American Heart Association Guidelines Research Articles

Abstract TP4: Accuracy Of Patient-Reported Body Weight On A Mobile Stroke Unit Compared To Measured Body Weight And Alteplase Dosing Implications

Background: Administration of intravenous tissue plasminogen activator is standard of care for patients presenting with acute ischemic stroke. The optimal dose, per American Heart Association guidelines, is 0.9 mg/kg of IV alteplase to maximize clinical effectiveness while minimizing complications. With the integration of mobile stroke units (MSUs), IV alteplase is more frequently administered in the prehospital setting. Patient-reported body weights, instead of measured body weights, remain commonplace in MSUs due to logistical challenges of accurate weighing systems on MSUs. It is unknown whether patient-reported weights can be safely used, as previous cohort studies have reported that 16% to 33% of patient-reported weights are inaccurate. Methods: We retrospectively analyzed all MSU patients from January 2018 to July 2021 who were given IV alteplase and subsequently transported to one of our network hospitals. Patient or family-reported weights used in the MSU for IV alteplase administration and subsequent measured patient weights were retrospectively collected. Reported weights were deemed accurate if within 10% of the measured patient weights. Results: A total of 66 patients received IV alteplase on the MSU. The median age of these patients was 64 years (interquartile range (IQR) 53-78). Forty eight percent of IV alteplase treated patients were women. Median last known well to IV alteplase bolus time was 58.5 minutes (IQR 47- 92). Twenty of the 66 patients had a reported body weight greater than 100 kg, all of whom were confirmed to weigh more than 100 kg at hospital arrival. Of the remaining 46 patients, the median administered dose of IV alteplase was 0.90 mg/kg (IQR 0.88-0.95). Seventeen percent of patients were inaccurately dosed; 4% of patients were underdosed and 13% of patients were overdosed. One patient who was overdosed (1.01 mg/kg) had symptomatic intracranial hemorrhage. Conclusion: Within our single-center cohort, patient-reported weights were an accurate surrogate for measured patient weights for administration of IV tPA in the prehospital MSU setting. However, patient-reported weights may increase dosing errors which could have both efficacy and safety implications.

Abstract WMP32: EMR Alert Improves Compliance With Dysphagia Assessment In Stroke Patients

Introduction: Dysphagia in patients after a stroke is very common. There is a risk factor for aspiration pneumonia and is associated with worse patient outcomes. The American Heart Association guidelines recommend that a swallow screening be performed on all stroke patients prior to any oral intake. Stroke can present with a variety of symptoms and may not be identified at the time of the patient’s presentation. In analyzing patient data in which the dysphagia screening was not completed, it was identified to occur at the first oral intake of a medication. Our hypothesis is that if the nurse was alerted at the time of medication administration that a dysphagia screening needs to be completed, we could improve our compliance with this quality measure. Method: A new Electronic Medical Record (EMR) process was developed, that based on certain criteria, triggered an alert for the nurse when the first oral medication barcode was scanned. Within the alert there is a link to document the dysphagia screening. After documentation of the screening, the nurse is returned to the medication administration record to continue her administration. The criteria for triggering the alert is twofold. The first trigger is based on the presenting chief complaint on arrival to the emergency department. These would include chief complaints such as stroke symptoms, dizziness, weakness, etc. The second trigger occurs when the physician enters an order for dysphagia screening to be completed by nursing. With each of these triggers, the EMR logic looks to see if a dysphagia screen has already been documented and the alert only is generated if it has not. This process was initiated in the EMR in February 2021 for all 12 hospitals in the University Hospitals health system. Results: At University Hospitals Parma Medical Center dysphagia screening compliance improved from 82% in QTR 3 2020 to 90% in QTR 2 2021. Overall, in the University Hospital health system compliance improved from 85% in QTR 3 2020 to 89% in QTR 2 2021. Conclusion: An EMR alert has assisted the nurse to remember to complete this important dysphagia screening and improved compliance with this quality measure. In addition, nurses have reported an increase in satisfaction with the new workflow.

AiRDose: Developing and Validating an Augmented Reality Smartphone Application for Weight Estimation and Dosing in Children.

