National Institute Of Cardiovascular Diseases Research Articles

Working conditions and occupational stress among nurses in Bangladesh: a cross-sectional pilot study

Occupational stress is common among nurses and is thought to be one of the key factors for the global shortages of nurses. To the best of our knowledge, no study has been done to assess occupational stress among Bangladeshi nurses. This study aimed to investigate the association of sociodemographic characteristics and occupational characteristics with stress experienced by nurses working in a specialized hospital in Dhaka, Bangladesh. A cross-sectional study design was employed involving 155 nurses working in the National Institute of Cardiovascular Disease (NICVD). Data were collected using a self-administered questionnaire with the Bengali version of the Occupational Stress Index (OSI). Both univariate (Student t-test or ANOVA) and multivariate analyses (linear regression) were performed to identify the sociodemographic and work-related factors associated with occupational stress. The average score on the OSI was 147.1 – moderate level of occupational stress among nurses. The OSI score was higher in males (150.25) than in females (143.94). Nurses who were aged >40 years, and single, had nursing experience between 10 and 20 years and were considering promotion tended to suffer more stress than their peers. Findings from linear regression showed that the OSI score was significantly (p < 0.001) associated with the work conditions: role overload, role ambiguity, role conflict, responsibility, support from colleagues and rational coping. The findings indicated the importance of occupational characteristics in relation to occupational stress among nurses. Further results of this study can be utilized by researchers and policymakers to guide preventative measures to reduce occupational stress among nurses.

Frequency of Thrombolysis in Myocardial Infarction III Flow in Patients With Primary Percutaneous Coronary Intervention: Not All Culprit Vessels Are Completely Occluded in ST Elevation Myocardial Infarction.

BackgroundST elevation myocardial infarction (STEMI) is classically characterized by total occlusion of the culprit coronary artery. However during primary percutaneous coronary intervention (PCI) thrombolysis in myocardial infarction (TIMI) 0 flow is not observed in all patients' culprit arteries in angiographic views. This study was conducted to find out the frequency of TIMI flow in acute STEMI patients in view of the above concept. The aim of this study was to evaluate the frequency of pre-procedural TIMI III flow in those patients who underwent primary PCI for acute STEMI in a public sector hospital in Karachi, Pakistan.MethodologyThis study is an audit of already saved data in the catheterization laboratory of the National Institute of Cardiovascular Diseases (NICVD), Karachi, that was collected prospectively from January 2016 to December 2018. These data were collected after taking consent from those patients who presented to hospital within 12 hours of symptoms and underwent primary PCI. Data were entered and analyzed on Statistical Package for the Social Sciences (SPSS) version 19 (IBM Corp., Armonk, NY, USA).ResultsA total of 8018 patients were included in this study who presented with STEMI and underwent primary PCI. Out of them 80.9% were males. Hypertension was the leading risk factor in 54.1% (4340) of patients. TIMI III flow was present in 11.4% of patients before primary PCI, while TIMI 0, I and II flow were present in 57.1%, 15.1%, and 16.3% of patients respectively (p<0.001). Fourteen percent of patients with TIMI III flow were of age group 51 to 60 years. Among those who had TIMI III flow, 11.2% were those with door to balloon time of <90 minutes. In 11% of cases, left anterior descending (LAD) artery had TIMI III flow as compared to other vessels (p<0.001). The length of the lesion was significantly smaller in patients who had TIMI III flow compared to those who had TIMI 0-II flow.ConclusionsThis study revealed that not all patients with acute STEMI had totally occluded culprit coronary artery but some of them had angiographic TIMI I-III flow in the infarct-related artery. Further studies are needed to find the reason for re-establishment of flow in the culprit vessel in STEMI patients before PCI.

