In-hospital Period Research Articles

Efficacy and safety of dapagliflozin in non-diabetic patients with primary anterior ST-elevation myocardial infarction initiated in early hospital period

Abstract Background The effectiveness of SGLT2 inhibitors has been proven in all types of chronic heart failure (HFpEF, HFmrEF, and HFrEF), regardless of the presence of diabetes mellitus. There are still no clear recommendations regarding the timing of SGLT2 inhibitor administration after myocardial infarction (MI) and its influence on prognosis. It can be assumed that it is appropriate to consider the possibility that, if started quickly after the presentation of acute MI, SGLT inhibition might enhance outcomes in patients. Objective This study aims to investigate the efficacy and safety of the SGLT2 inhibitor Dapagliflozin in primary anterior ST-segment elevation myocardial infarction (STEMI) initiated in early hospital period, irrespective of heart failure manifestation. Methods The study includes 124 non-diabetic patients with primary anterior STEMI who underwent primary PCI and had left ventricular ejection fraction (LV EF) ≤45% and NT-proBNP > 900 pg/ml at symptom onset within 24 hours, regardless of heart failure symptom manifestation. Patients with cardiogenic shock were excluded. 62 patients received standard medical treatment including beta-blockers, ACE inhibitors (Control group), while the other 62 patients were administered the SGLT2 inhibitor Dapagliflozin 10 mg once a day during the first 48 hours of inpatient treatment, in addition to standard therapy (Dapa group). All patients were followed up for one year. Echocardiography was performed during the first 24 hours. Echocardiography and NT-proBNP were repeated at the end of the year. The primary endpoint was the one-year heart failure hospitalizations and secondary endpoints included one year cardiovascular mortality and changes in NT-proBNP, plasma creatinine and glycosylated hemoglobin levels. Results The study shows a significant difference in heart failure hospitalization between the groups. In the Control group, it was 25.8%, and in the Dapa group, it was 8.1% (p = 0.008). Initially, there were no significant changes in NT-proBNP levels; 1152.2 ± 222.4 pg/ml in the Control group and 1197.3 ± 279.8 pg/ml in the Dapa group (p= 0.33). At the end of a year, NT-proBNP increased in the Control group (1827.4 ± 317.8 pg/ml), whereas in the Dapa group, it significantly decreased (613.5 ± 215.6 pg/ml) (p < 0.01). One-year cardiovascular mortality in the Control and Dapa groups was 9.7% and 4.8%, respectively(p=0.491). Other blood markers did not differ, and side effects were comparable during the in-hospital period as well as at the end of the year. Conclusion Early administration of Dapagliflozin among non-diabetic patients with primary anterior STEMI is associated with a significant decreasing of heart failure hospitalization rate and NT-proBNP level. Additionally, early administration of dapagliflozin does not impact on safety indicators.

Trends in Mortality After Incident Hospitalization for Heart Failure Among Medicare Beneficiaries

Despite advances in treatment and care quality for patients hospitalized with heart failure (HF), minimal improvement in mortality has been observed after HF hospitalization since 2010. To evaluate trends in mortality rates across specific intervals after hospitalization. This cohort study evaluated a random sample of Medicare fee-for-service beneficiaries with incident HF hospitalization from January 1, 2008, to December 31, 2018. Data were analyzed from February 2023 to May 2024. Unadjusted mortality rates were calculated by dividing the number of all-cause deaths by the number of patients with incident HF hospitalization for the following periods: in-hospital, 30 days (0-30 days after hospital discharge), short term (31 days to 1 year after discharge), intermediate term (1-2 years after discharge), and long term (2-3 years after discharge). Each period was considered separately (ie, patients who died during one period were not counted in subsequent periods). Annual unadjusted and risk-adjusted mortality ratios were calculated (using logistic regression to account for differences in patient characteristics), defined as observed mortality divided by expected mortality based on 2008 rates. A total of 1 256 041 patients (mean [SD] age, 83.0 [7.6] years; 56.0% female; 86.0% White) were hospitalized with incident HF. There was a substantial decrease in the mortality ratio for the in-hospital period (unadjusted ratio, 0.77; 95% CI, 0.67-0.77; risk-adjusted ratio, 0.74; 95% CI, 0.71-0.76). For subsequent periods, mortality ratios increased through 2013 and then decreased through 2018, resulting in no reductions in unadjusted postdischarge mortality during the full study period (30-day mortality ratio, 0.94; 95% CI, 0.82-1.06; short-term mortality ratio, 1.02; 95% CI, 0.87-1.17; intermediate-term mortality ratio, 0.99; 95% CI, 0.79-1.19; and long-term mortality ratio, 0.96; 95% CI, 0.76-1.16) and small reductions in risk-adjusted postdischarge mortality during the full study period (30-day mortality ratio, 0.88; 95% CI, 0.86-0.90; short-term mortality ratio, 0.94; 95% CI, 0.94-0.95; intermediate-term mortality ratio, 0.94; 95% CI, 0.92-0.95; and long-term mortality ratio, 0.95; 95% CI, 0.93-0.96). In this study of Medicare fee-for-service beneficiaries, there was a substantial decrease in in-hospital mortality for patients hospitalized with incident HF from 2008 to 2018, but little to no reduction in mortality for subsequent periods up to 3 years after hospitalization. These results suggest opportunities to improve longitudinal outpatient care for patients with HF after hospital discharge.

