Clinical effect of levosimendan combined with recombinant human brain natriuretic peptide in the treatment of acute heart failure / 重庆医学

Objective To study the clinical effect of levosimendan combined with recombinant human brain natriuretic peptide(rhBNP)on patients with acute heart failure.Methods A total of 100 patients with acute heart failure in the hospital from December 2019 to December 2021 were selected as the research sub-jects.According to different treatment options,the subjects were divided into the control group,levosimendan group,rhBNP group and combined treatment group,with 25 cases in each group.The control group received traditional conventional diuretic,tube expansion and other treatment;the levosimendan group was treated with levosimendan on the basis of the control group;the rhBNP group was treated with rhBNP on the basis of the control group;the combined treatment group was treated with levosimendan and rhBNP on the basis of the control group.The improvement of New York Heart Association(NYHA)classification,death,rehospitaliza-tion rate,6-minute walking distance,improvement of serological indicators and adverse reactions were recor-ded in each group.Results Before treatment,there was no significant difference in baseline data between the groups(P>0.05).On the 1 st and 3 rd day after treatment,the improvement of NYHA classification in the combined treatment group was better than that in the other groups(P<0.05),and the improvement of NY-HA classification in the levosimendan group and rhBNP group was better than that in the control group(P<0.05).The readmission rate within 6 months after treatment in the combined treatment group was lower than that in the other groups(P<0.05).At 5 and 9 days after treatment,the 6-minute walking distance in the combined treatment group was longer than that in the other groups(P<0.05).At 9 days after treatment,the left ventricular ejection fraction(LVEF)in the combined treatment group was higher than that in the other groups(P<0.05),and the level of N-terminal B-type natriuretic peptide(NT-proBNP)in the combined treatment group was lower than that in the other groups(P<0.05).No significant difference was found in the comparison of the occurrence of adverse reactions among the four groups(P>0.05).Conclusion The combina-tion of levosimendan and rhBNP in the treatment of patients with acute heart failure is superior to traditional treatment and monotherapy in early clinical improvement,and dose not increase the incidence of adverse reactions.

Construction of risk prediction model for predicting death or readmission in acute heart failure patients during vulnerable phase based on machine learning / 陆军军医大学学报

Objective To construct risk prediction models of death or readmission in patients with acute heart failure(AHF)during the vulnerable phase based on machine learning algorithms and screen the optimal model.Methods A total of 651 AHF patients with admitted to Department of Cardiology of the Second Affiliated Hospital of Army Medical University from October 2019 to July 2021 were included.The clinical data consisting of admission vital signs,comorbidities and laboratory results were collected from electronic medical records.The composite endpoint was defined as all-cause death or readmission for worsening heart failure within 3 months after discharge.The patients were divided into a training set(521 patients)and a test set(130 patients)in a ratio of 8:2 through the simple random sampling.Six machine learning models were developed,including logistic regression(LR),random forest(RF),decision tree(DT),light gradient boosting machine(LGBM),extreme gradient boosting(XGBoost)and neural networks(NN).Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate the predictive performance and clinical benefit of the models.Shapley additive explanation(SHAP)was used to explain and evaluate the effect of different clinical characteristics on the models.Results A total of 651 AHF patients were included,of whom 203 patients(31.2%)died or were readmitted during the vulnerable phase.ROC curve analysis showed that the AUC values of the LR,RF,DT,LGBM,XGBoost and NN model were 0.707,0.756,0.616,0.677,0.768 and 0.681,respectively.The XGBoost model had the highest AUC value.DCA showed that the XGBoost model exhibited greater clinical net benefit compared with other models,with the best predictive performance.SHAP algorithm analysis showed that the clinical features that had the greatest impact on the output of the model were serum uric acid,D-dimer,mean arterial pressure,B-type natriuretic peptide,left atrial diameter,body mass index,and New York Heart Association(NYHA)classification.Conclusion The XGBoost model has the best predictive performance in predicting the risk of death or readmission of AHF patients during the vulnerable phase.

Effect of acute and chronic glycemic ratio on the prognostic assessment in vulnerable phase of patients with acute heart failure / 中国医师进修杂志

Objective:To explore the effect of acute and chronic glycemic ratio on the prognostic assessment in vulnerable phase of patients with acute heart failure (AHF).Methods:The clinical data of 98 AHF patients who treatment in Nanjing Pukou Hospital of Traditional Chinese Medicine from May 2019 to May 2022 were collected retrospectively, the patients were followed up for 3 months, according to whether adverse events occurred in the vulnerable phase, the patients were divided into adverse prognosis group (31 cases) and non-adverse prognosis group(67 cases). The acute and chronic glycemic ratio was calculated based on the intravenous blood glucose and glycosylated hemoglobin (HbA 1c). The influencing factors of adverse prognosis of AHF patients in vulnerable phase was analyzed by Cox risk proportion model, the predictive value of acute and chronic glycemic ratio on adverse prognosis was evaluated by receiver operating characteristic (ROC) curve. Kaplan-Meier method was used to draw the survival curve and compared the risk of adverse prognosis in patients with different acute and chronic glycemic ratio. Results:The severity of cardiac function grading as well as total cholesterol, urea nitrogen, blood glucose, acute and chronic glycemic ratio, highly sensitive C-reactive protein (hs-CPR), left ventricular anteroposterior diameter, right atrial anteroposterior diameter in the adverse prognosis group were higher than those in the non-adverse prognosis group: (3.88 ± 0.18)mmol/L vs. (3.76 ± 0.24) mmol/L, (9.39 ± 1.07) mmol/L vs. (8.68 ± 1.79) mmol/L, (10.49 ± 2.20) mmol/L vs. (7.64 ± 1.57)mmol/L, 1.37 ± 0.47 vs. 1.04 ± 0.35, (3.85 ± 0.36) mg/L vs. (3.68 ± 0.28) mg/L, (48.47 ± 7.86) mm vs. (45.37 ± 3.56) mm, (47.18 ± 5.04) mm vs. (44.05 ± 6.11) mm, there were statistical differences ( P<0.05). Cox multivariate analysis showed that hypertension, white blood cell count, blood sodium, low density lipoprotein cholesterol, acute and chronic glycemic ratio were the risk factors for adverse prognosis in vulnerable phase ( P<0.05). The area under the curve of acute and chronic glycemic ratio for predicting adverse prognosis in vulnerable phase was 0.718 (95 CI: 0.618 - 0.805, P<0.01), with specificity of 62.7%, sensitivity of 77.4%, and cut-off value of 1.07. According to the cut-off value of acute and chronic glycemic ratio, the patients were divided into acute and chronic glycemic ratio>1.07 group (43 cases), acute and chronic glycemic ratio≤ 1.07 group (55 cases), there was a statistically significant difference in the event free survival between the two groups ( P<0.01). Conclusions:AHF patients who with high acute and chronic glycemic ratio have a high risk of adverse prognosis in the vulnerable phase, which can be used as a predictor of the prognosis patients.

