Ambulatory Patients Research Articles

FDG PET/CT imaging and circulating biomarkers of inflammation in desmoplakin cardiomyopathy.

Inflammation has been implicated in the pathogenesis of desmoplakin (DSP) cardiomyopathy, and retrospective studies have described abnormal myocardial fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) findings in symptomatic patients eventually diagnosed with DSP cardiomyopathy. We aimed to prospectively investigate if ambulatory patients with DSP cardiomyopathy had myocardial FDG uptake PET/CT imaging indicative of myocardial inflammation and if they had circulating biomarker evidence of inflammation. We prospectively recruited participants with DSP cardiomyopathy and participants with titin cardiomyopathy as a comparator group. Blood samples for clinical labs and proteomic profiling, myocardial perfusion single-photon emission computed tomography (SPECT) and myocardial FDG PET/CT were obtained for all participants. Ten participants with DSP cardiomyopathy (median age 36.5years (28, 60); 80% female; 100% White and non-Hispanic) and four participants with titin cardiomyopathy (median age 55.5years [38.5, 64]; 50% female; 100% White and non-Hispanic) were recruited. There were no significant differences between the groups in white blood cell count, ESR, hsCRP or hsTn. Three participants with DSP cardiomyopathy and two participants with titin cardiomyopathy had non-specific myocardial FDG uptake on PET/CT. All other participants had no myocardial FDG uptake. Integration of miRNA differential expression and their predicted targets from the differential expression proteomics data identified a total of 11 inverse miRNA-mRNA pairs potentially involved in the regulation of top 20 significantly enriched pathways, including pathways involved in metabolism, inflammasome/inflammatory signalling and cell death/pyroptosis. In a group of ambulatory patients with DSP and titin cardiomyopathy, we found no differences in FDG PET/CT findings or clinical circulating biomarkers of inflammation. However, miRNA-seq/proteomics analyses identified several enriched pathways and unique miRNA-protein pairs between DSP and titin cardiomyopathy, including pathways involved in inflammasome/inflammatory signalling. Future work will centre on evaluation during myocarditis-like episodes.

Inter-atrial block as a predictor of adverse outcomes in patients with HFpEF.

Inter-atrial block (IAB), a marker of electrical atrial dysfunction, is associated with an increased risk of atrial fibrillation (AF) and adverse events in various populations. The prognostic impact of IAB in heart failure (HF) with preserved ejection fraction (HFpEF) remains unknown. The aim of this study is to determine the prevalence of IAB and the association of IAB and AF with adverse events in HFpEF across different healthcare settings. To identify electrical atrial dysfunction, baseline ECG's and medical history were analysed in HFpEF patients in an ambulatory setting and after recent HF hospitalisation. Patients were categorised into (i) HFpEFNo IAB, (ii) HFpEFIAB, or (iii) HFpEFAF. Adverse events included HF hospitalisation, cardiac/sudden death and a composite of both. The ambulatory cohort included 372 patients [mean age 75±7years, 252 (68%) females]. The recently hospitalised cohort included 132 patients [mean age 81±10years, 80 (61%) females]. Ambulatory patients included 17 (4%) HFpEFnoIAB, 114 (31%) HFpEFIAB and 241 (65%) HFpEFAF, while recently hospitalised patients included 31 (23%), 73 (55%) and 28 (21%), respectively. After 33months of follow-up of ambulatory patients, composite endpoints occurred in 0 (0%) HFpEFnoIAB, 12 (11%) HFpEFIAB [HR 4.1 (95% CI 0.5-522.6)] and 59 (24%) HFpEFAF patients [HR 10.1 (95% CI 1.5-1270.4), P<0.001]. Recently hospitalised patients showed a similar trend, with composite endpoints in 10 (32%) HFpEFnoIAB, 31 (42%) HFpEFIAB (HR 1.5 [95% CI 0.7-3.1]) and 22 (79%) HFpEFAF (HR 3.8 [95% CI 1.8-8.1], P<0.001). Progressive stages of electrical atrial dysfunction appeared to be prognostic markers of adverse outcomes in ambulatory and recently hospitalised patients with HFpEF. Ambulatory patients with HFpEF and no early stages of electrical atrial dysfunction showed to be at very low risk for adverse outcomes. Whether such patients benefit less strict management remains to be investigated.

A Case Series Examining Clinic, Laboratory, and Physical Function After Administration of Nusinersen in Adults With Spinal Muscular Atrophy, a Single-Center Study.

