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Background: Cardiovascular disease (CVD) is a major contributor to morbidity and mortality in people on hemodialysis (HD). Cardiovascular outcomes are reported infrequently and inconsistently across trials in HD. This study aimed to identify the priorities of patients/caregivers and health professionals (HPs) for CVD outcomes to be incorporated into a core outcome set reported in all HD trials., Methods: In an international online survey, participants rated the absolute importance of 10 cardiovascular outcomes (derived from a systematic review) on a 9-point Likert scale, with 7-9 being critically important. The relative importance was determined using a best-worst scale. Likert means, medians and proportions and best-worst preference scores were calculated for each outcome. Comments were thematically analyzed., Results: Participants included 127 (19%) patients/caregivers and 549 (81%) HPs from 53 countries, of whom 530 (78%) completed the survey in English and 146 (22%) in Chinese. All but one cardiovascular outcome ('valve replacement') was rated as critically important (Likert 7-9) by all participants; 'sudden cardiac death', 'heart attack', 'stroke' and 'heart failure' were all rated at the top by patients/caregivers (median Likert score 9). Patients/caregivers ranked the same four outcomes as the most important outcomes with mean preference scores of 6.2 (95% confidence interval 4.8-7.5), 5.9 (4.6-7.2), 5.3 (4.0-6.6) and 4.9 (3.6-6.3), respectively. The same four outcomes were ranked most highly by HPs. We identified five themes underpinning the prioritization of outcomes: 'clinical equipoise and potential for intervention', 'specific or attributable to HD', 'severity or impact on the quality of life', 'strengthen knowledge and education', and 'inextricably linked burden and risk'., Conclusions: Patients and HPs believe that all cardiovascular outcomes are of critical importance but consistently identify sudden cardiac death, myocardial infarction, stroke and heart failure as the most important outcomes to be measured in all HD trials., (© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)

Background: Public reporting of physician-specific outcome data for procedures, such as percutaneous coronary intervention (PCI), can influence physicians to avoid high-risk patients who may benefit from treatment. Prior physician attitudes toward public scorecards in New York State (NYS) have been studied, but the exclusion criteria have evolved. Additionally, patient perceptions toward such reports remain poorly understood. This study evaluates (1) whether exclusion of certain high-risk patients from public reporting of PCI outcomes in NYS has influenced physician attitudes, (2) current patient awareness and use of publicly reported outcome data, and (3) differences in physician and patient attitudes toward public reporting., Methods and Results: A questionnaire was administered to interventional cardiologists in NYS with specific emphasis on how modifications in publicly reported outcome data have influenced their practice. The results were compared with a 2003 survey administered by our group. A separate questionnaire regarding the publicly available NYS PCI Report was administered to patients referred to our center for possible PCI. The majority of interventional cardiologists indicated that the exclusion of patients with anoxic brain injury and refractory cardiogenic shock from public reporting has made them more likely to perform PCI for these subgroups. While patient awareness of the NYS PCI Report was low, patients were significantly more likely than physicians to think that publication of physician-specific mortality data can provide an accurate measure of physician quality, serve to improve patient care, and provide useful information in terms of physician selection., Conclusions: The study provides further evidence that public reporting of physician-specific outcome data influences physician behavior and indicates that significant discrepancies exist in how scorecards are perceived by physicians versus patients., (© 2017 American Heart Association, Inc.)

Aim: The purpose of this study was to reveal how Turkish patients experiencing acute myocardial infarction (AMI) for the first time decide to seek medical treatment following the initiation of the symptoms., Methods: This qualitative study was carried out by using the grounded theory. Data were collected in a university hospital cardiology clinic in Turkey between March 2009 and March 2010. The sample comprised 30 patients having experienced AMI for the first time. The data were collected by an in-depth interview technique via a semistructured interview form. All of the interviews were recorded using a tape-recorder., Results: The median decision-making time was 90 min. Two main themes emerged at the end of the study: "feeling of abnormality" and "thinking the situation is critical". Deciding to seek medical help was found to be a process which emerges with the severity of symptoms, an inability to manage symptoms, fear, and extrinsic factors., Conclusion: The results of this study show the importance of being aware of the symptoms when deciding to seek treatment. It is recommended to develop training programs about AMI symptoms and the importance of receiving early medical help by targeting society in general and the individuals with a diagnosis of coronary artery disease and their relatives in particular, and to organize awareness-raising campaigns supported by the media., (© 2013 The Authors. Japan Journal of Nursing Science © 2013 Japan Academy of Nursing Science.)

Aims: As part of the diagnosis related groups in Europe (EuroDRG) project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their DRG systems deal with patients admitted to hospital for acute myocardial infarction (AMI). The study aims to assist cardiologists and national authorities to optimize their DRG systems., Methods and Results: National or regional databases were used to identify hospital cases with a primary diagnosis of AMI. Diagnosis-related group classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify AMI patients according to different sets of variables into diverging numbers of DRGs (between 4 DRGs in Estonia and 16 DRGs in France). The most complex DRG is valued 11 times more resource intensive than an index case in Estonia but only 1.38 times more resource intensive than an index case in England. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only €420 in Poland but to €7930 in Ireland., Conclusions: Large variation exists in the classification of AMI patients across Europe. Cardiologists and national DRG authorities should consider how other countries' DRG systems classify AMI patients in order to identify potential scope for improvement and to ensure fair and appropriate reimbursement.

Anxiety has both functionally appropriate and inappropriate consequences. Among patients with cardiac disease, anxiety can be functionally appropriate when it prompts an individual to quickly seek treatment for acute cardiac signs and symptoms. But anxiety may have medical or psychological consequences when it is persistent or severe, including difficulty adhering to prescribed treatments and making recommended lifestyle changes, adoption of or failure to change risky behaviors, increased risk for acute cardiac events, and increased risk for in-hospital complications after admission for acute coronary syndrome. Yet, because anxiety is a universal emotion that is managed without consequence by many people, its importance is often ignored by healthcare providers. The impact of psychosocial (with a major emphasis on anxiety) and behavioral variables on biological outcomes was examined systematically. The research included (1) examination and comparison of the intensity of anxiety in international samples of various critically, acutely, and chronically ill cardiac patients; (2) determination of differences between men and women in the expression of anxiety; (3) investigation of factors predictive of anxiety levels, including perceived control; (4) studies of healthcare providers' knowledge of anxiety assessment and providers' practices in assessing and managing anxiety; and (5) determination of the impact of anxiety on clinical outcomes in cardiac patients. The goal of this program of research is to improve patients' outcomes on a widespread basis by placing anxiety in the forefront of clinical cardiac practice.