Down’s Syndrome with Congenital Heart Disease: Our Surgical Experience

Background: Our objective was to analyze the outcome of patients of Down’s syndrome with congenital heart diseases undergoing cardiac surgery.&#x0D; Methods: This was a retrospective study conducted between January 2013 and June 2019. 49 consecutive patients with Down’s syndrome with congenital heart disease admitted in pediatric cardiac surgery unit at National Institute of Cardiovascular Diseases (NICVD). Patients were followed up postoperatively for in-hospital outcome.&#x0D; Results: Among 49 patients the heart lesion ranked in incidence as follows- VSD 24(48.97%), AV canal defect 12(24.48%), TOF 6(12.24%), PDA 6(12.24%) and ASD 1(2.04%). Pulmonary hypertension was found in 63.25% patients. Moderate pulmonary hypertension was most common, found in 18(38.66%) patients. Severe and mild pulmonary hypertension was found in 10(32.38%) and 3(9.67%) patients respectively. All the patients had undergone surgical correction. The postoperative period was complicated in 44.89% of patients. The most frequent complication was pulmonary infection 20.40%, Wound infection 6.12% and low output syndrome 6.12% were the next. One patient had postoperative heart block, needed permanent pace maker implantation. In-hospital mortality was 12.24%.&#x0D; Conclusion: Patients with Down’s syndrome with congenital heart disease undergoing surgical correction had an acceptable postoperative morbidities and mortality.&#x0D; Cardiovasc. j. 2020; 13(1): 35-39

Impact of Body Mass Index on In-Hospital Length of Stay after Percutaneous Coronary Interventions

Background: In-hospital length of stay (LOS) is an important metric for assessing the quality of care and planning capacity within a hospital. Percutaneous Coronary Interventions (PCI) merit short LOS following an uncomplicated procedure. Various factors have been studied that may influence LOS. The relationship between BMI and LOS after PCI has not been thoroughly investigated, especially in Bangladesh.&#x0D; Methods: This cross-sectional observational study was conducted at National Institute of Cardiovascular Diseases, on total 100 patients who underwent PCI with two equally divided groups on the basis of BMI of Asian ethnicity: Group I (BMI &lt; 23 kg/m2) and Group II (BMI e” 23.0 kg/m2). In-hospital outcomes and LOS were observed and recorded after PCI.&#x0D; Results: The mean BMI of study population was 23.9 ± 1.9 kg/m2. The sum of occurrence of adverse in-hospital outcomes was 14.0%. Complications were significantly (p &lt; 0.01) higher in Group I than Group II. Among all adverse in-hospital outcomes, only acute left ventricular failure was found to be statistically significant between groups (p &lt; 0.01). The difference of mean LOS after PCI was higher in Group-I which was statistically significant (p &lt; 0.01). Diabetes mellitus and dyslipidemia were found to be the independent predictors for developing adverse in-hospital outcome (OR= 1.68 and 1.46; 95% CI = 1.25 – 2.24 and 1.16 – 1.83; p = 0.018 and 0.040, respectively). BMI was inversely associated with adverse in-hospital outcome after PCI (OR = 0.95; 95% CI = 0.91 – 0.98; p = 0.007).&#x0D; Conclusion: BMI is inversely associated with adverse in-hospital outcome after PCI. The underweight people are likely to experience longer LOS following PCI.&#x0D; Cardiovasc. j. 2020; 13(1): 19-26

Evaluation of a portable assembly catheter simulator using a 3D-printed heart model for percutaneous transvenous mitral commissurotomy in developing countries: Catheter simulator for PTMC.

We developed a catheter simulator for percutaneous transvenous mitral commissurotomy (PTMC) based on the data from a patient with mitral valve stenosis. The simulator has the following characteristics: 1) the simulator is portable and easy to assemble and disassemble, 2) the cardiac portion is created using a 3D-printer, based on patient computed tomography data, 3) the simulator uses a foot-operated water pump to create pulsatile flow, and 4) the fossa ovalis in the atrial septum of the heart model is made of a thin polyurethane membrane and is interchangeable. We aimed to assess the effectiveness of this novel simulator for training in PTMC using the Inoue balloon in developing countries. We used this simulator for training in the National Institute of Cardiovascular Diseases in Bangladesh (13 physicians), and in Kenyatta National Hospital in Kenya (11 physicians). The effectiveness of training was evaluated by questionnaire and the procedure time in simulation. The questionnaire obtained from the trainees showed that the model scored 4.7±0.5 for realism, utility of pulsatile flow scored 4.7±0.5, simulator utility scored 4.9±0.3, and the effect of training on PTMC performance scored 4.9±0.5. The procedure time in simulation was shortened from 30.0±12.6 min (first time), to 23.4±11.9 min (second time) and to 20.4 ± 11.1 min (third time) (p<0.01). The novel portable assembly catheter simulator using a 3D-printed heart model for PTMC received positive comments and improved the skills of trainees.

Psychosocial Impact of COVID-19 on Healthcare Workers at a Tertiary Care Cardiac Center of Karachi Pakistan.