The development of an order set for adults admitted for acute heart failure at a National University Hospital in the Philippines

Background and Objectives@#Heart Failure (HF) remains a major health concern worldwide. In the Philippine General Hospital (PGH), HF is consistently a top cause of mortality and readmissions among adults. The American College of Cardiology (ACC) and European Society of Cardiology (ESC) published guidelines for interventions that improve quality of life and survival, but they are underused and untested for local acceptability. Hospitals overseas used order sets created from these guidelines, which resulted in a considerable decrease in in-hospital mortality and healthcare costs. We aimed to develop an order set for adult patients with acute heart failure (AHF) admitted to the PGH Emergency Department (ED) to improve care outcomes.@*Methods@#This study utilized a mixed methods approach to create the AHF order set. ESC and ACC HF guidelines were appraised using the AGREE II tool. Class I interventions for AHF were included in the initial order set. Through focused group discussions (FGD), clinicians and other care team members involved in the management of AHF patients at PGH ED modified and validated the order set. Stakeholders were asked to use online Delphi and FGD to get a consensus on how to amend, approve, and carry out the order given.@*Results@#Upon review of HF guidelines, 29 recommendations on patient monitoring, initial diagnostic, and therapeutic interventions were adopted in the order set. Orders on subspecialty referrals and ED disposition were introduced. The AHF patient was operationally defined in the setting of PGH ED. The clinical orders fit the PGH context, ensuring evidence-based, cost-effective, and accessible care responsiveness to patients’ needs and suitable for local practice. Workflow changes due to COVID-19 were considered. Potential barriers to implementation were identified and addressed. The final order set was adopted for implementation through stakeholder consensus.@*Conclusion@#The PGH developed and adopted its own AHF order set that is locally applicable and can potentially optimize outcomes of care.

Efecto terapéutico de los inhibidores del cotransportador sodio-glucosa tipo 2 en la insuficiencia cardiaca aguda / Therapeutic effect of sodium-glucose cotransporter type 2 inhibitors in acute heart failure

Resumen La insuficiencia cardiaca aguda es una emergencia que aumenta la mortalidad cardiovascular debido a los síntomas y signos de congestión e hipoperfusión vascular. El manejo actual con diuréticos, inotrópicos y vasopresores mejora el estado clínico; sin embargo, la morbimortalidad asociada a esta patología sigue siendo altamente significativa. Por otra parte, los inhibidores del cotransportador sodio-glucosa tipo 2 (iSGLT2) han demostrado una reducción en la hospitalización y mortalidad cardiovascular en los pacientes con insuficiencia cardiaca crónica. Por ende, el objetivo de este artículo es analizar los efectos clínicos de este grupo farmacológico en la insuficiencia cardiaca aguda, con base en investigaciones científicas. Los hallazgos de estas investigaciones demostraron un beneficio clínico de los iSGLT2 sobre esta patología, con base a parámetros como mortalidad, hospitalización, eventos clínicos, función renal, efecto diurético y concentraciones del biomarcador NT-proBnp, los cuales se detallarán en el presente artículo. Por consiguiente, se concluyó que estos fármacos son seguros sobre la evolución clínica de la insuficiencia cardiaca aguda.

Abstract Acute heart failure is an emergency that increases cardiovascular mortality due to symptoms and signs of vascular congestion and hypoperfusion. Current management with diuretics, inotropes, and vasopressors improves the clinical status; However, the morbidity and mortality associated with this pathology remains highly significant. On the other hand, sodium-glucose cotransporter 2 (SGLT2i) inhibitors have shown a reduction in hospitalization and cardiovascular mortality in patients with chronic heart failure. Therefore, the objective of this article is to analyze the clinical effects of this pharmacological group in acute heart failure, based on scientific research. The findings of these investigations demonstrated a clinical benefit of SGLT2i on this pathology, based on parameters such as mortality, hospitalization, clinical events, renal function, diuretic effect and concentrations of the NTproBnp biomarker, which will be detailed in this article. Therefore, it was concluded that these drugs are safe on the clinical course of acute heart failure.

A Lady with a Broken Heart

Broken-heart syndrome (BHS) is an acute reversible myocardial injury of left or right ventricular myocardium in the absence of coronary occlusion. We, herein, discuss a case of a postmenopausal female presenting with angina equivalent with surface electrocardiogram (ECG) and echocardiography consistent for acute coronary syndrome. The patient was subsequently diagnosed and treated as BHS.

