bluuebunny/crossref_metadata_2025 huggingface dataset:
Donor-derived Ehrlichiosis: 2 Clusters Following Solid Organ Transplantation
Authors: Saha Aditi , Browning Charles , Dandamudi Raja , Barton Kevin , Graepel Kevin , Cullity Madeline , Abusalah Wala , Christine Du , Rossi Carla , Drexler Naomi , Basavaraju Sridhar V , Annambhotia Pallavi , Guillamet Rodrigo Vazquez , Eid Albert J , Maliakkal Joseph , Miller Aaron , Hugge Christopher , Dharnidharka Vikas R , Kandula Praveen , Moritz Michael J
Published: July 2021

Ehrlichiosis has been infrequently described as transmissible through organ transplantation. Two donor-derived clusters of ehrlichiosis are described here. During the summer of 2020, 2 cases of ehrlichiosis were reported to the Organ Procurement and Transplantation Network (OPTN) and the Centers for Disease Control and Prevention (CDC) for investigation. Additional transplant centers were contacted to investigate similar illness in other recipients and samples were sent to the CDC. Two kidney recipients from a common donor developed fatal ehrlichiosis-induced hemophagocytic lymphocytic histiocytosis. Two kidney recipients and a liver recipient from another common donor developed ehrlichiosis. All 3 were successfully treated. Clinicians should consider donor-derived ehrlichiosis when evaluating recipients with fever early after transplantation after more common causes are ruled out, especially if the donor has epidemiological risk factors for infection. Suspected cases should be reported to the organ procurement organization and the OPTN for further investigation by public health authorities.
Nabe: an energetic database of amino acid mutations in protein–nucleic acid binding interfaces
Authors: Liu Junyi , Liu Siyu , Liu Chenzhe , Zhang Yaping , Pan Yuliang , Wang Zixiang , Wang Jiacheng , Wen Ting , Deng Lei
Published: July 2021

Protein–nucleic acid complexes play essential roles in regulating transcription, translation, DNA replication, repair and recombination, RNA processing and translocation. Site-directed mutagenesis has been extremely useful in understanding the principles of protein–DNA and protein–RNA interactions, and experimentally determined mutagenesis data are prerequisites for designing effective algorithms for predicting the binding affinity change upon mutation. However, a vital challenge in this area is the lack of sufficient public experimentally recognized mutation data, which leads to difficulties in developing computational prediction methods. In this article, we present Nabe, an integrated database of amino acid mutations and their effects on the binding free energy in protein–DNA and protein–RNA interactions for which binding affinities have been experimentally determined. Compared with existing databases and data sets, Nabe is the largest protein–nucleic acid mutation database, containing 2506 mutations in 473 protein–DNA and protein–RNA complexes, and of that 1751 are alanine mutations in 405 protein–nucleic acid complexes. For researchers to conveniently utilize the data, Nabe assembles protein–DNA and protein–RNA benchmark databases by adopting the data-processing procedures in the majority of models. To further facilitate users to query data, Nabe provides a searchable and graphical web page.

Database URL: http://nabe.denglab.org
Multicentre prospective observational study for pulmonary vein stump thrombus after anatomical lung resections
Authors: Hattori Aritoshi , Takamochi Kazuya , Shiono Satoshi , Tsuboi Masahiro , Maniwa Yoshimasa , Suzuki Kazuhiro , Suzuki Kenji
Published: July 2021

OBJECTIVES

Our goal was to evaluate the incidence and frequent sites of pulmonary vein stump thrombus (PVST) formation after pulmonary resection.

METHODS

This is a prospective multicentre observational study conducted by 14 institutions in Japan. Enrolled patients underwent anatomical pulmonary resection including lobectomy, bilobectomy, pneumonectomy, left upper trisegmentectomy or lingular segmentectomy. Postoperative contrast-enhanced computed tomography was performed in the early period after the pulmonary resection to evaluate the incidence of PVST. Furthermore, univariable and multivariable analyses were performed to assess the risk factors associated with PVST using a logistic regression model.

RESULTS

The status of PVST based on postoperative contrast-enhanced computed tomography scans was prospectively evaluated for 1040 patients. Postoperative computed tomography evaluation was performed for 3 (range: 1–84) days on average after the pulmonary resection. PVST was found in 127 (12.2%) patients with left-sided (23.3%) predominance compared to the right side (4.9%) (P < 0.001). Furthermore, left upper lobectomy was the most frequent operative procedure (30.8%). Multivariable analyses demonstrated that left upper lobectomy (P = 0.001) and left-sided pulmonary resection (P < 0.001) were independent significant predictors of PVST. Cerebral infarction was observed in 9 (0.87%) patients during this period and included 6 (1.46%) in whom it developed after the operation was performed on the left side. Especially in the early postoperative phase, left pulmonary resection was significantly associated with the incidence of cerebral infarction (0.16% vs 1.21%; P = 0.028).

CONCLUSIONS

PVST is an early postoperative event that is frequently observed in patients undergoing left anatomical pulmonary resection, especially a left upper lobectomy.