Individual beverages have varying associations with cardiometabolic outcomes, but little is known about overall beverage quality and cardiometabolic risk after myocardial infarction (MI). We created the Beverage Quality Index (BQI) to assess beverage quality and examined its association with cardiometabolic outcomes after MI. We included 4365 Dutch post-MI patients from the Alpha Omega Cohort, aged 60–80 years. Diet was assessed at baseline (2002–2006) with a 203-item FFQ. The BQI included eight components (coffee, tea, milk, juices, sugar-sweetened beverages, alcohol, added sugar to coffee and tea, and energy from beverages), and ranged from 0 to 80. Multivariable Cox models were used to estimate HRs for the BQI in relation to incident diabetes mellitus (DM), major adverse cardiovascular events (MACE), recurrent cardiovascular disease (CVD) and fatal CVD over 3.4 y of follow-up, with follow-up for fatal CVD extended through 2018 (12.4 y). The average BQI was 50.0 ± 12.5. During 3.4 y of follow-up, we identified 186 incident cases of DM, 601 of MACE, 310 of recurrent CVD and 140 of fatal CVD. In multivariable models, a higher BQI (T3 vs. T1) was associated with lower risk of MACE [HR: 0.73 (0.59–0.90)], and recurrent CVD [HR: 0.67 (0.50–0.91)], but not with DM or CVD mortality. After 12.4 y of follow-up, 903 CVD deaths occurred. A significant inverse association with CVD mortality during long-term follow-up was found [HR: 0.81 (0.68–0.96)]. Overall beverage intake quality, as assessed by the BQI, may represent an important target for the prevention of recurrent CVD. • We developed the beverage quality index (BQI) to assess overall beverage quality. • Higher BQI was associated with lower risk of CVD recurrence and mortality in Dutch post-MI patients. • Overall beverage quality may be an important target for the secondary prevention of CVD. • The BQI could be used as a tool to guide healthy beverage choices in clinical settings but needs validation in other cohorts. [ABSTRACT FROM AUTHOR]

Myocardial infarction can be ruled out in patients with a single cardiac troponin measurement. Whether use of a uniform rule-out threshold has resulted in sex differences in care remains unclear. The purpose of this study was to evaluate implementation of a uniform rule-out threshold in females and males with possible myocardial infarction, and to derive and validate sex-specific thresholds. The implementation of a uniform rule-out threshold (<5 ng/L) with a high-sensitivity cardiac troponin I assay was evaluated in consecutive patients presenting with possible myocardial infarction. The proportion of low-risk patients discharged from the emergency department and incidence of myocardial infarction or cardiac death at 30 days were determined. Sex-specific thresholds were derived and validated, and proportion of female and male patients were stratified as low-risk compared with uniform threshold. In 16,792 patients (age 58 ± 17 years; 46% female) care was guided using a uniform threshold. This identified more female than male patients as low risk (73% vs 62%), but a similar proportion of low-risk patients were discharged from the emergency department (81% for both) with fewer than 5 (<0.1%) patients having a subsequent myocardial infarction or cardiac death at 30 days. Compared with a uniform threshold of <5 ng/L, use of sex-specific thresholds would increase the proportion of female (61.8% vs 65.9%) and reduce the proportion of male (54.8% vs 47.8%) patients identified as low risk. Implementation of a uniform rule-out threshold for myocardial infarction was safe and effective in both sexes. Sex-specific rule-out thresholds should be considered, but their impact on effectiveness and safety may be limited. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Many COVID-19 survivors suffer from persisting sequelae after acute disease. This is referred to as long COVID. The objectives of this study were to assess factors associated with long COVID and to analyze differences in persistent symptoms, findings on chest imaging, and pulmonary function between intensive care unit (ICU) and non-ICU hospitalized patients. Methods: We conducted a retrospective study including patients hospitalized with COVID-19. Patients were stratified into ICU patients and non-ICU patients. We analyzed the outcomes of patients who were in clinical follow-up 6 months after discharge with persistent symptoms, radiological and/or functional abnormalities. Logistic regression was used to examine the association between long COVID and patient characteristics. Results: A total of 549 patients were included. Eighty-one ICU patients (66%) and 146 (34%) non-ICU patients had persistent symptoms or abnormalities on chest imaging or lung function test minimally 6 months after discharge. Significantly more ICU patients had residual fibrotic abnormalities on chest CT and functional impairment. Female gender, myocardial infarction, OSAS, low PCO2 at admission, and longer hospital stay were associated with a higher risk of developing long COVID. Diabetes and treatment with tocilizumab were associated with a lower risk of developing long COVID. Conclusion: Of the patients hospitalized for COVID-19, 34–66% suffered from persistent symptoms, residual abnormalities on chest imaging, or reduced lung function at around 6 months after discharge. While persistent sequelae were more frequent in ICU patients, admission to the ICU was not found to be an independent risk factor for developing long COVID. [ABSTRACT FROM AUTHOR]

Aims Spontaneous coronary artery dissection (SCAD) is an under-recognized cause of myocardial infarction. We aimed to investigate SCAD survivors' perceptions of their quality-of-care and its relationship to quality-of-life. Methods and results An anonymous survey was distributed online to SCAD survivors involved in Australian SCAD support groups, with 172 (95.3% female, mean age 52.6 ± 9.2 years) participants in the study. The survey involved assessment of quality-of-life using a standardized questionnaire (EQ-5DTM-3L). Respondents rated the quality-of-care received during their hospital admission for SCAD with a median of 8/10 [interquartile range (IQR) 7–10]. Respondents ≤ 50 years vs. >50 years were more likely to perceive that their symptoms were not treated seriously as a myocardial infarction (χ2 = 4.127, df = 1, P < 0.05). Participants rated clinician's knowledge of SCAD with a median of 4/10 (IQR 2–8) and 7/10 (IQR 3–9) for Emergency and Cardiology clinicians, respectively (P < 0.05). The internet was the most selected source (45.4%) of useful SCAD information. The mean EQ-5DTM summary index was 0.79 (population norm 0.87). A total of 47.2% of respondents reported a mental health condition diagnosis, with 36% of these diagnosed after their admission with SCAD. Quality-of-life was significantly associated with perceived quality-of-care: EQ-5DTM index/(1-EQ-5DTM index) increased by 13% for each unit increase in quality-of-care after adjusting for age and comorbidities (P < 0.001). Conclusion While SCAD survivors rated their overall hospital care highly, healthcare providers' knowledge of SCAD was perceived to be poor, and the most common source of SCAD information was the internet. Mental health conditions were common, and a significant association was observed between perceived quality-of-care and SCAD survivors' quality-of-life. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify potential risk factors for myocardial infarction immediately following total hip arthroplasty. The 2016–2019 Nationwide Inpatient Sample database was used to identify patients who underwent primary total hip arthroplasty (THA) and suffered a myocardial infarction (MI). Patient data including demographics, admission, and comorbidities were recorded. Univariate analysis and subsequent multivariate logistic regression were performed to determine which circumstances affected the odds of MI. A total of 367,890 patients were identified for THA with 142 of those also having a myocardial infarction. Those who experienced an MI had increased length of stay, total charges, and generally negative dispositions compared to their non-MI counterparts (p < 0.001). Through regression analysis, factors that increased the odds of MI included older age [odds ratio (OR) 1.59, 95 % confidence interval (CI) 1.49–1.70], a female sex (OR 1.46, 95 % CI 1.37–1.55), previous coronary artery bypass graft (OR 1.20, 95 % CI 1.01–1.43), obesity (OR 1.12, 95 % CI 1.04–1.21), colostomy (OR 2.07, 95 % CI 1.21–3.56), and Parkinson's disease (OR 1.48, 95 % CI 1.13–1.95). Factors that decreased that risk included elective admission (OR 0.21, 95 % CI 0.19–0.22) and a tobacco related disorder (OR 0.69, 95 % CI 0.63–0.76). Patient risk for myocardial infarction following total hip arthroplasty varies in part based on their background and comorbidities. These findings can be used to better recognize those who should receive further precautions and tailor proper treatment strategies for THA. [ABSTRACT FROM AUTHOR]

