ABSTRACT
BACKGROUND: Heart transplantation is the therapy of choice in patients with advanced heart failure refractory to other medical or surgical management. However, heart transplants are associated with complications that increase posttransplant morbidity and mortality. Infections are one of the most important complications after this procedure. Therefore, infections in the first year after heart transplantation were evaluated. METHODS: A retrospective cohort study of infections after heart transplants was conducted in a teaching hospital in Colombia between 2011 and 2019. Patients registered in the institutional heart transplant database (RETRAC) were included in the study. Microbiological isolates and infectious serological data were matched with the identities of heart transplant recipients and data from clinical records of individuals registered in the RETRAC were analyzed. The cumulative incidences of events according to the type of microorganism isolated were estimated using Kaplan-Meier survival analyses. RESULTS: Seventy-nine patients were included in the study. Median age was 49 years (37.4-56.3), and 26.58% of patients were women. Eighty-seven infections were documented, of which 55.17% (48) were bacterial, 22.99% (20) were viral, and 12.64% (11) were fungal. Bacterial infections predominated in the first month. In the first year, infections caused 38.96% of hospital admissions and were the second cause of death after heart transplants (25.0%). CONCLUSION: Posttransplant infections in the first year of follow-up were frequent. Bacterial infections predominated in the early posttransplant period. Infections, mainly bacterial, were the second most common cause of death and the most common cause of hospitalization in the first year after heart transplantation.
Subject(s)
Bacterial Infections , Heart Failure , Heart Transplantation , Humans , Female , Middle Aged , Male , Retrospective Studies , Latin America/epidemiology , Heart Transplantation/adverse effects , Heart Failure/epidemiology , Heart Failure/surgery , Bacterial Infections/epidemiologyABSTRACT
Epidemiological studies suggest that approximately half of the patients with heart failure (HF) have reduced ejection fraction, while the other half have normal ejection fraction (EF). Currently, international guidelines consider QRS duration greater than 130 ms, in the presence of ventricular dysfunction (EF < 35%), as a criterion for selecting patients for cardiac resynchronization therapy (CRT). CRT helps restore intraventricular and auriculoventricular synchrony, improving left ventricular (LV) performance, reducing functional mitral regurgitation, and inducing reverse LV remodeling. This is evidenced by increased LV filling time and left ventricular ejection fraction, decreased LV end-diastolic and end-systolic volumes, mitral regurgitation, and septal dyskinesia. Because the mechanisms of dyssynchrony may be heterogeneous, no single measure may accurately predict response to CRT. Finally, CRT has been progressively shown to be safe and feasible, improves functional status and quality of life, reversely remodels the LV, decreases the number of hospitalizations, total mortality in patients with refractory HF, LV dysfunction, and intraventricular conduction disorders; is a pacemaker-based therapy for HF and thanks to current technology, safe remote monitoring of almost all types of cardiac devices is possible and provides useful alerts in clinical practice.
Los estudios epidemiológicos sugieren que aproximadamente la mitad de los pacientes con insuficiencia cardiaca (IC) tiene fracción de eyección reducida, mientras que la otra mitad, fracción de eyección (FE) normal. Actualmente, las guías internacionales consideran la duración de QRS mayor a 130 ms, en presencia de disfunción ventricular (FE < 35%), como criterio para selección de pacientes a terapia de resincronización cardiaca (TRC). La TRC ayuda a restaurar la sincronía intraventricular y auriculoventricular, mejorando el rendimiento del ventrículo izquierdo (VI), reduciendo la regurgitación mitral funcional e induciendo la remodelación inversa del VI. Esto se evidencia en el aumento del tiempo de llenado del VI y la fracción de eyección del VI, la disminución de los volúmenes telediastólico y telesistólico del VI, y la regurgitación mitral y discinesia septal. Como los mecanismos de la disincronía pueden ser heterogéneos, es posible que ninguna medida prediga con exactitud la respuesta a la TRC. Finalmente, la TRC cardiaca ha demostrado progresivamente ser segura y factible, mejora el estado funcional y la calidad de vida, remodela inversamente el VI, disminuye el número de hospitalizaciones, la mortalidad total en pacientes con IC refractaria, la disfunción ventricular izquierda y los trastornos de conducción intraventricular; es una terapia basada en marcapasos para la IC y gracias a la tecnología actual es posible realizar una supervisión remota y segura de casi todos los tipos de dispositivos cardiacos y obtener alertas útiles en la práctica clínica.
Subject(s)
Cardiac Resynchronization Therapy , Cardiology , Heart Failure , Mitral Valve Insufficiency , Ventricular Dysfunction, Left , Humans , Stroke Volume , Latin America , Quality of Life , Ventricular Function, Left , Heart Failure/therapy , Treatment Outcome , Ventricular Remodeling/physiologyABSTRACT
Epidemiological studies suggest that approximately half of the patients with heart failure (HF) have reduced ejection fraction, while the other half have normal ejection fraction (EF). Currently, international guidelines consider QRS duration greater than 130 ms, in the presence of ventricular dysfunction (EF < 35%), as a criterion for selecting patients for cardiac resynchronization therapy (CRT). CRT helps restore intraventricular and auriculoventricular synchrony, improving left ventricular (LV) performance, reducing functional mitral regurgitation, and inducing reverse LV remodeling. This is evidenced by increased LV filling time and left ventricular ejection fraction, decreased LV end-diastolic and end-systolic volumes, mitral regurgitation, and septal dyskinesia. Because the mechanisms of dyssynchrony may be heterogeneous, no single measure may accurately predict response to CRT. Finally, CRT has been progressively shown to be safe and feasible, improves functional status and quality of life, reversely remodels the LV, decreases the number of hospitalizations, total mortality in patients with refractory HF, LV dysfunction, and intraventricular conduction disorders; is a pacemaker-based therapy for HF and thanks to current technology, safe remote monitoring of almost all types of cardiac devices is possible and provides useful alerts in clinical practice.
