Clinical Outcomes In Cardiac Patients Research Articles

Readmission Trends and Outcomes of Transcatheter Edge-to-Edge Repair of Mitral Regurgitation With and Without Anemia.

Anemia is associated with worse clinical outcomes in cardiac patients. We aim to investigate the clinical outcomes and readmission rates in anemic patients undergoing transcatheter edge-to-edge repair (TEER) for severe mitral valve regurgitation (MR). The National Readmissions Database (NRD) from 2015 to 2018 was queried using the ICD-10 codes to identify patients admitted for TEER. Patients were divided into anemic and non-anemic sub-groups. Univariate and multivariate analyses were performed. Cardiovascular outcomes were assessed between cohorts at index admission and readmissions at 30, 90, and 180 days. STATA v.17 was used for analysis (StataCorp LLC, Texas, USA). Our final cohort included 28,995 patients who had undergone TEER in the United States between 2016 and 2019. About 1,434 (4.9%) had a diagnosis of anemia. The mean age of patients who had TEER with anemia and TEER without anemia was 76.9 ± 10.8 vs. 77.7 ± 10.2, respectively. In the adjusted model, anemic patients had higher odds of acute kidney injury (AKI) (aOR 2.21; 95% [CI 1.81-2.6; p<0.001]), HF (aOR 1.75; 95% [CI 1.28-2.3; p<0.001]), myocardial infarction (MI) (aOR 1.54; 95% [CI 1.01-2.33; p<0.041]), major adverse cardiac and cerebrovascular events (MACCE) (aOR 1.72; 95% [CI 1.2-9-2.3; p<0.001]), and net adverse event (aOR 1.85; 95% [CI 1.32-2.59; p<0.001]). The anemic group's readmission rate was overall higher at 30, 90, and 180 days from 2016 to 2019. Anemia was associated with increased adverse clinical outcomes and more extended hospital stays in patients with anemia who had undergone TEER procedures compared to the non-anemic group.

Effects of High-Intensity Interval Training vs Moderate-Intensity Continuous Training on Body Composition and Blood Biomarkers in Coronary Artery Disease Patients: A Randomized Controlled Trial.

Cardiac rehabilitation (CR) is essential in reducing cardiovascular mortality and morbidity. High-intensity interval training (HIIT) has emerged as a promising exercise intervention for enhancing clinical outcomes in cardiac patients. This study aimed to investigate the effects of two short-term exercise-based programs employing HIIT and moderate-intensity continuous training (MICT) in comparison to a control group concerning blood pressure, body composition, and blood biomarkers in patients diagnosed with coronary artery disease (CAD). Seventy-two CAD patients (14% women) underwent randomization into three groups: HIIT, MICT, and control. The training programs encompassed six weeks of supervised treadmill exercises, conducted thrice weekly. MICT targeted 70-75% of peak heart rate (HRpeak), while HIIT was tailored to 85-95% of HRpeak. The control group received guidance on adopting healthy lifestyles. Outcome measurements included evaluations of blood pressure, body composition, and blood biomarkers. In contrast to MICT, the HIIT exhibited superior improvements in body fat mass ( %HIIT: 4.5%, p 0.001 vs. %MICT: 3.2%, p 0.001), waist circumference ( %HIIT: 4.1%, p = 0.002 vs. %MICT: 2.5%, p = 0.002), hemoglobin A1c (HbA1c) ( %HIIT: 10.4%, p 0.001 vs. %MICT: 32.3%, p 0.001) and thyrotropin (TSH) ( %HIIT: 16.5%, p = 0.007 vs. %MICT: 3.1%, p = 0.201). Both HIIT and MICT induced significant enhancements across all variables compared to the control group. HIIT and MICT emerged as effective modalities for enhancing systolic and diastolic function, body composition, and blood biomarkers in CAD patients, with HIIT demonstrating incremental improvements over MICT. The absence of participation in exercise-based programs following cardiovascular events yielded less favorable outcomes. HIIT holds promise as an adjunct intervention in CR programs for CAD patients. https://clinicaltrials.gov/ct2/show/NCT03538119.

