Current practices in the diagnosis of acute pulmonary embolism: a comprehensive analysis of adherence to contemporary practice guidelines.

INTRODUCTION: Acute pulmonary embolism (PE) poses significant diagnostic challenges with potentially fatal outcomes if not promptly identified and treated. Despite the availability of clinical guidelines, adherence to diagnostic strategies varies globally, impacting patient outcomes. OBJECTIVES: To investigate the current diagnostic practices for PE among Polish physicians and their adherence to the contemporary European Society of Cardiology (ESC) 2019 Guidelines. PATIENTS AND METHODS: In this cross-sectional study utilizing a web-based survey developed through a Delphi methodology, we included hospital-based physicians across various specialties in Poland. The survey was focused on diagnostic practices, risk stratification, and adherence to the ESC 2019 Guidelines for PE. RESULTS: The study found limited use of guideline-recommended clinical prediction rules, with a large reliance on D-dimer assessments and CT pulmonary angiography. Risk stratification practices varied, often based on individual experience rather than evidence-based strategies. The vast majority of physicians (80.5%) had never contacted a Pulmonary Embolism Response Team (PERT), but 88% stated that they would if it were available. Cardiologists were more likely to employ guideline-recommended methods compared to other specialties. CONCLUSIONS: There is a need for increased adherence to guideline-recommended diagnostic and risk stratification strategies of acute PE among physicians in Poland. Enhancing the availability of Pulmonary Embolism Response Teams (PERTs) and promoting guideline-directed practices could improve diagnostic accuracy and patient outcomes.

Comparison of reorganized versus unaltered cardiology departments during the COVID-19 era: A subanalysis of the COV-HF-SIRIO 6 study.

BACKGROUND: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, numerous cardiology departments were reorganized to provide care for COVID-19 patients. We aimed to compare the impact of the COVID-19 pandemic on hospital admissions and in-hospital mortality in reorganized vs. unaltered cardiology departments. METHODS: The present research is a subanalysis of a multicenter retrospective COV-HF-SIRIO 6 study that includes all patients (n = 101,433) hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, with a focus on patients with acute heart failure (AHF). RESULTS: Reduction of all-cause hospitalizations was 50.6% vs. 21.3% for reorganized vs. unaltered cardiology departments in 2020 vs. 2019, respectively (p < 0.0001). Considering AHF alone respective reductions by 46.5% and 15.2% were registered (p < 0.0001). A higher percentage of patients was brought in by ambulance to reorganized vs. unaltered cardiology departments (51.7% vs. 34.6%; p < 0.0001) alongside with a lower rate of self-referrals (45.7% vs. 58.4%; p < 0.0001). The rate of all-cause in-hospital mortality in AHF patients was higher in reorganized than unaltered cardiology departments (10.9% vs. 6.4%; p < 0.0001). After the exclusion of patients with concomitant COVID-19, the mortality rates did not differ significantly (6.9% vs. 6.4%; p = 0.55). CONCLUSIONS: A greater reduction in hospital admissions in 2020 vs. 2019, higher rates of patients brought by ambulance together with lower rates of self-referrals and higher all-cause in-hospital mortality for AHF due to COVID-19 related deaths were observed in cardiology departments reorganized to provide care for COVID-19 patients vs. unaltered ones.

Impact of COVID-19 pandemic on acute heart failure admissions and mortality: a multicentre study (COV-HF-SIRIO 6 study).

AIMS: The coronavirus disease-2019 (COVID-19) pandemic has changed the landscape of medical care delivery worldwide. We aimed to assess the influence of COVID-19 pandemic on hospital admissions and in-hospital mortality rate in patients with acute heart failure (AHF) in a retrospective, multicentre study. METHODS AND RESULTS: From 1 January 2019 to 31 December 2020, a total of 101 433 patients were hospitalized in 24 Cardiology Departments in Poland. The number of patients admitted due to AHF decreased by 23.4% from 9853 in 2019 to 7546 in 2020 (P < 0.001). We noted a significant reduction of self-referrals in the times of COVID-19 pandemic accounting 27.8% (P < 0.001), with increased number of AHF patients brought by an ambulance by 15.9% (P < 0.001). The length of hospital stay was overall similar (7.7 ± 2.8 vs. 8.2 ± 3.7 days; P = not significant). The in-hospital all-cause mortality in AHF patients was 444 (5.2%) in 2019 vs. 406 (6.5%) in 2020 (P < 0.001). A total number of AHF patients with concomitant COVID-19 was 239 (3.2% of AHF patients hospitalized in 2020). The rate of in-hospital deaths in AHF patients with COVID-19 was extremely high accounting 31.4%, reaching up to 44.1% in the peak of the pandemic in November 2020. CONCLUSIONS: Our study indicates that the COVID-19 pandemic led to (i) reduced hospital admissions for AHF; (ii) decreased number of self-referred AHF patients and increased number of AHF patients brought by an ambulance; and (iii) increased in-hospital mortality for AHF with very high mortality rate for concomitant AHF and COVID-19.

