Heart & Lung最新文献

{"title":"Retraction Notice: Effects of Ventilatory Bundles on Patient Outcomes among ICU Patients: A Systematic Review and Meta-Analysis.","authors":"Dejina Thapa, Sek Ying Chair, Mei Sin Chong, Rishi Ram Poudel, Tenaw Gualu Melesse, Kai Chow Choi, Hon Lon Tam","doi":"10.1016/j.hrtlng.2024.11.015","DOIUrl":"10.1016/j.hrtlng.2024.11.015","url":null,"abstract":"","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792900","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":"Enhancing patient experience in the surgical ICU through virtual reality: A pre-post mixed-methods study.","authors":"Xinxing Ju, Li Jiang, Jie Yang, Qiyuan Zheng, Xiaoxin Liu","doi":"10.1016/j.hrtlng.2024.11.014","DOIUrl":"https://doi.org/10.1016/j.hrtlng.2024.11.014","url":null,"abstract":"<p><strong>Background: </strong>Patients in the Surgical Intensive Care Unit (SICU) often experience psychological stress.</p><p><strong>Objectives: </strong>To evaluate the feasibility, acceptability, and potential outcomes of virtual reality (VR) interventions for enhancing patient experience during SICU stay.</p><p><strong>Methods: </strong>This mixed-method study employed a pre-post-test design complemented by a sequential explanatory approach, conducted from January to December 2023 in the SICU of a hospital in China. Quantitative data (n = 32) were collected using a Visual Analog Scale to assess pain, fatigue, depression, anxiety, and comfort. Physiological parameters, including blood pressure (BP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO²) were obtained from a bedside patient monitor. Additionally, self-designed questionnaires were used to evaluate VR acceptance, while the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ) was used to assess discomfort related to VR interventions. Qualitative data from experimental patients (n = 10) were analyzed through in-depth interviews.</p><p><strong>Results: </strong>Post-intervention, patients showed significant reductions in pain, fatigue, depression, and anxiety, along with increased comfort levels (P < 0.05). There were no significant differences in pre- and post-intervention BP, HR, RR, or SpO². The mean VR acceptance score was 3.90±0.62, with minimal discomfort reported. Qualitative analysis revealed four themes: positive patient attitude toward VR, benefits of VR for well-being, multiple influences on VR implementation, and implementation of VR with safety assurance.</p><p><strong>Conclusion: </strong>VR interventions significantly reduced psychological stress and improved comfort in SICU patients, with high acceptance and minimal side effects. Further research is needed to optimize VR use in this setting.</p>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"93-101"},"PeriodicalIF":2.4,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781888","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":"Combined arm-leg endurance training vs. leg endurance training in patients with an implantable cardioverter defibrillator: A randomized controlled study","authors":"Ayşe Akdal ,&nbsp;Yusuf Karavelioglu ,&nbsp;Teyyar Gokdeniz ,&nbsp;Ayla Caglıyan Turk ,&nbsp;Ferhat Unal ,&nbsp;Ebru Calik Kutukcu","doi":"10.1016/j.hrtlng.2024.11.011","DOIUrl":"10.1016/j.hrtlng.2024.11.011","url":null,"abstract":"<div><h3>Background</h3><div>There is a lack of evidence regarding the effect of combining arm and leg training on arm exercise capacity, upper extremity functionality and safety in patients with implantable cardioverter-defibrillators (ICDs).</div></div><div><h3>Objective</h3><div>The aim of this study was to compare the effects of combined arm-leg endurance training (ET_arm+leg) with leg endurance training (ET_leg) alone on arm exercise capacity, cardiorespiratory fitness, and safety issues in patients with ICDs.</div></div><div><h3>Methods</h3><div>In this prospective randomized controlled study, 24 caucasian patients with an ICD (NYHA class II–III, mean age: 59.38±11.54 years, 20 male, 4 female) underwent cardiopulmonary exercise testing (CPET) and arm ergometry. The ET_leg intervention consisted of cycle ergometer training for 40 min at workload of 70–80 % of peak oxygen consumption (VO_2peak). The ET_arm+leg intervention also included arm ergometer training for 20 min at 60 % peak workload (W_peak). Both exercise programs were performed for a total of 30 sessions (5 days for 6 weeks). Quade's non-parametric covariance analysis was performed for changes between groups by adjusting before treatment.