Heart & Lung最新文献

{"title":"Long-term outcomes following aortic valve replacement in bioprosthetic vs mechanical valves.","authors":"Abeline R Watkins, Ryaan El-Andari, Nicholas M Fialka, Jimmy Jh Kang, Yongzhe Hong, Sabin J Bozso, Devilliers Jonker, Michael Moon, Jayan Nagendran, Jeevan Nagendran","doi":"10.1016/j.hrtlng.2024.09.016","DOIUrl":"https://doi.org/10.1016/j.hrtlng.2024.09.016","url":null,"abstract":"<p><strong>Background: </strong>Aortic valve disease(AVD) accounts for 33 % of valvular heart disease(VHD) but causes over 60 % of VHD mortality. For surgical AVR, mechanical valves are recommended for patients <50 years old and bioprosthetic valves for those >70 years old.</p><p><strong>Objectives: </strong>To investigate the long-term differences following AV replacement(AVR) comparing bioprosthetic and mechanical valves in patients aged 50-70.</p><p><strong>Methods: </strong>4,927 patients underwent AVR, 744 of which were propensity-matched 2:1 for bioprosthetic and mechanical valves. Outcomes included mortality, morbidity, and rates of reoperation.</p><p><strong>Results: </strong>The average age of the propensity-matched groups was 57 and 56.7 years, and female sex accounted for 26.4 % and 25.0 % for the bioprosthetic and mechanical valve groups, respectively. Other baseline demographics and comorbidities were similar between the groups. There were no deaths at 30 days and complication rates did not differ between groups(p > 0.05). Mortality at 1, 5, and 15 years was similar between groups. Reoperation rates at 5 and 10 years did not significantly differ between bioprosthetic and mechanical valves(p = 0.84, p = 0.31), although at 15-year follow-up, patients with bioprosthetic valves were more likely to require reoperation(21.2 % versus 9.7 %, adjusted hazard ratio 3.65, 95 % confidence interval 1.07-12.5, p = 0.0.39).</p><p><strong>Conclusions: </strong>Patients receiving AVR from 50 to 70 years old have similar long-term outcomes irrespective of whether they received bioprosthetic or mechanical valves, with only reoperation being significantly different at 15 years follow-up. With low rates of reoperation, mortality, and avoidance of anticoagulation, bioprosthetic valves are a reasonable option for patients 50-70 years old, although mechanical valves still provide a durability benefit for young patients.</p>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of intubation and hypoxemia on intraventricular hemorrhage in preterm infants during the first week: An observational study.","authors":"Yu-Ting Chen, Hsiang-Ping Wu, Hsiang-Yun Lan, Hsueh-Fang Peng, Shyi-Jou Chen, Ti Yin, Jen-Jiuan Liaw, Yue-Cune Chang","doi":"10.1016/j.hrtlng.2024.09.013","DOIUrl":"https://doi.org/10.1016/j.hrtlng.2024.09.013","url":null,"abstract":"<p><strong>Background: </strong>Preterm infants with intraventricular hemorrhage (IVH) are at a risk of developing neurodevelopmental disabilities. Few studies have examined the effects of oxygen saturation (SpO₂) changes and intubation procedures on the risk of IVH.</p><p><strong>Objectives: </strong>We examined the effects of intubation and the rates of three thresholds of hypoxemia on the occurrence of IVH in preterm infants during their first week in the neonatal intensive care unit (NICU).</p><p><strong>Methods: </strong>In this prospective observational cohort study, preterm infants with a gestational age (GA) of <37 weeks were included from two Level III NICUs in Taiwan. Continuous electrocardiography was used to monitor SpO₂ changes, and cranial ultrasonography was used to monitor IVH. Thresholds of hypoxemia (SpO₂ levels of <80 %, <85 %, and <90 %) were screened by digitally sampling data at 10-s intervals. Generalized estimating equations were used with logistic regression to analyze the effects of intubation and the rates of the three thresholds of hypoxemia on the risk of IVH during the first week after birth.</p><p><strong>Results: </strong>In all preterm infants (N = 73), the mean GA was 31.55 weeks, and the mean birth weight was 1508.86 g. Intubation within 3 days of birth, duration of mechanical ventilation and oxygen use, hypoxemia rate, and maternal use of magnesium sulfate before and during delivery were significantly associated with IVH. A multivariate analysis revealed that intubation was a key factor associated with the occurrence of IVH across different thresholds of hypoxemia (p = 0.004).