Admission Heart Rate Research Articles

ST yükselmesiz miyokard enfarktüslü yaşlı hastalarda hastane içi mortaliteyi öngörmek için yüksek duyarlı modifiye Glasgow prognostik skoru

Aim: Inflammation and malnutrition are poor prognostic markers in acute coronary syndromes. In this study, we aimed to investigate the association between high sensitive modified Glasgow prognostic score (HS-mGPS), derived from C-reactive protein and serum albumin levels, and in-hospital mortality of elderly patients with non-ST elevation myocardial infarction (NSTEMI).
 Material and Methods: Included subjects were recruited from three different tertiary health centers. Totally, 282 eligible patients aged >65 years with diagnosis of NSTEMI were retrospectively enrolled. Global Registry of Acute Coronary Events (GRACE) risk score for in-hospital mortality and HS-mGPS was calculated for each patient. Subjects were categorized according to their inflammation-based scores ((high HS-mGPS group (HS-mGPS ≥1, n=124) vs. low HS-mGPS group (HS-mGPS =0, n=158)). 
 Results: Both groups were similar regarding admission blood pressure levels, coronary angiography findings, treatment modalities and GRACE scores. Patients with high HS-mGPS had higher admission heart rate and longer hospitalization duration compared to low HS-mGPS group. In-hospital mortality rates were higher in high HS-mGPS group compared to low HS-mGPS group (21.8% (n=27) vs. 3.2% (n=5), respectively, P

Overnight admissions to a neonatal intensive care unit in Ethiopia are not associated with increased mortality.

BackgroundIn 2019, 2.4 million neonates died globally, with most deaths occurring in low-resource settings. Despite the introduction of neonatal intensive care units (NICUs) in these settings, neonatal mortality remains high, and caring for sick neonates around the clock can be challenging due to limited staff and resources.ObjectiveTo evaluate whether neonatal intensive care admissions during daytime and overnight hours affects in-hospital neonatal mortality.MethodsA retrospective case-control study was conducted using 2016 chart data at a University hospital in Ethiopia. Cases were defined as neonates who died in the NICU, and controls were defined as neonates who survived. Overnight hours were defined as 17:00 to 07:59, and day hours were defined as 08:00 to 16:59. Univariate and multivariate logistic regressions were used to investigate the relationship between time of admission and mortality, along with perinatal characteristics.ResultsA total of 812 neonates, 207 cases and 605 controls, met inclusion criteria. There were 342 admissions during the day and 470 overnight. Neonatal mortality (aOR 1.02, 95% CI [0.64–1.62], p = 0.93) was not associated with overnight admissions after controlling for maternal age, parity, C-section, birthweight, and gestational age, respiratory distress, and admission level of consciousness. Admission heart rate >160 (aOR 0.52, 95% CI [0.30–0.91], p = 0.02) was the only variable significantly associated with overnight admissions.ConclusionBeing admitted overnight to the NICU in Gondar, Ethiopia was not associated with increased mortality, consistent with a constant level of care, regardless of the time of admission. Further qualitative and implementation research are needed to understand contextual factors that have affected these data.

Effect of Presence versus Absence of Hypertension on Admission Heart Rate-Associated Cardiovascular Risk in Patients with Acute Coronary Syndrome.

Background and Aims Heart rate (HR) and hypertension are both important risk factors for adverse cardiovascular (CV) events in patients with established coronary artery disease (CAD). We sought to evaluate whether hypertension can modify the effect of admission HR on adverse CV events in patients with acute coronary syndrome (ACS). Methods A total of 1056 patients with ACS undergoing percutaneous coronary intervention (PCI) were analyzed. All patients were classified into three groups according to the tertiles of admission HR (T1: ≤66 bpm, n = 369; T2: 67–73 bpm, n = 322; and T3: ≥74 bpm, n = 365). The primary endpoint was defined as major adverse CV events (MACEs), including all-cause death, stroke, myocardial infarction, or unplanned repeat revascularization. The multivariate Cox regression model was performed to evaluate the association of admission HR with MACE stratified by hypertension. Results During the median follow-up of 30 months, a total of 232 patients developed at least one event. After adjusting for other covariates, elevated admission HR was significantly associated with an increased risk of MACE only in patients with hypertension (when T1 was taken as a reference, the adjusted HR of T2 was 1.143 [95% CI: 0.700–1.864] and that of T3 was 2.062 [95% CI: 1.300–3.270]); however, in patients without hypertension, admission HR was not associated with the risk of MACE (when T1 was taken as a reference, the adjusted HR of T2 was 0.744 [0.406–1.364] and that of T3 was 0.614 [0.342–1.101]) (P=0.025 for interaction). Conclusions In patients with ACS undergoing PCI, the association of elevated admission HR with an increased risk of MACE was present in individuals with hypertension but not in those without hypertension. This finding suggests a potential benefit of HR control for ACS patients when they concomitantly have hypertension.