</div></div><div><h3>Results</h3><div>Significant increases in time to reach VO_2peak (min), VO_2peak (L), VO_2peak/kg (L/kg/min), VO_2peak (%), W_peak, and test duration during arm ergometry were observed in the ET_arm+leg group (<em>p</em> &lt; 0.05). No shocks or ventricular tachycardia/fibrillation episodes were recorded.</div></div><div><h3>Conclusions</h3><div>ET_arm+leg had a more pronounced effect on cardiopulmonary exercise capacity and arm exercise capacity in patients with ICDs. Arm exercise training is safe in terms of ICD parameters and should be incorporated into cardiac rehabilitation for patients with ICDs.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 82-92"},"PeriodicalIF":2.4,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747974","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":"Perioperative respiratory muscle exercise in patients undergoing cardiac surgery: An evidence-based review","authors":"Qiaoying Wang ,&nbsp;Yanchun Peng ,&nbsp;Shurong Xu ,&nbsp;Huan Guo ,&nbsp;Yaqin Chen ,&nbsp;Lingyu Lin ,&nbsp;Liangwan Chen ,&nbsp;Yanjuan Lin","doi":"10.1016/j.hrtlng.2024.10.017","DOIUrl":"10.1016/j.hrtlng.2024.10.017","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced respiratory muscle management is imperative in cardiac surgery patients due to their universal risk of decreased perioperative respiratory muscle strength.</div></div><div><h3>Objectives</h3><div>Most existing articles primarily examine respiratory muscle exercise during either the preoperative, postoperative, or at-home phases. Consequently, there is a crucial need to consolidate the evidence for respiratory muscle exercise throughout the perioperative period of cardiac surgery.</div></div><div><h3>Methods</h3><div>A literature search was performed, encompassing guideline networks and databases up until July 2023. The literature was classified into seven thematic categories: preoperative assessment, patient education, trainers, training plans, quality control, safety monitoring, and outcome assessment. The quality of the included literature was assessed using the GRAGE evidence grading system to ascertain the level of recommendation associated with each piece of evidence.</div></div><div><h3>Results</h3><div>Nineteen papers were reviewed, encompassing 24 suggestions. These consisted of two suggestions on preoperative assessment, four on patient education, two on trainers, six on training programs, seven on quality control, two on safety monitoring, and one on outcome assessment. All 24 suggestions were categorized as strong recommendations, with 14 classified as high-quality evidence and ten as moderate-quality evidence.</div></div><div><h3>Conclusions</h3><div>Our study presents a succinct synthesis of the most robust evidence available on perioperative respiratory muscle exercise in cardiac surgery patients. We identified ten high-quality suggestions while an additional 14 moderate-quality suggestions. In the context of perioperative exercise, we recommend that moderate-intensity inspiratory muscle exercises be provided during the preoperative and postoperative phases upon transfer to the ward. We advocate for the implementation of low-intensity inspiratory muscle exercises during the postoperative phase while patients are in the intensive care unit.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 73-81"},"PeriodicalIF":2.4,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142723893","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":"Validity and reliability of the thirst distress scale and the short version of the xerostomia inventory for use in German patients with chronic heart failure: A multicenter cross-sectional study","authors":"Franziska Wefer ,&nbsp;Lars Krüger ,&nbsp;Nina Kolbe ,&nbsp;Melanie Seel ,&nbsp;Maria Lutao ,&nbsp;Franziska Ottenbreit ,&nbsp;Samee Anton ,&nbsp;Elena Wuzel-Samimi ,&nbsp;Anne Richter ,&nbsp;Irina Stuth ,&nbsp;Sascha Köpke ,&nbsp;Stefan Köberich","doi":"10.1016/j.hrtlng.2024.11.013","DOIUrl":"10.1016/j.hrtlng.2024.