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1.
Am Heart J ; 220: 59-67, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31785550

RESUMO

BACKGROUND: Despite a higher prevalence of sudden cardiac death (SCD), black individuals are less likely than whites to have an implantable cardioverter defibrillator (ICD) implanted. Racial differences in ICD utilization is in part explained by higher refusal rates in black individuals. Decision support can assist with treatment-related uncertainty and prepare patients to make well-informed decisions. METHODS: The Videos to reduce racial disparities in ICD therapy Via Innovative Designs (VIVID) study will randomize 350 black individuals with a primary prevention indication for an ICD to a racially concordant/discordant video-based decision support tool or usual care. The composite primary outcome is (1) the decision for ICD placement in the combined video groups compared with usual care and (2) the decision for ICD placement in the racially concordant relative to discordant video group. Additional outcomes include knowledge of ICD therapy and SCD risk; decisional conflict; ICD receipt at 90 days; and a qualitative assessment of ICD decision making in acceptors, decliners, and those undecided. CONCLUSIONS: In addition to assessing the efficacy of decision support on ICD acceptance among black individuals, VIVID will provide insight into the role of racial concordance in medical decision making. Given the similarities in the root causes of racial/ethnic disparities in care across health disciplines, our approach and findings may be generalizable to decision making in other health care settings.


Assuntos
Grupo com Ancestrais do Continente Africano , Morte Súbita Cardíaca/prevenção & controle , Técnicas de Apoio para a Decisão , Desfibriladores Implantáveis/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Educação de Pacientes como Assunto/métodos , Adulto , Afro-Americanos , Recursos Audiovisuais , Morte Súbita Cardíaca/etnologia , Humanos , Cooperação do Paciente/etnologia , Estudos Prospectivos , Recusa do Paciente ao Tratamento/etnologia , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Incerteza
2.
Radiol Med ; 125(3): 329-335, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31832987

RESUMO

INTRODUCTION: The management of patients bearing a cardiac implantable electronic device and needing a radiotherapy treatment is an important clinical scenario. The aim of this survey was to evaluate the level of awareness within the Italian Radiation Oncologist community on this topic. MATERIALS AND METHODS: A survey was promoted by the Young Group of Italian Association of Radiotherapy and Clinical Oncology (AIRO) with a questionnaire made up of 22 questions allowing for multiple answers, which was administered, both online and on paper version. It was addressed to Radiation Oncologists, AIRO members, participating in the National Congress held in 2015. RESULTS: A total of 113 questionnaires were collected back and analyzed (survey online: 50 respondents; paper version: 63). The answers showed a good level of awareness on the issue, but with a nonhomogeneous adherence to the different published guidelines (GL). There is a general low rate of referral for a preliminary cardiological evaluation in patients bearing PM/ICDs, in line with some published surveys; nevertheless, a focused attention to certain specific treatment factors and patient-centered point of view emerged. CONCLUSIONS: A generally good awareness of this topic was shown but homogeneous application of GL was not observed, possibly due to the multiplicity of available GL. A prospective data collection could help to better clarify the shadows on this topics.


Assuntos
Desfibriladores Implantáveis , Fidelidade a Diretrizes , Marca-Passo Artificial , Radioterapia (Especialidade) , Radioterapia , Adulto , Desfibriladores Implantáveis/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Itália , Marca-Passo Artificial/estatística & dados numéricos , Doses de Radiação , Radioterapia (Especialidade)/estatística & dados numéricos , Sociedades Médicas
3.
Rev Esp Cardiol (Engl Ed) ; 72(12): 1054-1064, 2019 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31727564

RESUMO

INTRODUCTION AND OBJECTIVES: This article presents the data corresponding to automated implantable cardioverter-defibrillator (ICD) implants in Spain reported to the Spanish Registry in 2018. METHODS: The data in this registry include both primary implants and generator replacements and were gathered from a data collection sheet voluntarily completed by implantation centers. RESULTS: In 2018, 6421 implant sheets were received compared with 7077 reported by Eucomed (European Confederation of Medical Suppliers Associations). This represents data on 90.7% of the devices implanted in Spain. Compliance ranged between 99.6% for the field "name of the implanting hospital" and 12.4% for "population of residence". A total of 173 hospitals reported their data to the registry, representing a slight decrease compared with hospitals participating in 2017 (n=181). CONCLUSIONS: After the reduction in ICD implants in 2017, the number of implants increased in 2018, with the highest number of ICDs implanted in Spain. The total number of implants remains much lower than the European Union average, with substantial differences between autonomous communities.