Objectives:Aim of this study was to determine the depression, stress, and anxiety level among healthcare workers working at a tertiary care cardiac center of Karachi Pakistan during COVID-19 pandemic.Methods:This survey was conducted at the National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Participants of the study were fulltime employees of hospital. Data were collected using an online questionnaire and Depression, Anxiety and Stress - 21 (DASS-21) scale was used.Results:A total of 224 healthcare workers were included, 46 (20.5%) participants were screened for moderate to severe depression, 20.1% (45) for moderate to severe anxiety, and 14.7% (33) for moderate to severe stress.Conclusion:A significant levels of depression, anxiety, and stress were noted with the major concerns of workplace exposure, increased risk of infection, and transmission to their families and friends.

Frequency of Three-Vessel Disease Among Patients With Non-ST Segment Elevation Myocardial Infarction.

Background: Though the presence of three-vessel disease (3VD) among patients with non-ST Segment Elevation Myocardial Infarction (NSTEMI) is relatively common, very limited data is available regarding its clinical significance. The current study aimed to determine the frequency of 3VD among NSTEMI patients presenting at the tertiary care hospital of Karachi, Pakistan.Methodology: This cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi from August 15 2015 to February 15 2016 over a sample of 139 NSTEMI patients. Data regarding patients' baseline characteristics were recorded in a proforma. Coronary angiography was performed to determine the presence of 3VD. The frequency of occluded arteries and 3VD was also recorded and the collected data was then analyzed using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY, USA).Results: A total of 139 NSTEMI patients were enrolled in the study with a mean age of 50.47 ± 12.47 years. The majority of them were males (70.5%), mostly ≥ 40 years of age (67.6%). Among the comorbidities, 50.4% of patients had diabetes mellitus (DM), 61.9% were hypertensive and 30.9% had dyslipidemia. The overall frequency of 3VD among the enrolled NSTEMI patients was 30.2%. Three major arteries were found to be occluded; 68.3% NSTEMI patients had occlusion in the left anterior descending (LAD) artery, followed by right coronary artery (RCA) among 49.6%, 40.3% had left circumflex (LCX) artery occlusion, and 50.4% had diagonal and obtuse marginal (OM) artery occlusion respectively. Among the effect modifiers, no significant impact of age, gender, and smoking habits was observed on the frequency of 3VD among NSTEMI patients (p > 0.05). Among the reported comorbidities, DM was significant among NSTEMI patients with 3VD (p < 0.05).Conclusion: Our study results indicated that a significant proportion of NSTEMI patients had 3VD, independent of the effect of age and gender.

Pakistan Following Foot Prints of Developed World in Structural Interventions: Experience of Transcatheter Aortic Valve Implantation Reported First Time.

BackgroundThe aim of this study was to evaluate the safety and efficacy of transcatheter aortic valve implantation (TAVI) program in a Tertiary care hospital in Karachi, Pakistan.MethodologyThis study was conducted by interventional cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi from July 2015 to February 2020. All patients of severe aortic stenosis (AS) who underwent TAVI were included. Baseline characteristics, in-hospital course and one-month follow-up data were collected.ResultsThis study included 100 consecutive patients with severe AS undergoing TAVI. Sixty-three (63.0%) patients were males and the mean age was 67.38 ± 10.73 years. Eighty-five (85%) patients were in the New York Heart Association (NYHA) class III-IV. Aortic valve mean gradient was 51.33±10.47 mmHg and 50% of patients had bicuspid aortic valves. Core valve was implanted in 86 (86%) and evolute-R aortic valve was implanted in 14 (14%) patients. TAVI was successfully done in 94% of patients. Post-deployment aortic valve mean gradient was 5.33±4.13 mmHg. Major vascular access site complications were noted in 14% and atrioventricular (AV) blocks were seen in 22% of cases. There was a significant difference in symptoms of patients before and after the procedure. Overall, eight (8%) patients expired during hospital stay. At one-month follow-up, 76% of patients were found to have no limitation of physical activities.ConclusionsResults of this study showed that TAVI is a safe procedure in these high-risk patients and is an alternative to surgery for AS patients in the region.

Ivabradine effects on heart rate and quality of life among chronic heart failure patients.

