scholarly journals Sepsis in Intensive Care Unit Patients: Worldwide Data From the Intensive Care over Nations Audit

2018 ◽  
Vol 5 (12) ◽  
Author(s):  
Yasser Sakr ◽  
Ulrich Jaschinski ◽  
Xavier Wittebole ◽  
Tamas Szakmany ◽  
Jeffrey Lipman ◽  
...  
Keyword(s):  
New York ◽  
Intensive Care ◽  
Heart Association ◽  
Mortality Rates ◽  
Outcome Data ◽  
Hospital Death ◽  
Icu Patients ◽  
Major Health Problem ◽  
Wide Variability ◽  
New York Heart Association

Abstract Background There is a need to better define the epidemiology of sepsis in intensive care units (ICUs) around the globe. Methods The Intensive Care over Nations (ICON) audit prospectively collected data on all adult (>16 years) patients admitted to the ICU between May 8 and May 18, 2012, except those admitted for less than 24 hours for routine postoperative surveillance. Data were collected daily for a maximum of 28 days in the ICU, and patients were followed up for outcome data until death, hospital discharge, or for 60 days. Participation was entirely voluntary. Results The audit included 10069 patients from Europe (54.1%), Asia (19.2%), America (17.1%), and other continents (9.6%). Sepsis, defined as infection with associated organ failure, was identified during the ICU stay in 2973 (29.5%) patients, including in 1808 (18.0%) already at ICU admission. Occurrence rates of sepsis varied from 13.6% to 39.3% in the different regions. Overall ICU and hospital mortality rates were 25.8% and 35.3%, respectively, in patients with sepsis, but it varied from 11.9% and 19.3% (Oceania) to 39.5% and 47.2% (Africa), respectively. After adjustment for possible confounders in a multilevel analysis, independent risk factors for in-hospital death included older age, higher simplified acute physiology II score, comorbid cancer, chronic heart failure (New York Heart Association Classification III/IV), cirrhosis, use of mechanical ventilation or renal replacement therapy, and infection with Acinetobacter spp. Conclusions Sepsis remains a major health problem in ICU patients worldwide and is associated with high mortality rates. However, there is wide variability in the sepsis rate and outcomes in ICU patients around the globe.

scholarly journals Preoperative cardiac function parameters as valuable predictors for nurses to recognise delirium after cardiac surgery: A prospective cohort study

2019 ◽  
Vol 19 (4) ◽  
pp. 310-319 ◽  
Author(s):  
Shining Cai ◽  
Jos M Latour ◽  
Ying Lin ◽  
Wenyan Pan ◽  
Jili Zheng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiac Function ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Classification ◽  
New York Heart Association

Background: Delirium is a common postoperative complication after cardiac surgery. The relationship between delirium and cardiac function has not been fully elucidated. Aims: The aim of this study was to identify the association between preoperative cardiac function and delirium among patients after cardiac surgery. Methods: We prospectively recruited 635 cardiac surgery patients with a planned cardiac intensive care unit admission. Postoperative delirium was diagnosed using the confusion assessment method for the intensive care unit. Preoperative cardiac function was assessed using N-terminal prohormone of brain natriuretic peptide (NT-proBNP), New York Heart Association functional classification and left ventricular ejection fraction. Results: Delirium developed in 73 patients (11.5%) during intensive care unit stay. NT-proBNP level (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01–1.52) and New York Heart Association functional classification (OR 2.34, 95% CI 1.27–4.31) were both independently associated with the occurrence of delirium after adjusting for various confounders. The OR of delirium increased with increasing NT-proBNP levels after the turning point of 7.8 (log-transformed pg/ml). The adjusted regression coefficients were 1.19 (95% CI 0.95–1.49, P=0.134) for NT-proBNP less than 7.8 (log-transformed pg/ml) and 2.78 (95% CI 1.09–7.12, P=0.033) for NT-proBNP greater than 7.8 (log-transformed pg/ml). No association was found between left ventricular ejection fraction and postoperative delirium. Conclusion: Preoperative cardiac function parameters including NT-proBNP and New York Heart Association functional classification can predict the incidence of delirium following cardiac surgery. We suggest incorporating an early determination of preoperative cardiac function as a readily available risk assessment for delirium prior to cardiac surgery.