Nutritional Risk Screening 2002 score is a predictor of prolonged hospitalizations after cardiac ablation procedures

Abstract Background Nutritional risk is a recognized factor of mortality, complications, and length of stay at a hospital in various medical conditions. This relationship was already proven in surgery, oncology, and selected cardiovascular diseases. Purpose This study aimed to analyze, if the Nutritional Risk Screening 2002 (NRS 2002) score is a predictor of the hospitalization length and in-hospital convalescence period defined as the time from the procedure to discharge among patients undergoing cardiac ablations. Methods 265 patients who underwent cardiac ablation in 2023 were included in this retrospective study. The analyzed parameters included the overall length of stay and the time of the in-hospital convalescence after the ablation procedure. They were combined with the nutritional risk assessed with NRS 2002, body mass, and body mass index. The analysis was also performed in subgroups regarding the type of arrhythmia. Results The regression analysis revealed a significant impact of the NRS 2002 score on the overall length of stay (B=0.89, p=0.003) and the in-hospital convalescence time (B=0.57, p=0.02). Subgroup analysis revealed that this relationship was particularly strong in the atrial fibrillation patients (B=1.10, p=0.001 and (B=0.91, p=0.002 respectively), and in atrial arrhythmias for the overall length of stay (B=0.92, p=0.001), and ventricular arrhythmias for the convalescence time (B=0.76, p=0.002). Lower body mass index impacted the prolonged convalescence time (B= -0.05, p=0.03), mainly in the atrial fibrillation subgroup (B= -0.08, p=0.04) and atrial arrhythmias (B= -0.05, p=0.04). Conclusions Nutritional risk is a factor that impacts the length of stay and in-hospital convalescence in patients undergoing cardiac ablations, particularly in atrial fibrillation patients.

First experience of focal pulsed field ablation for premature ventricular contractions

Abstract Introduction Pulsed field ablation (PFA) has emerged as a novel strategy to achieve ablation of cardiac tissue. Clinical evidence suggests a remarkable lesion durability and safety profile for AF ablation. Nonetheless, a growing interest exists in broadening its field of application for catheter ablation of ventricular arrhythmias (VA). The CENTAURI system arises as a promising PFA system for targeting VA as it allows pulsed electric field (PEF) delivery via standard, commercially available focal ablation catheters and concomitant coupling with their mapping systems. Purpose To assess, for the first time, the feasibility of focal PFA via the CENTAURI system for premature ventricular complex (PVC) ablation. Methods We conducted a prospective analysis of patients with either high burden (>10%) or symptomatic idiopathic PVC undergoing focal PFA using CENTAURI system at our institution. Procedures were performed between December 2022 and August 2023. Acute and long-term success were defined as no PVC recurrence during a 24h in-hospital monitoring period, and ≥80% burden reduction with absence of symptoms after at least 30 days post-ablation, respectively. PVC monitoring was performed by implantable loop recorder (ILR) or surface ECG Holter monitoring. Results Fourteen patients (age range: 16-87 years; 10 females) were included. Procedures were performed via the CENTAURI system in combination with CARTO 3 system and EnSite X EP system in 4 (28.6%) and 10 cases (71.4%) respectively. Targeted ablation sites were the right ventricular outflow tract (6 cases), right moderator band (2 cases), left postero-medial papillary muscle -PM- (2 cases), and right posterior PM, tricuspid annulus, left posterior fascicle and aortomitral continuity (AMC) in one case. On average, 6.5 applications were delivered to the site of origin with a mean contact force of 11g. Procedural duration and fluoroscopy time were 102 and 8.9 minutes. Two minor complications were observed: one transitory ST depression (solved after i.v. nitrate administration) after repeated applications to AMC, and a femoral pseudoaneurysm. The remaining 12 procedures were uneventful. Although most of the procedures were performed under general anesthesia due to concerns about potential significant muscular contraction, 3 cases (21.4%) were successfully managed with light sedation, without significant muscular contraction nor map shift. Incomplete abolishment of PVC during first 24 h was observed in 2 patients (14.3%). After a median follow-up of 113 days (IQR: 83-188), recurrences were detected in one patient (7.14%). Conclusion Herein we report the feasibility and efficacy of PVC ablation using a focal PEF delivery system (CENTAURI). Furthermore, we describe the possibility of performing PVC ablation with this technology under light sedation, which might be important for minimizing anesthesia impact on PVC burden.Table of characteristicsPVC morphologies

Patterns of perioperative arrhythmias in adult cardiac surgery: A single center study from Sri Lanka

Introduction: There is no published data on perioperative arrhythmias in adults undergoing cardiac surgery in Sri Lanka. The object of this study was to assess the patterns of peri operative arrhythmias in cardiac surgical patients. Methods and material: This is a prospective descriptive study of 100 patients in a single cardiothoracic unit in a tertiary care hospital in Sri Lanka from November 2018 to May 2020. Demographic data and clinical data were assessed in all patients. Furthermore, 24-hour Mobile Cardiac Outpatient Telemetry MCOT was assessed in a subset of patients. Results: There were 72 males and 28 females. The mean age was 60 (range 37-76 years). The majority (76) had undergone isolated coronary artery bypass grafting (CABG). The mortality was 3.5% in routine and 15% in urgent and emergency operations. Arrhythmias where lowest preoperatively (11%). Arterial fibrillation (AF) (6%) and sinus bradycardia (4%) were the commonest arrhythmias seen preoperatively. Arrhythmias were higher during surgery (29%) and ventricular fibrillation (VF) (25%) was the commonest. Arrhythmias were highest post operatively (34%) and (AF) (12%) was the commonest followed by sinus tachycardia (9%). The higher incidence of arrhythmias in the in-hospital postoperative period as compared to the preoperative period was significant (p=0.0001). A limited in-depth study using a mobile cardiac telemetry (MCOT) device showed a higher incidence of AF preoperatively (11%) and postoperatively (16%) but these differences were not significant when compared with that of routine investigations (p=0.18 and p=0.35 respectively). However, the MCOT detected some arrhythmias completely missed by routine ECG recordings, notably supraventricular tachycardia, both preoperatively (22%) and postoperatively (33%). Conclusions: This study has established baseline values of perioperative arrhythmias in the adult cardiac surgical patients in Sri Lanka. The MCOT methodology shows the potential for a more detailed study of arrhythmias and could inform decision-making in arrhythmia prophylaxis.