Spinal muscular atrophy is an incurable inherited disease caused by lower motor neuron death from mutations of the survival motor neuron genes. Intrathecal therapy with the antisense oligonucleotide, nusinersen, has been demonstrated to be beneficial in children with this disease, but the experience in adults, particularly ambulatory patients, is limited. We present a prospective observational case series from a single center using nusinersen therapy where we categorize 6 adult patients with spinal muscular atrophy into 2 functional categories: ambulatory (n = 3) or nonambulatory (n = 3). All received therapy that was administered intrathecally every 4 months. We monitored the course and laboratory data for 1 year and observed for side effects. There was no significant deterioration for 1 year. There was some minor improvement particularly in subjective changes. The benefit seems to decrease after 3 months. No significant complications were observed.

Preventative and curative treatment of venous thromboembolic disease in cancer patients

Cancer-associated venous thromboembolism (CAT) is common in patients with cancer and associated with significant morbidity and mortality. The incidence of CAT continues to rise, complicating patient care and burdening healthcare systems. Patients with cancer experiencing VTE face poorer prognoses, making prevention and effective management imperative. This narrative review synthesizes evidence on thromboprophylaxis in ambulatory patients with cancer receiving systemic therapy and acute treatment strategies for CAT. Risk assessment models (e.g., Khorana score) aid in identifying high-risk patients who may benefit from thromboprophylaxis. Pharmacological thromboprophylaxis with low molecular weight heparins (LMWHs) direct oral anticoagulants (DOACs) has been shown to reduce the risk of CAT without significantly increasing the risk of bleeding complications. However, implementation of risk-based strategies remains limited in clinical practice. For acute CAT management, LMWHs have been the standard of care, but DOACs are increasingly favored due to their convenience and efficacy. However, challenges persist, including bleeding risks and drug interactions. Emerging therapies targeting Factor XI inhibitors present promising alternatives, potentially addressing current limitations in anticoagulation management for CAT.

A comprehensive analysis of in-hospital adverse events after scopolamine administration: insights from a retrospective cohort study using a large nationwide inpatient database

BackgroundScopolamine is a widely used antiemetic in anesthetic practice, particularly for postoperative and post-discharge nausea and vomiting. Despite its frequent usage and recognized efficacy, concerns have emerged regarding the potential for increased side effects, particularly in elderly patients. Further research is needed to assess safety and determine age thresholds for adverse events. This study hypothesizes associations between perioperative scopolamine use, worse clinical outcomes, increased pneumonia, delirium, urinary retention, and readmissions.MethodsA large, retrospective cohort study was performed using the TriNetX Analytics Network database on patients undergoing major surgical procedures between Jan 1, 2009, and March 21, 2018, to examine the impact of perioperative scopolamine use on in-hospital adverse events. Patients were divided into age groups and compared to a control group. The primary outcomes assessed were delirium, pneumonia, in-hospital death, new antipsychotic use, readmission, and new onset urinary retention within 7 days post-surgery. 1:1 propensity score matching was performed to reduce bias. Relative risk and risk differences with 95% confidence intervals were estimated.ResultsAfter 1:1 propensity score matching, we identified a total of 403,816 (201,908 pairs) perioperative scopolamine users and nonusers. The cohorts of 20–29, 30–39, 40–49, 50–59, 60–69, and 70 + contained 22,910 (11,455 pairs), 44,170 (22,085 pairs), 58,590 (29,295 pairs), 71,660 (35,830 pairs), 88,386 (44,193 pairs), and 118,100 (59,050 pairs) patients respectively. Across older age cohorts, after propensity score matching, perioperative scopolamine recipients had significantly increased relative risk and risk difference of delirium, pneumonia, in-hospital mortality, new antipsychotic use, readmission, and new-onset urinary retention.ConclusionsIn this cohort study, perioperative scopolamine usage was associated with a significantly increased risk of in-hospital adverse events, both within the 70 + age cohort and among the 20–29, 30–39, 40–49, 50–59, and 60–69 age cohorts after major surgery. These findings highlight the need for careful assessment of scopolamine’s risks and benefits, especially for patients aged 40 and older. Scopolamine may be most suited for post-discharge nausea and vomiting in ambulatory patients and clinicians should reassess its standard use for postoperative nausea and vomiting, favoring shorter-acting agents with fewer side effects.

