Management Of Cardiac Disease Research Articles

Pulmonary function laboratory to assist in the management of cardiac disease.

Pulmonary function laboratory to assist in the management of cardiac disease.

Novel echocardiographic markers for left ventricular filling pressure prediction in heart failure with preserved ejection fraction (ECHO-PREDICT): a prospective cross-sectional study.

Heart failure with preserved ejection fraction is a complex clinical syndrome associated with a high level of morbidity and mortality, constituting 56% of heart failure cases and showing an increasing prevalence. The E/Ea ratio, used for echocardiographic assessment of left ventricular (LV) filling pressure, has been commonly recommended as a noninvasive measure. However, its validity lacks robust prospective validation in patients with preserved LV ejection fraction, and its accuracy has been questioned in comparison to patients with reduced LV ejection fraction. The objective of this study was to evaluate the accuracy of novel echocardiographic markers incorporating peak E velocity, left atrial volume index (LAVi), and pulmonary artery systolic pressure (PAP) for noninvasive estimation of LV end-diastolic pressure (LVEDP) against invasive measurement. In this cross-sectional study conducted at a tertiary care hospital, a sample size of 122 participants was utilized. Statistical analyses including independent samples t-test, χ2 test, and linear regression analysis were employed to explore correlations and predict outcomes. The results indicated that Group 1 (LVEDP <20mmHg) had a mean age of 59.25 years, while Group 2 (LVEDP >20mmHg) had a mean age of 56.93 years. Mitral E velocity positively predicted LVEDP, while Mitral E/A ratio showed a negative association. Notably, (E+PAP)/2, (E+LAVi)/2, and Mitral E exhibited good discriminative ability, with respective area under the curve values of 0.840, 0.900, and 0.854. (E+LAVi)/2 demonstrated the highest discriminatory power, with a threshold of 40.100, yielding high sensitivity (0.971) but relatively low specificity (0.302) in predicting LVEDP greater than 20. These findings emphasize the accuracy and utility of combining diastolic variables and peak E velocity as markers for left ventricular filling pressure in patients with a high burden of cardiac disease. Additionally, the study highlights the importance of these parameters in assessing cardiac abnormalities and supports the potential of novel echocardiographic parameters, particularly (E+LAVi)/2, in predicting LVEDP greater than 20. Further research is warranted to validate and explore the prognostic implications of these parameters in larger patient populations, ultimately improving the diagnosis and management of cardiac disease and enhancing clinical outcomes.

Roles of IL-33 in the Pathogenesis of Cardiac Disorders.

Interleukin-33 (IL-33) is a member of the IL-1 cytokine family and is believed to play important roles in different diseases by binding to its specific receptor suppression of tumorigenicity 2 (ST2). In the heart, IL-33 is expressed in different cells including cardiomyocytes, fibroblasts, endothelium, and epithelium. Although many studies have been devoted to investigating the effects of IL-33 on heart diseases, its roles in myocardial injuries remain obscure, and thus further studies are mandatory to unravel the underlying molecular mechanisms. We highlighted the current knowledge of the molecular and cellular characteristics of IL-33 and then summarized its major roles in different myocardial injuries, mainly focusing on infection, heart transplantation, coronary atherosclerosis, myocardial infarction, and diabetic cardiomyopathy. This narrative review will summarize current understanding and insights regarding the implications of IL-33 in cardiac diseases and its diagnostic and therapeutic potential for cardiac disease management.

Systemic under treatment of heart disease in patients with Duchenne muscular dystrophy

Duchenne muscular dystrophy is a devastating muscle disease characterized by muscle deterioration and cardiomyopathy. The cardiomyopathy is progressive in nature, marked by the accumulation of myocardial scarring and the loss of contractile function. The presence of cardiac disfunction is nearly universal in individuals with Duchenne muscular dystrophy with dysfunction being evident in patients < 10 years of age. In recognition of importance of prophylactic treatment, clinical guidelines recommend beginning treatment of the heart disease in Duchenne muscular dystrophy patients at 10 years of age, even in the absence of cardiac dysfunction. This manuscript evaluates the current practices of treatment of dystrophic cardiomyopathy. We make use of clinical data compiled by the Muscular Dystrophy Association to assess changes in medical management of cardiac disease in Duchenne muscular dystrophy patients in response to changes in guidelines. We find since the issuance of new guidelines Duchenne muscular dystrophy patients receiving cardiac-directed therapy are beginning it at significantly younger ages. However, we show that 64 % of individuals with Duchenne muscular dystrophy are not receiving the recommended cardiac therapies. The underlying causes of this gap in guideline adherence are complex but correcting this deficiency represent a significant opportunity to improve the clinical management of dystrophic cardiomyopathy.

