Coronary Care Unit Research Articles

Albumin-corrected anion gap (ACAG) is a prognostic biomarker for various diseases. As a derived metric, the relationship between ACAG and potential related biomarkers, along with their combined effect on death, has yet to be fully elucidated. This study aims to investigate the association between ACAG and mortality of congestive heart failure (CHF), and to identify the specific biomarkers related to increased ACAG and the risk of mortality in CHF. This study selected patients with CHF in intensive care units (ICU) from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were stratified based on their ACAG levels into four groups. The outcomes were 28-day and 1-year mortality of CHF. Cox proportional hazard analysis and subgroup analysis were performed to explore the predictive value of ACAG. The mediation analysis and Pearson correlation analysis were used to explore potential associated biomarkers. A total of 2,689 patients with CHF were included in this study. Of these, 697 and 1,207 patients died within 28 days and 1 year, respectively. Cox proportional hazard analysis showed that increased ACAG level was significantly associated with both 28-day and 1-year mortality (hazard ratio [HR]: 2.18, 95%CI: [1.67, 2.84] and HR: 1.44, 95%CI: [1.18, 1.74], respectively) after adjusting for confounding factors. The subgroup analysis demonstrated that ACAG exhibited a pronounced predictive value among patients admitted to the coronary care unit (CCU), or with myocardial infarction in both 28-day and 1-year mortality. The mediating effect of ACAG was found to be significant between lactate, phosphate and blood urea nitrogen (BUN) concerning 28-day mortality (mediated proportion: 44.0%, 37.4% and 16.5%, respectively), but not 1-year mortality. All three biomarkers showed significant correlations with ACAG. Elevated ACAG was a significant risk factor for 28-day and 1-year mortality in critically ill patients with CHF. ACAG plays an important role in mediating the association between lactate, phosphate and BUN and 28-day death in CHF patients.

Adherence to hand hygiene guidelines is paramount in preventing the transmission of nosocomial infections within healthcare settings. Healthcare workers play a critical role in maintaining aseptic conditions and preventing the spread of pathogens. This study aimed to evaluate the effectiveness of hand hygiene in reducing microbial contamination on the hands of healthcare workers in critical care units, including the Intensive Care Unit, Neurological Intensive Care Unit, Coronary Care Unit, Cardiac Intensive Care Unit and Surgical Intensive Care Unit. A convenient sampling method was utilized to select 44 healthcare workers for the study. Microbial contamination on the hands of these healthcare workers was assessed before and after hand hygiene. Swab samples were collected from the dominant hands and analyzed using microbiological techniques, including culturing on nutrient agar and MacConkey agar, Gram staining and biochemical tests. The results demonstrated a significant reduction in microbial load on the hands of healthcare workers after they practiced hand hygiene (mean before hand hygiene: 6.57 x 108 ± 2.31 x 108 CFU/mL compared to after hand hygiene: 2.11 x 108 ± 1.52 x 108 CFU/mL), p = 0.001. Before the intervention, a large number of hand swab samples had microbial contamination, including potentially pathogenic microorganisms such as Staphylococcus aureus, Staphylococcus spp., Escherichia coli, and Klebsiella pneumoniae. However, after the intervention, no microbial growth was observed on any hand sample. In conclusion, these findings unequivocally demonstrate the crucial role of effective hand hygiene in preventing the transmission of nosocomial infections within healthcare settings. Consistent adherence to hand hygiene guidelines is essential for maintaining a safe and hygienic environment for patients and healthcare workers alike.

Abstract Background: The Coronary Care Unit (CCU) requires effective managers to consider- the patient’s acute condition. Studies have indicated that nursing managers of such units face many challenges. The purpose of the study is to explain nursing managers’ CCU management experience. Materials and Methods: The current study has been conducted with a qualitative approach from November 2017 to February 2020 in the CCU of Al Zahra Heart Hospital in Shiraz, Iran. The participants consisted of 18 individuals out of nursing managers and Coronary Care Unit Nurses in Charge selected as purposeful. The data has been collected using unstructured interviews, focus groups, and field notes. The researchers used content analysis proposed by Graneheim and Lundman for interpreting the content of textual data using regular classification. Results: Data analysis led to the emergence of 3 themes and 8 subcategories. The theme of Inadequate Interaction by the Nursing Managers has been derived from the conceptualization of three subcategories “Senior Managers Insufficiently Supporting the Nursing Manager”, “Nonempathetic Communication by Nursing Manager” and “Nursing Manager, not Providing Ground for Motivating and Promoting Staff”.The main theme “Impaired Control and Supervision” includes two subcategories “Lack of Sufficient Supervision on Nursing Care Performance”, “Lack of Suitable Instrument to Monitor Unit’s Equipment and Nursing Staff’s Performance”, and the main theme, “ Incapability to Organize Performance”, is made up of three Subcategories “Nursing Managers Being Incapable to Manage Time”, “Inappropriately Organizing Activities”, and “Nursing Managers’ Limited Power in Planning Managerial Activities.” Conclusions: The current study-derived findings present a realistic image of nursing managers participating in CCU management, so the resulting themes indicate nursing managers’ perception of CCU management as ineffective. Thus, it is imperative to focus on promoting CCU nursing managers’ managerial performance.