Abstract 53: Patients With Tandem Lesions Undergoing Thrombectomy Have Increased In-Hospital Stroke Recurrence Risk

Introduction: Mechanical Thrombectomy improves outcomes in patients with acute ischemic stroke due to large vessel occlusion. Nearly 15% of patients have a tandem extracranial and intracranial occlusion. There is limited data on in-hospital outcomes in patients with acute tandem lesions undergoing thrombectomy. Methods: We included patients hospitalized with acute ischemic stroke and large vessel occlusion undergoing thrombectomy at our comprehensive stroke center over a 7-year period. Data on demographics and baseline risk factors, occlusion site, and acute treatment was pulled from the stroke registry. Records were reviewed for the study outcome which was recurrent ischemic stroke during the in-hospital period, defined as new or worsening neurological symptoms due to new infarct or extension of the infarct. All outcomes were confirmed by a second neurologist. Patients were followed for 90-days and received a 90-day call to determine their modified rankin scale. We defined good functional outcome as 90-day mRS 0-2. We used fisher’s exact test and t-tests to compare categorical and continuous variables and built binary logistic regression model to compare 90-day mRS across the two groups (tandem vs. non-tandem lesions), adjusting for age and NIHSS scale. Results: We identified a total of 1347 patients (mean age 72 years, 51% women) who underwent thrombectomy and 226 (16.7%) had tandem lesions and 108/226 (47.8%) underwent acute stenting. Patients with tandem lesions were more likely to be men (60.6% vs. 46.6%,), have hyperlipidemia (60.9% vs. 52.1%), coronary artery disease (25.3% vs. 19.0%), smokers (35.9% vs. 20.5%) and less likely to have atrial fibrillation (20.0% vs. 46.2%) and history of congestive heart failure (8.0% vs. 16.8%), all p<0.05. Patients tandem occlusions were more likely to have in-hospital recurrent ischemic stroke (8.0% vs. 4.1%, p = 0.012). Acute stenting was not associated with improved functional outcome at 90-days (aOR 0.86, 95% CI 0.41-1.82, p = 0.703). Conclusion: In this large cohort of thrombectomy patients, patients with tandem lesions had increased in-hospital recurrent stroke and acute stenting in this sub-group was not associated with improved functional outcome at 90-days.

The effect of in-hospital breast milk intake on the gut microbiota of preterm infants

The aim of this study was to explore the effect of in-hospital breast milk intake on the development of early gut microbiota in preterm infants in two dimensions: longitudinal over time and cross-sectional between groups. Researchers collected preterm infants' general data baseline characteristics, recorded their daily breast milk intake, probiotics, and antibiotics use, and collected their stool specimens at 1st week, 2ndweek, 3rd week and 4th week after birth. The researchers analyzed the effect of breast milk on gut microbiota of preterm infants by bioinformatics methods of intra-group longitudinal variation of gut microbiota structure and diversity in preterm infants and cross-sectional differences between >70% in-hospital breast milk intake (BM) group and ≤70% (PF) group. A total of 60 preterm infants were included in this study, and a total of 213 stool specimens were retained. BM had statistically different Shannon and Simpson indices between the first and fourth week after admission (P<0.05), both of them showed a lower diversity in the later week than in the previous week. The Shannon index and Simpson index of BM from week 3 onwards were statistically different from PF (P<0.05), and the Shannon index and Simpson index of BM were lower than those of PF. Significantly statistical differences (P<0.05) were found in the beta diversity of gut microbiota in preterm infants as time progressed, and both showed a lower beta diversity in the later week than in the preceding week. The dominant taxa of PF in the first postnatal week were Bifidobacterium animalis, etc., the dominant taxa of BM in the third postnatal week were Clostridium_sensu_stricto _1, etc. CONCLUSIONS: The development and evolution of gut microbiota in preterm infants' in-hospital period was a continuous, non-random process, and similar trends in species composition and changes in gut microbes emerged in preterm infants with different ratio of breast milk intake. In the NICU setting, alpha diversity was lower in preterm infants in the >70% breast milk intake group than in the ≤70% group when compared between groups at the same time, which may be related to delayed maturation of gut microbes and represents a more developmental gut time window.

