Cardiac Admissions Research Articles

Interrater Reliability of the 2015 Pediatric Acute Lung Injury Consensus Conference Criteria for Pediatric ARDS

Diagnostic guidelines for pediatric acute respiratory distress syndrome (PARDS) were developed at the 2015 Pediatric Acute Lung Injury Consensus Conference (PALICC). Although this was an improvement in creating pediatric-specific diagnostic criteria, there remains potential for variability in identification of PARDS. What is the inter-rater reliability of the 2015 PALICC criteria for diagnosing moderate-severe PARDS? What clinical criteria and patient factors are associated with diagnostic disagreements? Patients with acute hypoxic respiratory failure admitted from 2016-2021 who received invasive mechanical ventilation were retrospectively reviewed by two PICU physicians. Reviewers evaluated whether the patient met the 2015 PALICC definition of moderate-severe PARDS and rated their diagnostic confidence. Inter-rater reliability was measured using Gwet's Agreement Coefficient (AC1). 37 of 191 encounters had a diagnostic disagreement. Inter-rater reliability was "substantial" (AC1=0.74, 95% CI [0.65 - 0.83]). Disagreements were due to different interpretations of chest radiographs (56.8%), ambiguity in origin of pulmonary edema (37.8%), or lack of clarity if patient's current condition was significantly different from baseline (27.0%). Disagreement was more likely in patients who were chronically ventilated (OR 4.66, 95% CI [2.16-10.08], p<0.001), had a primary cardiac admission diagnosis (OR 3.36, 95% CI [1.18 - 9.53], p=0.02), or underwent cardiothoracic surgery during the admission (OR 4.90, 95% CI [1.60 - 15.00], p=0.005). Reviewers were at least moderately confident in their decision 73% of the time, however were less likely to be confident if the patient had cardiac disease or chronic respiratory failure. The inter-rater reliability of the 2015 PALICC criteria for diagnosing moderate-severe PARDS in this cohort was substantial, with diagnostic disagreements commonly due to differences in chest radiograph interpretations. Patients with cardiac disease or chronic respiratory failure were more vulnerable to diagnostic disagreements. More guidance is needed on interpreting chest radiographs and diagnosing PARDS in these subgroups.

CHANGES IN VASOACTIVE DRUG REQUIREMENTS AND MORTALITY IN CARDIAC INTENSIVE CARE UNIT PATIENTS.

Background: The Society for Cardiovascular Angiography and Intervention (SCAI) Shock Classification can define shock severity. We evaluated the vasoactive-inotropic score (VIS) combined with the SCAI Shock Classification for mortality risk stratification. Methods: This was a single-center retrospective cohort analysis including Mayo Clinic cardiac intensive care unit patients from 2007 to 2015. The peak VIS was calculated at 1 and 24 h after cardiac intensive care unit admission. In-hospital mortality was evaluated using multivariable logistic regression. Results: Of 9,916 included patients, vasoactive drugs were used in 875 (8.8%) within 1 h and 2,196 (22.1%) within 24 h. A total of 888 patients (9.0%) died during hospitalization. Patients who required vasoactive drugs within 1 h had higher in-hospital mortality (adjusted odds ratio [OR], 1.30; 95% confidence interval [CI], 1.03-1.65; P = 0.03) and in-hospital mortality rose with the VIS during the first 1 h (adjusted OR per 10 units, 1.22; 95% CI, 1.12-1.33; P < 0.001). The increase in VIS from 1 to 24 h was associated with higher in-hospital mortality (adjusted OR per 10 units, 1.16; 95% CI, 1.10-1.21; P < 0.001). These results were consistent in the 1,067 patients (10.9%) with cardiogenic shock. A gradient of in-hospital mortality was observed according to the VIS at 1 h and the increase in VIS from 1 to 24 h. Conclusions: Higher vasoactive drug requirements portend a higher risk of mortality, particularly a high VIS early after admission. The VIS provides incremental prognostic information beyond the SCAI Shock Classification, emphasizing the continuum of risk that exists across the spectrum of shock severity.

