Clinical cardiology
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Clinical cardiology · Apr 2019
Experience of extracorporeal cardiopulmonary resuscitation in a refractory cardiac arrest patient at the emergency department.
Extracorporeal cardiopulmonary resuscitation (ECPR) is a method to improve survival outcomes in refractory cardiac arrest. ⋯ The early transition from ACLS to ECPR may improve the ECPR outcomes. In addition, good outcomes are expected for ECPR performed after refractory arrest if the patient is young and experiences an ROSC event during ACLS. In post ECPR management, the majority of mortality events were occurred in the early period, and distal perfusion catheter and CRRT were frequently required.
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Clinical cardiology · Mar 2019
Multicenter StudyAnticoagulation in patients with atrial fibrillation and heart failure: Insights from the NCDR PINNACLE-AF registry.
In non-valvular atrial fibrillation (NVAF) patients, congestive heart failure (CHF) confers an increased risk of stroke or systemic thromboembolism. This risk is present in both heart failure (HF) with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). It is unclear if clinicians account for both types of CHF in their NVAF anticoagulation practices. Accordingly, we characterized current outpatient anticoagulation trends in NVAF patients with HFpEF compared to patients with HFrEF. ⋯ Patients with NVAF and HFpEF have significantly lower anticoagulation rates when compared to their HFrEF counterparts. These findings suggest a potential underappreciation of HFpEF as a risk factor in patients with NVAF.
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Clinical cardiology · Jan 2019
Multicenter StudyImpact of atrial fibrillation on patients hospitalized for acute myocarditis: Insights from a nationally-representative United States cohort.
Atrial fibrillation (AF) is associated with increased all-cause mortality in the general population. However, the impact of AF on the in-hospital outcomes of acute myocarditis (AM) patients is not well characterized. ⋯ AF was associated with increased risk of in-hospital mortality and complications in patients admitted to the hospital with acute myocarditis.
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Clinical cardiology · Jan 2019
Meta AnalysisImpact of tricuspid regurgitation and right ventricular dysfunction on outcomes after transcatheter aortic valve replacement: A systematic review and meta-analysis.
Far less attention has been paid to the prognostic effect of right-side heart disease on outcomes after transcatheter aortic valve replacement (TAVR) when compared with the left side. Therefore, we performed a systematic review and meta-analysis on the impact of tricuspid regurgitation (TR) and right ventricular (RV) dysfunction on outcomes after TAVR. We hypothesized that TR and RV dysfunction may have a deleterious effect on outcomes after TAVR. ⋯ The overall analysis revealed that moderate or severe TR at baseline increased all-cause mortality after TAVR (HR = 1.79, CI 95% 1.52-2.11, P < 0.001). Both baseline RV dysfunction (HR = 1.53, CI 95% 1.27-1.83, P < 0.001) and presence of RV dilation (HR = 1.83, CI 95% 1.47-2.27, P < 0.001) were associated with all-cause mortality. Both baseline moderate or severe TR and RV dysfunction worsen prognosis after TAVR and careful assessment of right heart function should be done for clinical decision by the heart team before the TAVR procedure.
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Clinical cardiology · Jan 2019
Multicenter StudyUtilization of palliative care in patients hospitalized with heart failure: A contemporary national perspective.
Despite advances in therapy, heart failure (HF) patients have significant symptom burden and poor quality of life. However, data on palliative care (PC) utilization in this population are scarce. We sought to assess national trends in PC utilization in patients admitted with acute HF. ⋯ PC is being utilized in an increasing but overall small number of patients hospitalized with HF. Further research is needed to identify the optimal role and timing of PC in HF patients.