Journal Of Cardiovascular Emergencies最新文献

{"title":"Early Acute Graft Rejection in a Heart Transplanted Child with Dilated Cardiomyopathy","authors":"I. Muntean, A. C. Barmou, A. Sin, H. Suciu, R. Togănel","doi":"10.2478/jce-2020-0007","DOIUrl":"https://doi.org/10.2478/jce-2020-0007","url":null,"abstract":"Abstract Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy in children. Heart transplantation is considered standard therapy in dilated cardiomyopathy with end-stage heart failure. We present a case of a 15-year-old patient diagnosed with DCM in the neonatal period, who underwent heart transplantation for end-stage heart failure. Despite the use of induction therapy, the endomyocardial biopsy performed at two weeks post-transplant revealed mixed moderate cellular (2R) and humoral (pAMR2) allograft rejection. Aggressive rejection treatment was initiated with good outcome. Besides endomyocardial biopsy, advanced echocardiography can also be a valuable noninvasive tool for rejection assessment.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"1 1","pages":"43 - 47"},"PeriodicalIF":0.4,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83051817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silent Acute Coronary Syndrome in a Mild Carbon Monoxide Poisoning","authors":"M. Eid","doi":"10.2478/jce-2020-0006","DOIUrl":"https://doi.org/10.2478/jce-2020-0006","url":null,"abstract":"Abstract Introduction: Carbon monoxide (CO) poisoning continues to be challenging in diagnosis and management. The complications related to CO poisoning are variable and unpredictable. Case presentation: We present the case of a 73-year-old woman who was involved in an indoor fire. Although she was asymptomatic and had a low CO level, she developed an acute coronary syndrome. The condition of the patient recovered remarkably after treatment with oxygen supplementation and anti-ischemic drugs. Conclusion: This case indicates that an acute coronary syndrome could represent a complication of CO poisoning even in asymptomatic patients with low levels of COHb.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"9 1","pages":"40 - 42"},"PeriodicalIF":0.4,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85178816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STEMI Networks in the COVID-19 Era","authors":"T. Benedek","doi":"10.2478/jce-2020-0009","DOIUrl":"https://doi.org/10.2478/jce-2020-0009","url":null,"abstract":"The COVID-19 pandemic impacts the management of cardiovascular emergencies in one of the most dramatic ways encountered in the history of modern cardiology. The relationship between SARS-CoV-2 infection and cardiovascular emergencies is bi-directional. From a logistic point of view, the management of cardiovascular emergencies is significantly affected by the COVID-19 pandemic. At the same time, the most severe forms of viral infection are encountered in patients with cardiovascular diseases (CVD). A recent survey conducted by the European Society of Cardiology (ESC) showed a dramatic decrease in the number of primary percutaneous interventions (pPCI) performed in patients with ST-segment elevation acute myocardial infarction (STEMI) across Europe.1 This was mainly caused by the fear of patients to present to STEMI hospitals or to call 112 when they had a chest pain, because they were more scared by the possibility to contact the new coronavirus than by the possibility to have a heart attack. This survey indicates that more than 80% of European centers are encountering a significant reduction in the number of pPCIs performed during the COVID-19 pandemic, most of them reporting decreases between 50% and 70% in the number of pPCI procedures. At the same time, more than 50% of pPCI centers reported that patients arrive later than usual for pPCI, beyond the optimal time window for revascularization.1 New logistic challenges include the need to exclude Sars-CoV2 infection in patients presenting to the emergency room and the need to take appropriate measures to protect medical staff in the emergency room and cath lab. These all take extra time, while we have learned very well in the latest years that time is muscle, time is life. As a consequence, in a recent material released by the ESC to serve as guidance for diagnosis and management of CVD during the COVID-19 pandemic, the ESC recommends to calculate an extra time of 60 minutes in the original time frame of maximum 2 hours from diagnosis to pPCI in the guidelines.2 Pragmatically speaking, this means that we have only one hour left, instead of two, to transport the patient to the closest cath lab, because we will lose