Pharmaceutical care of a critical patient with acute heart failure after PCI by clinical pharmacists / 中国药房

OBJECTIVE To explore the role of clinical pharmacists in the treatment of critical patients with acute heart failure after percutaneous coronary intervention （PCI）， and to provide reference for drug treatment and monitoring of such patients. METHODS Clinical pharmacists participated in the treatment of a critical patient with acute heart failure after PCI， and assisted physicians to jointly develop individualized medication plans based on domestic and foreign literature： it was suggested to give imipenem and cilastatin for anti-infective therapy， adjust drug dose according to renal function， and timely descend step therapy； Levetiracetam tablets were selected to prevent epilepsy； the differential diagnosis and treatment of rhabdomyolysis possibly caused by Atorvastatin calcium tablets were performed； the whole process of pharmaceutical care was conducted. RESULTS Physicians adopted the suggestions of clinical pharmacists. The acute heart failure of the patient was controlled， the pulmonary infection was improved， the adverse reaction symptoms were relieved， and the patient was successfully transferred out of the ICU. CONCLUSIONS For severe patients， when giving imipenem and cilastatin for anti-infection treatment，the clinical pharmacist should adjust the dose according to the patient’s renal function and be alert to the possible neurotoxicity. During the treatment with Atorvastatin calcium tablets，the clinical pharmacist should comprehensively analyze the risk of rhabdomyolysis. For the adverse reactions that have occurred， clinical pharmacist should promptly address symptomatic issues to ensure the safety and effectiveness of medication for patients.

Safety and efficacy of levosimendan in patients with acute heart failure: a prospective, multicenter, and observational study / 中华急诊医学杂志

Objective:To investigate the indication, effectiveness, tolerance, and safety of levosimendan in patients with acute heart failure (AHF) in 20 hospitals in Beijing, China.Methods:This prospective, observational, and multicenter study consecutively enrolled AHF patients who were treated with levosimendan at 20 hospitals in Beijing from April 2020 to March 2022. Baseline demographics, laboratory parameters, clinical presentation, concomitant diseases and medications were collected. After initiation of levosimendan, levosimendan administration, laboratory parameter pre- and post-administration, symptoms improvement, and adverse events were also collected.Results:Totally 800 AHF patients were included, 67% of whom were male, aged (65 ±17) years, 50% of whom had ischemic heart disease, and the left ventricular ejection fraction (LVEF) was (36±11)%. The dose of levosimendan was (11.84 ±2.11) mg and the mean infusion time was (1 450±307) min. Dyspnea was improved in 83.4% of AHF patients at 24 h after treatment. The level of B-type natriuretic peptide (BNP) significantly decreased from 689 (406-1509) pg/mL to 410 (156-697) pg/mL in all patients at 24-72 h after treatment ( P<0.001), and the level of N-terminal pro-brain natriuretic peptide (NT-pro BNP) decreased from 6910 (3 715-13 914) pg/mL to 2 851 (1 288-6 191) pg/mL ( P<0.001). Meanwhile, LVEF level also improved significantly [(40±11)% vs. (36±11)%, P<0.001]. During levosimendan administration, adverse events occurred in 74 (9.3%) patients, including hypotension (5.9%), arrhythmia (1.9%), and other symptoms (1.1%). Among them, 7 patients ( 2 patients with hypotension and 5 patients with ventricular tachycardia) interrupted levosimendan administration. Conclusions:The use of levosimendan is safe, and can improve symptoms reduce BNP or NT-pro BNP levels and increase LVEF level in AHF patients.

Worsening renal function and the plasma B-type natriuretic peptide in prognosis of patients with acute heart failure / 中国综合临床

Objective:To analyze the effects of different plasma B-type natriuretic peptide (BNP) changes on worsening renal function (WRF) on 1-year all-cause mortality in patients with acute heart failure (AHF).Methods:The clinical data of 399 patients with AHF admitted to our hospital from January 2015 to December 2019 were retrospectively analyzed. According to the severity of WRF, the patients were divided into non-severe worsening renal function (nsWRF) group, severe worsening renal function (sWRF) group and non-WRF group. Plasma BNP decrease was defined as a reduction of B-type natriuretic peptide (BNP) at the time of discharge by ≥30% compared with the time of admission.Demographic characteristics and medical history, clinical data at admission, during hospitalization and at discharge, and survival status 1 year after discharge were collected. The measurement data presented in the form of normal distribution are as follows: single factor analysis of variance is used for comparison between groups, and LSD- t test is used for comparison between pairs; The Kruskal Wallis rank sum test was used for the multi group comparison of non normal distribution measurement data, and Wilcoxon rank sum test was used for the pairwise comparison. The comparison of counting data between groups was conducted using χ 2 test. Survival analysis was conducted using the Kaplan Meier method and Log rank test, and the Cox proportional risk regression model was used to analyze the influencing factors of 1-year all-cause mortality in patients. Results:399 cases of AHF were divided into nsWRF group with 68 cases, sWRF group with 82 cases, and nWRF group with 249 cases. 86 cases (21.5%) died within 1 year after discharge. The one-year mortality rate of the sWRF group was higher than that of the nWRF group and nsWRF group [42.7% (35/82) vs 16.1% (40/249), 16.2% (11/68)], and the differences were statistically significant (The χ 2 values were 24.94 and 12.28 respectively, both P<0.001), while there was no statistically significant difference between the nWRF group and the nsWRF group (χ 2=0.00、 P=0.982). The 1-year mortality rate of the nWRF group and sWRF group with decreased BNP during hospitalization was lower than that of the non decreased BNP group [29.1% (6/55) vs 70.4% (19/27), 10.5% (17/162) vs 26.4% (23/87), The χ 2 values are 12.61 and 10.67 respectively, and the P values are <0.001 and 0.001, respectively. The occurrence of nsWRF during hospitalization did not increase the one-year all-cause mortality risk of AHF patients ( P=0.754), but the occurrence of sWRF increased the all-cause mortality risk of AHF patients (odds ratio=2.33, 95% confidence interval: 1.31-4.13, P=0.004). The decrease in BNP during hospitalization reduced the one-year all-cause mortality risk of AHF patients (odds ratio=0.36, 95% confidence interval: 0.23-0.55, P<0.001). Conclusions:NsWRF does not increase the one-year all-cause mortality risk of AHF patients, while sWRF increases the one-year all-cause mortality risk, and a decrease in BNP during hospitalization reduces the one-year all-cause mortality risk.