Cardiac Imaging in Women with Ischemic Heart Disease.

Cardiac diseases are the main cause of death for both sexes worldwide. Treatment varies widely according to the sex of a patient, as there are differences in physiopathology, epidemiology, clinical presentation and management. However, women have been largely excluded from research studies in this field. At present, differences are starting to be recognized and more attention is being paid to the identification of female-specific (or emergent) atherosclerotic risk factors. Diagnostic testing also merits attention because cardiac imaging offers important information to help diagnosis and guide cardiac disease management. In this sense, multimodal imaging should be used with the most cost-effective approach, integrating this information into the clinical sphere according to the pretest probability of the disease. In this review, we address sex-specific features of ischemic heart disease that should be considered in the clinical assessment of women, as well as the value of different imaging techniques (including technical and clinical aspects) for management of women with ischemic heart disease, and identify future areas of action concerning ischemic heart disease in women.

An Experimental Study to Evaluate the Effectiveness of Video Assisted Teaching on Knowledge Regarding Early Sign &amp; First aid Management of Cardiac Symptoms among General Population of Rohtas, Bihar

Introduction: Cardiovascular disease (CVD) is the leading cause of death worldwide. The prevalence of coronary artery disease (CAD), a major contributor to CVD, is related to the increasing Prevalence of modifiable risk factors, previous studies identified diabetes mellitus, hypertension, hypercholesterolemia, smoking, alcohol consumption, obesity and sedentary lifestyle as risk factors. However, certain risk factors may predominate in certain regions. Smoking is the main determinant of ischemic heart disease (IHD) amongst the East Indians of Bangalore, India and populations of certain Arab countries. India is also experiencing a large rise in chronic diseases, especially heart disease, stroke and diabetes. Cardiovascular disease will be the largest cause of death and disability by 2020 in India. It has been forecasted that 2.6 million people will die from coronary heart disease, which constitutes 54% of all cardiovascular disease deaths. AIM: To evaluate the effectiveness of video assisted teaching on knowledge regarding early sign &amp; first aid management of cardiac symptoms among general population of Rohtas, Bihar METHODOLOGY: The Experimental research is conducted using group pre-test and post-test design at Karkatpur, Akhorigola, Rohtas, Bihar from 6/02/2023 to 11/02/2023. A self-structured questionnaire tool was used to assess the knowledge regarding early sign &amp; first aid management of cardiac symptoms among 60 general population by adopting random sampling technique. Pre-test is conducted by using questionnaire tool and immediately after pre-test video assisted teaching programme was implemented. Just after the implementation of video, post-test was conducted by using same questionnaire tool. The results were analysed using descriptive and inferential statistical. RESULTS: The present study was aimed at assessing the effectiveness of video assisted teaching on knowledge regarding early sign and first aid management of cardiac symptoms among general population Akhorigola, Bihar. The relevant data was collected statistically based on objectives of the study. There are 60 participants. Before intervention in pre-test about early sign (10%) has good knowledge, (50%) has moderate knowledge and (40%) has poor knowledge. Whereas about first aid management (5%) has good knowledge, (70) has moderate knowledge and (25%) has poor knowledge. After intervention there is increase in knowledge about both early sign and first aid management. In post-test (88%) has good knowledge, (12%) has average knowledge and (0%) has poor knowledge about early sign. Whereas (66.7%) has good knowledge, (30%) has average knowledge and (3.3%) has poor knowledge regarding first aid management. CONCLUSION: At last as a researcher we concluded that there is increase in knowledge regarding early sign and first aid management of cardiac disease after video assisted teaching and there is no any correlation between both the variable early sign and first aid management. There is no association.