one hour with extra logistic measures specific for the COVID-19 period. This may significantly impact the choice of pPCI versus thrombolysis, leading to an increased number of treatment options in favor of thrombolysis. A recent correspondence from this year compared the emergency admissions for acute coronary syndromes (ACS) in 15 hospitals from Northern Italy in February-March 2020 versus January-February 2020 and the same period in 2019, and reported a significant decrease in the total number of ACS admissions in the COVID-19 period: 13.3 daily admissions for ACS vs. 18 daily admissions in the preceding month (p <0.001) and vs. 18.9 in the same period of 2019 (p <0.001).3 Another study analyzing ACS admissions in Austria reported a 39.4% decrease in the number of ACS admissions (25.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"14 1","pages":"24 - 25"},"PeriodicalIF":0.4,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78814981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship between Blood Viscosity and Acute Arterial Occlusion","authors":"Güney Erdoğan, M. Yenerçağ, U. Arslan","doi":"10.2478/jce-2020-0002","DOIUrl":"https://doi.org/10.2478/jce-2020-0002","url":null,"abstract":"Abstract Background: Blood viscosity is a strong predictor of cardiovascular events. However, the relationship between blood viscosity and acute arterial occlusion (AAO) has not been studied adequately so far. Objectives: The aim of the present study was to assess the relationship between whole blood viscosity (WBV) and AAO. Material and methods: The study included 93 patients who were diagnosed with AAO between January 2017 and September 2019, and 90 age- and sex-matched healthy controls. WBV was assessed using a validated calculation formula derived from hematocrit and total plasma protein levels, both as a low (LSR) and a high (HSR) shear rate. Results: There were no significant differences between the two groups in regards to the baseline characteristics, with the exception of smoking and LDL cholesterol levels. Subjects with AAO presented significantly higher WBV values both at LSR (32.2 ± 5.0 vs. 26.6 ± 5.0, p <0.001) and HSR (6.2 ± 0.3 vs. 5.7 ± 0.3, p <0.001). The ROC analysis revealed a cut-off value of 27.4 for WBV at LSR (sensitivity 66%, specificity 64%, AUC = 0.770, p <0.001) and a cut-off value of 5.29 in case of HSR (sensitivity 69%, specificity 74%, AUC = 0.801, p <0.001) for predicting AAO. Multivariate analysis, both LSR (OR 3.33, 95% CI: 1.20–9.43, p = 0.006) and HSR (p = 0.020, OR: 1.70, 95% CI: 1.020–1.123) were independent predictors of AAO. Conclusions: This study demonstrated that WBV levels at both HSR and LSR are significantly higher in the AAO group than in the control subjects, indicating that an increased WBV may be associated with the development of AAO.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"9 1","pages":"12 - 7"},"PeriodicalIF":0.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75039275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a New Cardiac Massage Facilitator Device on the Fatigue of Rescue Workers in Cardiopulmonary Resuscitation","authors":"M. A. Y. Heravi, Z. Amini, Mostafa Roshanravan, A. Gazerani","doi":"10.2478/jce-2020-0004","DOIUrl":"https://doi.org/10.2478/jce-2020-0004","url":null,"abstract":"Abstract Introduction: Cardiopulmonary resuscitation is a direct intervention for the prevention or postponement of death in patients with cardiac arrest. The fatigue of rescue workers is of high significance when performing cardiopulmonary resuscitation effectively. The present study aimed to investigate the effect of a cardiac massage facilitator device on the fatigue of rescue workers in cardiopulmonary resuscitation. Materials and Methods: This experimental study was carried out on 30 emergency medical aid non-continuous bachelor students, divided equally into two groups: one group performed cardiac massage using the device and the other without the device. Fatigue levels were assessed using a visual analog scale to evaluate fatigue severity. Results: The mean age of participants was 23.42 ± 2.02 years, the mean height was 175 ± 4.43 cm, and the mean weight was 65.45 ± 5.02 kg. There was a statistically significant difference between the mean fatigue scores of the two groups: 0.06 with the device vs. 0.57 without the device. Conclusion: Our results suggest that the cardiac massage facilitator device presented in this study could be effective in improving the quality of cardiac massage and be helpful in cardiopulmonary resuscitation.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"11 1","pages":"13 - 16"},"PeriodicalIF":0.