Showing papers in "Journal of the American Heart Association in 2020"
TL;DR: The prevalence of coronavirus disease 2019 (COVID19) has posed a great threat to people’s health worldwide, bringing a great challenges to the public healthcare systems.
Abstract: The prevalence of coronavirus disease 2019 (COVID19) has posed a great threat to people’s health worldwide, bringing a great challenges to the public healthcare systems. A recent study has confirmed that severe acute respiratory syndrome coronavirus 2 (SARSCoV2) uses severe acute respiratory syndrome coronavirus (SARSCoV) receptor angiotensinconverting enzyme 2 (ACE2) for host cell entry.1 ACE2 expression was previously found to correlate with susceptibility to SARSCoV infection in vitro.2 As with SARSCoV, higher ACE2 expression might also lead to higher risk of SARSCoV2 infection.
384 citations
TL;DR: This review will provide an overview of DOACs and act as a practical reference for clinicians to optimize DOAC use among common challenging scenarios and Topics addressed include appropriate indications, use in patients with specific comorbidities, and cost considerations.
Abstract: Direct oral anticoagulants (DOACs) have quickly become attractive alternatives to the long-standing standard of care in anticoagulation, vitamin K antagonist. DOACs are indicated for prevention and treatment of several cardiovascular conditions. Since the first approval in 2010, DOACs have emerged as leading therapeutic alternatives that provide both clinicians and patients with more effective, safe, and convenient treatment options in thromboembolic settings. With the expanding role of DOACs, clinicians are faced with increasingly complex decisions relating to appropriate agent, duration of treatment, and use in special populations. This review will provide an overview of DOACs and act as a practical reference for clinicians to optimize DOAC use among common challenging scenarios. Topics addressed include (1) appropriate indications; (2) use in patients with specific comorbidities; (3) monitoring parameters; (4) transitioning between anticoagulant regimens; (5) major drug interactions; and (6) cost considerations.
239 citations
215 citations
TL;DR: ICI-related myocarditis is a new entity that requires further research, and the following review will discuss the current literature available for aiding physicians to better diagnose and treat patients with this infrequent but fatal toxicity.
Abstract: T raditional cytotoxic chemotherapy and novel cancer therapies have various cardiotoxicities, ranging from heart failure to arrhythmias. One of the most exciting developments in cancer treatment is immunotherapy, which uses the immune system to attack malignancies. Among the immunotherapy armamentarium are immune checkpoint inhibitors (ICIs), which have shown promising results. ICIs are monoclonal antibodies that target the host immune negative regulation receptors, such as CTLA-4 (cytotoxic Tlymphocyte–associated protein 4), programmed cell death receptor 1 (PD-1), and programmed cell death ligand 1 (PDL1). There are currently 7 US Food and Drug Administration– approved ICIs, which include ipilimumab (anti-CTLA4), nivolumab, pembrolizumab, cemiplimab (anti–PD-1), avelumab, atezolizumab, and durvalumab (anti–PD-L1) (Table). The indications for their use in cancer treatment continue to expand for an increasing number of malignancies, and in some as first-line therapy. Parallel with the increased use, recognition of immune-related adverse events (IRAEs) has also improved. The most common fatal IRAE is colitis, but the associated mortality is low at 2% to 5%. At the other end of the spectrum is ICI-related myocarditis, which is an uncommon IRAE, but is associated with a high reported mortality. There is a need for increased awareness to suspect, diagnose, and treat ICI-related myocarditis. There are few large case series describing cardiotoxicities of ICIs, with the largest coming from adverse event reporting databases. Although these databases provide larger patient numbers and allow comparisons to other cancer therapeutics, they lack granular data on how the myocarditis was diagnosed or treated. Clinical trial data provide fewer patient numbers but allow for a more standardized reporting system of toxicity in the common terminology criteria for adverse events. Although there is a specified adverse event “myocarditis” in the category of “cardiac disorders” in the common terminology criteria for adverse events version 5, this does not provide a standard for how myocarditis is diagnosed or treated. The articles describing use of cardiac imaging studies or endomyocardial biopsy for diagnosis are limited to small case series and case reports, which have a wide variability in the use of either tool for diagnosis. Furthermore, there are even fewer reports of effective treatment using immunomodulators, which have variable dosing and choice of immunomodulation. ICI-related myocarditis is a new entity that requires further research, and the following review will discuss the current literature available for aiding physicians to better diagnose and treat patients with this infrequent but fatal toxicity.
