RESUMEN
BACKGROUND: Heart failure (HF) is a significant cause of morbidity and mortality in the United States, contributing to approximately 1 in 8 deaths. Individuals with end-stage HF (eHF) experience debilitating symptoms leading to poor quality of life (QoL). METHODS: We used the ICD-10 code for eHF (I5084) from the National Inpatient Sample (NIS) (2016-2020) to identify all patients with eHF. We used a multivariable logistic regression model to adjust for confounders and estimate the mortality probability in each arrhythmia cohort. Our primary outcome was in-hospital mortality risk in each group. A p-value of 0.05 was deemed significant. RESULTS: There were 22,703 hospitalizations with eHF (mean age 67 years ±16). Men represented 66.5â¯% (15,091) of the population. In this cohort, 59â¯% (13,018) were Caucasians, 27.2â¯% (6,017) were Blacks, 8.7â¯% (1,924) were Hispanics, and 2.9â¯% (505) were Asians. Of these individuals, 50.4â¯% (11,434) had atrial fibrillation (AFIB). The majority of the arrhythmia subgroups had independent associations with mortality, with adjusted odds ratio (aOR) for VFIB 5.8 (4.6-7.1), AFIB 4.3 (3.9-4.5), SVT 1.9 (1.6-2.4), and VT 1.2 (1.1-1.4), p < 0.0001, each. CONCLUSION: This analysis revealed that approximately half of the hospitalized population with end-stage heart failure are burdened with atrial fibrillation. Ventricular and atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia each carried an independent mortality risk, with ventricular fibrillation having the highest risk.
Asunto(s)
Arritmias Cardíacas , Insuficiencia Cardíaca , Mortalidad Hospitalaria , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arritmias Cardíacas/mortalidad , Arritmias Cardíacas/epidemiología , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/epidemiología , Mortalidad Hospitalaria/tendencias , Hospitalización/estadística & datos numéricos , Calidad de Vida , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
Amyloidosis is a leading cause of infiltrative cardiomyopathy and in turn heart failure with preserved ejection fraction. Amyloidosis is mainly classified into amyloid light chain (AL) or primary amyloidosis and transthyretin amyloidosis (ATTR) that is subdivided into wild-type ATTR (ATTRwt) and hereditary or familial transthyretin-related amyloidosis (hATTR). Moreover, strain preservation pattern in the left ventricular apex in echocardiography suggests cardiac amyloidosis and cardiac magnetic resonance (CMR) could identify an infiltrative process. Similarly, the radiotracer uptake of technetium-99m pyrophosphate by myocardium could indicate transthyretin accumulation. In contrast, serum-free light chain (FLC) alongside serum and urine immunoelectrophoresis could indicate AL amyloidosis. Here, we present a case of a 60-year-old male with a classical apical sparing on echocardiography but with an unremarkable CMR and technetium-99 m pyrophosphate.
RESUMEN
Pulmonary arterial hypertension is a rare disease that predominantly affects women. The pathophysiology of the disease is complex, with both genetic and hormonal influences. Pregnancy causes significant physiologic changes that may not be well tolerated with underlying pulmonary arterial hypertension, in particular leading to volume overload and increased pulmonary pressures. A multidisciplinary approach and careful monitoring are essential for appropriate management of pulmonary arterial hypertension during pregnancy. Nonetheless, outcomes are still poor, and pregnancy is considered a contraindication in patients with pulmonary arterial hypertension.
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Manejo de Atención al Paciente/métodos , Complicaciones Cardiovasculares del Embarazo , Ajuste de Riesgo/métodos , Femenino , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Complicaciones Cardiovasculares del Embarazo/terapia , Resultado del Embarazo , Embarazo de Alto Riesgo , Pronóstico , Hipertensión Arterial Pulmonar/diagnóstico , Hipertensión Arterial Pulmonar/fisiopatología , Hipertensión Arterial Pulmonar/terapiaAsunto(s)
Bloqueo Nervioso , Fracturas de las Costillas , Anestésicos Locales , Humanos , Manejo del DolorRESUMEN
The Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society Guidelines recommend prompt and effective multimodal analgesia for rib fractures that combines regional anesthesia (RA) techniques with pharmacotherapy to treat pain, optimize pulmonary function, and reduce opioid related complications. However, RA techniques such as epidurals and paravertebral blocks, are generally underutilized or unavailable for emergency department (ED) patients. The recently described serratus anterior plane block (SAPB) is a promising technique, but failures with posterior rib fractures have been observed. The erector spinae plane block (ESPB) is conceptually similar to the SAPB, but targets the posterior thorax making it likely more effective for ED patients with posterior rib fractures. Our initial experience demonstrates consistent success with the ESPB for traumatic posterior rib fracture analgesia. Herein, we present the first description of the ESPB utilized in the ED.
