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1.
Am Heart J ; 222: 8-14, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32006910

RESUMO

BACKGROUND: The prevalence of renal disease in cardiac intensive care units (CICUs) is increasing, but little is known about the utilization, concurrent therapies, and outcomes of patients requiring acute renal replacement therapy (RRT) in this specialized environment. METHODS: In the Critical Care Cardiology Trials Network, 16 centers submitted data on CICU admissions including acute RRT (defined as continuous renal replacement therapy and/or acute intermittent dialysis). RESULTS: Among 2,985 admissions, 178 (6.0%; interhospital range 1.0%-16.0%) received acute RRT. Patients receiving RRT, versus not, were more commonly admitted for cardiogenic shock (15.7% vs 4.2%, P < .01), cardiac arrest (9.6% vs 3.7%, P < .01), and acute general medical diagnoses (10.7% vs 5.8%, P < .01), whereas acute coronary syndromes (16.9% vs 32.1%, P < .01) were less frequent. Variables independently associated with acute RRT included diabetes, heart failure, liver disease, severe valvular disease, shock, cardiac arrest, hypertension, and younger age. In patients receiving acute RRT, versus not, advanced therapies including mechanical ventilation (55.6% vs 18.0%), vasoactive support (73.0% vs 35.2%), invasive hemodynamic monitoring (59.6% vs 29.2%), and mechanical circulatory support (27.5% vs 8.4%) were more common. Acute RRT was associated with higher in-hospital mortality (42.1% vs 9.3%, adjusted odds ratio 3.74, 95% CI, 2.52-5.53) and longer median length of stay (10.0 vs 5.3 days, P < .01). In conclusion, acute RRT in contemporary CICUs was associated with the provision of other advanced therapies and lower survival. CONCLUSIONS: These data underscore the risks associated with the provision of renal support in patients with primary cardiovascular problems and the need to develop standardized indications and potential futility measures in this specialized population.


Assuntos
Lesão Renal Aguda/epidemiologia , Doenças Cardiovasculares/complicações , Unidades de Cuidados Coronarianos/estatística & dados numéricos , Cuidados Críticos/métodos , Sistema de Registros , Terapia de Substituição Renal/métodos , Lesão Renal Aguda/complicações , Lesão Renal Aguda/terapia , Idoso , Canadá/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
2.
J Interv Cardiol ; 2019: 1686350, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31772514

RESUMO

Objectives: (1) To examine the incidence and outcomes of in-hospital cardiac arrests (IHCAs) in a large unselected patient population who underwent coronary angiography at a single tertiary academic center and (2) to evaluate a transitional change in which the cardiologist is positioned as the cardiopulmonary resuscitation (CPR) leader in the cardiac catheterization laboratory (CCL) at our local tertiary care institution. Background: IHCA is a major public health concern with increased patient morbidity and mortality. A proportion of all IHCAs occurs in the CCL. Although in-hospital resuscitation teams are often led by an Intensive Care Unit- (ICU-) trained physician and house staff, little is known on the role of a cardiologist in this setting. Methods: Between 2012 and 2016, a single-center retrospective cohort study was performed examining 63 adult patients (70 ± 10 years, 60% males) who suffered from a cardiac arrest in the CCL. The ICU-led IHCAs included 19 patients, and the Coronary Care Unit- (CCU-) led IHCAs included 44 patients. Results: Acute coronary syndrome accounted for more than 50% of cardiac arrests in the CCL. Pulseless electrical activity was the most common rhythm requiring chest compression, and cardiogenic shock most frequently initiated a code blue response. No significant differences were observed between the ICU-led and CCU-led cardiac arrests in terms of hospital length of stay and 1-year survival rate. Conclusion: In the evolving field of Critical Care Cardiology, the transition from an ICU-led to a CCU-lead code blue team in the CCL setting may lead to similar short-term and long-term outcomes.