PS-C13-3: MORTALITY RATE AND REDUCTION OF HOSPITALIZATION FOR ACUTE MYOCARDIAL INFARCTION IN RESEARCH INSTITUTE OF CARDIOLOGY&lt;RIC&gt;,BAKU IN COVID-19 PANDEMIC

Aims: To study the impact of quarantine during COVID19 pandemic on admission of patients with myocardial infarction to the intensive cardiac care unit of Research Institute of Cardiology Methods and Results: We conducted a single-centre,observational survey to collect data on admissions for acute myocardial infarction(AMI) at ICCU RIC during strict quarantine in April-May 2020,in Baku,Azerbaijan,compared with April-May 2019. We observe 10% reduction in admission rate for AMII patients admitted at intensive cardiac care unit in April-May 2020 in comparison to April-May 2019. We observed significant 40% reduction in admissions for AMI in April 2020 compared with April 2019, it also turned out to be the lowest number of intensive cardiac care unit admissions for AMI among all months of the last 5 years. Fatality cases of patients admitted in April-May 2020, was 70% higher than in the equivalent period of 2019. The month of May, following the month of April 2020, had the mortality rate of 26.6% among acute myocardial infarction patients admitted to the intensive cardiac care unit, and it was the highest mortality rate among all months in the last 5 years. During the April 2020, the first month of strict quarantine, in 86,6% &lt; 13 out of 15&gt;of AMI patients admitted to ICCU used narcotic analgesics to relieve pain. In May, narcotic analgesics for pain relief were used in 36.6% or in 11 out of 30 patients.86,6%, the percentage of patients with AMI who received narcotic analgesics for pain relief in April 2020 was the highest among 15 months, from April 2019 to June 2020.&lt;see table 2&gt;

The effect of clinical and haemodynamic variables on post-operative length of stay immediately upon admission after biventricular repair with Yasui operation following an earlier Norwood operation.

There are a variety of approaches to biventricular repair in neonates and infants with adequately sized ventricles and left-sided obstruction in the presence of a ventricular septal defect. Those who undergo this in a staged manner initially undergo a Norwood procedure followed by a ventricular septal defect closure such that the neo-aorta is entirely committed to the left ventricle and placement of a right ventricular to pulmonary artery conduit (Yasui operation). This study aimed to determine clinical and haemodynamic factors upon paediatric cardiac ICU admission immediately after the two-stage Yasui operation that was associated with post-operative length of stay. This was a retrospective review of patients who underwent the Yasui procedure after the initial Norwood operation between 1 January 2011 and 31 December 2020. Patients with complete data on admission were identified and analysed using Bayesian regression analysis. A total of 15 patients were included. The median age was 9.0 months and post-operative length of stay was 6days. Bayesian regression analysis demonstrated that age, weight, heart rate, mean arterial blood pressure, central venous pressure, pulse oximetry, cerebral near infrared spectroscopy, renal near infrared spectroscopy, pH, pCO2, ionised calcium, and serum lactate were all associated with post-operative length of stay. Discrete clinical and haemodynamic factors upon paediatric cardiac ICU admission after staged Yasui completion are associated with post-operative length of stay. Clinical target ranges can be developed and seem consistent with the notion that greater systemic oxygen delivery is associated with lower post-operative length of stay.

Non-occlusive mesenteric ischemia in critically ill patients.

Non-occlusive mesenteric ischemia (NOMI) is a life-threatening acute condition that has an overall in-hospital mortality rate of up to 75%. Critically ill patients are often admitted to intensive care units (ICUs) due to shock, and these patients are frequently at risk of developing NOMI. The objective of this study was to determine the clinical features of critically ill patients with NOMI and evaluate the risk factors for in-hospital mortality among these patients. We reviewed the electronic medical records of 7,346 patients who underwent abdominal contrast-enhanced computed tomography during their ICU stay at Samsung Medical Center (Seoul, Korea) between January 1, 2010 and December 31, 2019. After reviewing each patient's computed tomography (CT) scans, 60 patients were diagnosed with NOMI and included in this analysis. The patients were divided into survivor (n = 23) and non-survivor (n = 37) groups according to the in-hospital mortality. The overall sequential organ failure assessment (SOFA) score for the included patients upon admission to the ICU was 8.6 ± 3.1, and medical ICU admissions were most common (66.7%) among the patients. The SOFA score upon admission to the ICU was higher for the non-survivors than for the survivors (9.4 vs. 7.4; p = 0.017). Non-survivors were more often observed in the medical ICU admissions (39.1% vs. 83.8%) than in the surgical ICU admissions (47.8% vs. 10.8%) or the cardiac ICU admissions (13.0% vs. 5.4%). Laboratory test results, abdominal CT findings, and the use of vasopressors and inotropes did not differ between the two groups. In a multivariable analysis, SOFA scores >8 upon admission to the ICU (odds ratio [OR] 4.51; 95% 1.12-18.13; p = 0.034), patients admitted to the ICU with medical problems (OR 7.99; 95% 1.73-36.94; p = 0.008), and abdominal pain (OR 4.26; 95% 1.05-17.35; p = 0.043) were significant prognostic predictors for in-hospital mortality. The SOFA score >8 upon admission to the ICU, admission to the ICU for medical problems, and abdominal pain at diagnosis are associated with increased mortality among patients with NOMI.

