Common Cause Of Cardiovascular Death Research Articles

Coronary heart disease: leading cause of cardiovascular death from analysis of autopsies in a central european university centre

Abstract Introduction Cardiovascular diseases (CVD) are the most common cause of death globally including in developed countries. Data from autopsies may provide additional and up-to-date information. Purpose 1. To determine the proportion of deaths due to cardiovascular causes in the cohort of deceased persons who underwent autopsies 2. To describe the most frequent causes of cardiovascular death and record differences concerning age and gender. Methods A set of autopsies performed in the 6-year period (2017–2022) in a tertiary referral centre located in a Central European country were analyzed. The causes of death were classified as cardiovascular and non-cardiovascular. The division was performed based on the autopsy diagnosis according to the International Classification of Diseases (ICD)-10. Subsequently, cardiovascular causes of death were categorized by age (under 50 years, over 50 years) and gender (male, female). Results The total number of autopsies performed in the monitored period was 8651 (eight thousand six hundred and fifty-one) of which 4400 cases (50.9%) were classified by cardiovascular cause of death. Of those, coronary heart disease (CHD) was the most frequent cause of death (2340 cases; 50.9%). The vast majority of CHD patients were over 50 years of age (2083 cases, 92.2%), and males predominated (n=1569, 75.3%) over females (n=514, 24.7%). In the patients younger than 50 years of age, 155 deaths from CHD were recorded, males predominated nearly 6 times (132 males, 23 females, M:F ratio 5.74). Heart failure (HF) represented the second most common cause of cardiovascular death with 1191 cases (27.1%), again with dominance of patients over 50 years of age (684 male, 418 female, M:F ratio 1:64) In the patients under 50 years of age, the HF frequency was lower (89 cases), with a predominance of male patients (n=64) over females (n=25); M:F ratio 2.56. Pulmonary embolism accounted for the third highest share of deaths from cardiovascular reasons (370 cases; 8.4%), 330 patients were over 50 years of age and there was no significant gender difference observed (168 male, 162 female, M:F ratio 1.04). Other less frequent common diagnoses as causes of cardiovascular death observed in our cohort were as follows: hemorrhagic stroke (142 cases, 3.2%), aneurysm ruptures (107 cases; 2.4%), and esophageal varices (58 cases; 1.3%). Conclusions Death from cardiovascular causes accounted for more than half of the causes of death in the recent cohort of autopsied patients of a substantial size from a Central European country with coronary heart disease being the most common diagnosis accountable for half of the deaths from cardiovascular causes. Importantly, heart failure represented more than a quarter of deaths from cardiovascular causes. In both CHD and HF, the most vulnerable group was males over 50 years of age.

Time and cause of death in patients after acute coronary syndrome

Abstract Background Acute coronary syndrome (ACS) remains a substantial mortality burden despite enormous progress achieved in treatment and prevention in recent decades, yet systematic investigation of detailed causes of death among ACS patients remains limited. Objective This study aimed to describe the association between time and cause of death in patients after ACS using data from a large, multicenter, contemporary cohort. Methods Patients’ data from the China Chest Pain Database between 2015 and 2021 were linked to the China National Death Registration System Database using unique national IDs to obtain accurate vital status. Patients with documented death records were extracted into a merged database, which encompassed all deaths that occurred in the hospital and post-discharge out-of-hospital. Patients were enrolled with a discharge diagnosis of ACS. Cardiovascular (CV) mortality was defined as a death certificate with a CV diagnosis using the ICD-10 classification listed as the primary cause of death. A trend chi-square test was performed to assess the causes of death at different times after ACS. Results Among the 126,704 eligible patients, the mean age at baseline was 74 (66, 81) years old, 39.3% were women. Of these patients, 16,546 (13.1%) died during hospitalisation, 53,980 (42.6%) within the first six months after discharge, 19,664 (15.5%) from 6 to12 months after discharge, and 36,514 (28.8%) beyond 12 months after discharge. The most common cause of CV death was ischemic heart disease (70.1%), followed by ischemic stroke (7.1%) and hemorrhagic stroke (6.8%). The main causes of non-CV death were malignant tumours (37.1%) and respiratory disease (21.5%). For death in-hospital, within the first six months, from 6 to 12 months post-discharge, and beyond 12 months, the proportion of CV causes was 86.3%, 78.3%, 70.7%, and 67.9%, respectively (P<0.001). The proportion of deaths due to haemorrhagic stroke and aortic aneurysm/dissection increased progressively with time to death increasing (P<0.001). Meanwhile, the proportion of non-CV deaths continuously increased, reaching 13.7%, 21.7%, 29.3%, and 32.1%, respectively. Conclusion Despite cardiovascular diseases being the primary cause of death in patients after ACS, the causes of death vary among patients with different times of death, highlighting the importance of categorising patients into distinct population groups according to time after ACS for targeted cause-specific preventive strategies.

