Complicaciones intrahospitalarias del infarto agudo de miocardio. Incidencia y momento de aparición / In-hospital complications of acute myocardial infarction. Incidence and timing of their occurrence

Resumen Aunque la mortalidad del infarto de miocardio con elevación del segmento ST (IAMCEST) ha disminuido con el progreso de la reperfusión, la incidencia de sus complicaciones no ha cambiado. El objetivo del estudio es conocer la incidencia de las complicaciones hospitalarias del IAMCEST, su cronología de aparición e identificar sus predictores. Se realizó un análisis prospectivo de todos los pacientes consecutivos con IAMCEST ingresados en una unidad coronaria de un Hospital público de la ciudad de Buenos Aires desde septiembre de 2017 a marzo de 2020. De 263 pacientes con IAMCEST, el 47.2% (124) presentó complicacio nes siendo la insuficiencia cardíaca (IC) la más frecuente. El paro cardiaco previo al ingreso (PCR) (OR: 9.8; IC: 1.2-81.9; p = 0.03), la fracción de eyección del ventrículo izquierdo (Fey VI) < del 40% (OR: 2.3 IC: 1.3-3.9; p = 0.004) y la edad > de 68 años (OR: 2.2; IC: 1.2-4,0; p = 0.01) fueron sus predictores. La reperfusión exitosa (OR: 0.2 IC: 0.005-0.7; p = 0.02) y la presentación de Killip y Kimball (KK) A (OR: 0.0002 IC: 0.00001-0.003; p = < 0.00001) fueron factores protectores. El 88.7% (110) se complicó el primer día de internación y todos (con excepción de un solo paciente) dentro de las 48 horas. Las complicaciones post IAMCEST son muy frecuentes, suceden dentro de los primeros dos días de internación y la IC es la más prevalente. Detectamos un grupo con menor riesgo que podría tener una internación abreviada de solo 48 horas.

Abstract Although ST-segment elevation myocardial infarction (STEMI) mortality decreased with the progress of reperfusion, the incidence of hospital complications has not changed. We aimed to describe the incidence of STEMI complications in the coronary unit, the timing of their occurrence and to identify their predis posing and protective factors. This is a prospective analysis of all consecutive patients with STEMI admitted to a coronary care unit of a third level reference hospital from September 2017 to March 2020. Of the 263 STEMI, 124 developed complications (47.2%), and the most frequent was heart failure. In the multivariate analysis, pre-admission cardiac arrest (CA) (OR: 9.8; CI: 1.2-81.9; p = 0.03), left ventricular ejection fraction (Fey VI) < 40% (OR: 2.3 CI: 1.3-3.9; p = 0.004) and age > 68 years (OR: 2.2; CI: 1.2-4.0; p = 0.01) were predictors of complica tions. Successful reperfusion (OR: 0.2 CI: 0.005-0.7; p = 0.02) and the presentation of Killip and Kimball (KK) A (OR: 0.0002 CI: 0.00001-0.003; p = < 0.00001) were protective factors. Most complications occurred on the first day (88.7%) and in all but one patient within the first 48 hours. Acute complications of STEMI occurred very frequently and the most prevalent was heart failure. KKA and successful reperfusion are low risks predictors, while 6 out of 10 patients with Fey VI < 40%, Cardiac arrest before admission or age >68 years suffered an event. Almost all complications happened within the first 48 hours.