IRB number

16-205, Clinical trial registry: UMIN000027118.
Knowledge about atrial fibrillation and direct oral anticoagulation agents in Greek patients
Authors: Ioannidis A , Fragkiskou A , Paraskelidou M , Pechlevanis A
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) poses significant burden to patients, physicians, and healthcare systems globally. Patient knowledge about AF and its management is often limited though it is a perquisite for patient involvement and shared decision making. Direct oral anticoagulants (DOACs) are recommended for stroke prevention.

Purpose

The aim of this study was to assess the knowledge about AF and anticoagulation of AF patients.

Methods

Patients with AF on DOACs visiting the outpatient clinics of a city hospital in northern Greece were invited to participate. The Jessa AF Knowledge Questionnaire (JAKQ) was used (as part of the validation study of the Greek translation).

Results

In total, 285 patients participated (female 57.9%) with mean age 65 ± 13 years. The mean JAKQ score was 57.2 ± 17.4% corresponding to medium level of knowledge. Higher scores were positively associated with more schooling years and longer AF duration. The percentage of correct answer varied among the questions. One third of the participants answered wrongly (59 patients, 20.7%) or didn’t know (38 patients, 13.3%) what atrial fibrillation means. More than half of the patients didn’t know that AF is not always accompanied by symptoms and that medication cannot prevent AF permanently (154, 54.0% and 169, 59.3% respectively). The majority of patients knew that strokes are a consequence of AF and that blood thinners are prescribed in order to prevent clot formation (222, 77.9% and 226, 79.3% correspondingly). Moreover, most patients didn’t know correctly which painkiller they should prefer (177, 62.1%) and what to do when missing a dose (172, 60.4%). As expected patients who has experienced a bleeding event (minor or major that lead to medical care) scored higher (62.3% vs. 56.2%, p < 0.05). All patients replied that they would like to be offered more information (leaflets, online site, mobile applications, etc.).

Conclusions

A brief and validated questionnaire could be used to assess patients" knowledge of their condition and treatment, which would reveal important gaps. Further research is needed to evaluate if such an instrument could be used as a tool for individually tailored patient education.
Assessing the impact of education in atrial fibrillation: A systematic review
Authors: Cano Valls A , Hendriks JM , Sanders P , Mont LL , Gallagher C
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial Fibrillation (AF) is the most common heart rhythm disorder. Patient education is recommended as part of comprehensive AF management. Despite this the impact of education alone on outcomes in AF populations is unknown.

Purpose

The aim of this study was to describe the impact of education on clinically relevant outcomes in patient with AF including mortality, hospital admissions, emergency department presentations, stroke and quality of life. 

Methods

The authors searched Pubmed, Embase, CINAHL, Cochrane database and Psycinfo from inception until September 2019. Studies were included if they were prospective and of randomized controlled or observational design with a minimum follow-up 3 months and published in English.

Results

A total of 1667 studies were screened with 37 undergoing full text review and 6 meeting eligibility criteria. There was a total of 588 participants with a mean age of 65.63 ± 11.05 and 60.71% were male. A meta-analysis was unable to be performed due to heterogeneity in reporting of outcomes. Two studies examined the impact of education on mortality with no impact evident from either intervention. The impact of education on hospitalisations (all cause – 3 studies, cardiovascular – 1 study and AF - 2 studies) was explored in five studies with no impact on this outcome from any intervention. Similarly, there was no impact of education on emergency department presentations, except for one study in which a video was used in addition to standardised education. There was no impact on stroke from two studies exploring this outcome. There was no evidence of impact of education on general or AF specific quality of life.

Conclusions

There is little evidence to suggest that educational interventions to date have significantly impacted on death, hospitalisations, emergency department presentations or quality of life in AF populations. There is an urgent need to identify optimal modes and components of educational interventions to improve patient outcomes and reduce health care burden in AF.
Use of multiplate electrode aggregometry for personalisonalisation of antiplatelet therapy in left ventricular assisst device patients
Authors: Wypych-Zych A , Edwards G , Synowiec E , Stevens K , Mcdonagh S , Kiff K , Stoch U
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The use of Left Ventricular Assist Devices (LVAD) has noticeably improved the survival for patients with advanced heart failure.  However, this treatment is associated with significant adverse effects. Personalisation of antiplatelet therapy is a key in control and reduction of bleeding/thromboembolic complications of this treatment. However, ISHLT and the manufacturer still recommend unified treatment of 150 mg of acetylsalicylic acid for all LVAD patients. In our centre, we base the treatment decision on clinical picture and patient’s responsiveness to antiplatelet therapy. 

The treatment of choice is acetylsalicylic acid in doses 37.5 mg (1 patient), 75 mg (25 patients) and 150 mg (33 patients). For patients unresponsive or intolerant to acetylsalicylic acid we use 75 mg of clopidogrel, currently 9 patients.  1 patient receives both, 75 mg clopidogrel and 75 mg acetylsalicylic acid. 

Purpose

To gain a better understanding of the platelets function and patients" responses to antiplatelet therapy. In aim to reduce the prevalence of bleeding/thromboembolic related adverse events in LVAD patients, and therefore improve patients outcome.