Prognostic Value of Cardiac Magnetic Resonance in Assessing Right Ventricular Strain in Cardiovascular Disease: A Systematic Review and Meta-Analysis.

To evaluate the prognostic value of cardiac magnetic resonance (CMR) imaging in assessing right ventricular strain via meta-analysis of current literature. Right ventricular strain recorded with CMR serves as a novel indicator to quantify myocardial deformation. Although several studies have reported the predictive value of right ventricular strain determined using CMR, their validity is limited by small sample size and low event number. Embase, Medline and Web of Science were searched for studies assessing the prognostic value of myocardial strain. The primary endpoint was a composite of all-cause mortality, cardiovascular death, aborted sudden cardiac death, heart transplantation and heart failure admissions. A total of 14 studies met the selection criteria and were included in the analysis (n = 3239 adults). The random-effects model showed the association of parameters of right ventricular strain with major adverse cardiac events. Absolute value of right ventricular global longitudinal strain was negatively correlated with right ventricular ejection fraction (hazard ratio: 1.07, 95% confidence interval: 1.05-1.08; p = 0.013). Despite the small number of studies, right ventricular radial strain, right ventricular circumferential strain and right ventricular long-axis strain displayed potential prognostic value. Right ventricular strain measured with CMR is an effective prognostic indicator for cardiovascular disease.

Deferral of Non-Emergency Cardiovascular Interventions Triggers Increased Cardiac Emergency Admissions-Analysis of the COVID-19 Related Lockdown.

Data on the relation between non-emergency and emergency cardiac admission rates during the COVID-19 lockdown and post-lockdown period are sparse. Consecutive cardiac patients admitted to our tertiary heart center between 1 January and 30 June 2020 were included. The observation period of 6 months was analyzed in total and divided into three defined time periods: the pre-lockdown (1 January-19 March), lockdown (20 March-19 April), and post-lockdown (20 April-30 June) period. These were compared to the reference periods 2019 and 2022 using daily admission rates and incidence rate ratios (IRR). Over the observation period from 1 January to 30 June, cardiac admissions (including non-emergency and emergency) were comparable between 2019, 2020, and 2022 (n = 2889, n = 2952, n = 2956; p = 0.845). However, when compared to the reference period 2019, non-emergency admissions decreased in 2020 (1364 vs. 1663; p = 0.02), while emergency admissions significantly increased (1588 vs. 1226; p < 0.001). Further analysis of the lockdown period revealed that non-emergency admissions dropped by 82% (IRR 0.18; 95%-CI 0.14-0.24; p < 0.001) and 42% fewer invasive cardiac interventions were performed (p < 0.001), whereas the post-lockdown period showed a 52% increase of emergency admissions (IRR 1.47; 95%-CI 1.31-1.65; p < 0.001) compared to 2019. We demonstrate a drastic surge of emergency cardiac admissions post-COVID-19 related lockdown suggesting that patients who did not keep their non-emergency appointment had to be admitted as an emergency later on.

Analysis of gut microbiota in patients with acute myocardial infarction by 16S rRNA sequencing.

An increasing number of studies have shown that gut microbiota are associated with human cardiovascular disease, but the characteristics of intestinal flora in patients with acute myocardial infarction (AMI) are still unclear. In this study, we aimed to investigate the difference of intestinal microflora between patients with AMI and healthy people, and to find the effect of percutaneous coronary intervention (PCI) on intestinal microflora. A total of 60 stool samples and 60 peripheral blood samples were collected from 20 previously diagnosed AMI patients and 20 healthy people serving as controls. Gut microbiota communities were analyzed via 16 ribosomal RNA-sequencing (16S rRNA). Gut microbiota-derived metabolites, trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFA), in the blood were detected using stable isotope dilution high-performance liquid chromatography with on line electrospray ionization tandem mass spectrometry (LC/MS/MS). The results showed that a distinct pattern of gut microbiota was observed in AMI patients compared to healthy controls. AMI patients had lower microbiological richness but no significant change in diversity. Bacteroidetes and Verrucomicobia showed an upward trend, whereas Proteobacteria showed a downward trend in AMI patients. During a longitudinal study to compare the changes in bacteria before and after treatment, we found routine cardiac admission therapy 1 week after PCI surgery had no effect on the microbial community structure in patients. There were significantly higher levels of plasma TMAO in AMI patients' microbiota than that in the control group. Contrarily, there was no obvious change in SCFA. The gut microbiota of patients with AMI differs from that of normal people, and the metabolic products of microflora are more abundant in the plasma of AMI than control cases. Microflora may act on the cardiovascular system through metabolites, and regulation of the microfloral structure may be used in the future treatment of cardiovascular diseases.