To determine the effect of Ivabradine in lowering heart rate and quality of life in chronic heart failure patients. The observational study was conducted in the out-patient department of the National Institute of Cardiovascular Disease, Karachi, from December 2016 to June 2017, and comprised chronic heart failure patients aged 30-70 years who were on 5mg Ivabradine for 8-weeks. Heart rate was evaluated through electrocardiogram, and health-related quality of life was measured using the validated questionnaire. Baseline demographics and clinical characteristics were recorded, with follow-ups at week-4 and week-8. Safety and tolerability were assessed by adverse drug reactions monitoring. Data was analysed using SPSS 21. Of the 50 patients, 34(68%) were males. The overall mean age was 54.8±9.17 years. Baseline mean heart rate significantly reduced at first and second follow-up visit (p< 0.001). Mobility problems declined significantly as well (p<0.05). Health-related quality of life significantly improved on follow-up visits (p<0.001). There was significant control of heart rate in chronic heart failure patients with improvement in all parameters of quality of life.

Angiographic profile and outcomes of Pakistani women with ST elevation myocardial infarction.

To evaluate the angiographic profile and outcome of primary percutaneous coronary intervention in female patients with acute myocardial infarction. The cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from July 1, 2017, to March 31, 2018, and comprised of female patients presenting with acute myocardial infarction who underwent primary percutaneous coronary intervention and got enrolled in the National Cardiovascular Data Registry. Follow-up calls were made 1 year post-intervention and outcomes were noted. Data were analysed using SPSS 21. Of the 522 female patients with a mean age of 57.41±11.14 years, 334(64%) were hypertensive, 202(38.7%) diabetic, 16(3.1%) had a family history of coronary artery disease, and 9(1.7%) were smokers. Single-vessel disease was observed in 183(35.1%) patients, and three-vessel disease in 144(27.6%). Post-procedure thrombolysis in myocardial infarction flow (0-II) was observed in 29(5.6%) patients, bleeding in 2(0.4%), and in-hospital mortality was in 22(4.2%). Telephonic follow-up was successfully conducted in 436(87.5%) of the discharged patients, and, of them 15(3.4%) had expired and recurrence was reported by 10(2.3%) patients and 8(80%) of them underwent re-intervention. More than half the female patients had multi-vessel disease and bifurcation lesion was observed in more than three-fourth of the sample.

Arrhythmia in Acute Myocardial Infarction: A Six-Month Retrospective Analysis From the National Institute of Cardiovascular Diseases.

IntroductionAcute myocardial infarction (AMI) is a devastating medical emergency that requires immediate pharmacological and radiological intervention. With the advent of techniques such as percutaneous coronary intervention (PCI), pacemakers, and percussion pacing, survival rates have improved significantly. However, there are certain factors and complications associated with AMI that still lead to a high mortality rate, such as old age, advanced heart disease, diabetes mellitus (DM), and arrhythmias.Factors such as the type of arrhythmia, the heart rate, and the level at which dissociation occurs between atrial and ventricular rhythm all influence mortality and morbidity rates. Outcomes are further influenced by the sex of the patient, the type of AMI [ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI)], history of smoking, arrival times at the hospital, presence of hyperglycemia, previous history of cardiac surgery, and the need for a temporary pacemaker or a permanent pacemaker.As with most scientific studies, local data from Pakistan is hard to find on this topic as well. With this study, we hope to contribute valuable information and updates to the study of a developing problem from the developing world.ObjectiveWe aimed to analyze the frequency and outcomes of different types of arrhythmia in AMI.MethodsThis study involved a retrospective observational cohort. It was conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi from January 2019 to July 2019 (six months). All data were retrieved from the online database at the NICVD. Written consent was obtained from all patients. Patient confidentiality was ensured at all times.ResultsA total of 500 patients were included in the study. The mean age of our cohort was 56.17 ±14.01 years. NSTEMI was more prevalent than STEMI. Sinus arrhythmia (SA) was the most frequently recorded arrhythmia and had the best survival rates. Atrioventricular (AV) nodal blocks and ventricular tachycardia (VT) had the worst outcomes. The overall mortality rate was 11.4%, and the mean in-hospital length of stay was 2.07 ±1.54 days. Smoking increased mortality in all cases.ConclusionsAMI is complicated by several types of arrhythmia. SA is the most common arrhythmia in AMI. Mortality in AMI is largely due to AV nodal blocks and VT. Smoking increases mortality in all cases.

Effect of nurse led education on anxiety level among coronary artery bypass grafting pre-operative patients.

