation have been linked to development of diabetic retinopathy with CC formation in the retina due to aberrant retinal cholesterol homeostasis and not simply systemic dyslipidemia.

胆固醇结晶（CC）可导致视网膜出现从无症状斑块到视网膜动脉闭塞等一系列临床综合症，临床试验提供了降脂疗法在预防眼部病变方面疗效的证据。许多文献都将视网膜循环中的 CC 作为全身健康状况不良的标志，并试图将其用于死亡和中风风险的分类。最近，胆固醇积累和 CC 的形成与糖尿病视网膜病变的发展有关，视网膜中 CC 的形成是由于视网膜胆固醇平衡失调，而不仅仅是全身性血脂异常。

引用次数: 0

Traditional and non-traditional cardiovascular risk factor profiles in young patients with coronary artery disease 年轻冠心病患者的传统和非传统心血管风险因素概况

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-11 DOI: 10.1016/j.ahjo.2024.100471

Anish Adhikari , Sasha DeJesus , Nyein Swe , Georgeta Vaidean , Rachel Nahrwold , John Joshua , Monique Carrero-Tagle , Caleb Wutawanashe , Roland Hentz , Martin Lesser , Eugenia Gianos

Study objective

There is an increasing trend in myocardial infarction (MI) hospitalizations in young individuals. The prevalence of modifiable cardiovascular risk factors is high in this population. This study aims to assess the prevalence of traditional and non-traditional cardiovascular risk factors among young patients with coronary artery disease (CAD) including novel lipid and dietary biomarkers with a focus on potential gender differences.

Design

The Young Heart study is a prospective, single-center pilot cohort study. Baseline data included medical history, medications, and lifestyle factors. We also collected blood samples for lipid profile, lipoprotein (a), high-sensitivity C-reactive protein (hsCRP), and trimethylamine N-oxide (TMAO).

Participants

A total of 60 patients aged <60 years with CAD (on coronary CT or invasive angiogram) were included in the study.

Results

The median age was 51 years and predominantly male (70 %). Baseline assessment revealed a high prevalence of hypertension (76.7 %), hyperlipidemia (91.7 %), and obstructive CAD (88.3 %). 36.7 % had diabetes, 28.3 % had prediabetes, and 38.3 % had prior MI. Uncontrolled risk factors were prevalent, including increased waist circumference (54.6 %), metabolic syndrome (60.0 %), and LDL ≥70 mg/dL (47.5 %), Lp(a) ≥75 nmol/L (47.5 %). Furthermore, 41.7 % had hsCRP ≥2 mg/L, and 28.3 % had suboptimal TMAO levels. 70.0 % of patients were on guideline-directed doses of statins.

Conclusion

Young patients with CAD demonstrated a substantial burden of traditional and non-traditional cardiovascular risk factors. The study findings highlight the need for targeted interventions to improve risk factor control and optimize lifestyle behaviors. Further investigation is warranted to assess the impact of these interventions on cardiovascular outcomes.

研究目的年轻人心肌梗死（MI）住院率呈上升趋势。在这一人群中，可改变的心血管风险因素的患病率很高。本研究旨在评估冠状动脉疾病（CAD）年轻患者中传统和非传统心血管风险因素的患病率，包括新型血脂和饮食生物标志物，重点关注潜在的性别差异。基线数据包括病史、药物和生活方式因素。我们还收集了血样，用于检测血脂谱、脂蛋白（a）、高敏 C 反应蛋白（hsCRP）和三甲胺 N-氧化物（TMAO）。结果中位年龄为 51 岁，男性占绝大多数（70%）。基线评估显示，高血压（76.7%）、高脂血症（91.7%）和阻塞性 CAD（88.3%）的发病率较高。36.7%的人患有糖尿病，28.3%的人患有糖尿病前期，38.3%的人曾有过心肌梗死。未得到控制的风险因素普遍存在，包括腰围增大（54.6%）、代谢综合征（60.0%）、低密度脂蛋白≥70 毫克/分升（47.5%）、脂蛋白（a）≥75 毫摩尔/升（47.5%）。此外，41.7% 的患者 hsCRP ≥2 mg/L，28.3% 的患者 TMAO 水平不达标。70.0%的患者服用了指导剂量的他汀类药物。研究结果表明，有必要采取有针对性的干预措施，以改善风险因素控制和优化生活方式。有必要进一步调查评估这些干预措施对心血管预后的影响。

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引用次数: 0

Impact of atrial fibrillation on pulmonary embolism hospitalization: Nationwide analysis 心房颤动对肺栓塞住院治疗的影响：全国分析

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-01 DOI: 10.1016/j.ahjo.2024.100465

