Insights into clinical studies in cardiac surgery from the American Heart Association’s Scientific Sessions 2021: Part two / 中国胸心血管外科临床杂志

@#In the late-breaking trials session of the American Heart Association’s Scientific Sessions 2021, which took place in November 2021, six clinical trials in cardiac surgery published their primary results. This review will look into three of them including the management of patients with moderate or less-than-moderate tricuspid regurgitation at the time of surgery for degenerative mitral regurgitation, timing of ticagrelor cessation before coronary artery bypass grafting, and long-term outcomes of ticagrelor-based antiplatelet therapy for secondary prevention of coronary artery bypass grafting.

Insights into the clinical studies related to cardiovascular surgery from the American Heart Association’s Scientific Sessions 2021: Part one / 中国胸心血管外科临床杂志

@#In the American Heart Association’s Scientific Sessions 2021, the results of six clinical trials related to cardiovascular surgery were revealed. The PALACS trial demonstrated that posterior left pericardiotomy during open heart surgery was associated with a significant reduction in postoperative atrial fibrillation; the EPICCURE study found that injection of mRNA encoding vascular endothelial growth factor (VEGF-A mRNA) directly into the myocardium of patients undergoing elective coronary artery bypass grafting (CABG) improved patients’ heart function; the VEST trial once again proved the safety and potential value of external stent for vein graft. This article will interpret the above-mentioned three studies.

Atención de Enfermería en el paciente adulto con Paro Cardiorrespiratorio en el Hospital General San Francisco / Nursing care in the adult patient with Cardiorespiratory Arrest at the San Francisco General Hospital

1. INTRODUCCIÓNSegún la Organización Mundial de la Salud (OMS) se registran cada año más de 17 200 000 fallecimientos a nivel del mundo por causas cardiovasculares1-3.La enfermedad coronaria causa habitual de Paro Cardiorrespiratorio (PCR) en adultos4. Los pacientes de mayor riesgo corresponden a 50 y 70 años de edad, en un 70% hombres vs 30% mujeres, el 80% de estos se dan por Fibrilación Ventricular (FV) o Taquicardia Ventricular Sin Pulso (TVSP), datos registrados en 20175-7.En el Ecuador, acorde al Instituto Na-cional de Estadísticas y Censos (INEC) en el año 2019 se registraron 8 779 muertes a causa de isquemias del corazón, convir-tiéndose en la principal causa de morta-lidad general con un 11,80%8.En esta ruta se describe cuál es el papel de la enfermera como parte del equipo de respuesta ante un PCR, con base a las Guías de la American Heart Association (AHA).El procedimiento a seguir está expre-sado en el contexto de la Taxonomía de la North American Nursing Diagnosis Asso-ciation (NANDA), Nursing Interventions Classification (NIC), el nombre y siglas en inglés de la clasificación estandarizada y codificada de las intervenciones de en-fermería y Nursing Outcomes Classifica-tion (NOC), la clasificación de resultados obtenidos luego de los cuidados.

1. INTRODUCTIONAccording to the World Health Organiza-tion (WHO), more than 17 200 000 deaths worldwide are registered each year from cardiovascular causes1-3.Coronary heart disease is a common cause of Cardiorespiratory Arrest (CRP) in adults4 The highest risk patients co-rrespond to 50 and 70 years of age, 70% men vs 30% women, 80% of these are due to Ventricular Fibrillation (VF) or Pulseless Ventricular Tachycardia (PVT), data recorded in 20175-7. In Ecuador, according to the National Ins-titute of Statistics and Censuses (INEC) in 2019, 8 779 deaths were recorded due to ischemia of the heart, becoming the main cause of general mortality with 11.80%8.This route describes the role of the nurse as part of the response team to a CRA, based on the American Heart Association (AHA) Guidelines.The procedure to be followed is expressed in the context of the Taxonomy of the North American Nursing Diagnosis As-sociation (NANDA), Nursing Interven-tions Classification (NIC), the name and acronym in English of the standardized and coded classification of nursing inter-ventions and Nursing Outcomes Classifi-cation (NOC), the classification of results obtained after care.