Implementation evaluation of mhealth interventions in the secondary prevention of coronary artery disease: a supplementary review

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): La Trobe University Introduction mHealth technologies have evolved rapidly in recent years and are now widely implemented for the secondary prevention of coronary artery disease (CAD). While there is increasing evidence of their effectiveness, there are significant knowledge gaps concerning their reach, adoption, implementation, and maintenance. Purpose This study evaluates internal and external validity dimensions of mHealth-enabled cardiac disease management programs (DMPs) using elements of Glasgow’s RE-AIM (Reach-Effectiveness-Adoption-Implementation-Maintenance) Framework. It is a supplementary review to a systematic review and meta-analysis which evaluated effectiveness. Methods From the 27 studies reviewed for the previous systematic review on effectiveness, a citation search was performed to identify additional publications reporting on elements of reach, adoption, implementation, and maintenance. All eligible publications were independently coded by two team members using the 23-item RE-AIM extraction tool and analysed using mixed-methods to ascertain the reporting of these elements. Results In total, 35 publications were included in the analysis, 27 from the previous systematic review and 8 supplementary publications. The items for the Reach dimension indicated participant participation rates ranging between 18% to 67%, and used a wide range of exclusion criteria, relating to mental and cognitive impairment (37%), physical impairments (41%) and language issues (26%). Most (44%) interventions were solely home-based with nurses being the main health professionals delivering the intervention (adoption items). The implementation and maintenance items showed intervention duration of between 4-52 weeks (median 24 weeks) with intervention follow-up of between 1-48 months (median 6 months). Conclusions This review found great heterogeneity in the duration and follow-up of mHealth-enabled DMPs for patients with CAD, with low participation rates suggesting access barriers. Addressing RE-AIM dimensions in the evaluation of mHealth-enabled cardiac DMPs for patients with CAD is critically important for identifying factors affecting the reach, adoption, implementation, and maintenance of interventions in order to improve translation of research evidence into practice for patients, clinicians and health service organisations.

Focused cardiac ultrasound in pregnancy.

Cardiac disease in pregnancy is an important cause of maternal morbidity and mortality. In many high-income countries, acquired cardiac disease is now the largest cause of maternal mortality. Given its prevalence in low- and middle-income countries (LMICs), rheumatic heart disease is the most common cause of cardiac disease in pregnancy worldwide and is associated with poor maternal outcome. The diagnosis of cardiac disease in pregnancy is often delayed resulting in excess maternal morbidity and mortality. Maternal mortality review committees have suggested that prompt recognition and treatment of heart disease in pregnancy may improve maternal outcome. Given the similarities between symptoms of normal pregnancy and those of cardiac disease, the clinical diagnosis of heart disease in pregnancy is challenging with echocardiography being the primary diagnostic modality. Focused cardiac ultrasound (FOCUS) at the point of care provides supplemental data to the history and physical examination and has been demonstrated to permit early diagnosis and improvement in the management of cardiac disease in emergency medicine, intensive care, and anesthesia. It has also been demonstrated to be useful in surveillance for rheumatic heart disease in LMICs. The use of FOCUS may allow earlier and more accurate diagnosis of cardiac disease in pregnancy with the potential to decrease morbidity and mortality in both developed and developing countries.

Review on Advent of Artificial Intelligence in Electrocardiogram for the Detection of Extra-Cardiac and Cardiovascular Disease

Artificial intelligence (AI) is that encompasses machine learning (ML) combined with human intelligence had begun to reform medical practices into a new dimension. Advancements and developments of AI molds improved diagnostics in the field of cardiology. Electrocardiogram (ECG) is a simple and cost-effective tool to identify cardiac disorder and which is its reason for being into practice till date. Increasing the population of ECG big data annually requires automatic analysis and immediate interpretation for improved diagnosis. Modern AI techniques like deep learning (DL)-based convolutional neural networks (CNNs) provide an improved way of cardiac disease management and diagnosis. This review throws a light over application of AI in ECG analysis and its necessity. Rich sets of clinical ECG data curated carefully as private and public access developed for various cardiac and extra-cardiac diseases management. Rather than human ECG interpretation, AI can move modern medicine toward more personalized patient care. The intention of this review article is to assess clinical and research possibilities, gaps, and jeopardies involved in cardiac anomalies detection using ECG measurement.

Pregnancy After Cardiac Surgery.