The dose-response relationship and independent prognostic value of free fatty acids (FFA) for major adverse cardiovascular events (MACE) in patients with premature myocardial infarction are not well established. This study aimed to evaluate the impact of FFA levels on long-term outcomes and their combined effects with inflammatory markers, obesity, and insulin resistance. This prospective cohort study enrolled 1168 consecutive patients with premature myocardial infarction admitted to the coronary care unit ward of Tianjin Chest Hospital from March 2017 to December 2024. Participants were categorized into 4 groups (Q1-Q4) by baseline FFA quartiles. Over a median follow-up of 2.83 years (interquartile range, 2.58-3.10), the primary end point was MACE. Cox proportional hazards models and restricted cubic splines were used to assess associations and nonlinear relationships between FFA levels and MACE risk. FFA levels showed a U-shaped association with long-term prognosis in patients with premature myocardial infarction. Using Q2 (0.43-0.61 mmol/L) as reference, adjusted hazards for MACE were significantly higher in Q1 (hazard ratio [HR], 1.89 [95% CI, 1.11-2.96], P=0.009), Q3 (HR, 2.47 [95% CI, 1.55-3.93], P<0.001), and Q4 (HR, 2.94 [95% CI, 1.86-4.65], P<0.001). Joint analyses indicated synergistic risks increased when abnormal FFA coexisted with hs-CRP (high-sensitivity C-reactive protein) >5 mg/L, body mass index >28 kg/m2, or triglyceride-glucose index >9.21 mmol/L. Both elevated and decreased FFA levels independently increase MACE risk in patients with premature myocardial infarction. Abnormal FFA levels combined with high inflammation, obesity, and insulin resistance significantly increase the risk of MACE, highlighting their combined value in the long-term poor prognosis.

Abstract Background and Aims Contrast-induced nephropathy (CIN) is a complication that causes significant morbidity and mortality in patients with acute coronary syndrome (ACS), even after successful percutaneous coronary intervention (PCI). Early identification of high-risk patients is crucial for prognosis. In this study, we aimed to investigate the predictive value of the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) score, an alternative thromboembolism risk scoring model, in the development of CIN in patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing PCI, independent of atrial fibrillation. Method This retrospective study included patients hospitalized in the coronary intensive care unit between 2017 and 2023 with a diagnosis of NSTEMI and treated with PCI. Patients were divided into two groups based on the development of CIN, and their clinical, demographic, and laboratory findings were statistically compared. The ATRIA and CHA2DS2-VASc scores of the patients were calculated. Results A total of 550 patients who underwent PCI due to NSTEMI were included in the study. CIN was observed in 78 patients (14.1%) following PCI. While no difference was found between the groups in terms of gender, the mean age of patients who developed CIN was significantly higher at 67.1 ± 10.8 years compared to those without CIN (P &amp;lt; 0.001). The rates of diabetes, heart failure, and prior stroke were higher in the CIN group. The ejection fraction assessed via transthoracic echocardiography was significantly lower in the CIN group (43.4 ± 12.5%) compared to the non-CIN group (52.2 ± 10.6%) (P &amp;lt; 0.001). The volume of contrast media used during PCI was similar between the groups (P = 0.538). CHA2DS2-VASc and ATRIA scores were significantly higher in patients who developed CIN compared to those who did not (4.31 ± 1.52 vs. 2.23 ± 1.34, P &amp;lt; 0.001; 4.25 ± 2.55 vs. 3.26 ± 2.68, P &amp;lt; 0.001). Conclusion We demonstrated that a high ATRIA score has predictive value for the development of CIN in NSTEMI patients undergoing PCI. Additionally, the CHA2DS2-VASc score, previously shown to be associated with CIN in ACS patients, was also found to provide supplementary information for predicting the incidence of CIN in our study.

