Heart & Lung最新文献

{"title":"Machine learning-based return-to-work assessment system for acute myocardial infarction patients within 12 months","authors":"Xiaojun Wu ,&nbsp;Shiyu Wang ,&nbsp;Haoning Cui ,&nbsp;Xianghui Zheng ,&nbsp;Xinyu Hou ,&nbsp;Zhuozhong Wang ,&nbsp;Qifeng Li ,&nbsp;Qi Liu ,&nbsp;Tianhui Cao ,&nbsp;Yang Zheng ,&nbsp;Jian Wu ,&nbsp;Bo Yu","doi":"10.1016/j.hrtlng.2025.04.020","DOIUrl":"10.1016/j.hrtlng.2025.04.020","url":null,"abstract":"<div><h3>Background</h3><div>Returning to work is a critical indicator of recovery after acute myocardial infarction (AMI), and accurate identification of patients with low return-to-work rates is critical for timely intervention.</div></div><div><h3>Objectives</h3><div>To develop a machine learning (ML) model for predicting the return-to-work in AMI patients.</div></div><div><h3>Methods</h3><div>A retrospective study of data from 539 AMI patients was conducted using the Incidence Rate of Heart Failure After Acute Myocardial Infarction With Optimal Treatment database. Patients were randomly divided into training cohort and validation cohort (7:3). Seven ML algorithms were used to establish a prediction model for the training cohort. Model performance is evaluated by the area under the receiver operating characteristic curve (AUC), accuracy, F1 score, and Brier score.</div></div><div><h3>Results</h3><div>This study included 539 AMI patients (median [IQR] age, 50.0 [45.0, 54.0] years; 505 (93.7 %) were male, and 431 (80.0 %) returned to work within one year after discharge. The best-performing model was eXtreme gradient boosting, which achieved an AUC of 0.821 (95 % CI, 0.736–0.907), an accuracy of 0.802 (95 % CI, 0.733–0.861), and an F1 score of 0.873. The return-to-work score and stratification established based on this model can effectively distinguish patients into low, medium, and high probability groups (33.3 % vs. 60.0 % vs. 91.7 %, <em>P</em> &lt; 0.001). The model was deployed on an open website <span><span>https://amirtw.streamlit.app/</span><svg><path></path></svg></span>, providing a convenient evaluation and analysis tool for medical staff.</div></div><div><h3>Conclusion</h3><div>A new return-to-work ML model was developed, which may help identify patients with low return-to-work rates and may become an effective management tool for AMI patients.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"73 ","pages":"Pages 19-25"},"PeriodicalIF":2.4,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850733","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":"Out-of-hospital cardiac arrest: A 10-year analysis of survival and neurological outcomes","authors":"Daniel Schwaiger,&nbsp;Armin Krösbacher,&nbsp;Christine Eckhardt,&nbsp;Lukas Schausberger,&nbsp;Michael Baubin,&nbsp;Sasa Rajsic","doi":"10.1016/j.hrtlng.2025.04.003","DOIUrl":"10.1016/j.hrtlng.2025.04.003","url":null,"abstract":"<div><div><strong>Background</strong> Out-of-hospital cardiac arrest (OHCA) is a major public health issue with low survival rates.</div><div><strong>Objective</strong> Identification of predictors for survival and good neurological outcomes following OHCA.</div><div><strong>Methods</strong> This retrospective study included all OHCA patients between January 2014 and December 2023. Data was collected from the local resuscitation registry and hospital electronic medical records. Neurological outcomes were measured using the Cerebral Performance Category (CPC) scale.</div><div><strong>Results</strong> At hospital admission return of spontaneous circulation (ROSC) was achieved in 36 % of cases (411/1128), with overall survival rates of 29 % (328/1128) at 24 h and 16 % (178/1128) at 30 days, respectively. Good neurological outcomes (CPC 1 and 2) were observed in 13 % (144/1128) of patients. The main suspected cause of cardiac arrest was cardiac origin (54 %, 608/1128), followed by hypoxia (11 %, 127/1128). Survivors were significantly younger (60 vs 71 years, <em>p</em> &lt; 0.001), were less disabled (<em>p</em> &lt; 0.001), had a higher incidence of witnessed cardiac arrest (80 % vs 69 %, <em>p</em> = 0.018), received more often bystander cardiopulmonary resuscitation (CPR, 62 % vs 47 %, <em>p</em> = 0.003) or Dispatcher Assisted-CPR (44 % vs 32 %, <em>p</em> = 0.004). Moreover, patients who survived at least 30 days had a higher incidence of shockable initial rhythm (57 % vs 24 %, <em>p</em> &lt; 0.001).