Risk of Inappropriately Timed Live Vaccination After Pediatric Cardiovascular Surgery.

The American Academy of Pediatrics (AAP), Advisory Committee on Immunization Practices (ACIP), and Centers for Disease Control and Prevention (CDC) recommend delaying live vaccinations up to 11 months after transfusions of certain blood products due to the risk of immunoglobulins decreasing immunization efficacy. Because vaccination schedules recommend live immunizations at 12 months, infants aged 5 to 12 months who undergo cardiac surgery requiring blood products are potentially at risk for improper vaccination. The objective of this study was to identify the risk of inappropriately timed live vaccination in pediatric patients after cardiovascular surgery. This single-center, retrospective chart review included 345 patients 5 to 12 months of age who underwent cardiovascular surgery between January 1, 2010, and December 31, 2016. Included patients received packed red blood cells (PRBCs) and/or platelets during the surgical admission and a live vaccine within the first 18 months of life. The primary endpoint was the incidence of live vaccine administration within 7 months of receiving PRBCs and/or platelets. Of the 345 included patients, 67% (n = 230) were inappropriately vaccinated after receiving platelets and/or PRBCs during cardiac surgery. Infants who undergo cardiac surgery between the ages of 5 and 12 months are at risk for inappropriate live vaccination timing. A clinically significant percentage of pediatric patients who received blood products during a cardiac surgical admission later received live vaccines at times that were inconsistent with AAP, ACIP, and CDC recommendations. Future interventions aimed at educating providers and patients may be warranted.

Abstract 12558: Social Determinants of Health and 90-day Readmissions Among Pediatric Patients With Cardiac Disease

Introduction: Social determinants of health (SDoH) impact general pediatric readmissions and pediatric cardiac surgical mortality. Yet, little is known of their influence on readmissions in pediatric cardiac disease. Hypothesis: Children with cardiac disease from underrepresented populations, under-resourced neighborhoods or on public insurance are more likely to experience readmission. Methods: This was a multicenter retrospective study of patients &lt;18 years with a cardiac diagnosis and index hospitalization with survival to discharge in the Pediatric Health Information System database (1/1/2017-12/31/2020). The outcome was 90-day all-cause non-elective readmission. SDoH examined were race/ethnicity, insurance type, income, and child opportunity index (COI; a composite variable of residential socioeconomic resources). Mixed effects multivariable logistic regression models were performed. Results: Of 249,222 cardiac-related admissions in 161,039 patients, 90-day readmissions were 55,770 (22.4%). Overall mortality was 2.8% (1.8% in readmissions). Clinical factors associated with readmission were infancy, non-surgical index admission, extracorporeal membrane oxygenation, greater length of stay, and non-cardiac comorbidities. Controlling for these factors, there was greater adjusted odds of 90-day readmission in patients with public or other insurance (vs private), Hispanic or Non-Hispanic Black race/ethnicity (vs Non-Hispanic White) and lower COI area residents (vs higher) [Table]. Sub-analysis in the 38,711 cardiac surgical admissions (15.8% 90-day readmission rate), found similar observations for race and insurance in adjusted analyses. Conclusions: Children with cardiac disease from under-resourced areas, underrepresented populations and/or on public insurance have higher odds of 90-day readmission. Our data provide insights for future interventions to optimize hospital discharge planning in this population.