Mobitz Type I as the Initial Presentation of Multisystem Inflammatory Syndrome in Children.

To The Editors: Since the emergence of the novel coronavirus SARS-CoV-2, great attention was drawn to the multisystem inflammatory syndrome in children (MIS-C) – a life-threatening complication. Although conduction disorders are uncommon in childhood, a growing number of mild cases address these abnormalities with MIS-C.1 Usually they include prolonged QTc interval, first-degree atrioventricular block (AVB), right bundle branch block, ST-segment changes and tachyarrhythmias.1 This report illustrates the importance of cardiovascular monitoring in patients with MIS-C admitted to the pediatric intensive care unit (PICU). A previously healthy 9-year-old boy presented with a high fever of 39.4°C and vomiting lasting for 4 days. He tested positive for SARS-CoV-2 by RT-PCR from a nasopharyngeal swab. On physical examination, the patient was hypotensive (blood pressure of 90/50 mm Hg) and tachycardic (heart rate of 103 beats per minute). Initial laboratory tests revealed a WBC count of 6.3 × 109/L with relative neutrophilia (85%), elevated inflammatory markers (procalcitonin of 0.949 mcg/L, C-reactive protein of 165.6 mg/L, ferritin of 280.3 mcg/L, interleukin-6 of 352.8 ng/L, fibrinogen of 7.6 g/L and D-dimers of 4.45 mg/L) and elevated cardiac markers (troponin of 0.970 mcg/L and NT-pro-BNP of 6092 ng/L). Upon sudden development of bradycardia (heart rate of 45 beats per minute), electrocardiogram (ECG) revealed Mobitz type I second-degree AVB. Echocardiography documented moderate mitral regurgitation and normal left ventricular ejection fraction without pericardial effusion. Treatment in the PICU included empiric antimicrobial therapy with ceftriaxone and clindamycin, intravenous immunoglobulins, glucocorticoids, vasopressor support and diuretics. The fever receded after 7 days. The blood cultures were negative. However, ECG raised suspicion of possible progression to more advanced blocks with a P:QRS ratio of 3:1 while the cardiac markers were still elevated (troponin of 0.062 mcg/L and NT-pro-BNP of 4110 ng/L). Serial ECG revealed spontaneous conversion to normal sinus rhythm within 3 days, confirmed by the 24-hour ECG monitoring. The patient was discharged after 14 days. At the 3- and 6-months follow-up, a 24-hour ECG recording and ergometric testing showed normal rhythm without any signs of AVB. Mobitz type I second-degree AVB secondary to MIS-C is clinically difficult to recognize due to the predominant development of hypotension and tachycardia upon admission, whereas low and irregular heart rate would be indicative of such conduction disorder in a child without MIS-C.2 Several studies explored acute cardiovascular manifestations in MIS-C where Valverde et al included 286 cases and Regan et al described serial ECGs in 63 cases with a median of 5 ECGs per patient.1,3 Neither study reported a second-degree AVB. All patients with severe MIS-C require PICU admission due to possible rapid hemodynamic deterioration. Furthermore, all patients with Mobitz type I second-degree AVB should be admitted and monitored due to possible progression to bradycardia, hypotension and/or higher degree AVB.2 In conclusion, MIS-C cases started having unique presentations, including cardiac conduction disorders. Second-degree AVB can be a presenting finding of MIS-C and high clinical suspicion must be held for patients presenting with signs of shock.

Sex differences in refeeding among hospitalized adolescents and young adults with eating disorders.

To determine sex differences in refeeding (i.e., short-term nutritional rehabilitation) outcomes among hospitalized adolescents and young adults with eating disorders. We retrospectively reviewed electronic medical records of 601 patients aged 9-25 years admitted to the University of California, San Francisco Eating Disorders Program for medical and nutritional management between May 2012 and August 2020. Descriptive statistics, crude, and adjusted linear regression models were used to assess the association between sex and nutritional outcomes and predictors of length of stay. A total of 588 adolescents and young adults met eligibility criteria (16% male, mean [SD] age 15.96 [2.75], 71.6% anorexia nervosa, admission percent median body mass index [%mBMI] 87.1 ± 14.1). In unadjusted comparisons, there were no significant sex differences in prescribed kilocalories (kcal) per day at admission (2013 vs. 1980, p=.188); however, males had higher estimated energy requirements (EER, kcal) (3,694 vs. 2,925, p < .001). In linear regression models adjusting for potential confounders, male sex was associated with higher prescribed kcals at discharge (B=835 kcal, p < .001), greater weight change (B=0.47 kg, p=.021), and longer length of stay (B=1.94 days, p=.001) than females. Older age, lower admission weight, lower prescribed kcal at admission, higher EER, and lower heart rate at admission were factors associated with longer length of stay in a linear regression model. These findings support the development of individualized approaches for males with eating disorders to improve quality of care and health care efficiency among an underserved population.