Outcome of Pulmonary Embolism with and without Ischemic Stroke.

Background: Ischemic stroke is the second, and pulmonary embolism (PE) is the third most common cardiovascular cause of death after myocardial infarction. Data regarding risk factors for ischemic stroke in patients with acute PE are limited. Methods: Patients were selected by screening the German nationwide in-patient sample for PE (ICD-code I26) and were stratified by ischemic stroke (ICD code I63) and compared. Results: The nationwide in-patient sample comprised 346,586 hospitalized PE patients (53.3% females) in Germany from 2011 to 2014; among these, 6704 (1.9%) patients had additionally an ischemic stroke. PE patients with ischemic stroke had a higher in-hospital mortality rate than those without (28.9% vs. 14.5%, p < 0.001). Ischemic stroke was independently associated with in-hospital death (OR 2.424, 95%CI 2.278-2.579, p < 0.001). Deep venous thrombosis and/or thrombophlebitis (DVT) combined with heart septal defect (OR 24.714 [95%CI 20.693-29.517], p < 0.001) as well as atrial fibrillation/flutter (OR 2.060 [95%CI 1.943-2.183], p < 0.001) were independent risk factors for stroke in PE patients. Systemic thrombolysis was associated with a better survival in PE patients with ischemic thrombolysis who underwent cardio-pulmonary resuscitation (CPR, OR 0.55 [95%CI 0.36-0.84], p = 0.006). Conclusions: Ischemic stroke did negatively affect the survival of PE. Combination of DVT and heart septal defect and atrial fibrillation/flutter were strong and independent risk factors for ischemic stroke in PE patients. In PE patients with ischemic stroke, who had to underwent CPR, systemic thrombolysis was associated with improved survival.

The role of health policy in the prevention of venous thromboembolism in the UK National Health Service—Learning from the past, looking to the future

Venous thromboembolism is the third most common cause of cardiovascular death globally and many diagnoses are preventable. The UK NHS has led international efforts to reduce VTE, particularly hospital-associated VTE, through coordinated national policy action and world-leading research. Despite this, VTE remains an important cause of morbidity and mortality in the UK, as underlined by the recent COVID-19 pandemic. Future reductions in VTE incidence/deaths will require progress on several fronts: a better understanding of case mix; revisiting VTE risk assessment, focussing on thromboprophylaxis failure and improving awareness of VTE amongst clinicians and the public. Changes to healthcare delivery, with care increasingly delivered outside of hospital, alongside changing disease patterns, including the rise in obesity, have huge implications for VTE and will dramatically alter prevention. The UK, with its nationalised healthcare model and long history of policy action on VTE, provides a unique lens through which to study past successes and future priorities for VTE prevention.

Multimodality imaging of acute and chronic pulmonary thromboembolic disease.

Pulmonary embolism (PE) is a pathological entity characterised by venous thromboembolism in the pulmonary arteries. It is a common entity in daily clinical practice and is the third most common cause of cardiovascular death. Correct diagnostic work-up is pivotal to ensure timely institution of appropriate therapy. This requires recognition of the characteristic imaging findings and awareness of the role and peculiarities of the different imaging techniques involved in the diagnostic and therapeutic process. This review aims to showcase the most commonly encountered imaging findings associated with pulmonary thromboembolism for each imaging modality, outline their advantages and disadvantages, and define the specific role of these techniques in the clinical setting. The latest innovations concerning the diagnostic work-up of PE will be also briefly discussed, yielding a perspective on the future developments and challenges that the radiologist will have to face in the coming years.