Women with native heart valve disease who are considering getting pregnant should have a complete risk estimation to determine whether an intervention is required prior to becoming pregnantand, if so, to determine when it should be performed and what kind of surgical therapy will be used. Pregnancy is linked to early and late structural valve degeneration in women who have bioprostheses, suggesting a high reoperation rate. A mechanical valve during pregnancy increases the risk of maternal complications such as valve thrombosis and mortality. The claim that women with defective hearts should not become pregnant was driven by the high maternal death rate among cardiac patients who became pregnant.A preoperative anticoagulation therapy trial helped women scheduled for valve replacement to acquire complete information as to the choice of the prosthetic device. Integrated risk stratification scheme for pregnant patients with valvular heart disease, with WHO classification and an algorithmic approach to both preconception counseling and anticoagulation strategy as outlined here, as well as early referral to a cardiologist with expertise in the management of cardiac disease and pregnancy for these complex patients is recommended.However, in reality, some women present while pregnant and valve disease needs to be managed, balancing maternal outcome and fetal risk. In general, optimizing the hemodynamic situation of the mother is also beneficial to the fetus. However, cardiac surgery carries a high riskfor the fetus. No anticoagulant regimen can be said to be entirely safe for use during pregnancy, as there is a degree of risk with each regimen. Therefore, this review has been done to find appropriate management for women dealing with such conditions.

Cardiac Imaging and Management of Cardiac Disease in Asymptomatic Renal Transplant Candidates: A Current Update.

Given the high cardiovascular risk accompanying end-stage kidney disease, it would be of paramount importance for the clinical nephrologist to know which screening method(s) identify high-risk patients and whether screening asymptomatic transplant candidates effectively reduces cardiovascular risk in the perioperative setting as well as in the longer term. Within this review, key studies concerning the above questions are reported and critically analyzed. The lack of unified screening criteria and of a prognostically sufficient screening cardiovascular effect for renal transplant candidates sets the foundation for a personalized patient approach in the near future and highlights the need for well-designed studies to produce robust evidence which will address the above questions.

Regional left ventricular endocardial strains estimated from low-dose 4DCT: Comparison with cardiac magnetic resonance feature tracking.

Estimates of regional left ventricular (LV) strains provide additional information to global function parameters such as ejection fraction (EF) and global longitudinal strain (GLS) and are more sensitive in detecting abnormal regional cardiac function. The accurate and reproducible assessment of regional cardiac function has implications in the management of various cardiac diseases such as heart failure, myocardial ischemia, and dyssynchrony. To develop a method that yields highly reproducible, high-resolution estimates of regional endocardial strains from 4DCT images. A method for estimating regional LV endocardial circumferential and longitudinal ( ) strains from 4DCT was developed. Point clouds representing the LV endocardial surface were extracted for each time frame of the cardiac cycle from 4DCT images. 3D deformation fields across the cardiac cycle were obtained by registering the end diastolic point cloud to each subsequent point cloud in time across the cardiac cycle using a 3D point-set registration technique. From these deformation fields, were estimated over the entire LV endocardial surface by fitting an affine transformation with maximum likelihood estimation. The 4DCT-derived strains were compared with strains estimated in the same subjects by cardiac magnetic resonance (CMR); twenty-four subjects had CMR scans followed by 4DCT scans acquired within a few hours. Regional LV circumferential and longitudinal strains were estimated from the CMR images using a commercially available feature tracking software (cvi42). Global circumferential strain (GCS) and global longitudinal strain (GLS) were calculated as the mean of the regional strains across the entire LV for both modalities. Pearson correlation coefficients and Bland-Altman analyses were used for comparisons. Intraclass correlation coefficients (ICC) were used to assess the inter- and intraobserver reproducibility of the 4DCT-derived strains. The 4DCT-derived regional strains correlated well with the CMR-derived regional strains ( : r=0.76, p<0.001; : r=0.64, p<0.001). A very strong correlation was found between 4DCT-derived GCS and 4DCT-derived EF (r=-0.96; p<0.001). The 4DCT-derived strains were also highly reproducible, with very low inter- and intraobserver variability (intraclass correlation coefficients in the range of [0.92, 0.99]). We have developed a novel method to estimate high-resolution regional LV endocardial circumferential and longitudinal strains from 4DCT images. Except for the definition of the mitral valve and LV outflow tract planes, the method is completely user independent, thus yielding highly reproducible estimates of endocardial strain. The 4DCT-derived strains correlated well with those estimated using a commercial CMR feature tracking software. The promising results reported in this study highlight the potential utility of 4DCT in the precise assessment of regional cardiac function for the management of cardiac disease.