Methods

In 2020, we decided to introduce a structured/test-based approach to antiplatelet therapy in this patients group. With the use of Multiplate Electrode Aggregometry (MEA) we have attempted to diagnose platelet disorders and monitor effectiveness of antiplatelet therapy. Based on MEA platlets inhibition test we were able to tailor the therapy. 

The retrospective audit was conducted with inclusion criteria;

1. Thromboembolic events include pump thrombosis and any other ischemic complications. Bleeding events contains gastrointestinal (GI) and central nervous system (CNS) events.

2. Any thromboembolic and bleeding events after starting antiplatelet therapy, in the first year after LVAD implantation

Results

The tables below presents reduction in both thromboembolic and bleeding complications.

Conclusion

Presented data can be interpreted that, the test-based approach to antiplatelet therapy may be beneficial in limiting the adverse effects of LVAD therapy. However, it needs to be acknowledged that the observation was carried out on a small group of the patients, over a short period of time. Therefore, an extended period of observation is recommended to obtain further data.
Predictors of delay in door-to-balloon time in STEMI patients, treated in centers capable in primary PCI
Authors: Berga Congost G , Martinez Momblan MA , Valverde Bernal J , Marquez Lopez A , Ruiz Gabalda J , Garcia Picart J , Puig Campmany M , Brugaletta S
Published: July 2021

Funding Acknowledgements

The Government of Catalonia (Spain) provided funding for this research grant: PERIS 2019-2021

Introduction

European Society of Cardiology (ESC) clinical guidelines recommend a diagnosis-to-balloon time < 60 minutes in acute myocardial infarction with ST elevation (STEMI) when the patient directly arrives to emergency room (ER) of a center with primary angioplasty (PCI) capacity. Hospitals that implement a greater number of improvement strategies tend to have a shorter door-to-balloon time (D2B).

AIM

to describe the attendance times and to evaluate the causes of delay in attendance in STEMI patients.

Methods

This is an observational retrospective study, including all consecutive ≥18 years STEMI patients attended in the ER of a terciary Hospital capable in primary PCI from January 2013 to December 2016. Patients who were not activated as STEMI code from the hospital ER and without coronariography were excluded. Sociodemographic and clinical variables were collected for all the patients. ER management is based on the Plan-Do-Study-Act methodology, for this reason other organizational variables have been considered such as brief educational interventions aimed at emergency nurses. All the patients were stratified into two groups, according to their door-to-balloon time (< 70 minutes or equal/more).

Results

Overall 327 patients were included. Mortality was 11,6% and 88 minutes between arrival at the ER to balloon time. The delayed treatment group was older (p = 0.005), with more female (p = 0.060), usually admitted in not working hours (p = 0.001), with more atypical ECG STEMI signs or symptoms (p = 0.058) and (p = 0.087). They had also a  longer hospital stay (p = 0.041). Predictors of shorter D2B time were: typical STEMI ECG signs and brief education sessions to nurses for identification of a STEMI.

Conclusion

There are delays in the treatment of STEMI, especially in specific groups of patients with atypical clinical presentations. Brief educational session aimed at emergency nurses correlate with less delay. This shows that continuing education to emergency nurses along with other organizational improvement strategies can contribute to increasing the quality of care in the STEMI.
Quality of life after transcatheter aortic valve implantation: Perspectives from a Canadian data base
Authors: Lauck S , Yu M , Ding L , Webb J
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

We examined changes in quality of life (QOL) of patients after transcatheter aortic valve implantation (TAVI). 

Methods

We conducted an observational cohort study of consecutive patients who had TAVI between 2016-2019 in British Columbia, Canada. QOL was measured at baseline, 30-day and 1-year using the Kansas City Cardiomyopathy Questionnaire (KCCQ-OS). We used linear regression modelling to examine factors associated with 30-day changes in QOL, logistic regression modelling to identify predictors of having a poor outcome, and Cox regression modelling to ascertain risk estimates of the effect of QOL on 1-year mortality. 

Results

The cohort included 1,706 patients [742 women (43.5%)]; median [interquartile range, IQR] age 83 (77,86). Median (IQR) baseline KCCQ-OS was 45 (28.2,67), indicating severe impairment. Patients alive at 1-year (91.3%) reported a mean improvement of 24.1 (95% CI, 22.7-25.6) points in the KCCQ-OS at 30-day, which was sustained at 1-year (25.3; 95% CI, 23.8,26.8). Older age, lower baseline health status, lower aortic valve gradient, lower hemoglobin, atrial fibrillation and non-transfemoral access were associated with worse 30-day QOL. At 1-year, 65% of patients had a favourable outcome; additional risk factors for 1-year mortality (8.7%) were male sex, NYHA Class IV, severe pulmonary and renal disease, diabetes, and in-patient status.  

Conclusions

TAVI is associated with significant early improvement in QOL which is sustained at 1 year in a "real world" registry.  The inclusion of QOL can support treatment decision and the patient-centred evaluation of TAVI
Short-term health-related quality of life in patients with ischaemic stroke after PFO closure
Authors: Christopoulou G , Sigala E , Aragiannis D , Stamatopoulou E , Manthou P , Gkiata P , Vlachopoulos C , Trantalis G , Drakopoulou M , Toutouzas K , Tsioufis K
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction/Purpose: Patent foramen ovale (PFO) is common in asymptomatic adults and is associated with cryptogenic stroke (CS). We sought to evaluate the impact of PFO closure in health-related quality of life (HRQoL) in PFO patients with CS. 

