المؤلفون: Ruth A. Mathew Kalathil, MD, Akshay Machanahalli Balakrishna, MD, Ahmed El-Shaer, MD, Andrew M. Goldsweig, MD, MS, Khagendra Dahal, MD, Saraschandra Vallabhajosyula, MD, MSc, Ahmed Aboeata, MD

المصدر: Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 8, Iss 3, Pp 276-278 (2024)

مصطلحات موضوعية: Medicine (General), R5-920

الوصف: Coronary artery disease is the most common cause of heart failure, which is the leading cause of cardiovascular-related death worldwide. There are insufficient data to make strong recommendations for percutaneous coronary intervention (PCI) in patients with severe ischemic left ventricular systolic dysfunction (LVSD). In that context, we performed a meta-analysis to compare the outcomes of PCI with those of optimal medical therapy alone in patients with severe ischemic LVSD. A systematic search was conducted in PubMed, EMBASE, and ClinicalTrials.gov from inception to December 2023. Our outcome of interest was all-cause mortality in patients undergoing PCI vs medical therapy. We used random effects models to aggregate data and to calculate pooled incidence and relative risk with 95% CIs. Four studies including 2 randomized controlled trials with 2080 patients (PCI, 1082; optimal medical therapy, 998) were included. All-cause mortality did not differ significantly between the groups: 168 patients (15.5%) in the PCI group vs 200 patients (20.0%) in the optimal medical therapy group (relative risk, 0.88; 95% CI, 0.75-1.09; P=.25). In conclusion, the available evidence indicates that PCI does not improve all-cause mortality in patients with severe LVSD without lifestyle-limiting anginal symptoms. Further data are needed to identify subgroups of patients better served by each modality.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2542454824000250Test; https://doaj.org/toc/2542-4548Test

الوصول الحر: https://doaj.org/article/2bd3be6dfffd4b61a100d2376b2041b4Test

المؤلفون: Saraschandra Vallabhajosyula, MD, MSc, Khansa Ahmad, MD

المصدر: JACC: Advances, Vol 3, Iss 8, Pp 101048- (2024)

مصطلحات موضوعية: acute myocardial infarction, cardiogenic shock, health care delivery, outcomes research, resource utilization, Diseases of the circulatory (Cardiovascular) system, RC666-701, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2772963X24002400Test; https://doaj.org/toc/2772-963XTest

الوصول الحر: https://doaj.org/article/6ea51019b8c646aa814956d533cee730Test

المؤلفون: Payal K. Gurnani, PharmD, FCCM, Brooke Barlow, PharmD, Bryan Boling, DNP, FCCM, Laurence W. Busse, MD, MBA, FCCM, Jose L. Diaz-Gomez, MD, FCCM, Jenna Ford, MD, Gabrielle A. Gibson, PharmD, Ashish K. Khanna, MD, MS, FCCM, Jennifer S. Lee, PharmD, Ryan M. Rivosecchi, PharmD, Katherine M. Spezzano, PharmD, MBA, Nathan Thornton, DNP, Saraschandra Vallabhajosyula, MD, MSc, FCCM, Corey J. Witenko, PharmD, FCCM, Patrick M. Wieruszewski, PharmD

المصدر: Critical Care Explorations, Vol 5, Iss 10, p e0981 (2023)

