Right ventricular systolic pressure – Non-invasive bedside predictor of mortality and readmission in heart failure with reduced and preserved ejection fraction hospitalization

Objective: To study the prognostic role of right ventricular systolic pressure (RVSP) in patients with heart failure (HF). Background: Although RVSP is a readily available echocardiographic parameter, it is often underused. Its prognostic role in patients with heart failure is not well established compared with pulmonary artery pressure measured by right heart catheterization. Methods: This single-center retrospective cohort study included patients with acute heart failure hospitalization admitted to the hospital from January 2005 to December 2018. The primary predictor was right ventricular systolic pressure (RVSP) obtained from bedside transthoracic echocardiography at admission. We divided RVSP into two groups, RVSP <40 mm Hg (reference group) and RVSP 40 mm Hg. Primary outcome was all-cause mortality. Secondary outcomes were all-cause readmission and cardiac readmission. We conducted propensity-score matching and applied cox-proportional hazard model to compute hazard ratio (HR) with 95% confidence interval (CI). Results: Out of 972 HF patients, 534 patients had RVSP <40 mm Hg and 438 patients had RVSP 40 mm Hg. Patients with RVSP 40 mm Hg compared with RVSP <40 mm Hg were associated with higher rates of death [HR: 1.60, 95% CI: 1.22e2.09, P-value ¼ 0.001], all-cause readmissions [HR: 1.37, 95% CI: 1.09 e1.73, P-value ¼ 0.008] and cardiac readmissions [HR: 1.41, 95% CI: 1.07e1.85, P-value ¼ 0.014]. Conclusion: Higher RVSP (40 mm Hg) in HF patients was associated with higher rates of death, allcause readmissions, and cardiac readmissions. RVSP can be considered as a prognostic marker for mortality and readmission.P

Meta-analysis of ProGlide versus MANTA vascular closure devices for large-bore access site management

Introduction: The comparative effectiveness of ProGlide® compared with MANTA® vascular closure devices (VCDs) in large-bore access site management is not entirely certain, and has only been evaluated in underpowered studies. This meta-analysis aimed to evaluate the outcomes of ProGlide® compared with MANTA® VCDs. Methods: PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched systematically for relevant articles from the inception of the database until August 27, 2021. The outcomes of interest were all bleeding events, major bleeding, major and minor vascular complications, pseudoaneurysm, stenosis or dissection, and VCD failure. Risk ratios were used as point estimates of endpoints. All statistical analyses were carried out using R version 4.0.3. Results: Four observational studies and 1 pilot randomized controlled trial (RCT) were included in the final analysis. There was no significant difference between the ProGlide® and MANTA® groups in the risk of all bleeding events, major/life-threatening bleeding, major vascular complications, minor vascular complications, pseudoaneurysms, and/or stenosis or dissection of the entry site vessel. However, the incidence of VCD failure was higher in the ProGlide® group compared with the MANTA® group (RR 1.94; 95% CI 1.31e2.84; I2 ¼ 0%). Conclusion: In conclusion, both VCDs (ProGlide® and MANTA®) have comparable outcomes with regard to risk of bleeding, vascular complications, pseudoaneurysms, and/or stenosis or dissection of entry vessel. ProGlide® was however associated with higher device failure.

Electronic health records and outpatient cardiovascular disease care delivery: Insights from the American College of Cardiology’s PINNACLE India Quality Improvement Program (PIQIP)

Background There has been a push toward implementation of electronic health records (EHRs) in federally-funded hospitals under the current policies initiated by the Indian government, with a lack of evidence supporting their adoption. We analyzed data from the American College of Cardiology’s PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP) to evaluate the association between EHR use and quality of cardiovascular disease care in India. Methods and Results Between 2011–2016, we collected data on performance measures for patients with coronary artery disease (CAD), heart failure (HF) and atrial fibrillation (AF) among 17 participating practices in PIQIP. There were 19,035 patients with CAD, 9,373 patients with HF, and 1,127 patients with AF. Documentation of co-morbidity burden in patients with CAD was lower among practices with EHR—hypertension (49.8% vs. 52.1%, p = 0.003), diabetes (34.9% vs. 38.3%, p < 0.001), and hyperlipidemia (0.2 vs. 3.9%, p < 0.001). On the contrary, documentation of medication prescription was higher in CAD patients seen at practices with EHR—aspirin (63.2% vs. 17.8%, p < 0.001), clopidogrel (41.7% vs. 27.4%, p < 0.001), beta-blockers (61.4% vs. 9.8%, p < 0.001), and ACE-i or ARBs (53.9% vs. 16.4%, p < 0.001). Similarly, documentation of receipt of beta-blockers (43.8% vs. 10.7%, p < 0.001), ACE-i or ARBs (40.8% vs. 16.1%, p < 0.001), and beta-blockers + ACE-i or ARBs (36.4% vs. 3.6%, p < 0.001) was also significantly higher in patients with HF seen at practices with EHR. Among patients with AF, documentation of oral anticoagulation use was significantly higher among EHR practices—warfarin (42.5% vs. 26.1%, p < 0.001). Conclusions Documentation of receipt of guideline-directed medical therapy in CAD, HF, and AF was significantly higher in practices with EHRs in India compared with sites without EHRs. Our findings shed a spotlight on the value of EHRs in future health care policy-making in India with regard to widespread adoption of EHRs in primary and advanced specialty care settings across public and private sectors.