Inaccurate weight estimation is a contributing factor to medical error in pediatric emergencies, especially in the prehospital setting. Current American Heart Association guidelines recommend the use of length-based weight estimation tools such as the Broselow tape. We developed the AiRDose smartphone application that uses augmented reality to provide length-based weight estimates, as well as medication dosing, defibrillation energy, and equipment sizing recommendations; AiRDose was programmed to use Broselow conversions to obtain these estimates. The primary objective was to compare the length estimated by AiRDose with the actual length obtained by the standard tape measure. The secondary objectives were to compare the estimated weights and critical medication doses from AiRDose with current established methods. In this prospective validation study, lengths and estimated weights were obtained for children presenting to 2 emergency departments using AiRDose, Broselow, and a standard tape measure; actual weight was recorded from the patient chart. Using the AiRDose estimated weights, hypothetical doses of epinephrine and lorazepam were calculated and compared with doses recommended via Broselow and to actual weight-based doses. Spearman rank correlation coefficients were calculated. We defined an acceptable difference of 20% between AiRDose and standard measurements as clinically relevant. Five hundred forty-nine children (mean age, 4.8 years; standard deviation [SD], 2.9 years) were recruited. There were 99.6% of AiRDose lengths within a 20% difference of tape-measure lengths. There was a significant correlation between AiRDose and tape-measure length measurements (r = 0.989, P < 0.0001), and between AiRDose and Broselow weights (r = 0.983, P < 0.0001) and AiRDose and actual weights (r = 0.886, P < 0.0001). AiRDose lorazepam and epinephrine doses correlated significantly with Broselow lorazepam (r = 0.963, P < 0.0001) and epinephrine (r = 0.966, P < 0.0001) doses. Anthropometric estimates and medication dose recommendations provided by AiRDose strongly correlate with established techniques. Further study will establish the feasibility of using AiRDose to accurately obtain weight estimates and medication doses for pediatric patients in the prehospital setting.

2022 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration With the American Academy of Pediatrics, American Association for Respiratory Care, the Society

2022 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration With the American Academy of Pediatrics, American Association for Respiratory Care, the Society

Evaluation of penicillin‐gentamicin and dual beta-lactam therapies in Enterococcus faecalis infective endocarditis

BackgroundThe American Heart Association endorses penicillin G or ampicillin with gentamicin (A+G) or dual beta-lactam therapy with ampicillin and ceftriaxone (A+C) as first-line regimens for Enterococcus faecalis infective endocarditis (EFIE) caused by penicillin-susceptible isolates. ObjectivesTo compare rates of treatment modifications and failures among individuals treated with A+C vs. A+G therapies for EFIE. MethodsThis study was a retrospective, single-centre cohort of adult patients with EFIE treated with A+G or A+C therapy between July 2009 and July 2019. The primary outcome was rate of adverse events requiring treatment modification. Secondary outcomes included rates of any event requiring treatment modification and treatment failure. ResultsFifty-nine individuals with EFIE who received A+G (17 patients) or A+C (42 patients) therapy were included. Community-acquired EFIE from an unknown source was the most common (67.8%). Rates of adverse events requiring treatment modifications were 52.9% in A+G and 16.7% in A+C group (P = 0.005). Treatment modification was most frequently due to nephrotoxicity in the A+G group (90.0%). Incidence of acute kidney injury was 41.2% in A+G vs. 11.9% in the A+C group (P = 0.011). Rates of any event requiring treatment modifications were 58.8% in the A+G and 23.8% in A+C groups (P = 0.010). Treatment failure was observed in 23.5% in the A+G and 28.6% in A+C groups (P = 0.759). ConclusionsAn A+C regimen may provide a tolerable and equally efficacious option for treatment of EFIE in adults and confirms the American Heart Association guideline recommendation.