</p><p><strong>Conclusions: </strong>Although the rate of hypoxemia, duration of mechanical ventilation and oxygen use, and maternal use of magnesium sulfate were significantly associated with IVH, intubation within 3 days of birth was the key factor responsible for increased IVH risk.</p>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between diet-derived antioxidants and asthma: Insights from the NHANES survey 2003-2018 and Mendelian randomization analysis.","authors":"Linjie Chen, Congjie Chen, Mingyu Lin, Shiying Li, Xue Yi, Tongsheng Chen","doi":"10.1016/j.hrtlng.2024.09.014","DOIUrl":"https://doi.org/10.1016/j.hrtlng.2024.09.014","url":null,"abstract":"<p><strong>Background: </strong>Many studies have reported correlations between diet-derived antioxidants and asthma. Nevertheless, the probable association between diet-derived antioxidants and asthma remains a matter of discussion.</p><p><strong>Objectives: </strong>We explored the association between Diet-Derived Antioxidants and Asthma.</p><p><strong>Methods: </strong>We used data from the 2003-2018 National Health and Nutrition Examination Survey (NHANES) to assess the relationship between diet-derived antioxidants and asthma and a two-sample Mendelian randomization (MR) study was employed to assess the causal associations between lifelong diet-derived circulating antioxidant levels and the risk of asthma.</p><p><strong>Results: </strong>Participants with asthma were more likely to be young-to-middle-aged females, smokers, have lower income, belong to non-Hispanic Black ethnicity, have a high school education, have a BMI over 30. The dietary intakes of vitamin C, zinc, selenium, and CDAI were negatively associated with asthma risk (Vitamin C: OR = 0.76, 95 % CI: 0.63-0.91, P = 0.032; Zinc: OR = 0.86, 95 % CI: 0.75-1.00, P = 0.046; Selenium: OR = 0.85, 95 % CI: 0.73-0.98, P = 0.004; CDAI: OR = 0.80, 95 % CI: 0.65-0.97, P = 0.027). There was a significant nonlinear relationship between the dietary intake of vitamin C, zinc, and selenium and the risk of asthma (P_non-_linear < 0.05). However, no causal link between circulating antioxidants and asthma risk was found in the MR analysis. Sensitivity analyses supported the robustness of the results.</p><p><strong>Conclusion: </strong>In the observational study, we identified a negative correlation between the dietary intake of vitamin C, zinc, selenium, and CDAI and asthma risk, while our MR analyses did not find evidence to support a causal relationship between diet-derived antioxidants and the risk of asthma.</p>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of emergency transcatheter aortic valve replacement in patients with severe aortic stenosis complicated by cardiogenic shock: A systematic review and meta-analysis","authors":"","doi":"10.1016/j.hrtlng.2024.09.011","DOIUrl":"10.1016/j.hrtlng.2024.09.011","url":null,"abstract":"<div><h3>Background</h3><div>The application of transcatheter aortic valve replacement (TAVR) has been developed on different populations in many clinical studies. However, research dedicated to the application of emergency TAVR in patients with aortic stenosis (AS) experiencing cardiogenic shock is limited.</div></div><div><h3>Objective</h3><div>To investigate the safety and effectiveness of emergency TAVR in AS patients with circulatory collapse.</div></div><div><h3>Methods</h3><div>Studies on the application of emergency TAVR in AS patients with cardiogenic shock were screened from PubMed, Web of Science, and Embase databases. Two researchers independently screened the literature-extracted data and conducted a meta-analysis was conducted using STATA 16.0 software.</div></div><div><h3>Results</h3><div>17 studies comprising 36,886 patients undergoing emergency TAVR and 8,530 patients undergoing emergency SAVR or BAV. Emergency TAVR showed no difference in valve implantation success rate compared to elective TAVR. At 30-day endpoints comparison, emergency TAVR exhibited significantly higher all-cause mortality and readmission rates than elective TAVR (RR=2.73 95 %CI 2.04–3.65, <em>P</em> &lt; 0.01; RR=1.2 95 %CI 0.9–1.6, <em>P</em> &lt; 0.01), but reduced mortality risk compared to emergency SAVR/BAV (RD=-0.15 95 %CI -0.25 to -0.04, <em>P</em> = 0.005). At one year post-operation, people with emergency TAVR continued to have higher all-cause mortality than elective TAVR (RR=1.55 95 %CI 1.37–1.74, <em>P</em> &lt; 0.01) but similar with emergency SAVR/BAV (RD=-0.04 95 %CI -0.33 to 0.25, <em>P</em> = 0.796). Rates of severe bleeding and new-onset renal dialysis were higher after emergency TAVR, compared to elective TAVR, while the incidences of permanent pacemaker implantation, severe paravalvular leakage and stroke were similar.