Coronary Care Unit Research Articles

Prevalence and Molecular Typing of Methicillin and Vancomycin-Resistant Staphylococcus aureus Strains Isolated from the Noses of Imam Hassan Hospital Workers in Bojnurd, Iran in the fall of 2021

Introduction: Nosocomial infections are a global problem that has become a challenge in hospitals around the world since the 80s. One of the main sources of hospital infections is personnel. In this regard, the present study aimed to investigate the frequency, colonization rate, antibiotic resistance, and molecular types of Staphylococcus aureus in the personnel of key hospital departments, including emergency, infectious, Coronary Care Unit, and Intensive Care Unit Departments. Method: Nasal swab samples were collected from the personnel of the Emergency, Infectious, Coronary Care Unit, and Intensive Care Units Departments in the fall of 2021 and subsequently cultured. Confirmation of S. aureus strains was performed by biochemical tests, disk diffusion method, and agar screen test. Moreover, polymerase chain reaction for the evaluation of resistance genes was performed. Determination of agr group, determination of SCCmec type, and checking the presence of pvl, tst, and etc genes were also performed. Results: In total, 75 out of 214 staff nasal swab samples contained S. aureus. Prevalence of methicillin-resistant S. aureus was 65.3% confirmed by PCR test results. Based on the study of SCCmec types in MRSA strains, the most common type was SCCmecIII. Among the agr groups, type I was the most common, and in terms of the abundance of pvl, tsst, and etc genes, a relatively high prevalence was observed. Conclusion: Due to the increased level of personal and environmental health in hospitals, s. aureus colonizing the noses of personnel are more pathogenic and resistant due to the natural selection of strains. Therefore, they can cause more severe diseases following transmission to the patients.

Post-intensive cardiac care outpatient long-term outreach clinic (PICCOLO clinic): Defining health care needs and outcomes among coronary care unit survivors

ObjectivePatients who survive critical illness endure complex physical and mental health conditions, referred to as post-intensive care syndrome (PICS). The University of Michigan's post-intensive cardiac care outpatient long-term outreach (PICCOLO) clinic is designed for patients recently admitted to the coronary care unit (CCU). The long-term goal of this clinic is to understand post-CCU patients' needs and design targeted interventions to reduce their morbidity and mortality post-discharge. As a first step toward this goal, we aimed to define the post-discharge needs of CCU survivors. Design, setting, particpantsWe retrospectively reviewed case-mix data (including rates of depression, PTSD, disability, and cognitive abnormalities) and health outcomes for patients referred to the PICCOLO clinic from July 1, 2018, through June 30, 2021 at Michigan Medicine. ResultsOf the 134 referred patients meeting inclusion criteria, 74 (55 %) patients were seen in the PICCOLO clinic within 30 days of discharge. Patients seen in the clinic frequently screened positive for depression (PHQ-2 score ≥3, 21.4 %) and cognitive impairment (MOCA <26, 38.8 %). Further, patients also reported high rates of physical difficulty (mean WHODAS 2.0 score 28.4 %, consistent with moderate physical difficulty). Consistent with medical intensive care unit (ICU) patients, CCU survivors experience PICS. ConclusionThis work highlights the feasibility of an outpatient care model and the need to leverage information gathered from this care model to develop treatment strategies and pathways to address symptoms of PICS in CCU survivors, including depression, cognitive impairment, and physical disability.

The relationship of atrial fibrillation with left atrial size in patients with essential hypertension