Estimate the Spectrum and Prescription Pattern in Patients with Myocardial Infarction, Angina, Congestive Cardiac Failure at a Tertiary Care Hospital- Retrospective Study

Introduction: Analysis of the prescription patterns is essential to improve rational prescribing in cardiac patients to decrease the risk associated with cardiovascular drugs &amp; also to reduce morbidity and mortality. However, this type of study is progressively more important because of a boost in marketing of new medicines, variations in the prescribing and consumption of drugs, growing concern about delayed adverse effects, cost of drugs, and volume of prescription provokes us to carry out this study. &#x0D; Objectives: To evaluate cardiovascular disease (Myocardial Infarction (MI), ANGINA, and Congestive Cardiac Failure (CCF) drugs prescribing pattern &amp; its cost.&#x0D; Methods: This study is a Retrospective case study carried out for a period of 6months at Sagar Hospitals, Bangalore, by collecting the required data in a structured questionnaire.&#x0D; Results: Out of 250 patient cases observed, patients aged 60-69 were 31.6%, followed by 50-59 (26.8%) are more prone to CAD &amp; males were more when compared to females. The study showed the highest number of patients suffering from Angina and the second highest in MI, and few patients have been diagnosed with CCF.&#x0D; Conclusion: This study showed that Coronary artery disease was managed by antiplatelets, antihypertensives, statins, and diuretics;&#x0D; Angina has the highest diagnosis rate under this study. However, the antianginal drug class does not practice well. However, these studies also show the path for the pharmacist's role in promoting rational drug promotion in cardiac disease management.

Advances in telemedicine for the management of the elderly cardiac patient.

Telemedicine is the use of information and communication technology to deliver healthcare at a distance. It has been resorted to during the COVID-19 pandemic to lessen the need for in-person patient care decreasing the risk of transmission, and it can be of benefit afterward in the management of cardiac disease. The elderly population has unique challenges concerning the use of telehealth technologies. We thus review the advances in telemedicine technologies in treating elderly cardiac patients including in our discussion only studies with a mean age of participants above 60. Remote monitoring of blood pressure, weight, and symptoms, along with home ECG recording has been found to be superior to usual in-clinic follow up. Combining remote monitoring with video conferencing with physicians, patient education websites, and applications is also of benefit. Remote monitoring of Implantable Cardioverter Defibrillators (ICD) and Cardiac Resynchronization Therapy Defibrillators (CRT-D) is also beneficial but can be at the cost of an increase in both appropriate and inappropriate interventions. Implantable sensing devices compatible with remote monitoring have been developed and have been shown to improve care and cost-effectiveness. New smartphone software can detect arrhythmias using home ECG recordings and can detect atrial fibrillation using smartphone cameras. Remote monitoring of implanted pacemakers has shown non-inferiority to in clinic follow up. On the other hand, small-scale questionnaire-based studies demonstrated the willingness of the elderly cardiac patients to use such technologies, and their satisfaction with their use and ease of use. Large-scale studies should further investigate useability in samples more representative of the general elderly population with more diverse socioeconomic and educational backgrounds. Accordingly, it seems that studying integrating multiple technologies into telehealth programs is of great value. Further efforts should also be put in validating the technologies for specific diseases along with the legal and reimbursement aspects of the use of telehealth.

Pregnancy and Delivery with Cardiac Disease in Dr. Soetomo Hospital 2018

Background: Cardiac disease is one of the non obstetric problems causing mortality both in pregnancy and labor due to the complications. Preventions for the complications have not been implemented, thus the number of patients which have cardiac disease with complications and perinatal outcome with low birth weight is still high. Objective : To identify maternal and neonatal outcome of pregnant women with cardiac disease in dr. Soetomo Surabaya hospital in 2018. Method: Descriptive retrospective study using medical records in dr. Soetomo Surabaya hospital 2018. Result: We found 1433 pregnancy cases with 51 (3,6 %) patients were having cardiac disease and included in this research. The most common maternal complication was pulmonary hypertension 16 cases. A dead case was found 1 case (1,9 %) with eissenmenger syndrome. We found the perinatal outcome of 30 babies (58.8%) born with a weight of 2500 gram and under. There are 7 patients with cardiac disease that have been corrected (13,7%). Among those 7 patients, 6 had a perinatal outcome with a birth weight of more than 2500 gram. Conclusion : Most pregnant patients with cardiac disease in dr. Soetomo Surabaya hospital 2018 are already having some complications with perinatal outcomes of low birth weight. Therefore, management of cardiac disease in pregnancy to prevent complications by means of preconception counseling, good antenatal care, and appropriate referrels are still needed to improve the quality of maternal and neonatal outcomes.

