Treatment Of High-risk Patients Research Articles

Guidelines, Clinical Evidence, and Real-Life Practice: How to Find Your Way in Managing Hypercholesterolaemia

Prof Masana presented evidence that low-density lipoprotein (LDL) cholesterol is a causal factor for atherosclerosis and that cardiovascular disease (CVD)-relative risk (RR) is reduced proportionally to LDL reductions, regardless of the type of monotherapy used. Combination therapy offers the advantage of increased lipid-lowering efficacy and a reduction in the side effects associated with high-intensity statins. The rationale thus exists for replacing high-intensity statin therapy with high-intensity cholesterol-lowering therapy. Prof Farnier gave an in-depth description of the results of the IMPROVE-IT, FOURIER, and ODYSSEY-Outcomes trials, demonstrating that the magnitude of clinical benefit is independent of whether it is achieved by statins, ezetimibe, or PCSK9 inhibitors. The IMPROVE-IT study also showed that the magnitude of benefit is proportionate to the absolute decrease in LDL cholesterol. This is consistent with the conclusions of a meta-analysis of randomised controlled statin trials, showing that patients achieving very low LDL cholesterol levels have a reduced risk of major cardiovascular (CV) events compared with those achieving moderately low levels. The greatest benefits for reductions in major adverse CV events from lowering LDL cholesterol occur in patients with diabetes. The above studies have led the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) taskforce on PCSK9 inhibitors to outline a strategy for additional treatment, with patients on maximally-tolerated statin doses failing to achieve LDL cholesterol goals at 4 weeks being considered for ezetimibe treatment, and those failing to achieve goals after a further 4 weeks being considered for PCSK9 inhibitors. Votes from the audience, collected at the start and end of each presentation, showed that the speakers convinced delegates that the lower the LDL cholesterol level achieved the better the outcome for patients would be, that combination therapy is as effective as single dose high-intensity statins, and that statins plus ezetimibe should be considered as standard treatment in high-risk patients, particularly in Type II diabetes mellitus (T2DM) patients.

Antiplatelet Treatment for Catheter-Based Interventions in High-Risk Patients: Current Guidelines and Expert Opinion.

Catheter-based interventions have revolutionized treatment of both coronary artery disease and aortic valve disease. Yet, these procedures are accompanied by thromboembolic and bleeding complications. Antiplatelet agents and anticoagulants with tolerable risk of bleeding complications are required to protect from recurrent thromboembolic events. Although guidelines for antithrombotic treatment in patients undergoing percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) are available, scarce evidence exists regarding therapeutic recommendations for patients at high risk for thromboembolic events or major bleeding. The choice of optimal antiplatelet therapy after PCI in patients with complex coronary artery disease and concomitant atrial fibrillation often poses a clinical challenge. The antiplatelet therapy in patients undergoing TAVR is so far based mostly on expert consensus. The present review addresses state-of-the-art antithrombotic therapy, particularly focusing on patients at high risk of thromboembolic and bleeding events, and aims to provide recommendations for clinical practice.

Early Versus Late Intervention in High Risk Patients with Non ST Elevation Myocardial Infarction

Early Versus Late Intervention in High Risk Patients with Non ST Elevation Myocardial Infarction

Nursing Assessment of Tissue Plasminogen Activator for Pulmonary Embolism

Nursing Assessment of Tissue Plasminogen Activator for Pulmonary Embolism

Prehabilitation in thoracic surgery

Surgical resection remains the best treatment option for patients with early stage of non-small cell lung cancer (NSCLC). However, it may be responsible of postoperative complication and mortality, especially in patients with impaired pulmonary function. Enhanced recovery after surgery (ERAS) programs have been focused mainly in minimal invasive surgery approach during lung resection and respiratory rehabilitation after surgery. Preoperative exercise-based intervention (prehabilitation) has demonstrated reduction of morbi-mortality in other surgeries but in thoracic surgery continues to be under discussion. Cardio-pulmonary exercise test (CPET) is the gold standard technique to predict postoperative morbi-mortality. The implementation of a preoperative respiratory rehabilitation could optimize patient's physical capacity before surgery and improve outcomes and enhance recovery. The aim of this systematic review of the literature is to identify the effectiveness and safety of prehabilitation programs in thoracic surgery, the type of exercise and its duration, and the group of patients with best benefit. Prehabilitation is a safe intervention without side effects in patients. High-intensity interval training (HIT) with duration of 2 to 6 weeks seems to be the best exercise programme in a prehabilitation intervention but it exists heterogeneity in terms of intensity and duration. Prehabilitation increase exercise capacity and significantly enhances pulmonary function. But the reduction of postoperative complication and mortality has not been clearly demonstrated. Different criteria selection, type of intervention and small sample size, in addition to no randomization, could justify disparate results. It seems that not all patients can benefit from prehabilitation and it could be indicated only in patients with impaired lung function. Further randomized clinical trials with enough patients, correct duration of HIT (2 to 6 weeks) and focused in COPD patients are needed to clarify the suitability of prehabilitation. Meanwhile, safety of prehabilitation and good results of some studies support this intervention in high-risk patients.

