Chronic Heart Research Articles

Registered nurses\u2019 experiences of communication with patients when practising person\u2013centred care over the phone: a qualitative interview study

BackgroundTo explore registered nurses’ (RNs’) experiences of practising person-centred care (PCC) by telephone with people diagnosed with chronic obstructive pulmonary disease and/or chronic heart failure.MethodsQualitative interview study. Four RNs were individually interviewed before, during, and after participating in an intervention practising PCC by telephone. The interviews were analysed using qualitative content analysis.ResultsThe results reflect three categories of their experience: realize the complexity of practising PCC by distance, gain insight into what PCC communication meant to RNs and their approach, and develop the professional role by practising PCC theory and ethics.ConclusionsPCC over the telephone facilitate healthcare and support patients. Through careful listening, the RNs (1) created space for the individual patients to express their thoughts and feelings and (2) emphasized each patient’s capabilities and resources. The RNs also gained an understanding of PCC and what it means to patients and to themselves as practitioners. Potential implications are that it is important for RNs practising PCC by telephone to remould their role, to listen carefully, and to communicate as equals in conversations that respect both parties’ knowledge and expertise. Health professionals need supervision and support to fully understand the person-centred approach and provide communications that support it.

Atrial Fibrillation and Diabetes Mellitus: the Control of Thromboembolic Risk

Atrial fibrillation is one of the most common concomitant diseases in patients with diabetes mellitus (DM). Meta-analyses of multiple studies have shown that the risk of AF is higher for diabetic patients with impaired glucose homeostasis than for patients without DM. Patients with AF and DM were younger, more frequently had arterial hypertension, chronic kidney disease, heart failure, and ischemic heart disease, and stroke and were characterized with a more severe course of AF. The article discusses possible mechanisms of the mutually aggravating effects of DM and AF, scales for evaluating the risk of bleeding (CHADS2, CHA2DS2‑VASc, HAS-BLED), and the role of anticoagulants. A meta-analysis of 16 randomized clinical studies, including 9 874 patients, has demonstrated the efficacy of oral anticoagulants in prevention of stroke with an overall decrease in the relative risk by 62 % compared to placebo (95% confidence interval, from 48 to 72 ). For prevention of complications in patients with AF and DM, current antithrombotic therapies can be used, specifically the oral factor Xa inhibitor, rivaroxaban, which is the best studied in patients with AF and DM and represents a possible alternative to warfarin in such patients.

Inhibition of G protein-gated K+ channels by tertiapin-Q rescues sinus node dysfunction and atrioventricular conduction in mouse models of primary bradycardia

Sinus node (SAN) dysfunction (SND) manifests as low heart rate (HR) and is often accompanied by atrial tachycardia or atrioventricular (AV) block. The only currently available therapy for chronic SND is the implantation of an electronic pacemaker. Because of the growing burden of SND in the population, new pharmacological therapies of chronic SND and heart block are desirable. We developed a collection of genetically modified mouse strains recapitulating human primary SND associated with different degrees of AV block. These mice were generated with genetic ablation of L-type Cav1.3 (Cav1.3−/−), T-type Cav3.1 (Cav3.1−/−), or both (Cav1.3−/−/Cav3.1−/−). We also studied mice haplo-insufficient for the Na+ channel Nav1.5 (Nav1.5+/) and mice in which the cAMP-dependent regulation of hyperpolarization-activated f-(HCN4) channels has been abolished (HCN4-CNBD). We analysed, by telemetric ECG recording, whether pharmacological inhibition of the G-protein-activated K+ current (IKACh) by the peptide tertiapin-Q could improve HR and AV conduction in these mouse strains. Tertiapin-Q significantly improved the HR of Cav1.3−/− (19%), Cav1.3−/−/Cav3.1−/− (23%) and HCN4-CNBD (14%) mice. Tertiapin-Q also improved cardiac conduction of Nav1.5+/− mice by 24%. Our data suggest that the development of pharmacological IKACh inhibitors for the management of SND and conduction disease is a viable approach.

