Critical Pathways in Cardiology最新文献

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Elevated Cystatin C Predicts Higher Mortality in Chronic Heart Failure Independently of Renal Function. 胱抑素 C 升高可预测慢性心力衰竭患者的高死亡率,与肾功能无关。
Critical Pathways in Cardiology Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI: 10.1097/HPC.0000000000000316
Marta Carreira, José Paulo Araújo, Paulo Bettencourt, Patrícia Lourenço
{"title":"Elevated Cystatin C Predicts Higher Mortality in Chronic Heart Failure Independently of Renal Function.","authors":"Marta Carreira, José Paulo Araújo, Paulo Bettencourt, Patrícia Lourenço","doi":"10.1097/HPC.0000000000000316","DOIUrl":"10.1097/HPC.0000000000000316","url":null,"abstract":"<p><strong>Introduction: </strong>Cystatin C (CysC) is a known prognostic marker in cardiovascular diseases and its role in acute heart failure (HF) has been documented.</p><p><strong>Methods: </strong>We prospectively recruited HF patients followed in a HF clinic. Inclusion criteria: HF diagnosed ≥6 months, optimized evidence-based therapy, and ejection fraction <40% (Heart Failure with reduced ejection fraction). Exclusion criteria: renal replacement therapy and hospitalizations or therapeutic adjustments in the previous 2 months. A venous blood sample and 24-hour urine were collected. Follow-up: 5 years; endpoint: all-cause mortality. CysC was measured and creatinine clearance (CrCl) was calculated using 24-hour urine creatinine excretion. A Receiver operating characteristic curve was used to assess association of CysC with 5-year mortality. The prognostic role of CysC was determined using Cox-regression analysis. The multivariate model included CrCl (24-hour urine).</p><p><strong>Results: </strong>We evaluated 215 chronic stable Heart Failure with reduced ejection fraction patients. Mean age was 68 years, 72.1% were male. Median CysC = 1.15 mg/L, creatinine = 1.20 mg/dL, and CrCl = 63.6 mL/min. During follow-up, 103 (47.9%) patients died. The area under the curve for CysC in predicting mortality was 0.77 (0.70-0.83). Best cut-off value for death prediction = 1.00 mg/L with a sensitivity = 83.5%, specificity = 56.2%, positive predictive value = 63.7%, and negative predictive value = 78.7%. Multivariate-adjusted (age-, B-type natriuretic peptide-, evidence-based therapy, New York Heart Association class, and CrCl) 5-year mortality Hazard ratio = 2.40 (95% Confidence interval, 1.25-4.61), P value = 0.008 when CysC ≥1.00 mg/L.</p><p><strong>Conclusions: </strong>Patients with CysC <1.00 mg/L have almost 80% probability of being alive at 5 years; If CysC ≥1.00 mg/L, there is almost 2.5-fold higher death risk independently of B-type natriuretic peptide and CrCl.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":"23 3","pages":"119-123"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037196","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}
引用次数: 0
Applying a Computer-based Warfarin Management System at a Large Tertiary Cardiovascular Center in Iran. 在伊朗一家大型三级心血管中心应用基于计算机的华法林管理系统。
Critical Pathways in Cardiology Pub Date : 2024-09-01 Epub Date: 2024-04-05 DOI: 10.1097/HPC.0000000000000357
Somayyeh Barati, Mohammad Mehdi Mohammadpour, Mohammad Ali Sadrameli, Saeed Hosseini, Majid Maleki, Reza Golpira, Hooman Bakhshandeh, Majid Kyavar, Jamal Moosavi, Bahram Mohebbi, Azita H Talasaz, Stefano Barco, Frederikus A Klok, Parham Sadeghipour
{"title":"Applying a Computer-based Warfarin Management System at a Large Tertiary Cardiovascular Center in Iran.","authors":"Somayyeh Barati, Mohammad Mehdi Mohammadpour, Mohammad Ali Sadrameli, Saeed Hosseini, Majid Maleki, Reza Golpira, Hooman Bakhshandeh, Majid Kyavar, Jamal Moosavi, Bahram Mohebbi, Azita H Talasaz, Stefano Barco, Frederikus A Klok, Parham Sadeghipour","doi":"10.1097/HPC.0000000000000357","DOIUrl":"10.1097/HPC.0000000000000357","url":null,"abstract":"<p><strong>Background: </strong>Regarding adjustments to warfarin dosage, numerous studies have shown that computerized methods are superior to those based on personal experience.