Intra- and interatrial conduction abnormalities: hemodynamic and arrhythmic significance.

Alterations of normal intra- and interatrial conduction are a common outcome of multiple cardiovascular conditions. They arise most commonly in the context of advanced age, cardiovascular risk factors, organic heart disease, atrial fibrosis, and left atrial enlargement. Interatrial block (IAB), the most frequent and extensively studied atrial conduction disorder, affects up to 20% of the general primary care population. IAB can be partial (P wave duration ≥ 120ms on any of the 12 ECG leads) or advanced (P wave ≥ 120ms and biphasic morphology (positive-negative) in inferior leads). Advanced IAB is an independent risk factor for supraventricular tachyarrhythmias and embolic stroke in a variety of clinical settings. Advanced IAB is a cause of left atrial electromechanical dysfunction and left atrioventricular dyssynchrony and has been associated with left ventricular diastolic dysfunction. P wave duration is associated with cardiovascular and all-cause mortality in the general population. Atrial conduction abnormalities should be identified as markers of atrial remodeling, prognostic indicators, and, in the case of advanced IAB, a true arrhythmologic syndrome. IAB and other P wave abnormalities should prompt the search for associated conditions, the treatment of which may partially reverse atrial remodeling or prevent it if administered upstream. Future studies will help define the role of preventive therapeutic interventions in high-risk patients, including antiarrhythmic drug therapy and oral anticoagulation. Implications for the treatment of heart failure and for pacing should also be further investigated.

Austrian recommendations for the management of polycythemia vera.

Polycythemia vera (PV) is aclonal disease arising from hematopoietic stem cells. Erythrocytosis is the hallmark of the disease but leukocytosis, thrombocytosis and splenomegaly may also be present. Thromboembolic complications occur in about 20% of patients. Circulatory disturbances as well as pruritus represent frequent symptoms of the disease. Mutations in the JAK2 gene are present in 95% of patients in exon14 (V617F) and in 3% in exon12. The main goal of the treatment for patients with PV is the prevention of thromboembolic events, transformation to myelofibrosis and acute myeloid leukemia. Interferon alpha and hydroxyurea are used as first-line treatment for high risk patients. For patients unresponsive to first-line therapy ruxolitinib is available.

Cost-effectiveness of optimized adherence to prevention guidelines in European patients with coronary heart disease: Results from the EUROASPIRE IV survey

BackgroundThis study aims to assess the cost-effectiveness of optimized guideline adherence in patients with a history of coronary heart disease. MethodsAn individual-based decision tree model was developed using the SMART risk score tool which estimates the 10-year risk for recurrent vascular events in patients with manifest cardiovascular disease (CVD). Analyses were based on the EUROASPIRE IV survey. Outcomes were expressed as an incremental cost-effectiveness ratio (ICER). ResultsData from 4663 patients from 13 European countries were included in the analyses. The mean estimated 10-year risk for a recurrent vascular event decreased from 20.13% to 18.61% after optimized guideline adherence. Overall, an ICER of 52,968€/QALY was calculated. The ICER lowered to 29,093€/QALY when only considering high-risk patients (≥20%) with decreasing ICERs in higher risk patients. Also, a dose-response relationship was seen with lower ICERs in older patients and in those patients with higher risk reductions. A less stringent LDL target (<2.5 mmol/L vs. <1.8 mmol/L) lowered the ICER to 32,591€/QALY and intensifying cholesterol treatment in high-risk patients (≥20%) instead of high-cholesterol patients lowered the ICER to 28,064€/QALY. An alternative method, applying risk reductions to the CVD events instead of applying risk reductions to the risk factors lowered the ICER to 31,509€/QALY. ConclusionDepending on the method used better or worse ICERs were found. In addition, optimized guidelines adherence is more cost-effective in higher risk patients, in patients with higher risk reductions and when using a less strict LDL-C target. Current analyses advice to maximize guidelines adherence in particular patient subgroups.