Arterial hypertension, chronic kidney and severe valvular heart disease predict worse outcome after postponing non-emergency cardiac interventions during the COVID-19-pandemic

Abstract Background Deferral of non-emergency cardiac procedures is associated with increased early emergency cardiovascular hospitalizations. Criteria to identify patients at risk for adverse events when postponing their scheduled intervention are needed. Aim The aim of this study was to identify predictors associated with worse clinical outcome in cardiac patients whose non-emergency cardiovascular intervention has been deferred during the COVID-19 pandemic. Methods This monocentric retrospective study included patients whose non-emergency cardiac intervention has been postponed during COVID-19-related lockdown between March 19th and April 30th 2020. Cox regression was performed to identify predictors of the combined endpoint emergency cardiovascular hospitalization and death. Patients’ outcome after 12 months was compared to a seasonal control group undergoing non-emergency interventions in 2019 as scheduled. Results The combined endpoint of death and emergency cardiovascular hospitalization occurred in 70 (36.5%) of 193 patients with a postponed cardiovascular intervention. The planned intervention was deferred by a median of 23 [19 – 36] days. Arterial hypertension (Hazard ratio [HR] 2.27; 95%-Confidence interval [CI] 1.00-5.12; P=0.049), chronic kidney disease (HR 1.89; 95%-CI 1.03 – 3.49, P=0.041) as well as severe valvular heart disease (HR 3.08; 95%-CI 1.68-5.64; P&amp;lt;0.001) were independent predictors of death or emergency hospitalization. Kaplan-Maier estimators of the combined endpoint were 31% in patients with arterial hypertension, 56% in patients with severe valvular heart disease and 77% with both risk factors (HR 12.4, 95%-CI 3.8-40.7; P&amp;lt;0.001) and only 9% in patients without these risk factors (log rank P&amp;lt;0.001). Separate analyses of patients with arterial hypertension, chronic kidney disease and severe valvular heart disease revealed that deferred patients showed significantly poorer clinical outcomes when compared to the control group 2019 (log rank P&amp;lt;0.001, P=0.006 and P&amp;lt;0.001, respectively). NT-proBNP cut-off ≥ 1,109 pg/ml best predicts the occurrence of primary endpoint event in deferred patients (AUC 0.71; P&amp;lt;0.001; sensitivity 64%, specificity 69%). Conclusion Our results suggest that patients with either arterial hypertension, chronic kidney or severe valvular heart disease are at very high risk for emergency hospitalization and increased mortality in case of postponed cardiac interventions even in supposed stable clinical status. Risk is even higher in patients suffering from a combination of these conditions. In addition, measuring NT-proBNP levels might help to identify those at high or very high risk.

Cardiac Transitional Care Effectiveness: Does Overall Comorbidity Burden Matter?

BackgroundCardiovascular disease is the most common cause of mortality and hospitalization in the United States. Transitional care initiatives can improve outcomes for cardiac patients, but it is unclear whether patients with different baseline comorbidity burden benefit equally. We evaluated the effectiveness of the Bridging the Discharge Gap Effectively (BRIDGE) program, a nurse-practitioner-led transitional care clinic, in mitigating adverse clinical outcomes in cardiac patients with varying Charlson comorbidity index (CCI). MethodsWe studied patients referred to BRIDGE between 2008 and 2017 postdischarge for a cardiac condition. Using proportional hazards regression models, we evaluated associations between attendance at BRIDGE and hospital readmission, emergency department (ED) visit, and a composite outcome consisting of readmission, ED visit, or mortality, and assessed interaction between BRIDGE attendance and CCI. ResultsOf 4559 patients, 3256 (71.4%) attended BRIDGE. In patients with low CCI, attendance at BRIDGE was inversely associated with hospital readmission (adjusted hazard ratio = 0.82, 95% confidence interval [CI]: 0.69, 0.97, P = .02) and the composite endpoint (adjusted hazard ratio = 0.84, 95% CI: 0.72, 0.98, P = .02). Associations of BRIDGE attendance with both readmission and ED visit were significantly weaker in patients with high CCI (adjusted P, interaction = .007 and .03, respectively). Overall, BRIDGE attendance was associated with an 11% lower hazard of developing the composite endpoint (95% CI: 2%, 19%, P = .01). ConclusionsAttendance at a transitional care clinic is inversely associated with risk of readmission and a composite endpoint in cardiac patients with low CCI. Future research should investigate modified transitional care programs in patients with varying comorbidity burden.

