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Heart failure intensive care

Ashleigh Long, Paul Mahoney
BACKGROUND: Transcatheter mitral valve-in-valve (TMVIV) or valve-in-ring (TMVIR) replacement has shown early promise in patients deemed poor surgical candidates as a less invasive alternative to conventional reoperative mitral valve (MV) replacement. OBJECTIVE: This retrospective, single-center study reviewed the procedural outcomes of all TMVIV and TMVIR procedures between 2013-2018 at a large tertiary referral center serving the southeastern United States. An analysis of patient safety measures was also performed, with a retrospective assessment of relative procedural safety that included preoperative risk stratification and postoperative mortality predictors, operative time, average blood loss, length of hospital stay, and readmission rates...
June 15, 2018: Journal of Invasive Cardiology
John S Harrington, Edward J Schenck, Clara Oromendia, Augustine M K Choi, Ilias I Siempos
PURPOSE: We examined whether patients with acute respiratory distress syndrome (ARDS) lacking risk factors are enrolled in therapeutic trials and assessed their clinical characteristics and outcomes. METHODS: We performed a secondary analysis of patient-level data pooled from the ARMA, ALVEOLI, FACTT, ALTA and EDEN ARDSNet randomized controlled trials obtained from the Biologic Specimen and Data Repository Information Coordinating Center of the National Heart, Lung and Blood Institute...
June 2, 2018: Journal of Critical Care
Matthew J Fenton, Philippa Horne, Jacob Simmonds, Sophie L Neligan, Rachel E Andrews, Michael Burch
OBJECTIVE: Understanding the clinical course and time-frame for recovery is helpful to guide management and counselling following a diagnosis of Dilated Cardiomyopathy (DCM). We aimed to document outcomes and time to recovery for a cohort of patients with a dilated cardiomyopathy phenotype. METHODS: An observational cohort methodology was used to collect retrospective data from the departmental database for those identified with DCM. Data relating to mode of presentation, echocardiographic parameters, clinical management and outcome were collated and analysed...
September 1, 2018: International Journal of Cardiology
Brit Long, Alex Koyfman, Eric J Chin
INTRODUCTION: Acute heart failure (AHF) accounts for a significant number of emergency department (ED) visits, and the disease may present along a spectrum with a variety of syndromes. OBJECTIVE: This review evaluates several misconceptions concerning heart failure evaluation and management in the ED, followed by several pearls. DISCUSSION: AHF is a heterogeneous syndrome with a variety of presentations. Physicians often rely on natriuretic peptides, but the evidence behind their use is controversial, and these should not be used in isolation...
June 1, 2018: American Journal of Emergency Medicine
John K Yue, Angel Ordaz, Ethan A Winkler, Hansen Deng, Catherine G Suen, John F Burke, Andrew K Chan, Geoffrey T Manley, Sanjay S Dhall, Phiroz E Tarapore
OBJECTIVE: Predictors of surgical outcomes following traumatic axis (C2) fractures in octogenarians remain undercharacterized. METHODS: Patients aged ≥80-years undergoing cervical spine surgery following traumatic C2 fractures were extracted from the National Sample Program of the National Trauma Data Bank (2003-2012). Outcomes include overall inpatient complications, individual complications >1% incidence, hospital length of stay (HLOS), discharge disposition, and mortality...
June 7, 2018: World Neurosurgery
Elena Tomaselli Muensterman, James E Tisdale
Prolongation of the heart rate-corrected QT (QTc) interval increases the risk for torsades de pointes (TdP), a potentially fatal arrhythmia. The likelihood of TdP is higher in patients with risk factors, which include female sex, older age, heart failure with reduced ejection fraction, hypokalemia, hypomagnesemia, concomitant administration of ≥ 2 QTc interval-prolonging medications, among others. Assessment and quantification of risk factors may facilitate prediction of patients at highest risk for developing QTc interval prolongation and TdP...
June 8, 2018: Pharmacotherapy
Gianfranco Sanson, Massimiliano Sartori, Lorella Dreas, Roberta Ciraolo, Adam Fabiani
BACKGROUND: Extubation failure (ExtF) is associated with prolonged hospital length of stay and mortality in adult cardiac surgery patients postoperatively. In this population, ExtF-related variables such as the arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2 /FiO2 ), rapid shallow breathing index, cough strength, endotracheal secretions and neurological function have been sparsely researched. AIM: To identify variables that are predictive of ExtF and related outcomes...