195 citations
TL;DR: Sodium‐glucose cotransporter 2 inhibitors protect against cardiovascular disease and death in diverse subsets of patients with type 2 diabetes mellitus regardless of cardiovascular disease history.
Abstract: Background Several trials have demonstrated protective effects from inhibition of sodium‐glucose cotransporter 2 among patients with type 2 diabetes mellitus. There is uncertainty about the consist...
144 citations
TL;DR: In patients presenting with ST‐segment–elevation myocardial infarction, interleukin‐1 blockade with anakinra significantly reduces the systemic inflammatory response compared with placebo.
Abstract: Background ST‐segment–elevation myocardial infarction is associated with an intense acute inflammatory response and risk of heart failure. We tested whether interleukin‐1 blockade with anakinra sig...
133 citations
TL;DR: A cardio‐oncology expert panel from the French Working Group of Cardio‐Oncology has undertaken an ambitious effort to analyze and harmonize the most recent American and European guidelines to propose roadmaps and decision algorithms that would be easy for clinicians to use in their daily practice.
Abstract: The considerable progress made in the field of cancer treatment has led to a dramatic improvement in the prognosis of patients with cancer. However, toxicities resulting from these treatme...
130 citations
TL;DR: This review summarizes and critically analyze relevant studies on SVD triggers and pathogenesis, current approaches to protect BHVs from calcification, obtaining low immunogenic BHV tissue from genetically modified animals, and potential strategies for SVD prevention in the clinical setting.
Abstract: The implantation of bioprosthetic heart valves (BHVs) is increasingly becoming the treatment of choice in patients requiring heart valve replacement surgery. Unlike mechanical heart valves, BHVs are less thrombogenic and exhibit superior hemodynamic properties. However, BHVs are prone to structural valve degeneration (SVD), an unavoidable condition limiting graft durability. Mechanisms underlying SVD are incompletely understood, and early concepts suggesting the purely degenerative nature of this process are now considered oversimplified. Recent studies implicate the host immune response as a major modality of SVD pathogenesis, manifested by a combination of processes phenocopying the long-term transplant rejection, atherosclerosis, and calcification of native aortic valves. In this review, we summarize and critically analyze relevant studies on (1) SVD triggers and pathogenesis, (2) current approaches to protect BHVs from calcification, (3) obtaining low immunogenic BHV tissue from genetically modified animals, and (4) potential strategies for SVD prevention in the clinical setting.
110 citations
TL;DR: This meta‐analysis identified several key risk factors for delirium and cognitive decline following CABG, most of which are nonmodifiable.