Reanimação cardiopulmonar para leigos: avaliação de vídeos sob a perspectiva do letramento digital em saúde

Objective: to analyze the quality indicators and technical content of the videos for lay people posted on the YouTube platform, on cardiopulmonary resuscitation in adults and their audiovisual production regarding the principles of digital health literacy. Method: a descriptive and exploratory study, which selected videos recorded between December 2015 and April 2021. They were analyzed by indicators of the production of audiovisual material, considering the American Heart Association guidelines and the principles of digital health literacy. Descriptive and inferential statistics were performed. Results: of the 121 videos analyzed, 26 did not comply with any indicator on cardiopulmonary resuscitation, four reached 81% compliance, eight videos reached 79%, nine reached 69% and 74 videos, from 6% to 63%. According to the principles of digital health literacy, one video met 85% of the indicators, 81 met from 50% to 80% and 39, from 10% to 49%. A positive correlation was identified between literacy and cardiopulmonary resuscitation. Conclusion: no video presented 100% compliance with the American Heart Association guidelines. The absence of mechanisms for supervision and control over health-related contents allows for the posting of mistaken videos, which have been used as a learning method by people and can thus miss their greatest goal: save lives.

Cardiopulmonary resuscitation for lay people: Evaluation of videos from the perspective of digital health literacy

to analyze the quality indicators and technical content of the videos for lay people posted on the YouTube platform, on cardiopulmonary resuscitation in adults and their audiovisual production regarding the principles of digital health literacy. a descriptive and exploratory study, which selected videos recorded between December 2015 and April 2021. They were analyzed by indicators of the production of audiovisual material, considering the American Heart Association guidelines and the principles of digital health literacy. Descriptive and inferential statistics were performed. of the 121 videos analyzed, 26 did not comply with any indicator on cardiopulmonary resuscitation, four reached 81% compliance, eight videos reached 79%, nine reached 69% and 74 videos, from 6% to 63%. According to the principles of digital health literacy, one video met 85% of the indicators, 81 met from 50% to 80% and 39, from 10% to 49%. A positive correlation was identified between literacy and cardiopulmonary resuscitation. no video presented 100% compliance with the American Heart Association guidelines. The absence of mechanisms for supervision and control over health-related contents allows for the posting of mistaken videos, which have been used as a learning method by people and can thus miss their greatest goal: save lives.

Analysis of the adequacy of infant cardiopulmonary resuscitation according to chest compression technique based on the 2020 AHA guidelines

The quantitative and qualitative differences between the two-finger (TF) and two-thumb-encircling hands (TT) techniques were not sufficiently investigated to determine which is more effective for single-rescuer infant cardiopulmonary resuscitation (CPR). As the type of chest compression (CC) technique can impact survival rates and prognoses of patients, this study aimed to compare the adequacy of single-rescuer infant CPR CC techniques and explore participants’ CPR experiences using an exploratory sequential mixed methods design. To assess the adequacy of CC and ventilation according to technique, 70 students who completed basic life support provider certification among students from emergency medical services and nursing departments of a single college performed CC using the TF and TT techniques (4 sets of 5 cycles with a ratio of 30:2) in simulation. Meanwhile, a numeric rating scale was used to measure fatigue. SPSS (v. 25.0, IBM Corp, Armonk, NY, USA) was used to analyze the collected data by frequency analysis, descriptive statistics, paired t-test, and repeated measures analysis of variance (ANOVA). We conducted focus group interviews and analyzed CPR experiences. There were statistically significant differences between the TF and TT techniques in fatigue score (6.09 vs. 4.23 points, p &lt; 0.001), average hands-off time (6.77 vs. 7.43 s, p =0.001), mean ventilation volume (41.40 vs. 35.51 ml, p = 0.002), CC accuracy rate (65.89% vs. 77.11%, p = 0.011), mean CC rate (104.37 vs. 107.11 beats/min, p = 0.020), overall CPR score (78.26 vs. 84.37 points, p = 0.005), and overall compression score (82.60 vs. 92.54 points, p &lt; 0.001). Furthermore, we found significant differences over time in mean CC count (p = 0.030), mean ventilation volume (p = 0.042), and mean hands-off time (p = 0.029). Two categories (ambivalent attitudes and perception of pain) and five sub-categories were derived based on the results. In conclusion, as stated in the 2020 American Heart Association (AHA) guidelines, both TF and TT techniques are useful for single-rescuer infant CPR. Overall, TT technique provides higher quality of compressions at the cost of fewer ventilations. We recommend future studies of more diverse groups and techniques.

