The Canadian journal of cardiology
-
Review Meta Analysis
Risk Factors for Post-TAVI Bleeding According to the VARC-2 Bleeding Definition and Effect of the Bleeding on Short-Term Mortality: A Meta-analysis.
In this study we investigated the effect of post-transcatheter aortic valve implantation (TAVI) bleeding (per Valve Academic Research Consortium-2 [VARC-2] bleeding criteria) on 30-day postoperative mortality and examined the correlation between pre- or intraoperative variables and bleeding. ⋯ Post-TAVI bleeding, in particular, major bleeding/life-threatening bleeding, increased 30-day postoperative mortality. Transapical access was a significant bleeding risk factor. Preexisting AF independently correlated with TAVI-associated bleeding, likely because of AF-related anticoagulation. Recognition of the importance and determinants of post-TAVI bleeding should lead to strategies to improve outcomes.
-
Multicenter Study
Temporal Trends of Reperfusion Strategies and Hospital Mortality for Patients With STEMI in Percutaneous Coronary Intervention-Capable Hospitals.
The aim of this study was to examine temporal trends and provincial variations in reperfusion strategies and in-hospital mortality among patients presenting with ST-segment elevation myocardial infarction (STEMI) at hospitals in Canada capable of performing percutaneous coronary intervention (PCI). ⋯ The use of pPCI in STEMI has increased significantly in Canada; however, significant interprovincial variation remains. Changes in reperfusion strategies do not appear to have had an impact on in-hospital mortality rates. Patients who underwent lysis followed by PCI in a systematic fashion had the lowest mortality.
-
An 87-year-old man with persistent atrial fibrillation experienced heartburn and dysphagia at 2 years 9 months after initiation of dabigatran. An esophagogastroduodenoscopy demonstrated multiple longitudinal white plaques with ulcers in the narrowed midesophagus compressed between the left atrium and the tortuous aorta. We speculate that the esophageal stenosis contributed to stasis of dabigatran within the esophagus, resulting in prolonged mucosal contact with the caustic contents of the drug. Progressive enlargement of the left atrium may have led to the late onset of the potentially serious complication.
-
Management of cardiac surgery health human resources (HHR) has been challenging, with recent graduates struggling to secure employment and a shortage of cardiac surgeons predicted as early as 2020. The length of cardiac surgery training prevents HHR supply from adapting in a timely fashion to changes in demand, resulting in a critical need for active workforce management. This study details the results of the 2015 Canadian Society of Cardiac Surgeons (CSCS) workforce survey undertaken as part of the CSCS strategy for active workforce management. ⋯ Participants highlighted a need for improved career counselling and formal mentorship. Although the job market is perceived to be improving, a mismatch in the cardiac surgery workforce supply and demand remains because current trainees continue to experience difficulty securing employment after the completion of residency training. Trainees have identified improved career counselling and mentorship as potential strategies to aid graduates in securing employment.
-
Drug shortages have been reported for > 35 years. Attention to this problem increased recently after the Sandoz crisis, in which a warning letter by the Food and Drug Administration caused supply changes that suspended the availability of numerous medications. The frequency of drug shortages has increased recently. ⋯ The critical importance of drug shortages is increasingly recognized by members of the public, and health care providers must sometimes make major efforts to minimize their adverse consequences. Although data are limited, such efforts come at a price that patients and the health care system should not have to bear; they divert pharmacists and physicians from their already busy clinical duties and often require complex and risky adjustments in medical regimens. If drug shortages are here to stay, clinicians, drug manufacturers, and relevant organizations should work together to increase accountability for drug availability and adaptation to shortages, and to create more effective tools with which to anticipate and respond to critical supply fluctuations.