مصطلحات موضوعية: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9

الوصف: OBJECTIVES:. A number of trials related to critical care pharmacotherapy were published in 2022. We aimed to summarize the most influential publications related to the pharmacotherapeutic care of critically ill patients in 2022. DATA SOURCES:. PubMed/Medical Literature Analysis and Retrieval System Online and the Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update. STUDY SELECTION:. Randomized controlled trials, prospective studies, or systematic review/meta-analyses of adult critically ill patients assessing a pharmacotherapeutic intervention and reporting clinical endpoints published between January 1, 2022, and December 31, 2022, were included in this article. DATA EXTRACTION:. Articles from a systematic search and the Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update were included and stratified into clinical domains based upon consistent themes. Consensus was obtained on the most influential publication within each clinical domain utilizing an a priori defined three-round modified Delphi process with the following considerations: 1) overall contribution to scientific knowledge and 2) novelty to the literature. DATA SYNTHESIS:. The systematic search and Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update yielded a total of 704 articles, of which 660 were excluded. The remaining 44 articles were stratified into the following clinical domains: emergency/neurology, cardiovascular, gastroenterology/fluids/nutrition, hematology, infectious diseases/immunomodulation, and endocrine/metabolic. The final article selected from each clinical domain was summarized following a three-round modified Delphi process and included three randomized controlled trials and three systematic review/meta-analyses. Article topics summarized included dexmedetomidine versus other sedatives during mechanical ventilation, beta-blocker treatment in the critically ill, restriction of IV fluids in septic shock, venous thromboembolism prophylaxis in critically ill adults, duration of antibiotic therapy for Pseudomonas aeruginosa ventilator-associated pneumonia, and low-dose methylprednisolone treatment in severe community-acquired pneumonia. CONCLUSIONS:. This concise review provides a perspective on articles published in 2022 that are relevant to the pharmacotherapeutic care of critically ill patients and their potential impact on clinical practice.

وصف الملف: electronic resource

العلاقة: http://journals.lww.com/10.1097/CCE.0000000000000981Test; https://doaj.org/toc/2639-8028Test

الوصول الحر: https://doaj.org/article/3501dc94a03441e289fba7e7a354e2a7Test

المؤلفون: Saraschandra Vallabhajosyula, MD, Stephanie R. Payne, BA, Jacob C. Jentzer, MD, Lindsey R. Sangaralingham, MPH, Kianoush Kashani, MD, MS, Nilay D. Shah, PhD, Abhiram Prasad, MD, Shannon M. Dunlay, MD, MS

المصدر: Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 5, Iss 2, Pp 320-329 (2021)

مصطلحات موضوعية: Medicine (General), R5-920

الوصف: Objective: To evaluate post–acute care utilization and readmissions after cardiac arrest (CA) and cardiogenic shock (CS) complicating acute myocardial infarction (AMI). Methods: With use of an administrative claims database, AMI patients from January 1, 2010, to May 31, 2018, were stratified into CA+CS, CA only, CS only, and AMI alone. Outcomes included 90-day post–acute care (inpatient rehabilitation or skilled nursing facility) utilization and 1-year emergency department visits and readmissions. Results: Of 163,071 AMI patients, CA+CS, CA only, and CS only were noted in 3965 (2.4%), 8221 (5.0%), and 6559 (4.0%), respectively. In-hospital mortality was noted in 10,686 (6.6%) patients: CA+CS, 1935 (48.8%); CA only, 2948 (35.9%); CS only, 1578 (24.1%); and AMI alone, 4225 (2.9%) (P

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2542454820302605Test; https://doaj.org/toc/2542-4548Test

الوصول الحر: https://doaj.org/article/dc6f80c4db2f4118902fabe895a3c9e4Test

المؤلفون: Jacob C. Jentzer, MD, Anusha G. Bhat, MD, Sri Harsha Patlolla, MBBS, Shashank S. Sinha, MD, MSc, P. Elliott Miller, MD, Patrick R. Lawler, MD, MPH, Sean van Diepen, MD, MSc, Ashish K. Khanna, MD, David X. Zhao, MD, PhD, Saraschandra Vallabhajosyula, MD, MSc

المصدر: Critical Care Explorations, Vol 4, Iss 2, p e0637 (2022)