Abstract: Background Coronary artery bypass grafting (CABG) is known to improve heart function and quality of life, while rates of surgery-related mortality are low. However, delirium and cognitive decline are common complications. We sought to identify preoperative, intraoperative, and postoperative risk or protective factors associated with delirium and cognitive decline (across time) in patients undergoing CABG. Methods and Results We conducted a systematic search of Medline, PsycINFO, EMBASE, and Cochrane (March 26, 2019) for peer-reviewed, English publications reporting post-CABG delirium or cognitive decline data, for at least one risk factor. Random-effects meta-analyses estimated pooled odds ratio for categorical data and mean difference or standardized mean difference for continuous data. Ninety-seven studies, comprising data from 60 479 patients who underwent CABG, were included. Moderate to large and statistically significant risk factors for delirium were as follows: (1) preoperative cognitive impairment, depression, stroke history, and higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) score, (2) intraoperative increase in intubation time, and (3) postoperative presence of arrythmia and increased days in the intensive care unit; higher preoperative cognitive performance was protective for delirium. Moderate to large and statistically significant risk factors for acute cognitive decline were as follows: (1) preoperative depression and older age, (2) intraoperative increase in intubation time, and (3) postoperative presence of delirium and increased days in the intensive care unit. Presence of depression preoperatively was a moderate risk factor for midterm (1-6 months) post-CABG cognitive decline. Conclusions This meta-analysis identified several key risk factors for delirium and cognitive decline following CABG, most of which are nonmodifiable. Future research should target preoperative risk factors, such as depression or cognitive impairment, which are potentially modifiable. Registration URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020149276.
107 citations
TL;DR: Survival in children with CHD has increased substantially since the 1980s; however, no significant improvement has been observed this century highlighting the need of life‐time management.
Abstract: Background Despite advances in pediatric health care over recent decades, it is not clear whether survival in children with congenital heart disease (CHD) is still increasing. Methods and Results W...
105 citations
TL;DR: Overall, 12% of patients manifested critical QTc prolongation, and the combination caused greater prolongation than either drug alone, which means the balance between uncertain benefit and potential risk when treating COVID‐19 patients should be carefully assessed.
Abstract: Background Despite a lack of clinical evidence, hydroxychloroquine and azithromycin are being administered widely to patients with verified or suspected coronavirus disease 2019 (COVID-19). Both drugs may increase risk of lethal arrhythmias associated with QT interval prolongation. Methods and Results We analyzed a case series of COVID-19-positive/suspected patients admitted between February 1, 2020, and April 4, 2020, who were treated with azithromycin, hydroxychloroquine, or a combination of both drugs. We evaluated baseline and postmedication QT interval (corrected QT interval [QTc]; Bazett) using 12-lead ECGs. Critical QTc prolongation was defined as follows: (1) maximum QTc ≥500 ms (if QRS <120 ms) or QTc ≥550 ms (if QRS ≥120 ms) and (2) QTc increase of ≥60 ms. Tisdale score and Elixhauser comorbidity index were calculated. Of 490 COVID-19-positive/suspected patients, 314 (64%) received either/both drugs and 98 (73 COVID-19 positive and 25 suspected) met study criteria (age, 62±17 years; 61% men). Azithromycin was prescribed in 28%, hydroxychloroquine in 10%, and both in 62%. Baseline mean QTc was 448±29 ms and increased to 459±36 ms (P=0.005) with medications. Significant prolongation was observed only in men (18±43 ms versus -0.2±28 ms in women; P=0.02). A total of 12% of patients reached critical QTc prolongation. Changes in QTc were highest with the combination compared with either drug, with much greater prolongation with combination versus azithromycin (17±39 ms versus 0.5±40 ms; P=0.07). No patients manifested torsades de pointes. Conclusions Overall, 12% of patients manifested critical QTc prolongation, and the combination caused greater prolongation than either drug alone. The balance between uncertain benefit and potential risk when treating COVID-19 patients should be carefully assessed.
TL;DR: Sex differences in the prescription of cardiovascular medication exist among patients at high risk or with established cardiovascular disease in primary care, with a lower prevalence of aspirin, statins, and angiotensin‐converting enzyme inhibitors prescription in women and a lowerPrevalence of diuretics prescription in men.