Background and Objectives: There are few studies suggesting that the Triglyceride–Glucose Index (TyG), which is mostly defined as a predictor of diabetes, can be used as a predictor of coronary artery disease. In this study, we investigated the relationship between TyG index and acute coronary syndrome (ACS). Materials and Methods: Patients who were hospitalized in the coronary intensive care unit between January 2023–December 2024 were included in the study regardless of the admission diagnosis. ACS defined as ST elevation myocardial infarction (STEMI) and non-STEMI. The TyG index was calculated with the formula LN [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The relationship between the presence of acute coronary syndrome and troponin level was compared with the TyG index. Results: A total of 586 individuals, 353 (60.2%) males and 233 (39.8%) females, were included in this study. The mean TyG index value was calculated as 75 ± 0.31 (4.03–5.99). ACS was detected in 36.9% (n = 216) of the participants. The mean TyG index was higher in the group with ACS (4.92 ± 0.29) than in the group without ACS (4.65 ± 0.27), p < 0.001). Similarly, the mean value of triglyceride (171.58 ± 114.45 vs. 120.92 ± 63.02, CI 95%, p < 0.001) and glucose (133.57 ± 48.87 vs. 104.88 ± 34.76, CI 95%, p < 0.001) were also higher in the group with acute coronary syndrome. In logistic regression analysis, the TyG index was identified as the most significant predictor of ACS, associated with a 30.994-fold increase in ACS probability. Conclusions: This study demonstrated that the TyG index is a significant predictor of acute coronary syndrome independent of the hospitalization reason. The TyG index can be used as a valuable marker in clinical practice because it includes modifiable risk factors for coronary artery disease.

Background: Ventricular arrhythmias are among the most life-threatening complications following acute myocardial infarction (AMI), frequently contributing to early mortality. Hypokalemia, a common electrolyte disturbance during AMI, may further destabilize cardiac electrical activity and predispose to fatal dysrhythmias. Early recognition and correction of hypokalemia are therefore critical in minimizing arrhythmic events and improving patient outcomes. Objective: To determine the frequency of ventricular arrhythmias in patients presenting with acute myocardial infarction and to assess their association with hypokalemia. Methods: A cross-sectional comparative study was conducted in the Coronary Care and Intensive Care Units of Gulab Devi Teaching Hospital, Lahore. A total of 100 patients with confirmed AMI, irrespective of gender, were enrolled through purposive sampling. Demographic details, type of myocardial infarction, serum potassium levels, and predisposing factors were recorded using a structured proforma. Electrocardiograms were evaluated to identify ventricular tachycardia (VT), ventricular fibrillation (VF), and premature ventricular contractions (PVCs). Data were analyzed using SPSS version 26. Quantitative variables such as age, height, weight, and serum potassium were expressed as mean ± SD, while qualitative variables were presented as frequencies and percentages. The Chi-square test was applied to assess the association between hypokalemia and ventricular arrhythmias, considering p &lt; 0.05 statistically significant. Results: Of the 100 AMI patients, 66 were male and 34 female, with a mean age of 57.82 ± 11.21 years. The mean potassium level was 4.13 ± 0.86 mmol/L. Hypokalemia (serum potassium &lt; 3.4 mmol/L) was found in 13% of patients. Ventricular arrhythmias were observed in 20% of participants, including VT (9%), VF (6%), and PVCs (5%). A significant association was found between hypokalemia and ventricular arrhythmias (p = 0.000), while gender showed no significant relationship (p = 0.916). Current smoking also demonstrated a strong correlation (p = 0.002). Conclusion: The study concluded that hypokalemia was significantly associated with the development of ventricular arrhythmias in patients with acute myocardial infarction, underscoring the importance of routine electrolyte monitoring and timely correction to prevent life-threatening cardiac events.