Formulation and Evaluation of Polyherbal Extract Used in the Prognosis of Pulmonary Embolism

Pulmonary embolism (PE) is a common and potentially deadly form of venous thromboembolic disease. It is the third most common cause of cardiovascular death and is associated with multiple inherited and acquired risk factors as well as advanced age. It is the condition in which one or more arteries in the lungs become blocked by a blood clot causing various chronic symptoms is said to be pulmonary embolism and there are various allopathic medications are currently available on the management of the emboli including the various clot dissolvers( thrombolytics ) and blood thinners ( anticoagulants ) also surgical processes are performed according to the sevearity. But there is a herbal aspects which is useful as well in case of prognosis of the various kind of emboli including pulmanary emboli and it shows numerous health benefits along with its physiological activity with minimum or less side effects

Pre-Existing Left Bundle Branch Block and Clinical Outcomes After Transcatheter Aortic Valve Replacement

BackgroundFew reports on pre-existing left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve replacement (TAVR) are currently available. Further, no present studies compare patients with new onset LBBB with those with pre-existing LBBB. ObjectivesThis study aimed to investigate the association between pre-existing or new onset LBBB and clinical outcomes after TAVR. MethodsUsing data from the Japanese multicenter registry, 5,996 patients who underwent TAVR between October 2013 and December 2019 were included. Patients were classified into 3 groups: no LBBB, pre-existing LBBB, and new onset LBBB. The 2-year clinical outcomes were compared between 3 groups using Cox proportional hazards models and propensity score analysis to adjust the differences in baseline characteristics. ResultsOf 5,996 patients who underwent TAVR, 280 (4.6%) had pre-existing LBBB, while 1,658 (27.6%) experienced new onset LBBB. Compared with the no LBBB group, multivariable Cox regression analysis showed that pre-existing LBBB was associated not only with a higher 2-year all-cause (adjusted HR: 1.39; 95% CI: 1.06-1.82; P = 0.015) and cardiovascular (adjusted HR: 1.60; 95% CI: 1.04-2.48; P = 0.031) mortality, but also with higher all-cause (adjusted HR: 1.43, 95% CI: 1.07-1.91; P = 0.016) and cardiovascular (adjusted HR: 1.81, 95% CI:1.12-2.93; P = 0.014) mortality than the new onset LBBB group. Heart failure was the most common cause of cardiovascular death, with more heart failure deaths in the pre-existing LBBB group. ConclusionsPre-existing LBBB was independently associated with poor clinical outcomes, reflecting an increased risk of cardiovascular mortality after TAVR. Patients with pre-existing LBBB should be carefully monitored.

Risk Stratification and Management of Intermediate-Risk Acute Pulmonary Embolism.

Pulmonary embolism (PE) is the third most common cause of cardiovascular death and necessitates prompt, accurate risk assessment at initial diagnosis to guide treatment and reduce associated mortality. Intermediate-risk PE, defined as the presence of right ventricular (RV) dysfunction in the absence of hemodynamic compromise, carries a significant risk for adverse clinical outcomes and represents a unique diagnostic challenge. While small clinical trials have evaluated advanced treatment strategies beyond standard anticoagulation, such as thrombolytic or endovascular therapy, there remains continued debate on the optimal care for this patient population. Here, we review the most recent risk stratification models, highlighting differences between prediction scores and their limitations, and discuss the utility of serologic biomarkers and imaging modalities to detect right ventricular dysfunction. Additionally, we examine current treatment recommendations including anticoagulation strategies, use of thrombolytics at full and reduced doses, and utilization of invasive treatment options. Current knowledge gaps and ongoing studies are highlighted.

In-hospital mortality and associated factors among patients admitted with venous thromboembolism at selected public hospitals of Harar Town, Eastern Ethiopia.