Longer Hospitalizations and Higher In-Hospital Mortality for Acute Heart Failure during the COVID-19 Pandemic in Larger vs. Smaller Cardiology Departments: Subanalysis of the COV-HF-SIRIO 6 Multicenter Study.

Background: The coronavirus disease-2019 (COVID-19) pandemic is surging across Poland, leading to many direct deaths and underestimated collateral damage. We aimed to compare the influence of the COVID-19 pandemic on hospital admissions and in-hospital mortality in larger vs. smaller cardiology departments (i.e., with ≥ 2000 vs. < 2000 hospitalizations per year in 2019). Methods: We performed a subanalysis of the COV-HF-SIRIO 6 multicenter retrospective study including all patients hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, focusing on patients with acute heart failure (AHF) and COVID-19. Results: Total number of hospitalizations was reduced by 29.2% in larger cardiology departments and by 27.3% in smaller cardiology departments in 2020 vs. 2019. While hospitalizations for AHF were reduced by 21.8% and 25.1%, respectively. The length of hospital stay due to AHF in 2020 was 9.6 days in larger cardiology departments and 6.6 days in smaller departments (p < 0.001). In-hospital mortality for AHF during the COVID-19 pandemic was significantly higher in larger vs. smaller cardiology departments (10.7% vs. 3.2%; p < 0.001). In-hospital mortality for concomitant AHF and COVID-19 was extremely high in larger and smaller cardiology departments accounting for 31.3% vs. 31.6%, respectively. Conclusions: During the COVID-19 pandemic longer hospitalizations and higher in-hospital mortality for AHF were observed in larger vs. smaller cardiology departments. Reduced hospital admissions and extremely high in-hospital mortality for concomitant AHF and COVID-19 were noted regardless of department size.

[Two rare cases of left ventricular non-compaction diagnosed in elderly patients]. / Dwa rzadkie przypadki izolowanego niescalonego miesnia lewej komory zdiagnozowane u pacjentów w podeszlym wieku.

Isolated non-compaction of the left ventricle (LVNC) is a rare disorder, classified as a primary genetic or unclassified cardiomyopathy. Left ventricular non-compaction is characterised by an altered myocardial wall with prominent trabeculae and deep intertrabecular recesses caused by intrauterine arrest of compaction. This anomaly creates two layers consisting of compacted and non-compacted myocardium. Left ventricular non-compaction is associated with high rates of morbidity and mortality in adults with no specific therapy. We report two rare cases of LVNC diagnosed in elderly patients.

[Acute coronary syndrome induced by hypoglycemia in the course of insulinoma--a case report]. / Ostry zespól wiencowy indukowany napadami hipoglikemii w przebiegu wyspiaka trzustki--opis przypadku.

Insulinoma is the most frequent endocrine tumour of the pancreas derived from the beta cells which, while retaining the ability to synthesise and secrete insulin, is autonomous from the normal feedback mechanisms. The characteristic clinical manifestation of this neoplasm is fasting hypoglycaemia, with sympathoadrenal and neuroglycopenic symptoms. In extremely rare cases insulinoma can be a cause of acute coronary syndrome. Surgical removal is the treatment of choice and recurrences are uncommon. We report a case of a 74-year-old man with acute coronary syndrome caused by adrenergic stimulation during severe hypoglycaemic seizures in the course of insulinoma.

[Congenitally corrected transposition of the great arteries with coexisting stenosis of pulmonary trunk valve and ventricular septum defect in a 55-year-old woman--a case report]. / Wrodzone skorygowane przelozenie wielkich pni tetniczych wspólistniejace ze stenoza zastawki pnia plucnego i ubytkiem czesci bloniastej przegrody miedzykomorowej u 55-letniej kobiety.

Congenitally corrected transposition of the great arteries (CCTGA) is a rare cardiac malformation. This anomaly is characterised by atrioventricular as well as ventriculoarterial discordance. Isolated CCTGA may cause no symptoms until adult life. Most CCTGA cases with concomitant cardiac abnormalities are symptomatic and are therefore usually diagnosed in childhood. In the majority of patients, congestive heart failure secondary to right ventricular dysfunction occurring by the fifth or sixth decade enables diagnosis. We present an oligosymptomatic 55-year-old woman with corrected transposition of the great arteries and coexisting stenosis of pulmonary trunk valve and ventricular septum defect.