Heart & Lung最新文献

{"title":"Outcomes of Covid-19 among patients with ischemic heart disease: A propensity matched analysis","authors":"Mirza Faris Ali Baig MD ,&nbsp;Aravind Dilli Babu MBBS ,&nbsp;Bengt Herweg MD ,&nbsp;Debbie A. Rinde-Hoffman MD, FACC","doi":"10.1016/j.hrtlng.2024.08.010","DOIUrl":"10.1016/j.hrtlng.2024.08.010","url":null,"abstract":"<div><h3>Background</h3><p>Prior research has linked cardiovascular diseases with higher COVID-19 mortality and worse hospital outcomes, particularly in severe heart failure. Large population-based data regarding the impact of pre-existing ischemic heart disease (IHD) on COVID-19 outcomes is not well established.</p></div><div><h3>Objective</h3><p>To study the impact of COVID-19 infection on IHD hospital mortality and other outcomes.</p></div><div><h3>Methods</h3><p>The study included a patient cohort from the 2020 and 2021 National Inpatient Sample (NIS) database. Propensity score matching was used to match the study cohort (COVID-19 with IHD) to controls (COVID-19 without IHD) using a 1:1 matching ratio. The outcomes analyzed were in-hospital mortality, rates of acute kidney injury (AKI), acute myocardial injury (AMI), cardiogenic shock, cardiac arrest, mechanical ventilation, tracheal intubation, pulmonary embolism (PE), ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges.</p></div><div><h3>Results</h3><p>A total of 2,532,652 patients met the inclusion criteria (1,199,008 females [47.3 %), predominantly Caucasian 1,456,203 (57.5 %); mean [SD] age 63, (5.4), including 29,315 (1.1 %) patients with a history of IHD. Following propensity matching, 4,772 COVID-19 patients with and without IHD were matched. IHD patients had higher rates of AMI (adjusted odds ratio (aOR) 3.75, 95 % CI 3.27–4.31, <em>p</em> &lt; 0.001), cardiogenic shock (aOR 2.89, 95 % CI 1.60–5.19, <em>p</em> &lt; 0.001), VT (aOR 3.26, 95 % CI 2.48–4.29, <em>p</em> &lt; 0.001), and VF (aOR 2.23, 95 % CI 1.25–3.99, <em>p</em> &lt; 0.001). The odds ratios of in-hospital mortality, AKI, PE, mechanical ventilation, tracheal intubation, and resource use were not significantly different.</p></div><div><h3>Conclusion</h3><p>A history of IHD does not impact COVID-19 mortality but increases the risk of in-hospital cardiac complications.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 291-297"},"PeriodicalIF":2.4,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049956","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":"Pleural effusions identified by thoracic ultrasound predict poor quality of life in patients with acute decompensated heart failure","authors":"Erick Joel Rendón-Ramírez ,&nbsp;Víctor Manuel Fraga-Enríquez ,&nbsp;Perla Rocío Colunga-Pedraza ,&nbsp;Homero Nañez-Terreros ,&nbsp;Ramiro Flores-Ramírez ,&nbsp;Fernando Canseco ,&nbsp;José M Porcel ,&nbsp;Edgar Francisco Carrizales-Sepúlveda","doi":"10.1016/j.hrtlng.2024.08.008","DOIUrl":"10.1016/j.hrtlng.2024.08.008","url":null,"abstract":"<div><h3>Introduction</h3><p>Pleural effusion (PE) is a common manifestation of acute decompensated heart failure (ADHF); however, its influence on the quality of life (QoL) is unknown.</p></div><div><h3>Objectives</h3><p>To identify whether PE detected using thoracic ultrasound (TUS) is associated with poorer QoL in patients with ADHF and a reduced ejection fraction (≤40 %).</p></div><div><h3>Methods</h3><p>We conducted a prospective, longitudinal, descriptive, observational, single-center study at a university hospital in Mexico. We included participants with a reduced left ventricular ejection fraction who were admitted for ADHF. We performed TUS and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) within the first 48 h of hospitalization.</p></div><div><h3>Results</h3><p>Forty patients with ADHF (30 males and 10 females; mean age, 51.24 ± 16.942 years) were included in this study. The participants were categorized into two groups: those with (<em>n</em> = 25, 62.5 %) or without (<em>n</em> = 15, 37.5 %) PE on TUS. We found a statistically significant association between the presence of PEs and a worse perception of QoL. The mean MLHFQ score in the group of patients with PEs was 40 points, compared to 12 points in the group without PEs (<em>p</em> &lt; 0.001). Poorer QoL was associated with a higher quantity of pleural fluid, as evidenced by the greater number of intercostal spaces occupied by the PE (<em>p</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>Patients with ADHF and a reduced ejection fraction who present with PE have a worse perception of QoL than patients without PE.