Venous thromboembolism is the third most common cause of cardiovascular death and is responsible for more than 3 million deaths annually worldwide. Despite high rates of morbidity and mortality associated with venous thromboembolism, limited studies have been conducted on in-hospital mortality and its associated factors in Ethiopia, particularly in study settings. To assess in-hospital mortality and associated factors among patients admitted with venous thromboembolism at selected public hospitals of Harar town, Eastern Ethiopia, from 10 March 2018 to 8 March 2022. A retrospective cohort study design was conducted among 502 patients admitted with venous thromboembolism at Hiwot Fana Comprehensive Specialized Hospital and Jugal General Hospital using a simple random sampling technique. Data extraction formats were used to collect data from patient medical record cards. Then data were coded and entered into EpiData version 3.1 computer programs and exported to SPSS version 26 for analysis. Bivariate and multivariate backward Cox regression analysis was used to verify the associated factors of in-hospital mortality among venous thromboembolism patients. A p-value of less than 0.05 at a 95% confidence interval was used to establish a statistically significant association. A total of 502 patient medical record cards with outcome variables were included in the study. More than half of the patients 350 (69.7%) were females. Among the 502 patients who were admitted with venous thromboembolism, 8.2% (95% CI: 5.6-10.6) of patients had in-hospital mortality. DM (AHR = 4.28, 95% CI: 1.80-10.15, p = 0.001) and unfractionated heparin duration (AHR = 10.26, 95% CI: 2.45-43.01, p = 0.001) were statistically significant association with venous thromboembolism mortality. Approximately 8.2% of venous thromboembolism patients died in the hospital. Diabetes and heparin were independently associated with higher mortality. Therefore, it is better to give more attention to the patients co-morbid with diabetes mellitus and for unfractionated heparin treatment duration to reduce venous thromboembolism mortality.

Abstract 18959: Glycosphingolipid-Mediated Cardiomyocyte and Immune Cell Dysfunction in Hypoplastic Left Heart Syndrome

Introduction: Hypoplastic Left Heart Syndrome (HLHS) is the leading indication for heart transplant and the most common cause of cardiovascular death in infants. However, the mechanisms associated with heart failure progression in HLHS are poorly understood. Glycosphingolipids (GSLs) have been implicated in a variety of biological and disease processes, however, the role of GSLs in the context of HLHS pathophysiology have not been explored. Here we test the hypothesis that aberrant GSLs drive maladaptive cardiac and immune cell responses and predispose HLHS patients to pathologic remodeling and eventual cardiac dysfunction. Methods: GSL content was measured by mass-spectrometry. To test the direct effect of the specific GSL species, lactosylceramide (LacCer), cardiac and peripheral immune cells (PBMCs) were treated with liposomes containing 3uM LacCer (C18:0 and C24:0). Mitochondrial respiration was assessed using the Seahorse Bioanalyzer (Agilent). Expression of metabolic proteins were assessed by western blot. Statistical analysis between 2 groups was performed using an unpaired T-test. Results: LacCer is significantly increased in heart tissue and in isolated PBMCs from patients with HLHS (A), and isolated mitochondria are highly enriched with LacCer. Moreover, exogenous LacCer is sufficient to impair cardiomyocyte mitochondrial fatty acid beta-oxidation (B), induce ROS generation, and decrease the expression of metabolic proteins Additionally, exogenous LacCer is sufficient to promote inflammation and decrease mitochondrial bioenergetics in PBMCs (C). Conclusions: These data highlight a novel role for LacCer in modulating cardiomyocyte and immune cell phenotypes and suggest aberrant GSLs contribute to the HLHS pathophysiology. Elucidation of the molecular mechanisms involved in impaired immune cell and cardiomyocyte responses in HLHS is crucial and these data suggest a unique avenue for therapeutic intervention in this population.