Емпатія як складова професійної компетентності диспетчера служби екстреної (швидкої) медичної допомоги

The article highlights the problem of empathy of emergency medical service dispatchers, since it is the dispatcher who is the first person with whom a person comes into contact in a crisis situation. The sample of researchers consisted of 63 people, mostly from the eastern regions of Ukraine, who were divided into groups based on gender, place of residence, and length of service. The results of an empirical study of the features of empathy as a component of the professional competence of the E(S)MH dispatcher are presented. The distribution of E(S)MH service personnel depending on the levels of emotional intelligence components is determined; compared to the previous year, depending on different types of activities, the presence of problems with work or other regular daily activities due to physical health, emotional problems that also interfere with normal social life with family, friends, etc. The empirical study made it possible to state that about half of the study subjects are characterized by an average integrative level of emotional intelligence, who are able to manage their emotions at a high level, low levels of self-motivation and empathy; a high level of emotional intelligence is characteristic of only one tenth of the study subjects. There are statistically significant differences in emotional intelligence and its components among EMS workers depending on their gender, place of residence and length of service: men living in rural areas have twice as high levels of emotional intelligence, emotional awareness, emotion management, empathy and recognition of other people's emotions as men living in cities and women, regardless of their place of residence; male medical professionals with 11 to 20 years of work experience show significantly higher levels of empathy compared to women with this work experience; women are characterized by a gradual decrease in the level of empathy with the acquisition of experience during their professional career; regardless of the length of service, men's empathy scores are slightly higher than women's, which, in turn, indicates that men are easier to adapt to difficult working conditions; the highest rates of emotional intelligence, as well as empathy, were found in men with work experience from 21 to 30 years. Prospects for further research in the context of creating a program of education and training for the development of empathic skills in E(S)Md dispatchers are outlined. It is especially important to pay attention to modeling crisis situations that reflect real challenges in their work and improve communication with potential ambulance patients

The pattern of diabetic care and glycemic control among the ambulatory diabetic patients in tertiary care settings in Bangladesh

Diabetes mellitus is a major public health concern in Bangladesh. The pattern of diabetic care and control of blood sugar among diabetic patients are not well described. We assessed the pattern of diabetic care among ambulatory diabetic patients attending tertiary care hospitals in Bangladesh, and explored the relationship of glycemic control with behavioral and metabolic risks. Any patient 18 years and older attending the medicine outpatient department (OPD) at randomly selected three government tertiary hospitals in three divisions in Bangladesh were examined by hospital doctors. If a patient who was diagnosed as having diabetes and produced any medical document to support the diagnosis was recruited following an informed consent. Data on socio-demographic characteristics, diabetic care plan and behavioral risks, including tobacco use, physical activity, healthy diet (daily fruits and vegetable consumption) and salt intake were obtained from study participants by recall. Three milliliters of venous blood were tested to determine uncontrolled diabetes by measuring glycated hemoglobin (HbA1C > 7.0), and hyperlipidemia by measuring total cholesterol (> 200 mg/dL), high density lipoprotein/HDL (< 40 Mg/dL, low density lipoprotein/ LDL (> 200 mg/dL), and Triglyceride (> 160 mg/dL). A Total of 465 patients were enrolled. The Mean age was 49 years (SD:11) and 58% were women. Sixty percent patients were on a treatment plan of anti-diabetic drugs (drug), healthy diet (diet) and physical activity (PA), 13.3% diet and drug, 9.7% on drug only, 6.4% on diet and PA, 3.9% on PA and drug, 1.3% on PA only and 0.9% on diet only. Two- third of the patients (68.6%) had uncontrolled diabetes, which was three times higher, if a patient had diabetes for more than five years than otherwise (OR: 3.31, 95% CI 2.06–5.33), two times higher if a patient did not consume fruits (OR: 2.28, 1.34–3.87), or three times higher, if a patient did not consume vegetables (OR: 3.70, 95% CI 1.80–7.59) than otherwise, 78% higher, if a patient had taken extra salt in meal than otherwise (OR: 1.78, 95% CI 1.13–2.80) and nine times higher, if a patient had a raised total cholesterol level (> 200 mg/dL) than otherwise (OR: 9.60, 95% CI 2.60–35.40) and three times higher, if a patient had a raised LDL level compared than otherwise (OR: 3.33, 95% CI: 1.93-5.70). Diabetic patients seeking care at tertiary hospitals in Bangladesh follow diverse diabetic care plans and the majority of them do not have diabetes under control. Unhealthy dietary practice and hyperlipidemia among diabetic patients contribute to uncontrolled diabetes. Routine monitoring of blood glucose and enforcing lifestyle modifications could promote effective control of diabetes among diabetic patients in Bangladesh.

Non-intensive care unit feasibility for ambulatory veno-venous extracorporeal membrane oxygenation patients.