Assuntos
Cateterismo Cardíaco , Reanimação Cardiopulmonar , Unidades de Cuidados Coronarianos , Parada Cardíaca/terapia , Síndrome Coronariana Aguda/epidemiologia , Idoso , Estudos de Coortes , Angiografia Coronária , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Estudos Retrospectivos
5.
Heart Surg Forum ; 22(5): E396-E400, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31596719

RESUMO

BACKGROUND: Cardiovascular surgery is associated with substantial risk for postoperative bleeding with increased patient morbidity and mortality. Numerous intraoperative techniques have been utilized to reduce this risk. This study was to assess postoperative bleeding-related parameters following Bentall procedures and to examine the impact of intraoperative surgical sealant application. METHOD: The medical/surgical records of 100 consecutive Bentall procedure cases were examined retrospectively for perioperative surgical sealant use and postoperative bleeding-related outcomes. RESULTS: Of the 100 patient cases, three died during the postoperative period, and 97 were evaluable. Surgical sealant was utilized in 56 patient cases (57.8%). The utilization versus no utilization of surgical sealant was associated with significant reductions in most postoperative bleeding-related parameters, including less drainage (P = .028), resternotomy for hemorrhage (P = .036), transfusion of red blood cells (P = .022 at 48 hours; P = .027 total in-hospital), transfusion of fresh frozen plasma (P = .04 at 48 hours; P = .004 total in-hospital), and a higher percentage of cases not needing blood transfusion (P = .002). The surgical sealant group had longer cardiopulmonary bypass circuit (P = .016) and aortic cross-clamp time (P = .001), with no significant between-group differences in intubation time (P = .636) or intensive care unit duration (P = .294). When excluding urgent cases or Stanford type A aortic dissections, intensive care unit duration significantly was shorter in the surgical sealant group (P = .017). Surgical sealant use was not associated with any adverse events. CONCLUSION: The application of surgical sealant to the anastomosis suture line in Bentall procedures reduces postoperative drainage, bleeding, and transfusion utilization. Further studies are warranted to investigate these benefits in prospective, randomized clinical trials.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Adesivo Tecidual de Fibrina/uso terapêutico , Hemorragia Pós-Operatória/prevenção & controle , Adesivos Teciduais/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Estudos de Coortes , Unidades de Cuidados Coronarianos/estatística & dados numéricos , Drenagem/estatística & dados numéricos , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Plasma , Reoperação , Estudos Retrospectivos , Esternotomia , Resultado do Tratamento
6.
Mayo Clin Proc ; 94(10): 1994-2003, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31585582

RESUMO

OBJECTIVE: To determine whether a low Braden skin score (BSS), reflecting increased risk for skin pressure injury, would predict lower survival in cardiac intensive care unit (CICU) patients after adjustment for illness severity and comorbidities. PATIENTS AND METHODS: This retrospective cohort study included consecutive unique adult patients admitted to a single tertiary care referral hospital CICU from January 1, 2007, through December 31, 2015, who had a BSS documented on CICU admission. The primary outcome was all-cause hospital mortality, using elastic net penalized logistic regression to determine predictors of hospital mortality. The secondary outcome was all-cause post-discharge mortality, using Cox proportional hazards models to determine predictors of post-discharge mortality. RESULTS: The study included 9552 patients with a mean age of 67.4±15.2 years (3589 [37.6%] were females) and a hospital mortality rate of 8.3%. Admission BSS was inversely associated with hospital mortality (unadjusted odds ratio, 0.70; 95% CI, 0.68-0.72; P<.001; area under the receiver operator curve, 0.80; 95% CI, 0.78-0.82), with increased short-term mortality as a function of decreasing admission BSS. After adjustment for illness severity and comorbidities using multivariable analysis, admission BSS remained inversely associated with hospital mortality (adjusted odds ratio, 0.88; 95% CI, 0.85-0.92; P<.001). Among hospital survivors, admission BSS was inversely associated with post-discharge mortality after adjustment for illness severity and comorbidities (adjusted hazard ratio, 0.89; 95% CI, 0.88-0. 90; P<.001). CONCLUSION: The admission BSS, a simple inexpensive bedside nursing assessment potentially reflecting frailty and overall illness acuity, was independently associated with hospital and post-discharge mortality when added to established multiparametric illness severity scores among contemporary CICU patients.


