Circulation reports最新文献

Progress in intensive care for cardiovascular disease, including catheter-based therapies and mechanical circulatory support, has improved patient survival. Conversely, the numbers of patients with severe disease and older patients with multimorbidities have increased, resulting in complications during management in the intensive care unit (ICU). In addition to ICU-acquired weakness and delirium, postintensive care syndrome (PICS) has recently been recognized, defined as a prolonged impairment in physical, cognitive, and mental status. Physiotherapy is an important treatment option to prevent and ameliorate PICS. Recently, the goals of early-phase physiotherapy have shifted beyond short-term outcomes, such as reducing the length of ICU and hospital stays and recovery of physical function, to include long-term outcomes, such as return to social activity and reduced rehospitalization. Thus, appropriate physiotherapy management and intervention during the ICU are potentially crucial, because high-quality phase I cardiovascular rehabilitation leads to a seamless approach to the next phase of rehabilitation. This review summarizes current clinical issues, the implementation of assessment and treatment strategies in acute-phase physiotherapy, and future perspectives and challenges in cardiovascular intensive care.

Background: Several studies have reported that age influences the severity of hospitalization-associated disability (HAD) after cardiac surgery. However, age-specific differences in the incidence and characteristics of HAD remain unclear. Therefore, this study aimed to clarify the incidence and characteristics of HAD according to age group.

Methods and results: This prospective, multicenter observational study included 604 patients who underwent elective cardiac surgery at 12 acute-care hospitals. HAD was defined as a decrease of ≥5 points in the Barthel Index score from the preoperative assessment to the discharge assessment. The HAD incidence rate was 6.8% for patients aged 65-74 years, 14.5% for patients aged 75-89 years, and 10.4% overall. The characteristics varied by age group. In the 65-74 age group, the incidence of HAD was influenced by a higher prevalence of comorbidities, level of prehospital nursing care, preoperative left ventricular ejection fraction, intubation time, and physical function. In the 75-89 age group, HAD incidence was associated with Kihon Checklist score, level of nursing care, the use of rehabilitation services, preoperative physical function, and intubation time.

Conclusions: The incidence of HAD in post-cardiac surgery patients was 10.4%, increasing with age. Factors affecting the incidence of HAD differed by age group.

Background: Atrial fibrillation (AF) after bioprosthetic valve (BPV) replacement is common in older patients with multiple comorbidities and is associated with a heightened risk of thromboembolism. Anticoagulation therapy is often indicated, but renal impairment and other comorbidities elevate bleeding risk, making clinical decisions complex. This study compared clinical outcomes between warfarin and direct oral anticoagulants (DOACs) in this high-risk population.

Methods and results: This subgroup analysis of the BPV-AF Registry included 612 patients treated with oral anticoagulants after BPV replacement, stratified by renal function: normal or mild impairment (creatinine clearance [CCr] ≥50 mL/min), mild-to-moderate impairment (30 mL/min ≤ CCr < 50 mL/min), and moderate-to-severe impairment (15 mL/min ≤ CCr < 30 mL/min). Baseline characteristics and outcomes were analyzed within each stratum. The composite outcome of stroke, systemic embolism, and cardiovascular events was numerically less frequent in the DOAC than warfarin group across all strata, although the differences were not statistically significant. Major bleeding also tended to be lower in the DOAC group.

Conclusions: In this study from a Japanese nationwide registry comparing outcomes of AF patients after BPV replacement with severe renal impairment between those treated with DOACs and those treated with warfarin, comparative conclusions between DOACs and warfarin cannot be drawn because of the small sample size. Nonetheless, both anticoagulants may be acceptable in clinical practice, highlighting the need for individualized decision-making based on patient risk.