The prognostic value of dynamic changes in SII for the patients with STEMI undergoing PPCI

BackgroundPredicting the prognosis of primary percutaneous coronary intervention(PPCI) in ST-segment elevation myocardial infarction (STEMI) patients in the perioperative period is of great clinical significance. The inflammatory response during the perioperative period is also an important factor. This study aimed to investigate the dynamic changes in the systemic immune inflammatory index (SII) during the perioperative period of PPCI and evaluate its predictive value for in-hospital and out-of-hospital outcomes in patients with STEMI.MethodsThis retrospective study included 324 consecutive patients with STEMI who were admitted to the cardiac care unit. Blood samples were collected before PPCI, 12 h (T1), 24 h, 48 h after PPCI, the last time before hospital discharge (T2), and 1 month after hospital discharge. The SII was calculated as (neutrophils×platelets)/lymphocytes. Based on whether the primary endpoint occurred, we divided the patients into event and non-event groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors that might influence the occurrence of the primary endpoint. Dynamic curves of SII were plotted, and receiver operating characteristic (ROC) curves were drawn for each node to calculate the optimal critical value, sensitivity, and specificity to assess their predictive ability for in-hospital and out-of-hospital courses. Kaplan-Meier curves were used to analyze the differences in survival rates at different SII inflammation levels.ResultsHigh levels of SII were individually related to the occurrence of the in-hospital period and long-term outcomes during the post-operative follow-up of STEMI patients (in-hospital SII: T1:OR 1.001,95%CI 1.001–1.001, P < 0.001; SII following hospital discharge: T1M: OR 1.008,95%CI 1.006–1.010, P < 0.001). Patients with high SII levels had lower survival rates than those with low SII levels. The analysis showed that the SII 12 h after (T1) and SII 1 month (T1M) had excellent predictive values for the occurrence of in-hospital and out-of-hospital outcomes, respectively (AUC:0.896, P < 0.001; AUC:0.892, P < 0.001).ConclusionThere is a significant relationship between the dynamic status of SII and prognosis in patients with STEMI. This study found that the 12 h and SII 1 month affected in-hospital and out-of-hospital outcomes, respectively. Consequently, we focused on the dynamic changes in the SII.

Clinical and functional status and postoperative complications in patients with chronic thromboembolic pulmonary hypertension in the age aspect

Aim. To study the clinical and functional status and the early postoperative follow-up in elderly patients with chronic thromboembolic pulmonary hypertension (CTEPH).Material and methods. Patients with CTEPH were divided into two groups: group 1 (35 people) – patients ≥65 years old, group 2 (98 people) – &lt;65 years old. The baseline clinical and functional data of both groups and the in-hospital period after pulmonary endarterectomy, were analysed.Results. Patients with CTEPH ≥65 years old compared with patients &lt;65 years old were characterized by a higher comorbidity, a higher incidence of adverse cardiovascular events and the presence of chronic heart failure IV class (p&lt;0.05). Echo-CG data in patients with CTEPH ≥65 years old were characterized by a large size of the left atrium, more pronounced hypertrophy of the right ventricle free wall, interventricular septum and the left ventricular posterior wall compared with younger patients (p&lt;0.05). Also, in patients ≥65 years old, lower values of the left ventricular ejection fraction were found with preservation of global myocardial contractility (p&lt;0.05). The early postoperative period in patients with CTEPH ≥65 years is characterized by a more severe course compared to the group of patients &lt;65 years due to a larger proportion of patients with the development of newly diagnosed atrial fibrillation, multiple organ failure and postoperative bleeding (p&lt;0.05). Despite this, there were no intergroup differences in the length of the hospital period and in-hospital mortality (p&gt;0.05).Conclusion. The early postoperative results of pulmonary endarterectomy in elderly patients with CTEPH showed no differences in the length of hospital stay and in-hospital mortality compared with younger patients, which indicates the feasibility of surgical treatment of this category of patients in the specialized cardiac surgical centers.

REASONABLE INCOMPLETE REVASCULARIZATION USING MINIMALLY INVASIVE CORONARY ARTERY BYPASS GRAFTING TECHNIQUES

HighlightsIn multivessel coronary artery disease coronary artery bypass grafting under cardiopulmonary bypass using the internal thoracic artery is the accepted standard of revascularization, however, it is characterized by high trauma. Minimally invasive techniques offset this disadvantage but cannot always provide complete revascularization. Determination of feasibility and combined use of incomplete revascularization with minimally invasive techniques of coronary artery bypass may be a worthy alternative to traditional coronary bypass in a certain group of patients. At the same time, literature the data are ambiguous and deficient in the world. Aim. To justify the use of minimally invasive coronary artery bypass technique in incomplete myocardial revascularization in patients with stable ischemic heart disease from the standpoint of efficacy and safety.Methods. The retrospective study focuses on the analysis of minimally invasive coronary artery bypass grafting (minimally invasive direct coronary artery bypass grafting and off-pump coronary artery bypass surgery using sternotomy) and traditional CABG with cardiopulmonary bypass in patients with multivessel coronary artery disease (n = 429) performed in the period from 2013 to 2017. Depending on the CABG technique and the type of revascularization (complete/incomplete), all patients were divided into 3 groups with two comparison subgroups in each. The completeness of revascularization was assessed using the residual SYNTAX score (rSS). The SYNTAX revascularization index (SRI) was calculated using the following formula: SRI = [1 – (rSS/bSS)] × 100. Subsequently, a two-stage (short- and long-term) analysis of the adverse events frequency was carried out.Results. The minimally invasive incomplete revascularization (IR) group and the traditional complete revascularization (CR) group. The rSS in the IR group was 3.0 [2.0; 5.0] compared with the group without traditional CABG, whereas the SRI was 84.31 [75.00; 89.19] % compared with 100.00 [100.00; 100.00] %, respectively (p&lt;0.001). The analysis of in-hospital period did not reveal significant differences in the number of primary and secondary endpoints. Taking into account the additional endpoints, the IR group had a lower level of intraoperative blood loss – 300 [200; 310] mL compared with 500 [400; 500] mL in the CR group (p&lt;0.001). Moreover, the need for blood transfusion was significantly lower – by 4.27 times (95% CI: 0.124–0.441, p&lt;0.001). The length of patients stay with IR in the intensive care unit was 4.12 times shorter (95% CI: 1,954–8,994, p&lt;0.001). The 1-year follow-up visit revealed full comparability between the groups in terms of frequency of both primary and secondary endpoints. There were no differences in freedom from MACCE and mortality.The minimally invasive CR group and the traditional CR group. The in-hospital period and 1-year follow-up visits showed similar outcomes, comparable to the minimally invasive IR and traditional CR groups. The minimally invasive IR group and the minimally invasive CR group. The analysis of in-hospital period and 1-year follow-up visits did not reveal any differences in endpoints. Freedom from MACСE and death was similar as well.Conclusion. The data obtained indicate a similar safety profile and effectiveness of IR. Minimally invasive IR is appropriate with rSS ≤3 and SRI ≥84.3% and can be considered as an alternative approach to myocardial revascularization in patients for whom traditional CABG is undesirable.

