The impact of wearable continuous vital sign monitoring on deterioration detection and clinical outcomes in hospitalised patients: a systematic review and meta-analysis

BACKGROUND

Timely recognition of the deteriorating inpatient remains challenging. Wearable monitoring systems (WMS) may augment current monitoring practices. However, there are many barriers to implementation in the hospital environment, and evidence describing the clinical impact of WMS on deterioration detection and patient outcome remains unclear.

OBJECTIVE

To assess the impact of vital-sign monitoring on detection of deterioration and related clinical outcomes in hospitalised patients using WMS, in comparison with standard care.

METHODS

A systematic search was conducted in August 2020 using MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, CENTRAL, Health Technology Assessment databases and grey literature. Studies comparing the use of WMS against standard care for deterioration detection and related clinical outcomes in hospitalised patients were included. Deterioration related outcomes (primary) included unplanned intensive care admissions, rapid response team or cardiac arrest activation, total and major complications rate. Other clinical outcomes (secondary) included in-hospital mortality and hospital length of stay. Exploratory outcomes included alerting system parameters and clinical trial registry information.

RESULTS

Of 8706 citations, 10 studies with different designs met the inclusion criteria, of which 7 were included in the meta-analyses. Overall study quality was moderate. The meta-analysis indicated that the WMS, when compared with standard care, was not associated with significant reductions in intensive care transfers (risk ratio, RR 0.87; 95% confidence interval, CI 0.66-1.15), rapid response or cardiac arrest team activation (RR 0.84; 95% CI 0.69-1.01), total (RR 0.77; 95% CI 0.44-1.32) and major (RR 0.55; 95% CI 0.24-1.30) complications prevalence. There was also no statistically significant association with reduced mortality (RR 0.48; 95% CI 0.18-1.29) and hospital length of stay (mean difference, MD - 0.09; 95% CI - 0.43 to 0.44).

CONCLUSION

This systematic review indicates that there is no current evidence that implementation of WMS impacts early deterioration detection and associated clinical outcomes, as differing design/quality of available studies and diversity of outcome measures make it difficult to reach a definite conclusion. Our narrative findings suggested that alarms should be adjusted to minimise false alarms and promote rapid clinical action in response to deterioration. PROSPERO Registration number: CRD42020188633 .

How do presbylarynx and presbycusis affect the Voice Handicap Index and the emotional status of the elderly? A prospective case-control study

OBJECTIVE

To assess the influence of presbylarynx and presbycusis on Voice Handicap Index and emotional status.

METHODS

A case-control, prospective, observational, cross-sectional study was conducted of patients aged 65 years or older referred to an otorhinolaryngology department from January to September 2020. Presbycusis was assessed by pure tone and vocal audiometry. Each subject underwent fibre-optic videolaryngoscopy with stroboscopy, and presbylarynx was considered when two or more of the following endoscopic findings were identified: vocal fold bowing, prominence of vocal processes in abduction, and a spindle-shaped glottal gap. Each subject completed two questionnaires: Voice Handicap Index and Geriatric Depression Scale (short-form).

RESULTS

The studied population included 174 White European subjects, with a mean age of 73.99 years, of whom 22.8 per cent presented both presbylarynx and presbycusis. Multivariate linear regression revealed that only presence and severity of presbylarynx had an influence on Voice Handicap Index-30 scores. However, both spindle-shaped glottal gap and presbycusis influenced Geriatric Depression Scale scores.

CONCLUSION

Presbylarynx has a strong association with the impact of voice on quality of life. Presbylarynx and presbycusis seem to have a cumulative effect on emotional status.

A Chest Patch for Continuous Vital Sign Monitoring: Clinical Validation Study During Movement and Controlled Hypoxia

BACKGROUND

The standard of care in general wards includes periodic manual measurements, with the data entered into track-and-trigger charts, either on paper or electronically. Wearable devices may support health care staff, improve patient safety, and promote early deterioration detection in the interval between periodic measurements. However, regulatory standards for ambulatory cardiac monitors estimating heart rate (HR) and respiratory rate (RR) do not specify performance criteria during patient movement or clinical conditions in which the patient's oxygen saturation varies. Therefore, further validation is required before clinical implementation and deployment of any wearable system that provides continuous vital sign measurements.