Early application of Shakubatracvalsartan in elderly patients with acute myocardial infarction and heart failure after interventional therapy / 中华老年医学杂志

Objective:To examine the clinical effect of early administration of Shakubatracvalsartan following early percutaneous coronary intervention(PCI)in patients diagnosed with acute myocardial infarction and acute heart failure.Methods:This study prospectively included 65 patients with acute myocardial infarction and acute heart failure who were admitted to the First People's Hospital of Shangqiu from June 2018 to October 2022.The patients were randomly divided into two groups: the control group(35 cases)and the observation group(30 cases).Both groups received early PCI treatment.After the operation, the control group received oral administration of Benazepril hydrochloride, while the observation group received oral administration of Shakubatracvalsartan for a duration of 8 weeks.The study compared the total treatment efficiency and cardiac function parameters, such as left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVEDD), and clear brain natriuretic peptide precursor(NT-proBNP)as well as myocardial injury markers(creatine kinase isoenzyme MB(CK-MB)and myoglobin(Myo))before and at 8 weeks of treatment between the two groups.Additionally, any adverse effects that occurred during the treatment period were also compared.Results:The total effective rate was 93.33%(28 cases)in the observation group and 71.43%(25 cases)in the control group.The observation group had a higher rate compared to the control group, and this difference was statistically significant( χ2=5.149, P<0.05).Both groups showed an increase in left ventricular ejection fraction, a decrease in left ventricular end-diastolic diameter, and a decrease in N-terminal pro-brain natriuretic peptide.In the observation group, the left ventricular ejection fraction was(48.52±3.28)%, which was higher than the control group's(43.86±2.52)%, and the left ventricular end-diastolic diameter was(46.70±2.88)mm and the N-terminal pro-brain natriuretic peptide was(680.44±87.04)pg/L, which were lower than the control group's(50.46±3.47)mm and(1 715.94±115.41)pg/L, respectively.These differences were statistically significant( t=13.434, 5.287, 5.330, P<0.05 for all).The levels of creatine kinase-MB and myoglobin in both groups were significantly lower after treatment.Specifically, the observation group had levels of(31.42±5.76)U/L and(34.42±5.36)mg/L, which were lower than the levels in the control group of(38.44±4.94)U/L and(43.15±7.46)mg/L.These differences were statistically significant( t=5.287, 5.330, P<0.05 for all).The readmission rate was 10.00%(3 cases)in the observation group and 14.29%(5 cases)in the control group.The readmission rate of the observation group was lower than that of the control group, and the difference was not statistically significant( χ2=0.021, P>0.05). Conclusions:The early administration of Shakubatracvalsartan following early PCI has been shown to effectively enhance cardiac function in patients with acute myocardial infarction and acute heart failure.It also facilitates the repair of myocardial cells and improves the therapeutic outcomes after surgery.

Exploratory study on quantitative analysis of nocturnal breathing patterns in patients with acute heart failure based on wearable devices / 生物医学工程学杂志

Patients with acute heart failure (AHF) often experience dyspnea, and monitoring and quantifying their breathing patterns can provide reference information for disease and prognosis assessment. In this study, 39 AHF patients and 24 healthy subjects were included. Nighttime chest-abdominal respiratory signals were collected using wearable devices, and the differences in nocturnal breathing patterns between the two groups were quantitatively analyzed. Compared with the healthy group, the AHF group showed a higher mean breathing rate (BR_mean) [(21.03 ± 3.84) beat/min vs. (15.95 ± 3.08) beat/min, P < 0.001], and larger R_RSBI_cv [70.96% (54.34%-104.28)% vs. 58.48% (45.34%-65.95)%, P = 0.005], greater AB_ratio_cv [(22.52 ± 7.14)% vs. (17.10 ± 6.83)%, P = 0.004], and smaller SampEn (0.67 ± 0.37 vs. 1.01 ± 0.29, P < 0.001). Additionally, the mean inspiratory time (TI_mean) and expiration time (TE_mean) were shorter, TI_cv and TE_cv were greater. Furthermore, the LBI_cv was greater, while SD1 and SD2 on the Poincare plot were larger in the AHF group, all of which showed statistically significant differences. Logistic regression calibration revealed that the TI_mean reduction was a risk factor for AHF. The BR_ mean demonstrated the strongest ability to distinguish between the two groups, with an area under the curve (AUC) of 0.846. Parameters such as breathing period, amplitude, coordination, and nonlinear parameters effectively quantify abnormal breathing patterns in AHF patients. Specifically, the reduction in TI_mean serves as a risk factor for AHF, while the BR_mean distinguishes between the two groups. These findings have the potential to provide new information for the assessment of AHF patients.

Effects of recombinant human brain natriuretic peptide combined with levosimendan on cardiac function,myocardial fibrosis and safety in patients with acute heart failure / 中国药师

Objective To explore the effects of recombinant human brain natriuretic peptide combined with levosimendan on cardiac function,myocardial fibrosis and safety in patients with acute heart failure(AHF).Methods 90 patients with AHF admitted to Changzhou First People's Hospital from May 2021 to April 2023 were randomly divided into the intervention group and the control group.The intervention group was treated with recombinant human brain natriuretic peptide combined with levosimendan,and the control group was treated with levosimendan.Both groups were treated for 14 days.Left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)and heart rate(HR)were recorded before and after treatment,and mean arterial pressure(MAP)was calculated.The levels of cardiac troponin T(cTnT)and myocardial creatine kinase isoenzyme(CK-MB)were measured in both groups.The levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and high-sensitivity C-reactive protein(hs-CRP)inflammatory factors were detected in both groups to assess the inflammation of the two groups.Serum soluble human stromal lysin(sST2)and serum fibroblast growth factor-21(FGF-21)levels were detected in both groups to evaluate myocardial fibrosis levels.The incidence of adverse reactions in the two groups was observed to evaluate drug safety.Result A total of 90 AHF patients were included,with 45 cases in the intervention group and 45 cases in the control group.After 14 days of treatment,HR,CK-MB,IL-6,TNF-a,hs-CRP,sST2 and FGF-21 levels of the intervention group were lower than those of control group(P＜0.05),LVEF,cTnT and MAP were higher than those in control group(P＜0.05),and LVEDD level had no statistical difference(P＞0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusions Recombinant human brain natriuretic peptide combined with levosimendan can effectively improve cardiac function and myocardial fibrosis in patients with AHF with good safety.