Assuntos
Fragilidade/diagnóstico , Fragilidade/mortalidade , Avaliação Geriátrica/métodos , Mortalidade Hospitalar , Lesão por Pressão/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos de Coortes , Unidades de Cuidados Coronarianos , Feminino , Fragilidade/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Valor Preditivo dos Testes , Lesão por Pressão/complicações , Prognóstico , Estudos Retrospectivos
7.
Cardiology ; 143(3-4): 85-91, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31514195

RESUMO

OBJECTIVES: Our goal was to determine the presentation and prognosis of influenza in an intensive cardiac care unit and to analyze the impact of an active surveillance program in the diagnosis. METHODS: We performed a prospective registry during the flu season in a coronary unit. In the first phase, no systematic screening was performed. Systematic influenza A and B detection was performed in a second phase for all patients admitted. RESULTS: From 227 patients, we identified 17 (7.5%) with influenza. Influenza patients were more likely to have a non-ischemic cause of admission (14 patients [82.4%] vs. 48 patients [40.3%], p = 0.002), fever (8 patients [47.1%] vs. 3 patients [2.6%], p < 0.001), and respiratory failure (7 patients [41.2%] vs. 8 patients [7%], p = 0.001). Influenza infection was an independent predictor of mortality (odds ratio 12.0, 95% confidence interval 1.9-13.6, p < 0.001). The incidence of influenza was 6.6% (6 patients) when no active screening was performed and 7.9% (11 patients) when systematic detection was performed (p = 0.005). The time to diagnosis was shorter in the systematic screening phase (0.92 ± 1.6 vs. 5.2 ± 3.8 days, p = 0.01). CONCLUSIONS: Influenza affects approximately 8% of patients admitted to an intensive cardiac care unit during the flu season, with a high mortality rate. An active surveillance program improves early detection.


Assuntos
Unidades de Cuidados Coronarianos/estatística & dados numéricos , Influenza Humana/epidemiologia , Sistema de Registros , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Estudos Prospectivos , Espanha/epidemiologia
8.
Enferm. intensiva (Ed. impr.) ; 30(3): 108-115, jul.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182969

RESUMO

Objetivo: El síndrome de burnout entre los profesionales de cuidados intensivos ha sido ampliamente documentado internacionalmente. Pocos estudios abordan la prevalencia en América Latina, y específicamente en Argentina no existen estudios de peso que aborden esta problemática. El objetivo del presente estudio fue determinar la prevalencia de burnout entre las enfermeras de cuidados intensivos de Argentina y los factores de riesgo relacionados. Materiales y métodos: Encuesta en línea, autoadministrada, para evaluar variables demográficas y puntuación en el Índice de Burnout de Maslach en 486 enfermeras de cuidados críticos entre los meses de junio y septiembre de 2016. Resultados: El 84,4% de los participantes presentan niveles moderados/altos de síndrome de burnout (IC 95% 80,8 a 87,4). No se encontró asociación significativa entre el burnout y el género, la edad, los años de práctica, el grado académico, el rol o la multiplicidad de empleos. No hubo diferencias estadísticamente significativas en la prevalencia de burnout entre los distintos tipos de población de atención (neonatal, pediátrica o de adultos). Se encontró que la variable relación enfermera:paciente de 1:3 o más se encuentra estadísticamente relacionada con las subescalas de agotamiento emocional y despersonalización (p = 0,002 y 0,0039, respectivamente). Conclusión: Más del 80% de las enfermeras que tienen a cargo el cuidado de pacientes críticamente enfermos en Argentina muestran niveles moderados/altos de burnout y esto se relaciona con una relación enfermera:paciente ≥ 1:3


Purpose: Burnout syndrome among intensive care professionals has been widely documented internationally. Few studies address the incidence and prevalence in Latin America. And there are no validated studies about the situation in Argentina. Our goal was to determine burnout prevalence among intensive care nurses in Argentina and related risk factors. Materials and methods: Online self-administered survey evaluating demographic variables and the Maslach Burnout Inventory in 486 critical care nurses between June and September 2016. Results: A percentage of 84.4 of participants show moderate or high levels of burnout syndrome (95% CI 80.8 to 87.4). No significant association was found between burnout and gender, age, years of practice, academic degree, role or multiplicity of jobs. There was no statistical difference in burnout prevalence among different types of populations of care (neonatal, paediatric or adult care). Nurse to patient ratios of 1:3 or higher was found to be a statistically significant risk factor for emotional exhaustion and depersonalization sub-scales (P = .002 and .0039, respectively). Conclusion: More than 80% of nurses caring for critically ill patients in Argentina show moderate or high levels of burnout syndrome and this is related to a high nurse:patient ratio (1:3 or higher)