Atrial fibrillation (AF) is the most common sustained arrhythmia and it is a major public health problem worldwide. Hypertension is one of the major risk factors for the development of AF. This study is carried out to determine the prevalence and independent risk factors for atrial fibrillation (AF) in hypertensive patients and to evaluate the relationship of AF with left atrial size. This is a retrospective observational cross – sectional study that used a retrospective electronic chart review of all admitted patients to cardiology department at King Abdullah university hospital (KAUH) in Irbid, Jordan, with a diagnosis of hypertension along with various acute cardiac admissions, including AF during 1-year period (January 1st to December 31 of 2021). Risk factors for AF (age, sex, DM, coronary artery disease, valvular heart disease, Cor-pulmonale, obstructive sleep apnea, and congestive cardiac failure) were retrieved from electronic charts of the patients. A total of 958 patients were admitted to the coronary care unit (CCU) and intermediate care unit (IMCU) during a 1-year period. Among them, 276 had 2 or 3 admissions. The main reason of admission was acute coronary syndrome (n = 491), heart failure (n = 180), and AF (n = 144), indicating AF prevalence of 15%. However, there were 40 patients with combined causes. All patients in the study (n = 958) were diagnosed with hypertension, including patients with atrial fibrillation (n = 144). The mean age of patients was 61.4 (± 11.46) years, and approximately two thirds of them were males (65.4%). The binary logistic regression model demonstrated a significant statistical relationship of age, left atrial size, coronary artery disease, left ventricular ejection fraction, left ventricular dimensions in systole and diastole, and heart failure with the occurrence of AF after controlling for gender, smoking, and diabetes. Findings indicate that left atrial size plays a significant role in the development of AF in patients with hypertension. However, the prevalence of AF significantly increased with advancing age in both sexes because of increased left ventricular hypertrophy, which leads to increased left atrial size.

Analysis of the unicentric registry of the Infarction Code program: retrospective cohort

Acute coronary syndrome (ACS) is the most serious manifestation of coronary heart disease. The Infarction Code (according to its initialism in Spanish, CI: Código Infarto) program aims to improve the care of these patients. To describe the clinical presentation and outcomes of CI program in a coronary care unit (CCU). A database of a CCU with 5 years of consecutive records was analyzed. Patients diagnosed with ACS were included. The groups with acute myocardial infarction with and without ST-segment elevation were compared using Student's t, Mann-Whitney U and chi-squared tests. We calculated the relative risk (RR) and 95% confidence intervals (95% CI) of cardiovascular risk factors for mortality. A total of 4678 subjects were analyzed, 78.7% men, mean age 63 years (± 10.7). 80.76% presented acute myocardial infarction with positive ST-segment elevation and fibrinolytic was granted in 60.8% of cases. Percutaneous coronary intervention was performed in 81.4% of patients, which was successful in 82.5% of events. Patients classified as CI presented mortality of 6.8% vs. 11.7%, p = 0.001. Invasive mechanical ventilation had an RR of 26.58 (95% CI: 20.61-34.3) and circulatory shock an RR of 20.86 (95% CI: 16.16-26.93). The CI program decreased mortality by 4.9%. Early fibrinolysis and successful coronary angiography are protective factors for mortality within CCU.

Analyzing predictors of in-hospital mortality in patients with acute ST-segment elevation myocardial infarction using an evolved machine learning approach

Acute ST-segment elevation myocardial infarction (STEMI) is a severe cardiac ailment characterized by the sudden complete blockage of a portion of the coronary artery, leading to the interruption of blood supply to the myocardium. This study examines the medical records of 3205 STEMI patients admitted to the coronary care unit of the First Affiliated Hospital of Wenzhou Medical University from January 2014 to December 2021. In this research, a novel predictive framework for STEMI is proposed, incorporating evolutionary computational methods and machine learning techniques. A variant algorithm, AGCOSCA, is introduced by integrating crossover operation and observation bee strategy into the original Sine Cosine Algorithm (SCA). The effectiveness of AGCOSCA is initially validated using IEEE CEC 2017 benchmark functions, demonstrating its ability to mitigate the deficiency in local mining after SCA random perturbation. Building upon this foundation, the AGCOSCA approach has been paired with Support Vector Machine (SVM) to forge the predictive framework referred to as AGCOSCA-SVM. Specifically, AGCOSCA is employed to refine the selection of predictors from a substantial feature set before SVM is utilized to forecast the occurrence of STEMI. In our analysis, we observed that SVM excels at managing nonlinear data relationships, a strength that becomes particularly prominent in smaller datasets of STEMI patients. To assess the effectiveness of AGCOSCA-SVM, diagnostic experiments were conducted based on the STEMI sample data. Results indicate that AGCOSCA-SVM outperforms traditional machine learning methods, achieving superior Accuracy, Sensitivity, and Specificity values of 97.83 %, 93.75 %, and 96.67 %, respectively. The selected features, such as acute kidney injury (AKI) stage, fibrinogen, mean platelet volume (MPV), free triiodothyronine (FT3), diuretics, and Killip class during hospitalization, are identified as crucial for predicting STEMI. In conclusion, AGCOSCA-SVM emerges as a promising model framework for supporting the diagnostic process of STEMI, showcasing potential applications in clinical settings.