Construction of nursing pathway and clinical application of an early warning scoring model for elderly patients with acute heart failure based on a modified emergency severity index / 中国中西医结合急救杂志

Objective To enhance the triage efficiency of patients with acute heart failure(AHF)by improving emergency severity index(ESI)score,and to achieve stratified care for patients with AHF.Additionally,the aim is to improve the combination of stratified scores and nursing care in emergency departments to address the limitations of current studies.Methods A retrospective nested cohort study was conducted on 120 patients with AHF admitted to the Affiliated Hospital of Guizhou Medical University from January 1,2019 to December 30,2021.According to the clinical outcomes of the patients,the patients were divided into subgroup A(71 cases,recovered after treatment,no serious complications during treatment),subgroup B[35 cases,discharged after treatment,multiple organ dysfunction syndrome(MODS),acute respiratory distress syndrome(ARDS),shock and other serious complications occurred during treatment],and subgroup C(14 cases,cardiac death during treatment).A prospective randomized controlled study involving 106 patients with AHF admitted to our hospital from January 1 to December 30,2022,was conducted,and the patients were divided into control group(53 cases)and stratified care group(53 cases)according to the random number table method.The control group received routine nursing care,while patients in the stratified care group received stratified care based on the ESI scoring clinical care pathway.The early warning score model of elderly patients with AHF was constructed with risk threshold as warning signal.The improved ESI scoring criteria were used to score AHF patients,with a total score of 25 points.The higher the score,the higher the risk.0-10 is divided into Ⅰ level risk,>10-20 is divided into Ⅱ level risk,>20 is divided into Ⅲ level risk.Implement nuring at grades Ⅲ,Ⅱ,and Ⅰ,respectively.The changes of modified ESI scores in subgroup A,subgroup B and subgroup C were observed,and Spearman correlation coefficient was used to evaluate the correlation between modified ESI scores and clinical outcomes of different severity of disease.Receiver operator characteristic curve(ROC curve)was drawn to evaluate the effectiveness of the risk threshold classification method of different nursing plan designs in the stratified nursing group and the control group,and to compare the efficiency differences of emergency nursing rescue time,rescue success rate,and stay time in the emergency department,and the incidence of complications such as MODS,ARDS,shock and nursing satisfaction during treatment between the stratified nursing group and the control group.Results The modified ESI score in subgroup C was the highest,significantly higher than that in subgroup B and A(19.6±1.7 vs.17.8±1.5,15.3±1.3,all P<0.05).Spearman correlation analysis showed that the modified ESI score was significantly positively correlated with the occurrence of complications,the occurrence of cardiac death,and the recovery after treatment(r values were 0.623,0.635,0.322,P values were 0.004,0.003,0.012,respectively).Therefore,an improved ESI score has a certain early warning effect on complications and cardiac death of patients.ROC curve analysis showed that the area under the ROC curve(AUC)of routine care for stratified care was 0.710 and 0.620,and the 95％ confidence interval(95％ CI)was 0.620-0.750 and 0.580-0.690,respectively,with Pvalues of 0.023 and 0.034.It shows that the difference between the two nursing methods is significant,and further indicates that the risk threshold classification method designed in this study is effective.With the increase of risk,the rescue time and emergency stay time of the two groups were gradually extended,and the success rate of rescue was gradually decreased,the rescue time and emergency stay time of grade Ⅲ risk were the longest and the success rate of rescue was the lowest,and the rescue time and emergency stay time of the stratified nursing group were significantly shorter than those of the control group(minutes:59.6±6.3 vs.76.5±7.2 and 57.6±5.4 vs.68.2±7.1,both P<0.05),the success rate of rescue was significantly increased[(68.7±6.1)％ vs.(54.6±5.2)％,P<0.05],and the difference of rescue time between grade Ⅰ risk and grade Ⅲ risk was the largest.There were significant differences in the success rate of rescue and the duration of emergency stay in grade Ⅲ risk.The incidence of complications such as MODS,ARDS and shock in stratified care group was significantly lower than that in control group[incidence of MODS:13.2％(7/53)vs.18.9％(10/53),incidence of ARDS:15.1％(8/53)vs.22.6％(12/53),incidence of shock:13.2％(7/53)vs.20.8％(11/53),all P<0.05],satisfaction of patients with service attitude,operation technique,comfort and timeliness were significantly improved compared with the control group[service attitude:28.3％(15/53)vs.18.9％(10/53),operation technology:30.2％(16/53)vs.20.8％(11/53),comfort:32.1％(17/53)vs.24.5％(13/53),timeliness:32.1％(17/53)vs.24.5％(13/53),all P<0.05].Conclusion Based on the modified ESI score,early risk warning thresholds are divided and stratified nursing is conducted,which is beneficial for timely intervention in AHF,effectively ensuring the clinical nursing value of patients during the implementation of medical measures,and has broad application prospects.