2017 American College of Cardiology/American Heart Association Clinical Guideline-based Prevalence of Hypertension in a semi-urban community in Nigeria: Public Health Perspective / Guía clínica de 2017 sobre prevalencia de hipertensión del American College of Cardiology/American Heart Association en una comunidad semi-urbana de Nigeria: Perspectiva de Salud Pública

Abstract Background: Evidence from previous studies has consistently revealed that patients develop target organ damage even with seemingly normal blood pressure thus informing the development of a new treatment guideline in 2017. The prevalence of hypertension in Nigeria ranges from 8-45%, however this is expected to change due to the new guideline. Thus, this study sought to estimate the prevalence of hypertension based on 2017 ACC/AHA clinical guidelines, and determine its associated factors. Methods: In this cross-sectional study a total of 296 participants were recruited with a simple random technique using a table of random numbers. Blood pressure, weight and height were measured and data was analysed with SPSS version 22. The primary outcome measures included proportion of respondents with hypertension based on AHA guideline and JNC 7 classifications, as well as the association between hypertension and BMI, age, sex and marital status. Results: The mean age of study participants was 38.71years, and male to female ratio was 2:3. Overall prevalence of hypertension was 63.5% and 22.6% based on the new guideline and JNC 7 classification respectively; higher risk of hypertension was significantly associated with the AHA guideline (p< 0.001). Association between body mass index, marital status (currently married/not married), sex, age group (≥40 vs. < 40years) and systolic as well as diastolic hypertension was significant (p< 0.001). Females were more than twice as likely to be hypertensive as males [OR: 2.51 (1.54 - 4.10)]. Age and weight were the only significant predictors of abnormal blood pressure, diastolic and systolic hypertension. Conclusion: Prevalence of hypertension based on the new guideline is staggeringly high and portends a huge public health problem. This conundrum requires immediate intervention in order to forestall the damaging effects of hypertension on vital body organs and for participants to lead a healthy life.

Resumen Antecedentes: La evidencia de los estudios previos ha revelado, consistentemente, que los pacientes desarrollan daños en los órganos diana aun cuando su presión arterial es aparentemente normal, lo cual ha impulsado el desarrollo de una nueva guía de tratamiento en 2017. La prevalencia de la hipertensión en Nigeria oscila del 8 al 45%, aunque está previsto que cambie, debido a esta nueva guía. En nuestro estudio calculamos la prevalencia de la hipertensión, basada en la guía clínica de ACC/AHA de 2017, y determinamos sus factores asociados. Métodos: En este estudio transversal reunimos a un total de 296 participantes mediante una técnica aleatoria simple, utilizando una tabla de números aleatorios. Medimos la presión arterial, el peso y la altura, y analizamos los datos con SPSS versión 22. Las medidas del resultado primario incluyeron la proporción de respondedores hipertensos, basándonos en la guía AHA y en la clasificación JNC 7, así como en la asociación entre hipertensión e IMC, edad, sexo y estado civil. Resultados: La edad media de los participantes del estudio fue de 38,71 años, siendo el ratio varón:mujer de 2:3. La prevalencia global de la hipertensión fue del 63,5% y del 22,6%, sobre la base de la nueva guía y la clasificación JNC 7, respectivamente. El mayor riesgo de hipertensión se asoció significativamente a la guía AHA (p< 0,001). La asociación entre índice de masa corporal, estado civil (actualmente casados/solteros), sexo, grupo de edad (≥40 vs. < 40 años), e hipertensión sistólica y diastólica fue significativa (p< 0,001). Las mujeres superaron en más del doble a los varones, en cuanto a la probabilidad de padecer hipertensión [OR: 2,51 (1,54 - 4,1)]. La edad y el peso constituyeron los únicos factores predictivos significativos de presión arterial anormal e hipertensión diastólica y sistólica. Conclusión: La prevalencia de la hipertensión basada en una nueva guía es asombrosamente elevada, presagiando un gran problema de salud pública. Este interrogante requiere una intervención inmediata, a fin de prevenir los efectos dañinos de la hipertensión en los órganos vitales, y animar a los participantes a llevar una vida sana.

Interpretation of 2018 American Heart Association Focused Update on Pediatric Advanced Life Support:An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care / 中国实用儿科杂志

In November 2018,the American Heart Association(AHA) updated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The new guideline provided the evidence review and treatment recommendation for antiarrhythmic drug therapy in pediatric shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. The update was carried out by the Pediatrics Working Group of the International Liaison Committee on Resuscitation(ILCOR)for ongoing clinical evidence review. The update continues with the view of 2015's edition that either lidocaine or amiodarone may be used to treat pediatric patients with shock-refractory ventricular fibrillation or pulseless ventricular tachycardia. The flow chart of cardiac arrest for pediatric advanced life support was slightly adjusted.