Retrospective Analysis of Hospital Acquired Infection and Antibiotic Resistance in Coronary Care Unit (CCU), Adult, and Pediatric Cardiology Wards.

Antibiotics resistance is an paramount threat affecting the whole world but nowhere situation is as gloomy as in India. No study till date regarding epidemiology of hospital acquired infections in coronary care units(CCU) and cardiology wards from India. From Indian perspective it is the first observational study to analyse microbiological profile and antibiotic resistance in CCU. The purpose of this observational study is to explore the epidemiology and importance of infections in CCU patients. After ethics committee approval, the records of all patients who were admitted in coronary care units, adult and pediatric cardiology wards surgery between January 2020 and December 2021 were reviewed retrospectively. The type of organism,source of infection ,age wise distribution and seasonal variability among patients who developed hospital acquired infection (HAI) were determined. 271 patients developed microbiologically documented HAI during from January 2020 to December 2021. Maximum number of organisms(78/271 28.78%) are isolated from urinary samples ,followed by blood stream(60/271 22.14%) and Endotracheal tube (54/271 19.92%). Acinetobacter baumanii (53/271, 19.5%) being the most common isolate among all the samples taken . Acinetobacter was the most frequent pathogens isolated in patients with LRTI and blood stream infection while E. coli was from urinary tract infection . In the adult population, infection with E. coli(24.6%) is the most common followed by Klebsiella pneumoniae (12.8%) and Acinetobacter baumanii (10.1%). In the pediatric population Acinetobacter baumanii (38.6%%) is the most common followed by Klebsiella pneumoniae (20.5%) and Methicillin Resistant Staphylococcus aureus, MRSA (6.8%). Commonly used antibiotics eg ciprofloxacin,ceftazidime and amikacin were found to be resistant against the top three isolates. Urinary tract was the most common site of infection and Gram-negative bacilli, the most common pathogens in adult as well as pediatric population. Antibiotic resistance was maximum with commonly isolated microorganisms.

Short-Term Prognosis of Elderly Patients Admitted to the Coronary Care Unit: A Subgroup Analysis of the MORCOR-TURK (Mortality and Morbidity in Coronary Care Units in Türkiye) Trial.

This subgroup analysis of the MORCOR-TURK (Mortality and Morbidity in Coronary Care Units in Türkiye) trial aimed to determine the short-term prognosis, mortality rates, and predictors for elderly patients followed in coronary care units (CCUs) in Türkiye. The MORCOR-TURK trial is a national, non-interventional, multicenter observational study conducted in Türkiye (ClinicalTrials.gov number NCT05296694). The study population includes CCU patients from 50 centers selected from all regions of Türkiye (between September 1 and 30, 2022 prospectively). In the subgroup analysis, patients were divided into two groups: Group 1 (ages 65 to < 75 years, n = 923 patients) and Group 2 (ages ≥ 75 years, n = 713 patients). At the end of the analysis, short-term prognosis, mortality rates, and predictors were documented. The mean age of Group 1 was 69 (67-72) years, and Group 2 was 80 (77-84) years. Chest pain was the most common reason for admission (968 patients [59.16%]), and acute coronary syndrome was the most common reason for hospitalization in the CCU (1,053 patients [64%]). Atrial fibrillation (AF) was the most common arrhythmia (356 patients [21.76%]). The mortality rate was 6.11% in elderly patients (4.23% in Group 1 and 8.56% in Group 2). The multivariate regression analysis showed that age (P = 0.046, P = 0.003), chronic kidney disease (P = 0.011, P = 0.045), and ventricular tachycardia/ventricular fibrillation (VT/VF) during hospitalization (P < 0.001) were the main factors that increased mortality in both groups. Other independent mortality risk factors were smoking for Group 1 and aortic stenosis for Group 2. This study represents the most comprehensive assessment of the short-term prognosis for elderly patients admitted to CCUs in Türkiye. It showed that coronary artery disease was the most common reason for admission and age over 75 and chronic kidney disease were the main determinants of mortality.

Machine learning-based prediction of coronary care unit readmission: A multihospital validation study.