Clinical characteristics and outcomes of the first 63 adult patients hospitalized with COVID-19: An experience from Oman

IntroductionTo identify the clinical characteristics and outcomes of hospitalized patients with COVID-19 in Oman. MethodsA case series of hospitalized COVID-19 laboratory-confirmed patients between February 24th through April 24th, 2020, from two hospitals in Oman. Analyses were performed using univariate statistics. ResultsThe cohort included 63 patients with an overall mean age of 48±16 years and 84% (n=53) were males. A total of 38% (n=24) of the hospitalized patients were admitted to intensive care unit (ICU). Fifty one percent (n=32) of patients had at least one co-morbidity with diabetes mellitus (DM) (32%; n=20) and hypertension (32%; n=20) as the most common co-morbidities followed by chronic heart and renal diseases (12.8%; n=8). The most common presenting symptoms at onset of illness were fever (84%; n=53), cough (75%; n=47) and shortness of breaths (59%; n=37). All except two patients (97%; n=61) were treated with either chloroquine or hydroxychloroquine, while the three most prescribed antibiotics were ceftriaxone (79%; n=50), azithromycin (71%; n=45), and the piperacillin/tazobactam combination (49%; n=31). A total of 59% (n=37), 49% (n=31) and 24% (n=15) of the patients were on lopinavir/ritonavir, interferons, or steroids, respectively. Mortality was documented in (8%; n=5) of the patients while 68% (n=43) of the study cohort recovered. Mortality was associated with those that were admitted to ICU (19% vs 0; p=0.009), mechanically ventilated (31% vs 0; p=0.001), had DM (20% vs 2.3%; p=0.032), older (62 vs 47 years; p=0.045), had high total bilirubin (43% vs 2.3%; p=0.007) and those with high C-reactive protein (186 vs 90mg/dL; p=0.009) and low corrected calcium (15% vs 0%; p=0.047). ConclusionsICU admission, those on mechanical ventilation, the elderly, those with high total bilirubin and low corrected calcium were associated with high mortality in hospitalized COVID-19 patients.

1196-P: Impact of Pharmacist-Driven Access to Therapy in Type 2 Diabetes Mellitus

The Diabetes Care guidelines recommend glucagon-like peptide 1 receptor agonists (GLP-1RA) as second line therapy in the setting of established atherosclerotic cardiovascular disease (ASCVD) and sodium glucose cotransporter 2 inhibitors (SGLT2i) as second line in the presence of chronic kidney disease or heart failure (HF). Formularies are often restrictive of these classes of medications and most require prior authorization (PA), which is a barrier to initiation of therapy. A pharmacist (PharmD) in the ambulatory setting is in an optimal position to navigate insurance formulary and medication cost issues. In addition, with knowledge of evidence-based medicine, a PharmD can provide the justification needed for a medication that adheres to guideline recommendations regardless of formulary status. This retrospective review evaluates if the PharmD in Endocrinology (Endo) clinic improved HbA1c through resolution of medication access problems allowing for initiation of guideline-based therapies. The PharmD documented on 190 patients with T2DM from 11/2018 to 11/2019. Average time managed by Endo was 1.4 years (median 9.4 months) and 38% of patients were previously prescribed or established on SGLT2 or GLP-1RA therapy for an average of 1.4 years (median 11.5 months). The majority of patients had Medicare or Medicaid plans (73%). ASCVD or HF was present in 30% of patients. HbA1c was <7% in 17.8% of patients. The PharmD assisted with initiation of GLP-1RA or SGLT2 for 74% of the patients through test claims, education, prior authorizations and appeal letters. Of the patients with CV disease, 79% (45/57) were prescribed one of the agents with proven CV benefits with the help of the PharmD. Average HbA1c prior to PharmD was 8.9% and average most recent HbA1c was 8.05% (-0.85, p<0.05). Time between HbA1c values was an average of 5.4 months. Most recent HbA1c was <7% in 36% of patients. The PharmD contributed to a significant HbA1c change through navigation of formulary requirements combined with knowledge of clinical evidence. Disclosure M. Allison: None.

