Response to commentaries by Kildemoes and Kristiansen

§1.1. Recent data documents that not a “majority” but only 40% of Danish patients arrive at the hospital within 30 minutes of ambulance call (7;8). §1.2. The Dutch study confirmed that, even in areas with 13 minutes transport time to the hospital, comparable to the Danish scenery, a prehospital thrombolytic strategy reduced treatment delay by nearly 1 hour (5). §1.3. We appreciate that the authors confirm our viewpoint, that is, quoting that “the mortality reduction more than doubles up,” “if hospital delay is totally eliminated (corresponding to a delay reduction of 1 hour).” In the future, patients should be diagnosed before hospital admission and either treated before hospital admission with thrombolysis or transferred directly to interventional center for primary PCI. In both settings, the delay at the local hospital, averaging 1 hour, would be eliminated (1;8). §2.0. Kildemoes and Kristiansen may have misunderstood our arguments regarding the Boersma formula. We recommend that they read our previous viewpoint (9). We have no reason to believe that distribution of patient delay in Denmark differs significantly from other countries. Moreover, we are surprised that the case fatality estimates implemented by Kildemoes and Kristiansen differs significantly from findings in a recent Danish Health Technology Assessment and findings in previous meta-analyses (2;4;6). §3.1. For 7 years, the present group of authors have worked with telemedicine in the prehospital evaluation of patients. Our close collaborators, the ambulance operators and the company delivering telemedicine equipment, have confirmed our cost data, whereas they disagree with the cost data implemented by Kildemoes and Kristiansen. §3.2. Equipment for twelve-lead ECG acquisition is necessary when implementing prehospital diagnosis, irrespective of whether the diagnoses are established by telemedicine, by paramedics, or by physicians. §5. A 1-hour reduction in treatment delay is achievable by a prehospital diagnostic strategy, both in the setting of prehospital thrombolysis and in the setting of prehospital referral to interventional centers for primary PCI (6;8). This reduction in treatment delay should have a major impact on AMI fatality (also in Denmark; 3;6).

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Treatment Delay Components for STEMI Patients Undergoing Primary PCI: Four Years of Progress

Heart Lung and Circulation ◽

10.1016/j.hlc.2012.05.133 ◽

2012 ◽

Vol 21 ◽

pp. S51-S52

Author(s):

D. Murdoch ◽

M. Yudi ◽

A. Sweeny ◽

M. Trikilis ◽

R. Jayasinghe

Keyword(s):

Treatment Delay ◽

Primary Pci

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The Predictive Value of Myoglobin for COVID-19-Related Adverse Outcomes: A Systematic Review and Meta-Analysis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.757799 ◽

2021 ◽

Vol 8 ◽

Author(s):

Chaoqun Ma ◽

Dingyuan Tu ◽

Jiawei Gu ◽

Qiang Xu ◽

Pan Hou ◽

...

Keyword(s):