The objective of this study was to identify the effect of nurse-led pre-operative education in minimizing the level of anxiety among patients waiting for Coronary Artery Bypass Grafting. This experimental study was accomplished at National Institute of Cardiovascular Diseases. Out of 136, there were 80 patients identified with the presence of anxiety using AKUADS 4 to 6 weeks before CABG. Data were collected by the primary researcher from July 2016 to December 2016. Patients with anxiety were divided into experimental and non-experimental groups. After pre-operative education to the experimental group, patients from both groups were re-assessed for anxiety level one week before CABG. Data were assessed through non-parametric Wilcoxon sign ranked and Mann Whitney tests. It was found that anxiety reduced significantly in post-assessment among experimental group participants. No significant difference was found for pre-anxiety assessment between experimental and non-experimental groups. It was noted that post assessment anxiety differed significantly between experimental and non-experimental groups. Pre-operative education was found effective to decrease level of anxiety among patients waiting for CABG. There was no significant difference between pre and post assessment among patients from non-experimental group.

Immediate and Short-Term Outcome of Percutaneous Atrial Septal Defects Closure in Adult Patients.

BackgroundAtrial septal defect secundum (ASD II) is the commonest of the congenital heart diseases in the adult population and the closure of ASD II causes a significant improvement in hemodynamics and the clinical status of the patient. However, it carries certain risks, especially the development of post-closure pulmonary edema and congestive cardiac failure, which may lead to death. Therefore, this study was designed to share our experience and to evaluate the immediate and short-term outcomes of percutaneous closure of ASD II in adult patients presenting at a tertiary care cardiac center in Karachi, Pakistan.MethodologyIn this study, we included 30 adult (≥ 40 years) patients who underwent percutaneous ASD II closure at the pediatric cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan, between June 1, 2017, and July 31, 2019. Data for this study were extracted from a prospectively collected departmental database. Extracted data for this study consisted of demographic profile, comorbid conditions, echocardiographic findings, cardiac catheterization data, pre and post six-month electrocardiographic findings, and New York Heart Association (NYHA) Functional Classification (FC).ResultsOut of 30 adult patients, 18 (60%) were female. The mean age of the patients at the time of ASD closure was 51.43 ± 7.09 years, ranging between 40 and 67 years. None of the patients had any post-intervention complications. Mean systolic pulmonary artery pressure (SPAP) on cardiac catheterization pre-implantation was 49.8 ± 16.3 mmHg range was 20-90 mmHg while SPAP immediately after device implantation was 37 ± 11.4 range 20 to 65 mmHg with p<0.001. Mean SPAP on pre-catheterization echocardiography was 58.8 ± 14.3, range 30-95 mmHg, while after six months, the mean SPAP was 34.5 ± 7.2, range 20-45 mmHg, with p<0.001 in 28 (93.3%) patients (in two patients, there was no TR). There was no mortality up till six months after the intervention. The functional class (FC) after six months of the procedure improved in most, 90% (27), of the patients.ConclusionThere were no complications immediately after the procedure. After six months, post-procedure SPAP decreased to < 50 mmHg in the majority of patients (96.6%). Functional class (FC) improved in most (90%) of the adult (≥ 40 years) patients undergone percutaneous atrial septal defects closure. Therefore, percutaneous closure of ASD II is a safe and effective procedure for adult patients.

Impact of Raised Blood Glucose Level on In-Hospital Outcome of Thrombolysed Patients with Acute Myocardial Infarction

Background: Diabetes mellitus (DM) is an established major cardiovascular risk factor associated with increased prevalence of coronary artery disease (CAD). Patients with diabetes often have numerous concomitant cardiac risk factors with a higher incidence of acute myocardial infarction (AMI) and congestive heart failure (CHF). Patients either with or without a prior history of DM may present with hyperglycemia during AMI. We analysed our population to determine whether admission hyperglycemia was a strong risk factor for in-hospital mortality and morbidity in patients with AMI and may be even stronger than a previous history of diabetes.In-hospital death risk of AMI patients without DM was about 2 to 4 times higher in patients with hyperglycemia than in those without hyperglycemia.&#x0D; Methods: This Prospective observational study was carried out at the National Institute of Cardiovascular Diseases (NICVD), Dhaka. A total number of 200 STsegment elevation AMI patients were enrolled in this study as per inclusion and exclusion criteria. They were subdivided on the basis of admission blood glucose into two groups. Group-1A and 2A were 50 patients with blood glucose &lt;200mg/dl (&lt;11.1mmol/l) and Group-1B and 2B were 50 patients with blood glucose ≥200mg/dl (11.1 ≥mmol/l). The numerical data obtained from the study were analyzed and significance of differences were estimated by using statistical methods. Computer based SPSS (Statistical Package for Social Science) were used.&#x0D; Results: In the present study mean age of the male and female were 56.10±11.86 and 57.83±13.74 years, p&gt;0.05%. There was no significant difference regarding risk factors and smoking was higher in both group. Regarding inhospital adverse outcome, death was significantly higher in hyperglycemic non diabetic group (p&lt;0.0001). It was two times (56%) higher than diabetic hyperglycemic (28%) group.Cardiogenic shock (66%) and CHF (56%) were also more common in hyperglycemic non diabetic group. Lowest patients (8%) died of AMI without DM with random blood glucose &lt;11.1 mmol/l (controlled). On the other hand highest improvement was in the controlled group (p&lt;0.0001).Multivariate analysis showed Diabetic status with normal blood sugar was a predictor of adverse outcome; but patients with hyperglycemia and no history of diabetes had a worse outcome and were independently associated with significant risk of in-hospital mortality. Age group &gt;65 years and Male sex were also associated with significant in-hospital mortality.&#x0D; Conclusion: Independent of diabetic status, the occurrence of hyperglycemia during AMI is associated with a subpopulation of patients at particularly high risk for an adverse clinical outcome. Even with the highly efficacious treatment strategies currently available, persons presenting with AMI and hyperglycemia are at increased risk for cardiogenic shock and CHF or death in hospital.&#x0D; Bangladesh Heart Journal 2020; 35(1) : 14-19