</div><div><strong>Conclusions</strong> Patients who survived at least 30 days were younger and male, had less disability, a shockable initial rhythm, and a cardiac arrest in public.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"73 ","pages":"Pages 1-8"},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845147","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":"Celebrating Excellence: AAHFN Fellowship Program and the Impact of Heart Failure Nurses","authors":"Linda Wick DNP, MSN, APRN, CHFN","doi":"10.1016/j.hrtlng.2025.04.006","DOIUrl":"10.1016/j.hrtlng.2025.04.006","url":null,"abstract":"","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages A2-A3"},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053224","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":"Non-invasive monitoring strategies for atrial fibrillation detection in adult cardiac surgery patients after hospital discharge: A scoping review","authors":"Osama Jaradat ,&nbsp;Peta Drury ,&nbsp;John Rihari-Thomas ,&nbsp;Steven Frost","doi":"10.1016/j.hrtlng.2025.04.023","DOIUrl":"10.1016/j.hrtlng.2025.04.023","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is a common complication after cardiothoracic surgery, affecting up to 50 % of patients. It can develop after discharge, leading to frequent hospital readmissions. There is a growing need for effective monitoring strategies to detect AF in the post-discharge period.</div></div><div><h3>Objectives</h3><div>To synthesis the available literature on various mobile monitoring devices used to detect AF in adult cardiac surgery patients post-discharge from the hospital.</div></div><div><h3>Methods</h3><div>Following Arksey and O’Malley’s framework and the PRISMA-ScR guidelines. A comprehensive search of six databases (PubMed; MEDLINE; CINAHL; Scopus; ProQuest; and Web of Science) was performed, including studies published between 2009 and 2024. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS).</div></div><div><h3>Results</h3><div>A total of 1256 de-duplicated studies were screened, and 102 studies underwent full-text review. Five studies were included: four prospective cohort studies, and one randomised clinical trial. Samples sizes ranged from 23 to 730 adults undergoing cardiac surgery, with follow-up between four weeks to three months post-discharge. Handheld and wearable ECG-based devices were the most used tools for AF detection, demonstrating high sensitivity and specificity. Their use effectively reduced unplanned hospital visits and improved clinical outcomes. Patient adherence to monitoring protocols was generally high, though variability in engagement was noted.</div></div><div><h3>Conclusions</h3><div>Handheld and wearable ECG- based devices, are effective for post-discharge AF detection in cardiac surgery patients. Integrating these tools into routine post-discharge care can improve patient outcomes. Future research should focus on long-term effectiveness and strategies to optimise patient engagement and implementation in clinical practice.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"73 ","pages":"Pages 9-18"},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845146","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":"Amiodarone Prophylaxis against postoperative atrial fibrillation in off-pump coronary artery bypass","authors":"Jaskirat Gill MD ,&nbsp;Ami G Shah PharmD, BCCCP ,&nbsp;Gabriele Di Luozzo MD ,&nbsp;Julie Mei PharmD ,&nbsp;Justin Carale PharmD ,&nbsp;Kristy Huang PharmD ,&nbsp;Anna S. Mueller MD ,&nbsp;Marcelina Victory-Stewart RN ,&nbsp;Seana Friedman DNP, RN ,&nbsp;Emilia Bagiella PhD ,&nbsp;Omar Lattouf MD ,&nbsp;John D. Puskas MD ,&nbsp;Mekeleya Yimen MD ,&nbsp;Himani V. Bhatt DO, MPA","doi":"10.1016/j.hrtlng.2025.03.009","DOIUrl":"10.1016/j.hrtlng.2025.03.009","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, with incidence increasing based on surgical complexity. While the CHA₂DS₂-VASc score has been validated to predict POAF risk, standardized prophylactic strategies remain unclear. This study evaluates the safety and efficacy of a low-dose oral amiodarone protocol for POAF prevention in high-risk patients undergoing isolated OPCAB procedures.