OBJECTIVE

The objective of this study is to determine the agreement between a chest-worn patch (VitalPatch) and a gold standard reference device for HR and RR measurements during movement and gradual desaturation (modeling a hypoxic episode) in a controlled environment.

METHODS

After the VitalPatch and gold standard devices (Philips MX450) were applied, participants performed different movements in seven consecutive stages: at rest, sit-to-stand, tapping, rubbing, drinking, turning pages, and using a tablet. Hypoxia was then induced, and the participants' oxygen saturation gradually reduced to 80% in a controlled environment. The primary outcome measure was accuracy, defined as the mean absolute error (MAE) of the VitalPatch estimates when compared with HR and RR gold standards (3-lead electrocardiography and capnography, respectively). We defined these as clinically acceptable if the rates were within 5 beats per minute for HR and 3 respirations per minute (rpm) for RR.

RESULTS

Complete data sets were acquired for 29 participants. In the movement phase, the HR estimates were within prespecified limits for all movements. For RR, estimates were also within the acceptable range, with the exception of the sit-to-stand and turning page movements, showing an MAE of 3.05 (95% CI 2.48-3.58) rpm and 3.45 (95% CI 2.71-4.11) rpm, respectively. For the hypoxia phase, both HR and RR estimates were within limits, with an overall MAE of 0.72 (95% CI 0.66-0.78) beats per minute and 1.89 (95% CI 1.75-2.03) rpm, respectively. There were no significant differences in the accuracy of HR and RR estimations between normoxia (≥90%), mild (89.9%-85%), and severe hypoxia (<85%).

CONCLUSIONS

The VitalPatch was highly accurate throughout both the movement and hypoxia phases of the study, except for RR estimation during the two types of movements. This study demonstrated that VitalPatch can be safely tested in clinical environments to support earlier detection of cardiorespiratory deterioration.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN61535692; https://www.isrctn.com/ISRCTN61535692.

Sustained ventricular tachycardia as a predictor of major adverse cardiac events in acute coronary syndrome patients

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

Sustained ventricular tachycardia (VT) is a frequent rhythm disturbance during an ischemic event like acute coronary syndrome (ACS). VT was frequently associated with worse prognosis, then is expected, that its presence is related to a higher incidence of major adverse cardiac events (MACE).

Objective

Evaluate if sustained VT was a predictor of MACE in ACS hospitalized patients.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided into two groups: A – patients without VT, and B – patients that presented VT on the hospitalization. VT was defined as a register or more of the VT with at least 30 seconds. Were excluded patients without a previous cardiovascular history or clinical data. MACE was defined as re-infarction, congestive heart failure, cardiogenic shock, a mechanical complication of myocardial infarction, completed atrioventricular block, sustained ventricular tachycardia, cardiac arrest, stroke and hospitalization death. Univariate logistic regression was performed to assess if VT in ACS patients was a predictor of MACE.

Results

A total of 29851 patients was analyze and 25725 had information regarding VT. From the group of patients that presented VT, 177 (1.1%) had re-infarction, 2415 (14.1%) had congestive heart failure, 816 (5.0%) had atrial fibrillation, 108 (0.7%) had a mechanical complication of myocardial infarction, 442 (2.7%) had completed atrioventricular block, 458 (2.8%) had cardiac arrest, 101 (0.6%) had stroke and 535 (3.3%) died. VT did not predict re-infarction (p = 0.071), mechanical complication of myocardial infarction (p = 0.979) and stroke (p = 0.500) in ACS hospitalized patients. Logistic regression revealed that VT in ACS patients was a predictor of congestive heart failure (odds ratio (OR) 2.304, p &lt; 0.001, confidence interval (CI) 1.742-3.047), atrial fibrillation (OR 2.078, p &lt; 0.001, CI 1.453-2.973), completed atrioventricular block (OR 1.831, p = 0.012, CI 1.145-2.928), cardiac arrest (OR 15.434, p &lt; 0.001, CI 11.429-20.843) and hospitalization death (OR 6.472, p &lt; 0.001, CI 4.484-9.342).