Evidence-Based Approach to Out-of-Hospital Cardiac Arrest.

Purpose of reviewOut-of-hospital cardiac arrest (OHCA) is a leading cause of death. Despite improvements in the cardiac disease management, OHCA outcomes remain poor. The purpose of this review is to provide information on the management of OHCA survivors, evidence-based treatments, and current gaps in the knowledge.Recent findingsMost common cause of death from OHCA is neurological injury followed by shock and multiorgan failure. Prognostication tools are available to help with the clinical decision-making. Taking measures to improve EMS response time, encouraging bystander CPR, early defibrillation, and targeted temperature management are shown to improve survival. Early activation of cardiac catheterization lab for coronary angiography, hemodynamic assessment, and mechanical circulatory support should be considered in patients with shockable rhythm and presumed cardiac cause, those with ST elevation, ongoing ischemia, or evidence of hemodynamic and electrical instability. Randomized controlled trials are lacking in this field and benefits of interventions should be weighed against risk of pursuing a futile treatment. COVID-19 pandemic has added new challenges to the care of OHCA patients.SummaryClinical decision-making to care for OHCA patients is challenging. There is a need for trials to provide evidence-based knowledge on the care of OHCA patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11936-021-00924-3.

Cardiac Disease in Pregnancy: Hypertrophic Obstructive Cardiomyopathy and Pulmonic Stenosis

The prevalence of cardiovascular disease in pregnancy is increasing, and cardiovascular disease is the leading cause of pregnancy-related death in the United States. 1 Petersen EE Davis NL Goodman D et al. Vital signs: Pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 states, 2013-2017. MMWR Morb Mortal Wkly Rep. 2019; 68: 423-429 Crossref PubMed Scopus (382) Google Scholar The physiologic adaptations to pregnancy include an increased heart rate, stroke volume, and substantial expansion in circulatory volume, which may pose significant cardiac stress to patients with cardiac disease. During labor, cardiac output increases further, and maternal expulsive efforts during the second stage of labor, with the decreased preload and increased afterload that accompany the Valsalva maneuver, may provoke decompensation in vulnerable patients. Cardiac output peaks immediately postpartum before the return to baseline over a period of several weeks; the immediate postpartum period also is associated with substantial intravascular fluid shifts. These changes, and the gradual return to baseline physiologic states, also may pose challenges to patients with preexisting cardiac disease. A multidisciplinary approach to the management of cardiac disease in pregnancy is essential, with management guided by input from cardiologists, specialists in maternal fetal medicine, anesthesiologists, and neonatologists. 2 ACOG perioperative ultrasound training in anesthesiology. Obstet Gynecol. 2019; 133: e320-e356 Crossref PubMed Scopus (153) Google Scholar In the case reports described herein, the presentation, management, and outcomes in two patients with significant cardiac disease diagnosed during pregnancy are detailed. The first case involved hypertrophic obstructive cardiomyopathy and the second pulmonic stenosis. These cases illustrate important principles of management of the physiologic stresses of pregnancy, labor, and delivery on patients with significant cardiac disease.

Staged management of cardiac disease and concomitant early lung cancer: a 20-year single-center experience.

