Trends in Medical and Device Therapies Following Incident Heart Failure in Denmark during 1996-2019: A Nationwide Register-Based Follow-Up Study.

Introduction: Data on temporal trends in guideline-based medical and device therapies in real-world chronic heart failure (HF) patients are lacking. Methods: Register-based nationwide follow-ups of temporal trends in characteristics, guideline-recommended therapies, one-year all-cause mortality, and HF rehospitalizations in incident HF patients in Denmark during 1996-2019. Results: Among 291,720 incident HF patients, the age at the onset of HF was stable over time. While initially fairly equal, the sex distribution markedly changed over time with more incidents occurring in men overall. Hypertension and diabetes increased significantly over time, while other comorbidities remained stable. Between 1996 and 2019, significant increases in angiotensin-converting enzyme inhibitor and angiotensin II-receptor blocker (ACEi/ARB) therapy (38.2% to 69.9%), beta-blocker therapy (15.5% to 70.6%), and mineralocorticoid receptor antagonist (MRA) therapy (11.8% to 34.5%) were seen. Angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) were introduced in the middle of the past decade, with minor increases but overall low uses: ARNI (2015: 0.1% vs. 2019: 3.9%) and SGLT2i (2012: <0.1% vs. 2019: 3.9%). Between 1999 and 2019, implantable cardioverter-defibrillator (ICD) use increased significantly: 0.1% to 3-4%. Cardiac resynchronization therapy (CRT) use similarly increased between 2000 and 2019: 0.2% to 2.3%. Between 1996 and 2019, one-year all-cause mortality decreased significantly: 34.6% to 20.9%, as did HF rehospitalizations (6% to 1.3%). Conclusions: Among 291,720 incident HF patients in Denmark during 1996-2019, significant increases in the use of ACEi/ARB, beta-blockers, MRAs, and devices were seen, with concurrent significant decreases in the one-year all-cause mortality and HF rehospitalization rates. The use of CRT, ARNI, and SGLT2i remained low, and MRAs were relatively underutilized, thereby representing future targets to potentially further improve HF prognoses.

Feasibility of continuous noninvasive arterial pressure monitoring in a prehospital setting, measurements during emergency transfer.

OBJECTIVES: In severely injured or acutely ill patients close monitoring of blood pressure (BP) can be crucial. At the prehospital scene and during transfer to hospital, the BP is usually monitored using intermittent oscillometric measurements with an upper arm cuff every 3-5 min. The BP can be monitored noninvasively and continuously using the continuous noninvasive arterial pressure (CNAP) device. In this study, we investigated the feasibility of a CNAP device in a prehospital setting. PATIENTS AND METHODS: The study was an observational convenience study. The CNAP device was applied to the patient once in the ambulance and measurements were carried out during transfer to hospital. The primary object was the number of patients in whom the CNAP device could monitor the BP continuously in a prehospital area en route to hospital. RESULTS: Fifty-nine patients were enrolled in this study. Fifty-four (92%) patients had their BP monitored continuously by the CNAP device. The main reasons for missing data were a mean BP below the detectable range, reduced pulse wave caused by constricted arteries in the fingers, or patients' excessive movements. The CNAP device provided continuous measurements after a median of 164.5 s. No complications and no adverse events were observed. CONCLUSION: Continuous measurement of the BP obtained by the CNAP device is feasible and safe in a prehospital setting under potentially difficult conditions.

[Prehospital arterial blood gas analysis after collapse connected to triathlon participation].

Long-distance athletes are at risk of serious fluid and electrolyte disturbances, such as hypernatraemia (dehydration). Recently, cases of serious morbidity have been reported, due to acute exercise-associated hyponatraemia, which can advance to encephalopathy. An arterial blood gas analysis (ABG) was drawn from collapsed athletes at the championship of full-distance triathlon 2015, and different electrolyte imbalances were found. Our findings show that prehospital ABG can assist in differentiating the cause of collapse, and presumably, targeted treatment can be initiated already on scene.