Veno-venous extracorporeal membrane oxygenation has increasingly been utilized to support patients in respiratory failure as a bridge to recovery or lung transplantation. As patients progress from cannulation to recovery or transplantation, it has been shown that physical therapy and ambulation are possible and beneficial for patient outcomes. We sought to evaluate the feasibility of managing these ambulatory VV-ECMO patients in a non-ICU setting by conducting a single-center, retrospective cohort study to characterize the daily data collection (i.e., CXRs, blood draws, etc.) and ICU and ECMO interventions and events (i.e., oxygenator/cannula exchange, sweep or flow adjustments, etc.). A total of 28 ECMO runs from patients ≥18 years of age who ambulated ≥100 feet while on VV ECMO between 2014 and 2020 were included for analysis. Patients were supported on ECMO a median of 33 [18-79.5] days with a mean of 4.0 (3.8,4.1) data collections per day. There was a mean of 1.1 (1.0,1.2) anticoagulation changes, 1.5 (1.4,1.6) ECMO interventions, and 0.40 (0.34,0.46) ICU interventions per day. There were very few instances of cannula repositioning or oxygenator exchanges - 0.05 (CI 0.04, 0.06) per day. Our data suggests that ambulatory VV-ECMO patients may tolerate less than ICU level of care and may even progress to outpatient management as ECMO technology continues to advance.

Generating Synthetic Healthcare Dialogues in Emergency Medicine Using Large Language Models.

Natural Language Processing (NLP) has shown promise in fields like radiology for converting unstructured into structured data, but acquiring suitable datasets poses several challenges, including privacy concerns. Specifically, we aim to utilize Large Language Models (LLMs) to extract medical information from dialogues between ambulance staff and patients to populate emergency protocol forms. However, we currently lack dialogues with known content that can serve as a gold standard for an evaluation. We designed a pipeline using the quantized LLM "Zephyr-7b-beta" for initial dialogue generation, followed by refinement and translation using OpenAI's GPT-4 Turbo. The MIMIC-IV database provided relevant medical data. The evaluation involved accuracy assessment via Retrieval-Augmented Generation (RAG) and sentiment analysis using multilingual models. Initial results showed a high accuracy of 94% with "Zephyr-7b-beta," slightly decreasing to 87% after refinement with GPT-4 Turbo. Sentiment analysis indicated a qualitative shift towards more positive sentiment post-refinement. These findings highlight the potential and challenges of using LLMs for generating synthetic medical dialogues, informing future NLP system development in healthcare.

Evaluation of an alternative centrifugation protocol for reducing total turnaround time

Abstract Objectives Centrifugation is a key process that should be controlled to ensure an adequate sample quality. To achieve rapid, standardized, and consistent sample centrifugation, we aimed to evaluate an alternative centrifugation protocol and its impact on the results of 20 biochemical determinations in serum. Methods The study included 45 ambulatory patients. Two serum-separating tubes were collected from each patient (Becton Dickinson (BD) Vacutainer® SST™ II Advance, 8.5 mL Ref. 366468). One of the tubes was centrifuged at 2530 × g for 10 min (control method), while the other tube was centrifuged under alternative centrifugation conditions, namely 2530 × g for 7 min. Results The analysis of results revealed that calcium, total bilirubin, and magnesium exhibited a constant and proportional systematic bias. However, considering the proportional mean difference, all analytes met the desirable bias performance established by our laboratory, except for magnesium, which met the minimum bias criteria. Conclusions Our study demonstrates that both centrifugation protocols are interchangeable for measuring the studied analytes, thereby ensuring adequate sample quality.

Factors affecting target INR levels in homebound and ambulatory patients who use warfarin

Objective: To investigate the rates of reaching target international normalised ratio levels and the factors affecting these rates in patients undergoing warfarin therapy. Method: The prospective cross-sectional study was conducted between 16.08.2023 and 16.11.2023 at Izmir Bozyaka Training and Research Hospital and comprised patients of either gender who had been reciving warfarin therapy for at least 6 months. Those who were under the care of Home Health Services were in group A, while those being followed up at the cardiology outpatient clinic were in group B. All the patients had been receiving regular monitoring for international normalised ratio. Data was collected using a self-designed 41-item questionnaire. Data was analysed using SPSS 27. Results: Of the 200 patients, 100(50%) were in each of the 2 groups. The overall mean age of the sample was 69.54±12.70 years. There were 131(65.5%) females, 108(54%) had international normalised ratiolevel within the target range, 101(50.5%) stated they had received education about warfarin, 120(60%) were aware of the side effects, and 81(40.5%) indicated they experienced complications while using warfarin. Group A patients received more education/information about warfarin, and warfarin-related complications were fewere in such patients (p&lt;0.05). Conclusion: International normalised ratio monitoring among patients under the care of Home Healthcare Service was more reliably and effective compared to cardiology inpatients. Key Words: Warfarin therapy, Anticoagulants, Patients’ education.