Method

In this pilot study, 19 patients (mean age 47 ± 7.7; 13 male) who underwent PFO closure at our center were invited to a short-term clinical follow up (mean follow-up period 6-10 months). All patients had suffered an ischaemic stroke and their disability level was assessed using the Modified Rankin Scale (MRS, no significant disability 63%). HRQoL was assessed using the 36-Item Short Form Survey (SF-36) and the European Quality of Life-5 Dimensions Questionnaire (EQ-5D) preoperatively and at follow-up. 

Results

Both SF36 and EQ-5D scores improved after the operation as shown by the self-rating scores (20,67% and 40,52% higher scores, respectively). Patients with major mobility problems were more likely to be current smokers (r = 0.481) and those who had lower scores on the MRS scale (r=-0.571) rated higher their scale diagram.  The categories of energy/fatigue (r = 0.459; p = 0.048), social functioning (r = 0.547; p = 0.015) and pain (r = 0.550; p = 0.015) were positively correlated with physical function. Finally, there was a positive correlation between role limitations due to emotional problems and energy/fatigue (r = 0,519; p = 0.023), and between energy/fatigue and emotional well-being (r = 0.519; p = 0,023).

Conclusions

The results of our study indicate that shortly after PFO, subjects perceive improvements in their QoL. However, it seems that poorly rated physical function was more common in active smokers, and affects patients" social life and their emotional state. Health care professionals should encourage these patients to participate in rehabilitation and psychological support programs postoperatively.
Continuity of care in heart failure patients
Authors: Olsen K , Falun NF , Keilegavlen HK
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 Heart failure (HF) requires follow-up over time and by several different health services. The positive effects of follow-up care in secondary care services is well known. However, there is a lack of knowledge in how HF patients experience continuity of care a through various health care services in secondary and primary care.

Purpose

To explore how HF patients experience continuity of care through secondary and primary health care services.

Methods

The study used an inductive design by performing four semi-structured focus group interviews. Overall, 17 patients, mean age of 71 years (range 42-95), 11 men and 6 women, All patients were receiving regular and individual follow-up by cardiac nurses in primary care after hospital discharge The interviews were analysed through qualitative content analysis.

Results

Gaps in continuity of care were described as challenging. Information about HF at the time of discharge from hospital were not always fully comprehended. Patients experienced physical strain of being lost and abandoned after discharge from hospital. They did not know whom to contact for follow-up.  Appointments with the GP was not agreed or scheduled weeks ahead. Patients appreciated home visit by a cardiac nurse in primary care who provided the patients with knowledge in self-care administration. When experiencing deterioration they could call the cardiac nurse, who could facilitate fast track to the hospital. Self-care was difficult to comprehend, especially for those experiencing comorbidities. Patients also  described the importance of sharing knowledge and experience of living with HF with other patients in a secondary care setting, organized by specialised cardiac nurses.

Conclusions

There are gaps in continuity in patients’ pathways, throughout both secondary and primary healthcare. Even though patients receive information at discharge from hospital, they felt insecure when returning home. Health care services in the primary care provided the patients with both knowledge and confidence as they regularly met the patients, both at home and in organized primary care meetings.
Keeping the plates spinning: a qualitative study of the multifaceted role of caregiving in HFpEF
Authors: Pearson CR , Khair E , Forsyth F , Sowden E , Deaton C
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health Research School for Primary Care Research

OnBehalf

Optimise HFpEF

Background

Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of all heart failure cases yet remains poorly understood, diagnosed and managed, which can add complexity to the caregiver role. No study to date has explicitly investigated the experiences of informal caregivers of people with HFpEF.

Objective

The aim of this study was to explore and understand the role and experiences of informal caregivers of people with HFpEF.

Methods and design

A qualitative study using semi-structured interviews involving caregivers alone, patients alone or caregiver/patient dyads. The interviews were performed as part of a larger programme of research in HFpEF. Participants were recruited from three regions of England. Interviews were transcribed verbatim and analysed thematically.

Results

22 interviews were conducted with a total of 38 participants, 17 of which were informal caregivers. Three inter-related themes were identified: (1) ‘spinning plates’ - the multifaceted nature of informal caregiving: household manager, health manager and motivator; (2) ‘the spinning falters’- the barriers to caregiving: lack of HFpEF awareness, information and support, the burden of multimorbidity, caregiver stress and the caregiver’s health status; (3) ‘keeping the plates spinning’- the facilitators of caregiving: being informed, being appreciated, having a champion (a health care professional that is key to managing the patient’s HFpEF), and engaging a wider support network.