Relationship between admission vitals and brain herniation in 32 cats: a retrospective study.

The aim of the study was to evaluate whether any admission vitals correlated with the presence of brain herniation diagnosed via MRI in cats presenting with neurologic signs. Medical records at two veterinary university referral centers were reviewed to identify cats that underwent brain MRI between 2010 and 2019. A control group of cats with intracranial lesions without concurrent brain herniation was analyzed for comparison. Data relating to signalment, vitals on admission, abnormalities observed on initial neurologic examination, underlying etiology, advanced imaging findings and outcome were reviewed. A Modified Glasgow Coma Scale (MGCS) score was determined retrospectively based on initial neurologic examination. Logistic regressions were performed to investigate the relationship between each risk factor and the odds of brain herniation as diagnosed on MRI. Thirty-two cats with brain herniation and 44 cats with abnormal brain MRI without evidence of herniation (as a control group) based on MRI findings were included. Cats with intracranial neoplasia vs other diagnoses were found to be at increased risk of herniation (odds ratio [OR] 4.8, 95% confidence interval [CI] 1.8-13.8; P = 0.001). The odds of herniation increased with age (OR 1.1, 95% CI 1.01-1.2; P = 0.031). Cats with herniation had a significantly lower level of consciousness in their MGCS score (P <0.0001) than cats without herniation. There was no significant difference in either motor activity or brainstem reflexes between the groups (P >0.05). Admission heart rate and blood pressure were not associated with brain herniation. Cats with herniation were presented with a significantly lower level of consciousness in their MGCS score; however, this clinical feature cannot be directly attributable to and predictive of herniation. Older cats with intracranial neoplasia are more likely to have brain herniation.

Increased discharge heart rate might be associated with increased short-term mortality after acute coronary syndrome

Background In acute coronary syndrome (ACS) patients there are mostly studies evaluating prognostic value of admission heart rate. We tried to understand the prognostic value of discharge heart rate in a spectrum of ACS patients. Methods A total of 473 consecutive ACS patients were included in the study. Forty-three (9.1%) of them were unstable angina pectoris, 268 (56.7%) were non-ST elevation myocardial infarction and 162 (34.2%) of them were ST elevation myocardial infarction patients. Discharge heart rates of the patients were recorded and the patients were followed-up for 1 year. The primary end-point was all-cause mortality. Results The mean age of the patients was 64 ± 12. The patients were divided into three subgroups according to discharge heart rates (<78, 78–89, ≥90 beats per minute). Patients with a higher discharge heart rate had higher serum troponin, glucose levels and higher admission heart rates, had lower ejection fraction values and had acute heart failure complication more frequently than the patients with a lower discharge heart rate. A total of 72(16%) patients died during 1 year follow-up. In multivariate logistic regression analysis, an increased discharge heart rate was independently associated with 1-month mortality after ACS, but it was not independently associated with 6-month or 1-year mortality after ACS. Every 1 bpm increase in discharge heart rate resulted in a significant increased risk of 8.2% in 1-month all-cause mortality. Conclusion Increased heart rate at discharge is an independent predictor of 1-month mortality in ACS patients. This relationship disappears after 1-month through 1-year follow-up.

Heart Rate and Mortality in Patients With Acute Symptomatic Pulmonary Embolism

The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known. Does an association exist between baseline HR and PE outcome across the continuum of HR values? The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of≥ 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of< 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4%to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2%to 98.0%. In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE.

Prognostic value of neutrophil-lymphocyte ratio in cardiogenic shock complicating acute myocardial infarction: A cohort study.