Prognostic value of the diagnosis of anemia in patients with heart failure: an analysis based on the Colombian heart failure registry (RECOLFACA)

BackgroundAnemia represents a commonly reported comorbidity in patients diagnosed with heart failure (HF), related with a higher risk of unfavorable outcomes such as recurrent hospitalizations and mortality. There is a lack of evidence in Latin America regarding this topic. Our aim was to evaluate the prognostic value of the diagnosis of anemia in patients from the Colombian Heart Failure Registry (RECOLFACA).MethodsRECOLFACA registry included adult ambulatory patients with HF in 60 medical centers in Colombia during 2017–2019. Baseline characteristics of patients diagnosed with anemia and those without anemia were compared. The main outcome was all-cause mortality. A Cox proportional hazards regression model was used to evaluate the factors linked to the main outcome in patients with anemia. A statistically significant p-value was < 0.05.ResultsFrom the 2528 patients included in RECOLFACA, 2409 had at least one available hemoglobin value, and 726 (30.1%) corresponded to a diagnosis of anemia. Patients with anemia were significantly older, and had a higher prevalence of comorbidities, especially hypertension, type 2 diabetes, and chronic kidney disease (CKD). Patients without anemia had significantly lower mortality rate of 0.30 per 1000 person-years (95% CI 0.26–0.35), compared to patients diagnosed with anemia who had a mortality rate of 0.42 per 1000 person-years (95% CI 0.26–0.98) (p < 0.001). Lastly, the multivariate model results showed that the presence of an anemia diagnosis was associated with a significantly greater risk of mortality (HR 1.48; 95% CI 1.06, 2.05, p < 0.001).ConclusionsAnemia represents a highly prevalent comorbidity in patients with HF in Colombia and is also related with higher mortality in ambulatory patients during follow-up period. Our results highlight the relevance of anemia in the pathophysiology of HF. Nevertheless, due to its observational nature, out study results must be validated and further explored in future studies to elucidate the potential underlying mechanisms of this association.Graphical

PREVALENCE OF MISSED NURSING CARE AMONG SENIOR NURSING STAFF

Missed nursing care (MNC) refers to the partial, delayed, or omitted delivery of essential patient care. It is a critical issue in healthcare systems worldwide, directly impacting patient safety, satisfaction, and outcomes. While extensively studied in developed nations, evidence from low- and middle-income countries, particularly Pakistan, remains limited. Objective: To evaluate the prevalence of MNC among senior nursing staff and identify contributing factors in a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted among 245 registered nurses working in the ICU, ER, and other departments of Sir Ganga Ram Hospital, Lahore. Data were collected using an adapted questionnaire assessing MNC frequency and analyzed using SPSS. Descriptive statistics were calculated, and the reliability and validity of the tool were confirmed through Cronbach’s Alpha and Kaiser-Meyer-Olkin (KMO) measures. Results: The study found a high prevalence of MNC, with discharge planning (Mean = 2.77, SD = 1.14), patient ambulation (Mean = 1.79, SD = 0.99), and mouth care (Mean = 2.26, SD = 1.23) identified as the most frequently missed tasks. Contributing factors included excessive workload, resource shortages, and insufficient staffing. Nurses with less experience were more likely to report missed tasks, highlighting the importance of clinical exposure and training in reducing care omissions. Conclusion: Missed nursing care poses a significant challenge to healthcare quality and patient safety in Pakistan. Addressing these issues requires systemic reforms, including improved staffing ratios, resource allocation, and professional development programs. These findings provide valuable insights for policymakers and healthcare administrators to implement effective interventions aimed at mitigating MNC and enhancing nursing care quality.