The association of unstable heart disease and resectable lung cancer is rare. The impacts of staged management, cardiac surgery with cardiopulmonary bypass (CPB) versus angioplasty, on long-term survival and cancer recurrence remain debated. We report our experience using staged management. From 1997 to 2016, 107 patients were treated at the Quebec Heart and Lung Institute: 72 underwent cardiac surgery with CPB (group 1), 35 were treated with angioplasty (group 2), followed by oncological pulmonary resection. Two postoperative deaths (3%) and 1 ischaemic heart complication (1%) were reported in group 1. One death (3%) was reported in group 2. Two-year overall survival was 82% (59/72) in group 1 and 80% (28/35) in group 2; 5-year overall survival was 62% (33/53) in group 1 and 63% (19/30) in group 2. Two-year disease-free survival in group 1 was 79% (57/72) and 77% (27/35) in group 2; 5-year disease-free survival was 58% (31/53) in group 1 and 60% (18/30) in group 2. The independent risk factors for death after thoracic surgery were transfusions (P = 0.004) and grade ≥3 complications (P = 0.034). Independent risk factors for recurrence included the cancer stage (P < 0.001) and, paradoxically, a shorter delay between cardiac and lung procedures (P = 0.031). When a staged management remains feasible after cardiac procedure, oncological outcomes of patients with cardiopathy and lung cancer are satisfactory. CPB does not seem to be deleterious. The delay between procedures should intuitively be as small as possible but not at the expense of good recovery after the cardiac procedure.

Abstract 17369: Addressing Missed Opportunities for Cardiometabolic Primary Prevention of Veterans Referred for Stress Testing

Introduction: Patients presenting to stress testing have a high prevalence of cardiometabolic risk factors (RF) which are not at guideline supported goals. Referral to stress testing is often a patient’s first presentation to CV care and represents a missed opportunity for delivery of risk reduction strategies. Hypothesis: Implementation of a cardiometabolic prevention initiative for cardiology-naïve patients referred to stress testing will result in improved delivery of guideline-directed prevention care. Methods: A consecutive prospective cohort of patients who underwent stress testing (12/1/2019-1/31/2020) after implementation of a linked cardiometabolic prevention referral for those with low risk stress tests was compared to a retrospective standard of care (SOC) cohort (9/1/2019-10/1/2019) from a single center Veterans Hospital. Outcomes assessed were change in CV risk reduction care at 90 days following stress test. Results: Of 181 patients, 62.5% were naïve to cardiology specialty care, had &gt;1 CV risk factor not meeting guideline goals, 6% had typical angina as presenting symptoms, and greater than 70% of stress tests were normal or low risk. Baseline CV RF were common and failed to reach goals in SOC and intervention cohorts respectively with LDL above goal (40 vs. 33%), stage 1 or greater hypertension (67 vs 81%), Diabetes with HgA1c &gt; 7 (48 vs. 21%), overweight or obese (68 vs. 79%), current tobacco (11 vs. 12%), and elevated mean 10-year ASCVD risk (32 vs.20%). At 90 days, 28% of SOC cohort had intensification of CV prevention care as compared to 76% of intervention cohort (X 2 26.8, p&lt;0.05). Conclusions: A stress testing setting represents a valuable opportunity to deliver cardiometabolic prevention care. Integration of risk reduction strategies is imperative to shift from cardiac disease management to patient centered health promotion.

Intensified ambulatory cardiology care: effects on mortality and hospitalisation\u2014a comparative observational study

Since 2010, an intensified ambulatory cardiology care programme has been implemented in southern Germany. To improve patient management, the structure of cardiac disease management was improved, guideline-recommended care was supported, new ambulatory medical services and a morbidity-adapted reimbursement system were set up. Our aim was to determine the effects of this programme on the mortality and hospitalisation of enrolled patients with cardiac disorders. We conducted a comparative observational study in 2015 and 2016, based on insurance claims data. Overall, 13,404 enrolled patients with chronic heart failure (CHF) and 19,537 with coronary artery disease (CAD) were compared, respectively, to 8,776 and 16,696 patients that were receiving usual ambulatory cardiology care. Compared to the control group, patients enrolled in the programme had lower mortality (Hazard Ratio: 0.84; 95% CI: 0.77–0.91) and fewer all-cause hospitalisations (Rate Ratio: 0.94; 95% CI: 0.90–0.97). CHF-related hospitalisations in patients with CHF were also reduced (Rate Ratio: 0.76; 95% CI: 0.69–0.84). CAD patients showed a similar reduction in mortality rates (Hazard Ratio: 0.81; 95% CI: 0.76–0.88) and all-cause hospitalisation (Rate Ratio: 0.94; 95% CI: 0.91–0.97), but there was no effect on CAD-related hospitalisation. We conclude that intensified ambulatory care reduced mortality and hospitalisation in cardiology patients.