In critically ill patients with acute myocardial infarction (AMI), the relationship between the early administration of β‐blockers and the risks of in‐hospital and long‐term mortality remains controversial. Furthermore, there are conflicting evidences for the efficacy of the early administration of intravenous followed by oral β‐blockers in AMI. We conducted a retrospective analysis of critically ill patients with AMI who received the early administration of β‐blockers within 24 hours of admission. The data were extracted from the Medical Information Mart for Intensive Care IV database. We enrolled 2467 critically ill patients with AMI in the study, with 1355 patients who received the early administration of β‐blockers and 1112 patients who were non‐users. Kaplan‐Meier survival analysis and Cox proportional hazards models showed that the early administration of β‐blockers was associated with a lower risk of in‐hospital mortality (adjusted hazard ratio [aHR] 0.52; 95% confidence interval [95%CI] 0.42‐0.64), 1‐year mortality (aHR 0.54, 95%CI 0.47‐0.63), and 5‐year mortality (aHR 0.60, 95%CI 0.52‐0.69). Furthermore, the early administration of both oral β‐blockers and intravenous β‐blockers followed by oral β‐blockers may reduce the mortality risk, compared with non‐users. The risks of in‐hospital and long‐term mortality were significantly decreased in patients who underwent revascularization with the early administration of β‐blockers. We found that the early administration of β‐blockers could lower the risks of in‐hospital and long‐term mortality. Furthermore, the early administration of both oral β‐blockers and intravenous β‐blockers followed by oral β‐blockers may reduce the mortality risk, compared with non‐users. Notably, patients who underwent revascularization with the early administration of β‐blockers showed the lowest risks of in‐hospital and long‐term mortality. [ABSTRACT FROM AUTHOR]

Aims We investigated the prevalence of sarcopenia and its influence on 1-year major adverse cardiac events (MACEs) in patients after successful percutaneous coronary intervention (PCI). Methods and results This retrospective medical record review using purposive sampling was conducted at a tertiary care university hospital in Korea. Medical records of a total of 303 patients (≥40 years) who underwent successful PCI between January 2014 and December 2020 were analysed. We retrospectively assessed sarcopenia at initial admission. Sarcopenia was assessed by a sarcopenia index based on a ratio of serum creatinine to serum cystatin C. MACE rates were evaluated within l year after PCI. A Kaplan–Meier analysis with a log-rank test was performed to compare the time with 1-year MACE event-free survival between groups with and without sarcopenia. Cox proportional hazards regression was conducted to assess sarcopenia's influence on MACE. The prevalence of sarcopenia and 1-year MACE after PCI were 24.8 and 8.6%, respectively. We found that sarcopenia at admission (hazard ratio, 3.01; 95% confidence interval, 1.22–7.38, P = 0.017) was significantly associated with 1-year MACE among patients after PCI. Conclusion Expanding knowledge of sarcopenia among cardiovascular nurses may aid in early recognition of patients at risk of sarcopenia. Our finding implies that the sarcopenia index based on serum creatinine and cystatin C may be available as a prognostic factor for MACE in patients undergoing PCI. Future studies should be conducted to prospectively validate the sarcopenia index with a multi-centre, large sample. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess and compare the impact of implementing a standard clinical pathway on clinical outcomes and quality of life among Acute Myocardial Infarction (AMI) patients at Dr. Ruth Katherina Martha Pfau Civil Hospital in Karachi, Pakistan. Methodology: A quasi-experimental non-randomized controlled study was conducted from September to December 2018, involving 220 AMI patients. The control group (110) received standard care, while the interventional group (110) was managed using a standardized clinical pathway. Data was collected using the AMI standard clinical pathway tool and the SF-36 questionnaire. Statistical analysis was performed using SPSS version 22, presenting categorical variables as frequencies and percentages, and continuous variables as mean and standard deviation. Mean differences in clinical parameters and quality of life were assessed using paired sample t-tests with a significance level set at p < 0.05. Results: Among the participants, 50% were in the control group and 50% in the interventional group, with a predominance of males. The quality-of-life scores significantly differed between the control and intervention groups (p < 0.001). Furthermore, significant improvements in quality of life were observed in both male and female patients' post -intervention (p < 0.001). Conclusion: Implementation of a standard clinical pathway led to improved clinical outcomes and quality of life among AMI patients. This highlights the potential benefits of standardized care pathways in enhancing patient outcomes in similar healthcare settings. [ABSTRACT FROM AUTHOR]

Cardiogenic shock (CS) is characterized by low cardiac output and sustained tissue hypoperfusion that may result in end-organ dysfunction and death. CS is associated with high short-term mortality, and its management remains challenging despite recent advances in therapeutic options. Timely diagnosis and multidisciplinary team-based management have demonstrated favourable effects on outcomes. We aimed to review evidence-based practices for managing patients with ischemic and non-ischemic CS, detailing the multi-organ supports needed in this critically ill patient population. [ABSTRACT FROM AUTHOR]

Background • Acute ST segment elevation myocardial infarction (ASTEMI) is the most common and serious type of AMI, percutaneous coronary intervention (PCI) is currently the most commonly used approach for clinical treatment of ASTEMI. After PCI, patients with ASTEMI are very prone to various complications, which will seriously threaten their health and life safety. Objective • This study aims to analyze the risk factors for complications in patients with acute ST-segment elevation myocardial infarction (ASTEMI) treated with percutaneous coronary intervention (PCI). Methods • A total of 107 patients with ASTEMI who were subjected to PCI from October 2021 to December 2022 were selected as study subjects. Patients were divided into a safety group (no complications, n = 63) and a risk group (n = 45) based on the presence of postoperative complications. Baseline data (age, sex, etc.), Killip classification, left ventricular ejection fractions (LVEF), and routine blood test results were collected from patients in both groups for Logistic regression analysis to obtain relevant factors affecting the occurrence of post-PCI complications. Results • There were no differences between the safety group and the risk group in terms of sex, age, body mass index (BMI), Killip classification, and infarct site (P > .05). Compared with the safety group, the risk group exhibited a higher proportion of patients with multiple pre-existing diseases, LVEF < 40%, and number of coronary artery lesions ≥ 1, and higher levels of hs-CRP, NT-proBNP, HbA1c and Scr (P < .05). Logistic regression analysis results showed that multiple pre-existing diseases, hs-CRP, NT-proBNP, HbA1c, and Scr were relevant factors affecting the occurrence of post-PCI complications (P < .05). Conclusion • Multiple pre-existing diseases, hs-CRP, NT-proBNP, HbA1c, and Scr were all independent risk factors for the occurrence of post-PCI complications. Future clinical attention should be paid to these indicators in patients with ASTEMI in order to prevent post-PCI complications. [ABSTRACT FROM AUTHOR]

The systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) have previously demonstrated predictive value in coronary artery disease (CAD). We developed on an expanded, novel systemic immune-inflammation response index (SIIRI), calculated as peripheral neutrophil × monocyte × platelet ÷ lymphocyte count. We assessed 240 patients with an acute coronary syndrome that subsequently underwent percutaneous coronary intervention. CAD severity was measured using the SYNTAX score. Laboratory measurements, including cell counts, were obtained on admission. On multivariate analysis, the SIIRI was an independent predictor of severe CAD with an adjusted odds ratio (OR) of 1.666 [1.376-2.017] per 105-unit increase. The SIIRI had the highest area under the receiver operator curve of.771 [.709-.833] compared to the SII, SIRI neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio. The optimal cut-off for SIIRI was 4.3 × 105, with sensitivity = 69.9% and specificity = 75.8%. Increment in model performance resulting from adding SIIRI versus other inflammatory indices was assessed using discrimination, calibration, and goodness-of-fit measures. When added to a baseline model, the SIIRI resulted in a significant increase in the c-statistic and significant net reclassification index (.808, P <.0001) and integrated discrimination index (.129, P <.0001), and a decrease in Akaike and Bayesian information criteria. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of azilsartan on myocardial remodeling after acute myocardial infarction (AMI). Methods: A total of 200 AMI patients under percutaneous coronary intervention (PCI) were selected from the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University from Jan 2021 to Dec 2021. The subjects were randomly divided to take either azilsartan or benazepril. Serum C1q tumor necrosis factor-associated protein 1 (CTRP1) levels were detected in all subjects after admission, and the indices of left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) were measured by using echocardiography. At the follow-up of 6 months and 1 year after PCI, the differences in CTRP1 and echocardiogram indices between the two groups were compared, and the influencing factors of myocardial remodeling after acute myocardial infarction were analyzed. Results: The levels of LVEDV and CTRP1 in all subjects at 6 months and 1 year after PCI were lower than those before discharge, and the LVEDV in the azilsartan group at 6 months and 1 year after PCI was lower than that in the benazepril group. An improvement in myocardial remodeling was obviously observed within 6 months after PCI, but the effect declined over time. Conclusions: Azilsartan can improve myocardial remodeling after acute myocardial infarction. CTRP1 may become an effective target for the prevention and treatment of myocardial remodeling after acute myocardial infarction. [ABSTRACT FROM AUTHOR]