Assuntos
Humanos , Masculino , Feminino , Adulto , Esgotamento Psicológico/epidemiologia , Cuidados Críticos , Fatores de Risco , Unidades de Cuidados Coronarianos/estatística & dados numéricos , Argentina/epidemiologia , Inquéritos e Questionários , Enfermeiras e Enfermeiros/estatística & dados numéricos , 24960 , Estudos Transversais , Intervalos de Confiança , Despersonalização
9.
Scand Cardiovasc J ; 53(4): 220-224, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31169422

RESUMO

Objectives. Two tools to categorize and present quality data, phase of care mortality analysis (POCMA) and failure to rescue (FTR) have been introduced in the cardiothoracic surgical environment, but not tested in Scandinavia. We aimed to investigate whether these tools could be used in a Norwegian patient population and to increase the understanding of why patients die after cardiac surgery. Design. A group of four, including one senior cardiothoracic surgeon and one senior anesthesiologist, scrutinized deaths within 30 days after cardiac surgery at the Clinic of Cardiothoracic Surgery, St. Olav's University Hospital, Norway between February 2012-October 2015 in line with the POCMA-methodology. We used the clinic's internal register to identify patients and utilized all available written information from each patient course. We decided whether each death was surgeon dependent, FTR or a result of a multifactorial etiology, and evaluated the strength of our decisions. Results. We identified 51 deaths out of 1983 operations in our study period, giving unadjusted mortality of 2.6%. Nine deaths were classified as surgeon dependent, 3 FTR and 39 multifactorial. Conclusions. POCMA- and FTR-analyses can be carried out in clinical data which is well documented. The operating surgeon is in many cases not responsible for operative mortality, very few die due to FTR, but most patients die due to a multifactorial etiology.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Serviço Hospitalar de Cardiologia , Unidades de Cuidados Coronarianos , Falha da Terapia de Resgate , Mortalidade Hospitalar , Indicadores de Qualidade em Assistência à Saúde , Procedimentos Cirúrgicos Vasculares/mortalidade , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Causas de Morte , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
11.
Notas enferm. (Córdoba) ; 19(33): 55-63, jun.2019.
Artigo em Espanhol | LILACS | ID: biblio-1008171

RESUMO

Desde el momento en que se diagnostica una enfermedad cuyo tratamiento va a requerir un ingreso hospitalario, tanto el paciente como sus familiares se ven implicados en un proceso durante el cual pueden experimentar diversas alteraciones emocionales. El objetivo de este trabajo se centra en determinar el apoyo emocional de la enfermera frente a la demanda de los pacientes en el servicio de Unidad Coronaria. Metodología: El estudio fue descriptivo, observacional y prospectivo. La población estuvo compuesta por todo el personal de enfermería de nivel operativo, de los tres turnos en el servicio de Unidad Coronaria de una institución privada de la ciudad de Córdoba. (N: 20). Las dimensiones estudiadas fueron vincular, comunicacional, experticia técnica y ambiental. Dentro de los resultados hallados se puede observar que en la dimensiones vincular y comunicacional existe un mayor défcit, no así en la dimensión ambiental y experticia técnica. Conclusión se observa que cuidar es la esencia de la enfermería, la seguridad emocional debe ser intervenida a los efectos de lograr mejorar la comodidad y seguridad en el periodo de hospitalización de los pacientes y sus familias(AU)


From the moment a disease is diagnosed whose treatment will require a hospital admission, Both the patient and his or her family members are involved in a process during which they may experience various emotional alterations. Te objective of this work is to determine the emotional support of the nurse in relation to the demand of patients in the coronary unit service. Methodology: Te study was descriptive, observational and prospective. Te population was composed of all the nursing staff of operational level, of the three shifts in the coronary unit service of a private institution in the city of Córdoba. (N: 20). Te dimensions studied were to link, communication, technical and environmental expertise. Conclusion is noted that care is the essence of the nursing, the emotional security must be intervened in order to achieve to improve the comfort and safety in the period of hospitalization of the patients and their families(AU)