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Bloqueo Nervioso/métodos , Manejo del Dolor/métodos , Dolor/etiología , Fracturas de las Costillas/complicaciones , Adulto , Anciano , Analgésicos Opioides/administración & dosificación , Anestésicos Locales/administración & dosificación , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Ultrasonografía IntervencionalRESUMEN
PURPOSE OF REVIEW: Heart failure is a global pandemic and there has been a growing effort to enroll patients from different geographical regions in randomized controlled trials. In this review, we examined regional variation in both patient characteristics and outcomes among several of the most recent global heart failure trials RECENT FINDINGS: Retrospective analyses of global heart failure trials have identified marked variations in both baseline characteristics and management of heart failure by region of enrollment. In some trials, this variation has been significant enough to cause differential treatment effects. We summarized key heterogeneity observed in global heart failure clinical trials. Differences in both patient population and organization of these trials abroad pose an important challenge in making interpretations and country-level decisions. As such, we encourage a concerted effort to account for these differences in future research.
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Salud Global , Insuficiencia Cardíaca/terapia , Selección de Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
More than 70 percent of behavioral health conditions are first diagnosed in the primary care setting. Yet physical and behavioral health care are typically provided separately, compelling many vulnerable patients to navigate the complexities of two separate systems of care. This policy brief examines five community health centers (CHCs) in California that have taken preliminary steps toward creating "one-stop shopping" for both physical and behavioral health care. The steps taken to increase integration by the CHCs include employing behavioral health providers, using a single electronic health record that includes both physical and behavioral health data, transforming the physical space, and developing mechanisms for effective transition of patients between providers. The findings emphasize the importance of changes to Medi-Cal reimbursement policies to promote same-day visits, as well as the importance of cultural changes to integrate behavioral health. They also highlight the need for comprehensive tools to assess and promote integration and to identify solutions for the most challenging activities required to achieve full integration.
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Centros Comunitarios de Salud/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Servicios de Salud Mental/organización & administración , Atención Primaria de Salud/organización & administración , California , Humanos , Estados UnidosRESUMEN
Childhood obesity is prevalent, is of consequence, and disproportionately affects racial/ethnic minority populations. By the preschool years, racial/ethnic disparities in obesity prevalence and substantial differences in many risk factors for obesity are already present, suggesting that disparities in obesity prevalence have their origins in the earliest stages of life. The reasons for racial/ethnic variation in obesity are complex and may include differences in cultural beliefs and practices, level of acculturation, ethnicity-based differences in body image, and perceptions of media, sleep, and physical activity. In addition, racial/ethnic differences in obesity may evolve as a consequence of the socio- and environmental context in which families live. The primary care setting offers unique opportunities to intervene and alter the subsequent course of health and disease for children at risk for obesity. Regular visits during childhood allow both detection of elevated weight status and offer opportunities for prevention and treatment. Greater awareness of the behavioral, socialcultural, and environmental determinants of obesity among ethnic minority populations could assist clinicians in the treatment of obesity among diverse pediatric populations. Specific strategies include beginning prevention efforts early in life before obesity is present and recognizing and querying about ethnic- and culturally specific beliefs and practices, the role of the extended family in the household, and parents' beliefs of the causative factors related to their child's obesity. Efforts to provide culturally and linguistically appropriate care, family-based treatment programs, and support services that aim to uncouple socioeconomic factors from adverse health outcomes could improve obesity care for racial/ethnic minority children.
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Comparación Transcultural , Etnicidad , Promoción de la Salud , Estilo de Vida/etnología , Obesidad , Adolescente , Índice de Masa Corporal , Niño , Preescolar , Competencia Cultural , Ambiente , Etnicidad/psicología , Etnicidad/estadística & datos numéricos , Promoción de la Salud/métodos , Promoción de la Salud/organización & administración , Disparidades en el Estado de Salud , Humanos , Obesidad/diagnóstico , Obesidad/etnología , Obesidad/prevención & control , Obesidad/psicología , Rol del Médico , Prevalencia , Factores de Riesgo , Factores Socioeconómicos , Estados Unidos/epidemiologíaRESUMEN
Eliminating racial/ethnic disparities in health and health care is a national priority, and obesity is a prime target. During the last 30 y in the United States, the prevalence of obesity among children has dramatically increased, sparing no age group. Obesity in childhood is associated with adverse cardio-metabolic outcomes such as hypertension, hyperlipidemia, and type II diabetes and with other long-term adverse outcomes, including both physical and psychosocial consequences. By the preschool years, racial/ethnic disparities in obesity prevalence are already present, suggesting that disparities in childhood obesity prevalence have their origins in the earliest stages of life. Several risk factors during pregnancy are associated with increased risk of offspring obesity, including excessive maternal gestational weight gain, gestational diabetes, smoking during pregnancy, antenatal depression, and biological stress. During infancy and early childhood, rapid infant weight gain, infant feeding practices, sleep duration, child's diet, physical activity, and sedentary practices are associated with the development of obesity. Studies have found substantial racial/ethnic differences in many of these early life risk factors for childhood obesity. It is possible that racial/ethnic differences in early life risk factors for obesity might contribute to the high prevalence of obesity among minority preschool-age children and beyond. Understanding these differences may help inform the design of clinical and public health interventions and policies to reduce the prevalence of childhood obesity and eliminate disparities among racial/ethnic minority children.