Conclusions

Informal caregivers play an important role in supporting people with HFpEF. The experience of caregiving to people with HFpEF is similar to HFrEF, but complicated by challenges of poor HFpEF information and support, and the burden of multimorbidity. Healthcare providers should assess the needs of informal caregivers as part of patient care in HFpEF. Caregivers and patients would both benefit from improved information and management of HFpEF and associated multi-morbidities. Helping caregivers ‘keep the plates spinning’ will require innovative approaches and coordination across the care continuum.
Developing a behavioural intervention to increase lay-people"s intentions to initiate CPR in the event of Out-of-Hospital Cardiac Arrest (OHCA)
Authors: Farquharson B , Dixon D , Williams B , Clegg G , Macinnes L , Ramsay P , Torrens C
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Medical Research Council

OnBehalf

BICeP Study Group

Background

Prompt, effective bystander cardiopulmonary resuscitation (CPR) is the single most important factor determining survival from out of hospital cardiac arrest (OHCA), increasing survival up to 4-fold. However only 35%-45% of people trained in CPR actually attempt it when required. This study uses psychological theory and behaviour change techniques (BCTs) to increase the proportion of bystanders who attempt CPR in a real emergency.

Design

Intervention development study

Methods

Intervention content was informed by two recent systematic reviews, which identified barriers to bystander CPR and BCTs within existing training programmes (PROSPERO CRD42018117438; CRD42019126745) and a qualitative study exploring participants’ views (n = 12) of draft text messages. A lay bystander user-involvement panel (n = 7) and an expert advisory group (comprising representatives from CPR training organisations) worked with the research team to co-produce the final intervention and agree the schedule for text message delivery.  BCT content was assessed by two independent experts. A framework analysis of interviews was undertaken. 

Results

Recognising and addressing fears, and helping people to better prepare for real-life situations were identified to be important to participants. Short, simple texts from a credible source and with a positive tone were strongly preferred, there was a strong aversion to anything "guilt-inducing". Pictures and personalisation were important, rewards less so. Regarding frequency: participants varied but around 1/week was considered adequate by most. A total of n = 35 text-messages with verified BCT content were co-developed with participants.

Conclusions

A text message intervention incorporating BCTs, which is acceptable to intended users and CPR trained individuals has been produced and will be subject to future evaluation.
Throwing cardiac rehabilitation into the 21st Century: a focus group study exploring the impact of COVID-19 on cardiac rehabilitation delivery in Victoria, Australia
Authors: Cartledge S , Rawstorn J , Tran M , Ryan P , Howden E , Jackson A
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac rehabilitation (CR) education and exercise are predominantly delivered in group face-to-face settings. This delivery model was challenged during the COVID-19 pandemic due to government enforced lockdowns which restricted the delivery of these models of care. The Australian state of Victoria experienced the longest and most severe local restrictions and was in lockdown for approximately 26 weeks of 2020. 

Purpose

We aimed to explore the experience, barriers and enablers of delivering CR during a pandemic, and identify strategies for future COVID-safe programs among cardiac rehabilitation clinicians.

Methods

Victorian members of the Australian Cardiovascular Health and Rehabilitation Association (ACRA) were invited to attend an exploratory qualitative online focus group in November 2020. An inductive thematic analysis was undertaken before deductively applying the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework to identify barriers and enablers for technology adoption in CR.

Results

30 members participated in a 106 minute focus group. 17 members who provided demographics represented multiple disciplines (nursing n = 13, exercise physiology n = 3, physiotherapy n = 1) and geographical settings (metropolitan n = 10, regional n = 4, rural n = 3). Four main themes were identified: Consequences of sudden service delivery change; Technology use – challenges and benefits; Capacity (program and staff); and The way forward. The deductive NASSS analysis demonstrated the main challenges of continuing remotely delivered CR lie with all adopters (staff, patients, carers) and with organisations. Future CR strategies included the importance of resuming face-to-face programs but important barriers including finding capacity, particularly staffing, to run concurrent telehealth programs remain to be addressed. 

Conclusion

The COVID-19 pandemic forced and expedited significant changes to CR delivery models. While clinicians agreed that delivery of CR via telehealth will continue, it is now timely to review remote models of care and plan how they will integrate alongside traditional face-to-face programs.
Cardiac rehabilitation for patients with heart failure: a national Danish register-based study of predictors of referral and outcomes
Authors: Thygesen LC , Zinckernagel L , Dalal H , Egstrup K , Glumer C , Gronbaek M , Holmberg T , Kober L , La Cour K , Nakano A , Nielsen CV , Sibilitz KL , Tolstrup JS , Zwisler AD , Taylor RS
Published: July 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation

Background

 Heart failure (HF) places a large burden on patients and society as a major cause of morbidity, mortality and healthcare costs. Participation in exercise-based cardiac rehabilitation (CR) in people with HF is a clinically and cost-effective strategy and recommended in international clinical guidelines.

Purpose

The aims of this study were to: (1) examine the temporal trends and predictors of national CR referral, and (2) compare the risk of hospital readmission and mortality in those referred for CR compared to no referral.

Methods

All patients in Denmark with incident HF were identified by the Danish Heart Failure Register in the period 2010 to 2018 (n = 33,257) and CR referral assessed within 120 days of hospital admission. Multivariable logistic regression models were used to evaluate the association between CR referral and predictors and to compare risk of hospital readmission and mortality until 1 year between referred and not referred patients.