ABSTRACTBackgroundFamily members of patients admitted urgently to adult intensive care or coronary care units face significant psychological stress due to the sudden and severe nature of the illness. Having a greater understanding of their stressors and coping mechanisms is essential for developing interventions to support family members during and after critical care admissions.AimThis study aimed to explore the experiences and unique challenges faced by family members following an unplanned emergency hospitalisation to an adult critical care setting and to identify the coping strategies they employed.Study DesignUsing a descriptive qualitative design, we employed inductive reflexive thematic analysis on a purposeful sample of 27 participants, whose loved ones underwent unplanned admissions to an adult intensive or coronary care unit at a tertiary referral hospital.ResultsFindings generated four themes: moving forward and coping with the early unknowns, communication contributions to family crisis, challenges and emotional struggle of supporting a loved one in hospital and navigating and redefining normal.ConclusionThis study reveals the substantial psychological stress experienced by family members of patients following unplanned admissions to intensive or coronary care units. Participants emphasised the critical importance of effective communication, noting that uncertainty and a lack of updates heightened feelings of isolation and anxiety. Findings highlight the need for healthcare professionals to enhance communication and support strategies to promote a more supportive environment for families. Prioritising these aspects can enhance the experience of family members and contribute to better outcomes for both patients and their families.Relevance to Clinical PracticeRecognising the complex dynamics of family support and effective communication can help healthcare providers better address families' needs during critical medical events.

BackgroundAcute kidney injury (AKI) is associated with significant morbidity and mortality in critically ill patients. However, data on AKI in coronary care units (CCU) remain limited, particularly in low- and middle-income countries. This study aimed to determine the incidence, etiology, risk factors, and outcomes of AKI in a CCU setting in Thailand.MethodsIn this retrospective cohort study, we analyzed 209 patients admitted to a tertiary hospital CCU between January 2019 and September 2020. We collected data on baseline characteristics, comorbidities, medications, clinical parameters, and outcomes. Risk factors were assessed using multivariable logistic regression analysis.ResultsAKI occurred in 30.6% of patients, with multifactorial etiologies being the most common (42.2%). AKI was associated with significantly higher mortality at both 30 days (35.9% vs. 3.4%, p < 0.001) and 90 days (43.8% vs. 6.9%, p < 0.001). Independent risk factors for AKI included pre-existing chronic kidney disease (adjusted OR 3.47), reduced left ventricular ejection fraction (OR 3.19), mechanical ventilation (OR 3.08), and vasopressor use (OR 2.84). Independent predictors of kidney replacement therapy were mechanical ventilation (OR 11.26) and vasopressor use (OR 5.61).ConclusionsAKI is a frequent and severe complication among CCU patients in a low- to middle-income country, significantly increasing short-term mortality and hospital stay. Early identification of high-risk patients may improve outcomes through timely intervention and monitoring.

Although the link between hyperuricemia and various diseases like metabolic syndrome, stroke, and coronary artery disease had been recognized, data on the relationship of serum uric acid (SUA) with dyslipidemia in patients with acute myocardial infarction (AMI) are limited. This study was conducted to evaluate the association of serum uric acid with dyslipidemia in patients with acute myocardial infarction (AMI) at Chittagong Medical College Hospital, Chattagram, Bangladesh. This was a hospital based cross-sectional analytical study comprising one hundred AMI patients admitted in coronary care unit (CCU) in Chittagong Medical College Hospital between July 2020 to June 2021. Important variables in this study were serum uric acid, serum fasting total cholesterol, triglycerides, HDL-C, LDL-C, waist circumference, BMI, age and gender. Sixty-two percent AMI patient had hyperuricemia. Increased serum uric acid was significantly associated with increased TG, total cholesterol, LDL level and decreased HDL level in AMI patients. Serum uric acid significantly correlated with components of fasting lipid profiles in AMI patients. The proportion of patients with hyperuricemia was high in AMI patients. Serum uric acid was associated and correlated with components of fasting serum lipid profiles. Bangladesh J Med Biochem 2021; 14(2): 65-72