Practical guidance for healthcare professionals during the COVID-19 pandemic; with special emphasis on the care of cardiovascular patients and personal protection

A novel, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing the COVID-19 pandemic. There are concerns regarding the spread of disease by asymptomatic carriers to healthcare workers who continue to see patients and to perform procedures on them. The infection then could be transmitted through them to other patients who eventually, could infect persons in the community. Further, limitations of existing tests to detect new cases that are negative early in the disease; and the inability to use appropriate personal protection equipment (PPE)also contribute to the spread of infection. This document, from the COVID-19 Working Group of Wellness and Radial Intervention Society, describes considerations for management and care of cardiovascular disease (CVD) patients with the concept of COVID 19 `designated` Vs. enabled` centers for those with symptoms of and/ or confirmed COVID-19 disease Vs. asymptomatic suspects. It also provides guidance to healthcare professionals, hospital administrators, and policymakers in general and to those managing patients with CV and other diseases, regarding the concept of `levels of personal protection` for staff; with suggestions for `equivalent innovative alternatives`, and a` protection plan` for patients to prevent the spread of disease. The guidance can also be broadly applied to surgical branches in general and to other specialties involved with invasive, semi-invasive, and non-invasive procedures such as gastroenterology, urology, anesthesiology, otolaryngology, and ophthalmology which carry a higher risk of exposure for healthcare professionals.

Prevalence of elderly patients who refuse to get discharge from coronary intensive care unit in a tertiary care hospital of North India: a pilot study

Background: The elderly population ≥60 years is increasing as the life span is increasing. So is the number of elderly patients who are refusing to get discharge from the hospital is also increasing. Authors are conducting this study in the elderly population who want to stay against medical advice.The aim to find the prevalence of elderly patients who refuse to get discharge from Coronary Care Unit (CCU) in a Tertiary care hospital of North IndiaMethods: A retrospective, observational study conducted in patients of age ≥60 years admitted to the coronary intensive care unit of a tertiary health care centre who refused discharge from the unit, were included in the study. Results: Of the 575 patients 44(7.65%) were willing to stay against medical advice. Of these 24(54.5%) were males and 20(45.5%) females. 6(13.6%) patients were terminally ill suffering from malignancies. Among all the patients who were willing to stay against medical advice, 8(18.2%) were covered by some health insurance scheme of either State or Central Government. 3(6.8%) patients were discharged after 24 hours, 22(50%) patients after 48 hours, 14(31.9%) patients after 72 hours and 5(11.3%) patients after 96 hours of advising discharge from hospital.Conclusions: As the intensive care beds at tertiary healthcare level are limited, the treatment of other salvageable sick patients who need the intensive care is affected by the unnecessary stay in hospital. Apart from the worsened nurse to patient ratio this increases the cost of treatment. This is need of hour to provide safe environment for the elderly outside the hospital settings and increase resources to provide better homecare.

Measuring professional satisfaction and nursing workload among nursing staff at a Greek Coronary Care Unit / Avaliação da satisfação profissional e carga laboral das equipes de enfermagem nas Unidades de Cuidados Coronarianos Gregas / Evaluación de la satisfacción profesional y de la carga laboral del personal de enfermería en las Unidades Griegas de Cuidados Coronarios

ABSTRACT Objective To explore potential associations between nursing workload and professional satisfaction among nursing personnel (NP) in Greek Coronary Care Units (CCUs). Method A cross-sectional study was performed involving 66 members of the NP employed in 6 randomly selected Greek CCUs. Job satisfaction was assessed by the IWS and nursing workload by NAS, CNIS and TISS-28. Results The response rate was 77.6%. The reliability of the IWS was α=0.78 and the mean score 10.7 (±2.1, scale range: 0.5-39.7). The most highly valued component of satisfaction was “Pay”, followed by “Task requirements”, “Interaction”, “Professional status”, “Organizational policies” and “Autonomy”. NAS, CNIS and TISS-28 were negatively correlated (p≤0.04) with the following work components: “Autonomy”, “Professional status”, “Interaction” and “Task requirements”. Night shift work independently predicted the score of IWS. Conclusion The findings show low levels of job satisfaction, which are related with nursing workload and influenced by rotating shifts.