A partir do momento em que uma doença é diagnosticada, cujo tratamento exigirá uma internação hospitalar, tanto o paciente como seus familiares estão envolvidos em um processo durante o qual podem sofrer várias alterações emocionais. O objetivo deste trabalho é determinar o apoio emocional do enfermeiro em relação à demanda de pacientes no serviço de unidade coronariana. Metodologia: O estudo foi descritivo, observacional e prospectivo. A população foi composta por toda a equipe de enfermagem de nível operacional, dos três turnos no serviço de unidade coronariana do Sanatório Allende de Nueva Córdoba. (N: 20) As dimensões estudadas foram link, comunicação, perícia técnica e ambiental. Conclusão constatase que o cuidado é a essência da enfermagem, a segurança emocional deve ser intervencionada a fm de conseguir melhorar o conforto e a segurança no período de internação dos pacientes e suas famílias(AU)


Assuntos
Humanos , Assistência Centrada no Paciente , Unidades de Cuidados Coronarianos , Relações Enfermeiro-Paciente
12.
Heart Vessels ; 34(10): 1621-1630, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30969359

RESUMO

HAS-BLED score was developed for bleeding prediction in patients with atrial fibrillation (AF). Recently, it was also used in patients undergoing percutaneous coronary interventions (PCI). This study analyzes the HAS-BLED predictivity for bleedings and mortality in patients with acute coronary syndromes (ACS) without AF, and evaluates the utilization of alternative criteria for renal dysfunction. The study population was composed of 704 patients with ACS. Six-hundred and eleven patients completed the follow-up. The HAS-BLED score was calculated both using the original definition of renal dysfunction, both using three alternative eGFR thresholds (< 30, < 60 and ≤ 90 ml/min/1.73 mq). In-hospital and post-discharge bleedings and mortality were recorded, and calibration and discrimination of the various risk models were evaluated using the Hosmer-Lemeshow test and the C-statistic. In-hospital bleedings were 4.7% and mortality was 2.7%. Post-discharge bleedings were 3.1% and mortality was 4.4%. Regarding bleeding events and in-hospital mortality, the HAS-BLED original risk model demonstrated a moderate-to-good discriminative performance (C-statistics from 0.65 to 0.76). No significant differences were found in predictive accuracy when applying alternative definitions of renal dysfunction based on eGFR, with the exception of post-discharge mortality, for which HAS-BLED model assuming an eGFR value < 60 ml/min/1.73 mq showed a discriminative performance significantly higher in comparison to the other risk models (C-statistic 0.71 versus 0.64-0.66). In conclusion, in our ACS population, the HAS-BLED risk score showed a fairly good predictive accuracy regarding in-hospital and follow-up bleeding events and in-hospital mortality. The use of renal dysfunction alternative criteria based on eGFR values resulted in out-of hospital mortality predictive accuracy enhancement.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Rim/fisiopatologia , Intervenção Coronária Percutânea/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Medição de Risco/métodos , Idoso , Unidades de Cuidados Coronarianos/estatística & dados numéricos , Feminino , Taxa de Filtração Glomerular , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
13.
Cardiology ; 142(2): 67-72, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30999316

RESUMO

BACKGROUND: Previous studies have indicated that cardiovascular mortality follows a seasonal trend. The aim of this work was to determine the evolution of mortality throughout the year in a cardiology department. METHODS: All admissions and deaths occurring in our Cardiology Department over a 5-year period (2013-2017) were recorded retrospectively. RESULTS: From a total of 17,829 hospital admissions, 500 patients died (2.8%, 0.3 patients/day). The mean age of deceased patients was 74.2 ± 13.1 years, and 186 (37.2%) were women. Mortality ranged from 0.17 deaths/day in August to 0.40 deaths/day in February (p = 0.03), and from 0.20 deaths/day in summer to 0.36 deaths/day in winter (p = 0.001). There was also a trend towards a variation in hospitalizations, with a peak in January (10.5 admissions/day) and the lowest figure in August (7.0 admissions/day), p = 0.047. We found no significant seasonal trend regarding mortality rate with respect to the number of hospital admissions (p = 0.89). The most common cause of death was refractory heart failure (267 patients [65.8%]). A noncardiac cause of death was observed in 134 patients (26.8%). CONCLUSIONS: In a cardiology department, there are twice as many deaths in winter as in summer. Hospitalizations also tend to be more frequent in winter than in summer.