</p><p><strong>Objectives: </strong>To report the efficacy of a computer-based warfarin management system (WMS) in the Iranian population.</p><p><strong>Methods: </strong>By utilizing the existing dosing algorithms and obtaining expert opinions, we developed a computer-based WMS at a large tertiary cardiovascular center. The time in therapeutic range and the number of international normalized ratio (INR) tests of clinic patients were compared before and after the implementation of WMS.</p><p><strong>Results: </strong>Overall, 803 patients with 5407 INR tests were included in the before phase and 679 patients with 4189 INR tests in the after phase. The mean time in therapeutic range was 57.3% before and 59% after WMS implementation [mean difference, 1.64; 95% confidence interval (CI), -1.12-4.40]. In the before phase, the mean number of INR tests was 6.7, which dropped to 6.1 tests in the after phase (mean difference, -0.61; 95% CI, -0.97 to -0.24). Only 54.5% of the warfarin dosing prescriptions were consistent with the dosing recommendations of the WMS, and adherence to the WMS was poorest in the highest INR target range.</p><p><strong>Conclusions: </strong>For the first time in Iran, we demonstrated that a computerized system was as effective as a traditional experience-based method to monitor INR in VKA-anticoagulated patients. Furthermore, it could reduce both the number of INR tests and that of visits.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"124-130"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855893","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}
引用次数: 0
Bivalirudin versus heparin in patients undergoing percutaneous coronary intervention in acute coronary syndromes. 急性冠状动脉综合征患者接受经皮冠状动脉介入治疗时,比伐卢定与肝素的比较。
Critical Pathways in Cardiology Pub Date : 2024-07-29 DOI: 10.1097/HPC.0000000000000372
Chayakrit Krittanawong, Tania Ahuja, Zhen Wang, Yusuf Kamran Qadeer, Errol Moras, Hafeez Ul Hassan Virk, Mahboob Alam, Hani Jneid, Samin Sharma
{"title":"Bivalirudin versus heparin in patients undergoing percutaneous coronary intervention in acute coronary syndromes.","authors":"Chayakrit Krittanawong, Tania Ahuja, Zhen Wang, Yusuf Kamran Qadeer, Errol Moras, Hafeez Ul Hassan Virk, Mahboob Alam, Hani Jneid, Samin Sharma","doi":"10.1097/HPC.0000000000000372","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000372","url":null,"abstract":"<p><strong>Introduction: </strong>Data on outcomes between unfractionated heparin and bivalirudin anticoagulation during percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS) remains inconclusive. We aimed to systematically analyze PCI outcomes comparing unfractionated heparin and bivalirudin.</p><p><strong>Methods: </strong>We systematically searched Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception in 1966 through January 2024 for studies evaluating PCI outcomes comparing unfractionated heparin and bivalirudin. Two investigators independently reviewed data. Conflicts were resolved through consensus. Random-effects meta-analyses were used.</p><p><strong>Results: </strong>Ten prospective trials were identified that enrolled 42,253 individuals who presented with an acute coronary syndrome. Our analysis found that heparin when compared to bivalirudin was associated with an increased risk of trial-based definition of major bleeding (RR 1.68, 95% CI 1.29-2.20), non-access site complications (RR 4.6, 95% CI 1.75-12.09), TIMI major bleeding (RR 1.70, 95% CI 1.20-2.41), major bleeding risks (RR 1.87, 95% CI 1.49-2.36), cardiovascular disease death (RR 1.26, 95% CI 1.02-1.57), and thrombocytopenia (RR 1.67, 95% CI 1.07-2.62). There were no statistically significant differences between heparin and bivalirudin for all-cause mortality, MACE, stroke, reinfarction, target vessel revascularization, acute or stent thrombosis.</p><p><strong>Conclusions: </strong>The present meta-analysis demonstrates bivalirudin reduces major bleeding when used for anticoagulation during PCI in patients with acute coronary syndromes and is not associated with an increased risk of stent thrombosis or MACE.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972014","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}