374-P: External Validation and Clinical Application of the Risk Prediction Model for Severe Hypoglycemia in Type 2 Diabetes

We previously developed and internally validated a one-year risk prediction model for SH in type 2 diabetes using the National Health Insurance Service database and analyzing data from 1,173,820 subjects with type 2 diabetes. In this study, we planned external validation to verify the performance of the previously-developed risk prediction model in a tertiary hospital setting. From January 2018 to December 2018, 2,724 patients over 30 years old who visited the diabetes center were enrolled. The Harrell C-statistics were compared to identify the discrimination of the developed model. The predicted incidence and actual incidence of SH at 1 year in the development and validation cohort were compared by ranking subjects into deciles of predicted risk. External validation was performed with a total of 2,757 patients. The incidence rate of severe hypoglycemia was 12.6 per 1000 patient-year. The concordance index for SH was 0.854 in the external validation cohort. The sensitivity and specificity of this model prediction in the external validation cohort were 0.714 and 0.853, respectively. However, compared with the model for the development cohort, the incidence rate of SH in each decile group was three times higher than the predicted value. SH risk scores increased in proportion to the age and the duration of diabetes (P for trends <0.001, respectively). The HbA1c distribution was distributed in the form of a J-shape according to the decile group of SH risk score. The risk score for SH was higher in the subjects with chronic kidney disease, heart failure, and dementia than those with other major comorbidities. Our SH prediction model showed excellent discrimination when applied to type 2 diabetes subjects in the tertiary hospital. The results of this study confirm that the risk of hypoglycemia can be accurately predicted using this model. The actual number of SH events is higher than expected, which might be due to the characteristics of the subjects in the tertiary hospital. Disclosure Y. Ahn: None. J. Yun: None. J. Lee: None. K. Song: None. S. Ko: None.

421-P: Efficacy and Safety of Sodium–Glucose Cotransporter-2 Inhibitors: A Systematic Review and Meta-analysis

Background: Several large randomized trials suggest SGLT2Is may reduce mortality in addition to lowering A1c in patients with T2D. Treatment algorithms from the ADA and EASD now recommend a SGLT2I be initiated in patients with T2D who have chronic kidney disease or heart failure, regardless of A1c level. To better quantify the efficacy and safety of SGLT2Is, we conducted a systematic review and meta-analysis of all randomized trials of this drug class. Methods: We searched PubMed and Scopus (inception to June 2019) for randomized trials of at least 52 weeks duration enrolling adults with T2D that compared SGLT2Is with placebo. Outcomes included microvascular/macrovascular complications, mortality, change in cardiovascular (CV) risk factors, and adverse events. Continuous outcomes were calculated with standardized mean differences, and binary outcomes were calculated using odds ratios. Pooled analyses were performed with fixed and random effects models. Heterogeneity was assessed with the I2 statistic. Results: See Table for results. Conclusions: Patients who received SGLT2Is when compared to placebo had significantly lower rates of heart failure and A1c. These findings support the current ADA/EASD treatment recommendations. Subsequent cost effectiveness analyses will help further inform healthcare policy decisions. Disclosure J. Alexander: None. E.M. Staab: None. W. Wan: None. M. Franco: None. A.C. Knitter: None. C.C. Thomas: None. V.G. Press: Consultant; Self; Humana, Vizient Inc. M. Zeytinoglu: None. R. Skandari: None. K.E. Gunter: None. B. Bindon: None. S. Jumani: None. S.D. Bolen: None. N.M. Maruthur: Other Relationship; Self; Johns Hopkins HealthCare Solutions. E. Huang: None. L.H. Philipson: None. N. Laiteerapong: None. Funding American Diabetes Association (1-18-JDF-037 to N.L.); National Institutes of Health (P30DK092949)

P0200KEEP ON (KEEPING RAAS INHIBITION TREATMENT WITH OPTIMAL POTASSIUM CONTROL). DESIGN OF A CLINICAL TRIAL OF USING SODIUM ZIRCONIUM CYCLOSILICATE FOR KEEPING RAAS INHIBITION AND/OR MRAS IN PATIENTS WITH CKD AND CONGESTIVE HEART FAILURE HISTORY

Abstract Background and Aims Hyperkalemia (HK) is a potentially life-threatening condition, in patients with chronic kidney disease (CKD) and congestive heart failure (CHF). The majority of patients affected with CKD or CHF, must be treated with inhibitors of renin angiotensin aldosterone system (RAASi) and mineralocorticoid receptor antagonists (MRAs). However, the treatments previously mentioned, increase the risk of HK episodes, which is the main cause of RAASi and MRAs downtitration or discontinuation, representing an undesirable clinical scenario, given that the patients are at high risk of be deprived of their nephroprotective effect and cardio-renal benefits The aim of the study is: to analyze if, in patients with HK, CKD and CHF treated with RAASi and/or MRA, serum potassium (sK) reduction by Sodium zirconium cyclosilicate (SZC) treatment is non-inferior to RAASi and/or MRAs discontinuation or downtitration. Method Results The study will demonstrate results on serum electrolytes, renal function, albuminuria, KDQoL questionnaire and changes in relative overhydration (multifrequency bioimpedance -BCM Fresenius-) Conclusion The KEEP ON study will define the ability of SZC to facilitate the use of RAAS-I and / or MRA in patients with HK and cardiorenal syndrome allowing the maintenance of the medications recommended by international guidelines for the treatment of CHF at different degrees of CKD while maintaining the potential cardio-renal and nephroprotective benefit.