Abstract 14415: Clinical Characteristics and Predictors of the “Good Fontan”: A Multi-Institutional Study

Introduction: Fifteen-year survival after Fontan operation approaches 95%, but morbidities are increasingly prevalent. It is unknown how well cardiologists can predict which pts are at risk for major adverse events (MAE), but awareness is critical to enable appropriate counseling. We asked cardiologists the “surprise” question: would you be surprised if your patient has a MAE in the next year? Methods: We performed a prospective, multi-center study across New England. The attending cardiologist was asked the yes/no “surprise” question. Inclusion criteria included lateral tunnel or extracardiac Fontan and age &gt;10 yrs; individuals were excluded for current transplant evaluation, history of Fontan conversion, or pregnancy. Baseline clinical data were collected. After 12 months, cardiologists were surveyed to assess for MAE (see Table) and multivariate analysis (MVA) was performed for those deemed to be at risk and those with MAE. Results: From 2018-19, 146 pts and 40 cardiologists were enrolled at 9 sites. 99/146 pts (68%) were predicted to be a “Good Fontan.” After 1 yr, 17 (12%) patients experienced a MAE (Table). The simple kappa coefficient of ability to predict MAE was 0.17 (95% CI 0.02-0.32), suggesting ability to predict MAE was only 17% better than random chance. In MVA of those at risk (47/146), diuretic/beta blocker use (p=&lt;0.0001) and systolic dysfunction (p=0.0046) were associated with identified risk. MVA of pts who experienced MAE (n=17) found prior unplanned cardiac admission (p=0.0062), diuretic/beta blocker use (p=0.028) and significant AV valve regurgitation (p=0.049) to be associated with MAE. Conclusions: Cardiologists are only marginally able to identify which Fontan pts are at risk for MAE in the next year. There was overlap between factors associated with prediction of “at risk” group and MAE, namely use of diuretic/blocker and the linked systolic dysfunction/AV valve regurgitation, which merits close attention in follow-up and further study.

Les enjeux de la cardiologie de demain : le livre blanc du CNP cardiovasculaire

Psychoactive drugs, including illicit drugs, are associated with an increased rate of cardiovascular events. The prevalence and outcome of patients using these drugs at the time of admission to an intensive cardiac care unit is unknown.To assess the prevalence of psychoactive drugs detected in consecutive patients hospitalized in an intensive cardiac care unit for an acute cardiovascular event.This is a nationwide prospective multicentre study, involving 39 centres throughout France, including all consecutive patients hospitalized in an intensive cardiac care unit within 2 weeks. Psychoactive drug use will be assessed systematically by urine drug assay within 2 hours of intensive cardiac care unit admission, to detect illicit (cannabinoids, cocaine, amphetamines, ecstasy, heroin and other opioids) and non-illicit (barbiturates, benzodiazepines, tricyclic antidepressants, methadone and buprenorphine) psychoactive drugs. Smoking will be investigated systematically by exhaled carbon monoxide measurement, and alcohol consumption using a standardized questionnaire. In-hospital major adverse events, including death, resuscitated cardiac arrest and cardiogenic shock, will be recorded. After discharge, all-cause death and major adverse cardiovascular events will be recorded systematically and adjudicated at 12 months of follow-up.The primary outcome will be the prevalence of psychoactive drugs detected by systematic screening among all patients hospitalized in an intensive cardiac care unit. The in-hospital major adverse events will be analysed according to the presence or absence of detected psychoactive drugs. Subgroup analysis stratified by initial clinical presentation and type of psychoactive drug will be performed.This is the first prospective multicentre study to assess the prevalence of psychoactive drugs detected by systematic screening in consecutive patients hospitalized for acute cardiovascular events.

Introduction of a new scoring tool to identify clinically stable heart failure patients

Abstract Introduction Heart failure (HF) poses a burden on specialist care, making referral of clinically stable HF patients to primary care a desirable goal. However, a structured approach to guide patient referral is lacking. Methods The Maastricht Instability Score–Heart Failure (MIS-HF) questionnaire was developed to objectively stratify the clinical status of HF patients: patients with a low MIS-HF (0–2 points, indicating a stable clinical condition) were considered for treatment in primary care, whereas high scores (&amp;gt;2 points) indicated the need for specialised care. The MIS-HF was evaluated in 637 consecutive HF patients presenting between 2015 and 2018 at Maastricht University Medical Centre. Results Of the 637 patients, 329 (52%) had a low score and 205 of these 329 (62%) patients were referred to primary care. The remaining 124 (38%) patients remained in secondary care. Of the 308 (48%) patients with a high score (&amp;gt;2 points), 265 (86%) remained in secondary care and 41 (14%) were referred to primary care. The primary composite endpoint (mortality, cardiac hospital admissions) occurred more frequently in patients with a high compared to those with a low MIS-HF after 1 year of follow-up [29.2% vs 10.9%; odds ratio (OR) 3.36, 95% confidence interval (CI) 2.20–5.14]. No significant difference in the composite endpoint (9.8% vs 12.9%; OR 0.73, 95% CI 0.36–1.47) was found between patients with a low MIS-HF treated in primary versus secondary care. Conclusion The MIS-HF questionnaire may improve referral policies, as it helps to identify HF patients that can safely be referred to primary care. Funding Acknowledgement Type of funding sources: None.