RESUMO Objetivo Explorar as potenciais associações entre a carga laboral e a satisfação profissional das equipes de enfermagem nas Unidades de Cuidados Coronarianos Gregas. Método Estudo transversal com 66 membros das equipes que desenvolvem suas atividades em seis diferentes unidades, selecionadas aleatoriamente. A satisfação no trabalho foi avaliada pelo Index of Work Satisfaction (IWS) e a carga laboral pelo Nursing Activities Score (NAS), Comprehensive Nursing Antervention Score (CNIS) e Therapeutic Intervention Scoring System-28 (TISS-28). Resultados A taxa de resposta foi de 77.6%. A confiabilidade do IWS foi de α=0.78 e a média 10.7 (±2.1,intervalo:0.5-39.7). O componente de satisfação mais valorizado foi “Remuneração”, seguido por “Requisitos da Tarefa”, “Interação”, “Status Profissional”, “Políticas Organizacionais” e “Autonomia”. NAS, CNIS e TISS-28 foram correlacionados negativamente (p≤0.04) com os seguintes componentes de trabalho: “Autonomia”, “Status Profissional”, “Interação” e “Requisitos da Tarefa”. O trabalho no turno noturno definiu independentemente o índice de IWS. Conclusão Os resultados mostraram níveis baixos de satisfação no trabalho, que estão relacionados com a carga laboral e influenciados pelos turnos rotativos.

RESUMEN Objetivo Explorar las asociaciones potenciales entre la carga laboral y la satisfacción profesional del personal de enfermería en las Unidades Griegas de Cuidados Coronarios. Método Estudio transversal en 66 miembros das equipes, seleccionados al azar, que están empleados en 6 diferentes unidad griegas. La satisfacción en el trabajo se evaluó por el Index of Work satisfaction (IWS) y la carga laboral pelo Nursing Activities Score (NAS), Comprehensive Nursing Intervention Score (CNIS) y Therapeutic Intervention Scoring System-28 (TISS-28). Resultados La tasa de respuesta fue del 77,6%. La fiabilidad del IWS fue de α=0,78 y la media 10,7(±2,1, rango de escala:0,5-39,7). El componente de la satisfacción más valorado fue “Salario”, seguido de “Requisitos de la tarea”, “Interacción”, “Estatus Profesional”, “Políticas Organizacionales” y “Autonomía”. NAS, CNIS y TISS-28 se correlacionaron negativamente (p≤0.04) con los siguientes componentes de trabajo:”Autonomía”, “Estatus Profesional”, “Interacción” y “Requisitos de la tarea”. El trabajo en el turno nocturno definió independientemente el índice de IWS. Conclusión Los resultados muestran bajos niveles de satisfacción en el trabajo del personal de enfermería que están relacionados con la carga laboral e influenciados por los turnos rotativos.

The Pattern of Cardiac Disease at Coronary Care Unit of Dhaka Medical College Hospital.

Background: Epidemiological transition which is taking place in every part of the world, among all races, ethnic groups and cultures has resulted in the global rise in cardiovascular disease (CVD). Cardiovascular disease is the leading cause of morbidity and mortality throughout the world. We tried to assess the pattern of cardiac disease at coronary care unit (CCU) of tertiary care hospital. Methods: A cross sectional study conducted among the patients admitted at CCU of Dhaka Medical College Hospital (DMCH) during the period of 1st January 2010 to 31st December 2010. A total of 2415 patients were included in the study. Results: A total 2415 patients in the year 2010, were admitted at CCU of DMCH, among them 56% (n=1346) were male and 44% (n=1069) were female. Out of total admitted patients 220 (9%) were below 30 years of age and 588 ( 24%) & 1607 (67 %) were the age group of 31 to 44 years and 45 years and above age group respectively. Among the disease group ischemic heart disease( IHD) (45%) was the most common cause of hospitalization followed by heart failure (HF) (16%) valvular heart disease (9%), hypertension (7%) and arrhythmia (2%). Acute myocardial infarction (30 %) was the leading cause of IHD followed by unstable angina (15%). Conclusion: This study has found that almost three-quarters of cardiac disease were due to IHD, HF and valvular heart disease in decreasing order of frequency. Countries like Bangladesh can be able to spend very little resources to address those cardiovascular diseases. Along with public as well as private sector efforts, public awareness about the risk factors for cardiovascular diseases should be improved to reduce this sort mortality and morbidity.