Killip-Kimball classification in octogenarians with acute coronary syndrome: an 11-year experience / Clasificación de Killip-Kimball en octogenarios con síndrome coronario agudo: 11 años de experiencia

Abstract Objective: The objective of the study is to validate the use of the Killip-Kimball classification (KC) as a predictor of outcomes in an octogenarian cohort with acute coronary syndrome. Methods: A retrospective analysis of patients who underwent a catheterization procedure for acute coronary syndrome (ACS) was performed. ACS was defined as per the American Heart Association guidelines, and included ST-elevation myocardial infarction (STEMI), non-STEMI and Unstable Angina. We determined factors associated with the KC upon admission to the emergency room. Likewise, we compared in-hospital mortality, length of stay, and other outcomes dividing the patients by KC. Results: A total of 133 patients with a mean age of 83 years were analyzed and assigned a KC from 1 to 4 according to clinical presentation. Each group included 86, 9, 23, and 15 patients, respectively. In-hospital mortality was 12%, 5% in KC-I, 11% in KC-II, 22% in KC-III, and 40% in KC-IV with a significant difference between classes (p = 0.002). In addition, we found higher KC groups to be associated with acute kidney injury during the hospitalization (p < 0.01). Conclusion: Despite a strong reduction in mortality for elderly patients with ACS in recent decades, patients presenting with ACS and higher KC have a high mortality rate, as described in younger cohorts. KC remains a reliable prognostic tool, with applicability in octogenarian patients.

Resumen Objetivo: Validar el uso de la clasificación de Killip- Kimball como predictor de desenlaces en una cohorte de pacientes octogenarios con síndrome coronario agudo. Métodos: Se realizó un análisis retrospectivo de pacientes sometidos a cateterismo por síndrome coronario agudo (ACS). Se incluyeron infarto al miocardio con y sin elevación del segment ST, así como angina inestable, utilizando las definiciones de la American Heart Association (AHA). Se determinaron los factores que influyeron en la clasificación de Killip-Kimball (KC) al momento de ingreso al hospital. Se comparó la mortalidad, la estancia intrahospitalaria y otros desenlaces, dividiendo a los pacientes por su KC. Resultados: Un total de 133 pacientes se incluyeron en el análisis y se clasificaron dependiendo de su KC (I-IV). Cada grupo incluyó 86, 9, 23 y 15 pacientes, respectivamente. La edad media fue de 83 años. La mortalidad intrahospitalaria fue de 5, 11, 22 y 40%, respectivamente para cada KC, y 12% global. Hubo una diferencia significativa en la mortalidad por clase (p = 0.002). Adicionalmente, se encontró que a mayor KC, mayor riesgo de lesión renal aguda durante la hospitalización (p < 0.01). Conclusión: A pesar de una reducción en la mortalidad de adultos mayores con ACS en décadas recients, pacientes con ACS y mayor KC tienen riesgo aumentado de morir, igual que pacientes en grupos de edad menores. La KC continñua siendo una herramienta confiable para la clasificación y con utilidad pronóstica, con aplicabilidad en pacientes mayores de 80 años.

Nicardipine versus nitroglycerin for hypertensive acute heart failure syndrome: a single-center observational study / Journal of Rural Medicine

Objective: Nitroglycerin is a first-line treatment for hypertensive acute heart failure syndrome (AHFS). However, nicardipine is frequently used to treat hypertensive emergencies, including AHFS. In this study, we compared the effectiveness of nicardipine and nitroglycerin in patients with hypertensive AHFS.Patients and Methods: This single-center, retrospective, observational study was conducted at the intensive care unit of a Japanese hospital. Patients diagnosed with AHFS and systolic blood pressure 140 mmHg on arrival between April 2013 and March 2021 were included. The outcomes were the time to optimal blood pressure control, duration of continuous infusion of antihypertensive agents, duration of positive pressure ventilation, need for additional antihypertensive agents, length of hospital stay, and body weight changes. Outcomes were compared between the nicardipine and nitroglycerin groups. We also compared these outcomes between the groups after excluding patients who received renal replacement therapy.Results: Fifty-eight patients were enrolled (26 and 32 patients were treated with nitroglycerin and nicardipine, respectively). The nicardipine group had a shorter time to optimal blood pressure control (2.0 [interquartile range, 2.0–8.5] h vs. 1.0 [0.5–2.0] h), shorter duration of continuous anti-hypertensive agent infusion (3.0 [2.0–5.0] days vs. 2.0 [1.0–2.0] days), less frequent need for additional anti-hypertensive agents (1 patients [3.1%] vs. 11 patients [42.3%]), and shorter length of hospital stay (17.5 [10.0–33.0] days vs. 9.0 [5.0–15.0] days) than the nitroglycerin group. The duration of positive pressure ventilation and body weight changes were similar between the groups. The outcomes were similar after excluding patients who received renal replacement therapy.Conclusion: Nicardipine may be more effective than nitroglycerin for treating hypertensive AHFS.

Effects of intervention mapping on cardiopulmonary function for patients with acute heart failure in compensatory period / 中国实用护理杂志

Objective:To investigate the effects of intervention mapping on cardiopulmonary function for patients with acute heart failure in compensatory period, so as to provide references for their early rehabilitation activities.Methods:A total of 90 patients with acute heart failure admitted to Fuwai Central China Cardiovascular Hospital from October 2018 to October 2019 were enrolled in the present study. They were divided into experimental group and control group according to draw-lots-method, with 45 cases in each group. The control group received the routine care and activity plan, while the experimental group implemented intervention mapping-based stage early rehabilitation program. The indicators included 6MWT, forced expiratory volume in one second (FEV 1), brain natriuretic peptide (BNP) as well as Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the intervention effects were compared between the two groups. Results:There were no significant differences in FEV 1, 6MWT, BNP and MLHFQ scores between the two groups at admission ( P>0.05). On discharge, FEV 1, 6MWT were (2.17±0.44) L, (273.09±55.80) m in the experimental group, significantly higher than (1.94 ± 0.39) L and (236.44 ± 50.99) m in the control group; the plasma BNP were (676.79 ± 78.75) ng/L in the experimental group, significantly lower than (736.05 ± 78.77) ng/L in the control group; in addition, the physical demention, emotional dimenson, other demension scores and total scores of MLHFQ in the experimental group were (65.39 ± 5.02), (67.56 ± 4.99), (66.05 ± 4.16) and (66.33 ± 2.63) points, significantly higher than (59.79 ± 5.94), (64.33 ± 5.93), (62.76 ± 4.47), (62.36 ± 2.98) points in the control group, the differences were statistically significant ( t values were 2.56-6.51, all P<0.05). Conclusions:Designing and implementing stage early rehabilitation program using intervention mapping can promote cardiopulmonary function and quality of life of patients with acute heart failure in compensatory period.

