National cardiac registries: a systematic review

Background

Over the last thirty years, there has been exponential growth in the number and scale of national cardiovascular disease registries. We aimed to provide a comprehensive outline of contemporary national cardiac registries across all subspecialties.

Methods

We performed a systematic literature review by searching OvidMedline in August 2019 to identify registries relating to six pre-specified domains (Table). For inclusion, registries had to be national in nature, actively collecting data, and publishing either peer-reviewed publications or online reports.

Results

A total of 24,076 records were identified from six domain-specific Medline searches; 24,057 abstracts were screened with 19,435 non-relevant records excluded; 4,624 full texts were screened with 4,473 non-relevant texts excluded; and 151 registries met inclusion criteria representing 51 countries. Of these, 15 related to cardiac surgery, 27 to arrhythmia (17 device, 5 ablation, 7 atrial fibrillation), 21 to congenital heart disease (14 general, 2 interventional, 4 surgical, and 1 disease specific), 43 to coronary disease or percutaneous coronary intervention (22 PCI, 21 CAD), 27 to heart failure (13 heart failure, 5 transplant, 2 mechanical support, 7 disease specific), and 18 related to structural intervention (3 any, 13 transcatheter aortic valve replacement, 2 mitral intervention). Nine national registries (USA, Sweden, Finland, Denmark, UK, Portugal, Norway, Taiwan, and Singapore) covered multiple domains. Quality scoring using the Monash University Clinical Quality Registry Grading System (a composite score of recruitment, and data completeness, definitions, reliability and validation), demonstrated marked heterogeneity in quality between registries.

Conclusions

Cardiac registries have seen rapid growth, however the use and quality among various subspecialties differs markedly across world regions. Given the multiple benefits, clinicians, funders and health bureaucrats should be encouraged to focus on the range, quality and uptake of national registries.

Figure 1

Funding Acknowledgement

Type of funding source: None

Incidence, causes and predictors of unplanned hospital readmission after percutaneous coronary intervention

Background

Unplanned hospital readmissions post-percutaneous coronary intervention (PCI) result in a significant burden to the healthcare system and adverse patient outcomes. Understanding factors associated with 30-day readmission rates may help to reduce this burden. Data linkage of clinical quality registry data with routinely collected administrative datasets may assist in overcoming resource constraints that limit collection of follow-up data but is currently under-utilised worldwide.

Objective

To determine the incidence of, and factors associated with unplanned hospital readmissions in the first 30 days following PCI.

Methods

We prospectively collected data on 28,488 patients undergoing PCI between January 2013 and December 2018, who were enrolled in a multi-centre PCI registry. Data linkage to government administrative datasets was used to determine whether patients had an unplanned readmission within 30 days of PCI, the number of admissions prior to PCI and primary reason for readmission (as recorded by the International Classification of Diseases, 10th revision, Australian modification (ICD-10-AM) diagnosis codes). Patients were then divided into 3 groups: those who had 1 or more unplanned readmissions for primarily cardiac issues, those who those who had 1 or more unplanned readmissions for primarily non-cardiac issues, and those who were not readmitted, and compared for baseline, procedural and in-hospital care characteristics.

Results

In total, 3,059 patients (10.7%) had an unplanned hospital readmission within 30 days of PCI, of which, 1,848 patients (60.4%) were readmitted for primarily cardiac diagnoses. Independent predictors of both 30-day cardiac and non-cardiac readmissions were female sex, having >1 admission in the 12 months prior to PCI, acute coronary syndrome presentation, having any in-hospital complication and being discharged on an oral anticoagulant (all p<0.05). A stepwise increase in readmission risk was observed with increasing number of admissions from 1 to >4 admissions in the 12 months prior to PCI. Presentation with cardiogenic shock (p=0.04), having an unsuccessful PCI (p=0.02) and left ventricular systolic dysfunction (p=0.02) were independent predictors of cardiac readmissions but not non-cardiac readmissions. Conversely, age >60 years (p<0.001) and history of diabetes mellitus (p=0.02) were found to be independent predictors of non-cardiac readmissions only.