Correlação entre dois testes e a pontuação do Child Health Assessment Questionnaire em crianças com cardiopatia reumática

INTRODUÇÃO: As crianças que evoluem para cardiopatia reumática passam a conviver com limitações, tornam-se comumente restritas no desempenho de atividade do cotidiano. OBJETIVO Verificar a existência de correlação entre o desempenho no teste de caminhada de seis minutos (TC6M) e do degrau de três minutos (TD3) e a pontuação do child health assessment questionnaire (CHAQ) em criança com febre reumática. MÉTODOS: Estudo seccional sem grupo de comparação, descritivo e exploratório, realizado com 15 crianças. Foram avaliadas através dos testes submáximos, o TC6M e o TD3 e a avaliação da capacidade física sob a percepção do cuidador foi realizada por meio da aplicação do CHAQ . RESULTADOS: A média de idade 13,7 anos, desvio padrão 1,9 anos. A maioria dos acompanhantes eram mães, 66,7%, e uma parcela considerável dos cuidadores apresentou baixo nível socioeconômico e de escolaridade. O valor obtido na distância percorrida através do TC6M demonstrou um baixo desempenho, mediana (intervalo interquartil) 420 (101) metros que também foi observado no teste do degrau de três minutos, mediana (intervalo interquartil) 68 (6,5) degraus. Em relação ao questionário CHAQ foi observado ausência de comprometimento da capacidade física diante da percepção dos responsáveis com escore final do questionário de 0,1. A correlação entre o questionário e o teste de caminhada de seis minutos (correlação de Sperman = - 0,21) e, entre o questionário e o teste do degrau de três minutos, (correlação de Sperman = - 0,39). CONCLUSÃO: Não foi encontrada correlação dos testes submáximos, em relação à capacidade física obtida através da percepção dos responsáveis avaliada através do questionário. Esse resultado chama a atenção para a importância do fisioterapeuta inserir na sua prática clínica, nesse perfil de pacientes os testes submáximos.

Differences in self-reported health-related quality of life in heterosexual and sexual minority women surviving cancer: 2013 to 2018 national health interview survey.

e19038 Background: Health related quality of life (HRQoL) is associated with excess morbidity and mortality after cancer diagnosis. While a growing body of research indicates that sexual minority women (lesbian and bisexual women; SMW) experience greater risk for cancer diagnoses and cancer-related mortality, there is a paucity of evidence describing HRQoL in this population. This is a critical omission as assessment of sexual orientation differences in HRQoL may inform clinical interventions to improve health and survival of SMW after cancer diagnosis. This study examined associations between sexual orientation and HRQoL domains among female cancer survivors. Methods: Data from the 2013-2018 National Health Interview Survey (NHIS) was pooled. HRQoL was defined using individual indices across physical health, mental health, social, and financial domains. The association between sexual orientation and individual indices of HRQoL was assessed using weighted multivariable logistic regression analyses. Results: The sample included 97909 heterosexual, 1424 lesbian, and 1235 bisexual women who reported a cancer diagnosis. Sexual minority women were more likely to be college graduates (p < 0.001) and employed (p < 0.001); however, they had higher rates of being uninsured (p = 0.01) than their heterosexual counterparts. Reproductive cancers—including breast, ovarian, cervical, and uterine—accounted for 51% of cancer diagnoses in heterosexual women and 57.2% in SMW (p = 0.06). Sexual minority and heterosexual women had more similarities than differences in individual indices of HRQoL; however, several pertinent differences were noted. Specifically, SMW had higher odds of moderate (OR 1.46 [1.01-2.13]) and severe psychological distress (OR 2.10 [1.17-3.77]); chronic health conditions, including COPD (OR 1.72 [1.06-2.80]) and heart disease (OR 1.93 [1.32-2.83]); financial concerns about retirement (OR 1.36 [1.01-1.83]); food insecurity (OR 2.13 [1.23-3.68]), and severe food insecurity (OR 2.44 [1.28-4.67]). Conclusions: Sexual minority women with cancer diagnoses report worse indices of HRQoL. Poorer HRQoL may influence excess morbidity and mortality evidenced in these populations; however, future longitudinal studies are needed to assess prospective risk. Given our results, implementing interventions in the cancer setting to identify sexual minority patients in need of physical and mental health and financial services may reduce disparities.