Conclusions

VT in ACS patients predict MACE, namely congestive heart failure, atrial fibrillation, completed atrioventricular block, cardiac rest and hospitalization death.

Was the atrioventricular block similar in anterior and inferior ST-elevation myocardial infarction?

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

The presence of atrioventricular block (AVB) in ST-elevation myocardial infarction (STEMI) is more frequently registered when is identified in the inferior leads. However, AVB maybe occurs in anterior STEMI, yet the AVB and STEMI localization maybe had different implications.

Objective

Evaluate the impact and prognosis of AVB according to the STEMI localization.

Methods

Multicenter retrospective study, based on the Portuguese Registry of Acute Coronary Syndrome between 1/10/2010-3/05/2020. Patients were divided into two groups: A – patients with anterior STEMI, and B – patients with inferior STEMI. Were excluded patients without a previous cardiovascular history or clinical data regarding AVB occurrence. Logistic regression was performed to assess AVB as a prognostic marker in STEMI patients.

Results

From 32157 patients, was identified 462 with AVB, 72 in group A (15.6%) and 390 in group B (84.4%). Both groups were similar regarding gender (p = 0.710), age (p = 0.068), body mass index (p = 0.535), admitly directly to cat lab (p = 0.635), initial symptons until first medical contact (p = 0.561), smoker status (p = 0.483), diabetes mellitus (p = 0.331), coronary artery disease (p = 0.053), previous stroke (p = 0.332),  peripheral artery disease (p = 0.348), chronic kidney disease (p = 0.425), systolic blood pressure (p = 0.057), multivessel diasease (p = 0.235), new-onset of atrial fibrillation (p = 0.582), cardiac arrest (p = 0.062) and stroke complication (p = 0.685). Group B had higher left ventricular ejection fraction (LVEF) &gt;50% (16.9 vs 60.7%, p &lt; 0.001). On the other hand, group A had more arterial hypertension (79.7 vs 66.2%, p = 0.027), dislipidaemia (58.2 vs 54.4%, p = 0.038), heart rate at admission (81 ± 20 vs 59 ± 23, p &lt; 0.001), Killip-Kimball class &gt; I (45.7 vs 29.6%, p = 0.008), sinus rhythm at admission (84.5 vs 72.6%, p = 0.035), heart failure complication (65.3 vs 37.1%, p &lt; 0.001), cardiogenic shock complication (42.3 vs 24.7%, p &lt; 0.001), ACS mechanical complication (8.3 vs 3.1%, p = 0.047), sustained ventricular tachycardia during ACS hospitalization (19.4 vs 8.5%, p = 0.005) and hospitalization death (52.9 vs 44.7%, p &lt; 0.001). Logistic regression revealed that AVB in inferior STEMI was a predictor of new-onset of atrial fibrillation (odds ratio (OR) 3.817, p = 0.038, confidence interval (CI) 1.123-12.975), with a R2 Nagelkerke 24.4. Also, revealed that AVB in anterior STEMI was a predictor of death (OR 0.111, p &lt; 0.001, CI 0.034-0.366), with a R2 Nagelkerke 55.2.

Conclusions

AVB in inferior STEMI was a predictor of new-onset of atrial fibrillation and AVB in anterior STEMI was a predictor of death.

Sustained ventricular tachycardia in acute coronary syndromes the Portuguese experience

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

Acute coronary syndromes (ACS) are frequent and are associated with high levels of comorbidities and complications. Ventricular tachycardia (VT) is one of the most danger and stressful situations in ACS.

Objective

Evaluate predictors of ventricular tachycardia in ACS.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – patients without VT, and B – patients that presented VT on the hospitalization. VT was defined as a register or more of the VT with at least 30 seconds. Logistic regression was performed to assess predictors of VT in ACS patients.