</div></div><div><h3>Conclusion</h3><div>Despite emergency TAVR having higher readmission and mortality rates compared to elective TAVR, it is a relatively safe and effective treatment in cases of cardiogenic shock compared to emergency BAV/SAVR.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding attendance patterns and determinants in cardiac, pulmonary, and ICU Rehabilitation/Recovery programs: A systematic review and meta-analysis","authors":"","doi":"10.1016/j.hrtlng.2024.09.010","DOIUrl":"10.1016/j.hrtlng.2024.09.010","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac, pulmonary, and intensive care unit (ICU) rehabilitation/recovery programs are health promotion interventions designed to improve physical recovery, psychological well-being, and quality of life after acute illness while reducing the risk of adverse events.</div></div><div><h3>Objective</h3><div>Identify the difference in attendance rates for patients invited to a cardiac rehabilitation, pulmonary rehabilitation, or ICU recovery program and factors influencing attendance.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis by searching PubMed, EMBASE, CINAHL, Web of Science, and manual reference lists from inception to June 3, 2024. We included studies reporting patient attendance rates in eligible programs following acute illness hospitalization. Two team members independently screened articles and extracted data, with a third member reviewing and achieving consensus when necessary. Our main outcomes focused on the proportion of attendance in eligible programs among patients referred.</div></div><div><h3>Results</h3><div>Of 3,446 studies screened, 179 studies (<em>N</em> = 4,779,012 patients) were included across cardiac rehabilitation (<em>n</em> = 153 studies), pulmonary rehabilitation (<em>n</em> = 11 studies), and ICU recovery (<em>n</em> = 15 studies) programs. Pooled attendance rates were 53 % (95 % CI: 48-57 %) for cardiac rehabilitation, 56 % (95 % CI: 42-70 %) for pulmonary rehabilitation, and 61 % (95 % CI: 51-70 %) for ICU recovery programs. Significant attendance heterogeneity was present (cardiac I²=100 %, <em>p</em> &lt; 0.001; pulmonary I²=100 %, <em>p</em> &lt; 0.001; ICU I²=94 %, <em>p</em> &lt; 0.01). Barriers to attendance included transportation, distance, work conflicts, and patient factors (e.g., comorbidities, older age). Facilitators included male gender, younger age, higher education, income, provider recommendations, and flexible scheduling. Individual factors represented the primary domain affecting attendance.</div></div><div><h3>Conclusions</h3><div>The results indicate comparable attendance rates and factors shaping attendance across acute illness rehabilitation/recovery programs, with ICU recovery programs being the most well-attended on average.</div></div><div><h3>Registration</h3><div>PROSPERO CRD42022357261</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S014795632400181X/pdfft?md5=18f572d2d5ee58f86ebf90f64359cfa6&pid=1-s2.0-S014795632400181X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of exercise-based prehabilitation in patients undergoing coronary artery bypass grafting surgery: A systematic review of randomized controlled trials","authors":"","doi":"10.1016/j.hrtlng.2024.09.007","DOIUrl":"10.1016/j.hrtlng.2024.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative exercise-based rehabilitation improves the physical performance and health-related outcomes of patients undergoing coronary artery bypass grafting (CABG). However, the effectiveness of exercise-based prehabilitation in patients undergoing CABG remains unknown.</div></div><div><h3>Objective</h3><div>The purpose of this systematic review was to investigate the effects of exercise-based prehabilitation on functional exercise capacity, postoperative complications, anxiety, depression, self-efficacy, quality of life, length of hospital and intensive care unit stay, frailty, and endothelial function in patients undergoing CABG surgery.</div></div><div><h3>Methods</h3><div>This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study protocol is recorded in the PROSPERO database (registration number CRD42023488530). PubMed, the Physiotherapy Evidence Database (PEDro), Google Scholar, Web of Science, Scopus, and the Cochrane Library were searched from inception to December 2023. The titles and abstracts of the studies were screened using Rayyan Ai software. After full-text screening, randomized controlled trials that met the inclusion criteria were included.