Development of an Extended Reality Simulator for Basic Life Support Training.

Objective: Extended Reality (XR) is a simultaneous combination of the virtual and real world. This paper presents the details of the framework and development methods for an XR basic life support (XR-BLS) simulator, as well as the results of an expert usability survey. Methods: The XR-BLS simulator was created by employing a half-torso manikin in a virtual reality environment and using BLS education data that is in line with the 2020 American Heart Association guidelines. A head-mounted display (HMD) and hand-tracking device were used to perform chest compressions and ventilation and to enable the use of an automated external defibrillator in a virtual environment. A usability study of the XR-BLS simulator through an expert survey was also conducted. The survey consisted of a total of 8 items: 3, 2, and 2 questions about the ease of use of XR-BLS, delivery of training, and artificial intelligence (AI) instructor in the simulator, respectively. Results: The XR simulator was developed, and the expert survey showed that it was easy to use, the BLS training was well delivered, and the interaction with the AI instructor was clear and understandable. Discussion/Conclusion: The XR-BLS simulator is useful as it can conduct BLS education without requiring instructors and trainees to gather.

High school basic life support training: Is the trainer's experience of cardiopulmonary resuscitation in the actual setting important? A randomized control trial.

BACKGROUND:Although basic life support (BLS) has been taught in school by a variety of professionals, it is still unclear that, whether the instructor's previous cardiopulmonary resuscitation (CPR) experience is an important factor. This study aimed to compare the effect of BLS training, based on trainer experience in actual situations, on knowledge and skills of secondary high school students.MATERIALS AND METHODS:In this randomized controlled trial, 150 high school students were selected based on the inclusion criteria and then assigned into two groups, (76 in Group A), and (74 in Group B) randomly. Both groups were trained according to adult BLS: 2020 American Heart Association guidelines on mannequins in three 60 min in-person training sessions. The knowledge and skill scores were measured for both groups before, immediately, and 1 month after intervention by a questionnaire. Data were analyzed by the SPSS software version 22, using Chi-square, Mann–Whitney U, repeated-measure ANOVA tests, and statistically modeling at a significance level of 0.05.RESULTS:There were no significant differences between groups regarding demographic characteristics. The knowledge and skill scores in both groups increased significantly compared to baseline immediately and 1 month after the intervention (P = 0.001). However, there was no significant difference in knowledge scores between groups (P = 0.076(. However, at the immediacy and 1 month after the intervention, the skill score in “Group A” was significantly higher than the “Group B” (P = 0.001).CONCLUSIONS:The trainer's experience of CPR in the actual setting in the transfer of BLS knowledge is not important, but it improved Student's BSL skill acquisition score.

Postpartum Blood Pressure Findings and Readmission

To understand how blood pressure (BP) values and management of hypertension relate to readmission for preeclampsia with severe features, particularly in regard to the American Heart Association (AHA) guidelines.

Association between egg consumption and metabolic syndrome in Chinese population: a cross-sectional study

ObjectivesMetabolic syndrome (MS) comprises a constellation of symptoms that include abdominal obesity, hypertension, hyperglycaemia and dyslipidaemia. Dietary intake is a crucial environmental risk factor for MS, but the exact association...

Abstract 10739: Simulation Based Assessment of Trainee’s Performance in Post-Cardiac Arrest Resuscitation

Up to 22% of patients survive to hospital admission following out-of-hospital cardiac arrest (OHCA). Post cardiac arrest is complex and requires a multidisciplinary approach. Our aim is to assess trainee’s performance in managing post-cardiac arrest care using a high-fidelity manikin-based simulation. We also sought to obtain evidence regarding the validity of our findings. Methods: In this prospective, observational, simulation based study, participants ranging from sub interns to attending physicians evaluated and managed a post cardiac arrest patient, complicated by refractory status epilepticus. Critical actions were developed by a modified Delphi approach based on relevant American Heart Association guidelines and the Neurocritical Care Society’s Emergency Neurological Life Support protocols. The primary outcome measure was the critical action item sum score. We sought validity evidence to support our findings by comparing trainees’ performance across four levels of training. Results: Forty-nine participants completed the simulation. The mean sum of critical actions completed by participants was 10/21(49%). Eleven(22%) participants verbalized a differential diagnosis for the arrest. Thirty-two(65%) recognized the abnormal electrocardiography, and consulted cardiology. Forty trainees(81%) independently decided to start target temperature management (TTM), but only 20(41%) insisted on TTM when asked to reconsider. There was an effect of level of training on critical action checklist sum scores (novice mean score [standard deviation (SD)] = 4.8 (1.8) vs. intermediate mean score (SD) = 10.4 (2.1) vs. advanced mean score (SD) = 11.6 (3.0) vs. expert mean score (SD) = 14.7 (2.2) Conclusions: High-fidelity manikin-based simulation holds promise as an assessment tool in the performance of post-cardiac arrest care. Areas for further educational initiatives to improve performance include diagnostic work-up of OHCA and implementation of TTM.

