Heart Attack Patients Research Articles

Programmable Bio-nanochip Platform: A Point-of-Care Biosensor System with the Capacity To Learn.

The combination of point-of-care (POC) medical microdevices and machine learning has the potential transform the practice of medicine. In this area, scalable lab-on-a-chip (LOC) devices have many advantages over standard laboratory methods, including faster analysis, reduced cost, lower power consumption, and higher levels of integration and automation. Despite significant advances in LOC technologies over the years, several remaining obstacles are preventing clinical implementation and market penetration of these novel medical microdevices. Similarly, while machine learning has seen explosive growth in recent years and promises to shift the practice of medicine toward data-intensive and evidence-based decision making, its uptake has been hindered due to the lack of integration between clinical measurements and disease determinations. In this Account, we describe recent developments in the programmable bio-nanochip (p-BNC) system, a biosensor platform with the capacity for learning. The p-BNC is a "platform to digitize biology" in which small quantities of patient sample generate immunofluorescent signal on agarose bead sensors that is optically extracted and converted to antigen concentrations. The platform comprises disposable microfluidic cartridges, a portable analyzer, automated data analysis software, and intuitive mobile health interfaces. The single-use cartridges are fully integrated, self-contained microfluidic devices containing aqueous buffers conveniently embedded for POC use. A novel fluid delivery method was developed to provide accurate and repeatable flow rates via actuation of the cartridge's blister packs. A portable analyzer instrument was designed to integrate fluid delivery, optical detection, image analysis, and user interface, representing a universal system for acquiring, processing, and managing clinical data while overcoming many of the challenges facing the widespread clinical adoption of LOC technologies. We demonstrate the p-BNC's flexibility through the completion of multiplex assays within the single-use disposable cartridges for three clinical applications: prostate cancer, ovarian cancer, and acute myocardial infarction. Toward the goal of creating "sensors that learn", we have developed and describe here the Cardiac ScoreCard, a clinical decision support system for a spectrum of cardiovascular disease. The Cardiac ScoreCard approach comprises a comprehensive biomarker panel and risk factor information in a predictive model capable of assessing early risk and late-stage disease progression for heart attack and heart failure patients. These marker-driven tests have the potential to radically reduce costs, decrease wait times, and introduce new options for patients needing regular health monitoring. Further, these efforts demonstrate the clinical utility of fusing data from information-rich biomarkers and the Internet of Things (IoT) using predictive analytics to generate single-index assessments for wellness/illness status. By promoting disease prevention and personalized wellness management, tools of this nature have the potential to improve health care exponentially.

Circulation Research “In This Issue” Anthology

Circulation Research “In This Issue” Anthology

Depression in heart attack patients undertreated despite higher incidence in this group

Heart attack patients are more likely than others to experience depression, but less likely to be prescribed antidepressants.

Predicting Heart Attacks in Patients Using Artificial Intelligence Methods

<p class="zhengwen">Today the heart disease is one of the most important causes of death in the world. So its early prediction and diagnosis is important in medical field, which could help in on time treatment, decreasing health costs and decreasing death caused by it. In fact the main goal of using data mining algorithms in medicine by using patients’ data is better utilizing the database and discovering tacit knowledge to help doctors in better decision making.</p><p class="zhengwen">Therefore using data mining and discovering knowledge in cardiovascular centers could create a valuable knowledge, which improves the quality of service provided by managers, and could be used by doctors to predict the future behavior of heart diseases using past records. Also some of the most important applications of data mining and knowledge discovery in heart patients system includes: diagnosing heart attack from various signs and properties, evaluating the risk factors which increases the heart attack.</p>In this article the effort focused on evaluating the previous works on discovering knowledge using data mining in heart diseases field, and also explain the used algorithms in every one of the previous works, to help the future researchers to gain maximum benefits from these abilities. Because of this, in the next sections, first we will explain various works in data mining field using heart patients’ data, and will show the ability of data mining in various applications of heart disease field, and based on a table will show the history of data mining and it’s applications in heart diseases field. Finally we will provide the best methods and algorithms used in various applications of heart diseases using a comparison and will show the results in a table. It is obvious in the diagrams that the suggested method has the best performance and best quality in prediction.