Results

25361 in group A (98.6%) and 364 in group B (1.4%). Both groups were similar regarding gender, cardiovascular risk factors, except for dyslipidemia (61.7 vs 51.9%, p &lt; 0.001) and ST-segment elevation myocardial infarction (STEMI) location. Group B was elderly (67 ± 14 vs 70 ± 14, p &lt; 0.001), was admitted directly to the cat lab (10.6 vs 20.4%, p &lt; 0.001), had less time since the onset of symptoms until the admission (383 ± 157 vs 349 ± 121, p = 0.003), but presented higher previous history of heart failure (5.9 vs 10.6%, p &lt; 0.001), peripheral vascular disease (5.5 vs 8.4%, p = 0.015), chronic obstructive pulmonary disease (COPD) (4.4 vs 7.9%, p = 0.001) and dementia (1.7 vs 3.2%, p = 0.038). At admission presented higher levels of STEMI (42 vs 67%, p &lt; 0.001), dyspnea (29 vs 18.1%, p &lt; 0.001), syncope (1.3 vs 6.6%, p &lt; 0.001), cardiac arrest (0.4 vs 4.4%, p &lt; 0.001), Killip-Kimball classification &gt; I (14.8 vs 40.5%, p &lt; 0.001) and atrial fibrillation at admission (AF) (7.1 vs 15.3%, p &lt; 0.001). Ivabradine (3.7 vs 7.6%, p &lt; 0.001), aldosterone receptor antagonists (10.2 vs 24%, p &lt; 0.001), diuretic (28 vs 57.2%, p &lt; 0.001), amiodarone (5.6 vs 53.5%, p &lt; 0.001), digoxin (1.4 vs 4.7%, p &lt; 0.001) were more prevalent used in the admission. Group B exhibited higher multivessel disease (MVD) (51.5 vs 61.5%, p &lt; 0.001), culprit as common coronary trunk (CT) (1.7 vs 4.2%, p = 0.024), hybrid revascularization (0.8 vs 2%, p = 0.032) and left ventricular ejection fraction (LVEF)&lt;50% (38.7 vs 71%, p &lt; 0.001). On the other hand, the used of beta block (81.4 vs 62.3%, p &lt; 0.001), angiotensin-converting-enzyme inhibitor (85.5 vs 74.4%, p &lt; 0.001) and calcium channel blockers (10.1 vs 24%, p &lt; 0.001) since had a protect effect. Regarding reinfarction (0.9 vs 2.5%, p = 0.007), de novo heart failure (15.1 vs 50.3%, p &lt; 0.001), atrioventricular block (2.2 vs 17%, p &lt; 0.001), stroke (1.4 vs 4.9%, p &lt; 0.001) and death (3.4 vs 26.9%, p &lt; 0.001), all were higher in Group B. Logistic regression revealed COPD (odds ratio (OR) 1.9, p = 0.010, confidence interval (CI) 1.17-3.10), STEMI (OR 2.73, p &lt; 0.001, CI 2.00-3.73), AF (OR 2.30, p &lt; 0.001, CI 1.52-3.49), MVD (OR 1.44, p = 0.012, CI 1.08-1.92), CT (OR 2.87, p = 0.003, CI 1.45-5.69) and LVEF &lt; 50%  (OR 3.44, p &lt; 0.001, CI 2.52-4.71) as predictors of VT in ACS.

Conclusions

COPD, STEMI, AF, MVD, CT and LVEF &lt; 50% were predictors of VT in ACS.

Atrial Fibrillation in Acute Coronary Syndrome - early onset impact on MACE

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

on behalf of the Investigators of " Portuguese Registry of ACS "

Introduction

Atrial Fibrillation (AF) complicates approximately 10% of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on ACS patients’ (pts) prognosis.

Objective

To evaluate early onset (≤48h) de novo atrial fibrillation (AF) as predictor of major adverse cardiovascular events (MACE) and in-hospital complications.

Methods

Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 8/01/2019. Pts were divided in two groups: A – early onset de novo AF (EOAF), and B – late onset de novo AF (LOAF). Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Univariate logistic regression was performed to assess if LOAF in ACS was a predictor of MACE or complications.