Mubarak Hassan Yusuf , Akanimo Anita , Olayiwola Akeem Bolaji , Faridat Moyosore Abdulkarim , Chibuike Daniel Onyejesi , Maryam Yusuf , Utku Ekin , Arham Syed Hazari , Mourad Ismail

Introduction

Atrial fibrillation (AF) is the most common type of arrythmia affecting approximately 1–2 % of the adult population. Patients with an underlying history of atrial fibrillation have a greater chance of developing venous thromboembolism (VTE). Likewise, patients with VTE are at increased risk for AF. There has been conflicting evidence on the prognostic impact of AF in acute pulmonary embolism (PE) patients. The aim of this retrospective cohort study was to estimate the impact of AF on the clinical outcomes of hospitalization for PE.

Method

The 2016–2021 National Inpatient Sample database was searched for adult patients hospitalized with PE with associated history of AF as the principal discharge diagnosis. The primary outcome was inpatient mortality, while the secondary outcomes were length of stay (LOS), total hospital charge (THC), cardiogenic shock, acute respiratory failure, in-hospital cardiac arrest (IHCA). The outcomes were analyzed using multivariable logistic and linear regression analyses.

Results

A total of 1,128,269 patients were admitted for PE, 12.4 % of whom had underlying AF. The AF and non-AF cohorts had a mean age of 73.6 years and 61.6 years, respectively. PE patient with AF had significantly higher mortality compared to non-AF patients with PE (6.05 % vs 2.75 %, adjusted odds ratio of 1.67 [95 % CI 1.56–1.79; p < 0.0001]). The PE with AF cohort had increased odds of cardiac arrest, cardiogenic shock, respiratory failure requiring intubation, higher average length of stay (5.66 days vs 4.18 days, P < 0.001) and a higher total hospital cost (65,235 vs 50,118, P < 0.001).

Conclusion

AF was associated with increased inpatient mortality and worse clinical outcomes in hospitalization for acute PE.

导言心房颤动（房颤）是最常见的心律失常类型，约占成年人口的 1-2%。有心房颤动潜在病史的患者患静脉血栓栓塞症（VTE）的几率更大。同样，患有 VTE 的患者发生房颤的风险也会增加。关于急性肺栓塞（PE）患者心房颤动对预后的影响，目前还存在相互矛盾的证据。这项回顾性队列研究旨在估算房颤对 PE 住院临床预后的影响。方法在 2016-2021 年全国住院患者抽样数据库中搜索了因 PE 住院且主要出院诊断为房颤的成年患者。主要结果为住院患者死亡率，次要结果为住院时间（LOS）、住院总费用（THC）、心源性休克、急性呼吸衰竭、院内心脏骤停（IHCA）。结果共有 1,128,269 名 PE 患者入院，其中 12.4% 有潜在房颤。心房颤动和非心房颤动患者的平均年龄分别为 73.6 岁和 61.6 岁。有房颤的 PE 患者死亡率明显高于无房颤的 PE 患者（6.05% vs 2.75%，调整后的几率比为 1.67 [95 % CI 1.56-1.79; p < 0.0001]）。有房颤的 PE 患者发生心脏骤停、心源性休克、需要插管的呼吸衰竭的几率增加，平均住院时间延长（5.66 天 vs 4.18 天，P < 0.001），住院总费用增加（65,235 vs 50,118，P < 0.001）。