June 1, 2018: European Journal of Cardiovascular Nursing
Andrea Olivia Ciobanu, Leonida Gherasim
Ischemic hepatitis is an important, yet underdiagnosed pathological condition seen in either cardiology or hepatology clinics or intensive care units. The main causes are severe heart failure, circulatory and septic shock. Close monitoring of biological tests (AST, ALT, LDH) together with hemodynamic parameters (blood pressure, cardiac output and central venous pressure) allow for rapid and accurate diagnosis. Correction of hemodynamic parameters, hypoxemia, hepatic and/or renal dysfunction leads to a more favorable outcome of these patients...
March 2018: Mædica
Stefan P Kastl, Konstantin A Krychtiuk, Max Lenz, Klaus Distelmaier, Georg Goliasch, Kurt Huber, Johann Wojta, Gottfried Heinz, Walter S Speidl
BACKGROUND: Acute heart failure and cardiogenic shock are associated with an impaired intestinal perfusion, which may lead to a release of cytoplasmatic proteins by hypoxic epithelial injury. Intestinal fatty acid binding protein (iFABP), highly specific for the small bowel enterocyte, may pose a useful novel and very sensitive biomarker for predicting outcome of these patients.The aim of this study was to investigate whether circulating levels of iFABP are associated with mortality in patients with acute heart failure or cardiogenic shock requiring intensive care unit (ICU) admission...
May 29, 2018: Shock
Lanfranco Antonini, Cristina Mollica, Nadia Aspromonte, Vincenzo Pasceri, Antonio Auriti, Lucio Gonzini, Piero Maggioni, Furio Colivicchi
BACKGROUND: Rapid effective triage is integral to emergency care in patients hospitalized for heart failure, to guide the type and intensity of therapy. Several indexes and scores have been proposed to predict outcome; most of the them are complex and unfit to use at the bedside. METHODS: We propose a new prognostic index for in hospital mortality in acute heart failure. The index was built according to the formula; 220 - age - heart rate + systolic blood pressure - ( creatinine X 10)...
May 28, 2018: Minerva Cardioangiologica
Nicolas W Shammas, Ryan Kelly, Jon Lemke, Ram Niwas, Sarah Castro, Christine Beuthin, Jackie Carlson, Marti Cox, Gail A Shammas, Terri DeClerck, Kathy Lenaghan, Sunny Arikat, Marcia Erickson
Background: Hospital inpatient readmissions for patients admitted initially with the primary diagnosis of heart failure (HF) can be as high as 20-25% within 30 days of discharge. This, however, does not include admissions for observations or emergency department (ED) visits within the same time frame and does not show a time-dependent hospital encounter following discharge after an index admission. We present data on time-dependent hospital encounter of HF patients discharged after an index admission for a primary diagnosis of HF...
2018: Cardiology Research and Practice
Guangliang Hong, Dong Zheng, Lulu Zhang, Rui Ni, Grace Wang, Guo-Chang Fan, Zhongqiu Lu, Tianqing Peng
AIMS: Sepsis-caused multiple organ failure remains the major cause of morbidity and mortality in intensive care units. Nicotinamide riboside (NR) is a precursor of nicotinamide adenine dinucleotide (NAD+ ), which is important in regulating oxidative stress. This study investigated whether administration of NR prevented oxidative stress and organ injury in sepsis. METHODS: Mouse sepsis models were induced by injection of lipopolysaccharides (LPS) or feces-injection-in-peritoneum...
May 24, 2018: Free Radical Biology & Medicine
Alexander C Fanaroff, Anita Y Chen, Laine E Thomas, Karen S Pieper, Kirk N Garratt, Eric D Peterson, L Kristin Newby, James A de Lemos, Mikhail N Kosiborod, Ezra A Amsterdam, Tracy Y Wang
BACKGROUND: Intensive care unit (ICU) use for initially stable patients presenting with non-ST-segment-elevation myocardial infarction (NSTEMI) varies widely across hospitals and minimally correlates with severity of illness. We aimed to develop a bedside risk score to assist in identifying high-risk patients with NSTEMI for ICU admission. METHODS AND RESULTS: Using the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry linked to Medicare data, we identified patients with NSTEMI aged ≥65 years without cardiogenic shock or cardiac arrest on presentation...
