होम Journal of Cardiac Failure Improved Survival with HeartMate II Left Ventricular Assist Device for Acute Cardiogenic Shock

Improved Survival with HeartMate II Left Ventricular Assist Device for Acute Cardiogenic Shock

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यह पुस्तक आपको कितनी अच्छी लगी?
फ़ाइल की गुणवत्ता क्या है?
पुस्तक की गुणवत्ता का मूल्यांकन करने के लिए यह पुस्तक डाउनलोड करें
डाउनलोड की गई फ़ाइलों की गुणवत्ता क्या है?
खंड:
17
साल:
2011
भाषा:
english
पृष्ठ:
1
DOI:
10.1016/j.cardfail.2011.06.363
फ़ाइल:
PDF, 55 KB
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आप पुस्तक समीक्षा लिख सकते हैं और अपना अनुभव साझा कर सकते हैं. पढ़ूी हुई पुस्तकों के बारे में आपकी राय जानने में अन्य पाठकों को दिलचस्पी होगी. भले ही आपको किताब पसंद हो या न हो, अगर आप इसके बारे में ईमानदारी से और विस्तार से बताएँगे, तो लोग अपने लिए नई रुचिकर पुस्तकें खोज पाएँगे.
2

Diabetes and Heart Failure: Does the Type of Anti-Diabetic Therapy Matter?

साल:
2011
भाषा:
english
फ़ाइल:
PDF, 55 KB
S108 Journal of Cardiac Failure Vol. 17 No. 8S August 2011
increasing nurses’ knowledge of HF SM principles and has increased nurses’ ability
to use the TB method. Retention will be assessed in 3 months using the the same
survey.

Table 1 (continued )

Laboratory Data
Sodium
Creatinine

348
Diabetes and Heart Failure: Does the Type of Anti-Diabetic Therapy Matter?
Lazaros A. Nikolaidis, Swetang Shah, Laurie Russell, Alfred A. Bove; Cardiology,
Temple University School of Medicine, Philadelphia, PA
Diabetes mellitus (DM) and heart failure (HF) are frequent co-morbidities that adversely affect each other’s prognosis. Patients with both DM and HF are treated
with a spectrum of therapies ranging from “diet only” to oral hypoglycemic (notwithstanding the glitazone limitations in advanced (NYHA III-IV) HF), insulin or combination. Although adequate DM control remains a desirable goal, there is no
consensus about what type of anti-diabetic therapy is better suited for HF patients.
We identified 160 patients with systolic LV dysfunction (LVEF ! 50%) and type II
DM from our chronic HF clinic. We investigated the relationship between glycemic
control, chronic therapy for HF and diabetes and hospitalization for acutely decompensated HF (ADHF) within the past 3 years. Demographically, the majority of our
patients (66%) were African-Americans, 58% were male and 53% were non-ischemic. Baseline LVEF was 27 6 4% and baseline HgbA1c was 8.3 6 2 g/dl. Outpatient
anti-DM therapy ranged from “diet only” (15%), to oral medicines only (35%), insulin only (40%) and insulin combined with oral medicines (10%). Insulin users had
significantly higher HgbA1c than non-users (8.7 6 2.3 vs. 7.8 6 2.2 g/dl, P!
0.05) There were no significant baseline differences between the group hospitalized
for ADHF (n564) and those who did not (n596) with regard to age, gender, race,
baseline HgbA1c, baseline LVEF or cardiovascular therapies. The distribution of
DM therapy however demonstrated different trends with insulin monotherapy
(45% vs. 37%, pw ; 0.08) or diet-control only (22% vs. 12%, pw0.08) being more
common and metformin use -among all oral anti-diabetic therapies- being less common (14% vs. 26%, pw 0.06) among patients with a history of ADHF hospitalization. In our predominantly African-American population of type II diabetic
patients with advanced systolic dysfunction, there was a notable trend of metformin
therapy associated with freedom from ADHF hospitalization, independent of
HgbA1c control. These data are concordant with studies suggestive that metformin
should not be withheld from diabetic patients with HF and support a plausible
cardio-protective role.

349
Improved Survival with HeartMate II Left Ventricular Assist Device for Acute
Cardiogenic Shock
Susan Lien1, Ryan C. Nelson1, Scott McNitt1, H. Todd Massey1, Jeffrey D. Alexis1,
Leway Chen1, Eugene Storozynsky1, Michael W. Fong2; 1Cardiology Division,
Cardiac Surgery Division, University of Rochester Medical Center, Rochester, NY;
2
Cardiology Division, University of Southern California, Los Angeles, CA
Background: Acute cardiogenic shock (aCS) is associated with high rates of morbidity and mortality despite advancements in therapy. The development of ventricular
assist devices (VADs) has emerged as an effective option to rescue patients from circulatory collapse following myocardial infarction, acute myocarditis, or post-cardiotomy shock. The HeartMate II left ventricular assist device (HM-II LVAD) has not
been formally studied for use in aCS. We hypothesized that survival with the HMII LVAD used as the primary mechanical assist device in aCS would be superior to
other mechanical circulatory support (MCS) strategies. Methods: Single center retrospective review of patients who presented to the University of Rochester in aCS
and received MCS between January 2001 and April 2010. Comparison was made
to evaluate the primary use of the HM-II LVAD for aCS vs. other initial MCS options.
A total of 107 patients received MCS in the form of LVAD or biventricular assist device for aCS; 16 received the HM-II LVAD and 91 patients received other initial
MCS options. The primary outcomes included mortality at 30 days, 90 days, and 6
months, and survival to discharge. Results: Baseline characteristics are presented
in Table 1. The etiology of aCS was predominately due to acute myocardial infarction
or post-cardiotomy shock. Mortality at 30 days, 90 days, and 6 months was significantly lower in the HM-II LVAD group vs. the other MCS device group, and survival
to hospital discharge was improved (Table 2).
Table 1. - Clinical Characteristics