Background:While the physical implications of acute myocardial infarction (AMI) have been extensively studied, its psychological aspects, particularly post-traumatic growth (PTG) and post-traumatic stress disorder (PTSD) have gained increasing attention. This retrospective cohort study aimed to investigate the correlations between age, PTG, and PTSD in the context of AMI.Methods:A total of 250 cases of patients with AMI were included in the study, sourced from the coronary care unit of Hanzhong Central Hospital and followed up in the outpatient department from January 2017 to June 2023. The data collection for this study was conducted from July 2023 to August 2023. Patients were divided into two groups based on their age at the time of AMI: 148 patients in the Younger group (≤45 years) and 102 patients in the Older group (>45 years). The patients were assessed for PTSD using the PTSD Checklist-Civilian Version (PCL-C) and for PTG using the Posttraumatic Growth Inventory (PTGI). Statistical analysis was conducted to examine the correlations and associations between age and PTG and PTSD symptoms.Results:The findings revealed significant age-related variations in PTSD symptomatology and PTG following AMI. Older adults exhibited higher re-experience (p < 0.001), lower hyperarousal (p = 0.023), and lower avoidance/numbing (p = 0.037) symptoms compared to younger adults, along with decreased scores in PTG domains such as relating to others (p < 0.001), appreciation of life (p < 0.001), spiritual change (p < 0.001), and personal strength (p < 0.001). The correlation analysis further demonstrated that age was significantly positively correlated with re-experience (r = 0.366, p < 0.001) and negatively correlated with avoidance/numbing (r = –0.129, p = 0.041), hyperarousal (r = –0.154, p = 0.015), relating to others (r = –0.393, p < 0.001), appreciation of life (r = –0.256, p < 0.001), spiritual change (r = –0.285, p < 0.001), and personal strength (r = –0.460, p < 0.001). Linear regression analysis showed that for every year increase in age, the beta coefficient for re-experience was 0.369 (Standard Error (SE) = 0.051, t = 7.18, p < 0.001, 95% Confidence Interval (CI) [0.266, 0.466]), indicating a significant positive association. Conversely, age had significant negative associations with avoidance/numbing (β = –0.131, SE = 0.061, t = –2.11, p = 0.036, 95% CI [–0.249, –0.009]), hyperarousal (β = –0.158, SE = 0.067, t = –2.30, p = 0.022, 95% CI [–0.286, –0.022]), relating to others (β = –0.391, SE = 0.047, t = –8.36, p < 0.001, 95% CI [–0.485, –0.301]), appreciation of life (β = –0.263, SE = 0.058, t = –4.41, p < 0.001, 95% CI [–0.370, –0.142]), spiritual change (β = –0.282, SE = 0.054, t = –5.28, p < 0.001, 95% CI [–0.391, –0.179]), and personal strength (β = –0.464, SE = 0.049, t = –9.39, p < 0.001, 95% CI [–0.556, –0.364]).Conclusions:The study underscores the importance of adopting a multidimensional approach to patient care following AMI, tailored interventions to address the specific needs of younger and older adults, and the need for age-specific psychological assessment and intervention strategies in the management of patients recovering from AMI.

Coronary artery disease (CAD) is a leading cause of morbidity and mortality globally, with varying presentations including chronic coronary syndrome (CCS) and myocardial infarction (MI). The extent of vessel involvement plays a key role in prognosis and therapeutic decision-making. This retrospective observational study aimed to evaluate the prevalence of vessel disease (VD) patterns among patients with CCS and MI and to analyze associated risk factors at a tertiary care center. This study was conducted in Coronary Care Unit (CCU) and Department of Cardiology, Mymensingh Medical College Hospital (MMCH), Bangladesh, from November 2023 to December 2024. A total of 88 patients admitted with a diagnosis of chronic coronary syndrome (CCS) and myocardial infarction (MI) to the Department of Cardiology were included in the study. The mean age of patients was 51.91±11.27 years, with a male predominance (69.32%). Hypertension and Diabetes mellitus were the most common comorbid conditions. Overall, SVD was observed in 46.59% of patients, 3VD in 29.55% and DVD in 23.86%. Among CCS patients, 39.29% had SVD, 28.57% had DVD and 32.14% had 3VD. MI patients showed a higher prevalence of SVD (45%) and 3VD (35%). In Chronic Coronary Syndrome (CCS) hypertension is the most common risk factor (53.57%) affecting the Coronary artery Disease and also provoke Myocardial infarction (51.67%). Smoking was more frequent in CCS patients (57.14%), while DM was slightly more common in the MI group (46.67%). This study found that SVD was the most prevalent vessel disease pattern in both CCS and MI patients, while 3VD was more frequently observed among MI patients, highlighting the severity of coronary involvement. Risk factors such as HTN, DM and smoking were prominent across both groups, emphasizing the need for early risk factor modification in CAD management.