Abstract 12921: One Hand Open Palm Technique for Infant Cardiopulmonary Resuscitation: A Randomized Crossover Study

Introduction: The American Heart Association (AHA) CPR guidelines states that effective chest compression depth, rate and recoil are essential factors for establishment of return of spontaneous circulation. A recent survey from an international pediatric resuscitation collaborative showed that healthcare providers failed to meet the metrics of the AHA guidelines, with the greatest difficulty in achieving targeted chest compression depth in infants. The recommended techniques for infant compression include two finger (TFT) or two-thumb technique (TTT). We hypothesized using the heel of one palm (open palm technique, OPT) in infants will result in improved chest compression depth with decreased provider fatigue. Methods: Each participant performed three techniques including TFT, TTT, and novel open-palm technique (OPT) with randomization for sequence of techniques for each participant. Each technique was performed for 2 minutes followed by a 5-minute rest period on an infant manikin. Data were collected through Zoll R series defibrillators on chest compression depth, rate, and fraction. At the end of the study, each participant filled out a survey for difficulty level, finger fatigue, and rescuer fatigue. Results: Thirty pediatric critical care providers participated in the study consisting of 16 nurses, 9 respiratory therapists, 3 fellows, 2 nurse practitioners. The mean chest compression depth for OPT was significantly deeper (2.61 ± 0.63 cm) in comparison to TFT (2.25 ± 0.54 cm, p= 0.0004) but not significantly deeper in comparison to TTT (2.43 ± 0.46 cm, p= 0.0820). There were no significant differences between the three techniques in chest compression rate or chest compression fraction. The finger fatigue and rescuer fatigue surveys were graded from 0-10 with 10 being the most fatigue. OPT showed significantly less finger and rescuer fatigue in comparison to TTT and TFT (p&lt;0.05). Conclusion: This study demonstrated that OPT generated improved chest compression depth with considerably less rescuer and finger fatigue. However, chest compression depth with all three techniques failed to meet the AHA infant goal of 4 cm. Further research is needed to optimize CPR performance to achieve the targeted chest compression depth in infants.

Sodium Variability and Probability of Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage

ObjectivesVasospasm is a well-known complication of aneurysmal subarachnoid hemorrhage (aSAH) that generally occurs 4–14 days post-hemorrhage. Based on American Heart Association guidelines, the current understanding is that hyponatremic episodes may lead to vasospasm. Therefore, we sought to determine the association between repeated serum sodium levels of aSAH patients and its relationship to radiographic vasospasm. Materials and methodsA single-center retrospective analysis from 2007–2016 was conducted of aSAH patients. Daily serum sodium levels were recorded up to day 14 post-admission. Hyponatremia was defined as a serum sodium value of < 135 mEq/L. We evaluated the relationship to radiologic vasospasm, neurologic deterioration, functional status at discharge, and mortality. A repeated measures analysis using a mixed-effect regression model was performed to assess the interindividual relationship between serum sodium trends and outcomes. ResultsA total of 271 aSAH patients were included. There were no significant differences in interindividual serum sodium values over time and occurrence of radiographic vasospasm, neurologic deterioration, functional, or mortality outcomes (p = .59, p = .42, p = .94, p = .99, respectively) using the mixed-effect regression model. However, overall mean serum sodium levels were significantly higher in patients who had neurologic deterioration, poor functional outcome (mRS 3-6), and mortality. ConclusionsSerum sodium level variations are not associated with subsequent development of cerebral vasospasm in aSAH patients. These findings indicate that serum sodium may not have an impact on vasospasm, and avoiding hypernatremia may provide a neurologic, functional and survival benefit.