Оценка влияния 6-недельной терапии мельдонием (Милдронат®) на показатели бульбарной капилляроскопии у пациентки с хронической ишемической болезнью сердца и головного мозга

Оценка влияния 6-недельной терапии мельдонием (Милдронат®) на показатели бульбарной капилляроскопии у пациентки с хронической ишемической болезнью сердца и головного мозга

Патогенетические подходы к лечению аспирин-индуцированных гастроэнтеропатий при длительном приеме ацетилсалициловой кислоты у больных с хронической ишемической болезнью сердца

Патогенетические подходы к лечению аспирин-индуцированных гастроэнтеропатий при длительном приеме ацетилсалициловой кислоты у больных с хронической ишемической болезнью сердца

Abstract 339: Urban and Rural Patients Receive Different Care for Atrial Fibrillation

Background: Atrial fibrillation (AF) accounts for substantial resource utilization that is expected to increase as the US population ages. Management strategies for AF vary widely based on patient preference, physician specialty training, available resources, and other factors, but the impact that geography has on treatment variations for AF is unknown. Objective: We seek to evaluate differences in AF patient characteristics and management between urban and non-urban Medicare beneficiaries. Methods: Our cohort included all Medicare fee-for-service beneficiaries meeting the CMS chronic conditions warehouse definition of AF from 2013-2017. Beneficiaries were designated as urban and non-urban by rural-urban commuting area codes. AF procedures were tabulated based on CPT codes. The use of AF related medications was tabulated based on prescriptions for drugs of interest in Medicare Part D. Results: During our period of interest, Medicare AF patients were average age 79 yrs, and 52% were female. Urban patients were more likely to be black and have chronic kidney disease, diabetes, and ischemic heart disease. The average CHADS2VA2SC score was high (4.90 SD 1.71) and not meaningfully different between urban and non-urban groups. Most advanced interventions for AF increased over time driven mostly by increases in AF ablation (Figure). However, compared with non-urban patients, urban patients were more likely to undergo AF ablation (1.81 vs 1.42%, p<0.001), Watchman implantation (0.15 vs 0.11%, p<0.001), and cardioversion (0.06 vs 0.05%, p=0.015). Non-urban patients were more likely to be prescribed amiodarone (7.08 vs 6.09%, p=0.002) and warfarin (8.84 vs 7.40%, p<0.001) compared with urban patients and were less likely to be prescribed a direct oral anticoagulant. Conclusions: Despite urban and non-urban Medicare patients with AF being similar with regard to demographic and clinical characteristics, treatment of AF varied in important ways between these groups. In general, urban patients were more likely to receive interventional care for AF which, in some cases, has known associated benefits with regard to quality of life, morbidity, and mortality. Further work is needed to understand differences in outcomes between these two groups and to develop policy solutions to reduce treatment disparities.