Background/Objectives: Despite advances in personalized medicine, diabetes classification and management have remained widely unchanged for decades. The aims of the present study were to determine profiles of patients with type 2 diabetes at the time of their myocardial infarction and to assess 1-year cardiovascular events. Methods: All type 2 diabetic patients admitted for myocardial infarction in our Coronary Intensive Care Unit between 1 April 2021 and 30 June 2023 were included in this retrospective study. To identify patient profiles, we performed a data-driven cluster analysis based on the k-means method according to six characteristics considered as the most relevant in the literature (age at diabetes diagnosis, body mass index, glycated hemoglobin, glutamate decarboxylase antibodies, insulin resistance and beta-cell function). Cox multivariate models were used to identify predictors of 1-year cardiovascular event- and major adverse cardiovascular event-free survivals. Results: This study included 250 patients with a median age of 71 years. Our cluster repartition was as follows: 46% patients presented a severe insulin-deficient diabetes, 3% a severe insulin-resistant diabetes, 16% a mild obesity-related diabetes, 33% a mild age-related diabetes, and 2% patients suffered from a severe autoimmune diabetes. In multivariate analyses, the only independent factor for both longer cardiovascular event- and major adverse cardiovascular event-free survival was a higher glomerular function rate (hazard ratio of 0.97 and 0.98 per 1 mL/mn/1.73 m2; p = 0.01 and p = 0.03, respectively). Conclusions: This study suggests that the severe insulin-deficient diabetes and mild age-related diabetes pathophysiological phenotypes, easily estimated using insulin resistance and beta-cell function as well as age at diabetes diagnosis, body mass index, and glycated hemoglobin, were more frequent among diabetic patients at the time of their myocardial infarction. In daily clinical practice, caution is needed for patients with a low glomerular function rate, as this was associated with shorter cardiovascular event- and major adverse cardiovascular event-free survival at 1-year.

Accurate electrocardiogram (ECG) interpretation is an essential competency for nurses, particularly in cardiology, where the timely identification of arrhythmias can be lifesaving and significantly impact patient outcomes. Nurses often serve as the first line of clinical observation, making their ability to interpret ECGs critical for early intervention and safe patient care. However, numerous studies have highlighted persistent gaps in ECG interpretation skills among nursing staff, emphasizing the urgent need for effective, accessible educational strategies.This study aimed to assess the effectiveness of a self-directed e-learning (SDL) package in improving nurses’ knowledge and competency in arrhythmia interpretation within the cardiology department of Rashid Hospital, Dubai. A quasi-experimental, one-group pre-test/post-test design was utilized with a sample of 50 nurses working in Coronary Care Units. Data were collected using a validated, structured questionnaire that included demographic data and ECG interpretation tests. The SDL package covered foundational ECG knowledge, rhythm analysis, and arrhythmia management.Results showed a statistically significant 15.92% improvement in knowledge following the intervention (t = −6.668, p < .001). A notable correlation was observed with years of experience; nurses with 1–5 years of experience demonstrated the highest improvement (p = .020). No significant differences were found based on gender (p = .234) or area of practice (p = .139).This study highlights the critical need to strengthen nurses’ arrhythmia interpretation skills and demonstrates that SDL is an effective, flexible, and scalable approach to bridging competency gaps in high-acuity clinical areas such as cardiology.

The lectin-like oxidised low-density lipoprotein receptor-1 (LOX-1) mediates atherosclerotic plaque inflammation and vulnerability. On activation, LOX-1 sheds its extracellular domain into the circulation as soluble LOX-1 (sLOX-1). sLOX-1 is markedly elevated in patients with acute coronary syndrome (ACS). We prospectively assessed the associations between plasma sLOX-1 and the development of heart failure (HF), major adverse cardiovascular events (MACE) and coronary and left ventricular (LV) dysfunction in two cohorts of patients with ACS. The first cohort comprised 524 patients recruited during the acute index event at the coronary care unit of Skåne University Hospital, Malmö, Sweden. The second cohort included 363 patients with ACS treated with acute percutaneous intervention at Sahlgrenska University Hospital, Gothenburg, Sweden. Additionally, we examined the anti-inflammatory effects of LOX-1 blockade in vitro using human umbilical vein endothelial cells (HUVECs). In the first cohort, acute-phase sLOX-1 was associated with incident HF and MACE independently of cardiovascular risk factors, revascularisation and medication (HR per 1-SD sLOX-1 increase: 1.57 (95% CI: 1.10 to 2.23; p=0.012) for HF and 1.36 (1.08 to 1.71; p=0.009) for MACE). Elevated sLOX-1 was also associated with lower LV ejection fraction and accelerated remodelling, as measured by echocardiography at 1-year post-ACS. In the second cohort, sLOX-1 was negatively associated with left anterior descending coronary artery flow reserve and LV systolic function, and positively correlated with soluble markers of systemic inflammation and cardiac overload at 4 and 16 weeks post-ACS. In vitro, antibody-mediated LOX-1 blockade prevented oxidised low-density lipoprotein-induced HUVEC activation. Elevated plasma sLOX-1 at baseline and during follow-up is associated with incident HF and MACE, as well as cardiac and coronary dysfunction in patients with ACS. As plasma sLOX-1 levels may reflect the intensity of LOX-1 expression on vascular and immune cells, these findings support LOX-1 as a potentially important therapeutic target to improve prognosis in patients with ACS.