Assuntos
Arritmias Cardíacas/terapia , Cardiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Eletrofisiologia/estatística & dados numéricos , Sistema de Registros , Sociedades Médicas , Coleta de Dados , Feminino , Humanos , Masculino , Estudos Retrospectivos , Espanha
4.
N Z Med J ; 132(1500): 40-49, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31415498

RESUMO

AIMS: The ANZACS-QI Cardiac Implanted Device Registry (ANZACS-QI DEVICE) collects data on cardiac implantable electronic devices inserted in New Zealand. We evaluated completeness of data capture and quality of ANZACS-QI DEVICE in 2016. METHODS: Complete datasets within ANZACS-QI DEVICE, comprising DEVICE-PPM (permanent pacemakers) and DEVICE-ICD (implantable cardioverter defibrillators), from 1 January 2016 to 31 December 2016 were linked with the National Hospitalisation dataset (all New Zealand public hospital admissions). The total number of implants included procedures captured in either dataset. Variables assessed included age, gender, ethnicity, procedure type, implanting centre, admission and procedure date. RESULTS: DEVICE-PPM captured 85.9% of all PPM procedures (n=2,512). This was similar regardless of age, sex and ethnicity. In the 84.4% of procedures captured in both datasets, agreement was >97% for all variables except admission date (90.1%). DEVICE-ICD captured 81.3% of all ICD procedures (n=690). Capture was similar across age, sex and ethnicity groups. In the 76.8% of procedures captured in both datasets, agreement was >96% for all variables except admission date (90.6%). CONCLUSION: The ANZACS-QI DEVICE registry had a good capture rate and excellent agreement with the national dataset. This high concordance supports the use of both datasets for future research.


Assuntos
Bases de Dados Factuais/normas , Desfibriladores Implantáveis/estatística & dados numéricos , Marca-Passo Artificial/estatística & dados numéricos , Sistema de Registros/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Pesquisa Biomédica , Coleta de Dados , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia
5.
Am J Cardiol ; 124(5): 709-714, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31279406

RESUMO

Sudden cardiac arrest (SCA) rhythms have been traditionally divided into shockable [ventricular tachycardia (VT)/ventricular fibrillation (VF)] and nonshockable [(asystole (ASY)/pulseless electrical activity (PEA)] rhythms. It is unclear if the specific rhythm has implications on patient management and outcomes. We evaluated 1,433 patients who were admitted with SCA from 2000 to 2012 and were discharged alive. Of those, 1,123 patients had a recorded initial SCA rhythm. Subjects included were >18 years of age, and without an implantable cardioverter-defibrillator (ICD) in place at the time of the event. The likelihood of receiving an ICD for each SCA rhythm and the time to death were analyzed. Of the overall cohort of 1,123 SCA survivors (age of 62 ± 15 years; 39.2% women; 56.3% in-hospital SCA; 83% white; 67% coronary artery disease), 355 (31.6%) received an ICD, and 493 (43.9%) died over a mean follow-up of 3.8 ± 3.2 years. Patients with VF (n = 254, 43.6%) or VT (n = 83, 43.9%) were more likely to receive ICD therapy compared with those with ASY (n = 9, 5.3%) or PEA (n = 9, 4.8%; p <0.001). All-cause mortality was lower in VF patients compared with the other groups (p <0.0001). ICD therapy was associated with lower risk of death in the VF group (hazard ratio [HR] 0.61 [0.45 to 0.83]; p = 0.002) and strong trends toward less mortality in patients with VT (HR 0.64 [0.40 to 1.03]; p = 0.07) and ASY (HR 0.39 [0.12 to 1.31]; p = 0.13) but not in those with PEA (HR 0.93 [0.39 to 2.23]; p = 0.88). In conclusion, long-term survival in post-SCA patients is influenced by initial SCA rhythm. Although SCA survivors with shockable rhythms were more likely to receive ICDs, the ICD was associated with lower risk of death in most patients, including those with ASY. In conclusion, our data suggest that a more detailed SCA rhythm classification has important implications to patient management and long-term survival in this population.


Assuntos
Causas de Morte , Morte Súbita Cardíaca/etiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Cardioversão Elétrica/métodos , Sobreviventes , Centros Médicos Acadêmicos , Adolescente , Adulto , Fatores Etários , Idoso , Fibrilação Atrial/complicações , Intervalos de Confiança , Bases de Dados Factuais , Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica/estatística & dados numéricos , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Análise de Sobrevida , Estados Unidos , Fibrilação Ventricular/complicações
6.
Am Heart J ; 214: 28-35, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31152873

RESUMO

BACKGROUND: Thrill-seeking activities are a favorite pastime for people of all ages. Patients with hypertrophic cardiomyopathy (HCM) are often barred from participation on the basis of danger for arrhythmias. Our aim was to collect information regarding the safety of thrill-seeking activities for HCM patients. METHODS: An anonymous online survey invited adult HCM patients to report participation in 11 activities (rollercoaster riding, jet skiing, rafting, bungee jumping, rappelling, paragliding, kayaking/canoeing, motor racing, snowboarding, BASE jumping and skydiving) before and after HCM diagnosis, along with major (ICD shock, syncope) or minor (nausea, dizziness, palpitations, chest pain) adverse events related to participation, and relevant physician advice. RESULTS: Six hundred forty-seven HCM patients completed the survey, with 571 (88.2%) reporting participation in ≥1 TSAs (participant age 50.85 ±â€¯14.21, 56.6% female, 8143 post-diagnosis participations). At time of survey, 457 participants (70.6%) were ICD-carriers or had ≥1 risk factor for sudden cardiac death. Nine (1.5%) participants reported a major event during or immediately after (60 minutes) of surveyed activity. Minor adverse events were reported by 181 participants (31.6%). In addition, 8 participants reported a major adverse event >60 minutes later but within the same day. Regarding physician advice, of the 213 responders (32.9%) receiving specific advice, 56 (26.2%) were told safety data is absent with no definitive recommendation, while 24 (11.2%) and 93 (43.6%) were told TSAs were respectively safe or dangerous. CONCLUSIONS: In this cohort, participation in thrill-seeking activities rarely caused major adverse events. This information can be used for shared-decision making between providers and patients.