Troponin I ◽

Meta Analysis ◽

Severe Disease ◽

Cardiac Injury ◽

Case Fatality ◽

Adverse Outcomes ◽

Cardiac Biomarkers ◽

Severe Illness ◽

Poor Outcomes ◽

Meta Analyses

Objective: Cardiac injury is detected in numerous patients with coronavirus disease 2019 (COVID-19) and has been demonstrated to be closely related to poor outcomes. However, an optimal cardiac biomarker for predicting COVID-19 prognosis has not been identified.Methods: The PubMed, Web of Science, and Embase databases were searched for published articles between December 1, 2019 and September 8, 2021. Eligible studies that examined the anomalies of different cardiac biomarkers in patients with COVID-19 were included. The prevalence and odds ratios (ORs) were extracted. Summary estimates and the corresponding 95% confidence intervals (95% CIs) were obtained through meta-analyses.Results: A total of 63 studies, with 64,319 patients with COVID-19, were enrolled in this meta-analysis. The prevalence of elevated cardiac troponin I (cTnI) and myoglobin (Mb) in the general population with COVID-19 was 22.9 (19–27%) and 13.5% (10.6–16.4%), respectively. However, the presence of elevated Mb was more common than elevated cTnI in patients with severe COVID-19 [37.7 (23.3–52.1%) vs.30.7% (24.7–37.1%)]. Moreover, compared with cTnI, the elevation of Mb also demonstrated tendency of higher correlation with case-severity rate (Mb, r = 13.9 vs. cTnI, r = 3.93) and case-fatality rate (Mb, r = 15.42 vs. cTnI, r = 3.04). Notably, elevated Mb level was also associated with higher odds of severe illness [Mb, OR = 13.75 (10.2–18.54) vs. cTnI, OR = 7.06 (3.94–12.65)] and mortality [Mb, OR = 13.49 (9.3–19.58) vs. cTnI, OR = 7.75 (4.4–13.66)] than cTnI.Conclusions: Patients with COVID-19 and elevated Mb levels are at significantly higher risk of severe disease and mortality. Elevation of Mb may serve as a marker for predicting COVID-19-related adverse outcomes.Prospero Registration Number:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175133, CRD42020175133.

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Abstract MP29: Patient Characteristics And Outcomes Associated With In-hospital Onset Of Acute Decompensated Heart Failure

Circulation ◽

10.1161/circ.129.suppl_1.mp29 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Corey A Kalbaugh ◽

Patricia P Chang ◽

Kunihiro Matsushita ◽

Sunil K Agarwal ◽

Melissa Caughey ◽

...

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Hospital Admission ◽

Acute Decompensated Heart Failure ◽

Case Fatality ◽

Patient Characteristics ◽

Decompensated Heart Failure ◽

Hospital Length Of Stay ◽

Smoking History ◽

One Year

Introduction: There has been little focus on hospitalized acute decompensated heart failure (ADHF) that develops after admission, which may occur because of comorbid conditions, over-administration of fluid or post-surgical complications. Aims: To compare patient characteristics, case fatality, and hospital length of stay (LOS) associated with ADHF that develops after hospital admission as compared to those with ADHF at admission. Methods: Hospitalizations with possible ADHF were sampled, based on HF ICD codes, among those aged > 55 years from the four communities of the Atherosclerosis Risk in Communities Study (2005-2010). Medical records were abstracted with events classified by physician panel or computer classified. Case fatality was obtained through the National Death Index. We identified 4,503 (unweighted) events with definite/probable ADHF, after excluding those with unknown time of decompensation (n=81), hospital transfers (n=102), and race other than black or white (n=118). Demographic and clinical characteristics were compared by ADHF onset (at/after admission). Logistic regression was used to evaluate the association of ADHF onset with in-hospital mortality, and 28-days and one-year mortality, adjusted for demographics and comorbidity. Linear regression was used to evaluate the association of ADHF onset with log-transformed hospital LOS, adjusted for demographics. All analyses were weighted to account for the stratified sampling design. Results: Of 21,052 (weighted) ADHF events, 7.4% (n=1561) developed ADHF after admission. Patients with ADHF occurring after admission were older (mean: 79 vs. 75 years), and more likely white and female. Those with ADHF at admission were more likely to have a positive smoking history, COPD, and to be on dialysis. Presence of diabetes, hypertension and coronary artery disease were not significantly different between groups. In hospital mortality (16.5% vs. 6.3%; OR= 2.7, 95% CI=1.9-3.8) and 28-day mortality (23.9% vs. 10.1%; OR= 2.4, 95% CI=1.7-3.4) was higher among those who developed ADHF after admission. One-year case fatality was similar (39.4% vs. 33.6%; OR= 1.2, 95% CI=0.9-1.6). Unadjusted mean LOS was longer for those with ADHF occurring after admission (12.8 days, 95% CI=11.8-13.8) than those with ADHF at admission (7.2 days, 95% CI=6.8-7.6). The adjusted and geometric mean LOS was 1.3 days (95% CI=1.2-1.4) longer for those who developed ADHF after admission. Conclusion: Although patients with ADHF onset after admission were slightly older, differences in comorbidity do not indicate an easily identifiable subgroup for closer in-hospital monitoring. Development of ADHF after admission was associated with an alarmingly high early case fatality and longer hospital LOS compared to those with ADHF at hospital admission.

