Journal of the American Heart Association
-
Background We aimed to develop and validate a prediction model for in-hospital complications in children with tetralogy of Fallot repaired at an older age. Methods and Results A total of 513 pediatric patients from the Tianjin data set formed a derivation cohort, and 158 pediatric patients from the Hefei and Xiamen data sets formed validation cohorts. We applied least absolute shrinkage and selection operator analysis for variable selection and logistic regression coefficients for risk scoring. ⋯ With reference to the low-risk group, the intermediate- and high-risk groups conferred significantly higher in-hospital complication risks (adjusted odds ratio: 2.721 [95% CI, 1.267-5.841], P=0.0102; 9.297 [95% CI, 4.601-18.786], P<0.0001). A nomogram integrating the ARIAR-Risk classifier (absolute and relative low risk, intermediate risk, and aggressive and refractory high risk) with age and mean blood pressure showed good discrimination and goodness-of-fit for derivation (area under the receiver operating characteristic curve: 0.785 [95% CI, 0.731-0.839]; Hosmer-Lemeshow test, P=0.544) and external validation (area under the receiver operating characteristic curve: 0.759 [95% CI, 0.636-0.881]; Hosmer-Lemeshow test, P=0.508). Conclusions A risk-classifier-oriented nomogram is a reliable prediction model for in-hospital complications in children with tetralogy of Fallot repaired at an older age, and strengthens risk/benefit-based decision-making.
-
Multicenter Study
Association Between Active Commuting and Incident Cardiovascular Diseases in Chinese: A Prospective Cohort Study.
Background Active commuting is related to a higher level of physical activity but more exposure to ambient air pollutants. With the rather serious air pollution in urban China, we aimed to examine the association between active commuting and risk of incident cardiovascular disease in the Chinese population. Methods and Results A total of 104 170 urban commuters without major chronic diseases at baseline were included from China Kadoorie Biobank. ⋯ The associations of commuting mode with major cardiovascular disease were consistent among men and women and across different levels of other domain physical activity. Conclusions In urban China, cycling was associated with a lower risk of ischemic heart disease and ischemic stroke. Walking was associated with a lower risk of ischemic heart disease.
-
Multicenter Study
Outcomes and Resource Utilization Associated With Readmissions After Atrial Fibrillation Hospitalizations.
Background Atrial fibrillation is the most common arrhythmia worldwide. Data regarding 30-day readmission rates after discharge for atrial fibrillation remain poorly reported. Methods and Results The Nationwide Readmission Database (2010-2014) was queried using the International Classification of Diseases, Ninth Revision (ICD-9) codes to identify study population. ⋯ We identified a predictive model for increased risk of readmissions and treatment expense. Electrical cardioversion during index admission was associated with a significant reduction in 30-day readmissions and service charges. The 30-day readmissions correlated with a substantial rise in the cost of care.
-
Background The American College of Cardiology and American Heart Association periodically revise clinical practice guidelines. We evaluated changes in the evidence underlying guidelines published over a 10-year period. Methods and Results Thirty-five American College of Cardiology/American Heart Association guidelines were divided into 2 time periods: 2008 to 2012 and 2013 to 2017. ⋯ The decrease in the proportion of LOE C was highest in heart failure (24.8%), valvular heart disease (22.3%), and arrhythmia (19.2%). An increase in the proportion of LOE B was observed for these same areas: 31.8%, 23.8%, and 19.2%, respectively. Conclusions There has been a decrease in American College of Cardiology/American Heart Association guidelines recommendations, driven by removal of recommendations based on lower quality of evidence, although there was no corresponding increase in the highest quality of evidence.
-
Background The potential alterations of respiratory pathophysiology after cardiopulmonary resuscitation (CPR) are relatively undefined. While untreated arrest is known to affect post-cardiopulmonary resuscitation circulation, whether it affects respiratory pathophysiology remains unclear. We aimed to investigate the post-cardiopulmonary resuscitation changes in respiratory mechanics and neural respiratory drive with varying delays (5 or 10 minutes) in the treatment of ventricular fibrillation (VF). ⋯ The changes in imaging (P=0.027) and histopathology (P=0.012) were more severe in the VF10 group compared with the VF5 group. Conclusions There is an uncoupling between the respiratory center and ventilation after restoration of spontaneous circulation. Prolonged untreated arrest from cardiac arrest contributes to more serious alterations in lung pathophysiology.