Pediatric Heart Failure: Cardiac Ejection Fraction with Cardiomyopathy Decreased to 21% in Iron Deficient from 37% in Iron Sufficient Children

▪Introduction: The overall aim of our study was to determine if iron deficiency has harmful effects on cardiac function in children with chronic heart failure. Heart failure in children is a complex, heterogeneous disorder leading to a final common pathway of cardiomyocyte dysfunction and attrition. Cellular, animal, and human studies have shown that iron deficiency causes cardiomyocyte dysfunction that can be reversed with iron treatment. Cellular studies of human iron-deficient cardiomyocytes have shown that supplemental iron restores impaired contractility and relaxation. Animal studies have found that cardiomyocyte-specific deletions or alterations of critical iron proteins (transferrin receptor 1, hepcidin, ferroportin) produce cardiomyocyte iron deficiency (without anemia) and result in ultimately fatal cardiac dysfunction that can be rescued with intravenous (IV) iron. Over half of adults with chronic heart failure are iron deficient. Meta-analysis of small randomized clinical trials has shown that IV iron significantly reduces recurrent hospitalization, cardiovascular mortality, and all-cause mortality in iron deficient adults with heart failure. European Society of Cardiology, American College of Cardiology and American Heart Association guidelines recommend consideration of IV iron therapy for adult iron-deficient patients with heart failure.The prevalence and consequences of iron deficiency in children with heart failure have not been established. Previously, two small retrospective studies of children with heart failure have reported that 56% to 96% were iron deficient, with increased morbidity and mortality. The goals of our study of children with heart failure were to determine (i) how often iron status is assessed, (ii) the prevalence of iron deficiency, and (iii) the effects of iron deficiency on cardiac function in patients with cardiomyopathy.Methods: We retrospectively reviewed electronic medical records to identify pediatric patients ages 1-21 years old seen at Columbia University Irving Medical Center Pediatric Heart Failure clinic with absolute iron deficiency during 2010-2020. Heart failure was defined as presence of symptoms or systolic dysfunction by echocardiography. Patients were excluded with a history of heart transplant, isolated diastolic failure, or renal failure requiring dialysis. In adults with heart failure, a transferrin saturation <20% has a sensitivity of 94% and a specificity of 84% in identifying absolute iron deficiency, as determined from a bone marrow aspirate, and iron stores were present in 100% of patients with a transferrin saturation ≥30% (Circ Heart Fail. 2018;11:e0045). In children with heart failure, we used these criteria to define absolute iron deficiency as a transferrin saturation <20% and iron sufficiency as a transferrin saturation ≥30%.Patients with an intermediate transferrin saturation are likely a mixture of absolute and functional iron deficiency, and of iron sufficiency and were excluded from our analysis of cardiomyopathy. Cardiac ejection fraction was evaluated by an echocardiogram performed within 3 months of measurement of transferrin saturation.Results: Of 579 patients with heart failure, only 159 (27%) had any type of laboratory iron studies. Of patients with iron studies, 81 (51%) were evaluated as outpatients; 49% as inpatients. The cause of heart failure was cardiomyopathy (52%), congenital heart disease (34%), acute myocarditis (6%), and other (8%).In the 82 patients with heart failure due to cardiomyopathy, 39 (48%) were iron deficient and 16 (20%) iron sufficient. In the iron deficient children with cardiomyopathy, the left ventricular ejection fraction was lower than in the iron sufficient patients (median 21% vs. 37%; p=0.03 (Mann-Whitney); Figure). The groups did not differ significantly with respect to hemoglobin (Figure), sex, age, or New York Heart Association class.Conclusion: We report a clinically important decrease in cardiac ejection fraction in children with heart failure due to cardiomyopathy who have absolute iron deficiency. Potentially, iron treatment could safely and effectively reverse the harmful effect of iron deficiency on heart function and prospective randomized trials of oral and intravenous iron therapy are urgently needed. Measurement of iron status should routinely be included in the evaluation of children with heart failure. [Display omitted] DisclosuresNeunert: Novartis: Research Funding.