Comparison of Early Outcome of Off-pump and Conventional Coronary Artery Bypass Graft Surgery in Patients with Multivessel Coronary Artery Disease and Left Ventricular Dysfunction

Introduction: Left ventricular dysfunction is an important predictor of in-hospital mortality. Due to the theoretical and practical advantages to avoid the harmful effects of cardiopulmonary bypass (CPB), many cardiac surgeons are using Off-pump Coronary Artery Bypass (OPCAB)as an effective alternative to conventional CABG (CCAB) even in patients with reduced left ventricular (LV)ejection fraction. Objectives: This study performed in the National Institute of Cardiovascular Diseases (NICVD) evaluated the early outcomes of OPCAB in terms of mortality and major post-operative morbidities and compared them with that of CCAB in patients with multivessel coronary artery diseases and reduced left ventricular (LV) function.&#x0D; Methods: Total 120 patients with multivessel coronary artery disease with reduced left ventricular ejection fraction (d”50%)were allocated into two groups: a) 60 patients who underwent OPCAB and b) another 60 patients who underwent conventional CABG between January 2013 and December 2015. Pre-operative, peroperative and early post-operative variables were recorded, compiled and compared.&#x0D; Results: All risk factors and co-morbidities were homogenously distributed between the two groups. Majority of the patients had triple vessel disease. Nearly three-quarter (73.3%) of patients in OPCAB group and 80% in CCAB group received 3 grafts (p=0.470). The mean total operative time (268.5 ± 33.5vs. 296.3 ± 34.8minutes, p &lt; 0.001), intubation times(8.6±0.3 vs. 12.3±0.5 hours, p&lt;0.001), blood losses (377.8378 ± 45 ml vs. 602 ± 60 ml, p &lt; 0.001); requirements for blood and blood products (689.7±21.1 vs. 1199.3±34.5ml, p &lt; 0.0010),intensive care unit stays (31.7±0.9 hours versus 41.6±1.5 hours; p&lt;0.001) and hospital stays (8.2 ± 0.2days vs.10.3 ± 0.3days, p &lt; 0.001)were all significantly lower in the OPCAB group.&#x0D; Conclusion: OPCAB is a safe and effective operative revascularization procedure for patients with multivessel coronary artery disease and left ventricular dysfunction and is associated with reduced morbidity. However, a larger and omized trial with long-term followup may show the real benefits of OPCAB.&#x0D; Bangladesh Heart Journal 2020; 35(1) : 20-27

In-hospital Outcome of Percutaneous Coronary Intervention among Very Elderly Patients with Ischemic Heart Disease in a Dedicated Cardiac Hospital