Results

Overall, 45.0% of HF patients were referred to exercise-based CR, increasing from 31.7% in 2010 to 52.2% in 2018. Factors independently associated with higher CR referral were: NYHA functional class II, LVEF <50%, diagnosis of myocardial infarction and use of ACE inhibitor. Male gender, older age, region, unemployment, retirement, living alone, non-Danish ethnic origin, lower educational level, NYHA class IV, treatment for hypertension, existing chronic obstructive lung disease and stroke were associated with lower CR referral. CR referral was associated with lower risk of readmission (adjusted odds ratio: 0.90;95%CI: 0.85-0.95), HF-specific mortality (0.61; 0.39-0.95) and all-cause mortality (0.61; 0.55-0.69) as compared to no referral.

Conclusions

Although CR referral has increased over time, only some 1 in 2 diagnosed HF patients in Denmark are referred to exercise-based CR. CR referral is associated with lower risk in readmissions and mortality. Strategies to promote CR referral including healthcare professional education on the benefits of CR and alternative methods of CR delivery are urgently needed to improve access to CR, especially for high-risk groups.
Remote delivery of cardiac rehabilitation can achieve equivalent health-related quality of life outcomes to in-person methods in patients with coronary heart disease: a multi-site study
Authors: Gallagher R , Kirkness A , Farrell M , Roach K , Gooley L , Ashcroft S , Fletcher A , Stephenson C , Glinatsis H , Bruntsch C , Roberts J , Ladak L , Randall S , Candelaria D
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background In-person exercise-based cardiac rehabilitation (CR) has well-established benefits for health-related quality of life (HRQL) for patients with coronary heart disease (CHD). During COVID-19 pandemic restrictions, remote delivery replaced in-person CR, but the impact on HRQL is unclear. This study addresses this gap.

Methods Consecutive patients commencing CR at four sites in one Local Health District in Sydney were recruited (n = 194), recruited from December 2019 to October 2020. Remote delivery from March 2020 created a natural comparison group to in-person CR. HRQL was measured at CR entry and completion using the SF-12v2 and linear regression was used for analyses.

Results Participants were aged mean 65.94 (SD 10.45) years, were 80.9% male and diagnoses included elective PCI (37.9%), CABG (26.7%), and MI (34.9%) either with PCI (23.6%) or alone (11.3%). Participants received remote (n = 103, 53.1%) or in-person (n = 91, 46.9%; ≥ assessment + 2 sessions) CR, with more completions for in-person (75.8% vs 63.1%, p=.03). Remote participants were more likely to be white than ethnic minority (35.2% vs 13.6% p<.001), however, there were no differences in baseline HRQL for delivery group after adjustment.

HRQL improved from CR entry to completion regardless of delivery mode (adjusted). Most improvements occurred in physical function (SMD 6.37, 95% CI 4.81,7.92), role physical (SMD 5.72, 95% CI 4.29. 7.16) and physical component (SMD 5.77 95% CI 4.43, 7.12) scores. Least improvement occurred in mental component scores (SMD 1.65, 95%CI .53, 2.78).

Conclusion Remotely delivered CR provides comparable HRQL outcomes to in-person delivery, thus providing a promising alternative. Data are needed on cost-effectiveness, as well as staff and patient preferences.
Effectiveness of a physiotherapy and nutrition program in patients with coronary artery disease: randomized controlled trial
Authors: Munoz Gomez E , Sempere-Rubio N , Blesa J , Iglesias P , Mico L , Sanchez-Torrijos J , Girbes V , Soriano JM , Espi-Lopez GV , Mesa-Rico R , Timonet-Andreu E , Canca-Sanchez JC , Senra S , Fernandez-Oliver AL , Marques-Sule E
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction. Dietary and exercise interventions are effective strategies for improving physical and nutritional status of patients with coronary artery disease (CAD). However, few studies have applied a combined exercise protocol based on high intensity interval training (HIIT) and dietary education in patients with CAD with percutaneous coronary intervention (PCI).

Purpose

This study researches the effectiveness of a multidisciplinary program based in HIIT with dietary education (DEHIIT) in comparison with only HIIT, on adherence to Mediterranean diet in CAD patients with PCI.

Methods. A prospective, assessor-blinded, parallel group, randomized trial was developed. The study was developed at a University research lab. Forty-four adults diagnosed with CAD (between 40 and 72 years), were randomized to receive either combined dietary intervention and HIIT (DEHIIT, n = 22) or only HIIT (HIIT, n = 22). The adherence to the Mediterranean diet was assessed with a 14-item tool of adherence to the Mediterranean diet (MEDAS-14) at baseline and after the intervention. DEHIIT performed a 3-month dietary intervention program combined with 24 HIIT sessions at 85-95% of peak heart rate, whilst HIIT performed a 3-month HIIT sessions at 85-95% of peak heart rate. This study did not receive any funding. No conflict of interest is declared.

Results. After three months, regarding to MEDAS-14, DEHIIT increased the fish/seafood consumption significantly (p = 0.001) and decreased the fruit consumption (p = 0.032) and dry fruits (p = 0.006). And, when comparing between groups, DEHIIT obtained significantly more MEDAS-14 score (p = 0.01) and more adherence to dieta mediterránea (p = 0.001). No adverse events were reported.