Assuntos
Atitude do Pessoal de Saúde , Cardiomiopatia Hipertrófica/psicologia , Preferência do Paciente/psicologia , Médicos/psicologia , Assunção de Riscos , Adulto , Idoso , Cardiomiopatia Hipertrófica/complicações , Tomada de Decisão Compartilhada , Desfibriladores Implantáveis/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos
7.
Heart Fail Rev ; 24(6): 847-866, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31147814

RESUMO

Heart failure (HF) with preserved ejection fraction (HFpEF) represents half of HF patients, who are more likely older, women, and hypertensive. Mortality rates in HFpEF are higher compared with age- and comorbidity-matched non-HF controls and lower than in HF with reduced ejection fraction (HFrEF); the majority (50-70%) are cardiovascular (CV) deaths. Among CV deaths, sudden death (SD) (~ 35%) and HF-death (~ 20%) are the leading cardiac modes of death; however, proportionally, CV deaths, SD, and HF-deaths are lower in HFpEF, while non-CV deaths constitute a higher proportion of deaths in HFpEF (30-40%) than in HFrEF (~ 15%). Importantly, the underlying mechanism of SD has not been clearly elucidated and non-arrhythmic SD may be more prominent in HFpEF than in HFrEF. Furthermore, there is no specific strategy for identifying high-risk patients, probably due to wide heterogeneity in presentation and pathophysiology of HFpEF and a plethora of comorbidities in this population. Thus, the management of HFpEF remains problematic due to paucity of data on the clinical benefits of current therapies, which focus on symptom relief and reduction of HF-hospitalization by controlling fluid retention and managing risk-factors and comorbidities. Matching a specific pathophysiology or mode of death with available and novel therapies may improve outcomes in HFpEF. However, this still remains an elusive target, as we need more information on determinants of SD. Implantable cardioverter-defibrillators (ICDs) have changed the landscape of SD prevention in HFrEF; if ICDs are to be applied to HFpEF, there must be a coordinated effort to identify and select high-risk patients.


Assuntos
Morte Súbita/prevenção & controle , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Causas de Morte/tendências , Comorbidade , Morte Súbita/etnologia , Morte Súbita/etiologia , Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Hospitalização/tendências , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Prognóstico , Fatores de Risco , Função Ventricular Esquerda/fisiologia
8.
Cardiology ; 142(3): 129-140, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31189160

RESUMO

OBJECTIVE: This study sought to assess the impact of treatment with digitalis on recurrences of ventricular tachyarrhythmias in implantable cardioverter defibrillator (ICD) recipients with atrial fibrillation (AF) and heart failure (HF). BACKGROUND: The data regarding outcomes of digitalis therapy in ICD recipients are limited. METHODS: A large retrospective registry was used, including consecutive ICD recipients with episodes of ventricular tachyarrhythmia between 2002 and 2016. Patients treated with digitalis were compared to patients without digitalis treatment. The primary prognostic outcome was first recurrence of ventricular tachyarrhythmia at 5 years. Kaplan-Meier and multivariable Cox regression analyses were applied. RESULTS: A total of 394 ICD recipients with AF and/or HF was included (26% with digitalis treatment and 74% without). Digitalis treatment was associated with decreased freedom from recurrent ventricular tachy-arrhythmias (HR = 1.423; 95% CI 1.047-1.934; p = 0.023). Accordingly, digitalis treatment was associated with decreased freedom from appropriate ICD therapies (HR = 1.622; 95% CI 1.166-2.256; p = 0.004) and, moreover, higher rates of rehospitalization (38 vs. 21%; p = 0.001) and all-cause mortality (33 vs. 20%; p = 0.011). CONCLUSION: Among ICD recipients suffering from AF and HF, treatment with digitalis was associated with increased rates of recurrent ventricular tachyarrhythmias and ICD therapies. However, the endpoints may also have been driven by interactions between digitalis, AF, and HF.