Mortality burden from seasonal influenza in Chongqing, China, 2012–2018

ABSTRACT Purpose To estimate influenza-associated excess mortality rates (EMRs) in Chongqing from 2012 to 2018. Methods We obtained weekly mortality data for all-cause and four underlying causes of death (circulatory and respiratory disease (CRD), pneumonia and influenza (P&I), chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IDH)), and influenza surveillance data, from 2012 to 2018. A negative-binomial regression model was used to estimate influenza-associated EMRs in two age groups (<65 years and ≥65 years). Results It was estimated that an annual average of 10025 influenza-associated deaths occurred in Chongqing, corresponding to 5.2% of all deaths. The average EMR for all-cause death associated with influenza was 33.5 (95% confidence interval (CI): 31.5–35.6) per 100 000 persons, and in separate cause-specific models we attributed 24.7 (95% CI: 23.3–26.0), 0.8 (95% CI: 0.7–0.8), 8.5 (95% CI: 8.1–9.0) and 5.0 (95% CI: 4.7–5.3) per 100 000 persons EMRs to CRD, P&I, COPD and IDH, respectively. The estimated EMR for influenza B virus was 20.6 (95% CI: 20.3–21.0), which was significantly higher than the rates of 5.3 (95% CI: 4.5–6.1) and 7.5 (95% CI: 6.7–8.3) for A(H3N2) and A(H1N1) pdm09 virus, respectively. The estimated EMR was 152.3 (95% CI: 136.1–168.4) for people aged ≥65 years, which was significantly higher than the rate for those aged <65 years (6.8, 95% CI: 6.3–7.2). Conclusions Influenza was associated with substantial EMRs in Chongqing, especially among elderly people. Influenza B virus caused a relatively higher excess mortality impact compared with A(H1N1)pdm09 and A(H3N2). It is advisable to optimize future seasonal influenza vaccine reimbursement policy in Chongqing to curb disease burden.

Disseminating research findings using a massive online open course for maximising impact and developing recommendations for practice

BackgroundDeveloping recommendations for how we deliver healthcare is often left to leading experts in a field. Findings from the Integrated Palliative Care in cancer and chronic conditions (InSup-C) study, which aimed to identify best practice in integrated palliative care in cancer, chronic obstructive pulmonary disease (COPD) and heart failure, led to recommendations developed through an expert consultation process. We also wanted to develop these recommendations further with participants who were largely clinicians and members of the public.MethodsResults from the InSup-C study were disseminated through a three-week massive open online course (MOOC) which ran in 2016, 2017 and 2019. The first course helped develop the final recommendations, which were ranked by MOOC participants in the subsequent courses. MOOC participants were predominantly clinicians, but also academics and members of the public. They rated how important each recommendation was on a 9 point scale (9 most important). Descriptive statistics were used to analyse the ratings. The results were compared to findings from the consultation.ResultsFive hundred fifteen completed the last part of the course where the recommendations were ranked, of which 195 (38%) completed the ratings. The top recommendations related to: need to expand palliative care to non-malignant conditions; palliative care needs to include different dimensions of care including physical, psychological and spiritual; policies and regulations assessments should be made regularly; palliative care integration should be mandatory; and there should be greater availability of medicines. These differed compared to the top ranked recommendations by the consultation panel in relation to the importance of leadership and policy making. This may indicate that clinicians are more focused on daily care rather than the (inter) national agenda.ConclusionsWhilst both sets of recommendations are important, our study shows that we need to include the views of clinicians and the public rather than rely upon leading expert opinion alone. To keep recommendations fresh we need both the input of clinicians, the public and experts. When disseminating findings, MOOCs offer a useful way to gain greater reach with clinicians and the public, and importantly could be a vehicle to validate recommendations made by leading expert panels.

Blood Glucose Is a Representative of the Clustered Indicators of Multi-Organ Injury for Predicting Mortality of COVID-19 in Wuhan, China

Background: Most patients with Coronavirus Disease 2019 (COVID-19) were mild. Severe patients progressed rapidly to critical condition including multi-organ failure and even death. Identification of early predictive factors is urgently necessary to facilitate appropriate intensive care. Methods: We included all patient admitted to Wuhan Union Hospital and treated by the supportive medical team of Beijing Tongren Hospital as of March 20, 2020. Indicators of injuries for multiple organs, including the heart, kidney and liver, and glucose homeostasis were specifically analyzed for predicting primary outcomes (an intensive care unit (ICU) or death). Findings: The data of 120 patients with a severity equal to or greater than Moderate, discharged from the hospital or died were extracted. After excluding patients with chronic heart, kidney, liver disease and diabetes, 69 patients were included in the final analysis. There were 26 cases with primary outcomes including 16 deaths. Univariable analysis indicated that elevations of fasting blood glucose (FBG), lactate dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBDH), creatine kinase (CK) and creatinine (Cr) were associated with higher odds of primary outcomes and more hazards of death. Cox regression results indicated that FBG≥7mmol/L was the only independent predictor for death (HR = 3.75, 95% CI 1.26-11.15). Cluster analysis found more proximities of FBG (at the time of admission) with LDH, HDDH or Creatinine (at the time after 2-4 days of hospitalization) (r=0.43, 0.43 and 0.50, respectively, P<0.01 for all), indicating that FBG Among patients with primary outcomes, although FBG and LDH levels were much higher on admission, they dramatically decreased subsequently, while in deceased patients they increased continuously. Conclusions: FBG is a representative of the clustered indicators of multi-organ injury and the earliest predictor for poor outcomes and death in COVID patients. As it is easy to perform for clinical practices and self-monitoring, FBG testing will be much helpful for predicting critical condition to facilitate appropriate intensive care. Funding Statement: This study was funded by the National Key RD The Beijing Science and Technology Project. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The Research Ethics Commission of Beijing Tongren Hospital, Capital Medical University (TRECKY2020-013) approved the study and the Ethics Commission waived the requirement for informed consent.