Cardiogenic shock (CS) is the most severe complication after acute myocardial infarction (AMI) with mortality above 50%. Inflammatory response is involved in the pathology of CS and AMI. In this study, we aimed to evaluate the prognostic value of admission neutrophil-lymphocyte ratio (NLR) in patients with CS complicating AMI. Two hundred and seventeen consecutive patients with CS after AMI were divided into two groups according to the admission NLR cut-off value ≤7.3 and >7.3. The primary outcome was 30-day all-cause mortality and the secondary end-point was the composite events of major adverse cardiovascular events (MACE), including all-cause mortality, ventricular tachycardia/ventricular fibrillation, atrioventricular block, gastrointestinal haemorrhage and non-fatal stroke. Cox proportional hazard models were performed to analyse the association of NLR with the outcome. NLR cut-off value was determined by Youden index. Patients with NLR > 7.3 were older and presented with lower lymphocyte count, higher admission heart rate, B-type natriuretic peptide, leucocyte, neutrophil and creatinine (all P<.05). During a period of 30-day follow-up after admission, mortality in patients with NLR > 7.3 was significantly higher than in patients with NLR ≤ 7.3 (73.7% vs. 26.3%, P<.001). The incidence of MACE was also remarkably higher in patients with NLR > 7.3 (87.9% vs. 53.4%, P<.001). After multivariable adjustment, NLR > 7.3 remained an independent predictor for higher risk of 30-day mortality (HR 2.806; 95%CI 1.784, 4.415, P<.001) and MACE (HR 2.545; 95%CI 1.791, 3.617, P<.001). Admission NLR could be used as an important tool for short-term prognostic evaluation in patients with CS complicating AMI and higher NLR is an independent predictor for increased 30-day all-cause mortality and MACE.

The Correlations between Admission Heart Rate and Corrected QT Interval Prolongations with Coronary Artery Disease in Patients with Acute Coronary Syndrome

Background: Coronary heart disease is a major cause of mortality and this health problem is reaching pandemic in both developed, and developing countries. ACS carries significant morbidity and mortality and the prompt diagnosis, and appropriate treatment is essential. HR was identified as a risk predictor of ACS. Both continuous increase in high baseline heart rate and decrease in low baseline heart rate are associated with higher risk of CVD. Decreased heart rate could also cause dispersion of atrial repolarization which, in turn, initiate cardiovascular events.&#x0D; Aim: The aim of this study was to assess the correlation between heart rate and severity of coronary artery disease in patient with acute coronary syndrome.&#x0D; Patients and Methods: The retrospective study was conducted on 120 patients that fulfilled the inclusion criteria were recruited from Cardiology department in Tanta university hospitals presented with acute coronary syndrome.&#x0D; Results: There was highly significant difference between both groups regarding admission heart rate &amp; QTc interval. Both groups of low AHR&lt; 60 bpm &amp; high AHR &gt;90bpm were significantly associated with severe CAD &amp;.Mainly those patients with higher admission heart rate were more likely to have higher Syntax scores (severe coronary lesion). Also, patients with prolonged QTc had severe coronary artery diseases, higher SS &amp; high probability to suffer adverse cardiac events more than patients without prolonged QTc interval.&#x0D; Conclusion: The current study showed that QTc interval prolongation and admission HR are independent predictors of the severity of coronary artery disease in patients with acute coronary syndrome.

Heart rate trajectories in patients recovering from acute myocardial infarction: A longitudinal analysis of Apple Watch heart rate recordings

BackgroundUsing mobile health, vital signs such as heart rate (HR) can be used to assess a patient’s recovery process from acute events including acute myocardial infarction (AMI).ObjectiveWe aimed to characterize clinical correlates associated with HR change in the subacute period among patients recovering from AMI.MethodsHR measurements were collected from 91 patients (4447 HR recordings) enrolled in the MiCORE study using the Apple Watch and Corrie smartphone application. Mixed regression models were used to estimate the associations of patient-level characteristics during hospital admission with HR changes over 30 days postdischarge.ResultsThe mean daily HR at admission was 78.0 beats per minute (bpm) (95% confidence interval 76.1 to 79.8), declining 0.2 bpm/day (-0.3 to -0.1) under a linear model of HR change. History of coronary artery bypass graft, history of depression, or being discharged on anticoagulants was associated with a higher admission HR. Having a history of hypertension, type 2 diabetes mellitus (T2DM), or hyperlipidemia was associated with a slower decrease in HR over time, but not with HR during admission.ConclusionWhile a declining HR was observed in AMI patients over 30 days postdischarge, patients with hypertension, T2DM, or hyperlipidemia showed a slower decrease in HR relative to their counterparts. This study demonstrates the feasibility of using wearables to model the recovery process of patients with AMI and represents a first step in helping pinpoint patients vulnerable to decompensation.

Risk factors for laminitis and nonsurvival in acute colitis: Retrospective study of 85 hospitalized horses (2011-2019).