Clinical impact of antithrombotic therapy in transvenous lead extraction complications: a sub-analysis from the ESC-EORP EHRA ELECTRa (European Lead Extraction ConTRolled) Registry

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1096-1105
Author(s):  
Andrea Di Cori ◽  
Angelo Auricchio ◽  
François Regoli ◽  
Carina Blomström-Lundqvist ◽  
Christian Butter ◽  
...  
Keyword(s):  
New York ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Heart Association ◽  
Clinical Impact ◽  
Lead Extraction ◽  
Hospital Death ◽  
Class Iii ◽  
Association Class ◽  
New York Heart Association

Aims A sub-analysis of the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) Registry to evaluate the clinical impact of antithrombotic (AT) on transvenous lead extraction (TLE) safety and efficacy. Methods and results ELECTRa outcomes were compared between patients without AT therapy (No AT Group) and with different pre-operative AT regimens, including antiplatelets (AP), anticoagulants (AC), or both (AP + AC). Out of 3510 pts, 2398 (68%) were under AT pre-operatively. AT patients were older with more comorbidities (P < 0.0001). AT subgroups, defined as AP, AC, or AP + AC, were 1096 (31.2%), 985 (28%), and 317 (9%), respectively. Regarding AP patients, 1413 (40%) were under AP, 1292 (91%) with a single AP, interrupted in 26% about 3.8 ± 3.7 days before TLE. In total, 1302 (37%) patients were under AC, 881 vitamin K antagonist (68%), 221 (17%) direct oral anticoagulants, 155 (12%) low weight molecular heparin, and 45 (3.5%) unfractionated heparin. AC was ‘interrupted without bridging’ in 696 (54%) and ‘interrupted with bridging’ in 504 (39%) about 3.3 ± 2.3 days before TLE, and ‘continued’ in 87 (7%). TLE success rate was high in all subgroups. Only overall in-hospital death (1.4%), but not the procedure-related one, was higher in the AT subgroups (P = 0.0500). Age >65 years and New York Heart Association Class III/IV, but not AT regimens, were independent predictors of death for any cause. Haematomas were more frequent in AT subgroups, especially in AC ‘continued’ (P = 0.025), whereas pulmonary embolism in the No-AT (P < 0.01). Conclusions AT minimization is safe in patients undergoing TLE. AT does not seem to predict death but identifies a subset of fragile patients with a worse in-hospital TLE outcome.

Illness Perception and Its Changes During Six Months After Cardiac Rehabilitation

2019 ◽  
Vol 26 (3) ◽  
pp. 90-100
Author(s):  
Justė Lukoševičiūtė ◽  
Kastytis Šmigelskas
Keyword(s):  
New York ◽  
Social Factors ◽  
Nyha Class ◽  
Illness Perception ◽  
Heart Association ◽  
Class Iii ◽  
Cognitive Representations ◽  
Coronary Syndrome ◽  
Type D ◽  
New York Heart Association

Abstract. Illness perception is a concept that reflects patients' emotional and cognitive representations of disease. This study assessed the illness perception change during 6 months in 195 patients (33% women and 67% men) with acute coronary syndrome, taking into account the biological, psychological, and social factors. At baseline, more threatening illness perception was observed in women, persons aged 65 years or more, with poorer functional capacity (New York Heart Association [NYHA] class III or IV) and comorbidities ( p < .05). Type D personality was the only independent factor related to more threatening illness perception (βs = 0.207, p = .006). At follow-up it was found that only self-reported cardiovascular impairment plays the role in illness perception change (βs = 0.544, p < .001): patients without impairment reported decreasing threats of illness, while the ones with it had a similar perception of threat like at baseline. Other biological, psychological, and social factors were partly associated with illness perception after an acute cardiac event but not with perception change after 6 months.

scholarly journals Prognostic nomogram for the severity of acute organophosphate insecticide self-poisoning: a retrospective observational cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042765
Author(s):  
Ning Dong ◽  
Shaokun Wang ◽  
Xingliang Li ◽  
Wei Li ◽  
Nan Gao ◽  
...  
Keyword(s):  
New York ◽  
Characteristic Curve ◽  
Oral Intake ◽  
Heart Association ◽  
Northern China ◽  
Primary Outcome Measure ◽  
Plasma Cholinesterase ◽  
Hospital Death ◽  
Calibration Plot ◽  
Organophosphate Insecticide