Conclusion

Thirty-day unplanned hospital readmissions after PCI pose a significant burden to the health system. Most readmissions are primarily due to cardiac diagnoses. The most important predictive factor for both cardiac and non-cardiac readmissions appears to be the number of hospital admissions in the 12 months prior to PCI. This is valuable information for health administrators as treatment and discharge policies, and outpatient follow-up timetables may need to be tailored to patients at high risk for readmission following PCI.

Causes of readmission post-PCI

Funding Acknowledgement

Type of funding source: None

Measurement of the Low-Energy Antideuteron Inelastic Cross Section

In this Letter, we report the first measurement of the inelastic cross section for antideuteron-nucleus interactions at low particle momenta, covering a range of 0.3≤p<4  GeV/c. The measurement is carried out using p-Pb collisions at a center-of-mass energy per nucleon-nucleon pair of sqrt[s_{NN}]=5.02  TeV, recorded with the ALICE detector at the CERN LHC and utilizing the detector material as an absorber for antideuterons and antiprotons. The extracted raw primary antiparticle-to-particle ratios are compared to the results from detailed ALICE simulations based on the geant4 toolkit for the propagation of (anti)particles through the detector material. The analysis of the raw primary (anti)proton spectra serves as a benchmark for this study, since their hadronic interaction cross sections are well constrained experimentally. The first measurement of the inelastic cross section for antideuteron-nucleus interactions averaged over the ALICE detector material with atomic mass numbers ⟨A⟩=17.4 and 31.8 is obtained. The measured inelastic cross section points to a possible excess with respect to the Glauber model parametrization used in geant4 in the lowest momentum interval of 0.3≤p<0.47  GeV/c up to a factor 2.1. This result is relevant for the understanding of antimatter propagation and the contributions to antinuclei production from cosmic ray interactions within the interstellar medium. In addition, the momentum range covered by this measurement is of particular importance to evaluate signal predictions for indirect dark-matter searches.

Probing the Effects of Strong Electromagnetic Fields with Charge-Dependent Directed Flow in Pb-Pb Collisions at the LHC

The first measurement at the LHC of charge-dependent directed flow (v_{1}) relative to the spectator plane is presented for Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV. Results are reported for charged hadrons and D^{0} mesons for the transverse momentum intervals p_{T}>0.2  GeV/c and 3<p_{T}<6  GeV/c in the 5%-40% and 10%-40% centrality classes, respectively. The difference between the positively and negatively charged hadron v_{1} has a positive slope as a function of pseudorapidity η, dΔv_{1}/dη=[1.68±0.49(stat)±0.41(syst)]×10^{-4}. The same measurement for D^{0} and D[over ¯]^{0} mesons yields a positive value dΔv_{1}/dη=[4.9±1.7(stat)±0.6(syst)]×10^{-1}, which is about 3 orders of magnitude larger than the one of the charged hadrons. These measurements can provide new insights into the effects of the strong electromagnetic field and the initial tilt of matter created in noncentral heavy ion collisions on the dynamics of light (u, d, and s) and heavy (c) quarks. The large difference between the observed Δv_{1} of charged hadrons and D^{0} mesons may reflect different sensitivity of the charm and light quarks to the early time dynamics of a heavy ion collision. These observations challenge some recent theoretical calculations, which predicted a negative and an order of magnitude smaller value of dΔv_{1}/dη for both light flavor and charmed hadrons.

Evidence of Spin-Orbital Angular Momentum Interactions in Relativistic Heavy-Ion Collisions

The first evidence of spin alignment of vector mesons (K^{*0} and ϕ) in heavy-ion collisions at the Large Hadron Collider (LHC) is reported. The spin density matrix element ρ_{00} is measured at midrapidity (|y|<0.5) in Pb-Pb collisions at a center-of-mass energy (sqrt[s_{NN}]) of 2.76 TeV with the ALICE detector. ρ_{00} values are found to be less than 1/3 (1/3 implies no spin alignment) at low transverse momentum (p_{T}<2  GeV/c) for K^{*0} and ϕ at a level of 3σ and 2σ, respectively. No significant spin alignment is observed for the K_{S}^{0} meson (spin=0) in Pb-Pb collisions and for the vector mesons in pp collisions. The measured spin alignment is unexpectedly large but qualitatively consistent with the expectation from models which attribute it to a polarization of quarks in the presence of angular momentum in heavy-ion collisions and a subsequent hadronization by the process of recombination.