Real-world drug prescription patterns and mortality risk in patients hospitalized with acute heart hailure: impact of multimorbidity and heart failure phenotype

Abstract Background Real-world data on the impact of multimorbidity and of heart failure (HF) phenotype on longitudinal drug prescription patterns and dosing of guideline-recommended HF drugs and on mortality risk following acute HF (AHF) is sparse. Purpose We studied prescription rates (PR) and dosing of renin-angiotensin-system inhibitors (RASi), betablockers (BB), and mineralocorticoid-receptor antagonists (MRA) in patients hospitalized with AHF by comorbidity burden (CB) and HF phenotype on admission, at discharge, and at 6-month follow-up (6MFUP), and determined 12-month mortality risk. Methods Consecutive AHF patients enrolled on a 24/7 basis in a single-center prospective cohort study from 8/2014 to 2/2020, who had their left ventricular ejection fraction (LVEF) measured while in hospital, were eligible. Proportions of patients taking each HF drug class on admission, at discharge and at 6MFUP were determined in subgroups according to LVEF (&amp;lt;50% versus ≥50%) and CB (number present of: hypertension, chronic kidney disease, diabetes, anemia, chronic lung disease, psychiatric disorder, malignancy, atrial fibrillation, coronary disease, peripheral vascular disease, hypercholesterolemia). Results Of 943 patients, 47% had a LVEF &amp;lt;50%, and 53% had a LVEF of ≥50% (Table). CB was similar in both groups (p = 0.197), but patients with LVEF ≥50% were older and more often female (Table). Average PR of the 3 HF drug classes were higher in patients with LVEF &amp;lt;50% compared with ≥50% (mean count 2.2±0.8 vs. 1.7±0.8, respectively, p&amp;lt;0.001), but PR trajectories were similar: In patients with fewer comorbidities, PR were lower on admission but showed the greatest increase during the hospital stay (in particular for BB and RASi). PR improved in all patients irrespective of CB and reached a maximum at discharge (Figure). Still, many patients remained on suboptimal drug doses (irrespective of CB), and PR tended to decrease again at 6MFUP, except for MRA, which were often not prescribed at all even in patients with LVEF &amp;lt;50%. Absolute 12-month mortality risk was similar in the patients with LVEF &amp;lt;50% and ≥50%, but CB and number of HF drugs prescribed at discharge impacted significantly on 12-month mortality risk only in patients with LVEF &amp;lt;50% (Table). Conclusion In this study, PR of HF drugs increased during the in-hospital period, irrespective of HF phenotype. Neither PR, nor daily doses improved further after discharge. Prescription patterns were similar across spectra of LVEF and CB, but only in patients with LVEF &amp;lt;50% the number of comorbidities and of prescribed HF drug classes impacted mortality risk significantly. Given that timely implementation of foundational HF therapies (which today include also SGLT2 inhibitors) may improve outcomes, reasons for underprescription (e.g., suspected intolerability of individual drug classes or structural deficits of post-discharge HF management) in real world warrant further study and better control.TableFigure

Improved perioperative narcotic usage patterns in patients undergoing robotic-assisted compared to manual total hip arthroplasty

BackgroundRobot-assisted total hip arthroplasty (RA-THA) improves accuracy in achieving the planned acetabular cup positioning compared to conventional manual THA (mTHA), but optimal dosage for peri-RA-THA and mTHA pain relief remains unclear. This study aimed to compare pain control with opioids between patients undergoing direct anterior approach THA with the use of a novel, fluoroscopic-assisted RA-THA system compared to opioid consumption associated with fluoroscopic-assisted, manual technique.MethodsRetrospective cohort analysis was performed on a consecutive series of patients who received mTHA and fluoroscopy-based RA-THA. The average amount of postoperative narcotics in morphine milligram equivalents (MME) given to each cohort was compared, including during the in-hospital and post-discharge periods. Analyses were performed on the overall cohort, as well as stratified by opioid-naïve and opioid-tolerant patients.ResultsThe RA-THA cohort had significantly lower total postoperative narcotic use compared to the mTHA cohort (103.7 vs. 127.8 MME; P < 0.05). This difference was similarly seen amongst opioid-tolerant patients (123.6 vs. 181.3 MME; P < 0.05). The RA-THA cohort had lower total in-hospital narcotics use compared to the mTHA cohort (42.3 vs. 66.4 MME; P < 0.05), consistent across opioid-naïve and opioid-tolerant patients. No differences were seen in post-discharge opioid use between groups.ConclusionsFluoroscopy-based RA-THA is associated with lower postoperative opioid use, including during the immediate perioperative period, when compared to manual techniques. This may have importance in rapid recovery protocols and mitigating episode burden of care.