Patterns of Rheumatic Heart Disease Among Yemeni Patients in Cardiac Center of Al-Thawra General Hospital

Background: Rheumatic heart disease (RHD) is still a major public health problem and remains the most common cardiovascular cause of death among children and young adults. The recurrent episodes of acute rheumatic heart disease may cause the rapid progressive damage of the heart valves and chronic residual deformity resulting in stenosis or regurgitation or a combination of both stenosis and regurgitation.&#x0D; Methodology: A cross sectional Study, consecutive patients with RHD were enrolled from outpatient cardiac clinics and inpatient department of cardiac center of Al-thawra hospital in Sana’a city, Yemen between January and July 2020. Demographic, clinical, echocardiographic, and coronary angiography characteristics of patients were recorded.&#x0D; Results: 261 consecutive patients with rheumatic heart disease were analyzed with mean age of 33 ± 12.65, female patients represented 62.8% (165), illiterate patients represented 63.6% (166). The majority of the patients about 79.7% (208 patient) had mitral valve disease, 63.6% (166 patient) had aortic valve disease, 10.7% (28 patient) had organic tricuspid valve disease but the Isolated Mitral valve disease 23%( 60) , Isolated Aortic valve disease 10.3% (27) and Isolated organic tricuspid valve disease represent 4.2% (11) , double valve disease (mitral &amp; aortic ) represent 56% (146), triple valve disease (Mitral + Aortic + Tricuspid )represent 6.5% (17).A lot of complications of RHD detected in our study; CHF 36%(94) with low EF &lt;50% in 55.0%(144) and 34% (89) had dilated LV , 33.7%(86) developed AF , 14%(37) of the patient complicated by IE , spontaneous echo contrast 11%(29) but only 7.3%(19) developed Intra cardiac thrombus and new stroke 9.5% ( 25) , pericardial effusion 5.4% (14) and Active ARF 2.3%(6). Conclusion:&#x0D; Rheumatic heart disease is a big medical problem in Yemen and it affects children and young adults of poor and illiterate patients of both genders. The most common valvular lesion reported in our study was multivalvular lesion the predominant pure lesion was Mitral regurgitation followed by Mitral stenosis, Aortic regurgitation, with high organic affection of the tricuspid valve.

Gender Disparities in Presentation, Management, and Outcomes of Acute Pulmonary Embolism

Pulmonary embolism (PE) is the third most common cause of cardiovascular death; however, gender disparities in PE remain understudied. All PE cases at a single institution between January 2013 and June 2019 were retrospectively reviewed. The clinical presentation, treatment modalities, and outcomes were compared between men and women using univariate and multivariate analyses adjusting for differences in baseline characteristics. A total of 1,345 patients were diagnosed with acute PE, of whom 56.3% were women (n=757). Women had a significantly higher mean body mass index (29.4 vs 28.4) and a higher frequency of hypertension (53% vs 46%) and hormone use (6.6% vs 0%; all p <0.02). Men had a higher frequency of smoking (45% vs 33%, p <0.0001). Women had significantly lower PE severity index classifications (p=0.0009). The rates of intensive care unit admission, vasopressor requirements, extracorporeal membrane oxygenation cannulation, and mechanical ventilation were similar between the genders. There was no significant difference in the treatment modality used between the genders. Although the risk factors and PE severity index class differed between the genders, there was no significant difference in resource utilization or treatment modality. Gender was also not a significant predictor of in-hospital mortality, moderate or severe bleeding, increased length of stay, or readmission in the study population.