Readmission to the coronary care unit (CCU) has significant implications for patient outcomes and healthcare expenditure, emphasizing the urgency to accurately identify patients at high readmission risk. This study aims to construct and externally validate a predictive model for CCU readmission using machine learning (ML) algorithms across multiple hospitals. Patient information, including demographics, medical history, and laboratory test results were collected from electronic health record system and contributed to a total of 40 features. Five ML models: logistic regression, random forest, support vector machine, gradient boosting, and multilayer perceptron were employed to estimate the readmission risk. The gradient boosting model was selected demonstrated superior performance with an area under the receiver operating characteristic curve (AUC) of 0.887 in the internal validation set. Further external validation in hold-out test set and three other medical centers upheld the model's robustness with consistent high AUCs, ranging from 0.852 to 0.879. The results endorse the integration of ML algorithms in healthcare to enhance patient risk stratification, potentially optimizing clinical interventions, and diminishing the burden of CCU readmissions.

Echocardiographic evaluation of mitral inflow e wave velocity-to-tissue Doppler e’ wave velocity ratio (E/e’) as a prognostic indicator in ST-elevation myocardial infarction

Abstract AIMS AND OBJECTIVES: To study the clinical characteristics and to assess the usefulness of echocardiographic evaluation of mitral inflow E wave velocity-to-tissue Doppler e’ wave velocity ratio (E/e’) as a prognostic indicator in patients admitted with ST-elevation myocardial infarction (STEMI) with or without revascularization therapy to predict in-hospital mortality. BACKGROUND: Myocardial infarction is a high-risk condition, especially when filling pressure is raised, and earlier reports have suggested that E/e’ is associated with poor outcome. However, whether E/e’ predicts risk better than left ventricular ejection fraction (LVEF), which is the current standard of practice, is not known. MATERIALS AND METHODS AND RESULTS: The echocardiographic evaluation of mitral inflow E wave velocity-to-tissue Doppler e’ wave velocity ratio (E/e’) as a prognostic indicator in ST-elevation myocardial infarction” was carried out on 100 patients admitted in the Department of Cardiology of Fortis Escorts Heart Institute, Okhla, New Delhi, from November 2019 to March 2021. The mean age of the patients with ST-elevation myocardial infarction was 59.8 ± 11.3 years. In patients who had E/e’ &gt;15, male predominance and higher age (mean 63.7 ± 7.7 years) were found. Out of common cardiovascular risk factors, smoking and diabetes mellitus were found to be statistically significant. 67.7% of patients were belonged to the Killip Class II or more. In patients who had E/e’ &gt;15, 29 (93.5%) patients had LVEF ≤45%. Twenty-seven (87.1%) patients had deceleration time (DT) ≤140 ms. Moderate or severe mitral regurgitation (MR) was found in 19.4% of patients, while the mean values of LVEDD and LVESD were 50.4 ± 2.15 mm and 39.7 ± 3.3 mm, respectively. The mean velocity of E and A was 0.87 ± 0.12 m/s and 0.75 ± 0.11 m/s, respectively. The mean E/A ratio was 1.1 ± 0.22. The mean velocity of e’ was 5.02 ± 0.45 cm/s and E/e’ ratio was 17.48 ± 1.57. The association of various clinical features showed that male gender, higher age, smoking, and diabetes mellitus, cardiogenic shock, and Killip Class II or greater were significant factors associated with E/e’ &gt;15. Echocardiographic findings showed that LVEF ≤45%, higher LVEDD and LVESD, higher peak E velocity, DT ≤140 ms, lower mitral annulus e’ velocity, higher E/e’ ratio, and moderate or severe MR were significantly associated with E/e’ &gt;15. CONCLUSION: The current study concluded that Doppler echocardiographic estimation of E/e’ ratio can be used as a marker of elevated left ventricular filling pressure and hence can be used as a prognostic marker in risk stratification of patients admitted in coronary care units. The E/e’ ratio is an independent and powerful predictor of the in-hospital mortality.