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78288248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular Dysfunction in the Case of the Sever Fetal Aortic Stenosis – the Role of Speckle-tracking","authors":"L. Gozar, D. Toma, Amalia Făgărășan, Dorottya Miklósi, R. Togănel","doi":"10.2478/jce-2019-0016","DOIUrl":"https://doi.org/10.2478/jce-2019-0016","url":null,"abstract":"Abstract Congenital aortic stenosis (AS) occurs in around 0.2–0.5% of newborns, and its clinical severity is quite variable. Some of the newborns with AS require urgent medical care: prostaglandin infusion, balloon aortic valvuloplasty, or surgical intervention. Despite having a severe clinical evolution in neonates, the prenatal diagnosis of congenital AS is quite low. We present the case of a fetus with critical AS, who had been prenatally diagnosed at 35 weeks of gestation, via fetal cardiac ultra-sound. The echocardiographic parameters revealed a severely depressed left ventricular systolic function, with dilated chambers, and a severe aortic stenosis. Offline speckle-tracking analysis was performed in order to aid in deciding the optimal methods and timing of delivery. Left ventricular analysis revealed a severely impaired global longitudinal strain of 2.1%, left ventricular ejection fraction 18.4%, increased LV volumes, while the right ventricular function was only mildly depressed. Therefore, the decision was to delay the premature delivery, and the fetus was born at a gestational age of 38 weeks, in a hospital with a neonatal cardiovascular surgery department. The patient had undergone surgical repair of the cardiac anomaly at 3 days after birth.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"35 7 1","pages":"20 - 23"},"PeriodicalIF":0.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77234630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Pandemic and Cardiovascular Challenges","authors":"T. Benedek","doi":"10.2478/jce-2020-0003","DOIUrl":"https://doi.org/10.2478/jce-2020-0003","url":null,"abstract":"The recent COVID-19 pandemic impacts different levels of modern society on an unprecedented level. From the perspective of cardiovascular medicine, the recent outbreak of the new coronavirus infection is associated with several major challenges that may influence our practice of medicine on a short or even longer term. Analysis of COVID-19 fatality rates in countries with a high number of infections indicate that people with cardiovascular diseases are most exposed to the risk of death following infection with the new coronavirus. For instance, analysis of a group of 355 COVID-19 patients who have died in Italy showed that 30% of them had ischemic heart disease, 35% had diabetes, 24.5% had atrial fibrillation, and 9.6% had stroke as pre-existing comorbidities.1 This is in line with the already documented link between cardiovascular comorbidities and fatality rates in infections with coronaviruses, and indicates that in the setting of a viral pandemic, cardiac patients represent a high-risk group that requires special attention and dedicated treatment strategies.2 Over the last decades, in the attempt to provide the most effective life-saving therapy for cardiac patients, international scientific societies have released many guidelines for the treatment of various heart diseases, which have been implemented in clinical practice on a large scale. However, adherence to guidelines in the COVID era may represent a serious challenge for cardiology practitioners, and failure to provide the most effective recommended therapy could be reflected in a significant increase of cardiovascular mortality in a very close future. One of the most surprising findings observed in all the countries facing the COVID pandemic is that the number of presentations with ST-segment elevation acute myocardial infarction (STEMI) has been reduced by 50–70%. The same is true for all the other types of cardiovascular emergencies (acute heart failure, hypertensive emergencies, pulmonary embolism etc.). This does not mean that the risk of heart attacks was reduced or that the population has cured from cardiovascular diseases. Moreover, it is well known that any infection, leading to increased systemic inflammation, is associated with a higher risk of acute cardiovascular events in people with underlying atherosclerosis. The significant reduction in cardiovascular emergencies presentations can be explained only by the fact that patients are scared to present to the hospital, which they consider to be a dangerous place. As a consequence, a significant proportion of patients with chest pain prefer to remain at home, and many of them will die at home or will develop post-infarction heart failure, with significant reduction in their quality of life and increased costs for their healthcare, on a long term. At the same time, as the outbreak appeared unexpectedly, there are no current guidelines released by scientific societies on how to manage STEMI or NSTEMI cases in the COVID areas. No ","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"55 1","pages":"5 - 6"},"PeriodicalIF":0.