مصطلحات موضوعية: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9

الوصف: OBJECTIVES:. Mixed cardiogenic-septic shock is common and associated with high mortality. There are limited contemporary data on concomitant sepsis in acute myocardial infarction complicated by cardiogenic shock (AMI-CS). DESIGN:. Observational study. SETTING:. Twenty percent stratified sample of all community hospitals (2000–2014) in the United States. PARTICIPANTS:. Adults (> 18 yr) with AMI-CS with and without concomitant sepsis. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Outcomes of interest included inhospital mortality, development of noncardiac organ failure, complications, utilization of guideline-directed procedures, length of stay, and hospitalization costs. Over 15 years, 444,253 AMI-CS admissions were identified, of which 27,057 (6%) included sepsis. The sepsis cohort had more comorbidities and had higher rates of noncardiac multiple organ failure (92% vs 69%) (all p < 0.001). In 2014, compared with 2000, the prevalence of sepsis increased from 0.5% versus 11.5% with an adjusted odds ratio (aOR) 11.71 (95% CI, 9.7–14.0) in ST-segment elevation myocardial infarction and 24.6 (CI, 16.4–36.7) (all p < 0.001) in non-ST segment elevation myocardial infarction. The sepsis cohort received fewer cardiac interventions (coronary angiography [65% vs 68%], percutaneous coronary intervention [43% vs 48%]) and had greater use of mechanical circulatory support (48% vs 45%) and noncardiac support (invasive mechanical ventilation [65% vs 41%] and acute hemodialysis [12% vs 3%]) (p < 0.001). The sepsis cohort had higher inhospital mortality (44.3% vs 38.1%; aOR, 1.21; 95% CI, 1.18–1.25; p < 0.001), longer length of stay (14.0 d [7–24 d] vs 7.0 d [3–12 d]), greater hospitalization costs (×1,000 U.S. dollars) ($176.0 [$85–$331] vs $77.0 [$36–$147]), fewer discharges to home (22% vs 44%) and more discharges to skilled nursing facilities (51% vs 28%) (all p < 0.001). CONCLUSIONS:. In AMI-CS, concomitant sepsis is associated with higher mortality and morbidity highlighting the need for early recognition and integrated management of mixed shock.

وصف الملف: electronic resource

العلاقة: http://journals.lww.com/10.1097/CCE.0000000000000637Test; https://doaj.org/toc/2639-8028Test

الوصول الحر: https://doaj.org/article/5d00381e74d34e8eb3c8282c6fa15c50Test

المؤلفون: Saraschandra Vallabhajosyula, MD, MSc, Shannon M. Dunlay, MD, MS, Gregory W. Barsness, MD, P. Elliott Miller, MD, Wisit Cheungpasitporn, MD, John M. Stulak, MD, Charanjit S. Rihal, MD, David R. Holmes, Jr., MD, Malcolm R. Bell, MD, Virginia M. Miller, PhD

المصدر: CJC Open, Vol 2, Iss 6, Pp 462-472 (2020)