Candidate SNP Markers of Chronopathologies Are Predicted by a Significant Change in the Affinity of TATA-Binding Protein for Human Gene Promoters.

Variations in human genome (e.g., single nucleotide polymorphisms, SNPs) may be associated with hereditary diseases, their complications, comorbidities, and drug responses. Using Web service SNP_TATA_Comparator presented in our previous paper, here we analyzed immediate surroundings of known SNP markers of diseases and identified several candidate SNP markers that can significantly change the affinity of TATA-binding protein for human gene promoters, with circadian consequences. For example, rs572527200 may be related to asthma, where symptoms are circadian (worse at night), and rs367732974 may be associated with heart attacks that are characterized by a circadian preference (early morning). By the same method, we analyzed the 90 bp proximal promoter region of each protein-coding transcript of each human gene of the circadian clock core. This analysis yielded 53 candidate SNP markers, such as rs181985043 (susceptibility to acute Q fever in male patients), rs192518038 (higher risk of a heart attack in patients with diabetes), and rs374778785 (emphysema and lung cancer in smokers). If they are properly validated according to clinical standards, these candidate SNP markers may turn out to be useful for physicians (to select optimal treatment for each patient) and for the general population (to choose a lifestyle preventing possible circadian complications of diseases).

Oxy-hemodynamic effects during positioning of patients with myocardial acute infarction: a clinical trial

Aim: To analyze the effects of oxygen consumption and myocardial contractility during positioning in bed for patients with acute myocardial infarction (AMI) compared to non-cardiac hospitalized individuals. Method: clinical trial, controlled, randomized, parallel, blind. Randomization: position order in different decubiti; sizing: finite populations based on the prevalence of AMI, totaling 30 heart attack patients; Controls: hospitalized individuals matched for age and sex with blood pressure of less than 50 mm/Hg. Inclusion criteria for heart patients: Killip class I and II, up to 72 hours after the event. Data processing: SPSS®; statistical analysis: mean, mode, median; variance, standard deviation and coefficient of variation, Pearson coefficient, hypothesis testing, confidence intervals and ANOVA. 5% significance level. Preliminary results: significant difference (p=0.04) was found after comparing the cardiac index between decubitus positions. The left lateral position presented the smallest score.