Los estudios epidemiológicos sugieren que aproximadamente la mitad de los pacientes con insuficiencia cardiaca (IC) tiene fracción de eyección reducida, mientras que la otra mitad, fracción de eyección (FE) normal. Actualmente, las guías internacionales consideran la duración de QRS mayor a 130 ms, en presencia de disfunción ventricular (FE < 35%), como criterio para selección de pacientes a terapia de resincronización cardiaca (TRC). La TRC ayuda a restaurar la sincronía intraventricular y auriculoventricular, mejorando el rendimiento del ventrículo izquierdo (VI), reduciendo la regurgitación mitral funcional e induciendo la remodelación inversa del VI. Esto se evidencia en el aumento del tiempo de llenado del VI y la fracción de eyección del VI, la disminución de los volúmenes telediastólico y telesistólico del VI, y la regurgitación mitral y discinesia septal. Como los mecanismos de la disincronía pueden ser heterogéneos, es posible que ninguna medida prediga con exactitud la respuesta a la TRC. Finalmente, la TRC cardiaca ha demostrado progresivamente ser segura y factible, mejora el estado funcional y la calidad de vida, remodela inversamente el VI, disminuye el número de hospitalizaciones, la mortalidad total en pacientes con IC refractaria, la disfunción ventricular izquierda y los trastornos de conducción intraventricular; es una terapia basada en marcapasos para la IC y gracias a la tecnología actual es posible realizar una supervisión remota y segura de casi todos los tipos de dispositivos cardiacos y obtener alertas útiles en la práctica clínica.
ABSTRACT
BACKGROUND: Heart transplantation represents one of the last treatment options for advanced heart failure. Little is known about the factors associated with return to work in patients after heart transplantation. The aim of this study was to identify those factors. METHODS: A systematic literature review was conducted in the PubMed, LILACS, SCIELO and ScienceDirect databases using the keywords "trasplante cardiaco", "calidad de vida", "reingreso laboral", "return to work", "heart transplantation" and "occupation related". Quantitative studies with patients over 18 years of age that were published between January 2007 and June 2017 were included. RESULTS: A total of 6 articles were included, none from Latin America. Heart transplantation patients had a mean age of 51 years; approximately 17% were over 65 years of age; 73-84% were males; 7-16.4% were professionals; 70-86.6% were previously employed; and 30-60% returned to work. The following factors were related to return to work: higher education (pâ¯=â¯0.0017), young age (pâ¯=â¯0.003), better scores on the physical and mental domains of the SF-36 questionnaire (pâ¯=â¯0.035), higher six-minute walk test results (median of 560 m), and previous employment with less than 24 months interrupted by the inability to work (pâ¯=â¯0.017). Return to work occurred, on average, 6 to 7.5 months after heart transplantation. CONCLUSIONS: Return to work after heart transplantation is variable, with a tendency to be low, and is lower in patients near to retirement age. Protective factors were related to the social, physical and mental environment.
Subject(s)
Heart Transplantation , Return to Work , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
La satisfacción laboral y el capital psicológico contribuyen positivamente al bienestar psicológico de los trabajadores y pueden reducir los niveles de burnout en el contexto laboral. El objetivo de esta investigación fue evaluar la relación entre la satisfacción laboral, el capital psicológico y el síndrome de burnout. Participaron en este estudio 111 trabajadores. Los resultados mostraron una relación inversa entre las variables predictoras (satisfacción laboral y capital psicológico) y la variable dependiente (síndrome de burnout). De acuerdo con los análisis, las variables predictoras explican el 24% de la varianza del modelo; además, el modelo representó el 35% de la varianza cuando la dimensión de agotamiento emocional del síndrome de burnout fue evaluada como variable dependiente (e. g., después de excluir las otras 2 dimensiones del síndrome). Estos resultados evidencian beneficios potenciales en los programas dirigidos a promover la satisfacción laboral y el capital psicológico en el contexto organizacional
Job satisfaction and psychological capital contribute to workers' psychological well-being and may decrease burnout levels in the work environment. The goal of the present study was to assess the relationship between job satisfaction, psychological capital, and burnout syndrome. One hundred and eleven workers participated in the study. The results yielded an inverse relationship between the predictor variables (job satisfaction and psychological capital), and the dependent variable (the burnout syndrome). According to the analyses, the predictor variables included explain a considerable amount of variance (24%). Furthermore, the model accounted for 35% of the variance when the emotional exhaustion dimension of burnout syndrome was analysed as the dependent variable (i. e., after excluding the other 2 dimensions of the syndrome). These results highlight the potential benefits of programs aimed at promoting job satisfaction and psychological capital in organizational contexts