Assuntos
Fibrilação Atrial/terapia , Desfibriladores Implantáveis/estatística & dados numéricos , Digitoxina/efeitos adversos , Insuficiência Cardíaca/terapia , Taquicardia Ventricular/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/mortalidade , Desfibriladores Implantáveis/efeitos adversos , Digitoxina/uso terapêutico , Feminino , Alemanha/epidemiologia , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Recidiva , Estudos Retrospectivos , Análise de Sobrevida , Taquicardia Ventricular/etiologia
9.
Am Heart J ; 214: 69-76, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31174053

RESUMO

BACKGROUND: Left ventricular assist device (LVAD)-associated infections may be life-threatening and impact patients' outcome. We aimed to identify the characteristics, risk factors, and prognosis of LVAD-associated infections. METHODS: Patients included in the ASSIST-ICD study (19 centers) were enrolled. The main outcome was the occurrence of LVAD-associated infection (driveline infection, pocket infection, or pump/cannula infection) during follow-up. RESULTS: Of the 652 patients enrolled, 201 (30.1%) presented a total of 248 LVAD infections diagnosed 6.5 months after implantation, including 171 (26.2%), 51 (7.8%), and 26 (4.0%) percutaneous driveline infection, pocket infection, or pump/cannula infection, respectively. Patients with infections were aged 58.7 years, and most received HeartMate II (82.1%) or HeartWare (13.4%). Most patients (62%) had implantable cardioverter-defibrillators (ICDs) before LVAD, and 104 (16.0%) had ICD implantation, extraction, or replacement after the LVAD surgery. Main pathogens found among the 248 infections were Staphylococcus aureus (n = 113' 45.4%), Enterobacteriaceae (n = 61; 24.6%), Pseudomonas aeruginosa (n = 34; 13.7%), coagulase-negative staphylococci (n = 13; 5.2%), and Candida species (n = 13; 5.2%). In multivariable analysis, HeartMate II (subhazard ratio, 1.56; 95% CI, 1.03 to 2.36; P = .031) and ICD-related procedures post-LVAD (subhazard ratio, 1.43; 95% CI, 1.03-1.98; P = .031) were significantly associated with LVAD infections. Infections had no detrimental impact on survival. CONCLUSIONS: Left ventricular assist device-associated infections affect one-third of LVAD recipients, mostly related to skin pathogens and gram-negative bacilli, with increased risk with HeartMate II as compared with HeartWare, and in patients who required ICD-related procedures post-LVAD. This is a plea to better select patients needing ICD implantation/replacement after LVAD implantation.


Assuntos
Infecções Relacionadas a Cateter/etiologia , Coração Auxiliar/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/mortalidade , Desfibriladores Implantáveis/estatística & dados numéricos , Remoção de Dispositivo/estatística & dados numéricos , Feminino , França/epidemiologia , Ventrículos do Coração , Coração Auxiliar/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/mortalidade , Estudos Retrospectivos , Fatores de Risco
10.
J Am Coll Cardiol ; 73(24): 3082-3099, 2019 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-31221257

RESUMO

BACKGROUND: The benefits of cardiac resynchronization therapy (CRT) in patients with non-left bundle branch block (LBBB) conduction abnormality have not been fully explored. OBJECTIVES: This study sought to evaluate clinical outcomes among Medicare-aged patients with nonspecific intraventricular conduction delay (NICD) versus right bundle branch block (RBBB) in patients eligible for implantation with a CRT with defibrillator (CRT-D). METHODS: Using the National Cardiovascular Data Registry implantable cardioverter-defibrillator (ICD) registry data between 2010 and 2013, the authors compared outcomes in CRT-eligible patients implanted with CRT-D versus ICD-only therapy among patients with NICD and RBBB. Also, among all CRT-D-implanted patients, the authors compared outcomes in those with NICD versus RBBB. Survival curves and multivariable adjusted hazard ratios (HRs) were used to assess outcomes including hospitalization and death. RESULTS: In 11,505 non-LBBB CRT-eligible patients, after multivariable adjustment, among patients with RBBB, CRT-D was not associated with better outcomes, compared with ICD alone, regardless of QRS duration. Among patients with NICD and a QRS ≥150 ms, CRT-D was associated with decreased mortality at 3 years compared with ICD alone (HR: 0.602; 95% confidence interval [CI]: 0.416 to 0.871; p = 0.0071). Among 5,954 CRT-D-implanted patients, after multivariable adjustment NICD compared with RBBB was associated with lower mortality at 3 years in those with a QRS duration of ≥150 ms (HR: 0.757; 95% CI: 0.625 to 0.917; p = 0.0044). CONCLUSIONS: Among non-LBBB CRT-D-eligible patients, CRT-D implantation was associated with better outcomes compared with ICD alone specifically in NICD patients with a QRS duration of ≥150 ms. Careful patient selection should be considered for CRT-D implantation in patients with non-LBBB conduction.


Assuntos
Bloqueio de Ramo , Doença do Sistema de Condução Cardíaco , Terapia de Ressincronização Cardíaca , Desfibriladores Implantáveis/estatística & dados numéricos , Ventrículos do Coração/fisiopatologia , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Doença do Sistema de Condução Cardíaco/diagnóstico , Doença do Sistema de Condução Cardíaco/epidemiologia , Doença do Sistema de Condução Cardíaco/fisiopatologia , Doença do Sistema de Condução Cardíaco/terapia , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/métodos , Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/métodos , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Medicare/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Seleção de Pacientes , Sistema de Registros , Estados Unidos/epidemiologia
11.
Kardiol Pol ; 77(5): 561-567, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31066721