Impact of early readmission to the cardiac ICUon in-hospital mortality and hospital length of stay in 30,942 cardiac patients

Abstract Background The need for cardiac intensive care unit (ICU) beds remains high in order to monitor and treat emergency patients with severe cardiovascular diseases, particularly during the COVID-19 pandemic. Therefore, timely discharge strategies from the cardiac ICU to peripheral wards are crucial to meet the increasing demand for cardiac ICU beds. Early patient transfer from ICU to the peripheral ward may result in worsening of the patient's clinical condition and outcome with readmission to the ICU, while late transfer may require prolonged expert care and generate unwanted costs. Purpose To investigate whether unplanned readmission of cardiac patients to the cardiac ICU within 72 hours after the index ICU stay is associated with increased mortality risk (primary outcome) and prolonged total hospital length of stay (LOS) (secondary outcome), as well as to identify predictors of ICU readmission in cardiac patients. Methods Adult patients who were admitted to the cardiac ICU due to a primary cardiac admission diagnosis at a tertiary care center between 2003 and 2021 were included. Outcomes were analysed with multivariable regression models adjusted for 26 a priori defined variables on patient demographics, underlying comorbidity levels, ICU procedures and administered ICU drugs. Results 30,942 cardiac patients were included, out of whom 1,499 patients (4.84%) were readmitted to the cardiac ICU within 72 hours. 1,023 (68.2%) of readmitted patients were male. Compared to non-readmitted patients, readmitted patients were older, had more underlying comorbidities (Charlson Index), had more severe disease courses (SOFA score, TISS, APACHE II score and SAPS), as well as required more frequently vasopressor therapy, renal replacement therapy and coronary angiographies (Table 1). Readmission to the cardiac ICU was associated with higher in-hospital mortality risk (Odds Ratio 7.52, 95% Confidence Interval (CI) 4.15–12.27, P&amp;lt;0.001) and prolonged hospital LOS (Incidence Rate Ratio 1.56, 95% CI 1.15–1.58, P&amp;lt;0.001). Patients who were readmitted to the ICU had been discharged 18% earlier during the index ICU stay compared to non-readmitted patients (P&amp;lt;0.001). Of note, readmitted and non-readmitted patients had similar vital parameters at time of ICU discharge after their index ICU stay. During the index ICU stay, non-readmitted patients were prescribed more beta blockers (65.3% vs. 45.8%), ACE inhibitors (37.0% vs. 27.2%) and blood transfusions (10.7% vs. 7.7%). Conclusion Early readmission to the cardiac ICU was associated with increased in-hospital mortality and prolonged hospitalisation. Readmitted patients had been discharged earlier from their index ICU stay and required more comprehensive critical care. ICU discharge strategies should optimally be based on objective patient assessments to facilitate patient safety and shorten hospital length of stay. Artificial intelligence-based algorithms may support clinicians with safe ICU discharge. Funding Acknowledgement Type of funding sources: None.

Extubation delays and the associated prostaglandin and opiate dose following coarctation of the aorta repair

BackgroundCoarctation of the aorta (COA) is one of the most common congenital heart lesions. Most patients undergoing repair extubate without complication. A subset of patients are unable to extubate within 24 h postoperatively. ObjectiveWe examined risk factors determined a priori and their association with delays in extubation. MethodsThis is a retrospective single-center study at an academic quaternary children's hospital. All neonates (0–28 days) who underwent isolated coarctation repair via lateral thoracotomy between January 2008 – December 2019 were included. Delay in extubation was defined as duration from cardiac intensive care unit admission to time of extubation >24 h. Risk factors examined were total preoperative prostaglandin dose and total perioperative opiate dose following repair. Logistic regression analyses were performed using appropriate statistics with significance level set at p = 0.05. ResultsThere were 149 patients who met inclusion criteria, 102 (68.5 %) were intubated for >24 h. We found that patients who were smaller (3.2 kg vs. 3.4 kg, p = 0.012) and patients who were in the intensive care unit preoperatively (p = 0.048), were more likely to remain intubated >24 h. There was also a statistically significant difference between those that were extubated before 24 h postoperatively and those that were not with respect to the total amount of oral morphine milligram equivalent received (1.5 mg vs. 2.82 mg, p = 0.005). ConclusionsOf the 149 patients in our study, the majority (102 patients, 68.5 %) were unable to be extubated within 24 h of surgery following coarctation repair via lateral thoracotomy. Risk factors for delayed extubation were smaller neonates and patients who received greater amounts of opiates.