Risk of fluid accumulation after cardiac surgery

ObjectivePatients undergoing heart surgery are at high risk of postoperative fluid accumulation due to long procedures and cardiopulmonary bypass. In the present study, we sought to investigate the prevalence of postoperative fluid accumulation and its relation to adverse events in patients undergoing cardiac surgery. MethodsCAREBANK is prospective, single-center cohort study focusing on the adverse events after cardiac surgery. The study population was divided into 2 groups based on 5% postoperative weight gain. All the in-hospital adverse events are registered on the database. The end points of the present study were length of hospital stay, length of intensive care unit stay, occurrence of new-onset atrial fibrillation after hospital major bleeding episodes major cardiac events, cerebrovascular events, and death. Three-month and 1-year follow-up data also include all major adverse events. ResultsAltogether 1001 adult cardiac surgery patients were enrolled. The most frequent operations were coronary artery bypass grafting (56.3%). Five hundred fifty-four out of 939 (59.0%) patients had ≥5% weight gain during index hospitalization. Patients with a weight gain ≥5% were more likely to be women, have lower body mass index, had heart failure, and more often had preoperative atrial fibrillation. In-hospital period fluid accumulation was associated with reoperation due bleeding and longer total hospital stay. At 3 months' follow-up, weight gain 5% or more was associated with increased occurrence of new-onset atrial fibrillation, this was not reflected in the occurrence of strokes, transient ischemic attacks, or myocardial infarctions. ConclusionsPostoperative fluid excess is associated with adverse outcomes in cardiac surgery. Women, low-weight patients, and patients with cardiac failure or atrial fibrillation are prone to perioperative fluid accumulation.

Possible effect of the early administration of tranexamic acid on myocardial injury in patients with severe trauma

Hemodynamic stabilization plays a crucial role in the treatment of patients suffering from severe trauma. Current guidelines recommend the early administration of tranexamic acid (TXA) for bleeding control. While less blood loss can result in less end-organ damage, including myocardial injury, TXA also exhibits prothrombotic effects with potentially adverse myocardial effects. The aim of this study was to investigate the association between the administration of TXA and myocardial injury in patients with severe trauma. We conducted a monocentric cohort study including severely injured patients ≥ 18 years [defined by Injury severity score (ISS) ≥ 16], who were admitted to a tertiary care hospital between 2016 and 2019. Primary outcome measure was myocardial injury according to the fourth Universal Definition (= high sensitive troponin T ≥ 14 ng/l). Secondary endpoints were in-hospital major adverse cardiovascular events (MACE) and mortality. Main exposure was defined as administration of TXA during prehospital period. We conducted multivariate logistic regression models including predefined covariables. A total of 368 patients were screened. Among the 297 included patients (72% male, age. 55?21 years), 119 (40%) presented myocardial injury at hospital arrival. TXA was administered to 20/297 (7%) patients in the prehospital setting, and in 96/297 (32%) patients during pre-or in-hospital period. MACE incidence was 9% (26/297) and in-hospital mortality was 26% (76/297). The adjusted odds ratios (OR) for prehospital TXA and myocardial injury, MACE and mortality were 0.75 [95% confidence interval (CI): 0.25–2.23], 0.51 [95%CI: 0.06–4.30] and 0.84 [0.21–3.33], respectively. In the present cohort of patients suffering from severe trauma, prehospital TXA did not affect the incidence of myocardial injury.

Post-Discharge Risk of Mortality in Children under 5 Years of Age in Western Kenya: A Retrospective Cohort Study.

Limited evidence suggests that children in sub-Saharan Africa hospitalized with all-cause severe anemia or severe acute malnutrition (SAM) are at high risk of dying in the first few months after discharge. We aimed to compare the risks of post-discharge mortality by health condition among hospitalized children in an area with high malaria transmission in western Kenya. We conducted a retrospective cohort study among recently discharged children aged < 5 years using mortality data from a health and demographic surveillance system that included household and pediatric in-hospital surveillance. Cox regression was used to compare post-discharge mortality. Between 2008 and 2013, overall in-hospital mortality was 2.8% (101/3,639). The mortality by 6 months after discharge (primary outcome) was 6.2% (159/2,556) and was highest in children with SAM (21.6%), followed by severe anemia (15.5%), severe pneumonia (5.6%), "other conditions" (5.6%), and severe malaria (0.7%). Overall, the 6-month post-discharge mortality in children hospitalized with SAM (hazard ratio [HR] = 3.95, 2.60-6.00, P < 0.001) or severe anemia (HR = 2.55, 1.74-3.71, P < 0.001) was significantly higher than that in children without these conditions. Severe malaria was associated with lower 6-month post-discharge mortality than children without severe malaria (HR = 0.33, 0.21-0.53, P < 0.001). The odds of dying by 6 months after discharge tended to be higher than during the in-hospital period for all children, except for those admitted with severe malaria. The first 6 months after discharge is a high-risk period for mortality among children admitted with severe anemia and SAM in western Kenya. Strategies to address this risk period are urgently needed.