BackgroundAcute colitis is a serious cause of morbidity and death in horses. Recent studies have compared clinical features of coronavirus and salmonellosis, but no study has compared clinical features of enteric salmonellosis, coronavirus, and neorickettsiosis.Hypothesis/ObjectivesTo identify risk factors for laminitis and nonsurvival to discharge in horses with enteric salmonellosis, coronavirus, or neorickettsiosis.AnimalsEighty‐five horses hospitalized for acute colitis from 2011 to 2019.MethodsRetrospective case series. Medical record review (2011‐2019) of adult (≥2 years) horses with colitis. Primary outcomes were laminitis and survival to discharge. Multivariable logistic regression was performed to assess association between variables and the development of laminitis. Stepwise Cox regression was performed to assess association between variables and survival.ResultsSeventeen of 85 (20%) horses developed laminitis during hospitalization. Neorickettsiosis cases (11/26, 42%) were more likely to develop laminitis than coronavirus (0/16, 0%) cases (odds ratio [OR] 24.48; 95% confidence interval [CI]: 1.33‐451.74, P = .03). There was no significant difference in laminitis between salmonellosis and neorickettsiosis cases (OR 0.27; 95% CI: 0.07‐1.07, P = .06). Admission heart rate (OR 1.08; 95% CI: 1.02‐1.15, P = .01), total solids (OR 0.17; 95% CI: 0.06‐0.54, P = .003), band neutrophils (OR 1248.47; 95% CI: 6.62‐235 540, P = .008), and bicarbonate concentration (OR 0.68; 95% CI: 0.5‐0.92, P = .01) were predictive of development of laminitis during hospitalization. Sixty‐three of 85 (74%) horses survived to discharge: 16/16 (100%) coronavirus cases, 17/26 (65%) neorickettsiosis cases, 14/20 (70%) salmonellosis cases, and 16/23 (70%) unknown cases. Packed cell volume (hazard ratio [HR] 1.17; 95% CI: 1.09‐1.26, P < .001), L‐lactate concentration (HR 1.33; 95% CI: 1.14‐1.55, P < .001), and development of laminitis (HR 7.07; 95% CI: 1.67‐29.95, P = .008) were retained in the final multivariable model for prediction of nonsurvival to discharge.Conclusion and Clinical ImportanceNonsurvival and laminitis rates were high, likely related to the presence of neorickettsiosis in the region.

Bleeding predictors in acute coronary syndrome: does the age or clinical presentation matters?

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Bleeding is a quite common non-cardiac complication of acute coronary syndrome (ACS) and is associated with a negative prognosis impact. AIMS To determine the predictors of inhospital major bleeding (IHMB) in ACS and to evaluate whether they differ according to age and clinical presentation. METHODS A multicentric retrospective study which analysed 25524 patients(pts) with ACS, 25141 without and 383 with IHMB. By multivariate analysis, we determined IHMB predictors and evaluated the differences between age groups (&amp;lt;80 years; ≥80 years) and clinical presentation- ST elevation myocardial infarction (STEMI) or non-ST elevation ACS (NSTEACS). RESULTS By multivariate analysis we found 15 significant IHMB predictors (pvalue &amp;lt; 0,05): age≥75years, hypertension, previous angina, pulmonary disease, previous bleeding, atypical presentation (without pain), cardiac arrest, admission heart rate (HR)&amp;gt;100bpm, Killip4 at admission, ST-elevation, admission haemoglobin (Hb)&amp;lt;10g/dL, aspirin or Vitamin K antagonist (VKA) or ivabradine as previous medication and glycoprotein IIb/IIIa inhibitors (GPIIb/IIIa) use. Then, we made a sub-analysis in STEMI pts which revealed that IHMB predictors of pts &amp;lt;80 years were: female gender, age≥75years, chronic kidney disease (CKD), active neoplasm, previous bleeding, atypical presentation, cardiac arrest, admission HR &amp;gt; 100bpm, Killip IV on admission and GPIIb/IIIa use. By contrast, IHMB predictors of pts with ≥80 years were: valvular disease, atypical presentation, aspirin as previous medication and GPIIb/IIIa use. Finally, we made a sub-analysis in NSTACS pts which revealed that IHMB predictors of pts &amp;lt;80years were: previous angina, CKD, previous bleeding, cardiac arrest, Killip≥2 at admission, admission Hb &amp;lt; 10g/dL and VKA as previous medication. Conversely, IHMB predictors of pts with ≥80 years were previous bleeding, cardiac arrest and absence of normal QRS. In addition, by multivariate analysis we found that IHMB had an impact on inhospital mortality (OR = 2,2;pvalue &amp;lt; 0,001), however, by Cox regression there wasn’t an impact on 1-year mortality. CONCLUSION This study suggests that IHMB has impact on inhospital mortality and that its predictors differ with age and clinical presentation. The most powerful predictor was previous bleeding. Considering the importance of IHMB, increased efforts are needed to tailor antithrombotic therapy according to age, renal function and other comorbidities.