Effect of Application of Training Program about Electrocardiogram on Nurses Competency Level and Expected Clinical Outcome of Cardiac Patients

Effect of Application of Training Program about Electrocardiogram on Nurses Competency Level and Expected Clinical Outcome of Cardiac Patients

Predicting clinical outcome of cardiac patients by six malnutrition screening tools

Malnutrition is highly prevalent among hospital admissions and associated with, poor response to medical treatment, prolonged hospital stay, increased mortality and cost to the state. The aim of this study is to assess the ability of the nutrition screening tools to predict the clinical outcome of cardiac patients. Five hundred and twenty six patients underwent nutritional screening via Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Short Nutritional Assessment Questionnaire (SNAQ), Mini Nutritional Assessment-Short Form (MNA-SF), Nutritional Risk Screening (NRS) and Subjective Global Assessment (SGA) tools on admission and each subject was followed up until discharge and after one month to identify the clinical course and outcome. The mean hospital stay was 5.3 days and median hospital stay was 4.0 days. The mean hospital stay is increasing with the malnutrition level in MUST, NRS, MNA-SF, MST, NRS and SGA tools. The inpatient mortality is higher in high risk nutritional categories of all six malnutrition screening tools. MNA-SF, MST and SGA tools demonstrate a positive relationship between non-prophylactic antibiotic usage and poor nutritional status. High risk nutritional categories of MNA-SF and MST are associated with prescription of multivitamin/minerals. According to MNA-SF, MST and SGA the follow up mortality was increased with worsening nutritional status. The incidence of readmissions was increased gradually with deteriorating nutritional status categorized by MUST, SNAQ, MST and SGA tools. Malnutrition may be associated with poor clinical outcome of the cardiac patients during and after the hospital stay. Each tool reported a variable prediction in outcomes such as death, infection and prolonged hospital stay due to the poor nutritional status.

From Percutaneous Coronary Intervention (PCI) to Heart Rate Variability (HRV) Biofeedback: The Bridge Between High-Tech Medicine and High-Tech Psychology—How Can We Proceed in Clinical Practice?

Acute coronary syndromes (ACS), including unstable angina (UA) and myocardial infarction (MI), are clinical symptoms of heart disease, called ischemic heart disease (IHD), and are important causes of death worldwide and in Poland. Medical associations including the European Cardiac Society (ECS) and the American Heart Association (AHA) recognize psychological factors, including depression, anxiety, and stress, as important factors that influence progression of IHD among patients after ACS. Data are accumulating, showing that psychophysiological interventions and relaxation exercises improve clinical outcome in cardiac patients. In the medical literature, however, a number of clinical randomized, controlled studies document the effectiveness of practical medical recommendations (evidence-based medicine, EBM), but very little available data and almost no evidence-based guidelines support physician use of practical implementation of psychophysiological practice or relaxation. The present article describes a study in a Polish hospital cardiology unit, utilizing a psychophysiological stress profile (PSP) to assess patients after myocardial infarction, to assess which patients can utilize paced diaphragmatic breathing as home practice without extended biofeedback training, and which require more extensive biofeedback training. The article discusses safety issues in the use of a PSP in cardiac populations, and possible practical consequences of using a psychophysiological stress profile in clinical cardiac practice.