引用次数: 0
Unlocking the Potential of the HEART Pathway: Predicting MACE and Facilitating Nurse-Physician Collaboration in Chest Pain Unit. 释放 HEART Pathway 的潜力:预测 MACE 并促进胸痛科护士与医生的合作。
Critical Pathways in Cardiology Pub Date : 2024-07-23 DOI: 10.1097/HPC.0000000000000374
Zahra Behpour, Zahra Amirsardari, Haniye Aghakhani, Mohammadesmaeil Zanganehfar, Shiva Khaleghparast, Fidan Shabani, Hooman Bakhshandeh, Parham Sadeghipour
{"title":"Unlocking the Potential of the HEART Pathway: Predicting MACE and Facilitating Nurse-Physician Collaboration in Chest Pain Unit.","authors":"Zahra Behpour, Zahra Amirsardari, Haniye Aghakhani, Mohammadesmaeil Zanganehfar, Shiva Khaleghparast, Fidan Shabani, Hooman Bakhshandeh, Parham Sadeghipour","doi":"10.1097/HPC.0000000000000374","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000374","url":null,"abstract":"<p><strong>Background and objective: </strong>The HEART pathway serves as a tool for predicting major adverse cardiac events (MACE) among patients presenting with acute chest pain, aiding in early discharge of low-risk patients and reducing unnecessary cardiac investigations. This study aimed to evaluate physician-nurse reliability of the HEART pathway. Moreover investigates the efficacy of HEART pathway to predict 3-month MACE in patients with acute chest pain.</p><p><strong>Method: </strong>We conducted a prospective study on 97 patients experiencing acute chest pain. A team of three professionals - a nurse, a cardiology resident, and a cardiology attending physician - performed risk stratification. We assessed inter-rater reliability among the raters as well as explored 3-month MACE outcomes.</p><p><strong>Result: </strong>Excellent pairwise agreements were found between the raters. Overall agreement among raters was excellent, with an ICC of 0.84 (95% CI: 0.73 - 0.97). The HEART pathway score exhibited strong predictive power (AUC: 0.85) for 3-month MACE. At a cut-off score of 4, sensitivity, specificity, and negative predictive values were 87.5%, 58.9%, and 95.8%, respectively.</p><p><strong>Conclusion: </strong>The HEART pathway score effectively predicts 3-month MACE in patients with acute non-traumatic chest pain. Moreover, the high agreement among the attending physician, the resident physician, and the nurse suggests that nurses could use this tool, potentially reducing the workload on physicians.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749209","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}
引用次数: 0
Coronary perforation occurring during percutaneous coronary intervention is associated with persistently high mortality and complication. 在经皮冠状动脉介入治疗过程中发生的冠状动脉穿孔与居高不下的死亡率和并发症有关。
Critical Pathways in Cardiology Pub Date : 2024-07-17 DOI: 10.1097/HPC.0000000000000373
Mohammad Reza Movahed, Nishant Satapathy, Mehrtash Hashemzadeh
{"title":"Coronary perforation occurring during percutaneous coronary intervention is associated with persistently high mortality and complication.","authors":"Mohammad Reza Movahed, Nishant Satapathy, Mehrtash Hashemzadeh","doi":"10.1097/HPC.0000000000000373","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000373","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary perforation is one of the major complications of percutaneous coronary intervention (PCI). The goal of this study was to evaluate adverse outcomes and mortality in patients suffering from coronary perforation during PCI above the age of 30.</p><p><strong>Methods: </strong>The National Inpatient Sample (NIS) database, years 2016-2020, was studied using ICD 10 codes. Patients suffering from perforation were compared to patients without perforation during PCI.