Relationship Between the Coronary Artery Calcium (CAC) Score and the Angle Between the Aortic Valve and the Left Ventricular Inflow Long Axis (AV-LV) as Cardiovascular Risk Factors

Background: Cardiovascular disease (CVD) is one of the leading causes of mortality in both developed and developing countries. Therefore, identification of CVD risk factors is one of the most important steps in preventing this disease. Evidence suggests that imaging of the cardiac anatomy can be helpful for risk assessment. Objectives: This study aimed to assess two cardiac anatomy features, namely, the angle between the aortic valve and the left ventricular inflow long axis (AV-LV angle) and the coronary artery calcium (CAC) score. Patients and Methods: This cross-sectional study was conducted on 74 patients with indications for computed tomography angiography (CTA) according to the American Heart Association (AHA) guidelines from July 2019 to January 2020 in Iran. The Agatston method was applied to measure the CAC score. Besides, to determine the AV-LV angle, the angle between a line tangent to the aortic valve leaflets and a line through the center of the aorta toward the left ventricular apex was measured. The patients’ baseline characteristics were also documented by conducting interviews. Results: Of 74 patients, 56% were male. The mean age of the patients was 54.41 ± 12.31 years, and their mean body mass index (BMI) was 26.71 ± 3.89 kg/m2. The frequency of smoking was 28% among the participants. A history of hypertension was reported in 38.7% of the patients, and a history of dyslipidemia was reported in 36%. Besides, the history of myocardial infarction was reported in 4% of the patients, diabetes mellitus in 9.3% of the patients, and angioplasty in 6% of the patients. The CAC score only had significant relationships with hypertension and age (correlation coefficients = 0.51). On the other hand, the AV-LV angle had no significant relationship with the patients’ baseline characteristics. The statistical analysis of the AV-LV angle and CAC score showed no significant relationship between these parameters (P = 0.756). Conclusion: The AV-LV angle and the CAC score were not significantly associated. Further research is recommended to fill the knowledge gap regarding the cardiac anatomy features for cardiovascular risk assessment.

Different hypertension thresholds and cognitive decline: a pooled analysis of three ageing cohorts

BackgroundThe 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for high blood pressure (BP) in adults came up with a new definition of hypertension with a threshold BP level of 130/80 mmHg. But the 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guidelines adhered to a conventional hypertension definition as BP ≥ 140/90 mmHg. We aimed to compare the trajectories of cognitive decline between participants with BP < 130/80 mmHg in all BP measurement waves and others with all BP < 140/90 mmHg.MethodsThis pooled analysis involved middle-aged and older participants from three nationally representative ageing cohorts, including the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), and the China Health Retirement Longitudinal Study (CHARLS). Participants were divided into the Normal (BP < 130/80 mmHg on all occasions throughout the study), the Borderline (BP < 140/90 mmHg on all occasions throughout the study but not in the Normal group), and the High (the rest of participants) BP groups. Global cognitive Z score was calculated from tests on memory, executive function, and orientation.ResultsA total of 17,590 participants (HRS 6964, median follow-ups 12 years; ELSA 5334, median follow-ups 16 years; CHARLS 5292, median follow-ups 7 years) were included. No significant difference in global cognitive decline rate was detected between the Normal and the borderline groups (men, pooled β = − 0.006 standard deviation [SD]/year; 95% confidence interval [CI], − 0.020 to 0.008; P = 0.377; women, pooled β = 0.006 SD/year; 95% CI − 0.005 to 0.018; P = 0.269). Participants in the High group had a significantly faster cognitive decline (men, pooled β = − 0.011 SD/year; 95% CI − 0.020 to − 0.002; P = 0.013; women, pooled β = − 0.017 SD/year; 95% CI − 0.026 to − 0.008; P < 0.001) than that in the Borderline group.ConclusionsIndividuals in the Borderline group did not experience significantly faster cognitive decline compared with those in the Normal group. It might not be necessary for individuals with borderline BP (between 130/80 and 140/90 mmHg) to initiate antihypertension therapy in consideration of cognitive decline.