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Epidemiological Trend of Sepsis in Patients with Hospital Admissions Related to Hepatitis C in Spain (2000–2015): A Nationwide Study

Journal of Clinical Medicine ◽

10.3390/jcm9061607 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1607

Author(s):

Alejandro Alvaro-Meca ◽

Irene Maté-Cano ◽

Pablo Ryan ◽

Verónica Briz ◽

Salvador Resino

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Hospital Admission ◽

Chronic Hepatitis C ◽

Hospital Admissions ◽

Case Fatality ◽

Length Of Hospital Stay ◽

Data Set ◽

Epidemiological Trend ◽

Epidemiological Trends

Background: Hepatitis C virus (HCV) infection predisposes patients to other infectious diseases, such as sepsis. We aimed to analyze epidemiological trends of sepsis-related admissions, deaths, and costs in hospital admissions with chronic hepatitis C who had a hospital admission in Spain. Methods: We performed a retrospective study of all hospitalizations involving chronic hepatitis C in the Spanish Minimum Basic Data Set (MBDS) between 2000 and 2015. This period was divided into four calendar periods (2000–2004, 2005–2007, 2008–2011, and 2012–2015). Results: We selected 868,523 hospital admissions of patients with chronic hepatitis C over 16 years in the Spanish MBDS. Among them, we found 70,976 (8.17%) hospital admissions of patients who developed sepsis, of which 13,915 (19.61%) died during admission. We found an upward trend, from 2000–2003 to 2012–2015, in the rate of sepsis-related admission (from 6.18% to 10.64%; p < 0.001), the risk of sepsis-related admission (from 1.31 to 1.55; p < 0.001), and the sepsis-related cost per hospital admission (from 7198€ to above 9497€; p < 0.001). However, we found a downward trend during the same study period in the sepsis case-fatality rate (from 21.99% to 18.16%; p < 0.001), the risk of sepsis-related death (from 0.81 to 0.56; p < 0.001), and the length of hospital stay (LOHS) (from 16.9 to 13.9; p < 0.001). Moreover, the rate of bacterial Gram-positive and candidiasis infections decreased, while Gram-negative microorganisms increased from 2000–2003 to 2012–2015. Conclusions: Sepsis, in chronic hepatitis C patients admitted to the hospital, has increased the period 2000–2015 and has been an increasing burden for the Spanish public health system. However, there has also been a significant reduction in lethality and LOHS during the study period. In addition, the most prevalent specific microorganisms have also changed in this period.

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Treatment delay and reperfusion management of acute ST-segment elevation myocardial infarction: analysis of the China STEMI Care Project Phase 1

QJM ◽

10.1093/qjmed/hcaa186 ◽

2020 ◽

Author(s):

Y Zhang ◽

Y Tian ◽

P Dong ◽

Y Xu ◽

B Yu ◽

...

Keyword(s):