‘Broken Heart Syndrome’ Shows Strong Associations With Psychiatric Disorders

Back to table of contents Previous article Next article Clinical and Research NewsFull Access‘Broken Heart Syndrome’ Shows Strong Associations With Psychiatric DisordersNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:4 Dec 2015https://doi.org/10.1176/appi.pn.2015.10b13AbstractPatients with takotsubo (stress) cardiomyopathy were three times as likely as those who had had a typical heart attack to have received an acute or chronic psychiatric diagnosis.The connections between the heart and mind are becoming better understood, but most of this knowledge is related to common cardiovascular problems like acute heart attack and stroke. A lesser known cardiac condition on which more insight has recently been gained is takotsubo (stress) cardiomyopathy, often referred to as “broken heart syndrome.”Takotsubo Poses Risks for People with Neuropsychiatric Conditions: Named for its resemblance to the bulbous pots used to trap octopi, takotsubo (stress) cardiomyopathy causes the heart to contract abnormally and balloon out. Though long associated with emotional triggers like anxiety, data from a new registry points to a potential link between takotsubo (stress) cardiomyopathy and other psychiatric and neurological disorders.Satoshi Kurisu, M.D.Takotsubo cardiomyopathy involves the ballooning of the heart’s apex (the lower tip), resulting from a weakening of the surrounding heart muscle. Though takotsubo can lead to heart failure or arrhythmias, it is generally viewed as a benign heart condition. This disease predominantly affects older women, and emotional stress or anxiety (for example, loss of a loved one) is believed to be a common trigger.However, the data obtained from 1,750 patients as part of the International Takotsubo Registry found that this condition may not be so benign after all, noted study author Abhiram Prasad, M.D., a professor of interventional cardiology at St George’s University Hospital in London and an adjunct professor of medicine at the Mayo Clinic.“We found that the rates of serious complications during hospitalization, including death, were similar for takotsubo cardiomyopathy as for a typical heart attack,” he said. “Overall, nearly one-fifth of the patients experienced some serious event. And people with a psychiatric or neurologic diagnosis are at increased risk for one of these complications.”This increased risk is noteworthy since acute or chronic psychiatric issues were found to be three times as prevalent among takotsubo patients (42.3 percent) compared with people who experienced a typical heart attack (14.3 percent). Mood disorders were the most common diagnosis, present in about 20 percent of patients, while anxiety disorders were present in 10 percent.Neurological issues, particularly seizures or chronic migraines, were also more prevalent among takotsubo patients. Some 27.5 percent of patients with takotsubo (stress) cardiomyopathy reported an acute or chronic neurological problem, compared with 14.5 percent of heart attack patients.“These findings suggest a potential link between neuropsychiatric disorders and takotsubo cardiomyopathy and should prompt prospective studies,” Prasad said.Another take-home message of this study, Prasad noted, is that takotsubo cardiomyopathy affects more than older women. Also, previous reports on takotsubo cardiomyoptahty may have overemphasized this group of patients, thus leading to the mindset that takotsubo is a benign disease. “Yes, older women are the most prominent population group affected, and the analysis shows that the textbook takotsubo manifestation, an older woman who has an event following an emotional trigger like anxiety, does have a low risk of complications,” he said. “However, 20 percent of the patients were either men of any age or women under 50. In addition, physical events such as respiratory problems or sinus infections are more common triggers than emotional stimuli, while nearly one-third of patients appear to have no triggers at all. And these groups—younger adults, events without an emotional trigger, and people with a psychiatric diagnosis—are at risk for serious health problems.”The International Takotsubo Registry is a consortium of 26 centers in Europe and the United States set up to investigate clinical features, prognostic predictors, and health outcomes of takotsubo cardiomyopathy. This study was supported by research grants from the Mach-Gaensslen Foundation, Prof. Otto Beisheim Foundation, Swiss Heart Foundation, the Olten Heart Foundation, University of Zurich, Swiss National Science Foundation, and Foundation for Cardiovascular Research–Zurich Heart House. ■An abstract of “Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy” can be accessed here. ISSUES NewArchived

Paediatric drug development of ramipril: reformulation, in vitro and in vivo evaluation

Ramipril is used mainly for the treatment of hypertension and to reduce incidence of fatality following heart attacks in patients who develop indications of congestive heart failure. In the paediatric population, it is used most commonly for the treatment of heart failure, hypertension in type 1 diabetes and diabetic nephropathy. Due to the lack of a suitable liquid formulation, the current study evaluates the development of a range of oral liquid formulations of ramipril along with their in vitro and in vivo absorption studies. Three different formulation development approaches were studied: solubilisation using acetic acid as a co-solvent, complexation with hydroxypropyl-β-cyclodextrin (HP-β-CD) and suspension development using xanthan gum. Systematic optimisation of formulation parameters for the different strategies resulted in the development of products stable for 12 months at long-term stability conditions. In vivo evaluation showed Cmax of 10.48 µg/ml for co-solvent, 13.04 µg/ml for the suspension and 29.58 µg/ml for the cyclodextrin-based ramipril solution. Interestingly, both ramipril solution (co-solvent) and the suspension showed a Tmax of 2.5 h, however, cyclodextrin-based ramipril produced Tmax at 0.75 h following administration. The results presented in this study provide translatable products for oral liquid ramipril which offer preferential paediatric use over existing alternatives.