Neutrophil extracellular traps as a promising marker of poor prognosis in operated patients with infective endocarditisarditis.

Aim. To assess the prognostic value of the formation of neutrophil extracellular traps (NETs) in blood smears of operated patients with infective endocarditis (IE).Material and methods. We prospectively included 46 patients with verified IE and 50 patients with valvular heart disease without IE, hospitalized in a cardiac surgery hospital in 2021-2022 (Moscow), comparable by sex and age. In all patients, NETs were determined upon admission and 7 days after surgery using the MECOS-Ts2 automated microscope (Russia). Patients included in the study were prospectively followed during the in-hospital period (ME [IQR] 30,0 [21,0-41,0] days) for the primary composite endpoint (in-hospital all-cause mortality, embolic, intracardiac, infectious complications) and its individual components.Results. Patients with IE were predominantly male (n=37, 80,4%) with a median age of 55,5 [44,0-70,0] years. The primary combined endpoint was recorded in 76,1% (n=35) of those examined with IE. The NET level after 7 days was significantly higher in patients with IE who had primary combined endpoint events than in the group of operated patients with heart defects without IE (Me [IQR] 4,4 [0,6-26,6] vs 2,9 [1,1-4,3], respectively, p&lt;0,05). Patients with IE who died in the hospital had a significantly higher NET level compared with surviving patients with IE and the control group as at admission (9,2 [1,8-18,9] vs 4,2 [0,3-28 ,5] and 3,4 [1,76,9], respectively, p&lt;0,05), and in dynamics (18,2 [5,2-26,6] vs 4,0 [1, 0-26,6] and 2,9 [1,1-4,3], respectively, p&lt;0,001). The threshold value of dynamic NET ≥11,2% predicted in-hospital death with high accuracy (sensitivity 80,0%, specificity 90,0%, positive predictive value 66,7%, negative predictive value 100,0%, area under the curve 0,915, p=0,003) and the development of postoperative sepsis (sensitivity 75,0%, specificity 88,0%, positive predictive value 60,0%, negative predictive value 100,0%, area under the curve 0,884, p=0,01). The obtained cut-off values significantly predicted the death (OR 23,9 (95% CI 1,7-344,8, p=0,02)) and sepsis (OR 22,0 (95% CI 1,9-256,8, p=0,01)) in the hospital in operated patients with IE.Conclusion. The NET level in blood smears of operated patients with IE is a new promising marker for predicting the disease complicated course. NETs ≥11,2% in operated patients with IE increase the probability of hospital mortality by 24 times and postoperative sepsis by 22 times.

Primary spontaneous pneumomediastinum: 237 cases in a single-center experience over a 10-year period and assessment of factors related with recurrence.

To evaluate the precipitating factors and symptoms of primary spontaneous pneumomediastinum (PSPM) and to assess the factors related with recurrent spontaneous pneumomediastinum (RSPM). From 2010 to 2021, 237 PSPM patients were included in this retrospective study. Clinical information including in-hospital periods, morbidity, mortality, presenting symptoms, precipitating events, smoking, and asthma history was obtained. The patients with smoking history were subdivided into "ex-smoker" or "current smoker". The severity of asthma was categorized into "mild intermittent", "mild persistent", "moderate persistent", or "severe persistent". During follow-up, patients with RSPM were classified into "recurrence" group and the others were into "no recurrence" group. Multivariate regression analysis was used to elucidate the associated factors with RSPM. The mean age of study patients (men: women = 222: 15) was 23.4 years and mean period of hospital stay was 7.5 days. There was no mortality and morbidity. Most frequent symptom and precipitating factor were acute chest pain (n = 211, 89.0%) and cough (n = 72, 30.4%), respectively. RSPM occurred in 11 patients (4.6%). The proportion of patients with smoking (72.8% vs. 37.1%, p = 0.010) or asthma (81.8% vs. 39.8%, p<0.001) was significantly higher in "recurrence" group than "no recurrence" group. On multivariate analysis, asthma was the only factor associated with RSPM (mild intermittent/persistent, OR = 7.092, p = 0.047; moderate persistent, OR = 8.000, p = 0.011). PSPM is a benign disease with no morbidity and mortality. Asthma may be the associated factor with RSPM; thus, despite the low rate of recurrence, patients with asthma should be informed about the chance of RSPM.

Efeitos do cicloergômetro no pós-operatório sobre a capacidade funcional e o tempo de hospitalização em adultos submetidos a cirurgia cardíaca: protocolo de revisão sistemática

Introduction: Among patients undergoing cardiac surgery, some pulmonary and cardiac complications can be observed, which can increase the length of hospital stay. The cycle ergometer is used to try to improve this clinical scenario. However, some inconsistencies can be observed in the literature. Objective: To synthesize evidence on the effects of cycle ergometer use in the in-hospital postoperative period in relation to control therapy without cycle ergometer use on functional capacity and length of hospital stay in adults undergoing cardiac surgery. Methods: Systematic review of randomized clinical trials with patients undergoing cardiac surgery, to evaluate the effects of cycle ergometer use compared to control without cycle ergometer use. Primary outcomes: functional capacity and length of hospital stay. Searches: Medline, EMBASE, PEDro, Pubmed, Allied and AMED, Cinahl, Lilacs, Scielo, Scopus and Cochrane Central, ClinicalTrials.gov, ReBEC, and the references of included studies. Study selection will be conducted by three authors. The risk of bias will be assessed by two independent authors using the Cochrane Risk of Bias 2 (RoB 2) tool and conflicts will be resolved through consensus (in the absence of consensus, a third author will make the decision). The inverse variance method and random effects model will be considered in the meta-analysis. Continuous variables will be analyzed by weighted mean difference and dichotomous variables by relative risk (RR). We will use I2 statistics to estimate the amount of heterogeneity between studies. Discussion: Different cardiac surgeries are performed all over the world, and have been widely investigated. However, some gaps and controversies can be observed. Therefore, a systematic review is essential to clarify existing gaps.