The article discusses the BEST-CLI International Collaborative, which aims to improve care and outcomes for patients with chronic limb-threatening ischemia (CLTI) globally. The article highlights the increasing prevalence of peripheral arterial disease (PAD) and the need for evidence-based treatment strategies for CLTI. The BEST-CLI trial, funded by the National Heart, Lung, and Blood Institute, compared open surgery and endovascular therapy for CLTI patients. The article also mentions the BASIL-2 trial, which compared different revascularization strategies for CLTI. The BEST-CLI International Collaborative seeks to interpret the trial results, identify gaps in CLTI care, disseminate evidence-based medicine, and identify future research priorities. The text discusses the findings of a survey conducted among vascular specialists from 22 countries regarding the treatment of chronic limb-threatening ischemia (CLTI). The survey revealed wide disparities in the management of CLTI, including variations in patient demographics, diagnostic classification, treatment approaches, and costs. The text emphasizes the need for global education and collaboration to promote best practices in CLTI treatment and ensure equal access to evidence-based care. It also highlights the importance of considering local contexts and health economics when implementing treatment strategies. Additionally, the text mentions the potential of new technologies to improve revascularization outcomes and the importance of training programs to enhance physician skills in CLTI interventions. The text discusses the evolution of new technology in caring for patients with critical limb-threatening ischemia (CLTI) and emphasizes the importance [Extracted from the article]

Background and Aims: New‐onset atrial fibrillation (NOAF) is a common manifestation in critically ill patients. There is a paucity of evidence indicating a relationship between urinary ketones and NOAF. Methods: Critically ill patients with urinary ketone measurements from the Medical Information Mart for Intensive Care (MIMIC‐IV) database were included. The primary outcome was NOAF Propensity score matching was performed following by multivariable logistic regression. Results: A total of 24,688 patients with available data of urine ketone were included in this study. The urine ketone of 4014 patients was tested positive. The average age of the included participants was 63.8 years old, and 54.5% of them were male. Result of the fully‐adjusted binary logistic regression model showed that patients with positive urinary ketone was associated with a significantly lower risk of NOAF (Odds ratio, 0.79, 95% CI 0.7–0.9), compared with those with negative urinary ketone. In the subgroup analysis according to diabetic status, compared with nondiabetics, patients with diabetes had lower risk of NOAF (p‐values for interaction < 0.05). Results of other subgroup analyses according to gender, age, infection, myocardial infarction, and congestive heart failure were consistent with the primary analysis. Conclusions: Positive urinary ketone body may be associated with reduced risk of NOAF in critically ill patients during intensive care unit hospitalization. Further studies are needed to clarify the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Comorbidity network analysis (CNA) is a technique in which mathematical graphs encode correlations (edges) among diseases (nodes) inferred from the disease co-occurrence data of a patient group. The present study applied this network-based approach to identifying comorbidity patterns in older patients undergoing hip fracture surgery. This was a retrospective observational cohort study using electronic health records (EHR). EHR data were extracted from the one University Health System in the southeast United States. The cohort included patients aged 65 and above who had a first-time low-energy traumatic hip fracture treated surgically between October 1, 2015 and December 31, 2018 (n = 1,171). Comorbidity includes 17 diagnoses classified by the Charlson Comorbidity Index. The CNA investigated the comorbid associations among 17 diagnoses. The association strength was quantified using the observed-to-expected ratio (OER). Several network centrality measures were used to examine the importance of nodes, namely degree, strength, closeness, and betweenness centrality. A cluster detection algorithm was employed to determine specific clusters of comorbidities. Twelve diseases were significantly interconnected in the network (OER > 1, p -value <.05). The most robust associations were between metastatic carcinoma and mild liver disease, myocardial infarction and congestive heart failure, and hemi/paraplegia and cerebrovascular disease (OER > 2.5). Cerebrovascular disease, congestive heart failure, and myocardial infarction were identified as the central diseases that co-occurred with numerous other diseases. Two distinct clusters were noted, and the largest cluster comprised 10 diseases, primarily encompassing cardiometabolic and cognitive disorders. The results highlight specific patient comorbidities that could be used to guide clinical assessment, management, and targeted interventions that improve hip fracture outcomes in this patient group. [ABSTRACT FROM AUTHOR]

BACKGROUND: The coexistence of coronary artery disease (CAD) and depression is a growing concern, as both conditions lead to disability. Although depression is more prevalent in CAD patients than in the general population and has been associated with adverse cardiac outcomes, the underlying mechanisms linking depression and CAD are not yet fully understood. This study aims to assess the prevalence of depression in postmyocardial infarction (MI) patients as baseline data in Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study was conducted at King Saud Medical City, Riyadh. The study population included male and female patients who had survived MI from January 2022 to June 2022. A sample size of 323 patients was initially planned, but only 249 patients could be included on account of exclusions. The patients underwent screening for depression using Patient Health Questionnaire-2 (PHQ-2), and those who were positive on screening were further assessed using the PHQ-9 according to DSM-5 criteria. Sociodemographic data, comorbidities, and previous cardiac interventions were collected from medical records. RESULTS: The mean age of the study participants was 57.15 years, and majority (76.6%) were males. The prevalence of previously diagnosed depression was 9.2%, and 5.2% of patients reported using antidepressant medication. According to the PHQ-9 scores, 33.33% had depression, 9% had moderate depression, and 2.4% had severe depression. There were significant associations between the severity of depression and previous CAD (P < 0.05), previous coronary artery bypass graft surgery (P < 0.05), and heart failure (P < 0.05). CONCLUSION: This study reveals a high prevalence of depression in post-MI patients at King Saud Medical City. The findings highlight the need for comprehensive management of depression in this population to improve outcomes. Further research into the underlying mechanisms linking depression and CAD to develop effective interventions is required. [ABSTRACT FROM AUTHOR]