Hypothyroidism in acute coronary syndrome – A prospective Indian study

BackgroundEvidence suggests that hypothyroidism may be associated with an increased risk of acute coronary syndrome (ACS).The data regarding the influence of hypothyroidism on cardiovascular disease in the Asian population is conflicting. Therefore, we undertook this study to assess the overall prevalence of hypothyroidism in Acute Coronary Syndrome (ACS) patients and determine if there is a relationship between hypothyroidism, both sub-clinical and overt and other significant risk factors of ACS in an Indian population. MethodsWe studied 487 hospitalized patients between March 2018 and February 2021 with a diagnosis of ACS to determine the prevalence of hypothyroidism, both clinical and sub-clinical and their relationship with other known coronary risk factors. Thyroid function Tests - free T3, free T4 and TSH were collected from all the patients within 24 h of their admission to the coronary care unit (CCU) of 2 major hospitals in New Delhi and Imphal (Manipur). ResultsSubclinical hypothyroidism was prevalent in 44 (9 %), followed by overt hypothyroidism in 25 (5.2 %).Subclinical hypothyroidism was more common in females, whereas overt hypothyroidism was more common in males. ST Elevation Myocardial Infarction (STEMI) (52 %), followed by Non-ST-Elevation Myocardial Infarction (NSTEMI) (25 %), was the commonest diagnosis at presentation. Patients with overt hypothyroidism showed a higher proportion of increased triglyceride levels.Patients with hypothyroidism had no differences in the prevalence of concomitant diabetes hypertension and other coronary risk factors. ConclusionsPatients with ACS without known thyroid disorders should be screened for hypothyroidism since it is found frequently. There might be a case to treat their thyroid dysfunction appropriately.

Occupations, freedom, and values: a case study in a Coronary Intensive Care Unit

Occupations, freedom, and values: a case study in a Coronary Intensive Care Unit

A study to evaluate the effectiveness of self Instructional Module (SIM) in terms of knowledge regarding emergency management of myocardial infarction among staff nurses working in intensive coronary care unit (ICCU) of selected tertiary care hospital

A study to evaluate the effectiveness of self Instructional Module (SIM) in terms of knowledge regarding emergency management of myocardial infarction among staff nurses working in intensive coronary care unit (ICCU) of selected tertiary care hospital

Determination of Coronary Care Unit Nurses' Knowledge Regarding Patient Rehabilitation After Myocardial Infarction

Background: Cardiovascular disease (CVD) is the number one cause of death worldwide. Objective: To determine of coronary care unit nurses' knowledge regarding patient rehabilitation after myocardial infarction. Methodology: A cross- sectional study was designed in the Cardiac Care Unit of Al-Diwaniyah Teaching Hospital and the Specialized Center for Cardiac Surgery and Catheterization for the period from (November 7, 2022) to (May 12, 2023). A non-probability (purposive) sample consisting of (75 nurses) working in the above-mentioned study site. To determination of coronary care unit Nurses' knowledge regarding patient rehabilitation after myocardial infarction, the researcher used a tool that consists of two parts: The first part: is the demographic data of the study sample, and the second part: nurses' knowledge about patient rehabilitation after myocardial infarction includes 28 items. Results: The study showed that (48%) of the nurses in the study sample had fair levels of knowledge regarding patient rehabilitation after myocardial infarction. It also showed that there is a statistically significant relationship between the nurses' knowledge and their age. Conclusion: The current study concluded that the largest percentage of the participants in the study have fair knowledge about patient rehabilitation after myocardial infarction, while a small number of them have satisfactory knowledge.

EPidemiology Of Cardiogenic sHock in Scotland (EPOCHS): A multicentre, prospective observational study of the prevalence, management and outcomes of cardiogenic shock in Scotland.

Despite high rates of cardiovascular disease in Scotland, the prevalence and outcomes of patients with cardiogenic shock are unknown. We undertook a prospective observational cohort study of consecutive patients with cardiogenic shock admitted to the intensive care unit (ICU) or coronary care unit at 13 hospitals in Scotland for a 6-month period. Denominator data from the Scottish Intensive Care Society Audit Group were used to estimate ICU prevalence; data for coronary care units were unavailable. We undertook multivariable logistic regression to identify factors associated with in-hospital mortality. In total, 247 patients with cardiogenic shock were included. After exclusion of coronary care unit admissions, this comprised 3.0% of all ICU admissions during the study period (95% confidence interval [CI] 2.6%-3.5%). Aetiology was acute myocardial infarction (AMI) in 48%. The commonest vasoactive treatment was noradrenaline (56%) followed by adrenaline (46%) and dobutamine (40%). Mechanical circulatory support was used in 30%. Overall in-hospital mortality was 55%. After multivariable logistic regression, age (odds ratio [OR] 1.04, 95% CI 1.02-1.06), admission lactate (OR 1.10, 95% CI 1.05-1.19), Society for Cardiovascular Angiographic Intervention stage D or E at presentation (OR 2.16, 95% CI 1.10-4.29) and use of adrenaline (OR 2.73, 95% CI 1.40-5.40) were associated with mortality. In Scotland the prevalence of cardiogenic shock was 3% of all ICU admissions; more than half died prior to discharge. There was significant variation in treatment approaches, particularly with respect to vasoactive support strategy.