Results

29851 pts had ACS. EOAF occurred in 584 pts (2.0%) and LOAF in 360 pts (1.2%). EOAF were younger (73 ± 13 vs 77 ± 10, p &lt; 0.001) and smokers (21.3% vs 12.1%, p &lt; 0.001). LOAF had higher rates of diabetes mellitus (40.1% vs 30.2%, p &lt; 0.001), angina (30.8% vs 21.4%, p &lt; 0.001), previous ACS (22.5% vs 15.4%, p = 0.006), previous revascularization (percutaneous coronary intervention 14% vs 9.5%, p = 0.032; coronary artery bypass surgery 8.4% vs 3.9%, p = 0.004). ST-segment elevation myocardial infarction (MI) rates were higher in EOAF (56.8% vs 46.9%, p = 0.003) and were admitted directly to the cath lab more often (21.7% vs 13.4%, p = 0.001). Non-ST elevation MI rates were higher in LOAF (44.2% vs 37.7%, p = 0.048). LOAF times from first symptoms to admission were longer (420min vs 183%, p &lt; 0.001), mean brain natriuretic peptide levels were higher (579 vs 447, p = 0.009) and diuretics usage was more frequent (72.8% vs 54.3%, p &lt; 0.001). EOAF had higher rates of heart failure (32.1% vs 17.2%, p &lt; 0.001), atrioventricular block (10.5% vs 7.8%, p = 0.006) and sustained ventricular tachycardia (8.1% vs 3.1%, p = 0.001). LOAF had higher in-hospital mortality (14.2% vs 9.6%, p = 0.031) and longer hospital stay (12 days vs 7 days, p &lt; 0.001). Logistic regression confirmed that EOAF was predictive of in-hospital heart failure (p &lt; 0.001, OR 2.15) and atrioventricular block (p = 0.008, OR 7.46). Regarding 1 year-follow-up, EOAF had poorer prognosis comparing to LOAF (59.3% vs 73.0%, p = 0.018, OR 1.62, CI 1.09-2.42)

Conclusion

EOAF is predictive of MACE, namely heart failure and atrioventricular block, and is associated to poorer prognosis comparing to LOAF.

Endocardial left ventricular pacing Where are we a systematic review

Funding Acknowledgements

Type of funding sources: None.

Background

Endocardial left ventricular pacing is a technique used in cardiac resynchronization therapy (CRT), when a coronary sinus implant is not possible, conventional CRT was an unsuccess and in CRT nonresponders. We performed a systemic review to evaluate its risks and benefits.

Objective

Review the evidence regarding the efficacy and safety of endocardial left ventricular pacing.

Methods

A systemic research on MEDLINE and PUBMED with the term "endocardial left ventricular pacing", "biventricular pacing" or "endocardial left pacing". 1038 results were identified, however, just publish papers (excluding abstract) with more than 16 patients was admitted in these analyses. Comparisons pre and post CRT regard New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF) and QRS width was performed. Mean differences (MD) and confidence interval (CI) was used as a measurement of treatment.

Results

Eleven studies were selected, including a total of 560 patients. The studies were performed with different techniques, trans-atrial septal technique, trans-ventricular septal technique and transapical technique. Mean age 66.93 years old, 90.54% male, median ejection fraction of 28.86%, NYHA class of 3.03, QRS width 167,50 mseg. Ischemic etiologic in 43.88%, atrial fibrillation in 45.35% and left bundle branch block in 55.20%. Was reported several complications after the procedure, 8 pocket infection (7 studies), 17 transient ischemic attacks (10 papers), 17 ischemic stroke (all), 35 tromboembolic events (all) and 115 deaths, nevertheless, follow up in the different studies was diverse and heterogeneous. Significant improvement was registered in NYHA class (MD 0.64, CI 0.56-0.72, p &lt; 0.00001, I2 = 89%) (reported in 7 studies), LVEF (MD 6.20, CI 5.09-7.32, p = 0.002, I2 = 69%) %) (reported in 8 studies) and QRS width (MD 31.35, CI 26.11-36.60, p &lt; 0.00001, I2 = 89%) %) (reported in 5 studies), (all p &lt; 0.00001).

Conclusions

Left ventricular endocardial pacing is a feasible alternative to conventional CRT, when the last one is not possible. With clinical, electrocardiogram and echocardiogram improvement in several series. First data regarding this procedure were associated with higher stroke incidence, something contrary to the last study’s results. Nevertheless, at the moment just small series present this technique with heterogenous results and different approaches, being important further investigation.