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 279-283"},"PeriodicalIF":2.4,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141998653","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":"Optimizing outcomes: Impact of palliative care consultation timing in the cardiovascular intensive care unit","authors":"Sant Kumar MD ,&nbsp;Hunter VanDolah BS ,&nbsp;Ahmed Daniyaal Rasheed MD ,&nbsp;Serenity Budd MS ,&nbsp;Kelley Anderson PhD RN FNP ,&nbsp;Alexander I. Papolos MD ,&nbsp;Benjamin B.Kenigsberg M ,&nbsp;Narayana Sarma V. Singam MD ,&nbsp;Anirudh Rao MD ,&nbsp;Hunter Groninger MD FAAHPM","doi":"10.1016/j.hrtlng.2024.08.011","DOIUrl":"10.1016/j.hrtlng.2024.08.011","url":null,"abstract":"<div><h3>Background</h3><p>ICU patients and their families experience significant stress due to illness severity and prognostic uncertainty, making palliative care (PC) integral for symptom management, family support, and end-of-life care goals. The impact of PC in the Cardiac Intensive Care Unit (CICU) remains unstudied.</p></div><div><h3>Objective</h3><p>We explore the impact of early palliative care consultation (PCC) on patient outcomes in the CICU, including mortality, length of stay, and family meeting frequency.</p></div><div><h3>Methods</h3><p>This retrospective study at MedStar Washington Hospital Center included 209 adult patients admitted to the CICU between December 2021 and June 2022 receiving PCC. We compared outcomes between those receiving early (&lt;72 h) and late (&gt;72 h) PCC, including mortality, length of stay, and family meeting frequency. Statistical analysis included Wilcoxon rank sum tests, Chi-squared tests, Fisher's exact test, and Poisson regression models.</p></div><div><h3>Results</h3><p>The study included 209 patients admitted to the (M age = 68 years, SD = 14; 45 % female; 62 % Black, 30 % White) who received PCC, most (79 %) within 72 h. Early PCC was associated with shorter CICU stays (median, 3 vs. 5.5 days; <em>p</em> = 0.005). Early PCC patients had higher odds of family meetings (IRR=3.59; <em>p</em> &lt; 0.001) and experienced a change in code status sooner (median 1 day vs. 3 days, <em>p</em> &lt; 0.001). Late PCC patients were more likely to undergo tracheostomy (13.6% vs. 2.4 %; <em>p</em> = 0.007), cardioversion (9.1% vs. 1.8 %; <em>p</em> = 0.037), and have PEG tubes placed (13.6% vs. 2.4 %; <em>p</em> = 0.007).</p></div><div><h3>Conclusions</h3><p>Early PCC in the CICU is associated with shorter CICU stays, fewer procedures, and more frequent family meetings.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 265-271"},"PeriodicalIF":2.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141978269","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":"Predictors of COVID-19 severity in autoimmune disease patients: A retrospective study during full epidemic decontrol in China","authors":"Li-Ming Chen ,&nbsp;Jian-Bin Li ,&nbsp;Rui Wu","doi":"10.1016/j.hrtlng.2024.08.009","DOIUrl":"10.1016/j.hrtlng.2024.08.009","url":null,"abstract":"<div><h3>Background</h3><p>Early identification of risk factors for adverse COVID-19 progression in patients with autoimmune diseases is crucial for patient management, but data on the Chinese population are scarce.</p></div><div><h3>Objectives</h3><p>The purpose of this study was to identify predictors of severe COVID-19 in patients using blood cell ratios, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and other inflammatory markers.</p></div><div><h3>Methods</h3><p>A retrospective study of 855 patients (746 females; median age 49 years) with autoimmune diseases and concurrent COVID-19 was conducted from December 2022 to February 2023 at the Rheumatology and Immunology Department of the First Affiliated Hospital of Nanchang University. Disease severity was assessed according to the 8th edition of the National Health Commission of the People's Republic of China's COVID-19 Diagnosis and Treatment Guidelines. The clinical classification criteria group mild and moderate cases as nonsevere cases and severe and critical cases as severe cases. A multivariate logistic regression model was established to evaluate the relationships between COVID-19 severity and demographic characteristics, comorbidities, medication use, and laboratory findings.