Significados de la experiencia de una enfermera con su madre hospitalizada en una unidad intensiva coronaria / Meanings of the experience of a nurse with her mother hospitalized in an intensive coronary unit

El ingreso de un paciente a una Unidad de Cuidados Intensivos (UCI), es un acontecimiento estresante para los miembros de la familia y las experiencias que viven al separarse resultan traumáticas, pero pocas veces son acogidas por los profesionales del staff clínico. Se realizó un estudio de caso para develar la experiencia de una enfermera cuya madre estuvo hospitalizada en una unidad de cuidados intensivos coronaria, para contribuir a generar conocimiento comprensivo en enfermería sobre este fenómeno y aportar a la humanización del cuidado de los familiares. Metodología: Para ello, se aplicó el método de investigación cualitativa de aproximación fenomenológica de Husserl. Se entrevistó en profundidad a una enfermera, quien firmó previamente un consentimiento informado. El proceso de análisis fue realizado basado en Streubert & Carpenter y triangulado con investigadores expertos. Resultados: Se develaron cuatro grandes unidades de significado. La experiencia de tener a su madre hospitalizada en una UCI significa: (1) vivir como un divagar de sentimientos en torno a la muerte, (2) significa, también, una incapacidad de desvincularse del rol de enfermera y tener conciencia de gravedad, (3) significa contar con diferentes apoyos y, por último, significa un (4) cambio de roles al interior de la familia. Conclusión: Se evidencian los aspectos más importantes para realizar intervenciones de cuidados de enfermería personalizados considerando los aspectos emocionales y psicológicos de acuerdo a las singularidades de la enfermera como familiar de paciente hospitalizado en una unidad de paciente crítico.

A patient admitted in an Intensive Care Unit (ICU) is a stressful event for the members of a family, the experiencesbe separated can be traumatic, but rarely are understood by clinical staff. A case study was conducted to reveal the experience of a nurse whose mother was in a Coronary Intensive Care Unit in order to contribute to the construction of comprehensive knowledge in Nursing about this phenomenon, and make a contribution in the humanization of caring for family. Methodology: was applied a qualitative investigation method of approximation phenomenological from Husserl In depth was interviewed a nurse who previously signed an informed consent. The process of analysis was performed based on Streubert & Carpenter and triangulated with expert researchers. Results: Four major units of meaning were unveiled. The experience of having her mother hospitalized in an ICU means: (1) live as a ramble from feelings about death, (2) also means an inability to disengage from the role of nurse and be aware of gravity, (3) means having diff erent supports and fi nally, means a (4) Change of roles within the family. Conclusion: The results indicated the most important interventions of nursing care considering the custom and human emotional and psychological aspects according to the singularities of the nurse as a relative of an ill patient in a critical inpatient unit.

A quantitative study on work-related stressors of night shift nurses’in coronary care unit / 现代临床护理

Objective To explore the work-related stressors of night shift nurses’in coronary care unit(CCU).Method Semi-structured interviews were conducted among 6 night shift nurses in CCU with phenomenological method to analyze work experience of night shift.Result CCU night shift nurses’work-related stressors were found to be horror,frustration,overwork,interpersonal communication stress and shortage of work experience.Conclusion Strengthening psychological communication and emergency training to nurses,adopting incentive mechanism and organization support can relieve nurses’physical and psychological stress and improve work initiative.