Application of posaconzole in prophylactic antifungal treatment of patients with hematological malignancies

Objective To observe the effect and safety of posaconzole in prophylactic antifungal treatment of high-risk patients with hematological malignancies. Methods The effect of posaconzole on prevention of invasive fungal disease (IFD) during chemotherapy in 102 patients with hematological malignancies in Shanghai Ruijin Hospital from February 2014 to April 2017 were analyzed retrospectively. The correlation analysis was carried out by Spearman analysis. Results A total of 102 patients were included, and only 2 (1.96%) patients had IFD. 2 patients died because of development of hematological malignancies. 11 (10.8%) patients had to discontinuation of posaconzole because of sever adverse events. Two patients with IFD and 1 case of undiagnosed IFD had to discontinue posaconzole. The total rate of discontinuation was 13.7% (14/102). There was no correlation between the time of using pothiazol and the time of hospitalization (rs=-0.02, P= 0.853) and the time of neutrophilic deficiency (rs= 0.167, P= 0.113), but the time of hospitalization was positively correlated with the time of neutrophilic deficiency (rs= 0.448, P= 0.000). Conclusion Posaconzole could effectively and safely prevent IFD in patients with hematological malignancies. Key words: Hematological neoplasms; Mycoses; Posaconzole

Readmission and Comprehension of Diabetes Education at Discharge (ReCoDED Study)

Diabetes (DM) is a major contributor to risk for hospital readmission. The Diabetes Early Readmission Risk Indicator (DERRI) is a predictor of 30-day readmission in patients with DM that may allow early identification and intervention for high-risk patients. A limitation to DERRI is the absence of DM-specific factors as contributors to this risk. To address this, we investigated HbA1c, glycemic measures and variability (GV), changes in DM therapy at discharge, and patient responses to a novel post-discharge questionnaire directed at Patient Comprehension (PC) of instructions provided for home DM management. Non-critically ill adult patients with DM were contacted by phone within 48 hours of hospital discharge to complete the PC Questionnaire. To date, 70 subjects (type 1 n=9, type 2 n=53, pancreatogenic DM n=8) (mean age 57.2 ± 12.8 years, BMI 31 ± 8.8 kg/m2, 56% men, 71% Caucasian, HbA1c 8.6 ± 2.0%, DM duration 19 ± 12 years, mean BG prior to discharge (210 ± 49 mg/dL), GV (66 ± 35 mg/dl) have been recruited. Of 41 subjects completing the PC questionnaire, those reporting that discharge instructions for home DM management were not provided had lower PC scores (70.6% vs. 81.5%, p=0.025) and more readmissions (OR 5.6, p=0.04) than those reporting that instructions were given. Among the 60 subjects with one-month post-discharge data, 22 patients (37%) reporting ≥1 readmission had higher DERRI scores than those without readmissions (26% vs. 20%, p=0.023). HbA1c, GV and changes in DM treatment regimens were not associated with readmission. In summary, these results demonstrate that PC of discharge instructions may be a novel mediator of readmission risk and may add an additional measure of risk for hospital readmission. Disclosure J. Swami: None. A. Donihi: None. E. Karslioglu French: None. K. Delisi: None. D.S. Hlasnik: None. N. Patel: None. D. Pinkhasova: None. D.J. Rubin: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. M.T. Korytkowski: Advisory Panel; Self; Novo Nordisk Inc.. Other Relationship; Self; JAEB Center For Health Research.

A Cost Analysis of Intensified vs. Conventional Multifactorial Therapy of Patients with Type 2 Diabetes—The Steno 2 Study