</p></div><div><h3>Results</h3><p>The PLR, NLR, and SII were significantly greater in the severe COVID-19 group than in the nonsevere group (all <em>P</em> &lt; 0.05). In addition to classical independent clinical risk factors, increases in the PLR (OR: 1.004, 95 % CI: 1.001∼1.007, <em>p</em> = 0.001), NLR (OR: 1.180, 95 % CI: 1.041∼1.337, <em>p</em> = 0.010), and SII (OR: 0.999, 95 % CI: 0.998∼1.000, <em>p</em> = 0.005) were identified as risk factors for severe COVID-19 in patients with autoimmune diseases. After adjusting for clinical risk factors, the PLR (AUC: 0.592 vs. 0.865; <em>P</em> &lt; 0.05), NLR (AUC: 0.670 vs. 0.866; <em>P</em> &lt; 0.05), and SII (AUC: 0.616 vs. 0.864; <em>P</em> &lt; 0.05) demonstrated higher predictive values.</p></div><div><h3>Conclusion</h3><p>Early prediction of severe COVID-19 in patients with autoimmune diseases can be achieved using the NLR, PLR, and SII.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 272-278"},"PeriodicalIF":2.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S014795632400147X/pdfft?md5=ad10a960a76c9410ef1c3b0f6128dcb4&pid=1-s2.0-S014795632400147X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141978177","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":"Association of arteriovenous fistulae with precapillary pulmonary hypertension – A single center retrospective analysis of invasive hemodynamic parameters","authors":"John Malin ,&nbsp;Rasha Khan ,&nbsp;Jose Manuel Martinez Manzano ,&nbsp;Phuuwadith Wattanachayakul ,&nbsp;Andrew Geller ,&nbsp;Raul Leguizamon ,&nbsp;Tara A John ,&nbsp;Ian Mclaren ,&nbsp;Alexander Prendergast ,&nbsp;Simone A. Jarrett ,&nbsp;Kevin Bryan Lo ,&nbsp;Janani Rangaswami ,&nbsp;Christian Witzke","doi":"10.1016/j.hrtlng.2024.08.007","DOIUrl":"10.1016/j.hrtlng.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary hypertension (pH) is a well-known complication among patients with chronic kidney disease (CKD). Arteriovenous fistulae (AVF) have been associated with pH mainly by increasing cardiac output. However, the burden of precapillary pH in individuals with CKD and an AVF is unclear.</p></div><div><h3>Objectives</h3><p>To better and more fully understand the mechanism and development of precapillary pH in patients with AVF, as well as the consequences of precapillary pH in these patients.</p></div><div><h3>Methods</h3><p>This was a large retrospective study of patients with CKD stage 4 or 5 who underwent right heart catheterization (RHC) from 2018 to 2023. The data were stratified according to the presence of AVF. To determine if AVF was independently associated with precapillary pH, we used a multivariable logistic regression analysis adjusting for demographics and potential comorbidities associated with precapillary pH, including diagnosis of chronic lung disease, obstructive sleep apnea, connective tissue disease, history of venous thromboembolism, chronic anemia, and heart failure.</p></div><div><h3>Results</h3><p>Of 651 patients with CKD4 or CKD5, 145 (22 %) had AVF and 506 (78 %) did not have AVF. Within the AVF group, the median age was 64 years (IQR 54–71), and they were predominantly males (61 %, <em>n</em> = 88) and African American (77 %, <em>n</em> = 111). A total of 31 % (<em>n</em> = 45) had evidence of precapillary pH, 30 % (<em>n</em> = 43) of combined pH, and 14 % (<em>n</em> = 20) of isolated postcapillary pH. Compared to the non-AVF group, precapillary pH was more likely in the AVF group (31% vs 17 %, <em>p</em> &lt; 0.0001). On multivariable analysis, AVF was independently associated with precapillary pH (OR 2.47, CI 1.56–3.89; <em>p</em> &lt; 0.0001). The median time from dialysis initiation to RHC date (and precapillary pH diagnosis) was 6 years (IQR 3–8).</p></div><div><h3>Conclusion</h3><p>Based on RHC findings, almost one-third of patients with CKD and AVF had precapillary pH. The presence of AVF was independently associated with precapillary pH.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 260-264"},"PeriodicalIF":2.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908382","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":"The relationship between departmental culture and resuscitation-related moral distress among inpatient medical departments physicians and nurses","authors":"Dorit Weill-Lotan RH, PhD ,&nbsp;Freda Dekeyser-Ganz PhD, RN ,&nbsp;Julie Benbenishty RN PhD","doi":"10.1016/j.hrtlng.2024.07.001","DOIUrl":"10.1016/j.hrtlng.2024.07.001","url":null,"abstract":"<div><h3>Background</h3><p>While moral distress frequency and intensity have been reported among clinicians around the world, resuscitations have not been well documented as its source.