Heart & Lung最新文献

{"title":"Heart Failure Related Fatigue and Serum Osmolality: An Exploratory Analysis of the National Health and Nutrition Examination Survey","authors":"Christine R. Hoch PhD, RN, ACNS-BC, Jennifer Klinedinst, Karen Larimer, Stephen S. Gottlieb","doi":"10.1016/j.hrtlng.2024.08.003","DOIUrl":"10.1016/j.hrtlng.2024.08.003","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to explore the relationship of serum osmolality to HF-related fatigue, controlling for select physiologic covariates.</div></div><div><h3>Background</h3><div>Fatigue is a common symptom of heart failure (HF) associated with deleterious outcomes including increased morbidity and mortality. Underlying physiologic mechanisms of HF-related fatigue are not well understood. Hypervolemia and hypovolemia have been suggested as potential mechanisms of HF-related fatigue. Serum osmolality has been used as a physiologic measure to assess changes in volume status with therapeutic treatments to manage fluid imbalances. Low serum osmolality is associated with increased risk of mortality and hospital readmission in persons with HF. However, the relationship of serum osmolality and HF-related fatigue has not been well described.</div></div><div><h3>Methods</h3><div>We analyzed cross-sectional data from two waves of the National Health and Nutrition Examination Survey (2015-2016 and 2017-2018). Adults who self-reported having HF without co-morbid conditions known to contribute to fatigue were included in the study (unweighted n = 126). Data were weighted to provide US national estimates, and complex sample design used for analyses. Independent t tests and chi-square tests were used to explore differences between fatigued and nonfatigued adults with HF. Logistic regression analyses were used to calculate the odds of having fatigue. Bivariate logistic regression models were performed to assess the individual contributions of select physiologic covariates: age, sex, hemoglobin, body mass index (BMI) and presence of shortness of breath. Covariates with a significance of p≤.10 were included in the final model. Multivariate logistic regression was performed on the presence of fatigue as the outcome with physiologic predictors selected from the bivariate analysis: BMI and serum osmolality.</div></div><div><h3>Results</h3><div>Being female was associated with higher odds of experiencing fatigue when controlling for serum osmolality and body mass index (OR=4.91, p<.001, CI 2.200 – 10.954). Serum osmolality was lower in those that experienced fatigue compared to those without fatigue (t=-2.37, p=.032) Higher serum osmolality was associated with 7.6% lower odds of experiencing fatigue when controlling for sex and BMI (OR=.924, p=.014, CI .870 - .982).</div></div><div><h3>Conclusion</h3><div>Despite the deleterious outcomes associated with HF-related fatigue, physiologic mechanisms remain poorly understood. Serum osmolality may be associated with the experience of fatigue in persons with HF. Serum osmolality reflects the concentration of serum sodium, urea, and glucose. The differences in serum osmolality noted may be explained by dietary sodium, serum blood glucose, fluid restrictions or use of diuretics. Yet, serum osmolality is associated with mortality in persons with HF, suggesting changes in serum osmolality ma","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 381-382"},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418510","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":"Does Your Patient Need An Implanted Cardiac Defibrillator?","authors":"Jessica Bocchino MSN, RN-BC,&nbsp;Zoya Shir,&nbsp;Valerie Mc Donough","doi":"10.1016/j.hrtlng.2024.08.004","DOIUrl":"10.1016/j.hrtlng.2024.08.004","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this Quality Improvement Project was to identify heart failure patients who met criteria for an Implanted Cardiac Defibrillator.</div></div><div><h3>Background</h3><div>Patients with heart failure are at risk of ventricular arrhythmias. Implantable cardiac defibrillators (ICDs) can significantly reduce sudden cardiac death. Unfortunately, ICD implantation is often underutilized. Based on studies, the American College of Cardiology and American Heart Association recommend ICDs in patients with depressed Ejection Fractions (EF) and heart failure. The Centers for Medicare &amp; Medicaid Services have approved reimbursement for ICD placement in patients meeting criteria.</div></div><div><h3>Methods</h3><div>The Heart Failure Coordinators at Hackensack University Medical Center screened heart failure patients admitted to the hospital. Through real time screening and participation in Multidisciplinary Rounds (MDRs) we reviewed patients echocardiograms for ejection fractions (EF) of &lt; _35%, New York Heart Association (NYHA) class I-III and ensured the patient had received optimal medical therapy for at least 3 months. Those with a terminal illness, life expectancy, cognitive or severe psychiatric illness were not included. If patients met criteria a recommendation was sent to the provider for a possible consultation to Electrophysiology (EP). Additionally, the Heart Failure Algorithm was modified to suggest EP consults for patients with EF&lt; 35%.