Takotsubo syndrome in children / 中国小儿急救医学

Takotsubo syndrome (TTS) is an acute and mostly reversible cardiomyopathy that mimics an acute coronary syndrome with systolic dysfunction of left ventricular.Although supraphysiological epinephrine levels have been associated with TTS, the detailed pathophysiology is incompletely understood.According to the distribution of left ventricular wall motion abnormalities, various morphological subtypes have been identified.The ultimate diagnosis depends on cardiac imaging with left ventricular angiography during acute heart catheterization, as well as echocardiography and cardiac magnetic resonance.Management is based on observational data, while randomized multicenter studies are still lacking.Mechanical circulatory support is an emerging strategy for patients with TTS and shock, in order to avoid catecholamines and inotropes in particular.This review provides a general overview of TTS.However, the demographic characteristics, diagnosis, treatment and prognosis of TTS have not been well studied in children.

Effect of emergency heart failure units on readmission and mortality within 6 months after discharge in patients with acute heart failure / 中华急诊医学杂志

Objective:At present, emergency acute heart failure unit has been gradually carried out in China. This study is to analyze the impact of acute heart failure unit on the mortality and readmission rate of acute heart failure (AHF) within 6 months after discharge.Methods:Patients with AHF admitted to Emergency Department and Department of Cardiology, Peking University People's Hospital between December 2019 and December 2020, were prospectively collected. Patients with complicated malignant tumor, stage 4-5 chronic kidney disease, automatic discharge, and incomplete medical history were excluded. The baseline data, past medical history, admission condition, and auxiliary examination were collected. After discharge, the information of oral drugs, hospital readmission and death were collected through outpatient medical records in clinical data center or telephone consultation. Patients were divided into the emergency acute heart failure unit treatment group (emergency AHFU group), emergency routine treatment group (outside AHFU group) and cardiology treatment group according to the different treatment locations. SPSS 25.0 software was used for comparison between groups, and a P<0.05 was considered as statistically significant. ResuIts:A total of 238 patients with AHF were enrolled, 28 patients died in hospital, and 210 patients were followed up. Four cases were excluded from malignant tumor during follow-up, and 6 cases were lost to follow-up. There were 40 cases in the emergency AHFU group, 67 cases in the outside AHFU group, and 93 cases in the cardiology treatment group. According to the prognosis, the patients were divided into the poor prognosis group ( n=83) and good prognosis group ( n=145). The age, sex, vital signs and cardiac function of patients in the emergency AHFU group were basically the same as those in the outside AHFU group at admission, and the proportion of patients in the emergency AHFU group using non-invasive positive pressure ventilation was higher (52.5% vs. 32.8%, P<0.05). The utilization rate of angiotensin converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor enkephalinase inhibitors, β-blockers, diuretics and other oral drugs was higher in the emergency AHFU group after discharge, and patients also had more regular follow-up (95% vs. 79.1%, P<0.05). The 6-month readmission rate (15.0% vs. 40.3%, P<0.05) and the 6-month readmission and mortality composite results of patients in the emergency AHFU group (17.5% vs. 43.3%, P<0.05) were significantly lower than those in the outside AHFU group. COX regression analysis showed that the readmission rate of patients in the emergency AHFU group was lower than that in the outside AHFU group ( OR=2.882, 95% CI:1.267~6.611, P=0.12). Compared with the cardiology treatment group, the AHFU group had higher systolic blood pressure, faster heart rate, NT-probNP level, higher proportion of NYHA grade Ⅳ and Killip grade Ⅲ cardiac function (all P<0.05). The proportion of non-invasive mechanical ventilation in the AHFU group was significantly higher than that in the cardiology treatment group (52.5% vs. 30.1%, P<0.05). After discharge, there were no significant differences between angiotensin converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor enkephalinase inhibitors and β-blockers. There were also no significant differences in readmission and mortality rate 6 months after discharge. Binary logistics regression analysis found that the independent risk factors of AHF were routine emergency treatment, age, female sex, coronary heart disease, and BUN peak. Conclusions:The emergency acute heart failure unit is an independent protective factor for acute heart failure and reduced readmission rates within 6 months and readmission and mortality composite outcomes. Older age, female sex, coronary heart disease and elevated BUN peak are independent risk factors affecting the prognosis of AHF, which should be identified and preventive measures should be taken early.

Diagnóstico matemático del infarto agudo de miocardio y de la falla cardiaca mediante la entropía proporcional / Mathematical Diagnosis of Acute Myocardial Infarction and Failure Using Proportional Entropy

Introducción: Las teorías físicas y matemáticas han permitido el desarrollo de nuevas metodologías diagnósticas de la dinámica cardiaca. Entre estas se encuentra la evaluación de las proporciones de la entropía proporcional para diferenciar la normalidad de la enfermedad cardiaca, aunque su capacidad diagnóstica debe comprobarse en escenarios clínicos críticos específicos, como en la falla cardiaca y el infarto agudo de miocardio. Objetivo: Describir evaluaciones diagnósticas de la dinámica cardiaca en pacientes con infarto agudo de miocardio o falla cardiaca aguda. Métodos: En un estudio a doble ciegos con 20 Holter, 5 normales, 8 con falla cardiaca aguda y 7 con infarto agudo de miocardio, se aplicó un método fundamentado en las proporciones de la entropía tomando los valores máximos y mínimos de la frecuencia cardiaca y el número total de latidos por hora, en un mínimo de 18 horas, generando un atractor numérico. Se evaluó cada dinámica con base en la entropía y sus proporciones. Finalmente, se comparó la precisión diagnóstica del método matemático con respecto al diagnóstico clínico convencional. Resultados: Se diferenciaron matemáticamente los casos normales y patológicos mediante la evaluación en 18 horas con el método descrito, encontrando valores de sensibilidad y especificidad del 100 por ciento y un coeficiente Kappa de uno, indicando una concordancia diagnóstica perfecta del método matemático con respecto al diagnóstico clínico. Conclusiones: Las proporciones de la entropía permiten establecer diagnósticos objetivos de la dinámica cardiaca, diferenciando matemáticamente dinámicas normales de aquellas que presentan infarto agudo de miocardio y falla cardiaca aguda(CU)