</p></div><div><h3>Objectives</h3><p>to examine the relationship between intensity and frequency of resuscitation- related moral distress and departmental culture among nurses and physicians working in inpatient medical departments.</p></div><div><h3>Methods</h3><p>This was a cross-sectional, prospective study of medical inpatient department staff from three hospitals. Questionnaires included a demographic and work characteristics questionnaire, the Resuscitation-Related Moral Distress Scale (a revised version of the Moral Distress Scale measuring frequency and intensity of moral distress), and a Departmental Culture Questionnaire.</p></div><div><h3>Results</h3><p>64 physicians and 201 nurses (response rate 64 %) participated, with a mean of 8.4 (SD = 5.1) resuscitations in the previous 6 months. Highest moral distress frequency scores were reported for items related to family demands or having no medical decision related to life- saving interventions for dying patients. Highest moral distress intensity scores were found when appropriate care for deteriorating patients was not given due poor staffing and when witnessing a resuscitation that could have been prevented had the staff identified the deterioration on time. Most participants strongly agreed (<em>n</em> = 228, 86.0 %) that their department medical director considers it important for staff to determine patients’ end-of-life preferences and that quality of life is of the highest value.</p></div><div><h3>Conclusions</h3><p>Clinicians working in medical inpatient department suffer from moderate frequency and high intensity levels of resuscitation-related moral distress. There was a statistically significant association between intention to leave employment with resuscitation-related moral distress frequency and intensity.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 254-259"},"PeriodicalIF":2.4,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890993","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":"A systematic review and meta-analysis of the clinical benefits and adverse reactions of anti-fibrotics in non-IPF progressive fibrosing ILD","authors":"Woon Hean Chong MD,&nbsp;Dipika Agrawal MD,&nbsp;Ze Ying Tan MD,&nbsp;Sridhar Venkateswaran MD,&nbsp;Adeline Yit Ying Tan MD,&nbsp;Ching Yee Tan MD,&nbsp;Norris Chun Ang Ling MD,&nbsp;Noel Stanley Wey Tut Tay MD","doi":"10.1016/j.hrtlng.2024.07.010","DOIUrl":"10.1016/j.hrtlng.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><p>Anti-fibrotics can reduce restrictive impairment in idiopathic pulmonary fibrosis (IPF). However, its effectiveness in non-IPF progressive fibrosing interstitial lung disease (non-IPF PF-ILD) remains uncertain.</p></div><div><h3>Objective</h3><p>We assess the efficacy and safety of anti-fibrotics pirfenidone and nintedanib versus placebo among non-IPF PF-ILD adult patients.</p></div><div><h3>Methods</h3><p>Meta-analysis was performed using PubMed, SCOPUS, and Cochrane databases to identify randomized controlled trials (RCTs). At respective centers, non-IPF PF-ILD was defined as clinical and radiological findings inconsistent with IPF and greater than 5 % forced vital capacity (FVC) decline, worsening radiological fibrosis or respiratory symptoms.</p></div><div><h3>Results</h3><p>Among seven RCTs involving 1,816 non-IPF PF-ILD patients, anti-fibrotics significantly reduced decline in FVC from baseline in milliliters (MD -66.80milliliters; <em>P</em> &lt; 0.01) and percent predicted (MD -1.80 %; <em>P</em> &lt; 0.01) compared to placebo. However, severity of FVC decline was less than 10 % (<em>P</em> = 0.33) in both groups. No significant difference in the decline of 6MWD from baseline in meters (<em>P</em> = 0.19) while on anti-fibrotics, although those on pirfenidone had less decline in 6MWD (MD -25.12 m; <em>P</em> &lt; 0.01) versus placebo. The rates of all-cause mortality (<em>P</em> = 0.34), all-cause hospitalization (<em>P</em> = 0.44), and hospitalization for respiratory etiology (<em>P</em> = 0.06) were comparable in both groups. Adverse events of nausea/vomiting (54.2 % vs. 20.3 %; <em>P</em> &lt; 0.01), diarrhea (65.2 % vs. 27.6 %; <em>P</em> = 0.02), anorexia/weight loss (23.0 % vs. 7.7 %; <em>P</em> &lt; 0.01), neurological disorders (20.8 % vs. 12.6 %; <em>P</em> &lt; 0.01), and events requiring therapy discontinuation were higher (18.4 % vs. 9.9 %; <em>P</em> &lt; 0.01) in the anti-fibrotic group. Other adverse events of skin (<em>P</em> = 0.18) and respiratory disorders (<em>P</em> = 0.20) were equal.