Supraventricular premature beats are premature activations of the atria outside of the sinus node that is often benign. They typically present with irregular pulses and dynamic changes to pre-existing murmurs between sinus beats and ectopic beats, but rarely with bradycardia. We describe an elderly male with atrial bigeminy who presented for evacuation of a soft tissue collection in a regional hospital. On examination, he appeared bradycardic due to a significant pulse deficit, despite remaining haemodynamically stable and asymptomatic. This led to two emergency response teams being called and a brief admission to coronary care unit (CCU), primarily due to the ward's limited access to telemetry, before he underwent an uneventful surgery and was discharged. This case highlights the logistical challenges of monitoring such patients where telemetry is not readily available and emphasises the importance of recognising pulse deficits as a cause of peripheral bradycardia in otherwise stable patients with supraventricular ectopic beats.

ObjectiveTo investigate clinicians’ preferences for alcohol screening and brief interventions in clinical cardiology settings.ResultsA total of 664 cardiology clinicians responded to a cross-sectional survey (30.9% response rate), including 55.1% nurses, 21.4% assistant nurses, 18.8% doctors, and 4.7% other clinical staff. Among these participants, 87.5% indicated that patients should be screened for alcohol use on cardiology wards, 79.8% in outpatient clinics, 49.1% in emergency departments, and 45.9% on coronary care units. Doctors and nurses were the preferred professions to be responsible for screening across all clinical contexts, while fewer respondents indicated that assistant nurses or physiotherapists should be responsible for screening (p < .001). Most participants (85.2%) indicated that patients should be screened in more than one clinical context and 84.6% indicated that more than one profession should be responsible for alcohol screening. Clinicians’ preferred modality for assessing alcohol use was verbal screening (92% of participants), followed by questionnaires (53.5%), digital tools (28.5%), and alcohol biomarkers (22.1%, p < .001). Just over half of participants (58%) indicated that they would like to attend training on brief interventions. Findings suggest that task sharing, teamwork, and training may be effective strategies for implementation of alcohol screening and brief interventions in clinical cardiology.

BackgroundHeart failure (HF) and preserved ejection fraction (HFpEF) represents a growing health burden characterized by systemic inflammation. Yet, reliable and cost-effective inflammatory biomarkers for risk stratification in HFpEF remain limited.AimWe sought to examine the prognostic value of systemic immune-inflammation index (SII) on outcomes in HFpEF patients.MethodsThis study analyzed 458 (mean age:70.7 years; 59.2% women) participants with HFpEF admitted to the coronary care unit. HFpEF participants were grouped by SII values: Tertile 1 (SII ≤ 455.2), Tertile 2 (455.2–777.8), and Tertile 3 (SII > 777.8). Long-term associations between SII and composite outcomes, including all-cause, cardiovascular death, and HF rehospitalization, were evaluated. Decision curve analysis (DCA) assessed the clinical utility of SII-enhanced versus basic clinical models.ResultsBaseline demographics, comorbidities, and laboratory parameters varied significantly across SII tertiles. Of the total participants, 211 (46.1% ) experienced composite events over a mean follow-up of 41.8 months. When analyzed as a continuous variable, higher log-transformed SII was independently associated with increased risk of composite outcome of death and HF rehospitalization in the overall cohort (HR 1.50, 95% CI 1.18–1.92) and diabetic patients (HR 1.88, 95% CI 1.32–2.67), but not non-diabetic patients (HR 1.23, 95% CI 0.86–1.77) after multivariable adjustment. Similarly, in the fully adjusted tertile-based analysis, the highest SII tertile remained significantly associated with the composite outcome in the overall cohort (HR 1.70, 95% CI 1.15–2.52), with a particularly strong association observed in diabetic patients (HR 2.63, 95% CI 1.43–4.85), while no significant association was found in non-diabetic patients (HR 1.13, 95% CI 0.63–2.02). Restricted cubic splines demonstrated a linear relationship between SII and composite outcomes. SII showed superior prognostic accuracy compared to other inflammatory markers, and DCA confirmed improved clinical decision-making utility.ConclusionsIn patients with HFpEF, higher SII values were positively associated with risk of death and HF hospitalization, with particularly strong prognostic value in diabetic patients. SII represents a promising, accessible biomarker for enhanced risk stratification in HFpEF.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12967-025-06964-8.