Abstract: Background Sex differences in the management of cardiovascular disease have been reported in secondary care. We conducted a systematic review with meta-analysis of systematically investigated sex differences in cardiovascular medication prescription among patients at high risk or with established cardiovascular disease in primary care. Methods and Results PubMed and Embase were searched between 2000 and 2019 for observational studies reporting on the sex-specific prevalence of aspirin, statins, and antihypertensive medication prescription, including beta blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and diuretics, in primary care. Random effects meta-analysis was used to obtain pooled women-to-men prevalence ratios for each cardiovascular medication prescription. Metaregression models assessed the impact of age and year on the findings. A total of 43 studies were included, involving 2 264 600 participants (28% women) worldwide. Participants' mean age ranged from 51 to 76 years. The pooled prevalence of cardiovascular medication prescription for women was 41% for aspirin, 60% for statins, and 68% for any antihypertensive medications. Corresponding rates for men were 56%, 63%, and 69% respectively. The pooled women-to-men prevalence ratios were 0.81 (95% CI, 0.72-0.92) for aspirin, 0.90 (95% CI, 0.85-0.95) for statins, and 1.01 (95% CI, 0.95-1.08) for any antihypertensive medications. Women were less likely to be prescribed angiotensin-converting enzyme inhibitors (0.85; 95% CI, 0.81-0.89) but more likely with diuretics (1.27; 95% CI, 1.17-1.37). Mean age, mean age difference between the sexes, and year of study had no significant impact on findings. Conclusions Sex differences in the prescription of cardiovascular medication exist among patients at high risk or with established cardiovascular disease in primary care, with a lower prevalence of aspirin, statins, and angiotensin-converting enzyme inhibitors prescription in women and a lower prevalence of diuretics prescription in men.
TL;DR: An up‐to‐date overview on the epidemiology, etiology, microbiology, potential locations of infection in the right heart, diagnosis, imaging, common complications, management, and prognosis of right‐sided infective endocarditis is provided.
Abstract: Compared with the extensive data on left‐sided infective endocarditis (IE), there is much less published information on the features and management of right‐sided IE. Right‐sided IE accoun...
TL;DR: Compared with standard CA‐guided PCI, the use of IVUS imaging guidance to optimize stent implantation is associated with a reduced risk of cardiovascular death and major adverse events, such as myocardial infarction, target lesion revascularization, and stent thrombosis.
Abstract: Background Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) offers tomographic images of the coronary vessels, allowing optimization of stent implantation at...
TL;DR: An adequate intake of potassium is desirable to achieve a lower BP level but excessive potassium supplementation should be avoided, particularly in specific subgroups, according to the findings of a meta‐analysis.
Abstract: Background Epidemiologic studies, including trials, suggest an association between potassium intake and blood pressure (BP). However, the strength and shape of this relationship is uncertain. Metho...
University of Alberta1, Heart and Stroke Foundation of Canada2, University of Calgary3, University of Saskatchewan4, Laurentian University5, University of British Columbia6, University of Toronto7, University Health Network8, Women's College Hospital9, Université de Montréal10, Montreal Heart Institute11, McMaster University12, Dalhousie University13, University of Ottawa14, University of New Brunswick15, Queen's University16, Mayo Clinic17
TL;DR: This dissertation aims to provide a history of single-sex education in Sweden from 1989 to 2002, a period chosen in order to explore its roots as well as specific cases up to and including the year in which six students died from gunshot wounds.
