American heart journal plus : cardiology research and practice最新文献

{"title":"Sustainability and cost of typical and heart-healthy dietary patterns in Australia","authors":"Rachel E. Cobben ,&nbsp;Clare E. Collins ,&nbsp;Karen E. Charlton ,&nbsp;Tamara Bucher ,&nbsp;Jordan Stanford","doi":"10.1016/j.ahjo.2024.100448","DOIUrl":"10.1016/j.ahjo.2024.100448","url":null,"abstract":"<div><h3>Study objective</h3><p>The aim was to quantify and compare the environmental and financial impact of two diets: a heart-healthy Australian diet (HAD) and the typical Australian diet (TAD).</p></div><div><h3>Design</h3><p>The study involved a secondary analysis of two modelled dietary patterns used in a cross-over feeding trial.</p></div><div><h3>Setting</h3><p>The evaluation focused on two-week (7-day cyclic) meal plans designed to meet the nutritional requirements for a reference 71-year-old male (9000 kJ) for each dietary pattern.</p></div><div><h3>Main outcome measures</h3><p>The environmental footprint of each dietary pattern was calculated using the Global Warming Potential (GWP*) metric, taking into account single foods, multi-ingredient foods, and mixed dishes. Prices were obtained from a large Australian supermarket.</p></div><div><h3>Results</h3><p>The HAD produced 23.8 % less CO₂ equivalents (CO₂e) per day (2.16 kg CO₂e) compared to the TAD (2.83 kg CO₂e per day). Meat and discretionary foods were the primary contributors to the environmental footprint of the TAD, whereas dairy and vegetables constituted the largest contributors to the HAD footprint. However, the HAD was 51 % more expensive than the TAD.</p></div><div><h3>Conclusion</h3><p>Transitioning from a TAD to a HAD could significantly reduce CO₂ emissions and with benefits for human health and the environment. Affordability will be a major barrier. Strategies to reduce costs of convenient healthy food are needed. Future studies should expand the GWP* database and consider additional environmental dimensions to comprehensively assess the impact of dietary patterns. Current findings have implications for menu planning within feeding trials and for individuals seeking to reduce their carbon footprint while adhering to heart-healthy eating guidelines.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"45 ","pages":"Article 100448"},"PeriodicalIF":1.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224000910/pdfft?md5=c6325053f28118dc2a482fba8e3697c0&pid=1-s2.0-S2666602224000910-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in the approach to a patient with aortic stenosis and cardiac amyloidosis with ATTR mutation associated with negative scintigraphy - A case report","authors":"Gabriela Carvalho Monnerat Magalhães,&nbsp;Luciana Coutinho Bezerra,&nbsp;Beny Binensztok,&nbsp;Maysa Ramos Vilela,&nbsp;Ellen Fernanda das Neves Braga,&nbsp;Adriana Soares Xavier de Brito,&nbsp;Gabriel Cordeiro Camargo,&nbsp;Luiz Felipe Camillis,&nbsp;Helena Cramer Veiga Rey,&nbsp;Clara Weksler","doi":"10.1016/j.ahjo.2024.100444","DOIUrl":"10.1016/j.ahjo.2024.100444","url":null,"abstract":"<div><h3>Introduction</h3><p>Cardiac amyloidosis (CA) poses significant diagnostic and therapeutic challenges. In this case report, we detail a patient with CA due to a rare transthyretin (CA-TTR) mutation, manifesting with negative myocardial scintigraphy and requiring genetic testing for diagnosis. The patient also had severe aortic stenosis (AS), necessitating discussion with a heart team to determine the optimal treatment strategy.</p></div><div><h3>Case report</h3><p>A 70-year-old male with a family history of sudden death was previously diagnosed with third-degree atrioventricular block and treated with a pacemaker. He presented with worsening exertional dyspnoea, and examination revealed a third heart sound, a systolic murmur indicative of AS and bilateral muscular atrophy in the thenar region. Transthoracic echocardiography indicated severe AS and moderate left ventricular dysfunction, with images suggesting infiltrative disease. Pyrophosphate scintigraphy revealed no abnormal cardiac tracer uptake. Cardiac magnetic resonance imaging (MRI) revealed extensive, heterogeneous, subendocardial late gadolinium enhancement in both the atria and ventricles, which was consistent with CA. Genetic testing identified the Phe84Leu mutation in the TTR gene. Following heart team discussions, the patient underwent successful transcatheter aortic valve implantation (TAVI) and remained asymptomatic in follow-up, being monitored at an outpatient clinic specializing in CA and using tafamidis.</p></div><div><h3>Discussion</h3><p>CA-TTR can be an autosomal dominant disease with variable penetrance involving abnormal amyloid protein deposition in tissues and can often be diagnosed noninvasively via myocardial scintigraphy. However, some TTR mutations do not affect scintigraphy results, necessitating genetic testing when clinical suspicion is high, potentially avoiding endomyocardial biopsy. Moreover, AS occurs in up to 16 % of TTR amyloidosis patients, with the conditions mutually exacerbating each other. Recent consensus suggests that TAVI reduces mortality in patients with severe AS and amyloidosis.</p></div><div><h3>Conclusions</h3><p>Various diagnostic algorithms emphasize the use of myocardial scintigraphy for suspected CA-TTR. Genetic testing is crucial when scintigraphy results are negative, but clinical suspicion remains high, potentially circumventing invasive procedures. Compared with medical management alone, TAVI has been shown to improve quality of life and survival in patients with concurrent severe AS and CA.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"45 ","pages":"Article 100444"},"PeriodicalIF":1.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224000879/pdfft?md5=1993bba6a82405fad0006d6f41730eae&pid=1-s2.0-S2666602224000879-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142077381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climate change and cardiovascular health: Recent updates and actions for healthcare","authors":"Jasmine K. Malhi ,&nbsp;John W. McEvoy ,&nbsp;Roger S. Blumenthal ,&nbsp;Alan P. Jacobsen","doi":"10.1016/j.ahjo.2024.100443","DOIUrl":"10.1016/j.ahjo.2024.100443","url":null,"abstract":"<div><p>Climate change is a public health crisis predominantly due to fossil fuel combustion, that challenges planetary and human health. Considerable evidence exists to demonstrate the impact climate change has on cardiovascular disease primarily through air pollution, and non-optimal temperature. Conversely, healthcare systems themselves contribute substantially to climate change. Many clinicians personally report a sense of responsibility to reduce the detrimental impact of parts of our healthcare system on the environment. Roadmaps exist to guide decarbonization and reduce pollution in the healthcare sector. The first step in minimizing the climate impact of the provision of cardiovascular care is to determine the carbon footprint of highly resource dependent sectors such as critical care cardiology as well as the cardiac catheterization and electrophysiology laboratories. This should be followed by sustainable changes to address healthcare waste and energy use. Engagement from healthcare leadership, governmental organizations and major cardiac societies will be necessary to impact meaningful change.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"45 ","pages":"Article 100443"},"PeriodicalIF":1.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224000867/pdfft?md5=a242dd3d5ca732b821e68a4ed8673999&pid=1-s2.0-S2666602224000867-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141993425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of rest magnetocardiography in patients presenting to the emergency department with chest pain: A case series on the CardioFlux MCG","authors":"Sharon E. Mace ,&nbsp;Margarita Pena ,&nbsp;David J. Ahee ,&nbsp;Robert Takla","doi":"10.1016/j.ahjo.2024.100441","DOIUrl":"10.1016/j.ahjo.2024.100441","url":null,"abstract":"<div><h3>Background</h3><p>Magnetocardiography (MCG) may provide a rapid diagnostic option for patients presenting with chest pain in the emergency department (ED).</p></div><div><h3>Case summaries</h3><p>This case series presents two instances from a multicenter study, where MCG could have served as a rapid, non-invasive diagnostic tool for chest pain patients. In both cases, multiple high-sensitivity troponin (hsTn) tests yielded incorrect evidence of ischemia. In the first case, multiple positive hsTn tests led to the patient requiring 23 h of observation care, while MCG rapidly ruled out acute coronary syndrome (ACS). In the second case, MCG revealed findings indicative of cardiac ischemia where serial ECGs did not indicate ischemia and serial hsTns were normal. Subsequent cardiac catheterization confirmed 99 % stenosis in the patient's left main and left anterior descending arteries, necessitating coronary artery bypass grafting (CABG).</p></div><div><h3>Conclusion</h3><p>MCG offers a rapid, painless, non-invasive, radiation free assessment for patients presenting with acute chest pain. Integrating MCG into ED workflows has the potential to improve throughput, reduce the need for subsequent patient observation or inpatient admission, and minimize or eliminate the need for other more expensive non-invasive cardiac testing. MCG avoids some of the problems associated with other methods for diagnosing ischemia. MCG does not involve radiation or the use of pharmacologic agents which have a risk for allergic reactions and anaphylaxis, or the need for an intravenous line. Stress tests are frequently contraindicated or unable to be performed in patients on various medications, may require patient cooperation and in the case of exercise stress tests, the patient's capability to exercise. MCG requires no special patient preparation.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"45 ","pages":"Article 100441"},"PeriodicalIF":1.3,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224000843/pdfft?md5=48486f2100ab555cf318f8dfc4e7f3c0&pid=1-s2.0-S2666602224000843-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141990817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating fibrocyte levels correlate with left ventricular mass in middle-aged healthy adults without hypertension","authors":"Daniel S. Feuer ,&nbsp;Borna Mehrad ,&nbsp;Ellen C. Keeley","doi":"10.1016/j.ahjo.2024.100442","DOIUrl":"10.1016/j.ahjo.2024.100442","url":null,"abstract":"<div><h3>Background</h3><p>Fibrocytes, circulating bone-marrow derived cells that differentiate into fibroblasts and myofibroblasts, are a major source of hypertensive arterial fibrosis and correlate with left ventricular (LV) mass in subjects with hypertension. We tested whether circulating fibrocytes levels correlate with LV mass in middle-aged adults without hypertension.</p></div><div><h3>Methods</h3><p>We measured peripheral blood fibrocyte levels and their activated phenotypes in 13 middle-aged, non-hypertensive adults and performed cardiac magnetic resonance imaging to assess LV mass.</p></div><div><h3>Results</h3><p>There was a strong correlation between total fibrocyte levels (CD45 + Col1+) and LV mass index (<em>r</em> = 0.71, <em>p</em> = 0.006), as well as fibrocyte subsets expressing the chemokine markers CCR2 (<em>r</em> = 0.60, <em>p</em> = 0.032), CCR5 (<em>r</em> = 0.62, <em>p</em> = 0.029), CCR7 (<em>r</em> = 0.60, <em>p</em> = 0.034), co-expression of CXCR4 and CCR2 (<em>r</em> = 0.62, p = 0.029), α-SMA+ (<em>r</em> = 0.57, <em>p</em> = 0.044), CD133 (<em>r</em> = 0.59, <em>p</em> = 0.036), and pSTAT6 (<em>r</em> = 0.64, <em>p</em> = 0.032).</p></div><div><h3>Conclusions</h3><p>Circulating fibrocytes are associated with LV mass index in middle-aged, non-hypertensive adults and may be a harbinger for the development of hypertension.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"45 ","pages":"Article 100442"},"PeriodicalIF":1.3,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224000855/pdfft?md5=2dd7c26ff9c185edc2245da1dfb10ae9&pid=1-s2.0-S2666602224000855-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141990863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of exhaled carbon monoxide with atrial fibrillation and left atrial size in the Framingham Heart Study","authors":"Oseiwe B. Eromosele ,&nbsp;Ayelet Shapira-Daniels ,&nbsp;Amy Yuan ,&nbsp;Abdulkareem Lukan ,&nbsp;Olumuyiwa Akinrimisi ,&nbsp;Marius Chukwurah ,&nbsp;Matthew Nayor ,&nbsp;Emelia J. Benjamin ,&nbsp;Honghuang Lin","doi":"10.1016/j.ahjo.2024.100439","DOIUrl":"10.1016/j.ahjo.2024.100439","url":null,"abstract":"<div><h3>Background</h3><p>Exhaled carbon monoxide (eCO) is associated with subclinical and overt cardiovascular disease and stroke. The association between eCO with left atrial size, prevalent, or incident atrial fibrillation (AF) are uncertain.</p></div><div><h3>Methods</h3><p>eCO was measured using an Ecolyzer instrument among Framingham Heart Study Offspring and Omni participants who attended an examination from 1994 to 1998. We analyzed multivariable-adjusted (current smoking, and other covariates including age, race, sex, height, weight, systolic blood pressure, diastolic blood pressure, diabetes, hypertension treatment, prevalent myocardial infarction [MI], and prevalent heart failure [HF]). Cox and logistic regression models assessed the relations between eCO and incident AF (primary model), and prevalent AF and left atrial (LA) size (pre-specified secondary analyses). We also conducted secondary analyses adjusting for biomarkers, and interim MI and interim HF.</p></div><div><h3>Results</h3><p>Our study sample included 3814 participants (mean age 58 ± 10 years; 54.4 % women, 88.4 % White). During an average of 18.8 ± 6.5 years follow-up, 683 participants were diagnosed with AF. eCO was associated with incident AF after adjusting for established AF risk factors (HR, 1.31 [95 % CI, 1.09–1.58]). In secondary analyses the association remained significant after additionally adjusting for C-reactive protein and B-type natriuretic peptide, and interim MI and CHF, and in analyses excluding individuals who currently smoked. eCO was not significantly associated with LA size and prevalent AF.</p></div><div><h3>Conclusion</h3><p>In our community-based sample of individuals without AF, higher mean eCO concentrations were associated with incident AF. Further investigation is needed to explore the biological mechanisms linking eCO with AF.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"45 ","pages":"Article 100439"},"PeriodicalIF":1.3,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266660222400082X/pdfft?md5=f1c3cddaa7e2e01fb4542c63e75c47c2&pid=1-s2.0-S266660222400082X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141979332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol-driven approach to guideline-directed medical therapy optimization for heart failure: A real-world application to recovery","authors":"Crystal Lihong Yan ,&nbsp;David Snipelisky ,&nbsp;Mauricio Velez ,&nbsp;David Baran ,&nbsp;Jerry D. Estep ,&nbsp;E. Joseph Bauerlein ,&nbsp;Nina Thakkar Rivera","doi":"10.1016/j.ahjo.2024.100438","DOIUrl":"10.1016/j.ahjo.2024.100438","url":null,"abstract":"<div><p>The objective of our study was to evaluate the real-world effects of an aggressive, personalized protocol for guideline-directed medical therapy (GDMT) titration in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We conducted a two-center retrospective cohort study. Patients with HFrEF who presented to a HF clinic from January 2020 to December 2022 were placed on a GDMT protocol. 180 patients were included in the study. Mean GDMT score significantly increased from 4.7 to 5.9 (<em>p</em> &lt; 0.001) between initial and final visits. Mean left ventricular ejection fraction (LVEF) significantly increased from 28 % to 33 % (+5 %, <em>p</em> &lt; 0.001). 27 (15.7 %) of the 172 patients with complete New York Heart Association (NYHA) classification data had improvement by at least 1 class, while 2 (1.2 %) patients had worsening NYHA classification. 140 (77.8 %) patients had no unplanned hospitalizations between visits. 21 (11.7 %) patients had an unplanned hospitalization for acute HF during the study period with a mean time from first clinic visit to hospitalization of 183 days (range: 13–821 days). 2 (1.1 %) patients were hospitalized due to GDMT-associated adverse drug events (i.e. hypotension, hyperkalemia). 7 (3.9 %) patients died during the study period, which was lower than the predicted 1-year death rate for our cohort (12.3 %) using the MAGGIC score. In conclusion, an aggressive, personalized protocol for GDMT titration in patients with HFrEF led to significant improvements in LVEF, NYHA classification, hospitalization, and mortality in a real-world setting. This protocol may help serve as a road map to lessen the gap between clinical knowledge and practice surrounding optimization of GDMT and move HFrEF patients toward a path to recovery.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"45 ","pages":"Article 100438"},"PeriodicalIF":1.3,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224000818/pdfft?md5=80183d367d9c6b2407db692a56e41752&pid=1-s2.0-S2666602224000818-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141962718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline-directed medical therapy prescribing patterns and in-hospital outcomes among heart failure patients during COVID-19","authors":"Pratyaksh K. Srivastava ,&nbsp;Alexandra M. Klomhaus ,&nbsp;Asim Rafique ,&nbsp;Pooja S. Desai ,&nbsp;Lori B. Daniels ,&nbsp;Clyde W. Yancy ,&nbsp;Eric H. Yang ,&nbsp;Gregg C. Fonarow ,&nbsp;Rushi V. Parikh","doi":"10.1016/j.ahjo.2024.100440","DOIUrl":"10.1016/j.ahjo.2024.100440","url":null,"abstract":"<div><h3>Study objective</h3><p>The association of prior to admission guideline-directed medical therapy (GDMT) use in patients hospitalized with Heart Failure with Reduced Ejection Fraction (HFrEF, ejection fraction ≤40 %) and Coronavirus Disease 2019 (COVID-19) with in-hospital outcomes has not been well studied.</p></div><div><h3>Design/setting/participants/interventions/outcome measures</h3><p>Using the American Heart Association's Get With The Guidelines Heart Failure Registry, we identified HFrEF patients presenting with acute decompensated heart failure (ADHF) and compared rates of GDMT prescription between those presenting prior to and during the pandemic. In a subgroup of patients with a concomitant COVID-19 diagnosis, we evaluated the association of prior to admission GDMT use with in-hospital mortality and severe COVID-19.</p></div><div><h3>Results</h3><p>23,899 patients were admitted with HFrEF during the pandemic (2/16/20–3/24/21) and 26,459 patients were admitted in the year prior (2/16/19–2/15/20). In this overall cohort, prior to admission ACEI/ARB/ARNI (45.6 % vs 48.1 %, p &lt; 0.0001) and BB (56.9 % vs 62.4 %, p &lt; 0.0001) use was lower among admitted HFrEF patients during the pandemic when compared to the year prior. Rates of ACEI/ARB/ARNI, MRA, and triple therapy (ACE/ARB/ARNI + BB + MRA) prescription at discharge were higher during the pandemic compared to the year prior. Among a subgroup of those with HFrEF and COVID-19 (n = 333), prior to admission GDMT use was not associated with in-hospital mortality or severe COVID-19.</p></div><div><h3>Conclusion</h3><p>We found no association between prior to admission GDMT use and in-hospital mortality or severe COVID-19 among HFrEF patients admitted with ADHF and COVID-19. GDMT prescription at discharge for HFrEF patients overall has remained either similar or improved during the pandemic.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"45 ","pages":"Article 100440"},"PeriodicalIF":1.3,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224000831/pdfft?md5=2d0fdd03708262cb9f50db6885edc5af&pid=1-s2.0-S2666602224000831-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141963086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National cost savings, operational and safety benefits from use of magnetocardiography in the assessment of emergency department chest pain patients","authors":"Christopher W. Baugh ,&nbsp;Margarita E. Pena ,&nbsp;Robert B. Takla ,&nbsp;Ahmad O. Hadri ,&nbsp;Sharon E. Mace","doi":"10.1016/j.ahjo.2024.100434","DOIUrl":"10.1016/j.ahjo.2024.100434","url":null,"abstract":"<div><h3>Study objectives</h3><p>Patients frequently present to the emergency department (ED) with chest pain requiring further risk stratification. Traditional cardiac diagnostics such as stress testing may expose patients to ionizing radiation, may not be readily available, may take significant time for testing and interpretation, and adds cost to the workup. Magnetocardiography (MCG) is an alternative approach to assess candidates more quickly and efficiently than routine downstream testing.</p></div><div><h3>Design</h3><p>We created and ran 1000 trials of a Monte Carlo simulation. Using this simulation, we modeled the national annual impact by averting further cardiac diagnostics.</p></div><div><h3>Setting</h3><p>All EDs in the United States.</p></div><div><h3>Participants</h3><p>All ED adult patients with chest pain.</p></div><div><h3>Interventions</h3><p>Simulated use of MCG to reduce avoidable downstream cardiac diagnostics.</p></div><div><h3>Main outcome measures</h3><p>Our primary outcome was to estimate the impact of an MCG-first strategy on the annual national cost savings among eligible patients in the ED. Our secondary outcomes were the estimated reduction in short-stay hospitalizations, cancer cases, and cancer deaths due to radiation exposure.</p></div><div><h3>Results</h3><p>An MCG-first strategy was estimated to save a mean (±SD) of $574 million (±$175 million) by avoiding 555,000 (±93,000) downstream cardiac diagnostic tests. This resulted in a national annual cumulative decrease of 500,000 (±84,000) hospitalizations, 7,600,000 (±1,500,000) bed hours, 409 (±110) new cancer diagnoses, and 210 (±56) new cancer deaths due to radiation exposure from avoidable cardiac diagnostics.</p></div><div><h3>Conclusions</h3><p>If adopted widely and used consistently, an MCG-first strategy among eligible patients could yield substantial benefits by averting avoidable cardiac diagnostic testing.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"45 ","pages":"Article 100434"},"PeriodicalIF":1.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224000776/pdfft?md5=594a256ecb82a12c4d173fcd420f8465&pid=1-s2.0-S2666602224000776-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combination diuretic therapies in heart failure: Insights from GUIDE-IT","authors":"Jeffery Budweg ,&nbsp;Mustafa M. Ahmed ,&nbsp;Juan R. Vilaro ,&nbsp;Mohammad A. Al-Ani ,&nbsp;Juan M. Aranda Jr ,&nbsp;Yi Guo ,&nbsp;Ang Li ,&nbsp;Sandip Patel ,&nbsp;Alex M. Parker","doi":"10.1016/j.ahjo.2024.100436","DOIUrl":"10.1016/j.ahjo.2024.100436","url":null,"abstract":"<div><h3>Introduction</h3><p>Diuretics are the mainstay of maintaining and restoring euvolemia in the management of heart failure. Loop diuretics are often preferred, however, combination diuretic therapy (CDT) with a thiazide diuretic is often used to overcome diuretic resistance and increase diuretic effect. We performed an analysis of the GUIDE-IT study to assess all-cause mortality and time to first hospitalizations in patients necessitating CDT.</p></div><div><h3>Methods</h3><p>Patients from the GUIDE-IT dataset were stratified by their requirement for CDT with a thiazide to achieve euvolemia. A total of 894 patients were analyzed, 733 of which were treated with loop diuretics alone vs 161 used either chlorothiazide or metolazone in addition to loop diuretics. Kaplan-Meir curves were derived with log-rank <em>p</em>-values to evaluate for differences between the groups.</p></div><div><h3>Results</h3><p>There was no significant difference in all-cause mortality regardless of CDT utilization status (mean survival of 612.704 days vs 603.326 days, <em>p</em> = 0.083). On subgroup analysis, there was no significant difference in all-cause mortality amongst those using loop diuretics compared to CDT in the BNP-guided therapy group, (mean survival time 576.385 days vs 620.585 days, <em>p</em> = 0.0523), nor the control group (614.1 days vs 588.9 days; <em>p</em> = 0.5728). Time to first hospitalization was reduced in all using CDT compared to loop diuretics alone (280.5 days vs 407.2 days, <em>p</em> &lt; 0.0001). On subgroup analysis, both the BNP-guided group as well as the control group had reduced time to first hospitalization in the CDT group compared to those who did not require CDT (BNP group: 287.503 days vs 402.475 days, <em>p</em> ≤0.0001; control group 248.698 days vs 399.035 days, <em>p</em> = 0.0009).</p></div><div><h3>Conclusion</h3><p>Use of CDT is associated with earlier time to hospitalization, though no association was identified with increased all-cause mortality. Further prospective studies are likely needed to determine the true risk and benefits of combination diuretic therapy.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"45 ","pages":"Article 100436"},"PeriodicalIF":1.3,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266660222400079X/pdfft?md5=286071745bf1d2e77b4c6dfd626c8222&pid=1-s2.0-S266660222400079X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141962719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}