Cardiac arrest in Acute Coronary Syndrome: predictors and prognosis

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

on behalf of the Investigators of " Portuguese Registry of ACS "

Introduction

Cardiac arrest (CA) is a potential complication of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of CA in the setting of ACS.

Objective

To evaluate predictors and prognosis of CA in the setting of ACS.

Methods

Based on a multicenter retrospective study, data collected between 1/10/2010 and 4/09/2019. Patients (pts) without data on previous cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without CA; GB - pts with CA during hospitalization. Logistic regression and survival analysis was performed.

Results

Between 25718 pts with ACS, CA occurred in 651 (2.5%). GB was younger (65 ± 15 vs 67 ± 14, p &lt; 0.001), had higher rates of smoking (35.8% vs 26.4%, p &lt; 0.001), and lower rates of hypertension (62.3% vs 70.9%, p &lt; 0.001), diabetes (25.7% vs 31.7%, p &lt; 0.001), dyslipidaemia (53.8% vs 61.7%, p &lt; 0.001), previous ACS (17.2% vs 20.6%, p = 0.037) and coronary artery bypass grafting (CABG) (1.9% vs 5.1%, p &lt; 0.001). Both groups were similar regarding previous heart failure (p = 0.450) and chronic kidney disease (p = 0.560). GB had shorter times from first symptoms to admission (158min vs 243min, p &lt; 0.001). GA had higher rate of non-ST-elevation myocardial infarction (MI) (78.6% vs 41.4%, p &lt; 0.001), whether GB had higher rates of ST-elevation myocardial infarction (STEMI) (46.7% vs 18.1%, p &lt; 0.001), namely anterior (54.9% vs 46.9%, p &lt; 0.001). GB had lower blood pressure (BP) (122 ± 33 vs 139 ± 28, p &lt; 0.001), higher heart rate (HR) (83 ± 23 vs 77 ± 19, p &lt; 0.001), presented more frequently in Killip-Kimball class (KKC) ≥2 (37.6% vs 14.6%, p &lt; 0.001), in atrial fibrillation (AF) (13.9% vs 7.0%, p &lt; 0.001) and with right bundle block (10.6% vs 5.3%, p &lt; 0.001). GB had higher rates of common trunk culprit lesion (CL) (3.9% vs 1.6%, p &lt; 0.001), anterior descending coronary CL (49% vs 37%, p &lt; 0.001), 1 vessel lesion (53.4% vs 38.5%, p &lt; 0.001), lower CABG rates (4.3% vs 6.3%, p = 0.042), more left ventricle dysfunction (57.7% vs 38.7%, p &lt; 0.001) and needed more frequently mechanical ventilation (35.3% vs 1.1%, p &lt; 0.001), non-invasive ventilation (6.8% vs 1.6%, p &lt; 0.001) and provisory pacemaker (9.4% vs 1.3%, p &lt; 0.001). Logistic regression confirmed that older age (p &lt; 0.001, OR 1.89, CI 1.35-2.64), higher HR (p &lt; 0.029, OR 1.33, CI 1.03-1.71), lower BP (P &lt; 0.001, OR 2.67, CI 1.94-3.68), KKC ≥2 (p &lt; 0.001, OR 2.35, CI 1.84-3.00), AF at admission (p &lt; 0.001, OR 1.84, CI 1.34-2.51), STEMI (p &lt; 0.001, OR 4.08, CI 3.66-6.77), lower left ventricle function (p = 0.009, OR 1.38, CI 1.08-1.75) were predictors of CA. Event-free survival was higher in GA than GB (92.8% vs 83.3%, OR 1.68, p = 0.008, CI 1.41-2.47).

Conclusion

As expected, CA in the setting of ACS is associated with poorer prognosis. Several characteristics of the pts may help to predict the development of CA during hospitalization, allowing earlier identification and prompt treatment.

Septal vs apical defibrillator electrode placement a systematic review

Funding Acknowledgements

Type of funding sources: None.