ABSTRACT A study was conducted to assess the knowledge, practice and technique on hand hygiene among the nurses while caring for patients in selected areas of a selected hospital. The conceptual framework was developed on the basis of Becker and Miman’s health belief model. In this study, quantitative research approach and descriptive research design were used to achieve the objectives of the study. The study subjects were nurses from Medical Intensive care unit, Coronary care unit, Trauma Intensive care unit and Post operative ward. The nurses were selected through convenience sampling technique. Pilot study was done and all the strengths and weaknesses were analyzed. Data collection was done for 6 weeks. Assessment of practice and technique on hand hygiene among nurses was done by concealed participatory observation method and questionnaire was provided on the last two days of data collection in each of the four settings to assess the knowledge on hand hygiene among the nurses. The collected data were tabulated and analyzed using descriptive and inferential statistics. The demographic revealed that majority of the participants were females (93.9%), below 25 years (84.8 %), B.sc nurses (57.6%).45.5% of the nurses were having total work experience of 7-12 months and48.5% of them were having 7-12 months’ work experience in the current area. Only 63.3 % of the nurses had previous source of information on hand hygiene and among this group 48.5% of the nurses got the information only from textbooks. It was noted that only 39.4% of the nurses had adequate knowledge on hand hygiene. It was also noted that 21 nurses (63.6%) were having the average (51%-64%) score on hand hygiene technique, whereas one nurse (3%) was having the excellent (&gt;80%) and good score (65–75%) on hand hygiene technique. It was also revealed that the practice on hand hygiene before and after procedure was poor (&lt;50 %) for all the nurses. None of the participants were having good &amp; excellent hand hygiene practice before and after procedures. The study findings revealed that the age of the nurses had significant association with knowledge on hand hygiene at the level of P&lt;0.05. The age, present experience of the nurses had significant association with technique on hand hygiene at the level of P&lt;0.01. It was also revealed that the age of the nurses had significant association with practice before and after procedure on hand hygiene of nurses at the level of P&lt;0.001. No other demographic variables had significant association with knowledge, practice and technique on hand hygiene. It also found that there was a negative correlation between knowledge with practice and technique. It was also revealed that there was a positive correlation between practice and technique. There was no significant relationship between knowledge, practice and technique. This could be interpreted that even though the nurses had adequate knowledge, continuous monitoring was needed to enhance adherence to practice and technique on hand hygiene. It was also revealed that through the results, the researcher found that an in- service education should be conducted periodically to update knowledge on hand hygiene and to improve the practices and techniques among the nurses. The researcher conducted in -service education on hand hygiene among the nurses in all of the four setting.

Presence of Bacterial contamination in hospital environments, particularly intensive care units, poses a serious threat to global public health in the world with high morbidity and mortality rates. Of more concern is the emergence of multidrug-resistant bacteria on medical devices, inanimate surfaces, health care providers, and patients in the intensive care unit, which could lead to further cross-contamination and infection. This study aimed to assess the bacterial profile and their antimicrobial susceptibility patterns of bacterial isolates from the intensive care unit of the Emergency unit, internal medicine, and coronary unit of Misurata Central Unit of Misurata, Libya. A unit-based cross-sectional study was conducted on three Intensive Care units from 1st December 2024 to 27th December 2024. In this project, a total of 102 swab samples from the intensive care unit environment were collected using cotton swabs. Standard Microbiological techniques to include culture method and Gram stain, were employed for the identification of the isolates. Antimicrobial susceptibility tests for bacterial isolates were performed by using the Kirby-Bauer disk diffusion method. In the total of 102 swab samples, bacterial growth was observed in 19.6% (20/102) of the total samples. Out of the total bacterial growth recovered, the Coronary care unit had the highest, 50% (10/20), followed by the Emergency unit 35% (7/20), and the Internal medicine unit had 15% (3/20). The most frequently found isolate was Staphylococcus aureus 75% (15/20), followed by Streptococcus pyogenes 15% (3/20), Pseudomonas aeruginosa 5% (1/20), and E coli 5% (1/20). Results of the antibiotic susceptibility pattern revealed that most of the isolates are multidrug-resistant. Results from this study showed bacterial contamination of the ICU environments and their resistance patterns, which suggest that patients are prone to hospital-associated infection. It is recommended that strict sterilization of intensive care units be standardized and the hygiene of hospital workers be enforced to prevent transmission of infection in hospital environments.