RESUMO

BACKGROUND: The rate of cardiac device-related infective endocarditis (CDRIE) is increasing worldwide, but no detailed data are available for Poland. AIMS: We aimed to evaluate clinical, diagnostic, and therapeutic data of patients hospitalized due to CDRIE in 22 Polish referential cardiology centers from May 1, 2016 to May 1, 2017. METHODS: Participating cardiology departments were asked to fill in a questionnaire that included data on the number of hospitalized patients, number and types of implanted cardiac electrotherapy devices, and number of infective endocarditis cases. We also collected clinical data and data regarding the management of patients with CDRIE. RESULTS: Overall, 99 621 hospitalizations were reported. Infective endocarditis unrelated to cardiac device was the cause of 596 admissions (0.6%), and CDRIE, of 195 (0.2%). Pacemaker was implanted in 91 patients with CDRIE (47%); cardioverter­defibrillator, in 51 (26%); cardiac resynchronization therapy­defibrillator, in 48 (25%); and cardiac resynchronization therapy­pacemaker, in 5 (2.5%). The most common symptoms were malaise (62%), fever/chills (61%), cough (21%), chest pain (19.5%), and inflammation of the device pocket (5.6%). Cultures were positive in 77.5% of patients. The cardiac device was removed in 91% of patients. The percutaneous approach was most common for cardiac device removal. All patients received antibiotic therapy, and 3 patients underwent a heart valve procedure. Transesophageal echocardiography was performed in 80% of patients. The most common complication was heart failure (25% of patients). CONCLUSIONS: The clinical profile, pathogen types, and management strategies in Polish patients with CDRIE are consistent with similar data from other European countries. Transesophageal echocardiography was performed less frequently than recommended. The removal rate in the Polish population is consistent with the general rates observed for interventional treatment in patients with CDRIE.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Endocardite/etiologia , Marca-Passo Artificial/efeitos adversos , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Serviço Hospitalar de Cardiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Endocardite/diagnóstico por imagem , Endocardite/epidemiologia , Endocardite/cirurgia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/cirurgia , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/estatística & dados numéricos , Polônia/epidemiologia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/cirurgia
12.
Intern Med ; 58(16): 2333-2340, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31118368

RESUMO

Objective Remote monitoring (RM) of cardiac implantable electric devices (CIEDs) has been advocated as a healthcare standard. However, expert consensus statements suggest that all patients require annual face-to-face follow-up consultations at outpatient clinics even if RM reveals no episodes. The objective of this study was to determine the critical event rate after CIED implantation through RM. Methods This multicenter, retrospective, cohort study evaluated patients with pacemakers (PMs), implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillator (CRT-Ds) and analyzed whether or not the data drawn from RM included abnormal or critical events. Patients A total of 1,849 CIED patients in 12 hospitals who were followed up by the RM center in Okayama University Hospital were included in this study. Results During the mean follow-up period of 774.9 days, 16,560 transmissions were analyzed, of which 11,040 (66.7%) were abnormal events and only 676 (4.1%) were critical events. The critical event rate in the PM group was significantly lower than that in the ICD or CRT-D groups (0.9% vs. 5.0% or 5.9%, p<0.001). A multivariate analysis revealed that ICD, CRT-D, and a low ejection fraction were independently associated with critical events. In patients with ICD, the independent risk factors for a critical event were old age, low ejection fraction, Brugada syndrome, dilated phase hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Conclusion Although abnormal events were observed in two-thirds of the transmitted RM data, the critical event rate was <1% in patients with a PM, which was lower in comparison to the rates in patients with ICDs or CRT-Ds. A low ejection fraction was an independent predictor of critical events.


Assuntos
Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Cardiomiopatia Dilatada/cirurgia , Desfibriladores Implantáveis/estatística & dados numéricos , Marca-Passo Artificial/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Tecnologia de Sensoriamento Remoto/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
13.
Am J Cardiol ; 124(3): 362-366, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31103131

RESUMO

Sudden cardiac death (SCA) is a major cause of mortality with estimates of 450,000 deaths annually in the United States. The incidence of SCA differs between the sexes. Data regarding survival of women compared with men after SCA are, however, conflicting. We, therefore, examined the long-term survival of women versus men after SCA. A total of 1,433 (41% women; 44% out-of-hospital) survivors of SCA at our institution between 2002 and 2012 were followed to the primary end point of death through February 20, 2017. Women in our cohort were older (p = 0.02), were less likely to be white (p = 0.01), or to have suffered an acute myocardial infarction at the time of SCA (p < 0.001). They also had significantly shorter PR (p < 0.001) and QRS (p < 0.001) durations on their surface electrocardiogram, were more likely to present with an initial ventricular rhythm other than ventricular tachycardia or ventricular fibrillation (29% vs 22%, p = 0.001) and less likely to receive an implantable cardioverter defibrillator (22% vs 31%, p < 0.001). Over a median follow-up of 3.6 years, 674 (45%) patients died (53% women vs 43% men, p < 0.001). After adjusting for unbalanced baseline covariates, the sex difference in survival disappeared (hazard ratio 1.05; 95% confidence interval 0.85 to 1.29, p = 0.66). In conclusion, our results demonstrate comparable long-term mortality after SCA for men and women. Differences in unadjusted mortality are mainly due to older age, different risk profiles at the time of index event, and differential treatment with implantable cardioverter defibrillator.