Simulation-Based Assessment of Graduate Neurology Trainees' Performance Managing Acute Ischemic Stroke.

Multidisciplinary acute stroke teams improve acute ischemic stroke management but may hinder trainees' education, which in turn may contribute to poorer outcomes in community hospitals on graduation. Our goal was to assess graduate neurology trainee performance independently of a multidisciplinary stroke team in the management of acute ischemic stroke, tissue plasminogen activator (tPA)-related hemorrhage, and cerebral herniation syndrome. In this prospective, observational, single-center simulation-based study, participants (subinterns to attending physicians) managed a patient with acute ischemic stroke followed by tPA-related hemorrhagic conversion leading to cerebral herniation. Critical actions were developed by a modified Delphi approach based on relevant American Heart Association guidelines and the Neurocritical Care Society's Emergency Neurologic Life Support protocols. The primary outcome measure was graduate neurology trainees' critical action item sum score. We sought validity evidence to support our findings by comparing performance across 4 levels of training. Fifty-three trainees (including 31 graduate neurology trainees) and 5 attending physicians completed the simulation. The mean sum of critical actions completed by graduate neurology trainees was 15 of 22 (68%). Ninety percent of graduate neurology trainees properly administered tPA; 84% immediately stopped tPA infusion after patient deterioration; but only 55% reversed tPA according to guidelines. There was a moderately strong effect of level of training on critical action sum score (level 1 mean [SD] score 7.2 [2.8] vs level 2 mean [SD] score 12.3 [2.6] vs level 3 mean [SD] score 13.3 [2.2] vs level 4 mean [SD] score 16.3 [2.4], p < 0.001, R 2 = 0.54). Graduate neurology trainees reassuringly perform well in initial management of acute ischemic stroke but frequently make errors in the treatment of hemorrhagic transformation after thrombolysis, suggesting the need for more education surrounding this low-frequency, high-acuity event. High-fidelity simulation holds promise as an assessment tool for acute stroke management performance.

Effectiveness of Personalized Cardiovascular Risk Score on Employee Smoking Behavior: An RCT

Abstract Background Based on the Nudge Theory, an individual could make better decisions by offering small changes to the choices offered that could lead to dramatic changes in their behaviors. A cardiovascular risk score could be added to the employee health checkup report and become a good nudge for smoking employees. This study aimed to compare the effect of various personalized cardiovascular risk score reports on employee smoking cessation. Methods This three-arm randomized controlled trial recruited smoking employees of a 600-bed hospital in Bangkok, Thailand, and was conducted during January-April, 2020. The cardiovascular risk score of each participant was calculated by using the 2013 American College of Cardiology and American Heart Association guidelines. While a conventional annual checkup report was provided to all participants, intervention group A also received both smoking-positive and smoking-negative risk scores whereas intervention group B also received a smoking-positive risk score. The number of cigarettes was collected at weeks 0, 4, 8, and 12. The changes in the number of cigarettes were analyzed by using repeated measure ANOVA. Results Thirty-six smoking employees were recruited (mean age 35.67±10.54 years; male 97.2%). Two-third (66.7%) had a low cardiovascular risk. The participants smoked 53.03±47.88 cigarettes per week and 66.7% did not have the intention to quit smoking. For Group A, the number of cigarettes significantly reduced by 19.58 (p = 0.04), 28.92 (p = 0.00), and 35.50 (p = 0.00) at weeks 4, 8, and 12, respectively. For Group B, the number of cigarettes reduced by 14.25 (p = 0.13), 21.35 (p = 0.03), and 18.08 (p = 0.06) at weeks 4, 8, and 12, respectively. For Group C, the number of cigarettes increased by 0.42 (p = 0.96), 5.89 (p = 0.54), and 12.44 (p = 0.20) at weeks 4, 8, and 12, respectively. Conclusions Cardiovascular risk score in an employee checkup report could be a simple yet effective intervention for smoking cessation. Key messages Based on the Nudge Theory, an individual could make healthier decisions by offering small changes to the choices offered that could lead to a reduction in cigarette consumption. Cardiovascular risk score in an employee checkup report could be a simple yet effective intervention for smoking cessation.