Kardiol Pol
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Optimal treatment of ST segment elevation myocardial infarction (STEMI) should be initiated immediately. System delay is considered an important indicator of quality of care in STEMI, and at the same time it is an independent predictor of clinical outcomes. It can be modified largely by introducing organisational changes. Although conditions have been created in Poland for common use of electrocardiogram (ECG) teletransmission and direct transfer of all STEMI patients to cardiac catheterisation laboratories, no uniform management algorithms have been introduced. ⋯ An ECG teletransmission and teleconsultation system reduces the system delay. ECG teletransmission systems work well in rural areas with low population density and a single large PCI-capable hospital. With increasing experience, a gradual increase in the effectiveness of management protocols involving ECG teletransmission is seen.
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Intensive care unit (ICU) readmission after cardiac surgery is believed to be associated with higher in-hospital mortality and may predict poor outcomes. ICU readmissions use resources and increase treatment costs. ⋯ The most common cause of readmission to ICU is haemodynamic instability. Postoperative complication and in-hospital mortality rates are significantly higher in patients readmitted to ICU. Factors most commonly predisposing to readmission to ICU after cardiac surgery included advanced patient age, non-elective surgery, and longer initial stay in ICU after the surgery.
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Obstructive sleep apnoea (OSA) and atrial fibrillation (AF) are two conditions highly prevalent in the general population. OSA is known to cause haemodynamic changes, oxidative stress, and endothelial damage, and therefore promote vascular and heart remodelling which results in AF triggering and exacerbation. Coexistence of OSA and AF influences the course of both diseases, and therefore should be taken into consideration in patient management strategy planning. ⋯ OSA is highly prevalent in patients with AF in the Polish population, and affects approximately half of the patients. OSA patients are more likely to be older, have higher BMI, and greater waist and neck circumference. Persistent AF is the most common form of the arrhythmia in patients with OSA, while patients without OSA are more likely to have paroxysmal AF.
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Ticagrelor is the first reversibly binding oral P2Y12 receptor antagonist designed to reduce clinical thrombotic events in patients with acute coronary syndrome (ACS). Compared to clopidogrel, ticagrelor has been proven to significantly reduce the rate of death from vascular causes, myocardial infarction (MI), or stroke without an increase in the rate of overall major bleeding in patients who have an ACS with or without ST-segment elevation (STEMI and NSTEMI) or unstable angina (UA). ⋯ In a lifetime horizon, which should be used when comparing technologies with different impacts on mortality, cost-effectiveness evaluation resulted in more favourable economic outcomes for ticagrelor than for generic clopidogrel, with the cost per QALY well below the recommended willingness to pay threshold in Poland (24,965 PLN vs. 111,381 PLN).
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Diffuse brain injury is a key component of post-cardiac arrest syndrome reported in 30-80% of survivors of out-of-hospital cardiac arrest (OHCA). It is responsible for a high mortality rate, and is a common cause of cognitive and neurological deficits and disability. Symptom variability and dynamics and the rehabilitation potential remain poorly understood. ⋯ Cognitive and neurological symptoms are common after cardiac arrest brain injury. Establishing specialised neurorehabilitation centres is essential for treating these patients.