FACTORS INFLUENCING TREATMENT NONCOMPLIANCE IN HYPERTENSION MANAGEMENT AMONG RURAL AND URBAN RESIDENTS

Introduction: Hypertension is a prevalent health concern in both rural and urban populations, with varying rates of prevalence and treatment outcomes. This study aims to examine the factors contributing to decreased adherence to antihypertensive therapy among patients living in rural and urban areas. Essential arterial hypertension or hypertension is the most common cardiovascular cause of death in the population. It develops in more than half of the world's population over the age of 50, and affects 65% of men and 75% of women over the age of 70. The prevalence of hypertension is higher among rural residents (36.3%) compared to urban residents (29.6%). However, achieving target blood pressure values is a challenge for both groups, with only 8% of rural patients and 15% of urban patients reaching their treatment goals as reported in 2010. According to practicing doctors, the main reason for failing to reach target blood pressure levels is the low adherence of patients to their prescribed antihypertensive therapy. This noncompliance with treatment poses a significant obstacle to effective hypertension management.&#x0D; The article presents findings from an analysis of treatment adherence among 152 patients categorized into three groups: essential arterial hypertension (Group 1), hypertension and coronary heart disease (Group 2), and comorbidity between hypertension, coronary heart disease and type 2 diabetes (Group 3). The study included both urban and rural residents. Adherence to treatment was assessed using the 2008 8-item Morisky Medication Adherence Scale (MMAS-8) questionnaire.&#x0D; The analysis revealed distinct factors influencing adherence based on the patient's territorial affiliation. In the rural setting (Group 1), the primary reason for decreased adherence was patients independently discontinuing antihypertensive medication without notifying their doctor. In the urban setting (Group 1), patients tended to forget to take their medication as prescribed.&#x0D; In Group 2 (urban), challenges were observed in remembering the correct time for taking antihypertensive drugs, while rural patients in the same group tended to independently alter the dosage or discontinue medication. In Group 3 (urban), urban residents reported forgetting to take medication when away from home, whereas rural residents faced fewer difficulties in remembering their medication schedule.&#x0D; The research findings indicate that low adherence to antihypertensive therapy is not solely influenced by territorial affiliation or the specific course of hypertension. However, a notable factor affecting treatment adherence among both rural and urban residents is the more mobile lifestyle commonly observed in urban areas.&#x0D; Addressing the issue of low adherence to antihypertensive therapy requires tailored interventions that consider the unique challenges faced by rural and urban populations. Strategies should focus on improving patient education, enhancing medication reminders, and promoting better communication between patients and healthcare providers. By addressing these factors, it is possible to improve treatment adherence and subsequently enhance hypertension management outcomes for both rural and urban residents.

The prognostic value of CHA2 DS2 -VASc and modified-CHADS2 scores for cardiovascular events in diabetics and non-diabetics haemodialysis patients.

CHA2 DS2 -VASc and modified-CHADS2 score can easily estimate the risk of stroke in atrial fibrillation. Study's purpose was to evaluate these in haemodialysis patients, and assess the effect of diabetes mellitus (DM). The scores calculated in 237 haemodialysis patients, 121 diabetics (58 females) and 116 non-diabetics (41 females). Results correlated to cardiovascular events (acute myocardial infarction, atrial fibrillation, heart failure, peripheral arterial disease, stroke, mortality). CHA2 DS2 -VASc score correlated with the occurrence of stroke and heart failure (p < .01, p < .01), (p < .01, p < .01), respectively in diabetics and non-diabetics. CHA2 DS2 -VASc score could predict the risk of all-cause mortality in both groups, p = .03, p < .01, respectively, however, the risk of cardiovascular death could be predicted in non-diabetics, p < .01. Modified-CHADS2 score associated with heart failure (p = .04), cardiovascular (p < .01) and all-cause mortality (p < .01) only on non-diabetics. C statistics indicated that the first score showed modest discrimination in patients with and without DM, for stroke and all-cause mortality. The second score performed modestly only on patients without DM for all-cause mortality. Both scores showed poor calibration. Stroke was a common cause of cardiovascular death (OR = 3.52, 95% CI = 1.92-6.47, p < .01) and associated with central venous catheter (OR = 2.19, 95% CI = 1.12-4.27, p = .02) and pre-existing atrial fibrillation (OR = 1.94, 95% CI = 1.06-3.58, p = .03). CHA2 DS2 -VASc score correlated with stroke, heart failure and all-cause mortality in haemodialysis patients with and without DM. The risk of cardiovascular death could be predicted only in non-diabetics patients. Modified-CHADS2 score correlated with heart failure, cardiovascular and all-cause mortality only on non-diabetics. Both had modest discrimination and poor calibration.