EGS SO05 - Improving the Flow of Patients Attending Surgical Assessment Unit: Introduction of Ambulatory USS Slots - Closed Loop Audit

Abstract Background Modern emergency surgical service recognises that a significant proportion of patients presenting with acute abdomen can be diagnosed and treated in the ambulatory fashion. However, this approach requires multidisciplinary cooperation between the general surgery team and radiology department. We aimed to assess and improve the flow of patients presenting to Surgical Assessment Unit (SAU) with complaints of right iliac fossa (RIF) and right upper quadrant (RUQ) pain. Method We performed a retrospective analysis of all ambulatory patients returning to SAU of a District General Hospital with RUQ and RIF pain in January 2023. We measured the waiting time between the arrival to SAU and the time of USS. We presented the results in a local meeting and negotiated the introduction of two daily USS slots for SAU patients. We re-assessed the impact of the USS slots on waiting times in July 2023. Results In January 2023, 13 patients returned to SAU for USS. The minimum waiting time for this cohort was 59 minutes and the maximum waiting time was 3 hours and 39 minutes. The median was 2 hours and 15 minutes. In July 2023, 18 patients returned to SAU for USS. The minimum waiting time for this cohort was 4 minutes and the maximum waiting time was 2 hours and 20 minutes. The median was 1 hour and 5 minutes. There was an average reduction of 1 hour and 10 minutes in waiting time for USS. Conclusion The introduction of two USS slots per day for patients returning to SAU with RUQ and RIF pain resulted in a 48% reduction in waiting times. This improved the flow of patients, sped up the diagnosis and timely access to treatment, as well as significantly improved patients experience and satisfaction. We would recommend close co-operation between general surgery and radiology to allow timely access to imaging for patients presenting with acute abdomen to SAU.

Abstract 4135289: Renal Blood Perfusion is Closely Related to Right Ventricular Volume Overload in Congestive Heart Failure

Background: Cardiorenal syndrome (CRS) involves a bidirectional relationship where dysfunction in one organ exacerbates the other. A key factor in this interaction is the impact of right ventricular (RV) volume overload on renal blood flow, which is vital for the progression and management of heart failure (HF). Objective: This study aims to explore and quantify the relationship between right ventricular volume overload, i.e, echocardiographic assessments of right ventricular diameter (RVD), and the time-to-peak (TTP) of renal blood flow in patients with HF measured by 99mTc-DTPA renal scintigraphy. Methods: This single-center study included 304 stable, ambulatory HF patients admitted between October 2017 and August 2022. HF was diagnosed based on the 2016 ESC guidelines. Echocardiographic parameters, including RVD, and TTP of renal blood flow measured by 99mTc-DTPA renal scintigraphy, were collected. Statistical analysis was conducted using SPSS and R software, with Spearman correlation analysis used to assess the relationship between echocardiographic parameters and TTP. Results: The study showed there was a significant correlation between RVD and TTP (rs=0.535, P &lt;0.001), indicating that RV volume overload is closely related to impaired renal perfusion. The median TTP among the study population was 27.25 seconds (IQR: 21-39 seconds). Corrected for body surface area (BSA), RVD was found to be significantly higher in patients with heart failure with reduced ejection fraction (HFrEF) compared to heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-range ejection fraction (HFmrEF) (HFrEF: 20.62 mm/m 2 , HFmrEF: 18.72 mm/m 2 , HFpEF: 18.09 mm/m 2 ; p &lt; 0.001). Furthermore, right atrial diameter (RAD) corrected for BSA (RAD/BSA) demonstrated the strongest correlation with TTP in the HFrEF subgroup (rs=0.602, p&lt;0.001). Conclusions: Our findings highlight the significant impact of right ventricular volume overload on renal perfusion, providing valuable insights into the pathophysiology of CRS. These results suggest that therapeutic strategies aimed at reducing RV overload could enhance renal perfusion and improve overall outcomes in HF patients.

Abstract 4117927: Prevalence of Obstructive Sleep Apnea Among Consecutive Patients with Atrial Fibrillation Using WatchPAT Home Sleep Testing: A Prospective Cohort Study