Background: Cardiovascular disease, and ischemic heart disease (IHD), is a major cause of morbidity and mortality in the very elderly patients (&gt;80 years) worldwide. These patients represent a rapidly growing cohort presenting for percutaneous coronary intervention (PCI), now constituting more than one in five patients treated with PCI in real-world practice. Furthermore, they often have greater ischemic burden than their younger counterparts, suggesting that they have greater scope of benefit from coronary revascularization therapy. The elderly usually has higher prevalence of co morbidities and more often experience complications during and after revascularization procedures. Our aim was to evaluate clinical outcomes of PCI in patients older than 80 years, compared to their younger counterparts.&#x0D; Materials and methods: From July 2017 to July 2018 we included 212 patients with IHD purposively in Cardiology department of National Institute of Cardiovascular Diseases undergone PCI who were divided into 2 groups according to age: e” 80 years (n = 74) and &lt; 80 years (n = 138). Baseline clinical characteristics, indications for coronary intervention, in hospital outcomes were obtained. Study endpoint were Renal impairment, MI, LVF, emergency revascularization and death.&#x0D; Results: Very elderly patients were more frequently male (86%) and nonsmoker at present (41% vs. 63%, p=0.003), had higher prevalence of hypertension (60% vs. 50%, p&lt;0.13), and more often presented with NSTEMI (54% vs. 23%, p&lt;0.001). Elderly group had higher incidence of TVD and LM disease (36% vs. 26% and 9.5% vs. 2.9%, p=0.07) and more incidence of ostial (16.2% vs.5.1%,p=0.007) and calcified lesions (31.1% vs. 14.5%, p=0.004). Procedural success (TIMI III) were high in both groups, but still lower in the elderly as compared to younger group (95% vs. 97%, p=0.65). Very elderly patients had higher incidence of post PCI bleeding, CIN, MI, LVF and death (9.5% vs.6.1%, 8.2% vs.3.7%, 6.8% vs.5.8%, 9.5% vs. 5.1% and 5.4%vs.3.6%,p=0.07), whereas emergency revascularization were higher in younger group (5.4% vs. 6.5%, p=0.07).&#x0D; Conclusion: Very elderly patients aged ≥80 years face more vascular site complications during PCI, usually have more LM and TVD with more ostial and calcified lesions in comparison with younger group. Though procedural success is similar with younger group, they face more post PCI CIN, LVF and MI. Repeat revascularization was higher in younger group.&#x0D; Bangladesh Heart Journal 2020; 35(1) : 61-65

Vascular Surgery Practice Guidelines during COVID-19 Pandemic in a Setting of High Work Volume Against Limited Resources: Perspective of a Developing Country

BackgroundThe situation of coronavirus disease 2019 (COVID-19) pandemic in the Indian subcontinent is worsening. In Bangladesh, rate of new infection has been on the rise despite limited testing facility. Constraint of resources in the health care sector makes the fight against COVID-19 more challenging for a developing country like Bangladesh. Vascular surgeons find themselves in a precarious situation while delivering professional services during this crisis. With the limited number of dedicated vascular surgeons in Bangladesh, it is important to safeguard these professionals without compromising emergency vascular care services in the long term. To this end, we at the National Institute of Cardiovascular Diseases and Hospital, Dhaka, have developed a working guideline for our vascular surgeons to follow during the COVID-19 pandemic. The guideline takes into account high vascular work volume against limited resources in the country.MethodsA total of 307 emergency vascular patients were dealt with in the first 4 COVID-19 months (March through June 2020) according to the working guideline, and the results were compared with the 4 pre–COVID-19 months. Vascular trauma, dialysis access complications, and chronic limb-threatening ischemia formed the main bulk of the patient population. Vascular health care workers were regularly screened for COVID-19 infection.ResultsThere was a 38% decrease in the number of patients in the COVID-19 period. Treatment outcome in COVID-19 months were comparable with that in the pre–COVID-19 months except that limb loss in the chronic limb-threatening ischemia patients was higher. COVID-19 infection among the vascular health care professionals was low.ConclusionsVascular surgery practice guidelines customized for the high work volume and limited resources of the National Institute of Cardiovascular Diseases and Hospital, Dhaka were effective in delivering emergency care during COVID-19 pandemic, ensuring safety of the caregivers. Despite the fact that similar guidelines exist in different parts of the world, we believe that the present one is still relevant on the premises of a deepening COVID-19 crisis in a developing country like Bangladesh.