Background and Aim: Procalcitonin (PCT), a 14-kilodalton, Calc-1 gene-coded protein, consisting of 116 amino acids, issecreted under normal conditions, from thyroid C-cells. Physiological levels of PCT in serum are negligible.1To determine if procalcitonin can be used to predict the clinical outcome in acute Myocardial Infarction -(M.I.) patients. Methods-This was a prospective analytical study on patients with acute myocardial infarction, admitted under the department of General Medicine, JIPMER, from July, 2020 to June 2021. The Institute Ethics Committee (Human Studies) approved the protocol on 6th July, 2020. All patients both males and females, above 18 years of age, admitted in JIPMER under the Department of General Medicine, with definitive evidence of acute myocardial infarction, within 24 hours of admission were enrolled in the study. Results-After obtaining informed consent, 268 cases of acute M.I. were enrolled in the study. Baseline data and blood samples were collected for all 268 patients. Of these, 54 patients were excluded (24 had turned COVID-19 positive and were lost to follow up, while 30 were found to have infection on follow-up, or data were not available during follow-up). At the end of the study, hsCRP and procalcitonin levels were estimated for all the 214 patients and were followed up till 1 month after discharge. Mean age of the study population was 56.53±11.43 years, 73.4% of the cases were males with 22.5% were aged > 65 years. Out of 214 cases STEMI vs NSTEMI was 72% and 28% respectively.59.35% of the patients had poor clinical outcome during the studyperiod. Mean hsCRP value of the sample populationwas 73.52+/- 63.87 mg/L. Thedifference in hs-CRP values between poor and good clinical outcome groups was statistically not significant. Median procalcitonin value in our study population was 2085.12 (801.40 - 6841.40) pg/mL. There was no statistical significance in procalcitonin values among patients with poor and good clinical outcome groups. There was a statistically significant difference in clinical outcome between different Killip's classes (p-value (p value <0.001) and between patients with different ejection fraction (p <0.01). The difference in procalcitonin values between poor and not poor clinical outcome patients was statistically not significant probably because both poor and not poor clinical outcome classes had patients with statistically comparable ejection fraction (p-value 0.036) and Killip's classes (p-value 0.02). Levels of procalcitonin and hsCRPwere compared in acute myocardial infarction patients.hsCRP and procalcitonin levels in acute myocardial infarction patients are poorly correlated in the study population. Strength of correlation was 0.01. Conclusion-Acute M.I. is one of the leading causes of cardiovascular mortality around the world. Procalcitonin was elevated in both STEMI as well as NSTEMI patients without any statistical difference between poor vs good clinical outcome groups. The difference in procalcitonin values between poor and good clinical outcome patients was statistically not significant probably because both poor and good clinical outcome classes had patients with statistically comparable ejection fraction (p-value 0.036) and Killip's classes (p-value 0.02). This comparable distribution probably resulted in statistically insignificant difference between poor and good clinical outcome groups. Further studies with larger sample sizeare required to confirm this difference in procalcitonin in different Killip's classes and between different ejection fraction groups for attributing this as the reason for no statistical significance in procalcitonin levels between poor and not poor clinical outcome groups. [ABSTRACT FROM AUTHOR]

Background and Objectives: Psychological distress refers to a range of negative emotional experiences, such as anxiety, depression, and stress. Diabetes mellitus and myocardial infarction are two medical conditions that can have a significant impact on an individual's psychological well-being. Therefore, the study aimed to assess and compare psychological distress among diabetes mellitus and myocardial infarction patients in Erbil city. Methods: A quantitative, comparative study design was conducted on 100 patients whom 50 of them were diabetes mellitus patients at Layla Qasim Health Center and the other 50 were myocardial infarction patients at the Cardiac Centre in Erbil city. The data was collected from 20th April 2022 till 24th May 2023. Results: The result showed that less than half of myocardial infarction patients were old adults which is 42% between 57-68 years, married, illiterate and living in urban. On the other hand, less than half of diabetes mellitus patients were middle-aged adults, which is 42% between 45-56 years, married illiterate and living in urban. The ranges of the genders are equal with 50% being male and 50% being female. Also, more than half of myocardial infarction patients are non-smokers 52%, and 34% are smokers. In contrast, less than half of diabetes mellitus patients are 40% non-smokers, and 20% are smokers. Conclusions: The majority of diabetic mellitus patients had a moderate level of depression. At the same time, anxiety and stress were extremely severe, and most patients with myocardial infarction had an extremely severe level of depression, anxiety and stress. [ABSTRACT FROM AUTHOR]

Background: International evidence suggests patients receiving cardiac interventions experience differential outcomes by their insurance status. We investigated outcomes of in-hospital care according to insurance status among patients admitted in public hospitals with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods: We conducted a cohort study within the Australian universal health care system with supplemental private insurance. Using linked hospital and mortality data, we included patients aged 18 + years admitted to New South Wales public hospitals with AMI and undergoing their first PCI from 2017–2020. We measured hospital-acquired complications (HACs), length of stay (LOS) and in-hospital mortality among propensity score-matched private and publicly funded patients. Matching was based on socio-demographic, clinical, admission and hospital-related factors. Results: Of 18,237 inpatients, 30.0% were privately funded. In the propensity-matched cohort (n = 10,630), private patients had lower rates of in-hospital mortality than public patients (odds ratio: 0.59, 95% CI: 0.45–0.77; approximately 11 deaths avoided per 1,000 people undergoing PCI procedures). Mortality differences were mostly driven by STEMI patients and those from major cities. There were no significant differences in rates of HACs or average LOS in private, compared to public, patients. Conclusion: Our findings suggest patients undergoing PCI in Australian public hospitals with private health insurance experience lower in-hospital mortality compared with their publicly insured counterparts, but in-hospital complications are not related to patient health insurance status. Our findings are likely due to unmeasured confounding of broader patient selection, socioeconomic differences and pathways of care (e.g. access to emergency and ambulatory care; delays in treatment) that should be investigated to improve equity in health outcomes. [ABSTRACT FROM AUTHOR]

In the present review, we have discussed the fundamental issues of coronary revascularization in stable coronary artery disease and shown the pivotal differences between percutaneous coronary intervention and coronary artery bypass grafting regarding the long-term prognosis and clinical profiles. The analysis of the latest publications has demonstrated the advantages of open heart surgery due to the long-term survival and prevention of adverse events in specific groups of patients. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and Objectives: Psychological distress refers to a range of negative emotional experiences, such as anxiety, depression, and stress. Diabetes mellitus and myocardial infarction, are two medical conditions that can have a significant impact on an individual's psychological well-being. Therefore, in this study, we aimed to assess and compare psychological distress among diabetes mellitus (DM) and myocardial infarction (MI) patients in Erbil City. Methods: Quantitative, comparative study design was conducted on 100 patients 50 of them were diabetes mellitus patients in Layla Qasm Center and the other 50 were myocardial infarction patients at Cardiac Centre in Erbil City. The study was conducted from 12h April 2023 till 20th June 2023 and the data was collected from 20 h April 2022 till 24th May 2023. Results: The result showed that the majority of myocardial infarction patients were old adults which is (42%) between 57-68 years, married, illiterate and lived in urban. On the other hand, the majority of diabetes mellitus patients were middle-aged adults which are (42%) between 45-56 years, married illiterate and lived in urban. The ranges of the genders are equal which (50%) are male and (50%) being female. Also, most myocardial infarction patients are non-smokers (52%), and (34%) are smokers. In contrast, the majority of diabetes mellitus patients are (40%) non-smokers, and (20%) are smokers. Conclusions: psychological distress can negatively affect individuals who face chronic conditions such as myocardial infarction and diabetes mellitus.