</div></div><div><h3>Results</h3><div>Improvements in our compliance to the Get With The Guidelines- Heart Failure (GWTG-HF) Quality Measure AHAHF12: ICD Counseling or ICD Placed or Prescribed at Discharge increased by 20% from Quarter 1 203 to Quarter 2 2023 and additionally increased by 7% in Quarter 3. Through daily screening and the use of the Heart Failure Algorithm, cases were identified and presented at our monthly Heart Failure Adjudication meetings. These presentations not only assisted in referrals to EP, but also captured our audience. The presentations increased the awareness of our medical centers providers.</div></div><div><h3>Conclusion</h3><div>The use of daily screening increased referrals to Electrophysiology and identification of patients that met criteria for for device therapy. Consideration of ICD implantation must be a shared decision making process. As the population for heart failure continues to grow, device therapy can improve overall survival. It is vital to remain aware of technologies and devices that can refine management of complexed heart failure care.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Page 383"},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418511","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":"Insights from Implementing an AI-Enabled Peripheral Edema Monitor in UK-based Community Settings for Therapeutic Decision-Making","authors":"Oriane Chausiaux PhD, MsC, BsC, MPhil,&nbsp;Gareth Williams,&nbsp;Melanie Keyser,&nbsp;Michał Nieznański,&nbsp;Philip Downer,&nbsp;Anna Zieba,&nbsp;Lewis Bond,&nbsp;Jakub Zieba,&nbsp;Shamus Husheer","doi":"10.1016/j.hrtlng.2024.08.006","DOIUrl":"10.1016/j.hrtlng.2024.08.006","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the implications of deploying a telemonitoring device in the homes of patients with heart failure through family doctors.</div></div><div><h3>Background</h3><div>In recent years, a decline in in-person primary healthcare consultations has posed significant challenges, especially for elderly patients with heart failure, who often contend with multiple comorbidities. A notable concern is their lack of awareness regarding symptom changes, such as weight gain, breathlessness, or swelling of the feet.</div></div><div><h3>Methods</h3><div>A cohort of 122 patients from 11 primary care practices across the UK were equipped with connected weighing scales and an AI monitoring device, including an internet dongle when necessary. These patients primarily resided in socioeconomically deprived areas. The study focused on device acceptability, utilization rates, and the impact of generated alerts on clinical teams. Initially planned for a six-month duration, a majority of participants opted to extend their use of the AI-device.</div></div><div><h3>Results</h3><div>The deployment targeted high-risk patients with heart failure, characterized by complex health conditions and histories of non-adherence with self-checks.</div><div>Data availability was high, with usage statistics indicating:</div><div>Weighing scale usage (at least once = 60.7%; at least 16days/mth = 5.7%)</div><div>AI-device usage (at least once = 100%; at least 16days/mth = 71.3%)</div><div>This indicates the AI device's passive, automated nature may enhance data collection from traditionally disengaged patient groups. Acceptability was high, with few rejections and of the 40% of participants responding to usability surveys, 92% would likely recommend the device to a friend. Alert management did not significantly burden GP teams, with most alerts being relevant to heart failure or other critical conditions needing attention (COPD exacerbation, COVID-19 infection, lymphoedema etc.). GP feedback was notably positive, especially from practices with a dozen or more participating patients.</div></div><div><h3>Conclusion</h3><div>Despite the challenging chosen patient group (representative of the high-risk heart failure population in the area), data acquisition was excellent, allowing clinicians to get an overview of the patient's health status remotely. While the investigation was not a randomized controlled trial (RCT), anecdotal evidence suggests early problem identification without significantly increasing GP workload. Further research is essential before broader implementation. The pivotal trial for the AI-device is expected to take place in the US in 2025.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Page 385"},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418513","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":"Assessing the Heartfelt Device's Predictive Value in Heart Failure Management: Findings from the Multicenter FOOT Trial (UK)","authors":"Matthew Dewhurst MBBS, MRCP, MD NHS,&nbsp;Karen Hann,&nbsp;Iain Matthew,&nbsp;Lisa Gallagher,&nbsp;Gemma McCafferty,&nbsp;Hayley McKie,&nbsp;Sara Pick,&nbsp;Debbie Hughes,&nbsp;Louise Clayton,&nbsp;Will Nicolson,&nbsp;Susan Gent,&nbsp;Ganesan Kumar,&nbsp;Phil Keeling","doi":"10.1016/j.hrtlng.2024.08.005","DOIUrl":"10.1016/j.hrtlng.2024.08.