Insulin resistance is an independent factor to determine an exaggerated pressor response to ischemic rhythmic handgrip in non–diabetic older adults

Patients with type 2 diabetes display an exaggerated blood pressure (BP) response during exercise. However, the mechanism(s) underlying this abnormal exercise BP is poorly understood. A previous study demonstrated that the increase in muscle sympathetic nerve activity during post–exercise muscle ischemia (PEMI) is significantly associated with glucose control and insulin resistance markers such as fasting glucose, hemoglobin A1c (HbA1c), and hemoglobin model assessment of insulin resistance (HOMA‐IR) in middle aged type 2 diabetic patients. To date, evidence supporting a similar relationship between the pressor response to exercise and insulin resistance–related factors in non–diabetic older adults remains to be elucidated. It was hypothesized that exercise BP is associated with insulin resistance–related factors in non–diabetic older adults.PURPOSETo investigate the relationship between cardiovascular responses to handgrip exercise and insulin resistance–related factors in non–diabetic older adults.METHODSHealthy male (n=23) and female (n=23) older adults over 60 years without diabetes, chronic heart, kidney, or liver disease, or peripheral arterial disease volunteered to participate. Baseline measurements included: 1) insulin resistance–related factors (fasting blood glucose, HbA1C, insulin, and HOMA‐IR), 2) fasting lipid and lipoprotein levels (triglycerides, LDL and HDL cholesterols), 3) indexes of oxidative stress (derivatives of reactive oxygen metabolite and biological antioxidant potential), 4) oxygen uptake efficiency slope (OUES), an index of cardiorespiratory fitness, and 5) arterial stiffness (heart‐ankle pulse wave velocity: haPWV). We assessed heart rate and BP responses to 1) isometric handgrip of 30% MVC, 2) PEMI induced by tourniqueting the arm after isometric handgrip, 3) passive movement of the wrist during PEMI, and 4) rhythmic dynamic handgrip (RHG) with minimal effort during PEMI.RESULTSDiastolic BP (DBP) response to RHG with PEMI was significantly correlated with males (r=0.44, P=0.02), HbA1c (r=0.33, P=0.03), haPWV (r=0.45, P&lt;0.01), and systolic BP at rest. A forward stepwise multi‐regression analysis revealed that sex (β=0.508) and HbA1c (β=0.341) were significant determinants explaining the variance of DBP response to RHG with PEMI. We also found that DBP response to RHG with PEMI in abnormal HOMA‐IR group (2.5 ≤) (Δ33±3 mmHg) was significantly (P&lt;0.01) greater than that of normal HOMA‐IR group (&lt; 1.6) (Δ22±2 mmHg). No correlation between systolic BP responses and insulin resistance–related factors was found. No correlation between exercise BP and OUES was found.CONCLUSIONSThese data suggest that insulin resistance is significantly associated with the pressor response to exercise, especially ischemic exercise, in non–diabetic older adults.Support or Funding InformationSupported by JSPS KAKENHI JP17K01769, Health Science Center Foundation, and UTSW SHP Interdisciplinary Research Grant Program.