Age
Female (%)
Caucasian (%)
BMI
Clinical History
Cardiac arrest (%)
CAD (%)
DM (%)
Hemodynamics
CI

HeartMate II (n516)

Other VADs (n591)

p-value

51.4 6 9.4
37.5
100
29.4 6 6.6

53.4 6 13.9
32.3
90
27.7 6 5.3

0.382
0.679
0.549
0.549

50
43.8
43.8

38.6
41.1
24.4

0.394
0.844
0.132

1.8 6 0.5

1.8 6 0.6

0.751
(continued)

HeartMate II (n516)

Other VADs (n591)

p-value

138.0
1.3 6 0.5

137.8
1.7 6 1.8

0.376
0.293

HeartMate II (n516)

Other VADs (n591)

p-value

6.2%
6.2%
6.2%
93.8%

43.3%
52.8%
61.6%
41.1%

0.005
0.001
!0.001
!0.001

Table 2. - Outcomes

Primary Outcomes
30d Mortality
90d Mortality
6m mortality
Survival to Discharge

Conclusions: HM-II LVAD was associated with lower mortality compared to other
strategies and is a good initial treatment option for patients in aCS who require MCS.

350
Electronic Identifiers Accurately Identify Inpatient Heart Failure Admissions
Carrie Geisberg, Connie Lewis, Jack Starmer, Zachary Cox, Thomas DiSalvo,
Douglas Sawyer, Daniel Lenihan; Cardiovascular Medicine, Vanderbilt University,
Nashville, TN
Nationally heart failure (HF) remains a leading cause of hospital admissions. Accurate early identification, diagnosis, and treatment are essential to reduce length of
stay, readmission rates, improving outcomes measures and quality of life. Bundled
electronic medical record indicators collected at the time of admission to the hospital
are one strategy that might improve initiation of integrated physician order sets, as
well as HF disease education initiatives. Using the electronic medical record
(EMR) system, 3-patient data sets (n5366) were radomly generated from emergency
room, cardiac telemetry floor, and general hospital admissions from an academic
medical center over a combined period of 7-months. Data was collected to test the
performance of specific electronic identifiers from a customized electronic dashboard
using: BNP (b-type natriuretic peptide) ordered, BNP O500 (pg/ml), IV diuretic use,
documentation of HF in the patient’s electronic problem list, and a history of HF from
previous ICD-9 financial data in a logistic regression model. A confirmed diagnosis
of HF was assigned in 24.9% of patients by a physician’s review of the medical record using history, physical exam, laboratory and radiology data. A BNP ordered, IV
diuretic use, or a history of HF from patient’s electronic problem list increased the
probability of confirmed diagnosis of HF (81.3%, 88.1%, and 89.3%respectively).
A BNP O500 (pg/ml) was of little utility in identifying HF patients among a diverse
population of admission to a large medical center due to low number of patient identified (15.3%). When history of HF from patient’s electronic problem list or BNP ordered was added to IV diuretic use there was additive predictive value in accurate
confirmation of HF diagnosis (97.3%, 95.5% respectively) (table 1).

HF admissions n5366

ROC

Sensitivity (%)

Specificity (%)

Probability of
HF diagnosis (%)

BNP O 500 (pg/ml)*
BNP ordered*
IV Diuretic*
Hx of HF*
BNP ordered & IV diuretic*
Hx of HF & IV diuretic*

0.90
0.79
0.86
0.76
0.92
0.90

89.3
68.3
80.0
55.8
90.8
85.8

86.8
89.1
92.5
95.4
84.5
88.5

55.5
81.3
88.1
89.3
95.5
97.3

* p-value significant
The electronic identifiers of BNP ordered, IV diuretic use, and history of HF from
electronic problem list, accurately identifies patients with a confirmed diagnosis of
HF regardless of location in the hospital. Use of this EMR system to prompt HF order
sets, teaching from a multidisciplinary team, and and educational strategies may improve HF outcomes.

351
Pilot Program To Improve Self Management of Patients with Heart Failure by
Redesigning Care Coordination
Jessica Shaw1, Dan O’Neal2, Frances Zarella3, Kris Siddharthan2, Britta Neugaard1;
1
Quality Management, James A Haley VA, Tampa, FL; 2Research Service, James A
Haley VA, Tampa, FL; 3Nursing Service, James A Haley VA, Tampa, FL
Introduction: The prevalence of HF is projected to be 5.8 million in 2011. The Veterans Health Administration readmits more than half of those discharged with a HF