Características clínico epidemiológicas de pacientes con infarto miocárdico agudo / Clinical-epidemiological characteristics of acute myocardial infarction patients

Introducción: la cardiopatía isquémica, y entre estas el Infarto Agudo del Miocardio con elevación del segmento ST, es la primera causa de muerte a nivel mundial. Objetivo: describir las características clínico epidemiológicas de pacientes con infarto agudo del miocardio de la unidad de cuidados coronarios del Hospital General Docente Abel Santamaría Cuadrado de Pinar del Río, en 2011 y 2012. Material y Método: estudio observacional, descriptivo, retrospectivo transversal; universo 644 pacientes ingresados con elevación del ST. Los datos se tomaron de las historias clínicas. Resultados: 62% tenían entre 60- 79 años. 84.5% de los pacientes entre 30 y 49 años eran hombres. 81,6% fumaba y el 45,5% era diabético. La localización topográfica del infarto fue: inferior el 70,8%, anterior el 22,9% y anterior extensa el 6,2% de los pacientes. Como complicación, la arritmia se presentó en el 34% de los pacientes, la insuficiencia cardiaca en el 14,9% y la muerte en 7,7%. El 68,5% de los pacientes con arritmias tuvo fibrilación auricular. La trombolisis se empleó en el 55,2% de los pacientes apareciendo, entre las complicaciones, la hipotensión en el 30,7%. Conclusiones: el infarto miocárdico agudo fue más frecuente en pacientes de mayor edad, siendo antes de los 50 años cinco veces más frecuente entre los hombres. Los factores de riesgo más representados fueron el hábito de fumar y la diabetes mellitus. La localización más frecuente fue la inferior y la complicación las arritmias y dentro de estas la fibrilación auricular. La trombolisis se complica principalmente con hipotensión, pudiendo ser más empleada.

Introduction: ischemic cardiopathologies, and particularly high ST-segment acute myocardial infarction, constitute the first death cause in the world. Objective: to describe the clinical-epidemiological characteristics of acute myocardial infarction patients from the coronary care unit at Abel Santamaría Cuadrado Teaching General Hospital, in 2011 and 2012. Material and method: observational, descriptive, retrospective cross-sectional study; target group of 644 admitted patients with ST elevation. The data was taken from clinical records. Results: 62% of the patients were at ages 60-79 years, while 84.5% at ages 30-49 years were male. 81.6% were smokers, and 45.5% were diabetics. Topographical localization of the infarctions was: 70.8% of patients with inferior, 22.9% with anterior, and 6.2% with extended anterior. As complications, arrhythmia occurred in the 20% of patients, myocardial insufficiency in 14.9%, and death in 7.7%. 68.5% of patients with arrhythmias had atrial fibrillation. Thrombolysis was used in the 55.2% of patients; low blood pressure occurred as a complication in 30.7% of the cases. Conclusions: acute myocardial infarction was more frequent in older patients, being, at ages under 50 years, five times more frequent in male. The most represented risk factors were smoking and diabetes mellitus. The interior localization was the most frequent, as were arrhythmias among complications and atrial fibrillation in turn among them. Thrombolysis was complicated chiefly by high blood pressure; it would otherwise have been more used.

Expressão não verbal do paciente no cuidado: percepção do enfermeiro em unidade cardiointensiva / No verbal expression from the patient in care: perception of the nurse in cardio intensive care unit

Este estudo trata da percepção de enfermeiros relativa à observação, à identificação e à análise da comunicação não verbal para traduzir a reação e o sentimento do paciente. Realizado em 2009 em um hospital no Rio de Janeiro com quatorze enfermeiros. RESULTADOS: A comunicação não verbal foi citada no banho no leito (12%), pré-operatório (12%), pós-operatório (12%), admissão (12%), punção venosa (12%), visita familiar (8%), preparo de material (3%), dissecção venosa (3%), aspiração (3%), cardioversão (3%); 18% das enunciações não atendidas referem-se a situações de medo da morte (pré-operatório) e à incapacidade diante do abandono familiar. Os autores destacam que 7% dos pensamentos são representados por palavras, 38%, pela paralinguagem e 55%, pelos sinais corporais. CONSIDERAÇÕES: O enfermeiro observa, identifica e analisa a CNV para traduzir a reação, o sentimento do paciente e as necessidades a serem atendidas pelo cuidado.