Introduction: Follow-up at 21.2 years after the initiation of the Steno-2 study, demonstrated that intensified multifactorial intervention increases median life-span with 7.9 years and delays incident cardiovascular disease (CVD) with a median of 8.1 years compared to conventional multifactorial intervention. Here we aimed to analyse the direct medical costs in the two original treatment groups during 21.2 years of follow-up. Methods: In 1993, 160 Danish patients with type 2 diabetes and microalbuminuria were randomised to receive either conventional or intensified and target-driven multifactorial intervention for 7.8 years. Information on direct health costs was gathered from health registers and any difference of costs in the two groups was assessed by non-parametric bootstrap t-test analysis. Results: Intensified treatment was on average more expensive regarding drug prescriptions, but less expensive in primary health sector services (both p&amp;lt;0.0001) and in-patient admission costs (p=0.02), specifically related to CVD (p&amp;lt;0.0001) during the entire follow-up period. There was no significant difference in total costs between the intensified treatment group, $13.0M and the conventional treatment group, $12.3M (p=0.19). When further assessing the cost per patient year there was no significant difference between the intensified group, $9,648, and the conventional treatment group, $10,681 (p=0.13). Conclusion: Over an average follow-up of 21.2 years we found no significant increase in total costs or in costs per person year associated with intensified multipronged treatment for 7.8 years when compared to conventional multipronged treatment. Considering the substantial gain of years of life and health benefits achieved with intensified treatment we conclude that intensified multifaceted intervention in high-risk patients with type 2 diabetes is highly cost-effective in a Danish health care setting. Disclosure J. Gaede: None. J. Oellgaard: None. R. Ibsen: None. P. Gæde: None. E. Noertoft: Employee; Self; Novo Nordisk A/S. J. Kjellberg: None. O. Pedersen: None.

Endobarrier as a Pre Bariatric Surgical Intervention in High-Risk Patients: a Feasibility Study

BackgroundObesity surgery mortality risk scoring system (OS-MRS) classifies patients into high, intermediate and low risk, based on age, body mass index, sex and other comorbidities such as hypertension and history of pulmonary embolism. High-risk patients not only have a higher mortality but are more likely to develop post-operative complications necessitating intervention or prolonged hospital stay following bariatric surgery. Endoscopically placed duodenal-jejunal bypass sleeve (Endobarrier) has been designed to achieve weight loss and improve glycaemic control in morbidly obese patients with clinically proven effectiveness.The aim of this study was to assess if pre-operative insertion of endobarrier in high-risk patients can decrease morbidity and length of stay after bariatric surgery.Materials and MethodsBetween 2012 and 2014, a cohort of 11 high-risk patients had an Endobarrier inserted (E&BS group) for 1 year prior to definitive bariatric surgery. These patients were compared against a similar group undergoing primary bariatric surgery (PBS group) during same duration. The two groups were matched for age, gender, body mass index, comorbidities, surgical procedure and OS-MRS using propensity score matching. Outcome measures included operative time, morbidity, length of stay, intensive therapy unit (ITU) stay, readmission rate, percentage excess weight loss (%EWL) and percentage total weight loss (%TWL).ResultsPatient characteristics and OS-MRS were similar in both groups (match tolerance 0.1). There was no significant difference in total length of stay, readmission rate, %EWL and %TWL. Operative time, ITU stay, post-operative complications and severity of complications were significantly less in the E&BS group (p < 0.05) with significant likelihood of planned ITU admissions in the PBS group (p < 0.05).ConclusionEndobarrier could be considered as a pre bariatric surgical intervention in high-risk patients. It may result in improved post-operative outcomes in high-risk bariatric patients.

Current Role of Lipoprotein Apheresis in the Treatment of High-Risk Patients.

Lipoprotein apheresis (LA) is a therapeutic approach to save the lives of patients who are at an extremely high risk of developing cardiovascular events (CVE), especially after all other therapeutic options were not tolerated, or appeared not to be effective enough. Homozygous familial hypercholesterolemia represents a clear indication to start LA therapy. Another recognized indication is a severe hypercholesterolemia, which induced CVE, often in association with other risk factors. In the last years, an expressive elevation of lipoprotein(a) (Lp(a)) emerged as an indication for LA. In Germany, progress of atherosclerosis should have been documented before the permission to start LA therapy is given in these patients. Usually, all LA methods acutely decrease both LDL-C and Lp(a). However, specific columns which reduce only Lp(a) are available. Case reports and prospective observations comparing the situation before and during LA therapy clearly show a high efficiency with respect to the reduction of CVE, especially in patients with high Lp(a) levels. PCSK9 inhibitors may reduce the need for LA in patients with heterozygous or polygenetic hypercholesterolemia, but in some patients, a combination of these drugs with LA will be necessary. In the future, an antisense oligonucleotide against apolipoprotein(a) may offer an alternative therapeutic approach.