Clinical Features and Prognostic Factors of Acute Kidney Injury Caused by Adult Secondary Hemophagocytic Lymphohistiocytosis

Background and Aims: Hemophagocytic lymphohistiocytosis (HLH ) is a clinical syndrome caused by a cytokine storm and phagocytosis of blood cells. Acute kidney injury (AKI) is typically associated with a poor prognosis in HLH. In the present study, a retrospective analysis of patient data was performed to identify risk factors associated with HLH-induced AKI. Method: All patients were diagnosed with HLH between January 2009 and July 2019. HLH was diagnosed according to the HLH-2004 criteria and AKI was diagnosed according to the Kidney Disease Improving Global Outcomes guidelines, which were last updated in 2012. We collected the general information of the patients, clinical manifestations, treatments, as well as laboratory data from the electronic medical records. Results: We analyzed 600 patients with HLH in the present study. Serum phosphorus levels, administration of vasopressor, heart failure, gastrointestinal symptoms, disseminated intravascular coagulation, high admission heart rate, total bilirubin levels and albumin levels were independently associated with an increased risk of developing AKI. Independent risk factors for in-hospital mortality in patients were administration of vasopressor, AKI stage III, baseline Cystatin-C levels, total bilirubin levels, number of days of glucocorticoid therapy, fibrinogen and multi-organ failure. Interpretation: Patients with HLH usually exhibit a high rate of hospital mortality, particularly when combined with AKI. The risk factors for the occurrence of AKI and increased mortality identified in the present study may assist clinicians in the early prevention of the disease, and in the treatment of HLH-induced AKI, to improve the prognosis of patients. Funding: This work is financially supported by grants from Sichuan Provincial Science and Technology Key R & D Projects [No. 2017SZ0113, No. 2017SZ0144 and No. 2019YFS0282], 1·3·5 project for disciplines of Excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University [NO.2020HXFH049]. Declaration of Interest: None to declare. Ethical Approval: Ethical approval for the present study was obtained from The Ethical Committee of West China Hospital, Sichuan University. As we collected clinical data for retrospective analysis, the Ethics Committee waived the need for informed consent.

Minimum heart rate and mortality in critically ill myocardial infarction patients: an analysis of the MIMIC-III database.

BackgroundLow minimum heart rate (MHR) is common in critically ill myocardial infarction (MI) patients. However, the association between MHR and the mortality of critically ill MI patients remains unclear.MethodsIn this retrospective cohort study, a total of 2,031 critically ill MI patients were enrolled from the Medical Information Mart for Intensive Care (MIMIC)-III database. Patients were divided into a low MHR group [MHR <60 beats per minute (bpm)] and a high MHR group (MHR ≥60 bpm). A Cox proportional hazard model was used to elucidate the association between these two groups and the mortality of MI patients. The association between mortality and MHR as a continuous variable was analyzed non-parametrically using restricted cubic splines. Sensitivity analyses were conducted to determine the impact of different admission heart rate, hypertension, atrial fibrillation, and vasopressor use on our results.ResultsMI patients in the low MHR group had higher 30-day and 1-year mortality than those in the high MHR group (20.59% vs. 10.91%, P<0.001 and 29.76% vs. 19.31%, P<0.001, respectively). After adjustment, the low MHR group was significantly correlated with 30-day mortality [hazard ratio, 1.779, 95% confidence interval (CI), 1.400–2.261, P<0.001] and 1-year mortality (hazard ratio, 1.537, 95% CI, 1.272–1.859, P<0.001). This correlation remained remarkable in patients with low or high admission heart rate, with or without hypertension, and with or without atrial fibrillation. An apparent L-curve relationship was observed between the 30-day mortality or 1-year mortality and MHR as a continuous variable.ConclusionsMHR under 60 bpm may be associated with a higher risk for both 30-day and 1-year mortality in critically ill MI patients. These findings highlight the possibility of MHR as an early risk indicator and potential therapeutic target for mortality in critically ill MI patients, which warrants further investigation.