Abstract P048: Hospital Readmission Of Heart Failure Patients And Its Precipitated Factors And Hypertension

Introduction: Hypertension is one of the most prevalent modifiable risk factor for the development of heart failure (HF). Chronic heart failure (CHF) is the most common cause of readmission for patients in worldwide. Despite this recent attention to HF readmission, we know relatively little about its actual causes despite the fact that patients are in many ways best positioned to identify the underlying factors that contribute to their readmission. Objective: To systematically investigate the patients' perspectives about the reasons for their hospital readmission related to hypertension after discharged of stabalized HF patients and to study how to improve our heart failure care system to reduce the number of readmission in cost effective way. Method and Materials: Patients were recruited for this study was admitted to national institute of cardiovascular diseases, through emergency department. Patients discharged with a primary discharge diagnosis for HF who were then readmitted for any cause in the subsequent 6 month were eligible for the study. We recruited patients over the period of 3 month form June 2019 till August 2019. Eligible patients were approached, consented, and interviewed within the next 24 hours while they were still in hospital. Result: For the readmission, median length of stay was 6 days. Total 500 patient included, out of which 375 (75%) were male and most important cause of heart failure is ischaemic cardiomyopathy 400 (80%). No death recorded. Common reasons for readmission are lack of counselling 200(40%), under dose 75(15%), non-compliance 60(12%), volume over load 50(10%), hypertension 50(10%), secondary infection 35(7%). Conclusion: We concluded that hypertension is not largely associated with heart failure hospitalization in our study. But patient compliance of medication, appropriate fluid intake, self-care and life style modification are the important elements in hospital readmission of heart failure.

Statins and Abnormal Liver Function Tests: Is There a Correlation?

BackgroundStatins or 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors are one of the most commonly prescribed medications in cardiac patients. Just like any other class of drugs, they have the potential to cause liver injury over time even with judicious use. This drug-induced liver injury (DILI) can be either direct (hepatocellular) or idiosyncratic. As with multiple other hepatic pathologies, DILI may be asymptomatic or clinically silent. Therefore, it is prudent to carry out liver function tests (LFTs) from time to time. LFTs are an inexpensive, noninvasive, and quick first-line investigation to monitor liver status. However, the pattern of liver injury with statin use is not specific and a correlation over time may not be apparent.AimsTo evaluate derangement in LFTs over time with respect to statin use and determine if a correlation exists.MethodsThis was a retrospective observational cohort. All data were collected from the online database of the National Institute of Cardiovascular Diseases (NICVD), Karachi. Patients admitted to the NICVD from July 1, 2018, to December 31, 2018, were eligible for inclusion in the study. Only patients already taking a statin (in any dose) were considered for inclusion. LFTs were recorded from the database at inclusion, post-induction at six and 12 months. Extensive workup was done and great care taken to rule out other diseases that may have affected the LFTs.ResultsTwo hundred and four patients were eventually inducted into the study after a meticulous exclusion process. The male to female ratio was 4:1. The mean duration of statin use before induction into the study was 19.92±14.34 months. Patients were predominantly using only one of two statins, i.e., rosuvastatin 20mg/day or atorvastatin 40 mg/day. Elevations of LFTs were seen with both drugs throughout the study period. These elevations were almost always <2x the upper limit of normal (ULN); greater elevations were seen with atorvastatin 40 mg/day. The derangement in LFTs persisted and improvement was not seen.ConclusionsStatins cause dose-dependent borderline elevations of liver function tests over time. These elevations are clinically and statistically insignificant and should not deter physicians from prescribing or continuing statins.

Risk Factors Associated With Contrast-Induced Nephropathy after Primary Percutaneous Coronary Intervention.

BackgroundContrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI) is associated with increased mortality and morbidity. The aim of this study is to determine the frequency of CIN after primary PCI and its association with risk factors in patients with ST-segment elevation myocardial infarction (STEMI) at a tertiary care cardiac center in Pakistan.MethodologyIn this observational study, we included 282 patients who presented with STEMI and underwent primary PCI at the National Institute of Cardiovascular Disease, Karachi, Pakistan, from October 2017 to April 2018. The serum creatinine (mg/dL) levels were obtained at baseline and 48 to 72 hours after the primary PCI procedure, and patients with a 25% increase or ≥ 0.5 mg/dL rise in post-procedure creatinine level (after 48 to 72 hour) were categorized for CIN.ResultsOut of a total sample of 282 patients, 68.4% (193) were males, and the mean age was 56.4 ± 9.1 years. A majority of the patients, 78.7% (222), were hypertensive and 34% (96) were diabetic. The CIN was observed in 13.1% (37) of the patients, and increased risk of CIN was found to be associated with the presence of diabetes mellitus and increased (>200 mL) use of contrast during the procedure, with odds ratios of 2.3 (1.14-4.63) and 3.12 (1.36-7.17), respectively.ConclusionsThe CIN after PCI is a common complication associated with the presence of diabetes mellitus and the use of an increased amount of contrast during the procedure.