Accumulating evidence shows that NAFLD might play a role in the etiology and progression of CVD, but little is known on the association of NAFLD and CVD mortality in patients with a history of a myocardial infarction (MI). Therefore, we studied the relationship of Fatty Liver Index (FLI), as indicator for non-alcoholic fatty liver disease (NAFLD), with 12-year risk of cardiovascular disease (CVD) and all-cause mortality in post-MI patients. We included 4165 Dutch patients from the Alpha Omega Cohort aged 60–80 years who had an MI ≤10 years prior to study enrolment. NAFLD was defined as FLI ≥60. Patients were followed for cause-specific mortality from enrolment (2002–2006) through December 2018. Hazard ratios for CVD and all-cause mortality were obtained by multivariable Cox regression using FLI <30 (indicating absence of NAFLD) as the reference. Baseline FLI as a continuous measure was studied with mortality using restricted cubic splines analyses. The median (IQR) FLI was 68 (48–84). Sixty percent of the patients had FLI ≥60, who were more likely to be male and more often had diabetes, high blood pressure, and high serum cholesterol levels. During 12 years of follow-up, 2042 deaths occurred of which 846 from CVD. Patients with NAFLD were at increased risk of CVD mortality (HR: 1.55 [1.19, 2.03]) and all-cause mortality (HR: 1.21 [1.03; 1.41]) compared to patients without NAFLD. Results remained consistent after excluding patients with obesity and diabetes. To conclude, the adverse association of FLI with CVD mortality was stronger in female than in male patients with conventional cut-off points. FLI ≥60, indicating NAFLD, was a predictor for CVD and all-cause mortality in post-MI patients, independent of other cardiometabolic risk factors. However, cut-off points might differ between male and female patients for predicting CVD mortality. [ABSTRACT FROM AUTHOR]

• U-shaped nonlinear relationships between LDL-C and 3-month outcome were observed. • Lipid paradox was observed in AIS patients with no statin pretreatment. • Statin pretreatment may offset paradoxical phenomenon of LDL-C in AIS patients. Lipid paradox of low LDL-C may cause physicians to be reluctant to use statins in acute ischemic stroke (AIS) patients with low LDL-C levels at admission. This study investigated the association between LDL-C levels and early vascular outcomes and assessed the potential interaction effect between LDL-C and statin pretreatment on early outcomes. This was a study of a prospective, multicenter, registry of AIS patients with admission LDL-C. The subjects were divided into 3 groups according to LDL-C levels: low LDL-C (≤100 mg/dL); intermediate LDL-C (>100, <130 mg/dL); and high LDL-C (≥130 mg/dL). The primary early vascular outcome was a composite of stroke (ischemic or hemorrhagic), myocardial infarction and all-cause mortality within 3 months. The associations of LDL-C levels as a continuous variable and the risks of primary outcome using Cox proportional hazards models with restricted cubic splines were explored. A total of 32,505 patients (age, 69 ± 12; male, 58.6%) were analyzed. The 3 groups showed significant differences in the 3-month primary outcome, with highest events in the low LDL-C group; after adjustment, no significant associations with the 3-month primary outcome remained. U-shaped nonlinear relationships of LDL-C levels with the 3-month primary outcome were observed (P non-linearity <0.001), with substantial relationships in the no pretreatment subgroup. The relationships between admission LDL-C levels and early outcomes are complex but appear to be paradoxical in patients with low LDL-C and no statin pretreatment. The results suggest that statin pretreatment might offset the paradoxical response of low LDL-C on early vascular outcomes. Further study would be warranted. [ABSTRACT FROM AUTHOR]

Background: Mild cognitive impairment (MCI) has been reported after acute coronary syndrome (ACS), but it is uncertain who is at risk, particularly during inpatient admission. Objective: In this study, we aimed to explore the prevalence and cognitive domains affected in MCI during ACS admission and determine factors that identify patients most at risk of MCI. Methods: Inpatients with ACS were consecutively recruited from 2 tertiary hospital cardiac wards and screenedwith theMontreal Cognitive Assessment and theHopkins Verbal Learning Test. Screening included health literacy (Newest Vital Sign), depressive symptoms (Patient Health Questionnaire-9), and physical activity (Physical Activity Scale for the Elderly). Factors associated with MCI were determined using logistic regression. Results: Participants (n = 81) had amean (SD) age of 63.5 (10.9) years, and 82.7%weremale. In total,MCIwas identified in 52.5%, 42.5%with 1 screen and 10% with both. Individually, the Montreal Cognitive Assessment identified MCI in 48.1%, and the Hopkins Verbal Learning Test identified MCI in 13.8%. In Montreal Cognitive Assessment screening, the cognitive domains in which participants most frequently did not achieve the maximum points available were delayed recall (81. 5%), visuospatial executive function (48.1%), and attention (30.9%). Accounting for education, depression, physical activity, and ACS diagnosis, the likelihood of anMCI positive screen increased by 11%per year of age (odds ratio, 1.11; 95%confidence interval, 1.04-1.18) and by 3.6 times for thosewho are unmarried/unpartnered (odds ratio, 3.61; 95% confidence interval, 1.09-11.89). Conclusion: An estimated half of patients with ACS screen positive for MCI during admission,with single and older patientsmost at risk.Multiple areas of thinking were affected with potential impact on capacity for learning heart disease management. [ABSTRACT FROM AUTHOR]

Background Acute myocardial infarction (AMI) events have been reported among patients with certain viral and bacterial infections. Whether invasive pneumococcal disease (IPD) increases the risk of AMI remains unclear. We examined whether laboratory-confirmed IPD was associated with the risk of AMI. Methods We conducted a self-controlled case series analysis among adult Tennessee residents with evidence of an AMI hospitalization (2003–2019). Patient follow-up started 1 year before the earliest AMI and continued through the date of death, 1 year after AMI, or study end (December 2019). Periods for AMI assessment included the 7 to 1 days before IPD specimen collection (pre-IPD detection), day 0 through day 7 after IPD specimen collection (current IPD), day 8 to 28 after IPD specimen collection (post-IPD), and a control period (all other follow-up). We used conditional Poisson regression to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for each risk period compared with control periods using within-person comparisons. Results We studied 324 patients hospitalized for AMI with laboratory-confirmed IPD within 1 year before or after the AMI hospitalization. The incidence of AMI was significantly higher during the pre-IPD detection (IRR, 10.29; 95% CI: 6.33–16.73) and the current IPD (IRR, 92.95; 95% CI: 72.17–119.71) periods but nonsignificantly elevated in the post-IPD risk period (IRR, 1.83; 95% CI:.86–3.91) compared with control periods. The AMI incidence was higher in the post-IPD control period (29 to 365 days after IPD; IRR, 2.95; 95% CI: 2.01–4.32). Conclusions Hospitalizations with AMI were strongly associated with laboratory-confirmed IPD. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess lipid levels and to identify groups with poor lipid control group among patients with dyslipidemia. Methods: Data from 1,399 Korean patients with dyslipidemia older than 20 years were extracted from the Korea National Health and Nutrition Examination Survey. Complex sample analysis and decision- tree analysis were conducted with using SPSS for Windows version 27.0. Results: The mean levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein cholesterol were 211.38±1.15 mg/dL, 306.61±1.15 mg/dL, 118.48±1.08 mg/dL, and 42.39±1.15 mg/dL, respectively. About 61% of participants showed abnormal lipid control. Poor glycemic control groups (TC ≥ 200 mg/dL or TG ≥ 150 mg/dL or LDL-C ≥ 130 mg/dL) were identified through seven different pathways via decision-tree analysis. Poor lipid control groups were categorized based on patients’ characteristics such as gender, age, education, dyslipidemia medication adherence, perception of dyslipidemia, diagnosis of myocardial infarction or angina, diabetes mellitus, perceived health status, relative hand grip strength, hemoglobin A1c, aerobic exercise per week, and walking days per week. Dyslipidemia medication adherence was the most significant predictor of poor lipid control. Conclusion: The findings demonstrated characteristics that are predictive of poor lipid control and can be used to detect poor lipid control in patients with dyslipidemia. [ABSTRACT FROM AUTHOR]