"&lt;i&gt;Festina lente&lt;/i&gt;" — a multicenter study on the outcomes of carotid endarterectomy, depending on vessel suturing speed

Aim. Analysis of inhospital and long-term outcomes of conventional carotid endarterectomy (CEA) depending on vessel suturing speed.Material and methods. The present prospective multicenter study for the period from March 1, 2017 to October 1, 2020 included 2366 patients who underwent conventional CEA with patch angioplasty. Depending on the time required to apply 1 stitch, 4 groups of patients were formed: group 1 (n=471; 19,9%) — 1 stitch per 2 seconds; group 2 (n=865; 36,5%) — 1 stitch per 3 seconds; group 3 (n=692; 29,2%) — 1 stitch per 4 seconds; group 4 (n=338; 14,3%) — 1 stitch per 5 seconds. The term "stitch" refers to two needle punctures. The follow-up postoperative period was 18,5±11,0 months.Results. There were no deaths and myocardial infarctions (MI) in the inhospital postoperative period. In group 1, anastomotic bleeding (n=93; 19,7%; p&lt;0,0001) and stroke (n=3; 0,63%; p=0,02) due to internal carotid artery (ICA) thrombosis were more common. In the long-term follow-up period, there were no significant differences in mortality and MI rates. However, ICA restenosis requiring repeated CEA (n=37; 7,85%; p&lt;0,0001) and related stroke/transient ischemic attack (n=13; 2,8%; p=0,0001) were more often diagnosed in 1 group of patients. According to Kaplan-Meier curves, restenosis was most often revealed 6 months after CEA in the general sample.Conclusion. 1. Vessel suturing at a speed of 1 stitch per 2 seconds is associated with an increased risk of intraoperative ICA thrombosis, bleeding along the anastomosis, stroke, as well as restenosis and stroke in the long-term follow-up period. 2. Vessel suturing at a speed of 1 stitch per 5 seconds is not accompanied by an increase in inhospital stroke rate, despite the maximum ICA occlusion time relative to other groups of patients. 3. Vessel suturing at a speed of 1 stitch per 3 or 4 seconds characterized by the lowest incidence of all complications at the inhospital and long-term stages of postoperative follow-up.

A99 EFFICACY OF THE IN-HOSPITAL OBSERVATORY PERIOD FOR IBD PATIENTS WITH FLARE TREATED WITH ORAL CORTICOSTEROIDS

Abstract Background Inflammatory Bowel Disease (IBD) is a chronic, debilitating collection of diseases with significant impairment to patient quality of life and hospital burden. Patients with acute flare of their disease are managed with IV corticosteroids and ultimately transitioned to an oral equivalent. Despite no formal guideline recommendation, some patients remain in hospital on oral corticosteroids, primarily for observation. Given that each day spent in hospital carries significant costs, examining this observatory period is warranted. The utility of the observatory period for patients recently switched to oral corticosteroids has not yet been studied and may be unnecessarily increasing hospital stays and costs to the Canadian medical system. Purpose - Analyse the efficacy of the in-hospital period for patients on oral corticosteroids after an acute IBD flare in preventing recurrence in the 14 and 28 days post discharge. - Assess the relationship between length of the in-hospital “observatory” period with future hospital burden. Method - This retrospective cohort study identified patients with known IBD who were admitted to Royal Columbian Hospital under the Gastroenterology service primarily for acute flare of their disease from June 1, 2020 to June 30th, 2022. Patients were identified through the clinic EMR (Plexia) and hospital information was accessed via the Fraser Health Health Records Department. This study acheived ethics approval by the Fraser Health Research Ethics Board (Event: 2022376). - Inclusion criteria are as follows: - Age &amp;gt; 18 years old - Prior diagnosis of IBD as per CAG guidelines - Acute IBD flare is primary reason for hospitalization - Hospital management includes IV corticosteroids and discharge medications include a tapering course of oral corticosteroid. - Exclusion criteria are as follows: - Patients found to be non-compliant on outpatient medication regimen (i.e tapering dose of PO prednisone). - Patients with a complicated course in management (concurrent illness that impacted hospital stay). Result(s) -20 patients were identified, with 60 total hospital admissions. -35 visits included an observatory period, with 6 less than 24hr (1 hospital re-presentation), and 29 greater than 24hr (3 hospital re-presentations). -25 visits did not have an observatory period. -The relative risk of patients without an observatory period returning to hospital within 14 and 28 days compared to those with an observatory period was 4.2 and 1.75, respectively. Conclusion(s) These preliminary results suggest an increased relative risk for those without an in-hospital observatory period for short term re-hospitalization. However, we hypothesize this will significantly change once we have broadened our date range and increased our total number of hospitalizations, which is planned prior to the poster presentation date. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared