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Shared decision-making (SDM) promotes greater patient awareness about medical conditions and treatments, and facilitates patient involvement in care decisions. This two-stage multicenter study evaluated the impact of SDM in Taiwanese adults with atrial fibrillation (AF) eligible for novel oral anticoagulant (NOAC) therapy. Participants were NOAC-naïve (case) or dabigatran-experienced (control). During Stage I, case participants (n = 124) completed a semi-structured survey before and after viewing SDM materials on stroke prevention for AF. The surveys collected data on anxiety about AF, confidence in healthcare professionals, usefulness of SDM materials, and perception of different NOACs. During Stage II, both case participants (n = 87) and control participants (n = 104) completed another survey. Fewer case participants were anxious about AF (p p p p

Betel-quid (BQ) is a commonly used psychoactive substance that renders a specific cardiotoxicity. The purpose of this study was to investigate the association between BQ chewing and premature ventricular contractions (PVC) in patients with cardiopulmonary symptoms, and examine the potential influences of cardiovascular and chronic diseases on such relationship. Participants were 146 patients with cardiopulmonary symptoms who participated in 24-h Holter electrocardiogram monitoring during 2012&ndash, 2018 in a hospital serving residents that lived in a BQ high prevalence area. Data on substance uses and medical histories for cardiovascular and chronic diseases were collected. Baron&ndash, Kenny method was employed to evaluate possible mediation. In patients with cardiopulmonary symptoms, 36.3% were BQ users and 63.7% were nonusers. Adjusting for covariates, BQ chewing was significantly associated with heart failure and diabetes mellitus (adjusted odds ratio (aOR) = 3.4 and 2.3, respectively), but only heart failure was significantly correlated with a low and high level of PVC. Additionally controlling for the effect of heart failure, the risk of high PVC for BQ users reduced from 3.60 to 2.88, however, the risk for BQ chewers remained significant (95% CI: 1.06&ndash, 7.84). Heart failure was found to explain 27.7% of the excessive effect of BQ use on high PVC. In conclusion, BQ use is directly associated with an elevated risk of high PVC in patients with cardiopulmonary symptoms. The higher risk might be elevated among patients who suffered heart failure. Given several research limitations, the findings from this study offer future opportunities for validation.

Background Several randomized control trials have established that drugs can decrease the heart failure (HF) rehospitalization in patients with HF. However, limited studies have investigated the duration of medicine use to decrease the rehospitalization period in the real world. Hence, this study aims to investigate whether the evidence-based medicine decreases the HF rehospitalization in different treatment intervals in the clinical practice. Method We examined patients admitted with acute HF from the National Health Insurance Research Database in Taiwan. In addition, the major adverse cardiovascular events (MACE) were the composite endpoints of the in-hospital mortality and rehospitalization after 1 year. Furthermore, we analyzed the medicine use to decrease 14 days and 1, 6, and 12 months' HF rehospitalization. Results Overall, we examined 11,012 patients. The use of the renin–angiotensin system (RAS) blockers [hazard ratio (HR), 0.58; P < 0.01], β-blocker (HR, 0.67; P < 0.01), spironolactone (HR, 0.63; P < 0.01), and digitalis (HR, 0.67; P < 0.01) associated with the lower in-hospital mortality rate. The Cox regression analysis revealed that RAS blocker (HR, 0.86; P < 0.01) and β-blocker (HR, 0.71; P < 0.01) were independent predictors for MACE. Although RAS blockers declined rehospitalization to 6 months, β-blocker decreased the rehospitalization rate after 1 month use and the benefit persisted till 12 months. Furthermore, digitalis only lowered rehospitalization to 14 days. Conclusion This study suggests that the use of evidence-based medicine is associated with lower MACE for patients with HF, and these drugs could play vital roles in different periods to decrease the rehospitalization in the clinical setting.

Patient Initials or Identifier Number 32519867 ### Relevant Clinical History and Physical Exam Age: 61 Gender: male Past History: Gout, Poliomyelitis Chief complaint: Intermittent Chest pain for 3 days ST-elevation myocardial infarction and acute heart failure with pulmonary edema were

Protein S deficiency is an inherited thrombophilia associated with an increased risk of venous thromboembolism. However, arterial thrombosis is a relative rare complication of protein S deficiency and the prognosis of these patients was worse than those without protein S deficiency in the literature. Herein we reported a 43-year-old male with protein S deficiency experiencing several times acute peripheral arterial thrombosis of left leg. Surgical thrombectomy was performed initially but later endovascular treatment (EVT) was suggested. Although EVT was successfully performed by catheter-directed thrombolysis (CDT), arterial thrombosis still recurred three months later. CDT was tried again but thrombosis could not be treated by this strategy anymore. Therefore, we used mechanical thrombectomy device (Rotarex system) and successfully regained the straight-line blood flow to the foot after the procedure. Peripheral echo showed patent flow after 6 months follow-up. In conclusion, arterial thrombosis is a relative rare complication of protein S deficiency and prognosis was not well in the literature, our case reminds physicians that Rotarex system is a safe and highly efficient device for acute PAOD even in the patients with hypercoagulable state.

Infective endocarditis (IE) is an infection of the heart valves or the heart’s inner lining. The clinical symptoms of infectious endocarditis vary considerably, some are subtle and non-specific, which make the diagnosis difficult or the signs misleading. In some cases cardiac symptoms are associated with intra cardiac extension of the infection, including murmur, conduction blocks and congestive heart failure. However, there was no literature description of supraventricular tachycardia (SVT) as the initial presentation of IE. Herein we report a case of bacterial IE with SVT as the initial presentation of disease, which finally leaded to catastrophic outcome. This rare case should be the reminder for physicians that in patients with SVT in combination with higher level of inflammatory markers, one should also consider the possibility of IE, to help to avoid its catastrophic consequences.

The infection rate of arteriovenous (AV) grafts is high, but fungal etiology is rare. Only five cases of graft infection due to Candida albicans (C. albicans) or C. tropicalis have been described in the literature. Herein, we report the first case of AV graft infection caused by C. glabrata. A 60-year-old woman on maintenance hemodialysis for end-stage renal disease was admitted because of intermittent fever, for 10 days. Upon physical examination, tenderness over the AV graft site was noticed. Blood culture yielded C. glabrata and her clinical symptoms improved after she was treated with micafungin for 1 month. However, C. glabrata candidemia reoccurred 5 weeks later. Cure was achieved after removal of the AV graft and anidulafungin treatment. Pus was observed in the removed graft, from which C. glabrata was isolated. The outcome of our case and patients from the literature review suggest that removal of the infected graft is important for treatment success of AV graft Candida infection.