Pregnancy Outcomes in Women with Gestational Diabetes Mellitus Diagnosed in the First Versus Second Trimester [31E

INTRODUCTION: First trimester screening is recommended for patients at higher risk for gestational diabetes mellitus (GDM). We sought to compare pregnancy outcomes in women diagnosed with GDM in the first versus second trimester. METHODS: This was a retrospective cohort study evaluating patients with GDM at a university clinic. The early diagnosis group had abnormal first trimester GDM testing. The late diagnosis group had normal first trimester testing, followed by abnormal second trimester testing. Mean differences in treatment interventions and maternal/neonatal outcomes were compared between groups. RESULTS: Of 115 total patients, 32 (28%) were diagnosed with GDM in the first trimester and 83 (72%) were diagnosed in the second trimester. There was no difference in number of antenatal testing visits, ultrasounds, or patients requiring medication for glycemic control (p = 0.78, p = 0.92, p = 0.92). Mean gestational age at medication initiation was earlier in the early diagnosis group (24.2 vs. 31.5 weeks; p &lt; 0.001). There was no clinically meaningful difference in mean number of prenatal visits (11.7 vs. 10.4; p = 0.04) or nutrition consults (2.2 vs. 1.7; p = 0.005). Both groups had similar incidence of cesarean delivery and postpartum hemorrhage (p = 0.87, p = 0.57). There was no difference in minor or major adverse neonatal composite outcomes (p = 0.74, p = 0.48). CONCLUSION: Early GDM diagnosis and intervention in high-risk patients may positively impact their pregnancy by achieving similar maternal and neonatal outcomes without increasing the burden of clinic visits compared to those diagnosed in the second trimester.

A research progress on risk factors for stroke related infections

Stroke is the leading cause of death and disability in the world. It is the first disease that causes the death of Chinese residents, and hospital infection is the leading cause of death in stroke patients. This paper based on the research of the domestic and foreign articles, found that stroke predictor associated pneumonia, urinary tract infection mainly including the type, area, and the size of the brain injury, the patient′s age, sex, consciousness, swallowing and urination function, National Institute of Health Stroke Scale (NIHSS) score, trachea, invasive operation, indwelling catheter and diabetes mellitus, atrial fibrillation, cardiovascular disease, etc. Some results of the study are different, further validation and Meta-analysis are needed. This paper aims to provide a basis for nursing workers to assess the risk of infection in patients with cerebral apoplexy, so as to provide early prevention and intervention for high-risk patients. Key words: Stroke; Infection; Risk factors

“Guidelines Recommendations on the Treatment of Tricuspid Regurgitation. Where Are We and Where Do We Go With Transcatheter Valve Intervention”

Tricuspid regurgitation (TR) is an important clinical problem because it is frequent and carries a poor prognosis when it is left uncorrected. However, there is still a lack of awareness of tricuspid disease in the medical community. The indications for evaluation and surgical interventions in patients with TR were recently updated in the ESC/EACTS guidelines. Transcatheter tricuspid valve intervention (TTVI), almost exclusively valve repair, is at an early stage of development as only a few hundreds of patients have been treated. The first-in-man valve implantation was very recently performed. The recent ESC/EACTS Guidelines state that “The potential role of transcatheter tricuspid valve treatment in high-risk patients needs to be determined”. We shall review here which lessons of interest for TTVI can be learned from the Guidelines as regards evaluation and indications for surgery and try to imagine what could be the place of TTVI in the Guidelines in the future.

Value of three dimensional-speckle tracking imaging for predicting left ventricular function after non-ST-segment elevation myocardial infarction with percutaneous coronary intervention

Percutaneous coronary intervention (PCI) is the recommended treatment for high risk patients with non-ST-segment elevation myocardial infarction (NSTEMI). To investigate the application of three dimensional-speckle tracking imaging (3D-STI) on patients diagnosed with NSTEMI undergoing PCI. Forty-four NSTEMI patients and 20 healthy subjects that received basic clinical and laboratory examinations were included in our study. NSTEMI patients were divided into three groups: heart failure (HF) with normal ejection fraction (HF-NEF group, n = 19), heart failure with preserved ejection fraction (HF-PEF group, n = 14) and heart failure with a reduced ejection fraction (HF-REF group, n = 11). The global longitudinal peak systolic strain (GLS), global circumferential peak systolic strain (GCS), global radial peak systolic strain (GRS) and left ventricular (LV) torsion of all subjects were measured by 3D-STI before PCI and 1 month, 3 months after PCI. The high-sensitivity troponin T (hs-TNT), high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-brain natriuretic peptide (NT-pro BNP) were measured in each group. Correlations between these parameters and LV ejection fraction (LVEF) were tested by Pearson correlation analysis. GLS, GCS and torsion were significantly decreased in the 3 NSTEMI groups compared with control group (P < 0.05). GLS, torsion were significantly improved in the three NSTEMI groups at postoperative 1 and 3 months (P < 0.05). HF-REF group showed improved GCS on postoperative 1 and 3 month compared with preoperative data, and improved GLS at 3-month follow-up compared with 1-month follow-up (P < 0.05). The hs-TNT, hs-CRP and NT-pro BNP increased in the three NSTEMI groups before PCI (P < 0.05), and decreased at postoperative 1 and 3 month (P < 0.05). LVEF has the positive correlations with LV endsystolic volume (LVESV) and torsion, as well as the negative correlations with LVGLS, LVGCS, NT-pro BNP (P < 0.05). The combinative detection of 3D-STI and NT-pro BNP is an efficient way to assess the cardiac function in patients diagnosed with NSTEMI undergoing PCI.