ObjectiveTo develop a convenient nomogram for the bedside evaluation of patients with acute organophosphorus poisoning (AOPP).DesignThis was a retrospective study.SettingTwo independent hospitals in northern China, the First Hospital of Jilin University and the Lequn Hospital of the First Hospital of Jilin University.ParticipantsA total of 1657 consecutive patients admitted for the deliberate oral intake of AOPP within 24 hours from exposure and aged >18 years were enrolled between 1 January 2013 and 31 December 2018. The exclusion criteria were: normal range of plasma cholinesterase, exposure to any other type of poisonous drug(s), severe chronic comorbidities including symptomatic heart failure (New York Heart Association III or IV) or any other kidney, liver and pulmonary diseases. Eight hundred and thirty-four patients were included.Primary outcome measureThe existence of severely poisoned cases, defined as patients with any of the following complications: cardiac arrest, respiratory failure requiring ventilator support, hypotension or in-hospital death.Results440 patients from one hospital were included in the study to develop a nomogram of severe AOPP, whereas 394 patients from the other hospital were used for the validation. Associated risk factors were identified by multivariate logistic regression. The nomogram was validated by the area under the receiver operating characteristic curve (AUC). A nomogram was developed with age, white cells, albumin, cholinesterase, blood pH and lactic acid levels. The AUC was 0.875 (95% CI 0.837 to 0.913) and 0.855 (95% CI 0.81 to 0.9) in the derivation and validation cohorts, respectively. The calibration plot for the probability of severe AOPP showed an optimal agreement between the prediction by nomogram and actual observation in both derivation and validation cohorts.ConclusionA convenient severity evaluation nomogram for patients with AOPP was developed, which could be used by physicians in making clinical decisions and predicting patients’ prognosis.

scholarly journals Lockdown, slow down: impact of the COVID-19 pandemic on physical activity—an observational study

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001600
Author(s):  
Joanne Kathryn Taylor ◽  
Haarith Ndiaye ◽  
Matthew Daniels ◽  
Fozia Ahmed
Keyword(s):  
Physical Activity ◽  
New York ◽  
Heart Association ◽  
Evaluation Study ◽  
Activity Data ◽  
Cardiac Devices ◽  
Significant Difference ◽  
New York Heart Association ◽  
Using Data ◽  
The Uk

AimsIn response to the COVID-19 pandemic, the UK was placed under strict lockdown measures on 23 March 2020. The aim of this study was to quantify the effects on physical activity (PA) levels using data from the prospective Triage-HF Plus Evaluation study.MethodsThis study represents a cohort of adult patients with implanted cardiac devices capable of measuring activity by embedded accelerometery via a remote monitoring platform. Activity data were available for the 4 weeks pre-implementation and post implementation of ‘stay at home’ lockdown measures in the form of ‘minutes active per day’ (min/day).ResultsData were analysed for 311 patients (77.2% men, mean age 68.8, frailty 55.9%. 92.2% established heart failure (HF) diagnosis, of these 51.2% New York Heart Association II), with comorbidities representative of a real-world cohort.Post-lockdown, a significant reduction in median PA equating to 20.8 active min/day was seen. The reduction was uniform with a slightly more pronounced drop in PA for women, but no statistically significant difference with respect to age, body mass index, frailty or device type. Activity dropped in the immediate 2-week period post-lockdown, but steadily returned thereafter. Median activity week 4 weeks post-lockdown remained significantly lower than 4 weeks pre-lockdown (p≤0.001).ConclusionsIn a population of predominantly HF patients with cardiac devices, activity reduced by approximately 20 min active per day in the immediate aftermath of strict COVID-19 lockdown measures.Trial registration numberNCT04177199.

scholarly journals Peripoperative Mortalität nach ICD-Implantation

Herz ◽  
2021 ◽  
Author(s):  
Harilaos Bogossian ◽  
Dimitrios Panteloglou ◽  
Zana Karosiene ◽  
Susanne Macher-Heidrich ◽  
Heinz Jürgen Adomeit ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
New York ◽  
Heart Association ◽  
Icd Implantation ◽  
Eine Analyse ◽  
New York Heart Association ◽  
Dialysepflichtige Niereninsuffizienz ◽  
Perioperative Letalität