The course of patients with Chagas heart disease during episodes of decompensated heart failure

AimsThis study aimed to analyse the clinical presentation and prognosis of patients with Chagas cardiomyopathy and decompensated heart failure (HF), as compared with other aetiologies.Methods and resultsA prospective cohort of patients admitted with decompensated HF. We included 767 patients (63.9% male), with median age of 58 years [interquartile range 48.2–66.7 years]. Main aetiologies were non‐Chagas/non‐ischaemic cardiomyopathies in 389 (50.7%) patients, ischaemic disease in 209 (27.2%), and Chagas disease in 169 (22%). Median left ventricular ejection fraction was 26% (interquartile range 22–35%). Patients with Chagas differed from both patients with non‐Chagas/non‐ischaemic and ischaemic cardiomyopathies for a higher proportion of cardiogenic shock at admission (17.8%, 11.6%, and 11%, respectively, P < 0.001) and had lower blood pressure at admission (systolic blood pressure 90 [80–102.5], 100 [85–110], and 100 [88.2–120] mmHg, P < 0.001) and lower heart rate (heart rate 71 [60–80], 87 [70–102], and 79 [64–96.5] b.p.m., P < 0.001). Further, patients with Chagas had higher serum BNP level (1544 [734–3148], 1061 [465–239], and 927 [369–1455] pg/mL, P < 0.001), higher serum bilirubin (1.4 [0.922.44], 1.2 [0.77–2.19], and 0.84 [0.49–1.45] mg/dL, P < 0.001), larger left ventricular diameter (68 [63–73], 67 [58–74], and 62 [56.8–68.3] mm, respectively, P < 0.001), lower left ventricular ejection fraction (25 [21–30]%, 26 [22–35]%, and 30 [25–38]%, P < 0.001), and a higher proportion of patients with right ventricular function (48.8%, 40.7%, and 25.9%, P < 0.001). Patients with Chagas disease were more likely to receive inotropes than patients with non‐Chagas/non‐ischaemic and ischaemic cardiomyopathies (77.5%, 67.5%, and 62.5%, respectively, P = 0.007) and also to receive intra‐aortic balloon pumping (30.8%, 16.2%, and 10.5%, P < 0.001). Overall, the rates of death or urgent transplant were higher among patients with Chagas than in other aetiologies, a difference that was driven mostly due to increased rate of heart transplant during hospital admission (20.2%, 10.3%, and 8.1%). The prognosis of patients at 180 days after hospital admission was worse for patients with Chagas disease as compared with other aetiologies. In patients with Chagas, age [odds ratio (OR) = 0.934, confidence interval (CI)95% 0.901–0.982, P = 0.005], right ventricular dysfunction by echocardiography (OR = 2.68, CI95% 1.055–6.81, P = 0.016), and urea (OR = 1.009, CI95% 1.001–1.018, P = 0.038) were significantly associated with prognosis.ConclusionsPatients with Chagas cardiomyopathy and decompensated HF have a distinct clinical presentation and worse prognosis compared with other aetiologies.

Prognostic impact of mean heart rate by Holter monitoring on long-term outcome in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention.

Previous studies have shown elevated admission heart rate (HR) was associated with worse outcome in patients with myocardial infarction (MI). However, the prognostic value of mean heart rate (MHR) with Holter monitoring remains unclear. Our present study aims to evaluate the impact of MHR by Holter monitoring on long-term mortality in patients with ST-segment elevation myocardial infarction (STEMI). 1013 STEMI patients were divided into four groups according to the quartiles of MHR by Holter monitoring, Q1 (< 66bpm), Q2 66-72bpm), Q3 (73-78bpm), and Q4 (> 78bpm). The endpoint was long-term all-cause mortality. The predictive value of admission HR, discharge HR, and MHR was compared with receiver operating characteristic (ROC) curves. Patients in Q4 were more likely to present with anterior MI, high Killip class, relatively lower admission blood pressure, significantly increased troponin I, B-type natriuretic peptide, and decreased left ventricular ejection fraction. During a median of 28.3months follow up period, 91 patients (8.9%) died. The mortality in Q4 was significantly higher than in the other three groups (P < 0.001). After multivariate adjustment, Q4 was associated with a 1.0-fold increased risk of long-term all-cause mortality (HR = 2.096, 95% CI 1.190-3.691, P = 0.010). ROC analysis shows MHR with Holter (AUC = 0.672) was superior to admission HR (AUC = 0.556) or discharge HR (AUC = 0.578). MHR based on Holter monitoring provided important prognostic value and MHR > 78bpm was independently associated with increased risk of long-term all-cause mortality in patients with STEMI, and its predictive validity was superior to admission or discharge HR.