There are concerns about the potential effect of social distancing used to control COVID-19 on the incidence of cardiovascular diseases (CVD). Retrospective cohort study. We examined the association between lockdown and CVD incidence in a Zero-COVID country, New Caledonia. Inclusion criteria were defined by a positive troponin sample during hospitalization. The study period lasted for 2 months, starting March 20, 2020 (strict lockdown: first month; loose lockdown: second month) compared with the same period of the three previous years to calculate incidence ratio (IR). Demographic characteristics and main CVD diagnoses were collected. The primary endpoint was the change in incidence of hospital admission with CVD during lockdown compared with the historical counterpart. The secondary endpoint included influence of strict lockdown, change in incidence of the primary endpoint by disease, and outcome incidences (intubation or death) analyzed with inverse probability weighting method. A total of 1215 patients were included: 264 in 2020 vs 317 (average of the historical period). CVD hospitalizations were reduced during strict lockdown (IR 0.71 [0.58–0.88]), but not during loose lockdown (IR 0.94 [0.78–1.12]). The incidence of acute coronary syndromes was similar in both periods. The incidence of acute decompensated heart failure was reduced during strict lockdown (IR 0.42 [0.24–0.73]), followed by a rebound (IR 1.42 [1–1.98]). There was no association between lockdown and short-term outcomes. Our study showed that lockdown was associated with a striking reduction in CVD hospitalizations, independently from viral spread, and a rebound of acute decompensated heart failure hospitalizations during looser lockdown. [ABSTRACT FROM AUTHOR]

There are limited data around sex differences in the risk profile, treatments and outcomes of percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) lesions in contemporary interventional practice. We investigated the impact of sex on clinical and procedural characteristics, complications and clinical outcomes in a national cohort. We created a longitudinal cohort (2006–2018, n = 30,605) of patients with stable angina who underwent CTO PCI in the British Cardiovascular Intervention Society (BCIS) database. Clinical, demographic, procedural and outcome data were analysed in two groups stratified by sex: male (n = 24,651), female (n = 5954). Female patients were older (68 vs 64 years, P < 0.001), had higher prevalence of diabetes mellitus (DM), hypertension (HTN) and prior stroke. Utilization of intravascular ultrasound (IVUS), drug eluting stents (DES), radial or dual access and enabling strategies during CTO PCI were higher in male compared to female patients. Following multivariable analysis, there was no significant difference in in-patient mortality (adjusted odds ratio (OR):1.40, 95 % CI: 0.75–2.61, P = 0.29) and major cardiovascular and cerebrovascular events (MACCE) (adjusted OR: 1.01, 95 % CI: 0.78–1.29, P = 0.96). The crude and adjusted rates of procedural complications (adjusted OR: 1.37, 95 % CI: 1.23–1.52, P < 0.001), coronary artery perforation (adjusted OR: 1.60, 95 % CI: 1.26–2.04, P < 0.001) and major bleeding (adjusted OR: 2.06, 95 % CI: 1.62–2.61, P < 0.001) were higher in women compared with men. Female patients treated by CTO PCI were older, underwent lesser complex procedures, but had higher adjusted risk of procedural complications with a similar adjusted risk of mortality and MACCE compared with male patients. • Limited data about clinical profile and outcomes of CTO PCI stratified by sex • In current study, women observed adjusted higher odds of procedural complications but similar odds of death & MACCE compared with men • Randomised control trial data are needed to validate these observational study findings. [ABSTRACT FROM AUTHOR]

This article describes the author's experience of providing nursing care for a middle-aged critically ill patient with acute myocardial infarction and cardiogenic shock who died after his life support was removed. The nursing care was provided from November 11th to 30th, 2019. Data was collected using physical assessments, chart reviews, discussions with the medical team, and interviews with the family. Three health problems were identified: low cardiac output, anticipatory grieving, and decision-making on withdrawing life-sustaining treatment. The nursing intervention included two parts: for the patient, maintaining hemodynamic stability was the main outcome of the treatment; and for the families, the nursing intervention included providing flexible visiting hours, encouraging the expression of emotions, listening to their worries and concerns, and consulting the palliative care team and arranging a family meeting to discuss the withdrawal of life-sustaining treatment. Finally, the decision of withdrawing life-support was made by the family. This nursing care experience can provide a reference for nurses' caring for patients and their families who are facing unexpected death and anticipatory grieving in the future. [ABSTRACT FROM AUTHOR]

Objectives: This study was used to measure the level of tumor necrosis factor-alpha in patients with acute coronary syndrome. Method: A case control study was used; the level of tumor necrosis factor-alpha was measured in 39 patients with acute coronary syndrome (30 male, 9 female) & 20 (12 male, 8 female) control group; risk factors (smoking, hypertension, diabetes mellitus), duration of staying in cardiac care unit & complications (recurrent angina pain, hemodynamic, electrical) are also recorded. Result: we were found significant increase in the level of tumor necrosis factor-alpha in all patients with acute coronary syndrome as compared with control group (P value < 0.01) the highest level of tumor necrosis factor-alpha are associated with myocardial infarction rather than unstable angina patients & also high rate of complications. Conclusion: According to this study tumor necrosis factor-alpha was significantly increased in acute coronary syndrome & could be used for determining severity of the diseases in patients with acute coronary syndrome. [ABSTRACT FROM AUTHOR]

Background: The quality of marital relationships can impact couples’ cardiovascular health directly and indirectly. Given that communication is essential for a happy marriage and plays an important role in health, this study aimed to explain the positive interactions of couples after myocardial infarction.Methods: The current study was conducted qualitatively with the participation of seven couples (patient and his or her spouse) in teaching hospitals affiliated with Zahedan University of Medical Sciences. Purposive sampling was used to select participants. Then, unstructured in-depth interviews were conducted after obtaining informed consent. The interviews were immediately transcribed and analyzed. MAXQDA 2020 was used to categorize the data, and the method proposed by Elo and Kingas was used for data analysis.Results: The analysis of the data revealed that myocardial infarction could affect the way couples interact through two main themes including empathetic union (acceptance of each other’s true selves, mutual understanding, adjusting expectations, increase in cooperation and joint activities) and optimizing couples’ interactions (mutual care and attention, increase in intimacy, mutual reliance).Conclusion: This study indicated that positive couple interactions affected not only marital relationships but also health status, both directly and indirectly. Therefore, the findings of this study can be used to improve nursing student education and nursing care, and would help to develop educational and supportive interventions for patients and their spouses.

Background: Periprocedural myocardial infarction (PMI) is one of the mortality-related complications of percutaneous coronary intervention (PCI) and significantly affects short- and long-term adverse outcomes and immediate cardiovascular events. Our present study aimed to evaluate the association of preprocedural serum laboratory parameters and PMI in patients who received primary PCI and attempted to provide detailed data on the predictors of PCI-related PMI. Methods: A total of 1184 consecutive coronary artery disease (CAD) patients who received primary and elective PCI between July 2015 and June 2017 were included and divided into control group and PMI group. The data of serum laboratory parameters were collected from the electronic database of Meizhou People's Hospital. Results: The results indicated that preprocedural fasting blood glucose were higher in PMI group compared with the control group (p <.001). Patients with prior hyperlipidemia were more likely to have experienced PCI-related PMI (p =.018) and the preprocedural level of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, apolipoprotein B (Apo B), and LDL-C/high density lipoprotein cholesterol (HDL-C) were significantly enhanced in PMI group (p <.001). Multivariate regression analysis revealed that preprocedural fasting blood glucose > 6.11 mmol/L (p <.001, OR = 1.949, 95% CI: 1.444–2.630) and LDL-C levels ≥130 mg/dL (p =.005, OR = 1.941, 95% CI: 1.217–3.098) independently predicted PCI-related PMI. Conclusion: Our results indicated preprocedural fasting blood glucose >6.11 mmol/L and LDL-C levels ≥130 mg/dL may be useful predictors for PCI-related PMI. The study may provide a detailed data on the predictors of PCI-related PMI. [ABSTRACT FROM AUTHOR]