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;This study (NCT04072744) investigates the Heartfelt device's ability to predict heart failure events by monitoring peripheral edema, comparing its accuracy and data reliability against traditional daily weight monitoring. It aims to determine the device's effectiveness in providing early warnings to healthcare providers, patients, and caregivers about impending heart failure decompensations and assesses whether adjustments in alert sensitivity could improve patient outcomes, identifying the most efficient approach for ongoing heart failure management.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The Heartfelt device, a CE-marked device covered by FDA exemption, allows heart failure monitoring at home by using 3D imaging and AI to detect peripheral edema changes autonomously, requiring no patient input to collect data. In Europe it is regulated to send alerts on potential heart failure risks to patients, families, or providers based on its findings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The FOOT study enrolled 26 patients from five UK NHS hospitals between February 2020 and June 2022. They used the Heartfelt HF3 device at home, which operated normally but logged data and alerts without informing patients or healthcare teams to prevent bias, as well as Bluetooth scales for daily weight tracking as part of standard care. After six months, clinical records were reviewed for heart failure incidents.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In the cohort using the Heartfelt device, 9 heart failure events were recorded in 8 patients, including 2 outpatient visits, 6 hospital admissions, and one fatality, with the device providing an average lead time of 13 days (6.5-20) for deterioration. For standard care (daily weighing), there was an average of 1.1 days [0.3-4.1] of data each week versus 5.9 days [4.9-6.6] of foot volume data weekly recorded by the Heartfelt device. Before 5 of the hospitalizations and one death, the Heartfelt device issued alerts within the preceding two weeks. Alerts also preceded both outpatient incidents; however, the devices had been persistently alerting approximately weekly for several weeks prior, potentially due to excessively sensitive thresholds, so the outpatient events were counted as missed. In total, 6 out of the 9 heart failure events were deemed to be successfully predicted in advance.&lt;/div&gt;&lt;div&gt;Most patients lacked consistent weighing scale data due to adherence issues despite patients being told to follow the advice of regular weighing during the study. Yet, the weight data available indicated that at least 2 events (1 hospitalization and 1 death) could have been predicted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The Heartfelt device demonstrates superior capability in detecting peripheral edema indicative of heart failure worsening, offering more reliable data collection than traditional weight monitoring. Its predictive alerts potentially afford clinicians and caregivers an early warning system, a","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 383-385"},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418512","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":"Prevention of Heart Failure in Women with Disparities.","authors":"MaryBeth Vieira PhD, RN, CNE,&nbsp;Kristen A. Sethares","doi":"10.1016/j.hrtlng.2024.08.002","DOIUrl":"10.1016/j.hrtlng.2024.08.002","url":null,"abstract":"<div><h3>Purpose</h3><div>There is a need to examine genderized societal roles in women for reasons for gaps in physical activity levels to create community engaged action models to address these factors with the primary goal of decreasing all cause cardiovascular disease. The purpose of this study was to examine sociodemographic, contextual, system-related, and personal factors contributing to physical activity levels in women at risk through a community engaged approach</div></div><div><h3>Background</h3><div>Cardiovascular disease remains the leading cause of death across the population. Black and Hispanic women have persistently high CVD risk factors with all cause CVD highest in Black women. Heart failure which is an end result of many cardiovascular diseases is 19% higher in the Black population than the white population. One way to decrease the risk of cardiovascular disease is through physical activity. 24.3% of adults meet physical activity guidelines. Women, particularly those with economic, educational, and access disparities report the lowest levels of physical activity.</div></div><div><h3>Methods</h3><div>Focus groups were utilized to interview nine adult female community members in an area of high diversity and potential for sociodemographic disparities. Community stakeholders were recruited, hired, and trained by the PI to lead focus groups and analyze data. Semi-structured interviews were used to discuss facilitators, barriers, preferences, and perspectives related to physical activity in the context of participants’ lifestyle. The research team analyzed and coded the transcripts and identified themes contributing to physical activity. Lincoln and Guba's criteria were applied for rigor.