Reduction in thrombolytic order‐to‐needle time with addition of a pharmacist to a pulmonary embolism response team

AbstractIntroductionPulmonary embolism (PE) is the third most common cause of cardiovascular death in the United States. Institutions have implemented pulmonary embolism response teams (PERT) to hasten clinical decision making and therapeutic interventions. The extent to which critical care pharmacists are included in PERTs is not known. Although improved outcomes with pharmacist involvement in other emergency response teams (e.g., stroke teams) is well described, literature surrounding the impact of pharmacist inclusion in PERTs is limited. The objective was to evaluate if direct pharmacist inclusion in a PERT resulted in reduced time to systemic thrombolysis from time of medication order release in appropriate PE candidates.MethodsThis was a retrospective, observational study of patients with submassive or massive PE who received systemic thrombolysis at a large academic medical center. Patients were divided into two groups based on if they received systemic thrombolysis before or after the intervention. This intervention was the addition of a pharmacist to the PERT with emphasis on early communication between the PERT pharmacist and other stakeholders at time of PERT activation, and a revised thrombolytic preparation workflow emphasizing bedside preparation by the pharmacist. The primary outcome was time to administration of thrombolytic from time of medication order release.ResultsThirty‐four patients were included. Median time to thrombolytic administration was reduced in the post‐intervention group compared to the pre‐intervention group (23 min [14.8–42] vs. 54 min [42.8–69], p = 0.007). Bleeding events were not different between groups. Time to resumption of systemic anticoagulation after systemic thrombolysis was greater in the post‐intervention group.ConclusionInclusion of a pharmacist in the PERT at this institution significantly reduced time to administration of systemic thrombolysis from time of medication order release in appropriate PE candidates. Larger studies should be conducted to expand upon and confirm these findings.

Blueprint for developing an effective pulmonary embolism response network

IntroductionAcute pulmonary embolism (PE) is a major cause of morbidity and mortality in Portugal. It is the third most common cause of cardiovascular death after stroke and myocardial infarction. However, the management of acute PE remains poorly standardized, and there is a lack of access to mechanical reperfusion when indicated. Methods and resultsThis working group analyzed the current clinical guidelines for the use of percutaneous catheter-directed treatment in this setting and proposed a standardized approach for severe forms of acute PE. This document also proposes a methodology for the coordination of regional resources in order to create an effective PE response network, based on the hub-and-spoke organization design. ConclusionThis model can be applied at the regional level, but it is desirable to extend it to the national level.

Prolonged electrocardiography registration does not lead to increased diagnosis of atrial fibrillation in pulmonary embolism patients, but sex affects generic health-related quality of life: Findings from a randomized clinical trial

Pulmonary embolism (PE) is the third most common cause of cardiovascular death. Atrial fibrillation (AF) is the most common arrhythmia and is commonly detected in patients after embolic stroke. In this study, we set out to study if undiagnosed AF could be detected in patients with PE. In survivors of PE, persisting symptoms and exercise limitations are common. The disease burden of PE on quality of life (QoL) has received scarce attention. The primary aim was to study the prevalence of AF in patients with newly diagnosed PE. The secondary aim was to study QoL in PE patients. Patients with newly diagnosed acute PE were randomized 1:1 to long-term electrocardiogram (ECG) screening for AF (handheld ECG or ECG patch) or standard-of-care. The study participants were asked to complete RAND-36 questionnaires upon inclusion. In total 89 PE patients (mean age 74.6 years) were included, and 40 out of these patients were randomized to AF screening. The study was terminated early due to futility when analysis 1 year after inclusion did not find any patients with newly detected AF.RAND-36 showed that QoL was affected in PE patients. Interestingly, sex differences were found; women had a significantly lower QoL in the dimensions of vitality (P = .006), general health (P = .039), and mental health (P = .041). Screening for AF in PE patients did not yield a significant proportion of new cases. QoL is more affected in female patients with PE, and increased awareness of this is suggested.