Conclusions. A combined protocol including dietary intervention and HIIT can bring benefits for CAD patients with PCI on adherence to Mediterranean diet in comparison to only HIIT. Consequently, our combined program could be used as a treatment option in the therapeutic approach for these patients.
Haematology department nurses training makes a positive shift in reduction of in-hospital cardiac mortality
Authors: Viligorska K
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Due to general profile of emergency hospital it is lacking of regular specific training courses for nurses. Haematology department is the one that has a great number of complications after immunosuppressive and chemo-therapy that is why skills in acute cardiovascular care are crucial for haematology healthcare professionals. Training of basic skills of management of acute cardiac events for nurses that work with haematological patients should be considered as routine practice in order to improve patients’ care.

Purpose

Science is not a study, but an observation of what is around us, therefore we made a registry of acute cardiovascular events over the hospital departments and defined a need for acute cardiovascular training for nurses in haematology department.

Methods

Data analysis of 1 year observational study of acute cardiac events at emergency hospital was done. Nurses of haematology department were specifically instructed to provide first aid and contact internal medicine doctor on duty in case of signs of cardiovascular events in patients with acute lymphoblastic leukemia that were under 21-st day of chemotherapy due to high risk of thromboembolic complications. Among 573 cases, 110 cases were cardiovascular events diagnosed and managed at haematology department by emergency care multidisciplinary team of internal medicine doctor on duty and haematology nurses. For statistical analysis Microsoft Excel v.2019 was used.

Results

At haematology department of emergency hospital we detected 110 cases of cardiovascular events. Among them 50 cases of ST-elevation myocardial infarction (STEMI) treated in the first 10 minutes of the episode with successful outcome, 45 cases of ischemic stroke, only 5 of which were lethal due to severity of neurologic disorders, 15 cases of pulmonary embolism with successful outcome.

Conclusion

Training on acute cardiovascular care for haematology department nurses was beneficial and contributed to lower hospital mortality.
Association of age and dietary sodium intake in patients with heart failure: testing mediating effects of preference for salt and enjoyment of sodium-restricted diet
Authors: Chung ML , Moser DK , Miller JL , Lennie TA
Published: July 2021

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): National Institutes of Health (NIH)

Background

The poor taste foods in a low sodium diet and patients’ preferences for salty foods are known barriers to sodium restricted diet (SRD) adherence. Older adults may experience less enjoyment of SRD due to decreased sense of taste. However, little is known about how age is associated with sodium intake, preference for salt, and enjoyment of SRD in patients with heart failure (HF).

Purpose

The purpose of this study was to examine effect of age on dietary sodium intake through their preference for salt and enjoyment of SRD in patients with HF.

Methods

 In this cross-sectional study, we used baseline data from participants in a randomized controlled trial of a SRD intervention for patients with HF and their caregivers. Patients were asked to collect 24-hour urine to measure dietary sodium intake. Preference for salty food and enjoyment of SRD were assessed using a question on an 11-point numeric scale (range 0 to 10). Parallel mediation analyses were conducted using the PROCESS macro program in SPSS with 5,000 bootstrap samples.

Results

A total of 136 patients with HF (64% male, mean age = 60.3 ± 14.4, range 27 to 90, 80.1% white) had a mean 24-hr urine sodium of 4320mg (SD = 2053, range: 1553 mg – 11495 mg) with most (71%) having a 24-hr urine sodium > 3000mg. The mean preference for salty food was 5.3 (SD = 2.8) on a scale from 0 to 10 with 10 indicating greater preference and enjoyment of SRD was 4.4 (SD = 2.5) on the same scale. Age was significantly associated with sodium intake in that older patients were more likely to eat less sodium (effect= -40.3236, 95% CI= [-63.7151, -16.9321]). The indirect effects of age on sodium intake through preference of salty food (effect= .7033, 95% CI = [-2.3361, 4.5357]) and enjoyment of SRD (effect = -.0271, 95% CI = [ -3.2736, 2.2213]) were not significant, indicating that these factors did not mediate the relationship between age and dietary sodium consumption. When we controlled gender, education, and ethnicity, age was also associated with sodium intake, but the two indirect effects were not significant.

Conclusion

Although most patients consumed foods high in sodium, older patients were more likely to consume foods lower in salt. However, contrary to what we expected, preference for salty foods and enjoyment of SRD did not play mediator roles in the association of age with salt consumption. The findings suggest that older adults may need different types of intervention to promote adherence than younger patients. Further research is needed to explore other factors related to SRD (e.g., efficacy of SRD or perceived control of diet behaviors) that affect sodium intake in patients with HF.
Extrasystolic arrhythmia as a risk factor of atherosclerosis
Authors: Germanova O , Germanov VA , Galati G , Germanov AV , Shchukin YV
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Aim

To determine the relationship between hemodynamic changes in extrasystolic arrhythmia and atherosclerosis of main arteries.