</p></div><div><h3>Conclusion</h3><p>The advent of anti-fibrotics offers alternative treatment to reduce lung function decline.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 242-253"},"PeriodicalIF":2.4,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876757","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":"Self-care styles of patients with chronic obstructive pulmonary disease: A mixed methods case study","authors":"Marco Clari RN, PhD ,&nbsp;Federica Riva-Rovedda RN, MNS ,&nbsp;Valerio Dimonte RN, MNS ,&nbsp;Maria Matarese RN, MNS","doi":"10.1016/j.hrtlng.2024.07.011","DOIUrl":"10.1016/j.hrtlng.2024.07.011","url":null,"abstract":"<div><h3>Background</h3><p>In people affected by chronic obstructive pulmonary disease (COPD), self-care is crucial for improving quality of life, decreasing symptom burden, and reducing health care-related costs. Unlike other chronic conditions, little is known about the factors that influence different self-care styles in COPD patients.</p></div><div><h3>Objectives</h3><p>To explore the factors that could influence the self-care styles of patients with COPD.</p></div><div><h3>Methods</h3><p>A mixed methods case study design was used. Quantitative and qualitative data were collected at the same stage in a purposive sample of patients with COPD through questionnaires, interviews, and focus groups. Data were analyzed separately and then integrated to compare the cases.</p></div><div><h3>Results</h3><p>Thirty-seven patients with COPD were recruited from an outpatient clinic, pulmonary rehabilitation unit and online in a patient support group. On average, participants scored below the level of adequacy in all self-care dimensions. Self-care maintenance was influenced by patient age, education level, and economic status. Most participants reported performing self-care behaviors, while some did not because they found it difficult or because they did not recognize their importance. When the quantitative and qualitative data of patients with higher and lower levels of self-care were integrated, four different styles of self-care were identified according to COPD severity, psychological distress and level of self-efficacy: proactive, inactive, reactive, and hypoactive.</p></div><div><h3>Conclusions</h3><p>Personal, clinical, psychological, and social factors not only influence the level of self-care performed by COPD patients but also contribute to the understanding of different self-care styles. This knowledge could support health care professionals in tailoring educational interventions.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 231-241"},"PeriodicalIF":2.4,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0147956324001389/pdfft?md5=1c3d5e45a3eb5065c82a47e3a2f8a50f&pid=1-s2.0-S0147956324001389-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876758","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":"Ambulatory status and related factors in patients with spinal cord ischemia due to aortic aneurysm","authors":"Saranpat Puthai MD ,&nbsp;Wilawan Thirapatarapong MD","doi":"10.1016/j.hrtlng.2024.07.006","DOIUrl":"10.1016/j.hrtlng.2024.07.006","url":null,"abstract":"<div><h3>Background</h3><p>Spinal cord ischemia (SCI) is a serious complication that can occur at the onset of aortic aneurysm (AA) or after AA surgery. SCI impairs ambulation in patients. However, there is a lack of evidence regarding ambulatory status and its associated factors.</p></div><div><h3>Objectives</h3><p>To identify the ambulatory status of patients with SCI due to AA and/or AA surgery and sociodemographic and clinical characteristics factors associated with ambulatory status.</p></div><div><h3>Methods</h3><p>A descriptive study using a retrospective medical record data was undertaken. Data were collected from the electronic health records of SCI patients resulting from AA or who underwent surgical intervention for AA from January 2009 through December 2021. We analyzed the data to determine the ambulatory status before discharge. The demographic and clinical characteristics of the patients were investigated using chi-square and Fisher's exact tests to identify factors associated with ambulatory status.