Causes of death in patients with atrial fibrillation and a recent acute coronary syndrome or percutaneous coronary intervention: insights from the AUGUSTUS trial

Abstract Background Patients with atrial fibrillation (AF) and concomitant coronary artery disease are at increased risk for poor outcomes. Less is known about specific causes of death in this population. Methods We describe specific causes of death among patients with AF and acute coronary syndrome and/or percutaneous coronary intervention included in the AUGUSTUS trial and followed for 6 months. An independent clinical events committee, blinded to treatment assignment, adjudicated cause of death according to pre-defined criteria. The association between baseline factors and all-cause death was evaluated using Cox proportional hazards modeling. Results A total of 151 deaths occurred in 4614 patients and were adjudicated as follows: 111 (73.5%) deaths due to cardiovascular (CV) causes and 40 (26.5%) due to non-CV causes. The most common cause of CV death was sudden death (n=39 [35.1%]), followed by myocardial infarction (n=29 [26.1%]) and heart failure (n=24 [21.6%]). The most common causes of non-CV death were infection (n=11 [27.5%]), bleeding (n=8 [20.0%]), and malignancy (n=5 [12.5%]). Increasing age, African American race, history of heart failure, treatment with diuretics, and lower body weight were associated with an increased risk of all-cause death (Table). Conclusions Among patients with AF and coronary artery disease, cardiovascular causes were responsible for the majority of deaths within 6 months. Our findings provide relevant information to inform the design of future studies in this population. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): AUGUTUS was funded by Bristol Myers Squibb and Pfizer.

Acute pulmonary embolism: in hospital outcome from a prospective observational registry (M-PER) from a low-and middle-income country

Abstract Background Acute Pulmonary embolism the third most common cause of cardiovascular death in the world. Despite the large burden of acute pulmonary embolism, there is a paucity of prospective data from low-and middle-income countries. Purpose To study the clinical characteristics, treatment strategies employed, in-hospital outcome, one-year follow up results, and the prognostic factors in patients with acute pulmonary embolism from a low-and middle-income country. Methods All consecutive patients diagnosed with and treated for acute pulmonary embolism at our institution from November 2016 to November 2021 were included in the registry. Pulmonary embolism was diagnosed using clinical features (Wells' criteria of ≥3) supported by either CT angiogram or echocardiogram. Detailed history, clinical examination, preliminary basic blood investigations, cardiac troponins along with coagulation workup, ECG and ECHO were done for all patients. Patients were classified as having massive or high risk, submassive or intermediate risk and low risk pulmonary embolism based hemodynamic status, sPESI score, echocardiogram and cardiac troponins. Treatment was at the discretion of treating physician. In general, all patients with massive pulmonary embolism were considered for thrombolysis. All patients received anticoagulation with unfractionated heparin. Outcomes included hospital lengths of stay, all-cause in-hospital mortality and one year mortality Results 186 patients with acute pulmonary embolism were prospectively enrolled during period. 62% were male. Mean age was 42.38±13.4 years. The risk factors noticed include prior history of venous thromboembolism, active malignancy, recent surgery, trauma, immobilisation, diabetes, hypertension, and chronic obstructive pulmonary disease in 18%, 5%, 10%, 8%, 14%, 17%, 10% and 3% of our patients respectively. Shortness of breath (98%), chest pain (37%), leg swelling (37%), cough (33%), shock (27%), syncope (15%) and haemoptysis (12%) were the reasons for presentation. Sinus tachycardia was the commonest finding (80%). Right ventricular (RV) strain pattern was present in 68%, S1Q3T3 pattern in 56% and RBBB in 32%. RV dilatation was present in 93% and RV dysfunction in 75%. Thrombus was visualised in the pulmonary artery in 37% and right heart chambers in 12% (714). 26% were classified as high risk, 60% as intermediate risk and 13.4% as low risk acute pulmonary embolism. Overall 50% (92% of high-risk and 41% of intermediate risk) patients received fibrinolytic therapy. In hospital mortality was 16% (29 patients) of which 72% were from high-risk group. In the high-risk group those who were fibrinolysed had a lower mortality compared to those not lysed. (75% vs 40%). This difference was not observed in the intermediate risk group. Conclusion Acute pulmonary embolism is a disease with high in-hospital mortality. Fibrinolytic therapy with streptokinase has a lifesaving potential in high risk patients. Funding Acknowledgement Type of funding sources: None.

Identification of outcomes in clinical studies of interventions for venous thromboembolism in non‐pregnant adults

Identification of outcomes in clinical studies of interventions for venous thromboembolism in non‐pregnant adults