The cost of hospital readmissions: evidence from the VA.

This paper is an examination of hospital 30-day readmission costs using data from 119 acute care hospitals operated by the U.S. Veterans Administration (VA) in fiscal year 2011. We applied a two-part model that linked readmission probability to readmission cost to obtain patient level estimates of expected readmission cost for VA patients overall, and for patients discharged for three prevalent conditions with relatively high readmission rates. Our focus was on the variable component of direct patient cost. Overall, managers could expect to save $2140 for the average 30-day readmission avoided. For heart attack, heart failure, and pneumonia patients, expected readmission cost estimates were $3432, $2488 and $2278. Patient risk of illness was the dominant driver of readmission cost in all cases. The VA experience has implications for private sector hospitals that treat a high proportion of chronically ill and/or low income patients, or that are contemplating adopting bundled payment mechanisms.

Flexible regression models for rate differences, risk differences and relative risks.

Generalized additive models (GAMs) based on the binomial and Poisson distributions can be used to provide flexible semi-parametric modelling of binary and count outcomes. When used with the canonical link function, these GAMs provide semi-parametrically adjusted odds ratios and rate ratios. For adjustment of other effect measures, including rate differences, risk differences and relative risks, non-canonical link functions must be used together with a constrained parameter space. However, the algorithms used to fit these models typically rely on a form of the iteratively reweighted least squares algorithm, which can be numerically unstable when a constrained non-canonical model is used. We describe an application of a combinatorial EM algorithm to fit identity link Poisson, identity link binomial and log link binomial GAMs in order to estimate semi-parametrically adjusted rate differences, risk differences and relative risks. Using smooth regression functions based on B-splines, the method provides stable convergence to the maximum likelihood estimates, and it ensures that the estimates always remain within the parameter space. It is also straightforward to apply a monotonicity constraint to the smooth regression functions. We illustrate the method using data from a clinical trial in heart attack patients.

Protective and pathological roles of tissue factor in the heart.

Tissue factor (TF) is expressed in the heart where it is required for haemostasis. High levels of TF are also expressed in atherosclerotic plaques and likely contribute to atherothrombosis after plaque rupture. Indeed, risk factors for atherothrombosis, such as diabetes, hypercholesterolaemia, smoking and hypertension, are associated with increased TF expression in circulating monocytes, microparticles and plasma. Several therapies that reduce atherothrombosis, such as statins, ACE inhibitors, beta-blockers and anti-platelet drugs, are associated with reduced TF expression. In addition to its haemostatic and pro-thrombotic functions, the TF : FVIIa complex and downstream coagulation proteases activate cells by cleavage of protease-activated receptors (PARs). In mice, deficiencies in either PAR-1 or PAR-2 reduce cardiac remodelling and heart failure after ischaemia-reperfusion injury. This suggests that inhibition of coagulation proteases and PARs may be protective in heart attack patients. In contrast, the TF/thrombin/PAR-1 pathway is beneficial in a mouse model of Coxsackievirus B3-induced viral myocarditis. We found that stimulation of PAR-1 increases the innate immune response by enhancing TLR3-dependent IFN-β expression. Therefore, inhibition of the TF/thrombin/PAR-1 pathway in patients with viral myocarditis could have detrimental effects. The TF : FVIIa complex has both protective and pathological roles in the heart.

Recovering heart attack patients fail to adhere to prescribed medications

Recovering heart attack patients fail to adhere to prescribed medications

Reactive oxygen species adversely impacts bone marrow microenvironment in diabetes.