Diretrizes da american heart association para ressuscitação cardiopulmonar: conhecimento de socorristas / Directrices de la american heart association para resucitación cardiopulmonar: conocimiento de socorristas / American heart association guidelines for cardiopulmonary resuscitation: knowledge of rescuers

Objetivo descrever o conhecimento dos profissionais socorristas sobre o protocolo da American Heart Association para ressuscitação cardiopulmonar. Método estudo descritivo, com abordagem quantitativa, realizado com 40 socorristas de um Serviço de Atendimento Móvel de Urgência. Os dados foram coletados por meio de entrevista estruturada, utilizando-se um formulário construído com base nas recomendações da American Heart Association para ressuscitação cardiopulmonar. Resultados 70% dos entrevistados conhecem a sequência das manobras de ressuscitação cardíaca, 40% não conhecem a frequência e profundidade das compressões torácicas, 55% não sabem a técnica de identificação de parada cardiorrespiratória e 52,5% não sabem o número de ventilações a serem aplicadas durante um atendimento ao paciente em parada cardíaca com via aérea avançada. Conclusão o conhecimento dos socorristas, a despeito das novas diretrizes da American Heart Association para ressuscitação cardiopulmonar, não está atualizado conforme preconiza a entidade, demonstrando, assim, que essas diretrizes ainda não foram implantadas na prática.

Objetivo describir el conocimiento de socorristas sobre el protocolo de la American Heart Association para resucitación cardiopulmonar. Método estudio descriptivo, con enfoque cuantitativo, realizado con 40 socorristas de un Servicio de Atención Móvil de Urgencia. Datos recolectados a través de entrevista estructurada, utilizándose formulario basado en las recomendaciones de la American Heart Association para resucitación cardiopulmonar. Resultados 70% de los entrevistados conocen la secuencia de las maniobras de resucitación cardíaca, 40% no conocen la frecuencia y profundidad de las compresiones torácicas, 55% no saben la técnica de identificación de parada cardiorrespiratoria y 52,5% no saben el número de ventilaciones a aplicarse durante la atención al paciente en paro cardíaco con vía aérea avanzada. Conclusión el conocimiento de los socorristas, mismo con las nuevas directrices de la American Heart Association para resucitación cardiopulmonar, no está actualizado según la preconiza, señalando, así, que esas directrices aún no fueron implantadas en la práctica.

Objective to describe the knowledge of rescuers about the American Heart Association protocol for cardiopulmonary resuscitation. Method designed as a descriptive study with quantitative approach conducted with 40 rescuers from a Mobile Emergency Care Service. Data collection took place through a structured interview using a form designed based on the American Heart Association guidelines for cardiopulmonary resuscitation. Results 70% of the participants know the sequence of cardiac resuscitation steps, 40% do not know the frequency and depth of chest compressions, 55% do not know the cardiorespiratory arrest identification technique, and 52.5% do not know the number of breaths to be given during the care to advanced cardiac arrest patients. Conclusion the knowledge of rescuers, despite the new guidelines of the American Heart Association for cardiopulmonary resuscitation, is not updated as the entity recommends; thus, demonstrating that these guidelines have not yet been implemented in practice.

Application of the 2013 American College of Cardiology/American Heart Association Cholesterol Guideline to the Korean National Health and Nutrition Examination Surveys from 1998 to 2012

BACKGROUND: The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline for the treatment of blood cholesterol recommends statin therapy for individuals at high risk of atherosclerotic cardiovascular disease (ASCVD). The aim of this study was to investigate serial trends in the percentages of Korean adults considered eligible for statin therapy according to the new ACC/AHA cholesterol guideline. METHODS: Data from the Korean National Health and Nutrition Examination Survey (KNHANES) I (1998, n=7,698), II (2001, n=5,654), III (2005, n=5,269), IV (2007 to 2009, n=15,727), and V (2010 to 2012, n=16,304), which used a stratified, multistage, probability sampling design, were used as representative of the entire Korean population. RESULTS: The percentage of adults eligible for statin therapy according to the ACC/AHA cholesterol guideline increased with time: 17.0%, 19.0%, 20.8%, 20.2%, and 22.0% in KNHANES I, II, III, IV, and V, respectively (P=0.022). The prevalence of ASCVD was 1.4% in KNHANES I and increased to 3.3% in KNHANES V. The percentage of diabetic patients aged 40 to 75 years with a low density lipoprotein cholesterol levels of 70 to 189 mg/dL increased from 4.8% in KNHANES I to 6.1% in KNHANES V. People with an estimated 10-year ASCVD risk ≥7.5% and aged 40 to 75 years accounted for the largest percentage among the four statin benefit groups: 9.1% in KNHANES I and 11.0% in KNHANES V. CONCLUSION: Application of the 2013 ACC/AHA guideline has found that the percentage of Korean adults in the statin benefit groups has increased over the past 15 years.