</div></div><div><h3>Objective</h3><div>To evaluate the impact of low-dose amiodarone prophylaxis against POAF in high-risk patients undergoing OPCAB procedures.</div></div><div><h3>Methods</h3><div>This IRB-approved prospective study included all adult inpatients undergoing isolated OPCAB procedures at a single tertiary care facility between June 2018-June 2021 identified as high risk for POAF (preoperative CHA₂DS₂VASc score <u>&gt;</u> 2). Patients treated with amiodarone prophylaxis were compared to a retrospective historical control group which underwent similar OPCAB procedures in the same center prior to the implementation of amiodarone prophylaxis. Preoperative hospitalized inpatients received a weight-adjusted dose of oral amiodarone on each preoperative day until the day prior to surgery. Patients who were inadequately loaded (&lt;1 g) received 150 mg of amiodarone intravenously in the operating room. Patients with intraoperative symptomatic bradycardia received temporary prophylactic epicardial pacing wires. Postoperatively, all patients received an amiodarone regimen of 200 mg orally twice daily, continued for 15 doses or until discharge. Multivariate logistic models were used to determine the effect of low-dose oral amiodarone prophylaxis on new-onset POAF.</div></div><div><h3>Results</h3><div>A 10.7 % reduction in incidence of POAF requiring treatment was noted in the study group (OR=0.4; 95 % CI [0.167–0.958], <em>p</em> = 0.04), as well as a 12 % decrease in patients requiring AF treatment at discharge (<em>p</em> = 0.017), and significantly reduced time to extubation. All baseline characteristics and safety parameters were similar between groups.</div></div><div><h3>Conclusions</h3><div>The use of a low-dose amiodarone prophylaxis regimen led to significant reduction in new POAF, without apparent adverse effects. This regimen may be considered safe, effective, and feasible for implementation in high-risk OPCAB patients. Further studies in on-pump CABG and valvular patients are needed.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages 85-94"},"PeriodicalIF":2.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820493","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 posttraumatic stress symptoms and hope following intensive care unit discharge: Findings from a longitudinal cohort study” [Heart & Lung Volume 70, MarchApril 2025, Pages 223-229]","authors":"Klara Friberg MSc, RN, CCN ,&nbsp;Kristin Hofsø PhD, RN, CCN ,&nbsp;Tone Rustøen PhD, RN ,&nbsp;Johan Ræder PhD, MD ,&nbsp;Milada Hagen PhD ,&nbsp;Kathleen Puntillo PhD, RN, FCCM ,&nbsp;Brita Fosser Olsen PhD, RN, CCN","doi":"10.1016/j.hrtlng.2025.04.001","DOIUrl":"10.1016/j.hrtlng.2025.04.001","url":null,"abstract":"","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages 83-84"},"PeriodicalIF":2.4,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143817608","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":"Serum lactate dehydrogenase level as a predictor of 28-day mortality in critically ill patients with infective endocarditis: a retrospective cohort study from MIMIC IV database","authors":"Yuhan Qin ,&nbsp;Anhu Wu ,&nbsp;Yufei Wang,&nbsp;Xiaohan Qin,&nbsp;Jing Zhang,&nbsp;Xiaoxiao Guo","doi":"10.1016/j.hrtlng.2025.04.002","DOIUrl":"10.1016/j.hrtlng.2025.04.002","url":null,"abstract":"<div><h3>Background</h3><div>Infective endocarditis (IE) is a serious infectious disease with a rising incidence rate and high mortality rate. While lactate dehydrogenase (LDH) is a sensitive and accessible biomarker of inflammation, tissue damage and metabolic alteration, its prognostic value in IE remains unexplored.</div></div><div><h3>Objective</h3><div>This study aims to investigate the prognostic value of admission serum LDH levels for 28-day mortality in critically ill IE patients.</div></div><div><h3>Methods</h3><div>The data used in this retrospective cohort study was extracted from the MIMIC-IV database. Restricted cubic spline analysis, Cox regression, Kaplan-Meier survival analysis, and receiver operating characteristic analysis were performed to evaluate the predictive value of serum LDH in critically ill IE patients. Key clinical confounders for the adjusting Cox models were filtered by LASSO regression.