{"title":"Impact of atrial fibrillation on pulmonary embolism hospitalization: Nationwide analysis","authors":"Mubarak Hassan Yusuf , Akanimo Anita , Olayiwola Akeem Bolaji , Faridat Moyosore Abdulkarim , Chibuike Daniel Onyejesi , Maryam Yusuf , Utku Ekin , Arham Syed Hazari , Mourad Ismail","doi":"10.1016/j.ahjo.2024.100465","DOIUrl":"10.1016/j.ahjo.2024.100465","url":null,"abstract":"<div><h3>Introduction</h3><div>Atrial fibrillation (AF) is the most common type of arrythmia affecting approximately 1–2 % of the adult population. Patients with an underlying history of atrial fibrillation have a greater chance of developing venous thromboembolism (VTE). Likewise, patients with VTE are at increased risk for AF. There has been conflicting evidence on the prognostic impact of AF in acute pulmonary embolism (PE) patients. The aim of this retrospective cohort study was to estimate the impact of AF on the clinical outcomes of hospitalization for PE.</div></div><div><h3>Method</h3><div>The 2016–2021 National Inpatient Sample database was searched for adult patients hospitalized with PE with associated history of AF as the principal discharge diagnosis. The primary outcome was inpatient mortality, while the secondary outcomes were length of stay (LOS), total hospital charge (THC), cardiogenic shock, acute respiratory failure, in-hospital cardiac arrest (IHCA). The outcomes were analyzed using multivariable logistic and linear regression analyses.</div></div><div><h3>Results</h3><div>A total of 1,128,269 patients were admitted for PE, 12.4 % of whom had underlying AF. The AF and non-AF cohorts had a mean age of 73.6 years and 61.6 years, respectively. PE patient with AF had significantly higher mortality compared to non-AF patients with PE (6.05 % vs 2.75 %, adjusted odds ratio of 1.67 [95 % CI 1.56–1.79; <em>p</em> < 0.0001]). The PE with AF cohort had increased odds of cardiac arrest, cardiogenic shock, respiratory failure requiring intubation, higher average length of stay (5.66 days vs 4.18 days, <em>P</em> < 0.001) and a higher total hospital cost (65,235 vs 50,118, P < 0.001).</div></div><div><h3>Conclusion</h3><div>AF was associated with increased inpatient mortality and worse clinical outcomes in hospitalization for acute PE.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"46 ","pages":"Article 100465"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Trends and outcomes of different mechanical circulatory support modalities for acute myocardial infarction associated cardiogenic shock in patients undergoing early revascularization 对接受早期血运重建的急性心肌梗死相关心源性休克患者采用不同机械循环支持模式的趋势和结果

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-01 DOI: 10.1016/j.ahjo.2024.100468

Shafaqat Ali , Manoj Kumar , Irisha Badu , Faryal Farooq , Thannon Alsaeed , Muhammad Sultan , Lalitsiri Atti , Sanchit Duhan , Pratik Agrawal , Vijaywant Brar , Tarek Helmy , Taher Tayeb

Background

The use of Mechanical Circulatory Support (MCS) devices in cardiogenic shock (CS) is growing. However, the recent trends in using different MCS modalities and their outcomes in acute myocardial infarction associated CS (AMI-CS) are unknown.

Methods

The national readmission database (2016–2020) was used to identify AMI-CS requiring MCS. Cohorts were stratified as ECMO compared to Impella. Propensity score matching (PSM) was used to remove confounding factors. Pearson's x2 test was applied to matched cohorts to compare outcomes. We used multivariate regression and reported predictive margins for adjusted trend analysis.

Results

Among 20,950 AMI-CS hospitalizations requiring MCS, 19,628 (93.7 %) received Impella vs 1322 (6.3 %) were placed only on ECMO. ECMO group was younger (median age: 61 vs. 68 years, p < 0.001) and had a lower comorbidity burden. On propensity-matched cohorts (N 742), the ECMO cohort had higher adverse events, including mortality (51.6 % vs. 41.5 %), sudden cardiac arrest (SCA) (40.9 % vs. 31.8 %), acute stroke (9.2 % vs. 4.6 %) and major bleeding (16 % vs 12.2 %) [p < 0.05]. However, comparing ECPELLA (ECMO + Impella) to Impella alone, mortality (46.2 % vs. 39.4 %) and SCA (44 % vs. 36.4 %) rates were similar, though major bleeding was higher (18.2 % vs. 9.8 %). From 2016 to 2020, mortality trends for AMI-CS in the U.S. showed no significant change (p-trend: 0.071).

Conclusion

Despite advances in MCS modalities, the overall mortality rate for AMI-CS remains unchanged. ECMO use without LV unloading showed higher mortality and adverse events compared to Impella. Prospective studies are needed to verify these findings.

背景机械循环支持（MCS）设备在心源性休克（CS）中的使用日益增多。然而，在急性心肌梗死相关性心源性休克（AMI-CS）中使用不同 MCS 模式及其结果的最新趋势尚不清楚。方法使用国家再入院数据库（2016-2020 年）来识别需要 MCS 的 AMI-CS。队列按 ECMO 与 Impella 进行分层。采用倾向评分匹配法（PSM）去除混杂因素。对匹配队列进行皮尔逊 x2 检验，以比较结果。结果在 20,950 例需要 MCS 的 AMI-CS 住院患者中，19,628 例（93.7%）接受了 Impella 治疗，1322 例（6.3%）仅接受了 ECMO 治疗。ECMO 组患者更年轻（中位年龄：61 岁 vs. 68 岁，p < 0.001），合并症负担更轻。在倾向匹配队列（742 人）中，ECMO 队列的不良事件较多，包括死亡率（51.6% 对 41.5%）、心脏骤停（SCA）（40.9% 对 31.8%）、急性中风（9.2% 对 4.6%）和大出血（16% 对 12.2%）[p <0.05]。然而，将 ECPELLA（ECMO + Impella）与单独使用 Impella 相比，死亡率（46.2% 对 39.4%）和 SCA（44% 对 36.4%）相似，但大出血率更高（18.2% 对 9.8%）。从 2016 年到 2020 年，美国 AMI-CS 的死亡率趋势没有显著变化（P-趋势：0.071）。与 Impella 相比，使用 ECMO 而不进行 LV 负载显示出更高的死亡率和不良事件。需要进行前瞻性研究来验证这些发现。