مصطلحات موضوعية: Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Background: There are limited sex-specific data on patients receiving temporary mechanical circulatory support (MCS) for acute myocardial infarction-cardiogenic shock (AMI-CS). Methods: All admissions with AMI-CS with MCS use were identified using the National Inpatient Sample from 2005 to 2016. Outcomes of interest included in-hospital mortality, discharge disposition, use of palliative care and do-not-resuscitate (DNR) status, and receipt of durable left ventricular assist device (LVAD) and cardiac transplantation. Results: In AMI-CS admissions during this 12-year period, MCS was used more frequently in men—50.4% vs 39.5%; P < 0.001. Of the 173,473 who received MCS (32% women), intra-aortic balloon pumps, percutaneous LVAD, extracorporeal membrane oxygenation, and ≥ 2 MCS devices were used in 92%, 4%, 1%, and 3%, respectively. Women were on average older (69 ± 12 vs 64 ± 13 years), of black race (10% vs 6%), and had more comorbidity (mean Charlson comorbidity index 5.0 ± 2.0 vs 4.5 ± 2.1). Women had higher in-hospital mortality than men (34% vs 29%, adjusted odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.16-1.23; P < 0.001) overall, in intra-aortic balloon pumps users (OR: 1.20 [95% CI: 1.16-1.23]; P < 0.001), and percutaneous LVAD users (OR: 1.75 [95% CI: 1.49-2.06]; P < 0.001), but not in extracorporeal membrane oxygenation or ≥ 2 MCS device users (P > 0.05). Women had higher use of palliative care, DNR status, and discharges to skilled nursing facilities. Conclusions: There are persistent sex disparities in the outcomes of AMI-CS admissions receiving MCS support. Women have higher in-hospital mortality, palliative care consultation, and use of DNR status. Résumé: Contexte: On dispose de peu de données quant à l’influence du sexe sur les résultats pour les patients qui reçoivent une assistance circulatoire mécanique (ACM) temporaire à la suite d’un infarctus aigu du myocarde accompagné d’un choc cardiogénique (IAM-CC). Méthodologie: Nous avons recensé dans l’échantillon national des patients hospitalisés (NIS, National Inpatient Sample) tous les patients admis à l’hôpital pour un IAM-CC qui ont reçu une ACM de 2005 à 2016. Les résultats d’intérêt comprenaient la mortalité hospitalière, l’état à la sortie, le recours aux soins palliatifs et à une ordonnance de non-réanimation (ONR), l’implantation d’un dispositif d’assistance ventriculaire gauche (DAVG) permanent et la transplantation cardiaque. Résultats: Chez les patients admis à l’hôpital pour un IAM-CC durant la période de 12 ans étudiée, l’ACM a été utilisée plus fréquemment chez les hommes que chez les femmes (50,4 % vs 39,5 %; p < 0,001). Sur les 173 473 patients qui ont reçu une ACM (dont 32 % étaient des femmes), les méthodes employées se répartissaient comme suit : ballon de contre-pulsion intra-aortique, 92 %; assistance ventriculaire gauche percutanée, 4 %; oxygénation extracorporelle par membrane, 1 %; et au moins 2 types d’ACM, 3 %. Les femmes étaient plus âgées en moyenne (69 ± 12 ans vs 64 ± 13 ans), étaient plus souvent de race noire (10 % vs 6 %) et présentaient un plus grand nombre d’affections concomitantes (indice de comorbidité de Charlson moyen de 5,0 ± 2,0 vs 4,5 ± 2,1). Le taux de mortalité hospitalière était plus élevé chez les femmes que chez les hommes (34 % vs 29 %, risque relatif approché [RRA] corrigé : 1,19; intervalle de confiance [IC] à 95 % : de 1,16 à 1,23; p < 0,001) dans l’ensemble, ainsi que chez les utilisateurs d’un ballon de contre-pulsion intra-aortique (RRA : 1,20 [IC à 95 % : de 1,16 à 1,23]; p < 0,001), et chez les utilisateurs d’un DAVG percutané (RRA : 1,75 [IC à 95 % : 1,49 à 2,06]; p < 0,001), mais pas chez les utilisateurs de l’oxygénation extracorporelle par membrane ni chez les utilisateurs d’au moins 2 types d’ACM (p > 0,05). Le recours aux soins palliatifs, l’établissement d’une ordonnance de non-réanimation et l’orientation vers un établissement de soins infirmiers spécialisés à la sortie de l’hôpital étaient plus fréquents chez les femmes. Conclusions: Il existe toujours des disparités entre les sexes à l’égard des résultats pour les patients admis à l’hôpital pour IAM-CC recevant une ACM. Le taux de mortalité hospitalière était plus élevé chez les femmes, et celles-ci avaient plus souvent recours à une consultation en soins palliatifs et à une ONR.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2589790X20300706Test; https://doaj.org/toc/2589-790XTest

الوصول الحر: https://doaj.org/article/5b0ca3e3075e4ef4a6a87402f87e214fTest

المؤلفون: Saraschandra Vallabhajosyula, MD, Sri Harsha Patlolla, MBBS, P. Elliott Miller, MD, Wisit Cheungpasitporn, MD, Allan S. Jaffe, MD, Bernard J. Gersh, MBChB, DPhil, David R. Holmes, Jr., MD, Malcolm R. Bell, MD, Gregory W. Barsness, MD

المصدر: Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 4, Iss 4, Pp 362-372 (2020)