Introduction: Physical and mathematical theories have allowed the development of new diagnostic methodologies of cardiac dynamics, as one based on the evaluation of entropy proportions to differentiate normality from cardiac disease, although its diagnostic capacity must be yet determined in specific critical scenarios as acute heart failure and acute myocardial infarction Objective: To describe diagnostic evaluations of cardiac dynamics in patients diagnosed with acute myocardial infarction or acute heart failure. Methods: A blind study was developed with 20 Holter registries; 5 normal, 8 with acute cardiac failure and 7 with acute myocardial infarction. Then, a method based on the proportions of the entropy of the numerical attractors was applied. The maximum and minimum values of the heart rate and the total number of beats per hour were taken for at least 18 hours, with which numerical attractors were generated, which measure the probability of consecutive heart rate pairs. An evaluation of all dynamics was made based on the entropy and its proportions. Finally, a comparison between the diagnostic precision of the mathematical method with respect to the conventional clinical diagnosis was performed. Results: Normal cases were mathematically differentiated from the pathological ones through the evaluation of Holter registries for 18 hours, achieving values of sensitivity and specificity of 100 percent as well as a Kappa coefficient of 1, indicating a perfect diagnostic concordance between the mathematical method to diagnose the cardiac dynamics with respect to the clinical diagnosis. Conclusions: The proportions of entropy allow to establish objective diagnoses of cardiac dynamics, mathematically differentiating normal dynamics from those with acute myocardial infarction and with acute cardiac failure(AU)

Uso de Solución Hipertónica en pacientes con insuficiencia cardiaca aguda como terapia adyuvante a altas dosis de diuréticos / Use of Hypertonic Solution in patients with acute heart failure as adjunctive therapy to high-dose diuretics

Resumen La insuficiencia cardíaca aguda descompensada (ICAD) es una causa común de hospitalización, con repercusiones significativas en los sistemas de salud. El manejo agudo se basa en la reducción de la volemia con diuréticos de asa, sin embargo, un porcentaje de pacientes presenta resistencia o no logra la respuesta clínica esperada con este tratamiento. Una de las medidas que ha comprobado ser efectiva en este contexto, es el uso de solución salina hipertónica (SSH) en conjunto con dosis altas de diuréticos de asa, como medida terapéutica temida por sus posibles repercusiones sobre la función renal y posible sobrecarga de sodio. Objetivos: Determinar si el uso de solución salina hipertónica en pacientes con falla cardiaca aguda e hipervolemia genera un deterioro de la función renal. Determinar la respuesta del Pro-BNP ante el uso de la solución salina hipertónica en pacientes con falla cardiaca aguda como marcador de respuesta terapéutica. Determinar si el uso de solución salina hipertónica aumenta la diuresis sin generar cambios importantes en el sodio. Se muestran datos de pacientes con insuficiencia cardiaca aguda descompensada, que tras no presentar mejoría con altas dosis de diurético de asa en bolo, se les aplicó la solución hipertónica como adyuvante a este tratamiento. Se toma un total de 26 pacientes analizando datos generales clínicos y de laboratorio, se valoran curvas con la respuesta diurética y por parámetros de laboratorio a las 48 y 72 horas. El uso de solución salina hipertónica consigue un aumento de más de un 200% de la diuresis en 24 horas, con un descenso del Pro BNP de más de un 60% a las 48 horas, sin mostrar un cambio importante en los niveles de creatinina, nitrógeno ureico y sodio. Se requirió reposición de potasio en la totalidad de los pacientes. Se concluye que la infusión de furosemida más solución hipertónica es efectiva tanto en disminuir niveles de NT Pro-BNP en los pacientes, como en generar un aumento en el volumen de diuresis. La principal complicación fue la hipokalemia, sin cambios considerables en el valor de sodio, creatinina y nitrógeno ureico séricos.

Abstract Uso de Solución Hipertónica en pacientes con insuficiencia cardiaca aguda como terapia adyuvante a altas dosis de diuréticos Acute decompensated heart failure (AHF) is a common cause of hospitalization, with significant repercussions on health systems. Acute management is based on the reduction of blood volume with loop diuretics; however, a percentage of patients show resistance or do not achieve the expected clinical response with this treatment. One of the measures that has proven to be effective in this context is the use of hypertonic saline (HSS) in conjunction with high doses of loop diuretics, as a therapeutic measure feared due to its possible repercussions on kidney function and possible sodium overload. Objetives: To determine if the use of hypertonic saline in patients with acute heart failure and hypervolemia leads to a deterioration in renal function. To determine the response of Pro-BNP to the use of hypertonic saline in patients with acute heart failure as a marker of therapeutic response. Determine if the use of hypertonic saline increases urine output without causing significant changes in sodium. Data are shown from patients with acute decompensated heart failure, who after not presenting improvement with high doses of bolus loop diuretic, the hypertonic solution was applied as an adjunct to this treatment. A total of 26 patients are taken analyzing general clinical and laboratory data, curves with the diuretic response and by laboratory parameters are evaluated at 48 and 72 hours. The use of hypertonic saline solution achieves an increase of more than 200% in diuresis in 24 hours, with a decrease in Pro BNP of more than 60% at 48 hours, without showing a significant change in creatinine levels, urea nitrogen and sodium. Potassium replacement was required in all patients. It is concluded that the infusion of furosemide plus hypertonic solution is effective both in reducing levels of NT Pro-BNP in patients, and in generating an increase in the volume of diuresis. The main complication was hypokalemia, without significant changes in serum sodium, creatinine, and urea nitrogen.