Abstract: Colleen M. Norris, PhD, MSc, BScN, RN; Cindy Y. Y. Yip, PhD, MASc, PMP; Kara A. Nerenberg, MD, MSc; Marie-Annick Clavel, DVM, PhD; Christine Pacheco, MD, MSc; Heather J. A. Foulds, PhD, MSc, CEP; Marsha Hardy, MSW, RSW; Christine A. Gonsalves, PhD; Shahin Jaffer, MD, MHSc; Monica Parry, MEd, MSc, PhD, NP-Adult, CCN(C); Tracey J. F. Colella, RN, PhD; Abida Dhukai, NP, PhD Candidate; Jasmine Grewal, MD; Jennifer A. D. Price, PhD, RN, CCN(C); Anna L. E. Levinsson, PhD; Donna Hart, BA, RSW; Paula J. Harvey, BMBS, PhD; Harriette G. C. Van Spall, MD, MPH; Hope Sarfi; Tara L. Sedlak, MD; Sofia B. Ahmed, MD, MMSc; Carolyn Baer, MD; Thais Coutinho, MD; Jodi D. Edwards, PhD; Courtney R. Green, PhD, MSc; Amy A. Kirkham, PhD; Kajenny Srivaratharajah, MD, MSc; Sandra Dumanski, MD; Lisa Keeping-Burke, RN, PhD; Nadia Lappa, BEng; Robert D. Reid, PhD, MBA; Helen Robert, BComm; Graeme Smith, MD, PhD; Michelle Martin-Rhee, PhD; Sharon L. Mulvagh, MD, FRCPC, FACC, FASE, FAHA
TL;DR: A deep learning–based algorithm, combining a multilayer perceptron and convolutional neural network, for detecting significant AS using ECGs demonstrated high accuracy for significant AS detection using both 12‐lead and single‐lead ECGs.
Abstract: Background Severe, symptomatic aortic stenosis (AS) is associated with poor prognoses. However, early detection of AS is difficult because of the long asymptomatic period experienced by many patien...
TL;DR: According to a systematic review, rates of survival in ECLS in pregnant and postpartum women are high and major complications relatively low.
Abstract: Background The use of extracorporeal life support (ECLS) has expanded to include unique populations such as peripartum women This systematic review aims to (1) quantify the number of cases and ind
TL;DR: Twelve‐month treatment with GLP‐1RA, SGLT‐2i, and their combination showed a greater improvement of vascular markers and effective cardiac work than insulin treatment in type 2 diabetes mellitus.
Abstract: Background We investigated the effects of insulin, glucagon‐like peptide‐1 receptor agonists (GLP‐1RA), sodium‐glucose cotransporter‐2 inhibitors (SGLT‐2i), and their combination on vascular and ca...
TL;DR: The most distinctive feature of ARVC‐LV phenotype is the large amount of LV‐LGE/fibrosis, which impacts directly and negatively on the LV systolic function.
Abstract: Background This study assessed the prevalence of left ventricular (LV) involvement and characterized the clinical, electrocardiographic, and imaging features of LV phenotype in patients with arrhyt...
TL;DR: Fruits and vegetables are associated with cardiovascular benefit, with some sources associated with greater benefit and none showing an adverse association, and there were greater benefits for citrus, 100% fruit juice, and pommes among fruit sources and allium, carrots, cruciferous, and green leafy among vegetable sources.
Abstract: Background Public health policies reflect concerns that certain fruit sources may not have the intended benefits and that vegetables should be preferred to fruit. We assessed the relation of fruit ...
TL;DR: Statin use was associated with reduced in‐hospital mortality from COVID‐19 in patients with diabetes mellitus, and these findings, if validated, may further reemphasize administration of statins to patients with Diabetes mellitus during the CO VID‐19 era.
Abstract: Background Severe coronavirus disease 2019 (COVID-19) is characterized by a proinflammatory state with high mortality. Statins have anti-inflammatory effects and may attenuate the severity of COVID-19. Methods and Results An observational study of all consecutive adult patients with COVID-19 admitted to a single center located in Bronx, New York, was conducted from March 1, 2020, to May 2, 2020. Patients were grouped as those who did and those who did not receive a statin, and in-hospital mortality was compared by competing events regression. In addition, propensity score matching and inverse probability treatment weighting were used in survival models to examine the association between statin use and death during hospitalization. A total of 4252 patients were admitted with COVID-19. Diabetes mellitus modified the association between statin use and in-hospital mortality. Patients with diabetes mellitus on a statin (n=983) were older (69±11 versus 67±14 years; P<0.01), had lower inflammatory markers (C-reactive protein, 10.2; interquartile range, 4.5-18.4 versus 12.9; interquartile range, 5.9-21.4 mg/dL; P<0.01) and reduced cumulative in-hospital mortality (24% versus 39%; P<0.01) than those not on a statin (n=1283). No difference in hospital mortality was noted in patients without diabetes mellitus on or off statin (20% versus 21%; P=0.82). Propensity score matching (hazard ratio, 0.88; 95% CI, 0.83-0.94; P<0.01) and inverse probability treatment weighting (HR, 0.88; 95% CI, 0.84-0.92; P<0.01) showed a 12% lower risk of death during hospitalization for statin users than for nonusers. Conclusions Statin use was associated with reduced in-hospital mortality from COVID-19 in patients with diabetes mellitus. These findings, if validated, may further reemphasize administration of statins to patients with diabetes mellitus during the COVID-19 era.