Objective: By performing a meta‐analysis of published cohort studies, this review aims to evaluate the association between gouty arthritis (GA) and the risk of myocardial infarction (MI) and heart failure (HF), hence providing evidence for clinical management. Methods: Five electronic databases were searched from inception to July 28, 2022. Relative risk (RR) and 95% confidence intervals (CI) were calculated by random‐effect model or fixed‐effect model to evaluate the association between GA and the risk of MI and HF, respectively. Results: Eleven articles containing 13 studies were finally selected for meta‐analysis which covered 408 443 GA patients and 10 402 777 non‐GA patients. The results showed that GA was associated with the risk of MI and HF (MI: RR = 1.75, 95% CI: 1.45–2.11; HF: RR = 2.00, 95% CI: 1.91–2.10). And subgroup analysis showed that female GA patients had a higher risk of MI and HF than male GA patients. Further, younger GA patients had a higher risk of MI than older patients (≤44 years: RR = 2.82, 95% CI: 1.38–5.79; 45–69: RR = 1.85, 95% CI: 1.22–2.82; ≥70: RR = 1.52, 95% CI: 1.22–1.88). GA patients were mainly associated with the occurrence of non‐fatal MI (fatal MI: RR = 1.37, 95% CI: 0.76–2.48; non‐fatal MI: RR = 1.75, 95% CI: 1.45–2.11). Conclusions: GA is correlated with the risk of MI and HF. Both male and female GA patients have an increased risk of MI and HF. Meanwhile, female GA patients or younger GA patients have a higher risk of MI and HF. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgery plays a vital role in human health. Hypothyroidism is a common disorder that affects 4 - 10% of the world's population. One of the important challenges of cardiac surgery in hypothyroid patients is their perioperative management. Objectives: In this study, we determined the effects of hypothyroidism on complications after cardiac surgery. Methods: In this retrospective cohort study, patients who underwent cardiac surgery in Birjand, Iran, during 2016 - 2021 and had TSH > 5 μU/mL in adults ≤ 50 and TSH > 10 μU/mL in adults > 50 years old were included as the case group. Also, adults ≤ 50 with TSH 0.3 -- 5 μU/mL and adults > 50 years old with TSH 0.3 -- 10 μU/mL were included as the control group. The complications and outcomes of cardiac surgery were extracted from the patient files. Results: This study involved 30 patients with hypothyroidism and 90 controls. The two study groups were comparable regarding gender, type of cardiac surgery, history of diabetes, hypertension, heart failure, myocardial infarction (MI), and dyslipidemia (P > 0.05). The frequency distribution of cardiac and pulmonary complications, delirium, acute kidney injury (AKI), sepsis, and mortality ratio was not significantly different between the two groups (P > 0.05); the mean systolic and diastolic blood pressure before and after the surgery, duration of mechanical ventilation, cardiopulmonary bypass time, aortic clamp time, duration of ICU hospitalization, and amount of use of dopamine, epinephrine, and norepinephrine were also similar (P > 0.05). Conclusions: Hypothyroidism did not affect the frequency of complications and outcomes after cardiac surgery. Thus, achieving a euthyroid status in hypothyroid patients is unnecessary before cardiac surgery, and there is no need to postpone elective cardiac surgery until hypothyroidism is corrected. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although some studies have investigated sex-related outcomes up to 5 years after percutaneous coronary intervention (PCI), analyses at longer follow-up (ie, to 10 years) in large cohorts treated exclusively with drug-eluting stent (DES) platforms are lacking. Therefore, this study aimed to define whether sex-related differences in long-term outcomes after PCI persist both in the DES era and at longer-term follow-up. METHODS: Individual data of patients treated with DES in 5 randomized controlled trials with 10-year follow-up were pooled. Patients were divided into 2 groups by sex. The analysis of individual participant data was performed using a 1-stage approach by entering a clustering effect by parent study in all univariable and multivariable models focusing on sex. The main outcomes of interest for this analysis included cardiovascular death, myocardial infarction, repeat revascularization, and definite stent thrombosis to 10 years after PCI. Survival was analyzed by the Kaplan-Meier method to estimate the time to first event, and differences between the 2 groups were tested with the log-rank test. Hazard ratios (HRs) and 95% CIs were calculated with a Cox proportional hazards model. Conventional multivariable analyses with adjustment for relevant variables were performed. RESULTS: Among 9700 patients undergoing PCI with DES implantation included in the present analysis, 2296 were women and 7404 were men. Through to 10 years, cardiovascular death occurred in 407 of the 2296 female patients and 1012 of the 7404 male patients (adjusted HR [HRadj], 0.94 [95% CI, 0.80–1.11]). Female sex was associated with a lower risk of repeat revascularization of the target lesion (HRadj, 0.80 [95% CI, 0.74–0.87]), target vessel (HRadj, 0.81 [95% CI, 0.76–0.87]), and nontarget vessels (HRadj, 0.69 [95% CI, 0.62–0.77]). Compared with male patients, female patients displayed an increased risk of myocardial infarction in the first 30 days after PCI with DES (HRadj, 1.65 [95% CI, 1.24–2.19]) but a comparable risk of myocardial infarction thereafter. The risk of definite stent thrombosis was not significantly different between female and male patients (HRadj, 1.14 [95% CI, 0.89–1.47]). CONCLUSIONS: Through to 10-year follow-up after PCI with DES, female patients are at increased risk of early myocardial infarction, receive fewer repeat revascularizations, and have no difference in cardiovascular mortality compared with male patients. [ABSTRACT FROM AUTHOR]

Background: There is currently no consensus regarding the optimal anesthetic technique for total hip and knee arthroplasty (THA, TKA). This study aimed to compare the utilization rates and safety of spinal vs. general anesthesia in contemporary THA/TKA practice. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), a retrospective review of 307,076 patients undergoing total hip or knee arthroplasty under either spinal or general anesthesia between January 2015 and December 2018 was performed. Propensity matching was used to compare differences in operative times, hospital length of stay, discharge destination, and 30-day adverse events. The annual utilization rates for both techniques between 2011 and 2018 were also assessed. Results: Patients receiving spinal anesthesia had a shorter length of stay (P < 0.001) for TKA while no statistical differences in length of stay were observed for THA. Patients were also less likely to experience any 30-day complication (OR = 0.82, P <0.001 and OR = 0.92, P < 0.001 for THA and TKA, respectively) while being more likely to be discharged to home (OR = 1.46, P < 0.001 and OR = 1.44, P < 0.001 for THA and TKA, respectively). Between 2011 and 2018, spinal anesthesia utilization only increased by 1.4% for THA (P < 0.001) and decreased by 0.2% for TKA (P < 0.001), reaching 38.1% and 40.3%, respectively. Conclusion: Spinal anesthesia remains a grossly underutilized tool despite providing better perioperative outcomes compared to general anesthesia. As orthopedic surgeons navigate the challenges of value-based care, spinal anesthesia represents an invaluable tool that should be considered the gold standard in elective, primary total hip and knee arthroplasty. [ABSTRACT FROM AUTHOR]

Professor Joe Herman, a founding father of family medicine in Israel, passed away in 2023. He trained the first Israeli family physicians and played a crucial role in establishing family medicine in the country. Born in the United States in 1928, he volunteered to defend Israel in 1948 and later became a physician after working in orchards. He emphasized the importance of physical examination and close collaboration with nursing staff. Professor Herman was known for his skepticism towards medical science and his focus on self-examination after patient encounters. He will be remembered and missed by his family, friends, colleagues, and patients. [Extracted from the article]