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Thirst and xerostomia are prevalent and distressing symptoms in patients with chronic heart failure (CHF). Evaluation of interventions to alleviate these symptoms requires valid and reliable instruments. Such instruments are currently lacking for German patients with CHF.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to evaluate the structural and convergent validity, and internal consistency reliability of the German versions of the Thirst Distress Scale for Patients with Heart Failure (G-TDS-HF) and the short form of the Xerostomia Inventory (G-SXI).</div></div><div><h3>Methods</h3><div>A cross-sectional, multicenter study was conducted involving patients with CHF. Participants completed a questionnaire containing the G-TDS-HF, G-SXI, and a visual analog scale (VAS) to indicate intensity of thirst and xerostomia. Exploratory and confirmatory factor analyses were conducted to assess structural validity. To assess internal consistency reliability, McDonald's Omega total was calculated, and Pearson´s r was used to examine convergent validity.</div></div><div><h3>Results</h3><div>A total of 371 patients (62.4 (± 14.9) years, 28.3 % female) participated in the study. Factor analysis of the G-TDS-HF revealed a two-factor structure. One factor represents symptom occurrence, and the second factor is symptom distress. Internal consistency reliability was deemed adequate, with McDonald's Omega total coefficients of 0.81. The correlation between the sum scores of the G-TDS-HF and thirst intensity (VAS) was <em>r</em> = 0.44 (<em>p</em> &lt; 0.001). The G-SXI demonstrated a single-factor structure with a McDonald's Omega total of 0.71. The correlation between the G-SXI and xerostomia intensity (VAS) was <em>r</em> = 0.36 (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Results suggest that the G-TDS-HF and the G-SXI are valid and reliable instruments. Further research is warranted to assess responsiveness and test-retest reliability to strengthen the evidence.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 65-72"},"PeriodicalIF":2.4,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699028","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":"Board of Directors","authors":"","doi":"10.1016/S0147-9563(24)00217-6","DOIUrl":"10.1016/S0147-9563(24)00217-6","url":null,"abstract":"","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"69 ","pages":"Page v"},"PeriodicalIF":2.4,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698974","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":"Acute decompensated pulmonary hypertension outcomes in pulmonary arterial hypertension patients: systematic review and meta-analysis of proportions","authors":"Marcos Vinicius Fernandes Garcia MD PhD ,&nbsp;Abdelrahman Nanah MD ,&nbsp;Pedro Caruso MD PhD","doi":"10.1016/j.hrtlng.2024.11.009","DOIUrl":"10.1016/j.hrtlng.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Acute decompensated pulmonary arterial hypertension (ADPH) is characterized by right heart failure due to elevated afterload and inadequate cardiac output, and it presents a significant mortality risk. Understanding mortality proportions and the impact of life-sustaining therapies is crucial for informing clinical practice and patient prognosis.</div></div><div><h3>Objectives</h3><div>To assess mortality proportions in ADPH across different clinical settings and to assess how they vary depending on the type of life-sustaining interventions used.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis of proportions were conducted, examining mortality in ADPH focusing on three primary outcomes: ICU mortality, hospital mortality, and hospital mortality in patients requiring extracorporeal membrane oxygenation (ECMO). Common and random-effects meta-analyses were performed to calculate pooled mortality proportions with 95% confidence intervals (CI95%). Temporal trends were analyzed using meta-regression.