</div></div><div><h3>Results</h3><div>A total of 215 critically ill patients with diagnosed IE were included during their first intensive care unit admission. LDH was one of the most significant confounders identified by LASSO analysis. The crude and adjusted Cox models revealed a consistently independent and dose-response relationship between high serum LDH and higher mortality. The fully adjusted model showed each standard deviation increase in LDH (log2) was associated with a hazard ratio of 2.37 (95% CI: 1.51–3.71, p &lt; 0.001). Kaplan-Meier curves demonstrated significantly different survival patterns across LDH levels (p = 0.0032). The area under the curve (AUC) of LDH was higher than SOFA score (AUC=0.637 v.s. 0.573, p=0.251).</div></div><div><h3>Conclusion</h3><div>This study identified serum LDH as an independent predictor of mortality in critically ill IE patients.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages 74-82"},"PeriodicalIF":2.4,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799195","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":"Immediate and short-term outcomes of in-hospital canagliflozin initiation in acute heart failure: Results from the CANA-AHF randomized clinical trial","authors":"Rabab A. EL-Gazar ,&nbsp;Bassem Zarif ,&nbsp;Ahmed Ali Ali ,&nbsp;Mira Magdy William ,&nbsp;Maggie M. Abbassi ,&nbsp;Nirmeen A. Sabry","doi":"10.1016/j.hrtlng.2025.03.007","DOIUrl":"10.1016/j.hrtlng.2025.03.007","url":null,"abstract":"<div><h3>Background</h3><div>Early initiation of empagliflozin, a sodium-glucose cotransporter 2 inhibitor, in acute heart failure (AHF) patients increases urine output, reduces hospital stays, and enhances quality of life post-hospital discharge.</div></div><div><h3>Objectives</h3><div>This trial aims to investigate the effectiveness and safety of early canagliflozin initiation compared to empagliflozin in hospitalized AHF patients with volume overload.</div></div><div><h3>Methods</h3><div>This was a multicenter, prospective, open-labeled, randomized equivalence trial. AHF diabetic and non-diabetic patients were randomized within 24 h from hospital admission to either receive 100 mg canagliflozin or 10 mg empagliflozin in addition to the standardized protocol for an intravenous loop diuretic. The primary outcome was the median of daily diuresis during the hospitalization period.</div></div><div><h3>Results</h3><div>Hospitalized AHF patients were enrolled (71 patients per group). The median daily diuresis during the hospitalization period was 4200 ml in the canagliflozin group, which was statistically equivalent to empagliflozin (4117 ml) with a difference of 83 ml, which falls within the predefined equivalence margin (±10) % of the median of daily diuresis of empagliflozin; Δ = ±411.7 mL), confirming equivalence via bootstrap TSOT <em>p</em> &lt; 0.001. No difference was observed in diuretic response, dyspnea score, orthodema congestion score or length of hospital stay. The NT-proBNP level at day 30 post-discharge and the change in KCCQ-TSS from baseline to day 90 were statistically comparable between both groups, without differences in safety event incidence.</div></div><div><h3>Conclusion</h3><div>Canagliflozin could be a part of usual care for hospitalized AHF patients and an alternative to empagliflozin without safety concerns.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages 65-73"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143758972","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":"Barriers and facilitators to medication adherence in patients after PCI surgery: A mixed-methods systematic review","authors":"Yong Fang ,&nbsp;Zhili Jiang ,&nbsp;Zhihao Han ,&nbsp;Xinyue Xiang","doi":"10.1016/j.hrtlng.2025.03.008","DOIUrl":"10.1016/j.hrtlng.2025.03.008","url":null,"abstract":"<div><h3>Background</h3><div>Patients after Percutaneous coronary intervention (PCI) should adhere to evidence-based medications to relieve symptoms and prevent cardiovascular events. However, the factors affecting patient medication adherence remain unclear.</div></div><div><h3>Objectives</h3><div>To systematically synthesize the quantitative and qualitative evidence on the barriers and facilitators to medication adherence in patients after PCI surgery.