</div></div><div><h3>Results</h3><div>Five randomized controlled trials involving 616 participants were included. The systematic review suggests strong evidence that exercise-based prehabilitation improved functional capacity and moderate evidence that it reduced postoperative complications and length of hospital stay. Although there was conflicting evidence regarding the effects of exercise-based prehabilitation on quality of life, there was limited evidence of its effects on physical activity, anxiety, depression, self-efficacy, frailty, and endothelial function.</div></div><div><h3>Conclusions</h3><div>Exercise-based prehabilitation can be recommended for improvements in functional capacity, postoperative complications, and length of hospital stay in patients undergoing CABG.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “The association between food environment and cardiovascular disease outcomes: A systematic review” [Heart & Lung, volume 68 (2024), Pages 359-366/YMHL2427]","authors":"","doi":"10.1016/j.hrtlng.2024.09.009","DOIUrl":"10.1016/j.hrtlng.2024.09.009","url":null,"abstract":"","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0147956324001808/pdfft?md5=c7128c7a3c130103d0f341066cc3af3b&pid=1-s2.0-S0147956324001808-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modifiable risk factors and motivation for lifestyle change of CVD patients starting cardiac rehabilitation: The BENEFIT study","authors":"","doi":"10.1016/j.hrtlng.2024.09.008","DOIUrl":"10.1016/j.hrtlng.2024.09.008","url":null,"abstract":"<div><h3>Background</h3><p>To improve lifestyle guidance within cardiac rehabilitation (CR), a comprehensive understanding of the motivation and lifestyle-supporting needs of patients with cardiovascular disease (CVD) is required.</p></div><div><h3>Objectives</h3><p>This study's purpose is to evaluate patients’ lifestyle and their motivation, self-efficacy and social support for change when starting CR.</p></div><div><h3>Methods</h3><p>1782 CVD patients (69 % male, mean age 62 years) from 7 Dutch outpatient CR centers participated between 2020 and 2022. Modifiable risk factors were assessed with a survey and interviews by healthcare professionals during CR intake.</p></div><div><h3>Results</h3><p>Most patients exhibited an elevated risk in 3–4 domains. Elevated risks were most prominent in domains of (1) waist circumference and BMI (2) physical exercise (3) healthy foods intake and (4) sleep duration. Most patients chose to focus on increasing physical exercise, but about 20 % also wanted to focus on a healthy diet and/or decrease stress levels. Generally, motivation, self-efficacy and social support to reach new lifestyle goals were high. However, patients with an unfavorable risk profile had lower motivation and self-efficacy to work on lifestyle changes, while patients with lower social support had a higher chance to quit the program prematurely.</p></div><div><h3>Conclusions</h3><p>Our results underscore the need to begin CR with a comprehensive lifestyle assessment and highlight the importance of offering lifestyle interventions tailored to patients’ specific modifiable risk factors and lifestyle-supporting needs, targeting multiple lifestyle domains. Expanding the current scope of CR programs to address diverse patient needs and strengthening support may enhance motivation and adherence and lead to significant long-term benefits for cardiovascular health.</p></div><div><h3>Clinical trial registration number</h3><p>Netherlands Trial Register; registration number NL8443</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0147956324001651/pdfft?md5=41c918c7f17d3c92e14e108bd66a4dbb&pid=1-s2.0-S0147956324001651-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142243655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of aerobic exercise-based pulmonary rehabilitation on quality of life in pediatric asthma: A systematic review and meta-analysis","authors":"","doi":"10.1016/j.hrtlng.2024.09.005","DOIUrl":"10.1016/j.hrtlng.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><p>Pediatric asthma poses a significant global health burden, impacting the well-being and daily lives of affected children. Aerobic exercise-based pulmonary rehabilitation emerges as a promising intervention to address the multifaceted challenges faced by pediatric asthma patients.