</div></div><div><h3>Results</h3><div>Twenty-five observational studies conducted between 2003 and 2023, involving 1,249 ADPH patients, were included. The random-effect analysis revealed an ICU pooled mortality proportion of 29% (CI95% 25–34, <em>I</em>²=40%, <em>p</em>=0.12) and a pooled hospital mortality proportion of 38% (CI95% 31–47, <em>I</em>²=70%, <em>p</em>&lt;0.01). Pooled mortality proportion for patients on ECMO was 45% (CI95% 38–52, <em>I</em>²=0%, <em>p</em>=0.96). Patients receiving inotropes or vasopressors had pooled mortality proportion of 56% (CI95% 44–68, <em>I</em>²=42%, <em>p</em>=0.18) and 57% (CI95% 48–65, <em>I</em>²=57%, <em>p</em>=0.02), respectively. Meta-regression analysis revealed no significant trend in hospital mortality over the span of twenty years.</div></div><div><h3>Conclusions</h3><div>Variation in ADPH mortality across hospital settings and life-sustaining therapies underscores the complexity of managing ADPH. These findings inform clinical practice and support prognostic discussions with patients and families.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 57-64"},"PeriodicalIF":2.4,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696058","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":"Pulmonary arterial stiffness and vascular tone in pulmonary hypertension: Insights from waveform-derived reflection index and hemodynamic correlations","authors":"Mustafa Oğuz MD ,&nbsp;Mehmet Uzun MD ,&nbsp;İrem Yılmaz MD ,&nbsp;Almina Erdem MD ,&nbsp;Murat Demirci MD ,&nbsp;Nilüfer Ekşi Duran MD","doi":"10.1016/j.hrtlng.2024.11.007","DOIUrl":"10.1016/j.hrtlng.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary hypertension (PH) involves increased arterial stiffness and reduced vascular tone, affecting pulmonary arterial wave reflections. The Reflection Index (RI) may provide insights into these changes.</div></div><div><h3>Objective</h3><div>This study examines the utility of RI in PH patients by correlating it with key right heart catheterization (RHC) parameters.</div></div><div><h3>Methods</h3><div>Patients who underwent RHC with a preliminary diagnosis of PH, including those with normal RHC findings and those diagnosed with Group 1 and Group 4 PH, were included in the study. RI was defined as the ratio of systolic to diastolic pressure differences from pulmonary arterial waveforms and compared with hemodynamic, clinical, and echocardiographic parameters.</div></div><div><h3>Results</h3><div>The study included 115 patients (mean age 53.92 ± 16.43 years; 43.5% male). RI showed significant correlations with key RHC parameters, such as sPAP (r=0.359, p&lt;0.001), dPAP (r=0.322, p&lt;0.001), mPAP (r=0.339, p&lt;0.001), PVR (r=0.431, p&lt;0.001), and pSO2 (r=-0.243, p=0.011). Among echocardiographic measures, RI correlated with TRV (r=0.377, p&lt;0.001) and echo sPAP (r=0.359, p&lt;0.001). In multivariable analysis, RI (OR:1.032, p=0.003) and NT-proBNP (OR:1.004, p=0.049) remained significant predictors of PH. ROC analysis demonstrated the moderate predictive power for RI (AUC=0.806, p&lt;0.001), with 76.4% sensitivity and 78.5% specificity at a cut-off of 232.05.</div></div><div><h3>Conclusion</h3><div>RI is a valuable parameter for assessing pulmonary arterial stiffness and vascular tone in patients with PAH and CTEPH. Significant correlations were observed with key hemodynamic parameters, including PVR and mPAP. Additionally, RI demonstrated moderate predictive power for PH. These findings highlight the potential of RI as an independent marker of vascular health, providing direct insights into the pulmonary arterial bed.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 50-56"},"PeriodicalIF":2.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689447","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":"Comparing the in-hospital outcomes of patients with Takotsubo cardiomyopathy and chronic obstructive pulmonary disease","authors":"Chenlin Li MD ,&nbsp;Pengyang Li MD ,&nbsp;Xiaojia Lu MD ,&nbsp;Yan Chen MD ,&nbsp;Peng Cai MD ,&nbsp;Catherine Teng MD ,&nbsp;Jie Jing MS ,&nbsp;Jingkun Zhang MD ,&nbsp;Shiyan Jiang MD ,&nbsp;Yue Liu MD ,&nbsp;Jing Liang MD ,&nbsp;Yanxuan Wang MD ,&nbsp;Bin Wang MD, PhD","doi":"10.1016/j.hrtlng.2024.11.008","DOIUrl":"10.1016/j.hrtlng.2024.11.008","url":null,"abstract":"<div><h3>Background</h3><div>Secondary Takotsubo syndrome (TTS) differs from primary TTS in terms of clinical characteristics, management, and prognosis. COPD exacerbation has been recognized as a physical trigger for TTS, but its prognostic implications for secondary TTS are poorly understood.