Scattering Studies with Low-Energy Kaon-Proton Femtoscopy in Proton-Proton Collisions at the LHC

The study of the strength and behavior of the antikaon-nucleon (K[over ¯]N) interaction constitutes one of the key focuses of the strangeness sector in low-energy quantum chromodynamics (QCD). In this Letter a unique high-precision measurement of the strong interaction between kaons and protons, close and above the kinematic threshold, is presented. The femtoscopic measurements of the correlation function at low pair-frame relative momentum of (K^{+}p⊕K^{-}p[over ¯]) and (K^{-}p⊕K^{+}p[over ¯]) pairs measured in pp collisions at sqrt[s]=5, 7, and 13 TeV are reported. A structure observed around a relative momentum of 58  MeV/c in the measured correlation function of (K^{-}p⊕K^{+}p[over ¯]) with a significance of 4.4σ constitutes the first experimental evidence for the opening of the (K[over ¯]^{0}n⊕K^{0}n[over ¯]) isospin breaking channel due to the mass difference between charged and neutral kaons. The measured correlation functions have been compared to Jülich and Kyoto models in addition to the Coulomb potential. The high-precision data at low relative momenta presented in this work prove femtoscopy to be a powerful complementary tool to scattering experiments and provide new constraints above the K[over ¯]N threshold for low-energy QCD chiral models.

Exploring the structure of Xe isotopes in A ~ 130 region: Single particle and collective excitations

High and medium spin structures of 130,131Xe have been studied using α-induced fusion-evaporation reaction and the Indian National Gamma Array (INGA) coupled with a digital data acquisition system. Various new band structures and near yrast levels of 131Xe have been established. The multipolarities of the observed transitions have been assigned on the basis of the DCO ratios and the polarization asymmetry measurements. Band structures based on 1-quasi-particle (qp), 3-qp configurations have been observed. A new Magnetic Rotational (MR) band based on 5-qp configuration has also been established in 131Xe. The MR band has been interpreted in terms of shears mechanism with principal axis cranking (SPAC) calculations. Shell Model calculations are carried out to describe the non yrast states of 131Xe above the 11/2− isomer. New excited states have also been identified in 130Xe, produced in the same reaction.

Significant Left Main Coronary Artery Disease Does Not Incur Any Additional Risk to the Short Term Outcome of Off Pump Coronary Artery Bypass Grafting Surgery

Coronary artery disease is the most common form of heart disease and single most important cause of premature death in developed countries. Off pump coronary artery bypass grafting surgery has recently became widespread internationally and has produced good clinical outcome even in left main coronary artery disease following off pump coronary artery bypass grafting surgery. A prospective observational study was conducted in the department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh from January 2015 to September 2016 after fulfillment of enrollment criteria, 428 patients were studied for the purpose of the study and they were grouped in two, significant left main coronary artery disease in group A and non left main coronary artery disease requiring surgery in group B. Comparison of risk factors between groups demonstrates that diabetes mellitus and smoking habit between two groups were almost identical. 69.2% of patient with significant left main coronary artery group were hypertensive and 25.2% were dyslipidaemic in comparison to non left main coronary artery disease group which were 50.9% and 6.5% respectively. Requirement of per operative inotropic support was significantly higher in left main coronary artery group. 33.6% of patient of left main coronary artery group required per operative inotropic support whereas non left main coronary artery group require 24.8%. Postoperative inotropic support, mechanical ventilation time, ICU stay, hospital stay and complication were similar in both these groups. So, we can say that off pump coronary artery bypass grafting surgery for significant left main coronary artery disease is as safe as non left main coronary artery disease.