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引用次数: 0

Racial/ethnic disparities, artificial intelligence, and cutting-edge research: Proceedings from the 2023 Florida cardio-oncology symposium 种族/族裔差异、人工智能和前沿研究：2023 年佛罗里达心脏病肿瘤学研讨会论文集

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-01 DOI: 10.1016/j.ahjo.2024.100469

Katelyn A. Bruno , Michael G. Fradley , Sherry-Ann Brown , Avirup Guha , Lakeshia Cousin , Yi Guo , Walter G. O'Dell , Ashely J. Smuder , Shuang Yang , Dejana Braithwaite , Carl J. Pepine , Yan Gong

引用次数: 0

Overlap of frailty and malnutrition as prognosticators in older patients with heart failure 老年心力衰竭患者的预后指标--虚弱与营养不良的重叠

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-01 DOI: 10.1016/j.ahjo.2024.100467

Takuro Abe , Kentaro Jujo , Yudai Fujimoto , Daichi Maeda , Yuki Ogasahara , Kazuya Saito , Hiroshi Saito , Kentaro Iwata , Masaaki Konishi , Takeshi Kitai , Takatoshi Kasai , Hiroshi Wada , Shin-ichi Momomura , Nobuyuki Kagiyama , Kentaro Kamiya , Emi Maekawa , Yuya Matsue

Background

Physical frailty and malnutrition coexist in older patients with heart failure (HF) and form a vicious cycle exacerbating each other and can cause poor clinical outcomes. We aimed to clarify the association of prevalence of physical frailty and malnutrition and clinical outcomes in hospitalized patients with HF.

Methods

A total of 862 hospitalized patients aged ≥65 years with HF decompensation were included in this FRAGILE-HF post-hoc sub-analysis. Patients were categorized into Neither, Either, or Both groups based on the prevalence of physical frailty and malnutrition. The primary outcome was all-cause mortality within 1 year after discharge. Prognoses among the groups were compared in the entire cohort and in subgroups with preserved ejection fraction (pEF) and reduced/mildly reduced left ventricular ejection fractions (rEF/mrEF).

Results

The Neither, Either, and Both groups comprised 32 %, 40 %, and 28 % respectively. During a 1-year follow-up period, 101 (12 %) patients died. Kaplan–Meier analysis showed significant differences in the primary outcomes among the groups (P < 0.001). The Both group had a higher risk of mortality (HR: 2.47, 95 % CI: 1.38–4.42) than the Neither group, while the Either group showed insignificant risk increase (HR: 1.58, 95 % CI: 0.86–2.90). Similar trends were observed in the pEF and rEF/mrEF subgroups (P = 0.60).

Conclusions

Physical frailty and malnutrition coexist in approximately one-quarter of hospitalized older patients with HF and are associated with an increased risk of mortality. Assessing both conditions is crucial for risk stratification and interventions to mitigate their interplay.

背景老年心力衰竭（HF）患者的体质虚弱和营养不良同时存在，并形成恶性循环，相互加重，可导致不良的临床预后。我们的目的是明确心力衰竭住院患者身体虚弱和营养不良的患病率与临床预后之间的关系。方法共有 862 名年龄≥65 岁的心力衰竭失代偿期住院患者被纳入 FRAGILE-HF 事后子分析。根据体质虚弱和营养不良的发生率，将患者分为 "两者皆无 "组、"两者皆有 "组和 "两者皆有 "组。主要结果是出院后一年内的全因死亡率。比较了整个组群以及射血分数保留组（pEF）和左心室射血分数降低/轻度降低组（rEF/mrEF）中各组的预后情况。在为期一年的随访期间，101 名（12%）患者死亡。Kaplan-Meier 分析显示，两组患者的主要预后存在显著差异（P < 0.001）。两组患者的死亡风险（HR：2.47，95% CI：1.38-4.42）高于两组患者，而两组患者的死亡风险增加不明显（HR：1.58，95% CI：0.86-2.90）。在 pEF 和 rEF/mrEF 亚组中也观察到了类似的趋势（P = 0.60）。评估这两种情况对于进行风险分层和干预以减轻其相互作用至关重要。

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引用次数: 0