Low Cardiac Arrest Research Articles

Association between accelerometer-derived physical activity and incident cardiac arrest.

Studies on objectively measured physical activity (PA) have investigated acute cardiovascular outcomes but not cardiac arrest (CA). Our study aimed to investigate the dose-response relationship between accelerometer-measured PA and CA by intensity of PA. This prospective cohort study included 98 893 UK Biobank participants whose PA data were measured using wrist-worn accelerometers. Total PA volume was measured using the average overall acceleration. Minutes per week of light PA (LPA), moderate PA (MPA), and vigorous PA (VPA) were recorded. The incident CA was identified using diagnostic codes linked to hospital encounters and death records. Cox proportional hazard models with restricted cubic splines were used to study the associations, including sex differences. During the follow-up period (median: 7.31 years; interquartile range: 6.78-7.82 years), 282 incident CAs (0.39 per 1000 person-years) occurred. Total PA was inversely related to CA risk. The CA risk decreased sharply until the time spent in MPA or VPA reached ∼360 min or 20 min per week, respectively, after which it was relatively flat. The LPA was not associated with CA risk. Subgroup analyses showed a more pronounced association between PA and a reduced risk of CA in women compared to men. Accelerometer-measured PA, particularly MPA and VPA, was associated with a lower CA risk. Furthermore, a stronger association was observed in women than men.

Catheter-based therapy for intermediate or high-risk pulmonary embolism is associated with lower in-hospital mortality in patients with cancer: Insights from the National Inpatient Sample.

Pulmonary embolism (PE)is a common complication among patients with cancer and is a significant contributor to morbidity and mortality. Catheter-based therapies (CBT),including catheter-directed thrombolysis (CDT)and mechanical thrombectomy, have been developed and are used in patients with intermediate or high-risk PE. However, there is a paucity of data on outcomes in patients with cancer as most clinical studies exclude this group of patients. To characterize outcomes of patients with cancer admitted with intermediate or high-risk PE treated with CBT compared with no CBT. Patients with an admission diagnosis of intermediate or high-risk PE and a history of cancer from October 2015 to December 2018 were identified using the National Inpatient Sample. Outcomes of interest were in-hospital death or cardiac arrest (CA)and major bleeding. Inverse probability treatment weighting (IPTW)was utilized to compare outcomes between patients treated with and without CBT. Variables that remained unbalanced after IPTW were adjusted using multivariable logistic regression. A total of 2084 unweighted admissions (10,420 weighted) for intermediate or high-risk PE and cancer were included, of which 136 (6.5%) were treated with CBT. After IPTW, CBT was associated with lower death or CA (aOR 0.54, 95% CI 0.46-0.64) but higher major bleeding (aOR1.41, 95% CI 1.21-1.65). After stratifying by PE risk type, patients treated with CBT had lower risk of death or CA in both intermediate (aOR0.52, 95% CI 0.36-0.75) and high-risk PE (aOR0.48, 95% CI 0.33-0.53). However, patients with CBT were associated with increased risk of major bleeding in intermediate-risk PE (aOR2.12, 95% CI 1.67-2.69) but not in those with high-risk PE (aOR0.84, 95% CI 0.66-1.07). Among patients with cancer hospitalized with intermediate or high-risk PE, treatment with CBT was associated with lower risk of in-hospital death or CA but higher risk of bleeding. Prospective studies and inclusion of patients with cancer in randomized trials are warranted to confirm our findings.

Ethnopharmacological Overview on Natural Lignan and Neolignan for the Treatment of Cardiovascular Diseases and their Potential Pharmacological Mechanism

Traditional medicine have been used for many disease ailments from the many potentials abilities, and procedures based on assumptions, beliefs, and experiences of traditional societies to preserve their health benefits. Many rural or indigenous populations in many undeveloped nations place a high importance on traditional herbal remedies. Natural products are a common medicinal source that has been used for millennia in Asia, America, and Africa to treat a variety of maladies including high blood pressure, lower cardiac arrest, colic, influenza, dysentery, dyspepsia, and malaria. It contains several photochemical compounds that have distinct and intriguing biological effects. To bridge the gap for future research prospects, this study discusses the past and present state of research on antihypertensive properties of different natural sources of plant based lignan and neolignans in terms of medicinal usage, phytochemistry, pharmacological activities Calcium based, toxicity profile, and therapeutic usage. This assessment is based on a review of the literature in scientific journals and books obtained from libraries and electronic sources. Natural therapeutic properties are just one benefit of medicinal plants; they also provide disease prevention. In this concise overview study research, we are trying to summarize, aggregate the number of plants, and identify their ethnopharmacological properties.