Background: Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is associated with significant morbidity, mortality, and health system costs. Obstructive sleep apnea (OSA) is a highly prevalent condition affecting more than one third of the global adult population and, among patients with comorbid AF, contributes to poor AF related quality of life. However, the prevalence of undiagnosed OSA in the general AF population is unknown. Methods: In this pragmatic, phase IV prospective cohort study, we performed sleep testing on consecutively enrolled ambulatory AF patients for OSA using a cloud-based disposable home sleep test (the WatchPAT system). The primary outcome of our study was the prevalence of undiagnosed mild (5≤AHI&lt;15) or moderate/severe (AHI≥15) OSA in the general AF population. A prespecified power analysis supports 80% power to detect a &lt;5% difference in OSA prevalence compared to the general population (defined by AHI cut-offs of ≥5 or ≥15). Results: We performed sleep testing in 180 AF patients. Enrollment concluded early after a prespecified interim power analysis showed a larger than predicted difference of OSA prevalence between AF patients and the general population. Among the patients tested, 126 (70.4%) had paroxysmal AF, and 53 (29.6%) had persistent/long standing persistent AF. None had previous sleep testing. Our results show that the prevalence of OSA was 83.3% by AHI≥5 and 47.2% had moderate/severe OSA (AHI≥15). Patients with persistent or long standing persistent AF demonstrated even higher rates of OSA with 51 (96.3%) testing positive for OSA (AHI≥5) and 35 (64.2%) with moderate/severe OSA (AHI≥15). Conversely, standardized OSA screening instruments (Stop-BANG questionnaire or Epworth Sleepiness Scale) were poorly predictive of OSA in AF patients (AUC 0.66 and AUC 0.44, respectively). Conclusions: Undiagnosed OSA is highly prevalent in the general AF population. Our results demonstrate that OSA prevalence in AF patients exceeds that in the general population with a high degree of confidence. Widely used clinical prediction instruments cannot effectively be used to guide sleep testing decisions in AF patients. Our results suggest routine OSA testing should be performed in the comprehensive evaluation of all AF patients.

Final diagnoses and mortality rates in ambulance patients administered nebulized β2-agonists bronchodilators.

To assess final diagnoses and mortality rates (30day and 1year) in patients treated with the inhaled bronchodilator salbutamol by ambulance personnel, and to establish its role as an identifier of moderate to severe respiratory distress in the prehospital phase of treatment. In a descriptive retrospective observational study, patients experiencing respiratory distress and treated with inhaled bronchodilators, specifically salbutamol, in the prehospital setting within the Central Denmark Region during 2018-2019 were included. The study included 6318 ambulance transports, comprising 3686 cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), 234 with community-acquired pneumonia (CAP), 320 with heart disease (HD), 233 adults with asthma, 1674 with various other primary ICD-10 diagnoses (other ≥ 18years), and 171 patients under 18years. The 30day mortality rate for all patients was 10.7% (95% CI 9.8-11.6), with zero deaths within 30days among adults with asthma and those under 18. Excluding low mortality groups, AECOPD patients had the lowest 30day mortality at 10.2% (95% CI 9.1-11.3), and HD patients the highest at 15.3% (95% CI 10.6-19.9). The 1-year overall mortality rate increased to 32.1% (95% CI 30.2-34.0), with mortality staying low for asthma and under-18 groups, while differences between other groups lessened and became insignificant. Patients requiring inhaled bronchodilator treatment in ambulances exhibit notably high mortality rates at 30days and 1year, except for those with asthma or under 18. The need for prehospital bronchodilators could serve as a clear and unmistakable marker for moderate to severe respiratory distress, enabling early intervention.

Season-dependent characteristics of shock-related injuries in the Arctic zone of the Arkhangelsk region

Relevance. Studying the dynamics of injury rates, injury types and severity, as well as the treatment quality across various country regions, in particular the Arctic, is a prerequisite for managerial, healthcare, and strategic efficiency prior to and during hospital stay, taking into account the climate, geography, social and economic characteristics of every Russian Federation constituent.The objective is to analyse shock-related injuries in the Arctic zone of the Arkhangelsk region to understand season-related injury dynamics.Methods. Retrospective case series description parameters were used to study 140 patients with traumatic shock admitted to the Arkhangelsk Regional Clinical Hospital (ARCH) - a tier 1 trauma center. The analysed medical registration records included patient ambulance record and token (form 114/u), inpatient medical record (form 003/u), surgery logbook (form 008/u), patient radiographs, CT and nuclear MRI reports, as well as laboratory results. The study was conducted in accordance with ethical standards of the Declaration of Helsinki and European Community Directives (8/906 EC) and was approved by the local ethics committee of the Northern State Medical University of the Russian Ministry of Healthcare, Arkhangelsk (protocol no. 02/4-15 dated 04/08/2015). Statistical application package STATA ver.12 was used for statistical data processing.Results and discussion. The research demonstrated that the incidence of shock trauma is 4 times higher in men than in women. The vast majority of the injured are of working age. Seasonal distribution analysis per type of injuries and shock severity, including due to alcohol abuse, was carried out. The number of shock injuries is highest in winter, mainly due to road accidents which constitute 75.6 % of all injuries in winter. Throughout the year, over 50 % of shock injuries are combined injuries, that outperform isolated and multiple injuries in number. In particular, numerous combined injuries occur in winter with a responsible for almost 60 % among all other injuries. The majority the injured with shock-related trauma presented with stage 2 shock (49.3 %), whereas stage 1 and stage 3 shock was diagnosed in 27.9 % and in 21.4 % respectively. In winter, one in four patients with a shock-related injury presented with stage 3 shock. Alcohol-associated shock injuries are more numerous in summer (35.3 %), showing almost the same incidence as road traffic, domestic, and street injuries.Conclusion. The analysis of various types of injuries and season-related incidence of shock injuries in the Arctic territory of the Arkhangelsk region provides evidence to justify preventive measures to reduce the injury rates. Intensified efforts are required to minimise road traffic accidents in winter and combat alcohol abuse responsible for most injuries in summer. Since the vast majority of shock injuries occur in winter, in cold months ambulances must be equipped with local heating facilities, such as evacuation thermal bags with autonomous electric heating, thermal blankets, infusion warmers for blood transfusion and infusion sets.