Treatment of high-risk patients with severe aortic stenosis by the use of transcatheter aortic valve implantation

Aortic stenosis is the most common disease from the group of acquired heart diseases. The frequency and degree of damage of the aortic valve increases with age. The prevalence of this disease increases due to the general extension in life expectancy of the population. Aortic valve stenosis caused by calcification is the pathology with progressive course characterized by a poor prognosis at the stage of expanded symptoms. Five-year survival of patients with developed clinical picture of aortic stenosis without surgery, according to some estimates, is reduced to 15%, which is the worst figure, even in comparison with most potentially incurable cancer. In the treatment of aortic stenosis aortic valve replacement is the “gold standard” and gives positive results in all age groups of patients. Only one third of patients are sent for aortic valve replacement owing to high risk caused by the age, severity of the defect, reduced contractility of the left ventricle, pulmonary hypertension and other comorbidities. Aortic valve replacement in patients of the older age groups with concomitant diseases is associated with high level of hospital mortality. One of the attempts to reduce the frequency of complications and mortality in this group of patients is the implementation of a less traumatic surgery – transcatheter aortic valve implantation. At present our clinic has successfully performed more than 70 operations of transcatheter aortic valve implantation. Transcatheter aortic valve implantation is a good alternative to standard aortic valve replacement in patients with high risk of open-heart surgery.

Predictors associated with unplanned hospital readmission of medical and surgical intensive care unit survivors within 30\xa0days of discharge

BackgroundReducing the 30-day unplanned hospital readmission rate is a goal for physicians and policymakers in order to improve quality of care. However, data on the readmission rate of critically ill patients in Japan and knowledge of the predictors associated with readmission are lacking. We investigated predictors associated with 30-day rehospitalization for medical and surgical adult patients separately.MethodsPatient data from 502 acute care hospitals with intensive care unit (ICU) facilities in Japan were retrospectively extracted from the Japanese Diagnosis Procedure Combination (DPC) database between April 2012 and February 2014. Factors associated with unplanned hospital readmission within 30 days of hospital discharge among medical and surgical ICU survivors were identified using multivariable logistic regression analysis.ResultsOf 486,651 ICU survivors, we identified 5583 unplanned hospital readmissions within 30 days of discharge following 147,423 medical hospitalizations (3.8% readmitted) and 11,142 unplanned readmissions after 339,228 surgical hospitalizations (3.3% readmitted). The majority of unplanned hospital readmissions, 60.9% of medical and 63.1% of surgical case readmissions, occurred within 15 days of discharge. For both medical and surgical patients, the Charlson comorbidity index score; category of primary diagnosis during the index admission (respiratory, gastrointestinal, and metabolic and renal); hospital length of stay; discharge to skilled nursing facilities; and having received a packed red blood cell transfusion, low-dose steroids, or renal replacement therapy were significantly associated with higher unplanned hospital readmission rates.ConclusionsFrom patient data extracted from a large Japanese national database, the 30-day unplanned hospital readmission rate after ICU stay was 3.4%. Further studies are required to improve readmission prediction models and to develop targeted interventions for high-risk patients.

Secondary Prevention of Cardiovascular Diseases and Application of Technology for Early Diagnosis.

Cardiovascular diseases result in millions of deaths around the globe annually, most of which are avoidable if identified early. Preventive healthcare has a major role in the fight against cardiovascular diseases. Primary, secondary, and tertiary prevention have their own applications along with benefits and drawbacks. This paper aims to elevate the sensitivity of “secondary prevention of cardiovascular diseases.” Firstly, it discusses common types of cardiovascular diseases around the globe and their causes. Secondly, it analyzes different risk factors associated with cardiovascular diseases and then discusses incoming technological trends in cardiovascular disease prediction and finally provides an insight into the importance of secondary prevention of cardiovascular diseases and commonly prescribed interventions for high risk patients.