Materials and methods

We included 286 patients (175 men and 111 women). The investigation was made to reveal the signs of atherosclerosis. All patients were performed 24-hours ECG monitoring, blood lipid spectrum, TTE, TOE, ultrasound doppler of brachiocephalic arteries, abdominal aorta branches, lower extremities arteries, renal arteries. If prescribed - stress Echo, coronary angiography, renal arteries angiography, pancerebral angiography. All patients were made apexcardiography (ACG) and arterial vessels sphygmography (SG) of aa. carotis, ulnaris, radialis, femoralis, tibialis posterior. The main parameters included speed, acceleration, power, work in each phase of cardiocycle.

In accordance with amount of extrasystoles per 24 hours all the patients were divided into 2 groups: 1 – less than 3000 (144 patients), 2 – 3000 and more (142). They were grouped due to the age (see table 1 on the picture). Groups were common in age, sex, comorbidities.

Results

In group 2 the development and severity of atherosclerosis was more in group 2 (see table 2 on the picture). We determined the hemodynamic main parameters increase in first post-extrasystolic contraction with the following tendency: if earlier extrasystole appeared in cardiocycle, than more changes were observed.

Conclusion

Extrasystoles are additional risk factors of  atherosclerosis. Hemodynamic changes after the first post-extrasystolic contraction is the important mechanical trauma factor for the arterial vessels which can take part in atherosclerotic process. Weak places – carotid bifurcation, abdominal aorta bifurcation, large radius of aorta arch. We suppose that it’s necessary to treat the extrasystoles more than 3000 per 24 hours that appear early in cardiocycle (before the mitral valve opening and before the transmitral blood flow peak).
COVID-19 patients followed in Portuguese Primary Care: a retrospective cohort study based on the national case series
Authors: Tenreiro Patrícia , Ramalho André , Santos Paulo
Published: July 2021

Background

The pandemic state caused by SARS CoV-2 came to overburden all levels of healthcare, including Primary Care. In Portugal, most patients were followed in ambulatory, monitored by phone calls or face-to-face visits by their General Practitioner.

Objective

The aim was to characterize the pathway of COVID-19 outpatients in Primary Care and establish the risk factors that mostly influences the need for hospitalization or death during the follow-up.

Methods

A retrospective cohort study was established, based on the official Portuguese dataset of the first wave between March 2nd and June 30th 2020. The predictive effects of variables, including age, gender, residency and clinical features, were analysed using Cox regression analysis.

Results

A total of 38,545 patients infected with SARS-CoV-2 was included for analysis (56.3% female), with a median age of 47 years old. There were 4,327 hospitalized patients, 253 in intensive care units and 1,153 deaths. Females present lower risk of hospitalization (HR = 0.78; 95% CI: 0.73–0.82; P < 0.001) and age is associated with higher risk (HR = 7.08; 95% CI: 6.68–7.50; P < 0.001), as well as the presence of at least one comorbidity (HR = 7.03; 95% CI: 6.43–7.69; P < 0.001). Multivariate analysis showed that cardiovascular disease, diabetes, smoking, obesity, chronic kidney disease, cancer, chronic obstructive pulmonary disease, HIV and other immunodeficiencies, transplant or immunosuppression, haematological disorders, neurological disorders and liver disease increased the risk of hospitalization.

Conclusion

Male gender, age and the presence of comorbidities are the main determinants for hospitalization and death. These COVID-19 patients should receive a higher attention when they come to primary care for assistance.
AKAP79 Orchestrates a Cyclic AMP Signalosome Adjacent to Orai1 Ca2+ Channels
Authors: Kar Pulak , Barak Pradeep , Zerio Anna , Lin Yu-Ping , Parekh Amy J , Watts Val J , Cooper Dermot M F , Zaccolo Manuela , Kramer Holger , Parekh Anant B
Published: July 2021

To ensure specificity of response, eukaryotic cells often restrict signalling molecules to sub-cellular regions. The Ca2+ nanodomain is a spatially confined signal that arises near open Ca2+ channels. Ca2+ nanodomains near store-operated Orai1 channels stimulate the protein phosphatase calcineurin, which activates the transcription factor NFAT1, and both enzyme and target are initially attached to the plasma membrane through the scaffolding protein AKAP79. Here, we show that a cAMP signalling nexus also forms adjacent to Orai1. Protein kinase A and phosphodiesterase 4, an enzyme that rapidly breaks down cAMP, both associate with AKAP79 and realign close to Orai1 after stimulation. PCR and mass spectrometry failed to show expression of Ca2+-activated adenylyl cyclase 8 in HEK293 cells, whereas the enzyme was observed in neuronal cell lines. FRET and biochemical measurements of bulk cAMP and protein kinase A activity consistently failed to show an increase in adenylyl cyclase activity following even a large rise in cytosolic Ca2+. Furthermore, expression of AKAP79-CUTie, a cAMP FRET sensor tethered to AKAP79, did not report a rise in cAMP after stimulation, despite AKAP79 association with Orai1. Hence, HEK293 cells do not express functional active Ca2+-activated adenylyl cyclases including adenylyl cyclase 8. Our results show that two ancient second messengers are independently generated in nanodomains close to Orai1 Ca2+ channels.