Measurement of ϒ(1S) Elliptic Flow at Forward Rapidity in Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The first measurement of the ϒ(1S) elliptic flow coefficient (v_{2}) is performed at forward rapidity (2.5<y<4) in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV with the ALICE detector at the LHC. The results are obtained with the scalar product method and are reported as a function of transverse momentum (p_{T}) up to 15  GeV/c in the 5%-60% centrality interval. The measured ϒ(1S)v_{2} is consistent with 0 and with the small positive values predicted by transport models within uncertainties. The v_{2} coefficient in 2<p_{T}<15  GeV/c is lower than that of inclusive J/ψ mesons in the same p_{T} interval by 2.6 standard deviations. These results, combined with earlier suppression measurements, are in agreement with a scenario in which the ϒ(1S) production in Pb-Pb collisions at LHC energies is dominated by dissociation limited to the early stage of the collision, whereas in the J/ψ case there is substantial experimental evidence of an additional regeneration component.

Investigations of Anisotropic Flow Using Multiparticle Azimuthal Correlations in pp, p-Pb, Xe-Xe, and Pb-Pb Collisions at the LHC

Measurements of anisotropic flow coefficients (v_{n}) and their cross-correlations using two- and multiparticle cumulant methods are reported in collisions of pp at sqrt[s]=13  TeV, p-Pb at a center-of-mass energy per nucleon pair sqrt[s_{NN}]=5.02  TeV, Xe-Xe at sqrt[s_{NN}]=5.44  TeV, and Pb-Pb at sqrt[s_{NN}]=5.02  TeV recorded with the ALICE detector. The multiplicity dependence of v_{n} is studied in a very wide range from 20 to 3000 particles produced in the midrapidity region |η|<0.8 for the transverse momentum range 0.2<p_{T}<3.0  GeV/c. An ordering of the coefficients v_{2}>v_{3}>v_{4} is found in pp and p-Pb collisions, similar to that seen in large collision systems, while a weak v_{2} multiplicity dependence is observed relative to nucleus-nucleus collisions in the same multiplicity range. Using a novel subevent method, v_{2} measured with four-particle cumulants is found to be compatible with that from six-particle cumulants in pp and p-Pb collisions. The magnitude of the correlation between v_{n}^{2} and v_{m}^{2}, evaluated with the symmetric cumulants SC(m,n) is observed to be positive at all multiplicities for v_{2} and v_{4}, while for v_{2} and v_{3} it is negative and changes sign for multiplicities below 100, which may indicate a different v_{n} fluctuation pattern in this multiplicity range. The observed long-range multiparticle azimuthal correlations in high multiplicity pp and p-Pb collisions can neither be described by pythia 8 nor by impact-parameter-Glasma, music, and ultrarelativistic quantum molecular dynamics model calculations, and hence, provide new insights into the understanding of collective effects in small collision systems.

P2654Impact of cultural and linguistic diversity on ischaemic time and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI)

Background

Healthcare providers worldwide increasingly must face the challenge of providing care to culturally and linguistically diverse patients who may have limited proficiency in the primary working language of the country they are in. This language discordance may lead to delayed treatment and worse outcomes. The impact of limited English proficiency (LEP), in a predominantly English-speaking country like Australia, on time to reperfusion and outcomes following PCI for STEMI has not been previously studied.

Objective

Among patients undergoing PCI for STEMI, to compare baseline and procedural characteristics, time to reperfusion, and 30-day clinical outcomes in patients with LEP, compared to their English-proficient counterparts.

Method

We prospectively collected data on 7,721 patients undergoing PCI for STEMI between January 2013 and December 2017 who were enrolled in the state-wide multi-centre Victorian Cardiac Outcomes Registry. Data linkage to Department of Health administrative datasets was used to identify patients' primary spoken language. Patients who identified a language other than English as their primary spoken language were classified as having LEP. Patients' postcodes were used to identify socioeconomic status through Australian Government census data. The primary endpoint was 30-day major adverse cardiovascular events (MACE)