Racing against time: Emergency ambulance dispatches and response times, a register-based study in Region Zealand, Denmark, 2013-2022.

The global strain on Emergency Medical Services (EMS) is reflected in the increasing number of emergency ambulance dispatches. Shorter EMS response times have demonstrated some effect on very specific and rare conditions. It is unknown if the increased number of ambulance dispatches compromises response times. This study aimed to describe trends in emergency ambulance dispatches and response times from 2013 to 2022 in Region Zealand, Denmark. Additionally, it aimed to outline the demographic profile of emergency ambulance patients, including age and comorbidities. Using administrative data from the Region Zealand emergency medical dispatch center, a register-based study spanning from January 1, 2013, to December 31, 2022, was conducted. Data were linked with nationwide registries and priority A (emergency), or B (urgent) ambulance dispatches were included. Trends were examined overall and stratified by catchment areas corresponding to the hospitals with emergency departments in the region. Poisson and ordinal logistic regressions were used to analyze data. The study encompassed 678,789 emergency ambulance dispatches, with 55.0% priority A and 45.0% priority B. Among these, 667,788 had a valid personal identification number allowing for further analysis. Within the study population, females comprised 48.5%, while 49.1% of patients were 65years or more. Overall, 47.5% of patients had no comorbidities, while 7.7% and 44.8% had mild and severe comorbidities, respectively. Emergency ambulance dispatches increased from 56,867 in 2013 to 81,080 in 2022 (143%). Correspondingly, the dispatch incidence rate per 1,000 residents per year increased from 69.2 to 95.5. Stratification by catchment areas revealed significant disparities. The median response time for priority A dispatches increased from 7min:14s in 2013 to 8min:20s in 2022 and for priority B dispatches from 12min:23s to 15min:6s. From 2013 to 2022, emergency ambulance dispatches both priorities A and B increased in absolute numbers and per 1000 residents per year. Ambulance response times also increased for both priorities during the study period. The study shows regional disparities regarding to the rate of emergency ambulance dispatches and response times indicating challenges in resource distribution in the future for maintaining emergency care standards.

A real-world, prospective, observational, investigator initiated trial to evaluate early discharge following Angio-Seal™ vascular closure device in patients undergoing percutaneous coronary intervention

BackgroundCardiac catheterization procedures such as percutaneous coronary intervention (PCI) are widely used but with complications of access site bleeding. Manual compression (MC)is the well accepted technique to control bleeding but time consuming (15-20 min); vascular closure devices (VCDs) are used increasingly as an alternative to MC and require <5 min for deployment.We aimed to document the real-world experience with a bioabsorbable collagen closure device (Angio-Seal™) with absorbable traction suture in patients undergoing PCI. ObjectiveThe primary objective was time (hours) to discharge from hospital after the procedure; to document the incidence of vascular access site complications, time to ambulation and time to hemostasis were the secondary objectives. MethodThis was a prospective, observational, investigator-initiated clinical trial wherein adult patients who underwent PCI procedure through femoral access route, with deployment of Angio-Seal™ femoral closure device were included. ResultsAmongst the 100 patients enrolled, 68 % were males. systemic hypertension (63 %), and type-2 diabetes mellitus (37 %) were the major comorbidities reported. Mean overall time from the end of procedure to hemostasis was 2.32 ± 0.99min. Time to ambulation was 156.08 ± 36.81min and to hospital discharge was 25.21 ± 4.49 h, One subject experienced hematoma. No other complications particularly pertaining to vascular access site were observed. ConclusionAngio-Seal™ is an effective and safe VCD and results in early ambulation, rapid hemostasis, and discharge in patients undergoing PCI.