Assuntos
Parada Cardíaca/epidemiologia , Fatores Etários , Estudos de Coortes , Grupos de Populações Continentais , Desfibriladores Implantáveis/estatística & dados numéricos , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Fatores Sexuais
14.
J Am Coll Cardiol ; 73(14): 1756-1765, 2019 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-30975291

RESUMO

BACKGROUND: Information on young patients with Brugada syndrome (BrS) and arrhythmic events (AEs) is limited. OBJECTIVES: The purpose of this study was to describe their characteristics and management as well as risk factors for AE recurrence. METHODS: A total of 57 patients (age ≤20 years), all with BrS and AEs, were divided into pediatric (age ≤12 years; n = 26) and adolescents (age 13 to 20 years; n = 31). RESULTS: Patients' median age at time of first AE was 14 years, with a majority of males (74%), Caucasians (70%), and probands (79%) who presented as aborted cardiac arrest (84%). A significant proportion of patients (28%) exhibited fever-related AE. Family history of sudden cardiac death (SCD), prior syncope, spontaneous type 1 Brugada electrocardiogram (ECG), inducible ventricular fibrillation at electrophysiological study, and SCN5A mutations were present in 26%, 49%, 65%, 28%, and 58% of patients, respectively. The pediatric group differed from the adolescents, with a greater proportion of females, Caucasians, fever-related AEs, and spontaneous type-1 ECG. During follow-up, 68% of pediatric and 64% of adolescents had recurrent AE, with median time of 9.9 and 27.0 months, respectively. Approximately one-third of recurrent AEs occurred on quinidine therapy, and among the pediatric group, 60% of recurrent AEs were fever-related. Risk factors for recurrent AE included sinus node dysfunction, atrial arrhythmias, intraventricular conduction delay, or large S-wave on ECG lead I in the pediatric group and the presence of SCN5A mutation among adolescents. CONCLUSIONS: Young BrS patients with AE represent a very arrhythmogenic group. Current management after first arrhythmia episode is associated with high recurrence rate. Alternative therapies, besides defibrillator implantation, should be considered.


Assuntos
Arritmias Cardíacas , Síndrome de Brugada , Parada Cardíaca , Quinidina/uso terapêutico , Medição de Risco/métodos , Prevenção Secundária/métodos , Técnicas de Ablação/métodos , Adolescente , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/genética , Arritmias Cardíacas/prevenção & controle , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/epidemiologia , Síndrome de Brugada/fisiopatologia , Síndrome de Brugada/terapia , Criança , Desfibriladores Implantáveis/estatística & dados numéricos , Eletrocardiografia/métodos , Técnicas Eletrofisiológicas Cardíacas/métodos , Feminino , Parada Cardíaca/diagnóstico , Parada Cardíaca/prevenção & controle , Humanos , Masculino , Anamnese/estatística & dados numéricos , Fatores de Risco , Síncope/diagnóstico , Síncope/epidemiologia , Síncope/etiologia , Adulto Jovem
15.
Am J Cardiol ; 123(12): 1967-1971, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-30961910

RESUMO

Insertable cardiac monitors (ICM) are used in patients with suspected or known cardiac arrhythmias; the resulting diagnosis can lead to therapeutic interventions such as a pacemaker (PPM) or defibrillator (ICD) implant. We investigated the incidence of these implants in a large, real-world, cohort of ICM patients. The Optum© EHR de-identified database was used to identify patients with cardiovascular diseases, an ICM implant, ≥180 days of follow-up before and after ICM implant, and no previous history of a PPM or ICD. The Kaplan-Meier (KM) incidence estimates for device implants following an ICM implant were determined. A total of 19,173 patients with an ICM implant were identified. During a mean follow-up of 40 months, either a PPM or ICD was implanted in 21% of patients. A device was implanted in 25% of patients with history of syncope compared with 15% in patients with another indication for ICM implant (p <0.001). There was a significantly greater number of PPM implants following an ICM in patients with history of syncope compared with another indication for ICM implant (23% vs 13% p <0.001); in contrast, there was no difference in ICD implants between the 2 groups (3% in both groups, p = 0.84). In conclusion, a PPM or ICD was ultimately implanted in 21% of ICM patients. Pacemaker implant rates varied significantly with indication for ICM implant, whereas ICD implants rates were similar. In particular, patients with history of syncope had the greatest likelihood of needing a PPM during follow-up.


Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Desfibriladores Implantáveis/estatística & dados numéricos , Eletrocardiografia Ambulatorial/estatística & dados numéricos , Marca-Passo Artificial/estatística & dados numéricos , Idoso , Arritmias Cardíacas/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
16.
Health Serv Res ; 54(4): 880-889, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30937894