</p><p><strong>Results: </strong>PCI was performed in a weighted total of 10,059,269 patients. Coronary perforation occurred in 11,725 (0.12 %) of all PCI performed. The mortality rate of patients with perforations was very high in comparison to patients without perforations. (12.9% vs 2.5%, OR: 5.6, CI:5-6.3 p<0.001). Furthermore, patients with coronary perforations had much higher rates of urgent coronary bypass surgery, tamponade, cardiac arrest, and major cardiovascular outcomes. Mortality remained high and over 10% in the 5-year study period.</p><p><strong>Conclusion: </strong>Using a large national inpatient database, all-cause inpatient mortality in patients with coronary perforation is very high (over 10%) with persistently high mortality rates over the years study suggesting that treatment of perforations needs further improvement.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627941","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}
引用次数: 0
The Impact of a High Sensitivity Troponin HEART Pathway Based Clinical Decision Protocol on Observation Visits. 基于高灵敏度肌钙蛋白 HEART 途径的临床决策规程对观察访问的影响。
Critical Pathways in Cardiology Pub Date : 2024-07-05 DOI: 10.1097/HPC.0000000000000370
George Hughes, Iyesatta Emeli, Matthew Wheatley, Abhinav Goyal, Janetta Bryksin, Timothy Moran, Matthew Keadey, Michael A Ross
{"title":"The Impact of a High Sensitivity Troponin HEART Pathway Based Clinical Decision Protocol on Observation Visits.","authors":"George Hughes, Iyesatta Emeli, Matthew Wheatley, Abhinav Goyal, Janetta Bryksin, Timothy Moran, Matthew Keadey, Michael A Ross","doi":"10.1097/HPC.0000000000000370","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000370","url":null,"abstract":"<p><strong>Background: </strong>Use of high-sensitivity troponin (hs-cTn) might lead to an increase in hospital observation visits due to higher number of abnormal troponin levels.</p><p><strong>Study objectives: </strong>To determine the impact of incorporating hs-cTn into a chest pain clinical decision protocol (CDP) on observation visits in a large academic health system.</p><p><strong>Methods: </strong>This is a retrospective observational cohort study of all chest pain observation patients in four hospitals in an academic health system over 24 months. All hospitals used the Beckman Coulter Unicel Dxi instrument, and all shared the same emergency department (ED) chest pain protocol, which used the HEART pathway and serial troponins and directed ED dispositions to either an observation stay, ED discharge, or inpatient admission. Outcomes studied before and after introduction of a hs-cTn protocol included daily chest pain observation census, cost, observation hours, and inpatient admit rate. Census was reported as the daily chest pain observation census and as a proportion of all observation visits. Data was retrieved from a health system data warehouse and a cost accounting program.</p><p><strong>Results: </strong>There were 6,712 chest pain observation visits over 24-months, with 4,087 visits before and 2,634 visits after the hs-cTn protocol implementation. Comparison groups were similar in terms of age, gender, and type of insurance. There were 10.59 (95% CI: 10.24 - 10.95) daily chest pain observation visits before and 7.66 (95% CI: 7.34 - 7.97) visits after implementation, with a 28% (95% CI: 35% - 20%) decrease in the total daily census. As a portion of all observation visits, there was a 22% drop in the proportion that were observed for chest pain. The daily number of chest pain patients requiring inpatient admission was unchanged. The daily total direct cost for chest pain observation decreased with an effective daily cost savings of $4,313 USD (95% CI: $1,534 - $6,998). The total daily number of chest pain observation bed hours also decreased by 41.5 hours (95% CI 13.4 - 96.4 hr).</p><p><strong>Conclusion: </strong>Implementation of a hs-cTn chest pain protocol was associated with a significant decrease in the number and proportion of observation visits, a decrease in total daily cost and bed hours used, and no increase in inpatient admissions.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538752","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}
引用次数: 0