Mechanical circulatory device utilization in cardiac arrest: Racial and gender disparities and impact on mortality

The objectives of this retrospective study include identifying the utilization trend of mechanical circulatory devices (MCD) such as Intra-Aortic Balloon Pump (IABP), Impella and Extracorporeal Membrane Oxygenation (ECMO) in admissions with cardiac arrest, determining whether racial or gender disparities exist in their usage, and discerning if their use is associated with a reduction in mortality. By leveraging the National Inpatient Sample, we identified 229,180 weighted adult cardiac arrest admissions between October 1, 2015 and December 31, 2018. MCD were used in 6005 admissions (2.6%). IABP had the highest utilization, representing 77.8% of all MCDs, followed by Impella at 24.8%. The utilization of IABP decreased from 90.6% to 71.6%, while the use of Impella increased from 13.5% to 29.8% in this study period; both trends were statistically significant. MCD use was found to be lower in women compared to men (1.4% vs 3.6, P < 0.001) and in the Black population compared to White (1.5% vs 2.8%, P < 0.001). There was no difference in MCD utilization between Hispanic and the White cohorts. In-hospital mortality was lower in admissions associated with MCD (31.4% vs 45.9%, P < 0.001). ECMO was associated with the lowest mortality rate at 14.3%, followed by IABP at 28.1%. The use of Impella and combination therapy were not associated with a significant decrease in mortality. In conclusion, MCD use may decrease mortality in cardiac arrest, however their utilization appears to be lower in African Americans and in women.

Prevalence of psychoactive drug use in patients hospitalized for acute cardiac events: Rationale and design of the ADDICT-ICCU trial, from the Emergency and Acute Cardiovascular Care Working Group and the National College of Cardiologists in Training of the French Society of Cardiology

Psychoactive drugs, including illicit drugs, are associated with an increased rate of cardiovascular events. The prevalence and outcome of patients using these drugs at the time of admission to an intensive cardiac care unit is unknown. To assess the prevalence of psychoactive drugs detected in consecutive patients hospitalized in an intensive cardiac care unit for an acute cardiovascular event. This is a nationwide prospective multicentre study, involving 39 centres throughout France, including all consecutive patients hospitalized in an intensive cardiac care unit within 2weeks. Psychoactive drug use will be assessed systematically by urine drug assay within 2hours of intensive cardiac care unit admission, to detect illicit (cannabinoids, cocaine, amphetamines, ecstasy, heroin and other opioids) and non-illicit (barbiturates, benzodiazepines, tricyclic antidepressants, methadone and buprenorphine) psychoactive drugs. Smoking will be investigated systematically by exhaled carbon monoxide measurement, and alcohol consumption using a standardized questionnaire. In-hospital major adverse events, including death, resuscitated cardiac arrest and cardiogenic shock, will be recorded. After discharge, all-cause death and major adverse cardiovascular events will be recorded systematically and adjudicated at 12months of follow-up. The primary outcome will be the prevalence of psychoactive drugs detected by systematic screening among all patients hospitalized in an intensive cardiac care unit. The in-hospital major adverse events will be analysed according to the presence or absence of detected psychoactive drugs. Subgroup analysis stratified by initial clinical presentation and type of psychoactive drug will be performed. This is the first prospective multicentre study to assess the prevalence of psychoactive drugs detected by systematic screening in consecutive patients hospitalized for acute cardiovascular events.

P05-04 Physical activity level and sedentary time prior to cardiac ward admission among patients with cardiovascular disease and its association to all-cause mortality