RESUMO

OBJECTIVE: To evaluate two novel measures of physician network centrality and their associations with implantable cardioverter defibrillator (ICD) procedure volume and health outcomes. DATA SOURCES: Medicare claims and the National Cardiovascular Data Registry data from 2007 to 2011. STUDY DESIGN: We constructed a national cardiovascular disease patient-sharing physician network and used network analysis to characterize physician network centrality with two measures: within-hospital degree centrality (number of connections within a hospital) and across-hospital degree centrality (number of connections across hospitals). The primary outcome was risk-adjusted 2-year case fatality. Hierarchical logistic regression estimated the effects of physician's within-hospital and across-hospital degree centrality on case fatality. We included 105 109 ICD therapy patients and 3474 ICD implanting physicians in our analyses. PRINCIPAL FINDINGS: After controlling for other physician and hospital characteristics, we observed greater risk-adjusted case fatality among patients treated by physicians in the highest across-hospital degree tertile compared to lowest tertile (OR [95% CI] = 1.10 [1.04-1.16], P = 0.001) and lowest tertile volume physicians compared with highest volume (OR [95% CI] = 0.90 [0.84-0.95], P < 0.001). Physician's within-hospital degree tertile was inversely associated with case fatality but not statistically significant. CONCLUSIONS: Degree centrality measures capture information independent of procedure volume and raise questions about the quality of physicians with networks that predict worse health outcomes.


Assuntos
Doenças Cardiovasculares/cirurgia , Desfibriladores Implantáveis/estatística & dados numéricos , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Medicare/estatística & dados numéricos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos
17.
Crit Care Med ; 47(6): e502-e505, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30889030

RESUMO

OBJECTIVES: To compare 1-year all-cause mortality and major adverse cardiovascular events in cardiac arrest survivors with and without posttraumatic stress disorder symptomatology at hospital discharge. DESIGN: Prospective, observational cohort. SETTING: ICUs at a tertiary-care center. PATIENTS: Adults with return of spontaneous circulation after in-hospital or out-of-hospital cardiac arrest between September 2015 and September 2017. A consecutive sample of survivors with sufficient mental status to self-report cardiac arrest and subsequent hospitalization-induced posttraumatic stress disorder symptoms (cardiac arrest-induced posttraumatic stress symptomatology) at hospital discharge were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The combined primary endpoint was all-cause mortality or major adverse cardiovascular event-hospitalization for nonfatal myocardial infarction, unstable angina, congestive heart failure, emergency coronary revascularization, or urgent implantable cardio-defibrillators/permanent pacemaker placements within 12 months of discharge. An in-person posttraumatic stress disorder symptomatology was assessed at hospital discharge via the Posttraumatic Stress Disorder Checklist-Specific scale; a suggested diagnostic cutoff of 36 for specialized medical settings was adopted. Outcomes for patients meeting (vs not meeting) this cutoff were compared using Cox-hazard regression models. Of 114 included patients, 36 (31.6%) screened positive for cardiac arrest-induced posttraumatic stress symptomatology at discharge (median 21 d post cardiac arrest; interquartile range, 11-36). During the follow-up period (median = 12.4 mo; interquartile range, 10.2-13.5 mo), 10 (8.8%) died and 29 (25.4%) experienced a recurrent major adverse cardiovascular event: rehospitalizations due to myocardial infarction (n = 4; 13.8%), unstable angina (n = 8; 27.6%), congestive heart failure exacerbations (n = 4; 13.8%), emergency revascularizations (n = 5, 17.2%), and urgent implantable cardio-defibrillator/permanent pacemaker placements (n = 8; 27.6%). Cardiac arrest-induced posttraumatic stress symptomatology was associated with all-cause mortality/major adverse cardiovascular event in univariate (hazard ratio, 3.19; 95% CI, 1.7-6.0) and in models adjusted for age, sex, comorbidities, preexisting psychiatric condition, and nonshockable initial rhythm (hazard ratio, 3.1; 95% CI, 1.6-6.0). CONCLUSIONS: Posttraumatic stress disorder symptomatology is common after cardiac arrest, and cardiac arrest-induced posttraumatic stress symptomatology was associated with significantly higher risk of death and cardiovascular events. Further studies are needed to better understand the underlying mechanisms.


Assuntos
Cardiopatias/epidemiologia , Hospitalização , Mortalidade , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto , Idoso , Angina Instável/epidemiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Feminino , Parada Cardíaca/complicações , Cardiopatias/complicações , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , New York/epidemiologia , Marca-Passo Artificial/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Intervenção Coronária Percutânea/estatística & dados numéricos , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Transtornos de Estresse Pós-Traumáticos/diagnóstico
18.
G Ital Cardiol (Rome) ; 20(3): 136-148, 2019 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-30821295