Significance: Patients with diabetes mellitus suffer an excess of cardiovascular complications and recover worse from them as compared with their nondiabetic peers. It is well known that microangiopathy is the cause of renal damage, blindness, and heart attacks in patients with diabetes. This review highlights molecular deficits in stem cells and a supporting microenvironment, which can be traced back to oxidative stress and ultimately reduce stem cells therapeutic potential in diabetic patients. New research has shown that increased oxidative stress contributes to inducing microangiopathy in bone marrow (BM), the tissue contained inside the bones and the main source of stem cells. These precious cells not only replace old blood cells but also exert an important reparative function after acute injuries and heart attacks. The starvation of BM as a consequence of microangiopathy can lead to a less efficient healing in diabetic patients with ischemic complications. Furthermore, stem cells from a patient's BM are the most used in regenerative medicine trials to mend hearts damaged by heart attacks. A deeper understanding of redox signaling in BM stem cells will lead to new modalities for preserving local and systemic homeostasis and to more effective treatments of diabetic cardiovascular complications.

One in 10 Heart Attack Patients has Diabetes

Ten percent of patients presenting with an acute myocardial infarction had undiagnosed diabetes at the time of their heart attack, underlining the importance of evaluating such patients for diabetes while they are being treated, investigators have reported.The study found that 287 (10.1%) of the 2,854 patients enrolled in a 24-site U.S. acute MI registry, who were not known to have type 2 diabetes at hospital admission, actually had diabetes, reported Suzanne V. Arnold, MD, a cardiologist at Saint Luke's Mid America Heart Institute, Kansas City, MO. The data were presented at the American Heart Association's Quality of Care and Outcomes Research conference.The diabetes diagnosis was based on hemoglobin A levels of 6.5% or higher. If no HbA result was available, the diagnosis was based on at least two fasting glucose levels of 126 mg/dL or higher, or at least one fasting glucose level of 126 mg/dL or higher plus a glucose level at presentation of at least 200 mg/dL.Of the 287 patients who were identified as having unrecognized diabetes in the study, almost 70% (198) had not been diagnosed by the physician who treated them during their hospitalizations. This lack of a diagnosis was indicated by patients not having received education about diabetes while hospitalized or not being discharged with a diabetes medication.If a physician checked the HbA1c for a patient with an acute MI as part of routine clinical care, however, the likelihood that the patient would be diagnosed with diabetes was increased 18-fold, a statistically significant finding, Dr. Arnold said.The registry study is the TRIUMPH (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status) study. Ten percent of patients presenting with an acute myocardial infarction had undiagnosed diabetes at the time of their heart attack, underlining the importance of evaluating such patients for diabetes while they are being treated, investigators have reported. The study found that 287 (10.1%) of the 2,854 patients enrolled in a 24-site U.S. acute MI registry, who were not known to have type 2 diabetes at hospital admission, actually had diabetes, reported Suzanne V. Arnold, MD, a cardiologist at Saint Luke's Mid America Heart Institute, Kansas City, MO. The data were presented at the American Heart Association's Quality of Care and Outcomes Research conference. The diabetes diagnosis was based on hemoglobin A levels of 6.5% or higher. If no HbA result was available, the diagnosis was based on at least two fasting glucose levels of 126 mg/dL or higher, or at least one fasting glucose level of 126 mg/dL or higher plus a glucose level at presentation of at least 200 mg/dL. Of the 287 patients who were identified as having unrecognized diabetes in the study, almost 70% (198) had not been diagnosed by the physician who treated them during their hospitalizations. This lack of a diagnosis was indicated by patients not having received education about diabetes while hospitalized or not being discharged with a diabetes medication. If a physician checked the HbA1c for a patient with an acute MI as part of routine clinical care, however, the likelihood that the patient would be diagnosed with diabetes was increased 18-fold, a statistically significant finding, Dr. Arnold said. The registry study is the TRIUMPH (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status) study.