</p></div><div><h3>Objectives</h3><p>The purpose of this systematic review and meta-analysis was to comprehensively evaluate the effects of aerobic exercise-based pulmonary rehabilitation on pulmonary function and quality of life in pediatric asthma patients.</p></div><div><h3>Methods</h3><p>Randomized controlled trials (RCTs) involving pediatric participants (5–18 years) were included. Aerobic exercise program-based pulmonary rehabilitation interventions were assessed for their impact on actual and percentage predicted values of lung volumes and flow rates such as forced vital capacity (FVC), maximum mid-expiratory flow (FEF25–75), peak expiratory flow (PEF), forced expiratory volume in one second (FEV1), FEV1/FVC, and on quality of life (QoL) measures. A systematic search of databases, hand-searching, and consultation with experts identified relevant studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines guided study selection, data extraction, and quality assessment.</p></div><div><h3>Results</h3><p>The systematic review included 20 studies with diverse exercise interventions and outcomes. The meta-analysis using fixed-effects model showed that there was a significant improvement in FVC (% predicted) [SMD= 0.30, 95 %CI: 0.13, 0.48] and FEF25–75 (% predicted) [SMD= 0.31, 95 %CI: 0.03, 0.58] in the experimental group compared with the control group. Furthermore, using a random-effects model involving 12 studies, significant increases in the QoL [SMD= 0.70, 95 %CI: 0.14, 1.26] were found in the exercise group. Due to inter-study heterogeneity, additional analyses were conducted. Publication bias analysis indicated robustness, with no significant asymmetry in funnel plots.</p></div><div><h3>Conclusion</h3><p>Aerobic exercise-based pulmonary rehabilitation significantly enhances pulmonary function and quality of life in pediatric asthma patients. The findings, supported by improvements in FVC and FEF25–75, demonstrate the efficacy of these interventions. Quality of life measures also showed notable improvements. Despite inter-study heterogeneity, the results are robust, suggesting that aerobic exercise should be considered a valuable non-pharmacological strategy in managing pediatric asthma.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0147956324001614/pdfft?md5=be205720d66d0a6ec660e3fc0a3375f9&pid=1-s2.0-S0147956324001614-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing and content of serious illness conversations for patients with advanced heart failure in a specialty-aligned palliative care service","authors":"","doi":"10.1016/j.hrtlng.2024.09.004","DOIUrl":"10.1016/j.hrtlng.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><p>Patients with advanced heart failure (AHF) desire communication around values and goals prior to treatment decisions.</p></div><div><h3>Objectives</h3><p>To evaluate the timing and content of the first serious illness communication (SI conversation) for patients with AHF after referral to a specialist palliative care (PC) team (HeartPal).</p></div><div><h3>Methods</h3><p>In this retrospective cohort study, we used electronic health records to identify patients referred to HeartPal and their first SI conversations at a tertiary care hospital between October 2018 and September 2021. We used natural language processing and predetermined codes to quantify prevalence of prior goals of care conversations by the cardiology team within six months preceding the HeartPal consultation and the prevalence of hopes, fears, and seven conversation content codes. Consecutive SI conversations and patient outcomes were followed until March 2022.</p></div><div><h3>Results</h3><p>Of 468 patients (mean age: 64 years, 72 % male, 66 % referred for goals of care conversation), 25.2 % had prior documented goals of care conversations preceding the HeartPal consultation. During the study period, 206 (44.0 %) patients died (median time from initial SI conversation to death: 65 days, IQR 206) and 43.2 % engaged in multiple SI conversations before death. SI conversation analysis (<em>n</em> = 324) revealed that patients hoped to “be at home” (74.1 %, <em>n</em> = 240), “be independent” (65.7 %, <em>n</em> = 213) and “live as long as possible” (53.4 %, <em>n</em> = 173). Conversation content included goals of care (83.0 %), strengths (83.0 %), decision-making (79.3 %), spirituality (71.0 %), coping (52.2 %), and prognostic communication (43.5 %).</p></div><div><h3>Conclusion</h3><p>Specialist PC service provides documentation of goals and values and offers longitudinal follow-up for patients with AHF.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}