Resting heart rate predicts all-cause mortality in sub-Saharan African patients with heart failure: a prospective analysis from the Douala Heart failure registry (Do-HF).

Higher resting heart rate (HR) is associated with mortality amongst Caucasians with heart failure (HF), but its significance has yet to be established in sub-Saharan Africans in whom HF differs in terms of characteristics and etiologies. We assessed the association of HR with all-cause mortality in patients with HF in sub-Saharan Africa. The Douala HF registry (Do-HF) is an ongoing prospective data collection on patients with HF receiving care at four cardiac referral services in Douala, Cameroon. Patients included in this report were followed-up for 12 months from their index admission, for all-cause mortality. We used Cox-regression analysis to study the association of HR with all-cause mortality during follow-up. Of 347 patients included, 343 (98.8%) completed follow-up. The mean age was 64±14 years, 176 (50.7%) were female, and median admission HR was 85 bpm. During a median follow-up of 12 months, 78 (22.7%) patients died. Mortality increased steadily with HR increase and ranged from 12.2% in the lower quartile of HR (≤69 bpm) to 34.1% in the upper quartile of HR (>100 bpm). Hazard ratio of 12-month death per 10 bpm higher HR was 1.16 (1.04-1.29), with consistent effects across most subgroups, but a higher effect in participants with hypertension vs. those without (interaction P=0.044). HR was independently associated with increased risk of all-cause mortality in this study, particularly among participants with hypertension. The implication of this finding for risk prediction or reduction should be actively investigated.

Clinical predictors of prognosis in patients with traumatic brain injury combined with extracranial trauma.

Objective: The purpose of this study was to investigate whether routine blood tests on admission and clinical characteristics can predict prognosis in patients with traumatic brain injury (TBI) combined with extracranial trauma.Methods: Clinical data of 182 patients with TBI combined with extracranial trauma from April 2018 to December 2019 were retrospectively collected and analyzed. Based on GOSE score one month after discharge, the patients were divided into a favorable group (GOSE 1-4) and unfavorable group (GOSE 5-8). Routine blood tests on admission and clinical characteristics were recorded.Results: Overall, there were 48 (26.4%) patients with unfavorable outcome and 134 (73.6%) patients with favorable outcome. Based on multivariate analysis, independent risk factors associated with unfavorable outcome were age (odds ratio [OR], 1.070; 95% confidence interval [CI], 1.018-1.124; p<0.01), admission Glasgow Coma Scale (GCS) score (OR, 0.807; 95% CI, 0.675-0.965; p<0.05), heart rate (OR, 1.035; 95% CI, 1.004-1.067; p<0.05), platelets count (OR, 0.982; 95% CI, 0.967-0.997; p<0.05), and tracheotomy (OR, 15.201; 95% CI, 4.121-56.078; p<0.001). Areas under the curve (AUC) of age, admission GCS, heart rate, tracheotomy, and platelets count were 0.678 (95% CI, 0.584-0.771), 0.799 (95% CI, 0.723-0.875), 0.652 (95% CI, 0.553-0.751), 0.776 (95% CI, 0.692-0.859), and 0.688 (95% CI, 0.606-0.770), respectively.Conclusions: Age, admission GCS score, heart rate, tracheotomy, and platelets count can be recognized as independent predictors of clinical prognosis in patients with severe TBI combined with extracranial trauma.

The assessment of heart rate recovery index in patients with essential tremor

Aim: In this study, it was aimed to investigate whether heart rate recovery index(HRRI), which is marker of cardiovascular mortality, was affected in patients with essential tremor(ET). Materials and Method: The study was conducted as retrospective and it consisted of 30 patients with ET and 30 healthy controls which were similar in terms of age and gender. During admission blood pressure and heart rate, fasting blood tests, hemogram, transthoracic echocardiography and exercise stress test results were recorded. Results: The groups were similar in point of age, gender, smoking(p>0.05). Diastolic and systolic blood pressure of the groups were similar, whereas patients with ET had higher heart rate during admission. When exercise stress test results were assessed, 1 st minute heart rate recovery, 2 nd minute HRRI, 5 th minute HRRI were lower in ET group and these differences were statistically significant(respectively p=0.017; 0.033; 0.019). However both groups were similiar with regards to 3 rd minute HRRI(p=0.063) Conclusion: According to this study results it might be thought that cardiovascular and total mortality may be higher in ET patients than healthy controls due to lower HRRI. Furthermore, it can be speculated that this disease may have an autonomous component since HRRI might be marker of an abnormal autonomic nervous system response.