Realtime Monitoring of Cardiac Patients at Distance Using Tarang Communication

Nowadays heart attack patients are increasing day by day. Though it is tough to save the heart attack patients, we can increase the statistics of saving the life of patients & the life of others whom they are responsible for. The main design of this project is to track the heart attack of patients who are suffering from any attacks during driving and send them a medical need & thereby to stop the vehicle to ensure that the persons along them are safe from accident. Here, an eye blinking sensor is used to sense the blinking of the eye. spO2 sensor checks the pulse rate of the patient. Both are connected to micro controller. If eye blinking gets stopped then the signal is sent to the controller to make an alarm through the buffer. If spO2 sensor senses a variation in pulse or low oxygen content in blood, it may results in heart failure and therefore the controller stops the motor of the vehicle. Then Tarang F4 transmitter is used to send the vehicle number & the mobile number of the patient to a nearest medical station within 25 km for medical aid. The pulse rate monitored via LCD.The Tarang F4 receiver receives the signal and passes through controller and the number gets displayed in the LCD screen and an alarm is produced through a buzzer as soon the signal is received.

Abstract 357: Statewide Collaboration in Rural STEMI System Development in Resource Limited Environments- Where You Live Shouldn't Determine If You Live: North Dakota Mission: Lifeline

Background: Mission: Lifeline is a strategic initiative to save lives and reduce disability by improving emergency readiness and response to heart attack patients. Heart disease is the number one killer in North Dakota and nationally. North Dakota consists of 53 counties over 69,001 square miles with a population of 680,000. Thirty-four entire counties are designated medically underserved areas and 13 counties have some part of them designated medically underserved. A large number of residents reside in the 36 frontier counties 21% (142,800/680,000) with a population density of < 6 people/mile, and 9 rural counties 15% (102,000 of 680,000): < 5000 residents Population density of > 6/mile together making up just over one third of the state population and 85% (45 of 53) of the physical territory. Eight urban counties with a city of at least 15,000 make up the remaining population at 63% (428,400 of 680,000). In 2011, ND M:L received a $7.1 million grant to bridge gaps in disparities in access to care by streamlining statewide STEMI systems. Methods: A statewide initiative was implemented for pre-hospital recognition, education, triage, and treatment of STEMI patients to the most appropriate reperfusion strategy. • Ninety eight percent (123 of 125) licensed ground EMS received funding to enable pre-hospital 12 lead ECG acquisition and transmission to both referral and receiving hospitals • In person facilitated education were provided to each EMS agency in 3 rounds with focus on acquisition, recognition and triaging of STEMI patients utilizing the ACC/AHA guidelines. • PCI receiving hospital physician and nurse educator teams facilitated a standardized in person clinical STEMI education session at each of the 38 referring hospitals focused on utilizing a state recommended referring hospital STEMI protocol, EMS transport guideline, and a STEMI feedback process • Six of six PCI receiving hospitals collected data utilizing the ACTION GWTG Registry Results: • In ND aggregate data from Quarter 3 2012 to Quarter 3 2013 there have been marked improvements in several measures. The ND Mission: Lifeline composite score 93% (557/ 596) to 97% (471/482) 1ST EKG obtained Pre-hospital 46% (56/122) to 76% (92/121) ED Arrival to First In-Hosp ECG % within 10 minutes 66.% (81/122) to 84% (103/122) Arrival to Primary PCI <= 90 min. from 86% (32/37) to 100% (43/43) Conclusions: To sustain STEMI system of care for patients in ND, collaboration with regional partners, care standardization, aggregate data sharing and feedback have been identified as vital. Regional champions committed to systemization are central to EMS and referral hospital engagement and state level process improvement. PCI receiving hospitals lead the way in convening regional multidisciplinary teams meetings, and facilitating data feedback on STEMI systems at a state level to support a unified platform of sustainability.

E-028 Implementation of an ED-based Rapid Brain-Attack Triage Algorithm in a Regional Tele-stroke Network Positively Impacts Discharge Disposition for Stroke Patients

IntroductionImplementation of standardized algorithms and EMS transport to centers with catheter-based capabilities have impacted time-to-treatment and functional outcomes in ischemic cardiac patients. However, there are limited data on the impact...