That is the perception of nurses related to observation, identification and analysis of non-verbal communication to translate the patient's reaction and feelings during the care provided. Method: Qualitative approach through creative dynamics with fourteen nurses in cardio intensive unit, in Rio de Janeiro's Hospital, in 2009. RESULTS: The non-verbal communications is presented in the bath in bed (12%) preoperative (12%), postoperative (12%), admission (12%), venous puncture(12%), family visit (8%), preparation of material (3%), venous dissection (3%), aspiration (3%), cardio version (3%), 18% of statements missed refer to situations of fear death (preoperative) and the inability against family abandonment. DISCUSSION: There is a validation that 7% of the thoughts are represented by words and 93% by body signals. Considerations: the nurse observes, identifies and analyses the NCV to translate the reaction, the patient's feeling and needs to be met by care.

El estudio trata de la percepción de los enfermeros sobre la observación, identificación y análisis de la comunicación no verbal del paciente para traducir la reacción y el sentimiento durante el cuidado prestado. Método: Abordaje cualitativo, a través de dinámicas creativas con catorce enfermeros de la unidad cardio-intensivista, en un hospital de Rio de Janeiro, en 2009. RESULTADOS: La comunicación no verbal se presenta en el baño en la cama (12%), preoperatorio (12%), postoperatorio (12%), admisión (12%), punción venosa (3%), aspiración (3%), cardioversión (3%), 18% de no atendidas se refiere a situaciones de miedo frente la muerte (preoperatorio) y la incapacidad frente al abandono familiar. DISCUSIÓN: Ha validación de que 7% de los pensamientos son representados por palabras, y un 93% por los señales corporales. Consideraciones: el enfermero observa, identifica y analiza la CNV para traducir la reacción, el sentimiento del paciente y las necesidades que sean atendidas por el cuidado.

Drug utilization study in intensive coronary care unit of a tertiary care teaching hospital.

Background: Critically ill patients are admitted in Intensive coronary care unit. The intensive coronary care unit (ICCU) is a setting where a large number of drugs are administered to patients. Information on drug utilization in intensive coronary care units (ICUs) are lacking in India. Objectives: To identify pattern of drug use and suggest measures. Methods: Prospective drug utilization study was conducted in patients admitted in ICCU for six months. Data was collected in previously prepared case record form. Data was recorded from the admission of patient in ICCU to discharge from ICCU. Analysis was done by using drug use indicators, age and sex wise distribution, morbidity pattern of disease, frequency of drug use, cost of drug therapy and length of stay. Data analysed using Microsoft Excel. Total 605 cases were analysed. Results and Interpretation: Mean ± SD6 of age of all patients being admitted in ICCU is 57.05 ± 11.92 years. Most frequent morbidity found is myocardial infarction. Average number of drugs per encounter is 14.85. Percentage of encounters with an antibiotic and injection prescribed is 27.44% and 98.68% respectively. 34.46% drugs are prescribed by generic name and 43.75% drugs were prescribed from WHO essential drug list. Most commonly prescribed drug is Tablet Aspirin. Frequent injections used are promethazine, heparin, hydrocortisone, buprenorphine, streptokinase, metoprolol, Pentazocin and frusemide. Average drug cost per encounter is 867.84 Rs. 65.38% cost is spent on fibrinolytics. Conclusion: Average number of drugs per encounter is high it should be kept low whenever possible. From all drugs prescribed 42.66% drugs were parenteral. Percentage of drug prescribed by generic name is less. Drugs should be prescribed by generic name. Cost of drugs spend by patient is high. Antibiotics are less frequently prescribed. The mortality rate is low. Essential drug list for ICCU should be prepared. Seminar or group discussion can be done with health professionals working in ICCU to discuss drug utilization pattern for further improving prescribing pattern.