Pattern of STEMI and Its Related Clinical Factors in North Kordofan Sudan

Background: Myocardial infarction (MI) is a common emergency department (ED) and coronary care unit (CCU) presentation globally. The purpose of this investigation was to determine the prevalent pattern and clinical presentation of STEMI type among Sudanese patients in the state of Northern Kordofan (rural population). Methodology: This is a descriptive study conducted at Coronary Care Unit (CCU) at El-Obeid Teaching hospital in El-Obeid city, North Kordofan State, Sudan. The study included a full coverage of patients admitted with clinical diagnosis of STEMI, during the period from Nov 2018 to March 29, 2022. Besides initial presenting symptoms, the diagnosis and STEMI categorization based on the ECG findings. Results: Only 141 of the 174 patients admitted to our facility had comprehensive patient identification information. The majority of patients had an anterior presentation, followed by anteroseptal, inferior, anterolateral, septal, and inferolateral, with proportions of 46/141 (32.6%), 32/141 (22.7%), 29/141 (20.4%), 26/141 (18.4%), 7/141 (5.0%), and 1/141 (0.7%), respectively. Only 32/141 (22%) of the 141 individuals presented within 12 hours of their initial chest discomfort. Approximately 59 out of 141 (41.8%) patients presented themselves after 72 hours had passed. Streptokinase was administered to about 40 individuals, and 12 of them (30%) presented after 12 hours. Conclusion: STEM is prevalent in rural Sudan, with an increasing prevalence of anterior type. The majority of patients presented late in response to their initial chest discomfort, which can lead to unfavorable or poor outcomes. Health education regarding MI is considered essential in rural communities.

Adherence to the Clinical Practice Guidelines for the hospital management of patients with decompensated heart failure in a Coronary Care Unit in Colombia

To assess adherence to the recommendations for the diagnosis and management of hospitalized patients with Decompensated Heart Failure issued by the European Society of Cardiology in 2021 at a Coronary Care Unit at a fourth-level hospital in the city of Bogotá. A descriptive cross-sectional study was conducted, including hospitalized patients in the Coronary Care Unit at Hospital San José in Bogotá, with a primary diagnosis of Decompensated Heart Failure, from September 2021 to January 2023. Patient data were collected from medical records. Adherence to the Decompensated Heart Failure guidelines was described in the study. High adherence was observed for laboratory tests and medication prescriptions recommended by the 2021 European Society of Cardiology guidelines. However, there was low adherence to the request for thyroid function tests, troponin, and iron studies. The cause of heart failure and decompensation was adequately recorded. The most common cause of decompensation was acute coronary syndrome. Regarding the hemodynamic profile on admission, the majority presented as Stevenson B. Pharmacological adherence to Class I recommendations showed high compliance in prescribing beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and Angiotensin Receptor-Neprilysin Inhibitors. However, lower adherence was observed for Sodium-glucose co-transporter two inhibitors and Mineralocorticoid receptor antagonists. Variable adherence rates were recorded, emphasizing satisfactory compliance with class I recommendations for certain medications and laboratory tests. It is necessary to improve adherence in the request for paraclinicals, especially in thyroid function tests and ferrokinetic profiles.

Acute heart failure complicating acute coronary syndromes in patients admitted to Coronary Care Unit - Cardiac Center , Al-Thawra Hospital - Sanaa, Yemen