Demographic and Blood Lipid Profiles in Correlation with Heart Attacks among Mediterraneans

Aim: To evaluate the role of some demographic and plasma lipid variables in heart attack occurrence among Palestinians. Demographic variables under study include age, sex, smoking, sporting (walking, running, basketball, etc.) hypertension and diabetes mellitus. Cholesterol, triglyceride, LDL and HDL are the blood lipid variables under study. Materials and Methods: Descriptive analytical and correlation design were set as a frame for data collection. Data were collected from 186 subjects, representing both healthy and unhealthy heart groups. Ninety six were free from heart attacks while 89 were diagnosed as heart attack patients. Whole blood samples were collected in EDTA tubes. Plasma samples were used to measure total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides using the commercial Human Liquicolor Kits. Demographic information’s about subjects were collected from either subjects themselves or their attendant relatives in their respective hospitals. Results: The association between demographic and lipid profiles with occurrence of heart attack was demonstrated as statistically significant. Sporting and HDL factors negatively correlated with heart attack incidences. Moreover, statistical differences between the study groups were demonstrated in all study variables, except age and sporting. Conclusion: Irrespective of geographical or cultural factors, most of the studied demographic as well blood lipid profiles were significantly contributing to the occurrence of cardio problems as risk factors.

Toll-like receptor 3 plays a role in myocardial infarction and ischemia/reperfusion injury

Innate immune and inflammatory responses mediated by Toll like receptors (TLRs) have been implicated in myocardial ischemia/reperfusion (I/R) injury. This study examined the role of TLR3 in myocardial injury induced by two models, namely, myocardial infarction (MI) and I/R. First, we examined the role of TLR3 in MI. TLR3 deficient (TLR3−/−) and wild type (WT) mice were subjected to MI induced by permanent ligation of the left anterior descending (LAD) coronary artery for 21days. Cardiac function was measured by echocardiography. Next, we examined whether TLR3 contributes to myocardial I/R injury. TLR3−/− and WT mice were subjected to myocardial ischemia (45min) followed by reperfusion for up to 3days. Cardiac function and myocardial infarct size were examined. We also examined the effect of TLR3 deficiency on I/R-induced myocardial apoptosis and inflammatory cytokine production. TLR3−/− mice showed significant attenuation of cardiac dysfunction after MI or I/R. Myocardial infarct size and myocardial apoptosis induced by I/R injury were significantly attenuated in TLR3−/− mice. TLR3 deficiency increases B-cell lymphoma 2 (BCL2) levels and attenuates I/R-increased Fas, Fas ligand or CD95L (FasL), Fas-Associated protein with Death Domain (FADD), Bax and Bak levels in the myocardium. TLR3 deficiency also attenuates I/R-induced myocardial nuclear factor KappaB (NF-κB) binding activity, Tumor necrosis factor alpha (TNF-α) and Interleukin-1 beta (IL-1β) production as well as I/R-induced infiltration of neutrophils and macrophages into the myocardium. TLR3 plays an important role in myocardial injury induced by MI or I/R. The mechanisms involve activation of apoptotic signaling and NF-κB binding activity. Modulation of TLR3 may be an effective approach for ameliorating heart injury in heart attack patients.

Hospital length of stay and readmission: an early investigation.

This article is an investigation into the relationship between length of stay and readmission within 30 days of discharge from an acute care hospitalization. We estimated probability models for heart attack and for heart failure patients using generalized estimating techniques applied to hospital administrative data from California for calendar year 2008. The key independent variable was length of stay in the initial hospitalization. We found negative associations between length of stay and readmission probability, particularly in the case of heart attack. Simulated values of predicted readmissions based on a 1-day increase in length of stay yielded estimated reductions in readmission rates in the 7% to 18% range for heart attack patients and the 1% to 8% range for heart failure patients. Increasing length of stay for some patients may be a means of improving quality of care by reducing readmission during the 30-day postdischarge period.