RESUMO

BACKGROUND: The pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) monitors the main epidemiological data in real-world practice. The survey for the 2017 activity collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the Italian collaborating centers. METHODS: The Registry collects prospectively national PM and ICD implantation activity on the basis of European cards. RESULTS: PM Registry: data about 23 457 PM implantations were collected (19 378 first implant and 4079 replacements). The number of collaborating centers was 185. Median age of treated patients was 81 years (75 quartile I; 86 quartile III). ECG indications included atrioventricular conduction disorders in 37.1% of first PM implants, sick sinus syndrome in 19.5%, atrial fibrillation plus bradycardia in 13.2%, other in 30.2%. Among atrioventricular conduction defects, third-degree atrioventricular block was the most common type (21.0% of first implants). Use of single-chamber PMs was reported in 25.6% of first implants, of dual-chamber PMs in 66.7%, of PMs with cardiac resynchronization therapy (CRT) in 1.4%, and of single lead atrial-synchronized ventricular stimulation (VDD/R PMs) in 6.3%. ICD Registry: data about 19 023 ICD implantations were collected (13 898 first implants and 5125 replacements). The number of collaborating centers was 437. Median age of treated patients was 71 years (63 quartile I; 78 quartile III). Primary prevention indication was reported in 81.8% of first implants, secondary prevention in 18.2% (cardiac arrest in 6.4%). A single-chamber ICD was used in 27.0% of first implants, dual-chamber in 33.6% and biventricular in 39.3%. CONCLUSIONS: The PM and ICD Registry appears fundamental for monitoring PM and ICD utilization on a large national scale with rigorous examination of demographics and clinical indications. The PM Registry showed stable electrocardiographic and symptom indications, with an important prevalence of dual-chamber pacing. The use of CRT-PM regards a very limited number of patients. The ICD Registry documented a large use of prophylactic and biventricular ICD, reflecting a favorable adherence to trials and guidelines in clinical practice. In order to increase and optimize the cooperation of Italian implanting centers, online data entry (http://www.aiac.it/riprid) should be adopted at large scale.


Assuntos
Arritmias Cardíacas/terapia , Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Desfibriladores Implantáveis/estatística & dados numéricos , Marca-Passo Artificial/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Prevenção Primária/estatística & dados numéricos , Sistema de Registros , Prevenção Secundária/estatística & dados numéricos , Inquéritos e Questionários
19.
Mayo Clin Proc ; 94(4): 588-598, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30853259

RESUMO

OBJECTIVE: To evaluate inpatient trends in de novo complete cardiac implantable electronic device (CIED) procedures and subsequent all-cause 30-day readmissions in the United States. PATIENTS AND METHODS: We accessed the National Readmission Database to identify CIED implantation-related hospitalizations between January 1, 2010, and December 31, 2014, using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. In-hospital mortality and postprocedure all-cause 30-day readmissions were also analyzed. RESULTS: During the study period, a total of 800,250 CIED implantation hospitalizations were identified across the United States, with an in-hospital mortality rate of 0.9% (7423 of 800,250) and a 29% decrease in CIED-related index hospitalizations (188,086 in 2010 vs 134,276 in 2014). The all-cause 30-day readmission rate for the entire cohort was 13% (106,505 of 800,250), decreasing from 14% (26,134 of 188,085) in 2010 to only 13% (17,154 of 134,276) by 2014. Dual-chamber pacemakers were the most frequently implanted in-hospital CIEDs (473,615 of 800,250 [59%]). The most common cause for readmission was heart failure exacerbation, which remained unchanged over the study period. CONCLUSION: Our data reveal a steady decline in overall in-hospital CIED implantations and only a modest decline in readmission rates. The cause for this decline may be an impact of medical and regulatory changes guiding CIED implantations, but it deserves further investigation.


Assuntos
Cateterismo Cardíaco/tendências , Desfibriladores Implantáveis/estatística & dados numéricos , Marca-Passo Artificial/estatística & dados numéricos , Admissão do Paciente/tendências , Readmissão do Paciente/tendências , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Humanos , Masculino , Fatores de Risco , Estados Unidos
20.
Arq Bras Cardiol ; 112(5): 491-498, 2019 05.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30810607

RESUMO

BACKGROUND: The use of Cardiovascular Implantable Electronic Devices (CIED), such as the Implantable Cardioverter Defibrillator (ICD) and Cardiac Resynchronization Therapy (CRT), is increasing. The number of leads may vary according to the device. Lead placement in the left ventricle increases surgical time and may be associated with greater morbidity after hospital discharge, an event that is often confused with the underlying disease severity. OBJECTIVE: To evaluate the rate of unscheduled emergency hospitalizations and death after implantable device surgery stratified by the type of device. METHODS: Prospective cohort study of 199 patients submitted to cardiac device implantation. The groups were stratified according to the type of device: ICD group (n = 124) and CRT group (n = 75). Probability estimates were analyzed by the Kaplan-Meier method according to the outcome. A value of p < 0.05 was considered significant in the statistical analyses. RESULTS: Most of the sample comprised male patients (71.9%), with a mean age of 61.1 ± 14.2. Left ventricular ejection fraction was similar between the groups (CRT 37.4 ± 18.1 vs. ICD 39.1 ± 17.0, p = 0.532). The rate of unscheduled visits to the emergency unit related to the device was 4.8% in the ICD group and 10.6% in the CRT group (p = 0.20). The probability of device-related survival of the variable "death" was different between the groups (p = 0.008). CONCLUSIONS: Patients after CRT implantation show a higher probability of mortality after surgery at a follow-up of less than 1 year. The rate of unscheduled hospital visits, related or not to the implant, does not differ between the groups.


Assuntos
Arritmias Cardíacas/terapia , Dispositivos de Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Desfibriladores Implantáveis/estatística & dados numéricos , Idoso , Dispositivos de Terapia de Ressincronização Cardíaca/efeitos adversos , Desfibriladores Implantáveis/efeitos adversos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , Fatores de Tempo
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