</div></div><div><h3>Methods</h3><div>A systematic search of the literature on the barriers and facilitators to medication adherence in patients after PCI surgery was performed in English and Chinese databases, including PubMed, Embase, CINAHL, Web of Science, CNKI, Wanfang and CBM, from inception to March 1, 2023. Retrieved studies were screened based on inclusion and exclusion criteria. Two researchers independently performed data extraction and quality assessment. The analysis of the barriers and facilitators to medication adherence in patients was based on the six sub-components of the Capability, Opportunity, and Motivation model of Behavior (COM-B) model, a behavioral science framework. The systematic review was registered on PROSPERO (CRD42022338400).</div></div><div><h3>Results</h3><div>A total of 15 studies were included in the review. There were 31 factors identified that influenced medication adherence in patients after PCI surgery. Among these factors, 14 served as facilitators while 17 acted as barriers. All identified factors were subsequently mapped onto the six sub-components of the COM-B model.</div></div><div><h3>Conclusion</h3><div>Identification of the barriers and facilitators to medication adherence within the six categories of the COM-B model in patients undergoing PCI can serve as a foundation for developing intervention strategies. These strategies should target the identified factors across the COM-B model. A comprehensive approach will improve medication adherence among PCI patients.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages 57-64"},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143748657","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":"Evaluating equitable care in the ICU:Creating a causal inference template to assess the impact of life-sustaining interventions across racial and ethnic groups","authors":"Tristan Struja MD MSc MPH ,&nbsp;João Matos MSc ,&nbsp;Barbara Lam MD ,&nbsp;Yiren Cao ,&nbsp;Xiaoli Liu PhD ,&nbsp;Ziyue Chan ,&nbsp;Yugang Jia PhD MPH ,&nbsp;Christopher M. Sauer MD MPH PhD ,&nbsp;Helen D'Couto MD ,&nbsp;Irene Dankwa-Mullan MD MPH ,&nbsp;Leo Anthony Celi MD MS MPH ,&nbsp;Andre Kurepa Waschka PhD","doi":"10.1016/j.hrtlng.2025.03.011","DOIUrl":"10.1016/j.hrtlng.2025.03.011","url":null,"abstract":"<div><h3>Background</h3><div>Variability in the provision of intensive care unit (ICU)-interventions may lead to disparities between socially defined racial-ethnic groups.</div></div><div><h3>Objectives</h3><div>We aimed to study the use of invasive mechanical ventilation (IMV), renal replacement therapy (RRT), and vasopressor agents (VP) to identify disparities in outcomes across race-ethnicity in patients with sepsis.</div></div><div><h3>Methods</h3><div>Retrospective analysis of treatment effect with a target trial design with treatment assignment within the first 24 h in MIMIC-IV (2008–2019) using targeted maximum likelihood estimation. Of 76,943 ICU stays in MIMIC-IV, 32,971 adult stays fulfilled sepsis-3 criteria. Primary outcome was in-hospital mortality. Secondary outcomes were hospital-free days, and occurrence of nosocomial infection stratified by predicted mortality probability and self-reported race-ethnicity. Average treatment effects by treatment type and race-ethnicity, Racial-ethnic group (REG) or White group (WG), were estimated.</div></div><div><h3>Results</h3><div>Of 19,419 admissions that met inclusion criteria, median age was 68 years, 57.4 % were women, 82 % were White, and mortality was 18.2 %. There was no difference in mortality benefit associated with the administration of IMV, RRT, or VP between the REG and the WG. There was also no difference in hospital-free days or nosocomial infections. These findings are unchanged with different eligibility periods.</div></div><div><h3>Conclusion</h3><div>There were no differences in the treatment outcomes from three life-sustaining interventions in the ICU according to race-ethnicity. While there was no discernable harm from the treatments across mortality risk, on average there was also no measurable benefit. These findings highlight the need for research to better understand the risk-benefit ratio of interventions in the ICU.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"72 ","pages":"Pages 48-56"},"PeriodicalIF":2.4,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738801","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}