Background: Heart Failure with all its types and presentation is the end result of acute coronary syndrome. Coronary artery disease and its acute manifestations of ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina are remarked as acute coronary syndromes (ACS). Yemeni patients usually present themselves to hospital late due to a lack of society awareness of the symptoms of ischemic heart disease, absence of medical insurance, poverty, lack of medical aid and intensive care units (ICU), absence of ambulance services, and long distance to the facilitated hospital with equipped ICUs. Late presentation prevents giving thrombolytic therapy or performing invasive interventions within the right time. These factors in addition to other factors may contribute to the large number of heart failure post ACS. We designed this study to study the heart failure complicating acute coronary syndrome. Results: Out of 637 patients with ACS, 294 (39%) were in heart failure complicating ACS, with a median age of 51 years. Males represent 66% (194 patients) and females 34% (100 patients). Smoking represents 36%, khat chewing 88%, hypertension 53%, dyslipidemia 31%, past history of MI 29%, and diabetes mellitus 40%. Ischemic-type chest pain represents 49% and Dyspnea as primary symptom occurred in 29% with heart failure (HF). Late presentation of more than 12 hours represents 53% (111 patients) among patients with HF complicating STEMI or LBBB MI. These patients did not receive thrombolytic therapy or primary PCI. Patients who received thrombolytic therapy represent 45% (95 patients) of patients with HF-complicating ACS. No patients received primary PCI. Conclusions: Heart failure complicating ACS is common among our patients and associated with high in-hospital death and is mainly among young patients and related to late presentation, management with non-fibrine specific thrombolytic agents (streptokinase), and lack of STEMI catheterization team for 24 hours, seven days a week.

The Horrible Scenario in Cath Lab: Percutaneous Management of Guide Wire Entrapment During Coronary Intervention

The Horrible Scenario in Cath Lab: Percutaneous Management of Guide Wire Entrapment During Coronary Intervention

Pulmonary Artery Catheter Usage and Impact on Mortality in Patients With Cardiogenic Shock: Results From a Canadian Single-Centre Registry

BackgroundHemodynamic assessment for cardiogenic shock (CS) phenotyping in patients has led to renewed interest in the use of pulmonary artery catheters (PACs). MethodsWe included patients admitted with CS from January 2014 to December 2020 and compared clinical outcomes among patients who received PACs and those who did not. The primary outcome was the rate of in-hospital mortality. Secondary outcomes included use of advanced heart failure therapies and coronary intensive care unit (CICU) and hospital lengths of stay. ResultsA total of 1043 patients were analysed and 47% received PACs. Patients selected for PAC-guided management were younger and had lower left ventricular function. They also had higher use of vasopressor and inotropes, and 15.2% of them were already supported with temporary mechanical circulatory support (MCS). In-hospital mortality was lower in patients who received PACs (29.3% vs 36.2%; P = 0.02), mainly driven by a reduction in mortality among those in Society for Cardiovascular Angiography and Interventions (SCAI) stages D and E CS. Patients who received PACs were more likely to receive temporary MCS with Impella, durable ventricular assist devices (VADs), or orthotopic heart transplantation (OHT) (P < 0.001 for all analyses). CICU and hospital lengths of stay were longer in patients who used PACs. ConclusionsAmong patients with CS, the use of PACs was associated with lower in-hospital mortality, especially among those in SCAI stages D and E. Patients who received PACs were also more frequently rescued with temporary MCS or received advanced heart failure therapies, such as durable VADs or OHT.

Designing a Visiting Policy Based on the Challenges of the Coronary Care Unit: An Interactive Approach

Background: One of the psychological stressors for the patients admitted to the coronary care units (CCUs) is being away from family members and lack of visiting time. Also, one of the special needs of families is to visit patients during their hospitalization period. In order to enforce visiting rules in CCUs, it is important to take the needs of all staff, patients, and visitors into consideration, and a visiting policy should be adopted that ensures the most effective visiting system. Objectives: The present study aimed to design a visiting policy based on the challenges of the CCU ward using an interactive approach. Methods: This qualitative research was conducted with a participatory action research (PAR) approach in 2016 at Ganjavian Hospital, Dezful, Iran. Content analysis was performed based on the method proposed by Graneheim and Lundman (2004). Forty stakeholder participants were included in focus groups consisting of 3 to 7 people using a purposeful sampling method. Results: In order to determine the current situation, after analyzing the extracted codes in the focus groups and according to the similarities and conceptual content, 36 subcategories, 11 categories, and 3 subthemes, including improper physical factors, problems related to human factors, and improper policy quality, were obtained. After determining the current status of the visiting policy and problems, the new policy was developed by the planning group consisting of a representative from each of the focus groups. Conclusions: In the new visiting policy, efforts have been made to improve the quality of visiting by providing more opportunities for patient-companion and doctor-companion visiting, focusing on ensuring complete and timely information, assigning rooms for doctor-companion and patient-companion visiting, and paying attention to the required equipment. This program can be used by other planners while adjusting its items according to their conditions.