Abstract 12243: Impacts of Obesity in Clinical Outcomes in Patients Hospitalized for Atrial Flutter

Introduction: Atrial Flutter is an abnormal heart rhythm affecting the heart's upper chamber. It has comparative stroke risk to atrial fibrillation but differs in the arrhythmia's origin. There is Paucity of data comparing the relationship between obesity and atrial flutter. This study aims to bridge that gap. Methods: We analyzed the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS was searched for hospitalized adult patients with atrial flutter as a principal diagnosis with and without obesity as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. The secondary outcomes were the rate of catheter ablation, cardiogenic shock (CS), cardiac arrest (CA), total hospital charge (THC), and length of stay (LOS). Multivariate logistic and linear regression analyses were used accordingly to adjust for confounders. Results: About 1,891,479 patients were admitted for Atrial Flutter, 21% (398,040) had underlying Obesity. Cohorts with Obesity vs No Obesity had a mean age of 64.4 years [CI 64.3 - 64.5] vs 72.2 years [CI 72.1 - 72.3]; male (52.4% vs 50.4%), female (47.6% vs 49.6%); white (79.8% vs 82.2%), black (11.0% vs 7.8%), and Hispanic (6.2% vs 5.9%). Compared to patients without Obesity, patients admitted with coexisting Obesity had a statistically significant decrease in mortality (0.47% vs 0.95% aOR 0.72, 95% CI 0.64 - 0.81, P 0.001), CA (0.33% vs 0.42%, P=0.003), and CS (0.58% vs 0.61%, P<0.001) compared to those without obesity. The obesity cohorts also had a statistically significant increase in rates of catheter ablation (aOR 1.18, P<0.001), LOS (aIRR 1.05, P<0.001) and THC (aIRR 1.08, P<0.001). Conclusion: Patients admitted primarily for Atrial Flutter with co-existing Obesity had lower inpatient mortality, CA, and CS. There was a statistically significant increase in the rates of catheter ablation, LOS and THC among the obese group. Additional studies are required to elaborate on the management of this patient group.

Associations between Combined Influenza and Pneumococcal Pneumonia Vaccination and Cardiovascular Outcomes

Background: In 2017, the CDC listed heart disease as the leading cause of death, with pneumonia and influenza being the eighth cause of death. Several studies have suggested the protective effects of influenza vaccination on myocardial infarction (MI). Available evidence supports the use of influenza vaccination in decreasing cardiovascular events, and the Joint Commission considers influenza vaccination a metric of quality care for hospitalized patients. Our specific aim was to evaluate the combined use of pneumococcal pneumonia vaccine (PPV) and influenza vaccine on cardiovascular outcomes and mortality. Methods: A retrospective observational study was conducted using the 2012–2015 US National Inpatient Sample (NIS) database, to compare cardiovascular events in adult patients who did and did not receive vaccination during their hospitalization. ICD-9 codes were used to extract data for specific variables. The outcomes included MI, transient ischemic attacks, cardiac arrest, stroke, heart failure, and death. Adjusted relative risks (RR) were calculated using survey-weighted generalized linear models after adjusting for gender, race, socioeconomic status, diabetes, hypertension, hyperlipidemia, smoking status, prior coronary artery disease, and cerebrovascular disease. The effect of vaccination on in-hospital mortality was assessed in each subgroup of cardiovascular events using RR regressions. Results: This study included 22,634,643 hospitalizations, of which 21,929,592 did not receive immunization. Vaccination solely against influenza was associated with lower MI (RR = 0.84, 95% CI: 0.82–0.87, p < 0.001), TIA (RR = 0.93, 95% CI: 0.9–0.96, p < 0.001), cardiac arrest (RR = 0.36, 95% CI: 0.33–0.39, p < 0.001), stroke (RR = 0.94, 95% CI: 0.91–0.97, p < 0.001), and mortality (RR = 0.38, 95% CI: 0.36–0.4, p < 0.001). Vaccination with PPV alone was associated with MI (RR = 1.13, 95% CI: 1.11–1.16, p < 0.001), TIA (RR = 1.28, 95% CI: 1.26–1.31, p < 0.001), stroke (RR = 1.21, 95% CI: 1.18–1.24, p < 0.001), and lower mortality (RR = 0.47, 95% CI: 0.45–0.49, p < 0.001). Combined PPV and influenza vaccine was associated with lower mortality (2.21% vs. 1.03%, p < 0.001) and lower cardiac arrest (0.61% vs. 0.51%, p < 0.001). In the adjusted analysis, the RR was 0.46 (95% CI: 0.43, 0.49) for mortality in the combined vaccinated cohort. The combined vaccination group also had a significantly reduced risk of mortality among those admitted with MI (RR = 0.46), transient ischemic attacks (RR = 0.58), and stroke (RR = 0.42) compared to the nonvaccinated group. Conclusions: Our study shows a significantly reduced risk of mortality with influenza vaccine and PPV and with combined pneumococcal and influenza vaccination. These data suggest that in-hospital administration of pneumonia and influenza vaccines appears safe and supports the use of combined vaccination during hospitalization due to their cardiovascular benefits.