Efficacy of Inclisiran in Patients Having Familial Hypercholesterolemia: Heterozygous Compared to Homozygous Trait, a Systematic Review and Meta-analysis. 家族性高胆固醇血症患者服用英克利西兰的疗效:杂合子与同合子特质的比较,一项系统性综述和荟萃分析。
Critical Pathways in Cardiology Pub Date : 2024-06-01 Epub Date: 2024-03-05 DOI: 10.1097/HPC.0000000000000353
Rahul Rai, Payal Devi, Kapeel Kumar, Kainat Naeem, Hanesh Kumar, Kajal Kumari, Anish Kumar, Aman Kumar, Aqeel Muhammad, Muhammad Sohaib Khan, Ghulam Qadir, Shaheryar Ali, Mahveer Maheshwari, Mohammad Jawwad
{"title":"Efficacy of Inclisiran in Patients Having Familial Hypercholesterolemia: Heterozygous Compared to Homozygous Trait, a Systematic Review and Meta-analysis.","authors":"Rahul Rai, Payal Devi, Kapeel Kumar, Kainat Naeem, Hanesh Kumar, Kajal Kumari, Anish Kumar, Aman Kumar, Aqeel Muhammad, Muhammad Sohaib Khan, Ghulam Qadir, Shaheryar Ali, Mahveer Maheshwari, Mohammad Jawwad","doi":"10.1097/HPC.0000000000000353","DOIUrl":"10.1097/HPC.0000000000000353","url":null,"abstract":"<p><strong>Objective: </strong>To find out whether inclisiran sodium has different efficacy in heterozygous familial hypercholesterolemia (HeFH) and homozygous familial hypercholesterolemia (HoFH) patient groups.</p><p><strong>Methods: </strong>We conducted the systematic review and meta-analysis of ORION clinical trials. PubMed, Embase, and Clinicaltrials.gov databases were searched for the relevant studies. Atheroscalerotic parameters considered for our objective were low-density lipoprotein cholesterol, total cholesterol, proprotein convertase subtilisin/kexin type 9 (PCSK9), apolipoprotein B, and nonhigh-density lipoprotein cholesterol. Primary outcomes were the percentage difference in atheroscalerotic parameters at follow-up relative to baseline values. Our study examined these primary outcomes to determine whether there is a statistically significant difference between the HeFH and HoFH groups. Risk of bias was assessed by the Cochrane risk of bias tool. Meta-analysis was performed when at least 2 studies reported on the same variable.</p><p><strong>Results: </strong>Four ORION clinical trials provided the data related to the mean difference in the atheroscalerotic parameters at follow-up relative to baseline, of HeFH and HoFH patient populations, after administration of 300 mg inclisiran subcutaneously. We pooled together these mean differences for each group and applied a statistical test to analyze if the values were significantly different between the groups. The results of our study unveiled the significant difference in pooled mean differences in low-density lipoprotein cholesterol (HeFH: -48.62%; HoFH: -9.12%; P < 0.05), total cholesterol (HeFH: -30.31%; HoFH: -11.50%; P < 0.05), apolipoprotein (HeFH: -39.97%; HoFH: -14.68%; P < 0.05), and nonhigh-density lipoprotein (HeFH: -44.51%; HoFH: -12.22%; P < 0.05) between HeFH and HoFH groups. However, the difference in pooled mean difference in PCSK9 values (HeFH: -68.41%; HoFH: -56.25%; P = 0.2) between HeFH and HoFH groups was statistically insignificant. Studies were of high quality.</p><p><strong>Conclusions: </strong>There was a significant difference in the reductions in atherosclerotic lipid parameters in heterozygous and homozygous populations after the administration of inclisiran except for PCSK9 parameter. Further studies are needed to support this conclusion.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"73-80"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040555","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}
引用次数: 0
Current Gaps in the Provision of Safe and Effective Anticoagulation in Atrial Fibrillation and the Potential for Factor XI-Directed Therapeutics. 目前在为心房颤动患者提供安全有效的抗凝治疗方面存在的差距以及因子 XI 主导疗法的潜力。
Critical Pathways in Cardiology Pub Date : 2024-06-01 Epub Date: 2024-02-21 DOI: 10.1097/HPC.0000000000000351
Shaun G Goodman, Denis Roy, Charles V Pollack, Kori Leblanc, Kevin F Kwaku, Geoffrey D Barnes, Marc P Bonaca, Mellanie True Hills, Elena Campello, John Fanikos, Jean M Connors, Jeffrey I Weitz
{"title":"Current Gaps in the Provision of Safe and Effective Anticoagulation in Atrial Fibrillation and the Potential for Factor XI-Directed Therapeutics.","authors":"Shaun G Goodman, Denis Roy, Charles V Pollack, Kori Leblanc, Kevin F Kwaku, Geoffrey D Barnes, Marc P Bonaca, Mellanie True Hills, Elena Campello, John Fanikos, Jean M Connors, Jeffrey I Weitz","doi":"10.1097/HPC.0000000000000351","DOIUrl":"10.1097/HPC.0000000000000351","url":null,"abstract":"<p><p>The global prevalence of atrial fibrillation is rapidly increasing, in large part due to the aging of the population. Atrial fibrillation is known to increase the risk of thromboembolic stroke by 5 times, but it has been evident for decades that well-managed anticoagulation therapy can greatly attenuate this risk. Despite advances in pharmacology (such as the shift from vitamin K antagonists to direct oral anticoagulants) that have increased the safety and convenience of chronic oral anticoagulation in atrial fibrillation, a preponderance of recent observational data indicates that protection from stroke is poorly achieved on a population basis. This outcomes deficit is multifactorial in origin, stemming from a combination of underprescribing of anticoagulants (often as a result of bleeding concerns by prescribers), limitations of the drugs themselves (drug-drug interactions, bioaccumulation in renal insufficiency, short half-lives that result in lapses in therapeutic effect, etc), and suboptimal patient adherence that results from lack of understanding/education, polypharmacy, fear of bleeding, forgetfulness, and socioeconomic barriers, among other obstacles. Often this adherence is not reported to treating clinicians, further subverting efforts to optimize care. A multidisciplinary, interprofessional panel of clinicians met during the 2023 International Society of Thrombosis and Haemostasis Congress to discuss these gaps in therapy, how they can be more readily recognized, and the potential for factor XI-directed anticoagulants to improve the safety and efficacy of stroke prevention. A full appreciation of this potential requires a reevaluation of traditional teaching about the \"coagulation cascade\" and decoupling the processes that result in (physiologic) hemostasis and (pathologic) thrombosis. The panel discussion is summarized and presented here.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"47-57"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11191052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933347","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
Sex-Age Interplay Among Young Aged Egyptians With First Acute Myocardial Infarction. 首次发生急性心肌梗死的埃及年轻人中性别与年龄的相互作用
Critical Pathways in Cardiology Pub Date : 2024-06-01 Epub Date: 2023-12-29 DOI: 10.1097/HPC.0000000000000345
Ibtesam I El-Dosouky, Montaser M El Seqelly, Ahmed M Ebrahiem, Mohamed Abdelhady Mohamed
{"title":"Sex-Age Interplay Among Young Aged Egyptians With First Acute Myocardial Infarction.","authors":"Ibtesam I El-Dosouky, Montaser M El Seqelly, Ahmed M Ebrahiem, Mohamed Abdelhady Mohamed","doi":"10.1097/HPC.0000000000000345","DOIUrl":"10.1097/HPC.0000000000000345","url":null,"abstract":"<p><strong>Background: </strong>The burden of modifiable risk factors in young Egyptian adults presenting with first acute myocardial infarction (AMI), sex differences, sex-age interplay, and its relationship with demographic, angiographic characteristics, and type of AMI is a good topic for discussion.</p><p><strong>Methods: </strong>The study enrolled 165 young (≤45 years old) consecutive, eligible patients diagnosed with first AMI (ST-elevation myocardial infarction, non-ST-elevation myocardial infarction), for their demographic, angiographic, echocardiographic, and laboratory investigations and gender differences.</p><p><strong>Results: </strong>Our population were 29-45 years old and 12.1% were females, most of whom had ST-elevation myocardial infarction; obesity in females and smoking in males were the most prevalent; and the younger the age of females presenting with AMI the more aggressive underlying risk factors and the more reduction in left ventricular ejection fraction. Most of the female culprit lesions were thrombotic and the severity of atherosclerotic culprit lesions correlated positively with blood pressure.</p><p><strong>Conclusions: </strong>The age paradox in young females (regarding left ventricular ejection fraction and the traditional risk factors) and the thrombotic nature of the culprit lesion mandate early intensive 1-year and 2-year preventive strategies against coronary heart disease (CHD) with special concern for obesity as the main trigger early in life with proper control of blood pressure. In males, smoking cessation programs are the main target to ameliorate the progress of CHD hand in hand with the other 1-year and 2-year preventive strategies of CHD.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"95-102"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404696","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}
引用次数: 0
Association of Arterial Carbon Dioxide Tension Following In-Hospital Cardiac Arrest With Survival and Favorable Neurologic Outcome. 院内心脏骤停后动脉二氧化碳张力与存活率和良好神经系统预后的关系
Critical Pathways in Cardiology Pub Date : 2024-06-01 Epub Date: 2024-02-19 DOI: 10.1097/HPC.0000000000000350
Natalie Millet, Sam Parnia, Yevgeniy Genchanok, Puja B Parikh, Wei Hou, Jignesh K Patel
{"title":"Association of Arterial Carbon Dioxide Tension Following In-Hospital Cardiac Arrest With Survival and Favorable Neurologic Outcome.","authors":"Natalie Millet, Sam Parnia, Yevgeniy Genchanok, Puja B Parikh, Wei Hou, Jignesh K Patel","doi":"10.1097/HPC.0000000000000350","DOIUrl":"10.1097/HPC.0000000000000350","url":null,"abstract":"<p><strong>Background: </strong>In-hospital cardiac arrest (IHCA) continues to be associated with high morbidity and mortality. The objective of this study was to study the association of arterial carbon dioxide tension (PaCO2) on survival to discharge and favorable neurologic outcomes in adults with IHCA.</p><p><strong>Methods: </strong>The study population included 353 adults who underwent resuscitation from 2011 to 2019 for IHCA at an academic tertiary care medical center with arterial blood gas testing done within 24 hours of arrest. Outcomes of interest included survival to discharge and favorable neurologic outcome, defined as Glasgow outcome score of 4-5.</p><p><strong>Results: </strong>Of the 353 patients studied, PaCO2 classification included: hypocapnia (PaCO2 <35 mm Hg, n = 89), normocapnia (PaCO2 35-45 mm Hg, n = 151), and hypercapnia (PaCO2 >45 mm Hg, n = 113). Hypercapnic patients were further divided into mild (45 mm Hg < PaCO2 ≤55 mm Hg, n = 62) and moderate/severe hypercapnia (PaCO2 > 55 mm Hg, n = 51). Patients with normocapnia had the highest rates of survival to hospital discharge (52.3% vs. 32.6% vs. 30.1%, P < 0.001) and favorable neurologic outcome (35.8% vs. 25.8% vs. 17.9%, P = 0.005) compared those with hypocapnia and hypercapnia respectively. In multivariable analysis, compared to normocapnia, hypocapnia [odds ratio (OR), 2.06; 95% confidence interval (CI), 1.15-3.70] and hypercapnia (OR, 2.67; 95% CI, 1.53-4.66) were both found to be independently associated with higher rates of in-hospital mortality. Compared to normocapnia, while mild hypercapnia (OR, 2.53; 95% CI, 1.29-4.97) and moderate/severe hypercapnia (OR, 2.86; 95% CI, 1.35-6.06) were both independently associated with higher in-hospital mortality compared to normocapnia, moderate/severe hypercapnia was also independently associated with lower rates of favorable neurologic outcome (OR, 0.28; 95% CI, 0.11-0.73), while mild hypercapnia was not.</p><p><strong>Conclusions: </strong>In this prospective registry of adults with IHCA, hypercapnia noted within 24 hours after arrest was independently associated with lower rates of survival to discharge and favorable neurologic outcome.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"106-110"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933346","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}
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