Despite advances in the treatment of cardiogenic shock (CS), it remains associated with high mortality rates. To improve patient outcomes, management in a dedicated care center has been proposed. However, the definition of a dedicated CS center has not been systematically examined, and no consensus exists across major societies or guidelines. The aim of this scoping review was to identify key elements defining CS centers linked to better patient outcomes and guide future research. This review was conducted in accordance with the PRISMA extension for scoping reviews. The PubMed, Cochrane, and Web of Science electronic databases were systematically searched to identify studies published from inception to July 19, 2023. Twenty observational studies examining hospital characteristics and patient outcomes with CS were included. Higher volumes of CS patients, more board-certified cardiologists, percutaneous coronary intervention (PCI) availability 24/7, and the presence of cardiovascular intensive care units, left ventricular assist device (LVAD) centers, and hub-and-spoke systems were associated with better outcomes. Inconsistent associations were observed for the number of PCIs, extracorporeal membrane oxygenation, and percutaneous microaxial ventricular assist device procedures, and LVAD case volume and the availability of cardiac surgical support were not associated with improved outcomes. This scoping review identified candidate elements of CS centers linked to better outcomes, providing a foundation for developing an optimal CS care system.

Background: Heart failure (HF) is an increasing public health concern in Japan, largely related to the aging population. This protocol describes the rationale, objectives, and methods of the Hokuriku-plus Heart Failure Registry (HpHFR), designed to establish a comprehensive clinical and digital database to assess novel prognostic indicators in patients with HF.

Methods and results: HpHFR is a prospective, multicenter observational cohort study that has enrolled patients with acute or chronic HF from 5 Japanese centers. Eligible patients provided informed consent and underwent baseline clinical, laboratory, and biometric assessment, including digital phonocardiography and wearable device data. Follow-up assessment will be conducted at 4, 12, 26, and 52 weeks. Primary outcomes include all-cause death, HF-related hospitalization, and worsening HF. Secondary outcomes are the changes in clinical parameters over time. A digital substudy will investigate continuous biometric monitoring, and a genomic substudy explores the loss of chromosome Y as a prognostic biomarker.

Conclusions: In conclusion, this study protocol summarizes the development of a valuable prospective cohort resource. This registry will provide a unique dataset enabling multifaceted investigations to improve HF prediction and management by systematically integrating comprehensive clinical and laboratory data with biometric indicators derived from digital devices and genomic markers.

Background: Recently, shock teams have been introduced to optimize cardiogenic shock (CS) care; however, their clinical benefits remain unclear. We conducted a systematic review and meta-analysis to assess whether management by a shock team improves outcomes in patients with CS.

Methods and results: This meta-analysis was conducted according to the PRISMA guidelines. Studies comparing adults with CS managed with or without a shock team were identified from the PubMed, Web of Science, and Cochrane Library databases. The primary outcome was short-term mortality (cardiac intensive care unit, in-hospital, or 30-day mortality); the secondary outcome was bleeding. Of the 7 retrospective cohort studies that met the inclusion criteria, 3 without a critical risk of bias were included in the analysis. Shock team management was significantly associated with lower short-term mortality (odds ratio [OR] 0.52; 95% confidence interval [CI] 0.32-0.85; P=0.010) and bleeding complications (OR 0.62; 95% CI 0.43-0.91; P=0.010). Sensitivity analysis using crude data also supported the mortality benefit (OR 0.68; 95% CI 0.54-0.85; P<0.010). However, no randomized trials were included, and the certainty of evidence was rated very low owing to the risk of bias and inconsistency.

Conclusions: Shock team management may improve short-term outcomes in patients with CS; however, the level of evidence is very low. Further prospective studies are needed to evaluate optimal shock team composition and roles.

Background: Comprehensive monitoring of cardiovascular disease (CVD) is essential in rapidly aging societies such as Japan. The Japanese Circulation Society (JCS) launched the Japanese Registry Of All cardiac and vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) registry, linking annual JROAD questionnaires with nationwide DPC administrative claims to enable patient-level analyses of hospitalized CVD care. This Protocol Paper presents a comprehensive overview of the registry.

Methods and results: Using anonymized data (April 2012-March 2023), we described temporal trends in patient demographics, principal CVD diagnoses, major interventions, disease-specific severity, and hospital characteristics. From FY2012-FY2022, participating facilities increased from 610 to 860, with registered patients more than doubling. Median age rose from 73.0 to 75.0 years; patients aged ≥90 years nearly quadrupled. The proportion of angina pectoris admissions declined (26.8% to 11.7%), while absolute numbers remained stable. Atrial fibrillation/flutter admissions rose in both proportion (4.1% to 5.9%) and absolute number. Heart failure admissions increased steadily, with its proportion showing a U-shaped trend. Catheter ablations for atrial fibrillation/flutter increased over fivefold, exceeding 64,000, while percutaneous coronary interventions for acute myocardial infarction surpassed 46,000.