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89100909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brugada Syndrome – Report of Familial Occurrence Diagnosed in the Emergency Department","authors":"M. Fazel, F. Hamidi, E. Afshari","doi":"10.2478/jce-2020-0001","DOIUrl":"https://doi.org/10.2478/jce-2020-0001","url":null,"abstract":"Abstract Introduction: Brugada syndrome represents the clinical manifestation of a rare disease with genetic etiology. The syndrome is characterized by ventricular dysrhythmias associated with syncope or sudden cardiac death in the lack of any structural cardiac disease. The diagnosis of Brugada syndrome is established if a type 1 electrocardiographic (ECG) pattern of ST-segment and QRS morphology is present, in association with certain clinical manifestations and/or familial history. Case presentation: A 31-year-old male patient, without any medical history, presented in the emergency department (ED) of a clinical center. His only complaints consisted in palpitations, chest discomfort, and emotional stress related to the recent death of his wife. Earlier on the same day, his wife, a 25-year-old female was brought via emergency medical services (EMS) to the ED after presenting ventricular fibrillation. The female patient presented a long term history of chest pain and one year prior to this episode she presented idiopathic ventricular fibrillation, for which she had undergone implantation of an automated cardioverter defibrillator. As the couple were cousins, the EMS specialist suspected the presence of a familial cardiac disorder. The electrocardiogram of the male patient revealed a coved-type ST-segment elevation of 4 mm in leads V1–V3 compatible with type 1 Brugada syndrome. Conclusion: In case of Brugada syndrome, a genetic disorder associated with increased risk of SCD, the patient's first-degree relatives should be investigated as well, in order to identify the presence of the syndrome and to prevent SCD. As the sole established effective therapeutic measure for patients diagnosed with Brugada syndrome, ICD implantation should be considered in order to decrease the risk of syncope and SCD. This case is particular because a rare disease with familial etiology was identified in both husband and wife, who were cousins.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"1 1","pages":"17 - 19"},"PeriodicalIF":0.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85708788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors for In-hospital Mortality in Pediatric Patients with Acute Myocarditis – a Retrospective Study","authors":"D. Toma, L. Gozar, C. Șuteu, Amalia Făgărășan, R. Togănel","doi":"10.2478/jce-2019-0019","DOIUrl":"https://doi.org/10.2478/jce-2019-0019","url":null,"abstract":"Abstract Background: Acute myocarditis, a primary inflammatory cardiac disease commonly caused by viral infection, is an important cause of morbidity and mortality in children. Data obtained from forensic studies found an incidence of 15–33% for acute myocarditis in sudden deaths in the pediatric age group. Currently, there is a lack of data regarding the incidence and factors associated with short-term outcomes in pediatric patients admitted for acute myocarditis. The aim of the study was to identify predictors for in-hospital mortality in a pediatric population admitted with acute myocarditis. Material and methods: We conducted a retrospective observational cohort study that included 21 patients admitted for acute myocarditis. Clinical, laboratory, ECG, and imaging data acquired via 2D transthoracic echocardiography and cardiac magnetic resonance imaging were collected from the medical charts of each included patient. The primary end-point of the study was all-cause mortality occurring during hospitalization (period ranging from 10 to 14 days). The study population was divided into 2 groups according to the occurrence of the primary end-point. Results: The mean age of the study population was 99.62 ± 77.25 months, and 61.90% (n = 13) of the patients were males. The in-hospital mortality rate was 23.9% (n = 5). Patients in the deceased