TL;DR: Cardiovascular biomarkers may play an important role in CTRCD risk prediction in patients with breast cancer who receive cardiotoxic cancer therapy, particularly in those treated with sequential anthracycline and trastuzumab therapy.
Abstract: Background We examined the longitudinal associations between changes in cardiovascular biomarkers and cancer therapy–related cardiac dysfunction (CTRCD) in patients with breast cancer treated with ...
TL;DR: It is predicted that large-scale data-driven analytics could lead to huge benefits in health care; in the United States, where healthcare spending is 18% of gross domestic product, up to US$600 per person could be saved annually.
Abstract: W ith the digitization of all records and processes, and prevalence of cloud-driven services and Internet of Things, today’s era can truly be considered as an era of data. Machine learning (ML) and artificial intelligence (AI) skills are among the most sought-after skills today. McKinsey Global Institute research suggests that 45% of workplace activities in corporations could be automated with current technologies; 80% of that is attributable to existing ML capabilities, and breakthroughs in natural language processing could further the impact. Gartner forecasts that large-scale data-driven analytics could lead to huge benefits in health care; in the United States, where healthcare spending is 18% of gross domestic product, up to US$600 per person could be saved annually. Gartner also forecasts that data-driven insights for demand-supply matching could create an economic impact of $850 billion to $2.5 trillion. International Data Corporation forecasts that spending on AI and ML will grow to $79.2 billion by 2022, with a compound annual growth rate of 38% between the 2018 and 2022 period.
TL;DR: The effects of CO VID‐19 in the pediatric and young adult population are described and the cardiovascular involvement in COVID‐19 focusing on implications for patients with congenital heart disease in particular are reviewed.
Abstract: The corona virus disease -2019 (COVID-19) is a recently described infectious disease caused by the severe acute respiratory syndrome corona virus 2 with significant cardiovascular implications. Given the increased risk for severe COVID-19 observed in adults with underlying cardiac involvement, there is concern that patients with pediatric and congenital heart disease (CHD) may likewise be at increased risk for severe infection. The cardiac manifestations of COVID-19 include myocarditis, arrhythmia and myocardial infarction. Importantly, the pandemic has stretched health care systems and many care team members are at risk for contracting and possibly transmitting the disease which may further impact the care of patients with cardiovascular disease. In this review, we describe the effects of COVID-19 in the pediatric and young adult population and review the cardiovascular involvement in COVID-19 focusing on implications for patients with congenital heart disease in particular.
Baylor College of Medicine1, University of Birmingham2, University of Bristol3, Johns Hopkins University4, University at Buffalo5, Temple University6, University of Massachusetts Boston7, Ohio State University8, University of Michigan9, Emory University10, Cincinnati Children's Hospital Medical Center11, Loughborough University12
TL;DR: In this paper, a review summarizes current knowledge regarding how caregivers can be an important influence on children's eating self-regulation during early childhood and discusses the evidence supporting an association between caregiver feeding and child eating selfregulation.