Zusammenfassung Hintergrund Implantierbare Kardioverter-Defibrillatoren (ICD) sind zum Schutz vor plötzlichem Herztod bei Patienten mit primär- oder sekundärprophylaktischer Indikation etabliert. Wie bei allen komplexen operativen Verfahren verbleibt auch bei der ICD-Implantation ein Risiko für Komplikationen bis hin zum Tod. Gegenstand der vorliegenden Arbeit ist es, anhand der Datensätze zur obligaten Qualitätssicherung in Nordrhein-Westfalen die prozedurbezogene Mortalität nach ICD-Implantation zu analysieren. Methoden Aus den Datensätzen erfolgte eine Analyse der stationären Todesfälle bei allen 18.625 ICD-Implantationen der Jahre 2010 bis 2012. Ergebnisse Während des stationären Aufenthalts verstarben 118 Patienten (0,6 %) nach ICD-Implantation. Patienten im Alter über 80 Jahre (7 %) zeigten eine höhere Mortalität (1,9 % vs. 0,5 % bei < 80-jährigen Patienten, p > 0,001), ebenso Frauen (0,95 % vs. 0,54 % bei Männern; p = 0,004) und Patienten mit hoher NYHA(New York Heart Association)-Klasse (0,3 % bei NYHA II, 0,7 % bei NYHA III, 3,4 % bei NYHA IV; p < 0,001 für alle Vergleiche). Das Vorliegen von Diabetes mellitus (23 % des Kollektivs) beeinflusste die perioperative Letalität nicht, während eine dialysepflichtige Niereninsuffizienz eine signifikant erhöhte Mortalität aufwies (p < 0,001 gegenüber Patienten mit Kreatinin ≤ 1,5 mg/dl; p = 0,002 gegenüber nicht dialysepflichtigen Patienten mit Kreatinin > 1,5 mg/dl). Patienten mit sekundärprophylaktischer ICD-Indikation wiesen eine signifikant höhere Mortalität auf (1,2 % vs. 0,4 %; p < 0,001), die sich beim Auftreten von Komplikationen von 0,6 % auf 3,7 % erhöhte (p < 0,001). Schlussfolgerung Die operationsbezogene Mortalität bei ICD-Implantation ist bei Patienten über 80 Jahre, hoher NYHA-Klasse, Dialysepflicht, sekundärprophylaktischer Indikation und nach Auftreten von Komplikationen erhöht.

scholarly journals Response shift after coronary revascularization

2021 ◽  
Author(s):  
Tom H. Oreel ◽  
Pythia T. Nieuwkerk ◽  
Iris D. Hartog ◽  
Justine E. Netjes ◽  
Alexander B. A. Vonk ◽  
...  
Keyword(s):  
New York ◽  
Structural Equation ◽  
Life Story ◽  
Coronary Revascularization ◽  
Heart Association ◽  
Response Shift ◽  
Patient Characteristics ◽  
Equation Modeling ◽  
Sf 36 ◽  
New York Heart Association

Abstract Purpose The aims of this study were to investigate (1) the extent to which response shift occurs among patients with coronary artery disease (CAD) after coronary revascularization, (2) whether the assessment of changes in health-related quality of life (HRQoL), controlled for response shift, yield more valid estimates of changes in HRQoL, as indicated by stronger associations with criterion measures of change, than without controlling for response shift, and (3) if occurrences of response shift are related to patient characteristics. Methods Patients with CAD completed the SF-36 and the Seattle Angina Questionnaire (SAQ7) at baseline and 3 months after coronary revascularization. Sociodemographic, clinical and psychosocial variables were measured with the patient version of the New York Heart Association-class, Subjective Significance Questionnaire, Reconstruction of Life Events Questionnaire (RE-LIFE), and HEXACO personality inventory. Oort’s Structural Equation Modeling (SEM) approach was used to investigate response shift. Results 191 patient completed questionnaires at baseline and at 3 months after treatment. The SF-36 showed recalibration and reprioritization response shift and the SAQ7 reconceptualization response shift. Controlling for these response shift effects did not result in more valid estimates of change. One significant association was found between reprioritization response shift and complete integration of having CAD into their life story, as indicated by the RE-LIFE. Conclusion Results indicate response shift in HRQoL following coronary revascularization. While we did not find an impact of response shift on the estimates of change, the SEM approach provides a more comprehensive insight into the different types of change in HRQoL following coronary revascularization.

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