Outcomes of Acute Myocardial Infarction in Patients with Rheumatoid Arthritis

BackgroundThere is a paucity of data on the outcomes of acute myocardial infarction in patients with rheumatoid arthritis in the contemporary era. MethodsWe queried the National Inpatient Sample database (2002–2016) for hospitalizations with acute myocardial infarction. We described the trends and outcomes of acute myocardial infarction-rheumatoid arthritis compared with acute myocardial infarction-no rheumatoid arthritis. ResultsThe analysis included 9,359,546 hospitalizations with acute myocardial infarction, of whom 123,783 (1.3%) had rheumatoid arthritis. There was an increase in the number of hospitalizations with acute myocardial infarction-rheumatoid arthritis (Ptrend < .001). There was an observed downtrend in mortality rates for acute myocardial infarction-rheumatoid arthritis (5.8% in 2002 vs 5.2% in 2016, Ptrend = .01) corresponding to an increase in the utilization of percutaneous coronary intervention (Ptrend < .001). In the overall cohort of acute myocardial infarction, rheumatoid arthritis was independently associated with lower rate of in-hospital mortality (adjusted odds ratio 0.90; 95% confidence interval, 0.81-0.99, P = .03). Compared with ST-elevation myocardial infarction (STEMI)-no rheumatoid arthritis, STEMI-rheumatoid arthritis was associated with lower in-hospital mortality and cardiac arrest, while it was associated with higher discharges to nursing facilities. No difference in mortality was observed among non-ST-elevation myocardial infarction (NSTEMI)-rheumatoid arthritis and NSTEMI-no rheumatoid arthritis, while NSTEMI-rheumatoid arthritis was associated with lower cardiac arrest, cardiogenic shock, and hemodialysis, at the expense of higher bleeding events and discharges to nursing facilities. ConclusionIn this nationwide analysis, we found an increase in hospitalizations for acute myocardial infarction-rheumatoid arthritis. Among patients with acute myocardial infarction, rheumatoid arthritis was independently associated with lower in-hospital mortality, particularly in cases of STEMI.

Emergency call processing and survival from out-of-hospital ventricular fibrillation

Objectives: Our aim was to report the effect of the emergency call processing in the dispatching centre on survival from out-of-hospital ventricular fibrillation (VF). Methods: This retrospective cohort study was conducted in Helsinki Emergency Medical Services. All consecutive cases with out-of-hospital bystander witnessed VF of cardiac origin between 1 January 1997 and 31 December 2002 were included. Data were collected prospectively. Call processing times, call numbers per dispatcher and telephone guided cardiopulmonary resuscitation (CPR) were studied. Discharge alive from hospital was used as primary end point. Results: The study population consisted of 373 cases. Cardiac arrest (CA) was recognised in 296 cases (79.4%) by the dispatcher. Survival to discharge was 37.2% (110/296) if CA was recognised and 28.6% (22/77) if it was not recognised ( p = 0.1550). When the dispatcher handled <4 VF calls during the study period survival to discharge was 22.1% (17/77) compared to 38.2% (50/131) and 39.4% (65/165) when the call volume was 4–9 or >9 ( p = 0.0227). The mean time to dispatch a first responding unit (FRU) was 77.1 ± 44.3 s. Survival to discharge was 39.4% (65/165) when the FRU dispatching time was <60 s and 32.2% (67/208) when dispatching took ≥60 s ( p = 0.1496). The mean time to CA recognition was 170.2 ± 130.1 s. Spontaneous circulation was achieved more rapidly when the time was <150 s ( p = 0.0426), but there was no difference in survival to discharge. Telephone guided CPR instructions were given in 123 cases (35.5%). Survival to discharge was 43.1% (53/123) when CPR instructions were given and 31.7% (72/223) when they were not given ( p = 0.0453). Conclusions: We showed that low CA call numbers per dispatcher is associated with a decreased probability of survival. Giving telephone guided CPR instructions should be promoted as they influence the outcome. Further studies are needed to determine optimal call processing times.