May 25, 2018: Journal of the American Heart Association
Robert B Hawkins, J Hunter Mehaffey, Abra Guo, Eric J Charles, Alan M Speir, Jeffrey B Rich, Mohammed A Quader, Gorav Ailawadi, Leora T Yarboro
BACKGROUND: Postoperative atrial fibrillation (POAF) is a known risk factor for morbidity and mortality after cardiac surgery but has not been investigated in the left ventricular assist device (LVAD) population. We hypothesize that POAF will increase morbidity and resource utilization after LVAD placement. METHODS: Records were extracted for all patients in a regional database who underwent continuous-flow LVAD placement (n = 1064, 2009-2017). Patients without a history of atrial fibrillation (n = 689) were stratified by POAF for univariate analysis...
April 18, 2018: Journal of Thoracic and Cardiovascular Surgery
Leo F Buckley, Irene M Cooper, Kristina Navarro-Velez, Elaine L Shea, Joanna M Joly, Mandeep R Mehra, Lynne W Stevenson, Akshay S Desai
BACKGROUND: Concerns remain about the burden of nursing care required to implement pulmonary artery pressure monitoring of heart failure patients. METHODS: We conducted a retrospective analysis of patients (N = 15) with a PAP sensor at our center. We defined three categories of PAP activity and estimated the nursing time spent on PAP monitoring. RESULTS: During the 6 months after implantation, the median patient contact time was 67 (55-75) minutes/patient/month and the median frequency of patient contact was 5...
May 22, 2018: Heart & Lung: the Journal of Critical Care
Peter Schnuelle, Urs Benck, Benito A Yard
Renal-dose dopamine has fallen out of favor in the intensive care unit (ICU) during past years due to its ineffectiveness to prevent impending or to ameliorate overt renal failure in the critically ill. By contrast, growing evidence indicates that low-dose dopamine administered to the stable organ donor after brain death confirmation improves the clinical course of transplanted organs after kidney and heart transplantation. Ensuring a thorough monitoring for potential circulatory side effects, employment of dopamine at a dose of 4 μg/kg per minute is safe in the deceased donor...
May 23, 2018: Clinical Transplantation
Abdulaleem Alatassi, Mohamad Habbal, Hani Tamim, Musharaf Sadat, Eman Al Qasim, Yaseen M Arabi
BACKGROUND: The association of troponin-I levels and outcome in medical-surgical ICU patients has been studied before in populations with low to moderate prevalence of cardiovascular risk factors. The objective in this article is to examine the association of troponin-I levels with hospital mortality in patients with high prevalence of cardiovascular risk factors who were admitted with medical-surgical indications to a non-cardiac intensive care unit. METHODS: This was a retrospective study of adult patients admitted to a tertiary medical-surgical ICU between July 2001 and November 2011...
May 22, 2018: BMC Anesthesiology
Besma Nejim, Robert J Beaulieu, Husain Alshaikh, Mohammed Hamouda, Joseph Canner, Mahmoud B Malas
BACKGROUND: Patients with peripheral arterial disease (PAD) often have high comorbidity burden that may complicate post-interventional course and drive increased healthcare expenditures. Racial disparity had been observed in lower extremity revascularization (LER) patterns and outcomes. In 2014, Maryland adopted an all-payer rate setting system to limit the rising hospitalization costs. This resulted in an aggregate payment system in which hospital compensation takes place as an overall per capita expenditure for hospital services...
May 18, 2018: Annals of Vascular Surgery
Torsten Doenst, Hristo Kirov, Alexandros Moschovas, David Gonzalez-Lopez, Rauf Safarov, Mahmoud Diab, Steffen Bargenda, Gloria Faerber
For the year 2017, more than 21,000 published references can be found in PubMed when entering the search term "cardiac surgery". This review focusses on conventional cardiac surgery, considering the new interventional techniques only if they were directly compared to classic techniques but also entails aspects of perioperative intensive care management. The publications last year provided a plethora of new and interesting information that helped to quantify classic surgical treatment effects and provided new guidelines for the management of structural heart disease, which made comparisons to interventional techniques easier...
May 17, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Neil Sengupta, Ariela L Marshall, Blake A Jones, Sandra Ham, Elliot B Tapper
BACKGROUND AND AIMS: Little is known about outcomes of patients hospitalized for gastrointestinal bleeding (GIB) while they are taking direct oral anticoagulants (DOAC). We aimed to determine the frequency at which patients resume DOAC therapy following hospitalization for GIB in a real-world setting, and the risks and benefits. METHODS: We conducted a retrospective analysis of medical claims data from the Truven Health Marketscan Commercial Claims and Encounters Database, from January 1, 2010 through December 31, 2014...
May 15, 2018: Clinical Gastroenterology and Hepatology
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