</div></div><div><h3>Results</h3><div>Themes identified barriers to physical activity including access (cost, location, programming, community events, and safety), family factors (childcare), and discomfort with exercising in mixed gender environments. Genderized roles in family management were apparent with strong themes of prioritization of family needs over self, planning self-care around and after family needs, and lack of time related to these priorities. Difficulty with self-regulation, goal setting, and planning related to physical activity. There was lack of knowledge regarding purposes of physical activity in that participants felt more influenced by societal pressures of “ideal image” for women vs a goal of personal health promotion. Social support was a strong facilitator.</div></div><div><h3>Conclusion</h3><div>Themes indicated barriers particular to gender and socioeconomics that are consistent with high rates of cardiovascular risk in this population. Programming must be initiated to specifically address the needs identified by the participants in the study in order to increase physical activity, decrease risk factors and disease incidence, thus decreasing incidence of heart failure in the population.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Page 381"},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418509","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":"Treating chronic pulmonary heart disease with traditional Chinese medicine: Systematic evaluation and mechanistic insights into the resolving phlegm and activating blood approach","authors":"Tianwei Meng ,&nbsp;Weidong Wu ,&nbsp;Boyu Wang ,&nbsp;Chengjia Li ,&nbsp;Jiarui Li ,&nbsp;Jiawen Liu ,&nbsp;Jianying Wang ,&nbsp;Rui Qie","doi":"10.1016/j.hrtlng.2024.09.017","DOIUrl":"10.1016/j.hrtlng.2024.09.017","url":null,"abstract":"<div><h3>Background</h3><div>Chronic Pulmonary Heart Disease (CPHD) significantly impacts global health, especially among middle-aged and older adults. In China, the Traditional Chinese Medicine (TCM) technique of Resolving Phlegm and Activating Blood (RPAB) is widely used to treat CPHD, although high-quality evidence supporting its efficacy remains limited.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to rigorously assess the clinical efficacy of RPAB for CPHD and elucidate the mechanisms underlying its primary herbal components.</div></div><div><h3>Methods</h3><div>Through a detailed search of literature in both Chinese and English and strict inclusion and exclusion criteria, 18 randomized controlled trials (RCTs) were selected for meta-analysis. We identified RPAB's core herbal combinations using association rule analysis. This method statistically analyzes the frequency and correlation of herbal medicine usage. We then analyzed the chemical components of these combinations and investigated their potential intervention mechanisms on CPHD through network pharmacology.</div></div><div><h3>Results</h3><div>The combination of RPAB with Western medicine was superior to Western medicine alone in improving blood gas analysis and pulmonary function and reducing plasma viscosity in CPHD patients. The core herbal combination identified was <em>Astragalus membranaceus</em> (Fisch.) Bunge, <em>Ligusticum chuanxiong</em> Hort. ex S. H. Qiu &amp; al., and <em>Stellaria alsine</em> Grimm (ALS). This combination targeted 588 therapeutic and 27 core targets. It influenced ten core compounds across 34 pathways, primarily through the chemokine signaling pathway and the JAK-STAT signaling pathway.</div></div><div><h3>Conclusion</h3><div>RPAB with Western medicine significantly improves CPHD treatment outcomes. The study highlights the therapeutic potential of the ALS combination, which operates through multiple pathways to remodel pulmonary arteries, decrease inflammation, and lessen oxidative stress. These insights support the clinical application of RPAB in CPHD treatment and open new avenues for research and therapeutic development.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"69 ","pages":"Pages 111-126"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395371","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":"Evaluation of the quality and self-management related content of websites promoting physical activity engagement after myocardial infarction or cardiac surgery: A scoping review","authors":"Emily Bennett BPhty ,&nbsp;Hemakumar Devan PhD ,&nbsp;Leigh Hale PhD ,&nbsp;Emily Gray PhD","doi":"10.1016/j.hrtlng.2024.09.015","DOIUrl":"10.1016/j.hrtlng.2024.09.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Uncertainty about safe engagement in activity during early recovery after cardiac events is common. Websites are a potential source of health information, especially for those unable to access follow-up support from health professionals. The variability in online health information quality is concerning as poor web-based information can negatively impact patient health outcomes and the ability to self-manage.</div></div><div><h3>Objective</h3><div>To evaluate the quality and self-management-related content of websites providing information about physical activity following an MI or cardiac surgery.</div></div><div><h3>Methods</h3><div>Patient-facing websites were searched using three search engines (Google, Bing, and Yahoo). Information about activities of daily living (ADLs), exercise (aerobic and resistance), and safety considerations were explored. Self-management strategies for physical activity were evaluated using a customized 9-item checklist. Website quality was assessed using the 4-item JAMA framework criteria.</div></div><div><h3>Results</h3><div>31 websites were included. Aerobic exercise, ADLs, and safety considerations were the most comprehensively covered topics. Resistance exercise was less frequently and comprehensively covered. The median self-management checklist score was 3/9 (with nine being the highest possible score). Partnering with healthcare professionals, decision-making, action planning, and verbal persuasion were the most common self-management skills addressed by the websites. In contrast, ten or fewer websites modelled mastery experiences, vicarious experiences, reflection, problem-solving, and resource utilization. The median JAMA score for website quality was 2/4 (with four being the highest possible score).</div></div><div><h3>Conclusions</h3><div>The findings highlight quality improvement opportunities for web providers and provide insight for patients and clinicians regarding the highest quality websites that best meet the information and self-management needs following an MI or cardiac surgery.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"69 ","pages":"Pages 94-110"},"PeriodicalIF":2.4,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395370","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":"Long-term outcomes following aortic valve replacement in bioprosthetic vs mechanical valves","authors":"Abeline R. Watkins BSc ,&nbsp;Ryaan EL-Andari MD ,&nbsp;Nicholas M. Fialka MD ,&nbsp;Jimmy JH. Kang MD ,&nbsp;Yongzhe Hong MD, PhD. ,&nbsp;Sabin J. Bozso MD, PhD ,&nbsp;Devilliers Jonker MD ,&nbsp;Michael Moon MD ,&nbsp;Jayan Nagendran MD, PhD ,&nbsp;Jeevan Nagendran MD, PhD","doi":"10.1016/j.hrtlng.2024.09.016","DOIUrl":"10.1016/j.hrtlng.2024.09.016","url":null,"abstract":"<div><h3>Background</h3><div>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 &lt;50 years old and bioprosthetic valves for those &gt;70 years old.</div></div><div><h3>Objectives</h3><div>To investigate the long-term differences following AV replacement(AVR) comparing bioprosthetic and mechanical valves in patients aged 50–70.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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(<em>p</em> &gt; 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(<em>p</em> = 0.84, <em>p</em> = 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, <em>p</em> = 0.0.39).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"69 ","pages":"Pages 87-93"},"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 RN, PhD ,&nbsp;Hsiang-Ping Wu RN, PhD ,&nbsp;Hsiang-Yun Lan RN, PhD ,&nbsp;Hsueh-Fang Peng RN, MS ,&nbsp;Shyi-Jou Chen MD, PhD ,&nbsp;Ti Yin RN, PhD ,&nbsp;Jen-Jiuan Liaw RN, PhD, FAAN ,&nbsp;Yue-Cune Chang PhD","doi":"10.1016/j.hrtlng.2024.09.013","DOIUrl":"10.1016/j.hrtlng.2024.09.013","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>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).</div></div><div><h3>Methods</h3><div>In this prospective observational cohort study, preterm infants with a gestational age (GA) of &lt;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 &lt;80 %, &lt;85 %, and &lt;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.</div></div><div><h3>Results</h3><div>In all preterm infants (<em>N</em> = 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 (<em>p</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"69 ","pages":"Pages 78-86"},"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 ,&nbsp;Congjie Chen ,&nbsp;Mingyu Lin ,&nbsp;Shiying Li ,&nbsp;Xue Yi ,&nbsp;Tongsheng Chen","doi":"10.1016/j.hrtlng.2024.09.014","DOIUrl":"10.1016/j.hrtlng.2024.09.014","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>We explored the association between Diet-Derived Antioxidants and Asthma.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, <em>P</em> = 0.032; Zinc: OR = 0.86, 95 % CI: 0.75–1.00, <em>P</em> = 0.046; Selenium: OR = 0.85, 95 % CI: 0.73–0.98, <em>P</em> = 0.004; CDAI: OR = 0.80, 95 % CI: 0.65–0.97, <em>P</em> = 0.027). There was a significant nonlinear relationship between the dietary intake of vitamin C, zinc, and selenium and the risk of asthma (<em>P</em>_non-_linear &lt; 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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"69 ","pages":"Pages 71-77"},"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}