FEATURES OF MICROCIRCULATORY DYSFUNCTION ACCORDING TO WAVLET ANALYSIS LASER DOPPLER FLOWMETRY IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE AND CONCOMITANT DIFFUSE LIVER DISEASES

Aim. To determine the features of microcirculatory dysfunction and in patients with chronic ischemic heart disease, depending on the presence of concomitant diffuse liver disease. Materials and methods. We performed a prospective study on the basis of MC «Doctor Vera», as well as in the diagnostic department of Medbud Clinic between 2009 and 2019. A total of 187 patients were examined. Patients' blood flow was assessed by transthoracic echocardiography, wavelet analysis laser Doppler flowmetry (LDF). Results. In the analysis of indicators of microcirculatory dysfunction in patients with ischemic heart disease, statistically significant deterioration of wavelet analysis laser Doppler flowmetry was determined. In patients with ischemic heart disease and left ventricular ejection fraction &lt; 40 %, indicators of wavelet analysis LDF were significantly lower. We also found that the severity of diffuse liver disease significantly disrupts peripheral blood flow (Р &lt; 0.05). Conclusions. The results of intracardiac hemodynamics, microcirculatory dysfunction were first presented. In patients with isolated ischemic heart disease as the left ventricular EF decreased, a significant decrease in capillary blood flow was observed as a result of deterioration of central hemodynamics, development of atherosclerotic vascular changes, as well as an increase in their vascular tone. We have proved that in the presence of DLD in patients with ischemic heart disease and EF &lt; 40 %, the degree of increase in peripheral resistance and impaired venous outflow were more pronounced due to the depletion of vasoactive substances production, impaired their excretion by hepatocytes due to irreversible morpho-functional changes in liver at the stage of decompensation of HF, severe fibrosis, the formation of regeneration nodes. In patients with LC, the most severe disorders of peripheral blood flow were determined according to the data of the digital capillaroscopy, which testifies to the influence of the degree of liver damage on the state of microcirculation.

The Effect of Emotional Responses on Heart Rate Variability as a Risk Factor for Cardiovascular Disease

Objective: to identify clinically significant functional interactions between the autonomic nervous system and personal emotional sphere.Material and methods. 105 patients with cardiovascular diseases were examined. Using a clinical role-playing game, the states of the psycho-emotional arousal of modalities: «anger», «fear», «sadness», and «joy» with some intervals of relaxation between them were successively induced in the patients, and the intensity of the psycho-emotional arousal was also recorded. At the same time, the parameters of heart rate variability were registered using the KP-01 Holter monitoring system. The patients were divided into two groups depending on the presence of a high direct relationship between the recorded indicators.Results. It has been found that a high direct relationship (rs[9] = 0.70, p = 0.018) of the power spectral density in the low frequency range, the total index of autonomic disequilibrium, and the intensity of emotional responses is associated with a 3-4 risk of arterial hypertension, coronary heart disease , cardiosclerosis, chronic heart failure.Conclusion. The presence of these correlations is associated with cardiovascular disease and is an independent risk factor for its development.

The associations of indices of echocardiography with polymorphism of genes of angiotensinogen and angiotensin receptor type I in examined patients with chronic rheumatic heart disease

The purpose of study is to evaluate associations of polymorphism of genes encoding components of renin-angiotensin system and indices of echocardiography in examined patients with rheumatic heart disease (RHD). The sampling consisted of 128 patients with RHD and average age 58,96±0,34 years. The echocardiography was implemented using Philips Affinity 50 machine. The genetic typing was carried out according polymorphic markers Thr174Met, Met235Thr and А1166С by polymerase chain reaction in real-time with electrophoretic scheme of detecting the result of "SNP-EXPRESS". The heterozygosis of Thr174Met results in larger dilatation of left sections of heart. The Thr174Thr homozygotes characterized by large linear dimensions of right heart. The Thr235Thr homozygotes characterized by minimal parameters reflecting hypertrophy of left ventricle of heart. There was no significant difference in echocardiography indices in patients with A1166A polymorphism. The mutations in codon 235 and 174 did not affect distance of 6-minute walk test. The statistically significant difference in the distance of 6-minute walk test was obtained only for А1166С: the minimum distance indicators is in the group of A1166C heterozygotes - 291,46 (273,83-309,09) meters and the maximum distance in С1166С homozygotes - 357,20 (309,21-405,19) meters. In patients with RHD, Thr174Met heterozygosis can lead to dilatation of left heart camera, while homozygosis for Thr174Mr leads to dilatation of right heart camera and left ventricular hypertrophy. The Met235Thr heterozygosis, on the contrary, are characterized by minimal sizes of left atrium and right ventricle. Polymorphism of the A1166C gene encoding angiotensin type I receptor had practically no effect on echocardiography indices in patients with RHD.