Multicenter registry and test bed for extended outpatient hemodynamic monitoring: the hemodynamic frontiers in heart failure (HF2) initiative.

Background: Hemodynamic Frontiers in Heart Failure (HF2) is a multicenter academic research consortium comprised of 14 US institutions with mature remote monitoring programs for ambulatory patients with heart failure (HF). The consortium developed a retrospective and prospective registry of patients implanted with a wireless pulmonary artery pressure (PAP) sensor. Goals/aims: HF2 registry collects demographic, clinical, laboratory, echocardiographic (ECHO), and hemodynamic data from patients with PAP sensors. The aims of HF2 are to advance understanding of HF and to accelerate development of novel diagnostic and therapeutic innovations. Methods: HF2 includes adult patients implanted with a PAP sensor as per FDA indications (New York Heart Association (NYHA) Class III HF functional class with a prior hospitalization, or patients with NYHA Class II or brain natriuretic peptide (BNP) elevation without hospitalization) at a HF2 member site between 1/1/19 to present. HF2 registry is maintained at University of Kansas Medical Center (KUMC). The registry was approved by the institutional review board (IRB) at all participating institutions with required data use agreements. Institutions report data into the electronic registry database using REDCap, housed at KUMC. Results: This initial data set includes 254 patients implanted from the start of 2019 until May 2023. At time of device implant, the cohort average age is 73 years old, 59.8% are male, 72% have NYHA Class III HF, 40% have left ventricular ejection fraction (LVEF) < 40%, 35% have LVEF > 50%, mean BNP is 560 pg/ml, mean N-Terminal pro-BNP (NTproBNP) is 5,490 pg/ml, mean creatinine is 1.65 mg/dl. Average baseline hemodynamics at device implant are right atrial pressure (RAP) of 11 mmHg, pulmonary artery systolic pressure (PASP) of 47 mmHg, pulmonary artery diastolic pressure (PADP) 21 mmHg, mean pulmonary artery pressure (mPAP) of 20 mmHg, pulmonary capillary wedge pressure (PCWP) of 19 mmHg, cardiac output (CO) of 5.3 L/min, and cardiac index (CI) of 2.5 L/min/m2. Conclusion: A real-world registry of patients implanted with a PAP sensor enables long-term evaluation of hemodynamic and clinic outcomes in highly-phenotyped ambulatory HF patients, and creates a unique opportunity to validate and test novel diagnostic and therapeutic approaches to HF.

Compassionate Use of REGEN-COV® in Patients With Coronavirus Disease 2019 (COVID-19) and Immunodeficiency-Associated Antibody Disorders.

BACKGROUND: Patients with immunodeficiency-associated antibody disorders are at a higher risk of prolonged/persistent COVID-19 infection, having no viable treatment options. METHODS: A retrospective analysis of patients with primary and/or secondary immunodeficiency-associated antibody disorders who received casirivimab and imdevimab (REGEN-COV®) under emergency compassionate use. Objective were to describe safety and response to REGEN-COV, focusing on the subset of patients who had COVID-19 duration ≥21 days before treatment. RESULTS: Quantitative (change in oxygenation status and/or viral load) and/or qualitative (physician-reported clinical status) outcomes data are reported from 64 patients. Improvement in ≥1 outcome was observed in 90.6% of the overall patient group. Thirty-seven of these had COVID-19 duration ≥21 days before treatment; median time from diagnosis to REGEN-COV treatment was 60.5 days. Of the 29 patients with COVID-19 duration ≥21 days before treatment and available outcome data, 96.6% showed improvement in ≥1 outcome. In the 14 patients with post-treatment reverse transcription-polymerase chain reaction (RT-PCR) results available, 11 (78.6%) reported a negative RT-PCR following treatment, with 5 (45.5%) and 8 (72.7%) patients reporting a negative RT-PCR within 5 days and 21 days of treatment, respectively. Ten of 85 patients (11.8%) experienced serious adverse events; only one was an infusion-related reaction, possibly related to REGEN-COV. Two deaths were reported; neither were attributed to REGEN-COV. CONCLUSIONS: In this retrospective analysis of immunodeficient patients granted REGEN-COV under emergency compassionate use, REGEN-COV treatment was associated with rapid viral clearance and clinical improvement in patients with longstanding COVID-19. Adverse events were consistent with COVID-19 and its associated complications, and due to patients' concurrent medical conditions.

The effects of capital and human resource investments on hospital performance.

Data are employed from a sample of New York hospitals and the Hospital Consumer Assessment Healthcare Providers and Systems database to analyze the effects of capital spending, staffing levels, and salaries on hospital performance. The most striking result is that higher average salaries are associated with lower length of stay, lower mortality rate, and higher satisfaction but are not significantly related to cost per patient. Therefore, it appears that human resource investments may be associated with better patient outcomes without significantly increasing the cost of patient care.

Interhospital helicopter transport for stroke.

INTRODUCTION: The safety, cost efficacy, and time-to-treatment benefit of air transport of stroke patients have been acknowledged. We describe stroke patients transported to our facility by helicopter emergency medical services (HEMS) from a large rural area and compare 2 consecutive 3-year periods. METHODS: A retrospective chart review was conducted of all patients transferred by HEMS to our facility over 6 years. Data collected included patient demographics, pretransport imaging interpretation, final diagnosis, treatment, and outcomes. Trends between period 1 (January 1, 2003'December 31, 2005) and period 2 (January 1, 2006'December 31, 2008) were examined. RESULTS: A total of 347 acute stroke patients were transported by HEMS to our facility. The final diagnosis was intracerebral hemorrhage in 44%, subarachnoid hemorrhage in 24%, subdural hematoma in 14%, ischemic stroke or transient ischemic attack in 9%, and a nonstroke diagnosis in 7% of patients. Conventional cerebral angiography was performed in 28% of patients, and neurosurgical intervention, hematoma evacuation, or aneurysm clipping was performed in 32%. A final diagnosis of ischemic stroke or transient ischemic attack increased 3 times (4% vs. 12%, P < .05) from period 1 to 2. There was also a significant increase in the number of patients receiving intravenous tissue plasminogen activator before transport (0% vs. 3%, P < .01). CONCLUSIONS: The majority of our patients transported by HEMS for the management of acute stroke undergo urgent specialized diagnostics or interventions. This supports the role of interhospital HEMS transport in extending access to care in rural communities.