مصطلحات موضوعية: Medicine (General), R5-920

الوصف: Objective: To assess the effects of weekend admission vs weekday admission on the management and outcomes of acute myocardial infarction (AMI). Methods: Adult ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) hospital admissions were identified using the National (Nationwide) Inpatient Sample (2000-2016). Interhospital transfers were excluded. Timing of coronary angiography (CA) and percutaneous coronary intervention (PCI) relative to the day of admission was identified. Outcomes of interest included in-hospital mortality, receipt of early CA, timing of CA and PCI, resource utilization, and discharge disposition for weekend vs weekday admissions. Results: Of the 9,041,819 AMI admissions, 2,406,876 (26.6%) occurred on weekends. Compared with 2000, in 2016 there was an increase in weekend STEMI (adjusted odds ratio [aOR], 1.12; 95% CI, 1.08-1.16; P

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S254245482030045XTest; https://doaj.org/toc/2542-4548Test

الوصول الحر: https://doaj.org/article/58a8e22248044e5885a767aad5daf89fTest

المؤلفون: Saarwaani Vallabhajosyula, MBBS, Zhen Wang, PhD, M. Hassan Murad, MD, MPH, Shashaank Vallabhajosyula, MBBS, Pranathi R. Sundaragiri, MBBS, Kianoush Kashani, MD, MS, Wayne L. Miller, MD, PhD, Allan S. Jaffe, MD, Saraschandra Vallabhajosyula, MD

المصدر: Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 4, Iss 1, Pp 50-64 (2020)

مصطلحات موضوعية: Medicine (General), R5-920

الوصف: Data are conflicting regarding the optimal cutoffs of B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) to predict short-term mortality in patients with sepsis. We conducted a comprehensive search of several databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus) for English-language reports of studies evaluating adult patients with sepsis, severe sepsis, and septic shock with BNP/NT-proBNP levels and short-term mortality (intensive care unit, in-hospital, 28-day, or 30-day) published from January 1, 2000, to September 5, 2017. The average values in survivors and nonsurvivors were used to estimate the receiver operating characteristic curve (ROC) using a parametric regression model. Thirty-five observational studies (3508 patients) were included (median age, 51-75 years; 12%-74% males; cumulative mortality, 34.2%). A BNP of 622 pg/mL had the greatest discrimination for mortality (sensitivity, 0.695 [95% CI, 0.659-0.729]; specificity, 0.907 [95% CI, 0.810-1.003]; area under the ROC, 0.766 [95% CI, 0.734-0.797]). An NT-proBNP of 4000 pg/mL had the greatest discrimination for mortality (sensitivity, 0.728 [95% CI, 0.703-0.753]; specificity, 0.789 [95% CI, 0.710-0.867]; area under the ROC, 0.787 [95% CI, 0.766-0.809]). In prespecified subgroup analyses, identified BNP/NT-proBNP cutoffs had higher discrimination if specimens were obtained 24 hours or less after admission, in patients with severe sepsis/septic shock, in patients enrolled after 2010, and in studies performed in the United States and Europe. There was inconsistent adjustment for renal function. In this hypothesis-generating analysis, BNP and NT-proBNP cutoffs of 622 pg/mL and 4000 pg/mL optimally predicted short-term mortality in patients with sepsis. The applicability of these results is limited by the heterogeneity of included patient populations.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2542454819301584Test; https://doaj.org/toc/2542-4548Test

الوصول الحر: https://doaj.org/article/4ea4df8fff92416b87a373031cb5f16bTest

المؤلفون: Saraschandra Vallabhajosyula, MD, Abhiram Prasad, MD, Malcolm R. Bell, MD, Mandeep Singh, MD, MPH, Rajiv Gulati, MD, PhD, John M. Stulak, MD, Charanjit S. Rihal, MD, MBA, David R. Holmes, Jr, MD, Gregory W. Barsness, MD

المصدر: Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 4, Iss 3, Pp 345-346 (2020)

مصطلحات موضوعية: Medicine (General), R5-920

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2542454820300382Test; https://doaj.org/toc/2542-4548Test

الوصول الحر: https://doaj.org/article/99e7bdaa757546ba81efdb420861a2c2Test