</p></div><div><h3>Results</h3><p>Among the 4,142 patients diagnosed with AA, 30 developed SCI. Of these 30 AA patients with SCI, 63.3 % were male. The median age was 70 years, ranging from 39 to 89 years. Six had SCI at the time of AA diagnosis. Among the subset of 2,994 patients who underwent aortic surgery, 24 developed SCI postoperatively. At discharge, two-thirds of the SCI patients with AA were unable to ambulate, and almost half were bedridden. The factors associated with ambulatory status were length of stay, neurogenic bladder, and pressure ulcers.</p></div><div><h3>Conclusions</h3><p>Most patients with SCI due to AA and/or AA surgery are unable to walk before discharge. Length of stay, neurogenic bladder, and pressure ulcers were associated with poor ambulatory status. Older adults and those with medical comorbidities and complications are at particularly high risk for impaired ambulation.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 227-230"},"PeriodicalIF":2.4,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789949","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":"Appropriateness and outcomes of hospitalized patients telemetry monitored for cardiac arrhythmias in accordance with the American Heart Association Practice Standards–A multicenter study","authors":"Marianne Sætrang Holm ,&nbsp;Nina Fålun ,&nbsp;Trond Røed Pettersen ,&nbsp;Bjørn Bendz ,&nbsp;Roy Miodini Nilsen ,&nbsp;Jørund Langørgen ,&nbsp;Alf Inge Larsen ,&nbsp;Marianne Laastad Sørensen ,&nbsp;Kristin E. Sandau ,&nbsp;Tone Merete Norekvål","doi":"10.1016/j.hrtlng.2024.07.005","DOIUrl":"10.1016/j.hrtlng.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><p>To the best of our knowledge, no prospective research studies have compared clinical practice to the American Heart Association (AHA) updated practice standards for in-hospital telemetry monitoring.</p></div><div><h3>Objectives</h3><p>Our aims were therefore (1) to investigate how patients were assigned to telemetry monitoring in accordance with the AHA's updated practice standards, (2) to determine the number and type of arrhythmic events, and (3) to describe subsequent changes in clinical management.</p></div><div><h3>Methods</h3><p>This prospective multicenter study included 1154 patients at three university hospitals in Norway. Data were collected 24/7 over a four-week period, with follow-up measurements from telemetry admission until hospital discharge.</p></div><div><h3>Results</h3><p>Of patients assigned to telemetry, 67 % (<em>n</em> = 767) met practice standards, corresponding to AHA Class I or II. Patients were predominantly men (65 %, <em>n</em> = 748), and the mean age was 65 years (SD ±16). The study included both patients with cardiac and non-cardiac diagnoses from various medical and surgical departments throughout the hospitals. Ninety-one percent of the patients in Class III were monitored based on indications that were reclassified from Class II to Class III (not indicated) in the updated practice standards (patients admitted with chest pain or post-percutaneous coronary intervention (PCI) without complications). Overall, arrhythmic events occurred in 37 % (<em>n</em> = 424) of patients, and they occurred in all classes. Eighteen percent (<em>n</em> = 59) of arrhythmic events occurred in Class III. Of all arrhythmias, 3 % (<em>n</em> = 14) were life threatening, and all of them occurring within Class I. Telemetry monitoring led to changes in clinical management in 22 % (<em>n</em> = 257) of patients due to clinical alarms, of which 71 % (<em>n</em> = 182) were related to medication management.</p></div><div><h3>Conclusions</h3><p>Most patients were appropriately monitored according to the AHA practice standards, meeting Class I and II. Arrhythmias occurred in all classes, but life-threatening arrhythmias only occurred in patients in Class I. However, a daily re-assessment of each patient's telemetry indication is warranted.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 217-226"},"PeriodicalIF":2.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S014795632400133X/pdfft?md5=b5abf060d4e398207cb09a8157a7e5d3&pid=1-s2.0-S014795632400133X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789950","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}