BackgroundLow physical activity (PA) level and high sedentary time (SED) have been associated to cardiovascular (CVD) morbidity and mortality. Routinely assessing the PA-level of patients being admitted to hospital has been proposed. The aim was to explore PA-level and SED among patients prior to cardiac ward admission and whether this can predict all-cause mortality.MethodsA longitudinal observational study of patients with ischemic heart disease, heart failure, cardiac arrhythmia, valvular heart disorder and inflammatory heart diseases treated on cardiac wards (2015-2016) in Stockholm, Sweden. Data on PA-levels and SED prior to admission were collected by validated questionnaires during inpatient care. PA level a regular week was calculated by an index (3-19 points) including everyday PA and exercise. The cut-off of insufficiently physically active was set to > 9 points. Individuals' reporting ≥7 hours of sitting a normal day were categorised as high SED. Differences in PA-level and SED between different diagnose groups were explored by Benjamini-Hochberg procedure. The associations between PA-level and SED with all-cause mortality were analysed using cox regressions, adjusting for age, sex, diagnosis group, education level, disposable income, smoking status, alcohol consumption and eating habits.ResultsAmong 1148 patients with CVD, approximately 56% were considered as insufficiently physically active (>9 points). In addition, approximately half the study population were categorized as high SED (≥7 hours per day). There were differences in PA-level and SED between the various cardiovascular diagnoses, with individuals with heart failure and valvular heart disorder being in general more inactive and having higher levels of SED. A total of 200 deaths occurred during a median follow-up time of 2.6 years. The mortality was higher among those categorised as insufficiently physically active (HR 1.49, 95% CI 1.08-2.07) or high SED (HR 1.79, 95% CI 1.32-2.43) compared to those reporting sufficient PA and low SED, respectively.ConclusionA high amount reported insufficient PA and a high amount of SED preceding hospitalisation. There was an association between PA (negatively) and SED (positively) with all-cause mortality among patients with CVD. This highlights the prognostic value of assessing patients' PA-level and SED in clinical practice.

Characteristics of geriatric rehabilitation inpatients based on their frailty severity and change in frailty severity during admission: RESORT

BackgroundFrailty is prevalent amongst geriatric inpatients and worsens clinical outcomes. Determinants of admission frailty and changes in frailty severity are potential targets for intervention. ObjectiveTo identify characteristics associated with frailty severity at admission and change in frailty severity during geriatric rehabilitation. MethodsThe observational, prospective, longitudinal inception cohort REStORing health of acutely unwell adulTs (RESORT) includes geriatric rehabilitation inpatients. Demographic, medical, nutritional, functional, and psychological characteristics were analysed according to admission Clinical Frailty Scale. Linear and multinomial logistic regression prediction models identified admission characteristics predicting change in frailty severity during rehabilitation. ResultsA total 1716 inpatients (median age [IQR] 83.4 [77.7–88.6] years, 56.4 % females) were included. Poorer admission medical, nutritional, functional, and psychological status was associated with more severe frailty. Cardiac admissions, higher Cumulative Illness Rating Scale, greater number of medications, and better Short Physical Performance Battery at admission predicted improved frailty severity. Admission cognitive impairment, delirium, higher Charlson Comorbidity Index, and Hospital Anxiety and Depression Scale anxiety predicted worsened frailty severity. Explained variation was low. ConclusionsFrailer geriatric rehabilitation inpatients have more complicated disease and impaired nutritional, physical, and psychological markers. Admission cognitive impairment, delirium, comorbidity, and anxiety predict worsening frailty during rehabilitation, and require prompt management.

Impact of Noonan Syndrome on admissions for pediatric cardiac surgery.

Noonan Syndrome is the second most common genetic syndrome associated with congenital heart disease. Many patients with Noonan Syndrome will require a cardiac intervention. This study aimed to characterize the difference in cardiac surgery admissions in patients with and without Noonan Syndrome. Data regarding hospital admissions was collected using the Kids' Inpatient Database from 1997 to 2012. A cross-sectional study was conducted comparing baseline characteristics, cardiac morphology, cardiac surgery, and other comorbidities between those with and without Noonan Syndrome. Regression analysis was conducted to determine factors related to Noonan Syndrome and risk factors for increased length of hospitalization, need for ECMO, and inpatient mortality using Noonan Syndrome as the independent variable. A total of 46,169 admissions with cardiac surgery under 18 years of age were included in the final analyses. Of these 778 (1.6%) had Noonan Syndrome. Pulmonary stenosis, coronary anomalies, and valvuloplasty without valve replacement were independently associated with Noonan Syndrome. Those with Noonan Syndrome were 90% more likely to have chylothorax. Pediatric cardiac surgery admissions tended to be 4.5 days longer and cost $54,296 more in total charges with Noonan Syndrome. Inpatient mortality is also increased by Noonan Syndrome. Noonan Syndrome is present in a relatively small proportion of pediatric cardiac surgery admissions. Noonan Syndrome is independently associated with increased length and cost of such admissions as well as inpatient mortality.