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to examine the effects of COPD on in-hospital outcomes in TTS patients.</div></div><div><h3>Methods</h3><div>Using data from the National Inpatient Sample, patients with a primary diagnosis of COPD and a secondary diagnosis of TTS were identified (COPD-TTS group). Patients with a primary diagnosis of TTS and comorbid COPD were selected as a control group (TTS-COPD group). Then, we compared the in-hospital mortality and the incidence of adverse events before and after propensity score matching.</div></div><div><h3>Results</h3><div>603 patients were included in each of the TTS-COPD and COPD-TTS groups after matching. In both groups, the average age of included patients was about 68 years, and more than 85 percent of them were female. There were no statistically significant differences in the in-hospital mortality or the incident of cardiac arrest, ventricular arrhythmias, and AKI, between the two groups (All, p &gt; 0.05). Patients with COPD-TTS had a higher rate of acute respiratory failure (ARF) (p &lt; 0.001), a lower rate of cardiogenic shock (p = 0.001), and a longer length of hospital stay (LOS) (p &lt; 0.001) compared to patients with TTS-COPD.</div></div><div><h3>Conclusions</h3><div>Patients with COPD-TTS had a higher rate of ARF and a longer LOS but a lower risk of cardiogenic shock compared to patients with TTS-COPD.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 43-49"},"PeriodicalIF":2.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689172","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":"Door-to-Diuretic Time is related to length of hospital stay independent of diuretic dose among acute decompensated heart failure patients","authors":"Dillon J Dzikowicz PhD, RN, PCCN ,&nbsp;Mehmed Aktas ,&nbsp;Sunita Pokhrel Bhattarai PhD, RN ,&nbsp;Leway Chen MD, MPH ,&nbsp;Mary G. Carey PhD, RN, FAHA, FAAN","doi":"10.1016/j.hrtlng.2024.11.002","DOIUrl":"10.1016/j.hrtlng.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Acute decompensated heart failure (ADHF) treatment guidelines recommend initial dosages for diuretic drugs but lack guidance on treatment timing. Recent evidence indicates that faster treatment, or shorter Door-to-Diuretic (D2D) Time, may improve outcomes.</div></div><div><h3>Objectives</h3><div>This study assessed how diuretic dose, D2D Time, and their interaction affect hospital length of stay.</div></div><div><h3>Methods</h3><div>Data were analyzed from medical records of ADHF patients in the emergency department of a large academic center. We calculated the odds of longer hospitalization (&gt;7 days) based on diuretic dose, D2D Time, and their interaction, adjusting for age, sex, race, NYHA class, creatinine levels, systolic blood pressure, and comorbidity burden.</div></div><div><h3>Results</h3><div>Our sample of 198 patients who were hospitalized a total of 275 times (mean: 1.48±0.99 hospitalizations) were predominantly male (57 %), older (71, IQR:18.5), years), overweight/obese (30.12, IQR: 11.66 kg/m²), had multiple comorbidities (5.6 ± 2.1), and had a reduced ejection fraction (58 %, <em>n</em> = 159). The median length of hospital stay was 7.0 days (8.0). Peripheral edema was significantly higher among ADHF patients with prolonged hospitalization (28.69% vs. 15.68 %, <em>p</em> = 0.01). D2D Time was a statistically significant predictor of prolonged hospitalization without (OR=1.011609, <em>p</em> = 0.041) and with (OR=1.012409, <em>p</em> = 0.034) covariate adjustment. Neither the diuretic dose nor the interaction between the D2D Time and dose were significant predictors.</div></div><div><h3>Conclusion</h3><div>D2D Time significantly predicts prolonged hospitalization independently of diuretic dosing, highlighting a need for revised ADHF guidelines that include both diuretic dosing and timely administration. Further research is essential to refine these recommendations.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 36-42"},"PeriodicalIF":2.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683799","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}