Type D personality is associated with impaired psychological status and unhealthy lifestyle in Icelandic cardiac patients: A cross-sectional study

BackgroundType D (distressed) personality has been associated with adverse cardiac prognosis and poor emotional well-being in cardiac patients, but it is still unclear what mechanisms link Type D personality with poor clinical outcomes in cardiac patients. In the present cohort of Icelandic cardiac patients, we examined potential pathways that may explain this relationship. The objectives were to examine 1) the association between Type D personality and impaired psychological status, and to explore whether this association is independent of disease severity; and 2) the association between Type D personality and an unhealthy lifestyle.MethodsA sample of 268 Icelandic coronary angiography patients (74% males (N = 199); mean age 62.9 years (SD 10.5), range 28-85 years) completed the Type D Scale (DS14), Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS) at hospitalization. Health-related behaviors were assessed 4 months following angiography. Clinical data were collected from medical files.ResultsType D personality was associated with an increased risk of anxiety (OR 2.97, 95% CI:1.55-5.69), depression (OR 4.01, 95% CI:1.42-11.29), and stress (OR 5.99, 95% CI:3.08-11.63), independent of demographic variables and disease severity. Furthermore, fish consumption was lower among Type Ds, as 21% of Type Ds versus 5% of non-Type Ds consumed fish < 1 a week (p < 0.001). Type D patients were also more likely to smoke at follow-up (22% versus 10%, p = 0.024) and to use antidepressants (17% versus 9%, p = 0.049) and sleeping pills (49% versus 33%, p = 0.019) compared to non-Type Ds. Type D personality was not associated with other health-related behaviors, aside from trends towards less fruit and vegetable consumption, and more weight gain.ConclusionType D personality was associated with psychological distress and an unhealthy lifestyle in Icelandic cardiac patients. Future studies should further investigate the association between Type D personality and health-related behaviors.

“The Rust of Life”: Impact of Anxiety on Cardiac Patients

Anxiety has both functionally appropriate and inappropriate consequences. Among patients with cardiac disease, anxiety can be functionally appropriate when it prompts an individual to quickly seek treatment for acute cardiac signs and symptoms. But anxiety may have medical or psychological consequences when it is persistent or severe, including difficulty adhering to prescribed treatments and making recommended lifestyle changes, adoption of or failure to change risky behaviors, increased risk for acute cardiac events, and increased risk for in-hospital complications after admission for acute coronary syndrome. Yet, because anxiety is a universal emotion that is managed without consequence by many people, its importance is often ignored by healthcare providers. The impact of psychosocial (with a major emphasis on anxiety) and behavioral variables on biological outcomes was examined systematically. The research included (1) examination and comparison of the intensity of anxiety in international samples of various critically, acutely, and chronically ill cardiac patients; (2) determination of differences between men and women in the expression of anxiety; (3) investigation of factors predictive of anxiety levels, including perceived control; (4) studies of healthcare providers' knowledge of anxiety assessment and providers' practices in assessing and managing anxiety; and (5) determination of the impact of anxiety on clinical outcomes in cardiac patients. The goal of this program of research is to improve patients' outcomes on a widespread basis by placing anxiety in the forefront of clinical cardiac practice.

2006 Katharine A. Lembright Award—“The Thin Stream of Fear Trickling Through the Mind”: Impact of Anxiety in Cardiac Patients

Anxiety has both functionally appropriate and pathological consequences. Among people with cardiac disease, anxiety can be functionally appropriate when it triggers an individual to quickly seek treatment for acute cardiac symptoms. Anxiety, however, may have pathological consequences when it is persistent or severe. These consequences may include the following: difficulty adhering to prescribed treatments and making recommended lifestyle changes; adoption of or failure to change risky behaviors; increased risk for acute cardiac events; and increased risk for in-hospital complications after admission for acute coronary syndrome. Nevertheless, because anxiety is a universal emotion that is managed without consequence by many people, its significance is often ignored by healthcare providers. The purpose of this presentation is to describe findings from a biobehavioral program of research in which the impact of psychosocial (with a major emphasis on anxiety) and behavioral variables on biological outcomes has been systematically examined. In this program of research we have (1) examined and compared the intensity of anxiety in international samples of various cardiac patient groups; (2) determined gender differences in the expression of anxiety; (3) investigated factors predicting anxiety levels, including perceived control; (4) studied healthcare providers’ knowledge of anxiety assessment and their practices with regard to the assessment and management of anxiety; (5) determined the impact of anxiety on clinical outcomes in cardiac patients and elucidated mechanisms for the linkage; and (6) tested interventions to decrease anxiety and improve morbidity and mortality. We hope to improve patient outcomes on a widespread basis by placing anxiety in the forefront of clinical cardiac practice.