Myocardial Infarction ◽

Symptom Onset ◽

Phase 1 ◽

Coronary Intervention ◽

Treatment Delay ◽

Primary Pci ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Care Project

Summary Background The China ST-segment elevation myocardial infarction (STEMI) Care Project (CSCAP) was launched in 2011 to address the problems of insufficient reperfusion and long treatment delay in STEMI care in China. Aim To describe the baseline status of STEMI emergency care in Tertiary PCI Hospitals using Phase 1 (CSCAP-1) data. Design CSCAP-1 is a prospective multi-center STEMI registry. Methods and results A total of 4191 patients with symptom onset within 12 or 12–36 h requiring primary percutaneous coronary intervention (PCI), were enrolled from 53 tertiary PCI hospitals in 14 provinces, municipalities, and autonomous regions of China in CSCAP-1. Among them, 49.0% were self-transported to the hospital, 26.5% were transferred to the hospital by calling the emergency medical services directly, and 24.5% were transferred from other hospitals. In patients with symptom onset within 12 h, 83.2% received primary PCI, 5.9% received thrombolysis and 10.9% received conservative medications. The median door-to-balloon time was 115 (85–170) min and the median door-to-needle time for in-hospital thrombolysis was 80 (50–135) min. The overall in-hospital all-cause mortality was 2.4%, while it was 5.3% in the non-reperfusion group and 2.1% in the reperfusion group (P < 0.001). Conclusion Although a long treatment delay and a high proportion of patients transporting themselves to the hospital were observed, trends were positive with greater adoption of primary PCI and lower in-hospital mortality in tertiary hospitals in China. Our results provided important information for further integrated STEMI network construction in China.

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Stroke in Isfahan, Iran: Hospital Admission and 28-Day Case Fatality Rate

Cerebrovascular Diseases ◽

10.1159/000110418 ◽

2007 ◽

Vol 24 (6) ◽

pp. 495-499 ◽

Cited By ~ 18

Author(s):

Shahram Oveisgharan ◽

Nizal Sarrafzadegan ◽

Shahin Shirani ◽

Shidokht Hosseini ◽

Parisa Hasanzadeh ◽

...

Keyword(s):

Hospital Admission ◽

Case Fatality Rate ◽

Case Fatality ◽

Fatality Rate ◽

Day Case

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Relationship between treatment delay and final infarct size in STEMI patients treated with abciximab and primary PCI

BMC Cardiovascular Disorders ◽

10.1186/1471-2261-12-9 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Tim Tödt ◽

Eva Maret ◽

Joakim Alfredsson ◽

Magnus Janzon ◽

Jan Engvall ◽

...

Keyword(s):

Infarct Size ◽

Treatment Delay ◽

Primary Pci ◽

Final Infarct Size

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Safety of Metformin in Hospitalized Patients with COVID-19

10.36502/2020/droa.6171 ◽

2020 ◽

Vol 2 (3) ◽

pp. 68-71

Author(s):

Mikhail N ◽

Wali S

Keyword(s):

Lactic Acidosis ◽

Hospital Admission ◽

Retrospective Studies ◽

English Literature ◽

Hospitalized Patients ◽

Increased Risk ◽

Increase Risk ◽

Patients With Diabetes ◽

Pubmed Search ◽

Meta Analyses

Background: It is unclear whether metformin should be continued or discontinued in patients with coronavirus disease 2019 (COVID-19) admitted to the hospital. Objective: To review metformin safety, particularly its impact on mortality among hospitalized patients with COVID-19. Methods: Review of English literature by PUBMED search until September 11, 2020. Search terms included diabetes, COVID-19, metformin, Retrospective studies, meta-analyses, pertinent reviews, pre-print articles, and consensus guidelines are reviewed. Results: Retrospective studies suggest that metformin use prior to hospital admission may be associated with decreased mortality in patients with diabetes admitted to the hospital with COVID-19. Continuing metformin use after hospital admission did not have a significant impact on 28-day all-cause mortality. Metformin use after hospitalization of patients with COVID-19 was associated with approximately 4.6 times increase risk of lactic acidosis in patients with severe symptoms of COVID-19, patients taking 2 gm/d of metformin or higher, and patients with estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 kg/m2. Metformin use in the hospital was associated with a significant decrease in the risk of heart failure and acute respiratory distress syndrome (ARDS). Conclusions: In patients with diabetes and COVID-19 admitted to the hospital, metformin should not be used in presence of severe symptoms of COVID-19, kidney dysfunction (eGFR < 60 ml/min/1.73 m2), and with daily doses of 2 gm or more due to increased risk of lactic acidosis.

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