Assuntos
Unidades de Cuidados Coronarianos/estatística & dados numéricos , Insuficiência Cardíaca/mortalidade , Mortalidade Hospitalar/tendências , Estações do Ano , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/tendências , Estudos Retrospectivos , Espanha/epidemiologia
14.
Arch Cardiovasc Dis ; 112(5): 343-353, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30982720

RESUMO

BACKGROUND: Most data on the epidemiology of cardiogenic shock (CS) have come from patients with acute myocardial infarction admitted to intensive cardiac care units (ICCUs). However, CS can have other aetiologies, and could be managed in intensive care units (ICUs), especially the most severe forms of CS. AIM: To gather data on the characteristics, management and outcomes of patients hospitalized in ICCUs and ICUs for CS, whatever the aetiology, in France in 2016. METHODS: We included all adult patients with CS between April and October 2016 in metropolitan France. CS was defined (at admission or during hospitalization) by: low cardiac output, defined by systolic blood pressure<90mmHg and/or the need for amines to maintain systolic blood pressure>90mmHg and/or cardiac index<2.2L/min/m2; elevation of the left and/or right heart pressures, defined by clinical, radiological, biological, echocardiographic or invasive haemodynamic overload signs; and clinical and/or biological signs of malperfusion (lactate>2mmol/L, hepatic insufficiency, renal failure). RESULTS: Over a 6-month period, 772 patients were included in the survey (mean age 65.7±14.9 years; 71.5% men) from 49 participating centres (91.8% were public, and 77.8% of these were university hospitals). Ischaemic trigger was the most common cause (36.3%). CONCLUSIONS: To date, FRENSHOCK is the largest CS survey; it will provide a detailed and comprehensive global description of the spectrum and management of patients with CS in a high-income country.


Assuntos
Choque Cardiogênico , Idoso , Idoso de 80 Anos ou mais , Unidades de Cuidados Coronarianos , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Dados Preliminares , Prognóstico , Estudos Prospectivos , Sistema de Registros , Projetos de Pesquisa , Fatores de Risco , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/epidemiologia , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/terapia , Fatores de Tempo
15.
J Cardiovasc Med (Hagerstown) ; 20(5): 327-334, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30865139

RESUMO

AIMS: Objective data on epidemiology, management and outcome of patients with acute cardiac illness are still scarce, and producing evidence-based guidelines remains an issue. In order to define the clinical characteristics and the potential predictors of in-hospital and long-term mortality, we performed a retrospective, observational study, in a tertiary cardiac centre in Italy. METHODS: One thousand one hundred and sixty-five consecutive patients, admitted to our intensive cardiac care unit (ICCU) during the year 2016, were included in the study. The data were collected from the hospital discharge summary and the electronic chart records. RESULTS: Global in-hospital mortality was 7.2%. Predictors of in-hospital mortality were age [odds ratio (OR): 2.0; P = 0.011], female sex (OR: 2.18; P = 0.003), cardiac arrest (OR: 12.21; P = 0.000), heart failure/cardiogenic shock (OR: 9.99; P = 0.000), sepsis/septic shock (OR: 5.54; P = 0.000), acute kidney injury (OR: 3.25; P = 0.021) and a primary diagnosis of acute heart failure or a condition other than acute heart failure and acute coronary syndrome. During a mean follow-up period of 17.4 ± 4.8 months, 96 all-cause deaths occurred in patients who were still alive at discharge. One-year mortality rate was 8.2%. Predictors of long-term mortality were age (hazard ratio: 1.08; P = 0.000), female sex (hazard ratio: 0.59; P = 0.022), comorbidity at least 3 (hazard ratio: 1,60; P = 0.047), acute kidney injury (hazard ratio: 3.15; P = 0.001), inotropic treatment (hazard ratio: 2.54; P = 0.002) and a primary diagnosis of acute heart failure. CONCLUSION: In our Level-2 ICCU, predictors of in-hospital and long-term mortality are similar to those commonly found in a Level-3 ICU. These data strongly suggest that ICUs dealing with acute cardiovascular patients should be reorganized with a necessary upgrading of competences and resources for medical and nursing staff.