Results

Of the 7,721 patients included, 568 (7.4%) had LEP. Patients with LEP were more likely to be older, female, diabetic, have lower socioeconomic status and have severe renal impairment (all p<0.02). They were also more likely to present to a non-PCI capable hospital (p<0.001). Among primary PCI patients (n=5,385), symptom-to-balloon time was longer in the LEP group (237 [IQR 158–429] vs. 195 [IQR 141–326] minutes, p<0.001), driven mostly by longer symptom-to-door times (STDT) (150 [IQR 90–276] vs. 114 [IQR 75–215] minutes, p<0.001). LEP patients were also less likely to have a STDT≥120 minutes (48.8% vs. 41.7%, p-0.004). Patients with LEP had higher 30-day mortality (8.8% vs. 6.5%, p=0.04) and MACE (11.8 vs. 9.1%, p=0.04). They were also more likely to have severe left ventricular (LV) dysfunction post-STEMI (11.2% vs. 8.4%, p=0.003) and heart failure readmissions within 30 days of PCI (5.2% vs. 2.0%, p<0.001). On multivariate analysis, LEP was not an independent predictor of 30-day MACE (OR 1.27, 95% CI 0.82–1.95), but was an independent predictor of STDT≥120 minutes (OR 1.24, 95% CI 1.02–1.52).

Comparison of reperfusion times

Conclusion

Limited English-proficient patients with STEMI undergoing PCI tend to present later than their English-proficient counterparts and are more likely to have severe LV dysfunction and heart failure readmissions. LEP is an independent predictor of prolonged STDT but not 30-day MACE. This suggests that more effort needs to be placed in providing education in different languages to culturally and linguistically diverse patients, to encourage early presentation in the setting of STEMI.

P5290Impact of extreme obesity on long-term outcomes following percutaneous coronary intervention

Background

Obesity is a growing health concern worldwide, particularly in developed countries where there has been an unprecedented rise in the proportion of overweight and obese individuals in the population. Previous studies have reported a protective effect of obesity compared to normal BMI in patients undergoing percutaneous coronary intervention (PCI). However, it is unclear whether this effect extends to the extremely obese over long-term follow-up.

Objective

To determine whether an obesity paradox persists in contemporary PCI practice over long-term follow-up, and in particular to further evaluate the association between extreme obesity and long-term clinical outcomes after PCI.

Method

We prospectively collected data on 25,645 patients undergoing PCI between 1 January 2005 and 30 June 2017 who were enrolled in the statewide multi-centre Melbourne Interventional Group Registry. This registry collects data on all patients undergoing PCI at 6 academic tertiary hospitals. Patients were stratified by World Health Organization-defined BMI categories. Long-term mortality data was obtained by linkage to the National Death Index (NDI), a database that contains records of all deaths occurring in Australia. The primary endpoint was NDI-linked mortality. Median length of follow-up was 4.4 years (IQR 2.0–7.6 years).

Results

Of the study cohort, 24.6% had normal BMI (18.5–24.9 kg/m2), 0.9% were underweight (BMI <18.5 kg/m2) and 3.3% were extremely obese (BMI ≥40 kg/m2). As BMI increased, mean age decreased while the prevalence of diabetes increased (p<0.001). The proportion of females at both extremes of BMI. Procedural characteristics were similar across the groups although there was more radial access and less femoral access used with increasing BMI (p<0.001). In terms of secondary prevention therapy, underweight patients were significantly less likely to receive a beta blocker, ACE inhibitor and statins, compared to the other BMI groups. In-hospital, 30-day and long-term mortality were all highest for underweight patients (37.7%) and lowest for the moderately obese patients (BMI 35–40 kg/m2) (12.2%). After adjustment for age, comorbidities and presentation with cardiogenic shock, a U-shaped association between the different BMI categories and adjusted hazard ratio for long-term mortality was observed (Figure 1).

Figure 1

Conclusion

An obesity paradox is still apparent in contemporary practice with elevated BMI up to 35 kg/m2 associated with reduced long-term mortality after PCI. However, this protective effect appears not to extend to patients with extreme obesity. Factors behind this phenomenon are likely multifactorial and require further mechanistic and epidemiological studies.