group were significantly younger than the survivors (55.60 ± 56.18 months vs. 113.4 ± 78.50 months, p = 0.039). Patients that had deceased presented a significantly higher level of LDH (365 ± 21.38 U/L vs. 234.4 ± 63.30 U/L, p = 0.0002) and a significantly higher rate of ventricular extrasystolic dysrhythmias (60% vs. 6.25%, p = 0.02, OR: 22.5, 95% CI: 1.5–335) compared to survivors. The 2D echocardiography showed that patients that had deceased presented more frequently an impaired left ventricular ejection fraction (<30%) (p = 0.001) and a significantly higher rate of severe mitral regurgitation (p = 0.001) compared to survivors. Conclusions: The most powerful predictors for in-hospital mortality in pediatric patients admitted for acute myocarditis were the presence of ventricular extrasystolic dysrhythmias on the 24h Holter ECG monitoring, impaired left ventricular systolic function (LVEF <30%), the presence of severe mitral regurgitation, and confirmed infection with Mycoplasma pneumoniae.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"23 1","pages":"140 - 147"},"PeriodicalIF":0.4,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89947753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Chronic to Acute Models of Heart Failure – The Cost-Effectiveness Perspective","authors":"R. Hodaș, T. Benedek","doi":"10.2478/jce-2019-0021","DOIUrl":"https://doi.org/10.2478/jce-2019-0021","url":null,"abstract":"Cost-effectiveness is a new and rapidly expanding field of modern medicine. As new therapies continue to be introduced in the market, some of them being quite expensive, the cost related to healthcare in different clinical settings is constantly increasing. Therefore, a modern approach in healthcare politics is based on the calculation of cost-effectiveness, which reflects the balance between the cost of a therapy and its efficiency, translated into years of survival or quality of life. Heart failure (HF) is a disease which consumes a significant part of healthcare budget, most of its expenditures being represented by hospitalization costs. Several published studies reported that approximately two-thirds of the healthcare costs of HF are related to hospitalization.1,2 A current cost-of-illness systematic review highlights the latest worldwide estimations, suggesting that approximately 26 million individuals are affected by HF,3 with an expected prevalence of at least 3% by 2030, leading some to describe it as a global pandemic.4 Annually, both Europe and the US spend 1–2% of their healthcare resources for the management of HF.5 In terms of global economic burden, the healthcare of patients with HF has been assessed at $108 billion each year, with $65 billion credited to direct and $43 billion to indirect costs. The United States represents the largest contributor to worldwide HF charges and is responsible for 28.4% of overall HF costs, while Europe accounts for 6.83% of overall HF expenditure.6 Patients with chronic HF require frequent rehospitalizations, which significantly increases the economic burden of this devastating disease. A recently published review confirms that hospital admission-related costs contribute significantly to global HF-related direct costs, in a percentage between 44% and 96%.3 These readmissions proved to be specifically resource-intensive, as healthcare costs were estimated to $83,980 over the lifetime of each patient with HF. Another study reported that from global lifetime healthcare costs related to HF, almost 80% were associated with hospital stays.7 Chronic HF is a condition in which the heart cannot pump sufficient blood into the circulation to satisfy the needs of the entire body. The latest statistical report of the American Heart Association estimates that 0.4–2.2% of the population in industrialized states present this condition, with between 500,000–600,000 incident cases diagnosed per year.8 As a chronic disease, HF involves great lifetime expenses, mainly in the first year after diagnosis, while end-of-life healthcare is defined as the most expensive one.2 During the evolution of chronic HF, repeated episodes of acute decompensation can occur, which require immediate admission. A randomized controlled trial investigating outcomes in subjects with chronic HF reported that two-thirds of the subjects presented hospital readmission within the first year.9 Moreover, a recently published study demonstrated 30-day","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"51 1","pages":"123 - 125"},"PeriodicalIF":0.4,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84894819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}