Assuntos
Unidades de Cuidados Coronarianos , Doença das Coronárias/mortalidade , Mortalidade Hospitalar , Admissão do Paciente , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Comorbidade , Doença das Coronárias/diagnóstico , Doença das Coronárias/terapia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo
16.
Recenti Prog Med ; 110(1): 33-41, 2019 Jan.
Artigo em Italiano | MEDLINE | ID: mdl-30720015

RESUMO

INTRODUCTION: Heart failure (HF) is a main issue of modern healthcare system. Patient affected are continuously growing in number and age; therefore, an integrated management between different parts of healthcare system is crucial to optimize outcome and sustainability. So far, little is known about clinical pathways of HF patients in Sicily. METHODS: On initiative of the Regional HF Group of the Italian Association of Hospital Cardiologists (ANMCO), we decided to census all the Cardiology Unit of Sicily. A simple questionnaire elaborated by the group and exploring clinical and organizational matters of HF was sent to the Units. The answer arrived on a voluntary basis. RESULTS: 41/46 Units sent back the filled questionnaire. Five typologies of units were represented, based on complexity [1. Outpatient units; 2. Units without Intensive Care Unit (ICU); 3. Units with ICU; 4. Units with ICU and Cath Lab; 5. Units with ICU, Cath lab and Cardiac Surgery). A dedicated HF unit is present only in half centers, but it is formally recognized solely in 22% of Units. These Units have scarce dedicated staff and activity is predominantly based on personal initiative. Diagnostic and therapeutic tools are used appropriately in most of them, even though congestion is judged mainly through physical exam and echocardiography. Differently from the indications of the guidelines, post discharge titration of therapy lacks in almost 30% of centers. DISCUSSION AND CONCLUSIONS: In Sicily, HF is managed on a plan mainly based on personal initiative. The quality is sufficiently good but a more appropriate and structured organization in particular of the follow-up seems a necessary and improvable requirement in view of quality measurers and economic sustainability of health care.


Assuntos
Serviço Hospitalar de Cardiologia/estatística & dados numéricos , Unidades de Cuidados Coronarianos/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Insuficiência Cardíaca/terapia , Serviço Hospitalar de Cardiologia/organização & administração , Unidades de Cuidados Coronarianos/organização & administração , Procedimentos Clínicos/estatística & dados numéricos , Assistência à Saúde/organização & administração , Pesquisas sobre Serviços de Saúde , Humanos , Sicília
17.
Cardiovasc Diabetol ; 18(1): 4, 2019 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-30634972

RESUMO

BACKGROUND: Diabetes mellitus (DM) is a prevalent metabolic disease characterized by chronic hyperglycemia. A primary burden of DM is related to its long-term complications, which have been shown to impact the course of hospitalization and to influence patients' outcome. AIM: To assess the role of in-hospital glucose control on length of stay, 30-days and 1-year mortality. METHODS: This is a retrospective study that included patients admitted to the cardiac intensive care unit (CICU) of the Edith Wolfson Medical Centre between 01 January, 2010 and 31 December 2013. Blood glucose was measured by glucometer and fed into an interactive database. Glucose status was referred to as controlled when more than 50% of a given patients glucose values were between 71 and 200 mg/dL. Chisquared tests were used to assess the distribution of categorical variables, while the ttest was applied for continuous variables. A multivariate logistic regression model was used to analyze the association between glucose control and mortality. Cox regression was conducted to assess survival and 1-year mortality. RESULTS: 2466 patients were admitted to the CICU over the study period, of which 370 had concomitant diabetes mellitus. Controlled glucose status was associated with shorter length of hospital stay (1.6 ± 1.7 versus 2.6 ± 3.0, p < 0.001), reduced 30-day mortality (0.7% versus 4.6%, p < 0.001), and improved 1-year mortality (2.2% versus 7.5%, p < 0.001). Moreover, attainment of glucose control was independently associated with a significant decrease in 1-year mortality (OR = 0.371, 95% CI 0.140-0.988, p = 0.047). CONCLUSION: In-hospital control of glucose parameters is associated with shorter length of hospital stay, and lowered 30-day and 1-year mortality. An effort to maintain glucose levels within reference ranges is warranted in critically ill patients to reduce mortality.