Resonance assisted jump-in voltage reduction for electrostatically actuated nanobeam-based gateless NEM switches

Electrostatically actuated nanobeam-based electromechanical switches have shown promise for versatile novel applications, such as low power devices. However, their widespread use is restricted due to poor reliability resulting from high jump-in voltages. This article reports a new method for lowering the jump-in voltage by inducing mechanical oscillations in the active element during the switching ON process, reducing the jump-in voltage by more than three times. Ge_0.91Sn_0.09 alloy and Bi₂Se₃ nanowire-based nanoelectromechanical switches were constructed in situ to demonstrate the operation principles and advantages of the proposed method.

First Observation of an Attractive Interaction between a Proton and a Cascade Baryon

This Letter presents the first experimental observation of the attractive strong interaction between a proton and a multistrange baryon (hyperon) Ξ^{-}. The result is extracted from two-particle correlations of combined p-Ξ^{-}⊕p[over ¯]-Ξ[over ¯]^{+} pairs measured in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV at the LHC with ALICE. The measured correlation function is compared with the prediction obtained assuming only an attractive Coulomb interaction and a standard deviation in the range [3.6, 5.3] is found. Since the measured p-Ξ^{-}⊕p[over ¯]-Ξ[over ¯]^{+} correlation is significantly enhanced with respect to the Coulomb prediction, the presence of an additional, strong, attractive interaction is evident. The data are compatible with recent lattice calculations by the HAL-QCD Collaboration, with a standard deviation in the range [1.8, 3.7]. The lattice potential predicts a shallow repulsive Ξ^{-} interaction within pure neutron matter and this implies stiffer equations of state for neutron-rich matter including hyperons. Implications of the strong interaction for the modeling of neutron stars are discussed.

Diagnostic diversities of Clear Fluid encountered during Fine needle aspiration cytology with an analysis of various variables

Background: Incidental finding of clear fluid during fine needle aspiration (FNA) is not rare in day to day practice of cytology. Though clear in appearance, cells obtained from it may yield a diverse diagnosis ranging from an inconclusive opinion to a malignant lesion. So, clear fluid is not non-significant always; lack of proper processing and examination may prove fatal to a patient. Aim: To evaluate the diverse diagnosis of clear fluid. Materials and methods: During a period of three years, hundred and seven cases which yielded clear fluid during FNAC from different parts of the body were studied. Direct and indirect smears (wherever applicable) was prepared, stained and examined microscopically. Results: Of these 107 cases of clear fluid, Male: Female ratio was 1: 1.6. Maximum cases - 55 (51.40%) was found in the age group 21 to 40 years. Trunk held the most number of lesions - 54 cases (50.46%). FNA results were interpreted as inconclusive in 19 cases (17.76%), benign in 84 cases (78.50%), suspicious in 01 case (0.93%) and malignant in 03 cases (2.80%). Epidermal cyst was the most common benign lesion - 16 cases (14.95%). Malignant lesions found were papillary carcinoma of thyroid, carcinoma of breast and metastatic squamous cell carcinoma – one case each. Conclusion: Our study emphasizes on the importance of proper examination of clear fluid as it may prove helpful in an undiagnosed case of malignancy and it may also improvise the learning of young pathologists. Bangladesh Journal of Medical Science Vol.18(4) 2019 p.753-755

First Direct Measurement of Isotopic Fission-Fragment Yields of ^{239}U

A direct and complete measurement of isotopic fission-fragment yields of ^{239}U has been performed for the first time. The ^{239}U fissioning system was produced with an average excitation energy of 8.3 MeV in one-neutron transfer reactions between a ^{238}U beam and a ^{9}Be target at Coulomb barrier energies. The fission fragments were detected and isotopically identified using the VAMOS++ spectrometer at the GANIL facility. The measurement allows us to directly evaluate the fission models at excitation energies of fast neutrons, which are relevant for next-generation nuclear reactors. The present data, in agreement with model calculations, do not support the recently reported anomaly in the fission-fragment yields of ^{239}U, and they confirm the persistence of spherical shell effects in the Sn region at excitation energies exceeding the fission barrier by a few mega-electron volts.