Avaliação de vídeos sobre Suporte Básico de Vida (SBV) publicados no Youtube / Evaluation of Basic Life Support (BLS) videos published on YouTube

O presente trabalho tratará de uma análise de vídeos do YouTube relacionada ao suporte básico de vida de acordo com as diretrizes da American HeartAssociation (AHA) de 2010. O trabalho em questão é uma pesquisa do tipo exploratória, com abordagem quantitativa, realizada no sítio de compartilhamento de vídeos do YouTube, cujo endereço é "www.youtube.com.br, um "site bastante acionado pelos usuários da "internet" para adquirir conhecimentos de qualquer área. Foram analisados 104 vídeos. A média de duração dos vídeos foi de 6 minutos e 21 segundos. Dos 104 vídeos, 40 (38%) estavam de acordo com AHA e 64 (62%) não estavam conforme as diretrizes AHA. Quanto ao número de erros por vídeos os resultados demonstraram que metade dos vídeos analisados apresentaram 3 erros de publicação de acordo com AHA de 2010. Os vídeos analisados perfizeram um total de 148 desconformidades. O não seguimento da sequência CABD foi o erro mais comum observado com 45 (30,4%) aparições. Em relação à autoria dos vídeos, estes foram publicados por organização/instituição, pessoa física e ONG. Os vídeos analisados apresentaram um grande número de visualizações obtendo uma média de 23.829 visualizações... (AU)

This research will deal with an analysis of YouTube videos related to basic life support according to the guidelines of the American Heart Association (AHA) 2010. These is an exploratory research with a quantitative approach, carried out at the site of sharing YouTube videos, whose address is "www.youtube.com.br " a " site " that is very driven by users internet " to acquire knowledge in any field . 104 videos were analyzed. The average length of the videos were 6 minutes and 21 seconds. Of the 104 videos analyzed, 40 (38 %) were in accordance with AHA and 64 (62%) were not in accordance with guidelines AHA. As for the number of errors per video results showed that half of the videos analyzed present 3 Mistakes of publication according to AHA 2010. Videos analyzed resulted in a total of 148 discontinuities in total. Failure to follow the sequence CABD was the most common error observed in 45 (30.4%) appearances. Regarding the authorship of the videos were posted by the same organization / institution, individuals and NGOs. The videos analyzed showed a large number of views getting an average of 23,829 views... (AU)

Evolução das alterações e atualizações do protocolo 2007 da American Heart Association para prevenção da endocardite infecciosa / Evolution of amendments and updates of 2007 protocol of the American Heart Association for prevention of infective endocarditis

Determinados procedimentos odontológicos podem causar bacteremia transitória. Pacientes com condições cardíacas de risco podem desenvolver endocardite infecciosa. Há décadas a American Heart Association (AHA) estabelece recomendações sobre procedimentos odontológicos e condições cardíacas de risco para endocardite, as quais devem receber profilaxia antibiótica. O propósito desta revisão foi descrever a evolução das alterações e divulgar as novas recomendações da AHA para a prevenção da endocardite infecciosa, publicadas em 2007.

Some dental procedures can cause transient bacteremia that in patients with risk cardiac conditions can evolve to infective endocarditis. For decades the American Heart Association (AHA) has been establishing recommendations about the dental procedures and cardiac conditions that bring risk for infective endocarditis, which must receive antibiotic prophylaxis. The purpose of this study is to describe the evolution of the changes and disseminate the new recommendations by the AHAfor the prevention of infective endocarditis which was published in 2007.

Reanimación neonatal: ¿qué hay de nuevo? / Neonatal resuscitation: What is new?

A escala mundial, alrededor de 5 a 10% de recién nacidos requieren algún tipo de asistencia en el momento del nacimiento que puede ir desde maniobras de reanimación tan sencillas como la aspiración de secreciones y estimulación táctil, a otras más complejas como ventilación con presión positiva, compresiones torácicas externas y administración de epinefrina. Esto obliga a difundir un programa de reanimación que proporcione una oportunidad para aprender de manera organizada, apropiada y oportuna, la asistencia a recién nacidos para asegurar su adecuada transición a la vida extrauterina y disminuir los riesgos de daño neurológico. El Programa de Reanimación Neonatal (PRN) constituye un modelo preciso de educación médica de trascendental importancia, pues representa una prioridad dentro de los programas de salud reproductiva. Aquí se presentan las últimas recomendaciones de la Academia Americana de Pediatría y la Asociación Americana del Corazón para actualizar el PRN, basadas en diferentes niveles de evidencia. El conocimiento de las mismas y la destreza de quienes apliquen el programa seguramente ayudarán a disminuir uno de los grandes problemas de salud pública en México: la asfixia neonatal y sus complicaciones.

Worldwide, 5-10% of all newborns require some kind of intervention at birth. Thus, it is important to teach the Neonatal Resuscitation Program (NRP) to all personnel attending deliveries. This program provides a systematic approach to different situations encountered at birth to facilitate neonatal resuscitation. The NRP has been embraced by public health authorities among different countries. In this paper we summarize the most recent recommendations from the American Academy of Pediatrics (AAP) and American Heart Association (AHA) to update the NRP; these are based on different levels of evidence. The knowledge and practice of these recommendations will certainly help to improve neonatal outcomes and to decrease asphyxia and its complications.