Assuntos
Glicemia/efeitos dos fármacos , Unidades de Cuidados Coronarianos , Diabetes Mellitus/tratamento farmacológico , Cardiopatias/terapia , Unidades de Terapia Intensiva , Idoso , Biomarcadores/sangue , Glicemia/metabolismo , Estado Terminal , Bases de Dados Factuais , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Feminino , Cardiopatias/diagnóstico , Cardiopatias/mortalidade , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
Harefuah ; 158(1): 35-40, 2019 Jan.
Artigo em Hebraico | MEDLINE | ID: mdl-30663291

RESUMO

INTRODUCTION: Shortening door-to-balloon time intervals in ST-elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI) is necessary in order to limit myocardial damage. Direct admission to the cardiac care unit (CCU) facilitates this goal. We compared characteristics and short- and long-term mortality of PPCI-treated STEMI patients admitted directly to the CCU with those admitted via the emergency department (ED). METHODS: To compare 303 patients admitted directly to the CCU (42%) with 427 admitted via the ED (58%) included in the current registry comprising 730 consecutive PPCI-treated STEMI patients. RESULTS: Groups were similar regarding demographics, medical history and risk factors. Pain-to-CCU time was 151±164 minutes (median-94) for patients admitted directly and 242±226 minutes (160) for those admitted via the ED, while door-to-balloon intervals were 69±42 minutes (61) and 133±102 minutes (111), respectively. LVEF evaluated during admission (48.3±13% [47.5%] vs. 47.7±13.7% [47.5%]) and mean CK level (893±1157 [527] vs. 891±1255 [507], p=0.45) were similar between groups. Mortality was 4.2% vs. 10.3% at 30-days (p<0.002), 7.6% and 14.3% at one-year (p<0.01), reaching 12.2% and 21.9% at 3.9±2.3 years (median-3.5, p<0.004) among directly-admitted patients vs. those admitted via the ED, respectively. Long-term mortality was 4.1%, 9.4%, 21.4%, and 16% for pain-to-balloon quartiles of <140 min, 141-207 min, 208-330 min, and >330 mins, respectively (p=0.026). CONCLUSIONS: Direct admission of STEMI patients to the CCU for PPCI facilitated the attainment of guidelines-dictated door-to-balloon time intervals and yielded improved short- and long-term mortality. Longer pain-to-balloon time was associated with higher long-term mortality.


Assuntos
Unidades de Cuidados Coronarianos , Infarto do Miocárdio , Admissão do Paciente , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Serviço Hospitalar de Emergência , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores de Tempo , Resultado do Tratamento
19.
Am J Med ; 132(2): e46, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30686342
20.
Am Heart J ; 207: 76-82, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30487072

RESUMO

BACKGROUND: Traditionally, insertable cardiac monitor (ICM) procedures have been performed in the cardiac catheterization (CATH) or electrophysiology (EP) laboratory. The introduction of the miniaturized Reveal LINQ ICM has led to simplified and less invasive procedures, affording hospitals flexibility in planning where these procedures occur without compromising patient safety or outcomes. METHODS: The present analysis of the ongoing, prospective, observational, multicenter Reveal LINQ Registry sought to provide real-world feasibility and safety data regarding the ICM procedure performed in the CATH/EP lab or operating room and to compare it with insertions performed outside of these traditional hospital settings. Patients included had at least a 30-day period after the procedure to account for any adverse events. RESULTS: We analyzed 1222 patients (58.1% male, age 61.0 ± 17.1 years) enrolled at 18 centers in the US, 17 centers in Middle East/Asia, and 15 centers in Europe. Patients were categorized into 2 cohorts according to the location of the procedure: in-lab (CATH lab, EP lab, or operating room) (n = 820, 67.1%) and out-of-lab (n = 402, 32.9%). Several differences were observed regarding baseline and procedure characteristics. However, no significant differences in the occurrence of procedure-related adverse events (AEs) were found; of 19 ICM/procedure-related AEs reported in 17 patients (1.4%), 11 occurred in the in-lab group (1.3%) and 6 in the out-of-lab group (1.5%) (P = .80). CONCLUSIONS: This real-world analysis demonstrates the feasibility of performing Reveal LINQ ICM insertion procedures outside of the traditional hospital settings without increasing the risk of infection or other adverse events.


Assuntos
Cateterismo Cardíaco/estatística & dados numéricos , Unidades de Cuidados Coronarianos/estatística & dados numéricos , Técnicas Eletrofisiológicas Cardíacas/métodos , Salas Cirúrgicas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/efeitos adversos , Criança , Pré-Escolar , Técnicas Eletrofisiológicas Cardíacas/efeitos adversos , Técnicas Eletrofisiológicas Cardíacas/estatística & dados numéricos , Europa (Continente) , Extremo Oriente , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Miniaturização , Segurança do Paciente , Estudos Prospectivos , Sistema de Registros , Estados Unidos , Adulto Jovem
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