Abstract: A substantial body of research suggests that efforts to prevent pediatric obesity may benefit from targeting not just what a child eats, but how they eat. Specifically, child obesity prevention should include a component that addresses reasons why children have differing abilities to start and stop eating in response to internal cues of hunger and satiety, a construct known as eating self‐regulation. This review summarizes current knowledge regarding how caregivers can be an important influence on children's eating self‐regulation during early childhood. First, we discuss the evidence supporting an association between caregiver feeding and child eating self‐regulation. Second, we discuss what implications the current evidence has for actions caregivers may be able to take to support children's eating self‐regulation. Finally, we consider the broader social, economic, and cultural context around the feeding environment relationship and how this intersects with the implementation of any actions. As far as we are aware, this is the first American Heart Association (AHA) scientific statement to focus on a psychobehavioral approach to reducing obesity risk in young children. It is anticipated that the timely information provided in this review can be used not only by caregivers within the immediate and extended family but also by a broad range of community‐based care providers.
TL;DR: Women and minorities, particularly blacks, have continued to be inadequately represented in pivotal cardiometabolic clinical trials that support US Food and Drug Administration approval of new molecular entities, and may impair generalizability of trial results to routine clinical practice.
Abstract: Background In 1993, the US Food and Drug Administration established guidelines to increase diversity by sex and race/ethnicity of participants in clinical trials supporting novel drug approvals. In...
Emory University1, Columbia University2, National Institutes of Health3, Northwestern University4, University of Iowa5, University of Pittsburgh6, University of Arizona7, University of North Carolina at Chapel Hill8, Boca Raton Regional Hospital9, Stanford University10, George Washington University11, University of California, San Francisco12
TL;DR: The authors review the recent literature and current research opportunities to advance the cardiovascular health of today's young adults and suggest a repositioning of existing evidence‐based treatments to accommodate new sociotechnical contexts.
Abstract: Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have been offset by increasing racial/ethnic and gender disparities, persistence of unhealthy li...
TL;DR: Use of an ABC consistent pathway is associated with fewer major adverse events in patients with atrial fibrillation who have multiple comorbidities, use of polypharmacy, and prior hospitalization.
Abstract: Background For patients with atrial fibrillation, a comprehensive care approach based on the Atrial fibrillation Better Care (ABC) pathway can reduce the occurrence of adverse outcomes. The aim of this paper was to investigate if an approach based on the ABC pathway is associated with a reduced risk of adverse events in "clinically complex" atrial fibrillation patients, including those with multiple comorbidities, polypharmacy, and prior hospitalizations. Methods and Results We performed a post hoc analysis of the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial. The principal outcome was the composite of all-cause hospitalization and all-cause death. An integrated care approach (ABC group) was used in 3.8% of the multimorbidity group, 4.0% of the polypharmacy group, and 4.8%, of the hospitalized groups. In all "clinically complex" groups, the cumulative risk of the composite outcome was significantly lower in patients managed consistent with the ABC pathway versus non-ABC pathway-adherent (all P<0.05). Cox regression analysis showed a reduction of composite outcomes in ABC pathway-adherent versus non-ABC pathway-adherent for multimorbidity (hazard ratio [HR], 0.61, 95% CI, 0.44-0.85), polypharmacy (HR, 0.68, 95% CI, 0.47-1.00), and hospitalization (HR, 0.59, 95% CI, 0.42-0.85) groups. Secondary analyses showed that the higher number of ABC criteria fulfilled the larger associated reduction in relative risk, even for secondary outcomes considered. Conclusions Use of an ABC consistent pathway is associated with fewer major adverse events in patients with atrial fibrillation who have multiple comorbidities, use of polypharmacy, and prior hospitalization.
TL;DR: The prevalence, pathophysiology, predictors, management, and details of the complications of ECPR for OHCA, all of which have not been reviewed in previous literature, are clarified with the aim of facilitating understanding among acute care physicians.
Abstract: Extracorporeal cardiopulmonary resuscitation (ECPR) followed by targeted temperature management has been demonstrated to significantly improve the outcomes of out‐of‐hospital cardiac arres...