Conclusions: JROAD-DPC now captures over 1.5 million annual CVD hospitalizations, providing a nationwide, large-scale longitudinal view of cardiovascular care in Japan. Its scale and validated coding enable robust analyses of trends and outcomes, supporting national CVD policy evaluation and improvement.

Background: B-type natriuretic peptide (BNP) is a key biomarker for heart failure (HF) and widely used for risk stratification. Elevated BNP levels in acute stroke are linked to poor outcomes, but its prognostic value in the post-acute phase remains unclear.

Methods and results: This retrospective study included 876 patients admitted to a rehabilitation hospital after acute cerebral infarction or hemorrhage between February 2019 and December 2022. Patients were classified into 4 groups based on BNP or N-terminal prohormone of BNP. The primary outcome was all-cause unfavorable events, including in-hospital death or transfer due to worsening condition. The severely elevated BNP group had a significantly higher risk of all-cause unfavorable events (hazard ratio: 2.34; 95% confidence interval: 1.26-4.32) than the normal group. No significant difference was observed in the mildly or moderately elevated BNP groups. BNP showed superior predictive value over HF diagnosis in terms of area under the receiver operating characteristic curve (0.712 vs. 0.691), net reclassification improvement (0.304, P=0.002), and integrated discrimination improvement (0.025, P=0.015). Higher BNP was associated with lower body mass index, reduced estimated glomerular filtration rate, longer time from stroke onset, atrial fibrillation, and cardioembolic stroke.

Conclusions: BNP levels in the post-acute stroke phase were significantly associated with unfavorable outcomes and may serve as a useful prognostic marker.

Background: Studies of off-loading devices for chronic limb-threatening ischemia (CLTI) are scarce. We investigated (1) the effect of the application of early therapy sandals on changes in the Clinical Frailty Scale (CFS) scores of patients with CLTI before and after hospitalization, and (2) adverse events such as wound deterioration and reamputation.

Methods and results: We retrospectively analyzed the cases of 51 patients (51 limbs) with toe amputation after revascularization and compared 2 groups: patients who did not apply any load during the off-loading duration and focused on resistance training (the 'usual rehabilitation' group), and those who used therapeutic sandals and performed walking and aerobic exercises with partial off-loading from an early stage (the 'orthotic' rehabilitation group). The before-to-after hospitalization change in the CFS score was 0 (-1, 0) in the usual rehabilitation group, and 0 (0, 1) in the orthotic rehabilitation group (P=0.002), a significant difference. There were no significant between-group differences in wound healing duration (usual rehabilitation group, 48 [19,76.5] days; orthotic rehabilitation group, 41 [27.5,78.8] days) or reamputation rate (usual rehabilitation group, 5 [22%]; orthotic rehabilitation group, 3 [11%]).

Conclusions: The early postoperative use of therapeutic sandals tended to shorten the duration of complete off-loading after toe amputation due to CLTI and to help maintain CFS scores throughout the hospitalization duration. It was also shown to have a minimal impact on treatment delay and reamputation.

Background: Catheter ablation (CA) is a well-established therapy for arrhythmia, but the impact of CA strategies has not been thoroughly investigated. Nagano Prefecture comprises a large geographical area and some hospitals do not have cardiac surgeons, thus limiting the application of CA strategies. The aim of this study was to investigate the detailed strategies for CA in Nagano Prefecture and to clarify their efficacy and safety.

Methods and results: The Shinshu Catheter Ablation (Shinshu-AB) Registry is a multicenter prospective observational registry. Patients treated with CA for any type of arrhythmia are included. Data on the target arrhythmia(s), CA strategy, outcomes, and complications were collected and analyzed at Shinshu University Hospital. The study was approved by the institutional review boards of all investigational sites and registered in the UMIN Clinical Trials Registry (UMIN-55562). Primary endpoints were the composite incidence of arrhythmia recurrence, procedure-related adverse events, and cardiovascular events. The secondary endpoints were acute success, chronic success for >12 months, and all-cause death.

Conclusions: The Shinshu-AB Registry provides real-world data from the Nagano Prefecture on the outcomes and complications of CA for various types of arrhythmias.