Background

The optimal right ventricular defibrillator lead placement is still a debatable matter. We attempt to performed a systemic review to evaluate whether septal and apical placement had significant differences in the follow-up with an indication for implantation of these devices.

Objective

Review the evidence regarding the efficacy and safety of right ventricular apical and septal defibrillator lead placement.

Methods

A systemic research on MEDLINE and PUBMED with the term "septal pacing", "apical pacing" "septal defibrillation" or "apical defibrillation". 309 results were identified, however, after a serious analysis, several articles were excluded. Comparisons between apical and septal placement were performed regarding R wave amplitude, pacing threshold at 0.5 ms, lead impedance, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) and lead complication that produced lead re-placement. Mean differences (MD) and confidence interval (CI) was used as a measurement of treatment.

Results

Six studies were selected, including a total of 2180 patients. The studies were performed with different techniques, analyses and goals. The studies presented heterogeneous and diverse results, with a varied follow-up period, that resulted in the exclusion of one of the studies. Mean age 64.51 years old, 76.86% male, a median ejection fraction of 27.84%, NYHA class of 2.65, ischemic etiologic in 51.10% and a follow-up period of 26.49 months. Septal defibrillator lead placement was established in 772 patients, while the apical defibrillator lead placement was performed in 1399 patients. No differences regarding the lead performance on apical and septal placement were detected regarding the R-wave (MD -0.36, CI -0.75 - +0.03, p = 0.68, I2 = 0%) (reported in 3 studies) and lead impedance (MD -23.83, CI -51.36 - +3.69, p = 0.003, I2 = 82%) (reported in 3 studies). Pacing threshold seems to be favor a septal defibrillator lead implantation (MD -0.05, CI -0.09 - -0.02, p = 0.12, I2 = 53%) (reported in 3 studies). Concerning echocardiography parameters during the follow up period, LVEF (MD -0.83, CI -3.05 - +1.38, p = 0.10, I2 = 57%) (reported in 3 studies) and LVEDD (MD -0.51, CI -2.13 - +1.10, p = 0.20, I2 = 38%) (reported in 3 studies) were not significant influenced for the defibrillator lead placement. Lead complications that provoke a lead replacement was not significant between the lead placement (MD 1.25, CI 0.53 – 2.94, p = 0.71, I2 = 0%) (reported in 3 studies).

Conclusions

Just pacing threshold proved to improve the septal defibrillator lead placement. Neither the other lead parameters or the echocardiography results during the follow-up were influenced by the lead placement. For a definitive conclusion is important to further investigation.

Prognosis of new-onset of atrial fibrillation in acute coronary syndrome: Portuguese experience

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

Acute coronary syndrome (ACS) and atrial fibrillation (AF) are common diseases in developed countries and in some cases, the first episode of AF can occur during the ACS. A stressful event like an ACS can be a trigger for AF, being important to realize its impact and prognosis in the short and long term.

Objective

Evaluate the impact and prognosis of new-onset AF in ACS.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided into two groups: A – patients without new-onset AF, and B – patients that presented new onset of AF. Were excluded patients without a previous cardiovascular history or clinical data during the admission and the follow-up period. Logistic regression was performed to assess if new-onset AF in ACS was a predictor of major adverse cardiac events and mortality. Kaplan-Meier test was performed to establish the survival rates and re-admission for one year of follow up.

Results

9687 patients suffered ACS and had follow-up at 1 year, 9264 in group A (95.6%) and 423 in group B (4.4%). Both groups were similar regarding dyslipidemia, diabetes mellitus, previous coronary artery disease, multivessel disease after the cardiac catheterization. Group A had more smokers (28.2 vs 17.8%, p &lt; 0.001) and left ventricular ejection fraction (LVEF) &gt;50% (69.2 vs 45.1%, p &lt; 0.001). On the other hand, group B was elderly (67 ± 14 vs 75 ± 12, p &lt; 0.001), female (26.9 vs 34.0%, p &lt; 0.001), arterial hypertension (70.5 vs 77.5%, p = 0.005), was more admitted directly to the cat lab (12.5 vs 17.7%, p = 0.002), ST-segment elevation myocardial infarction (40.2 vs 49.9%, p &lt; 0.001), Killip-Kimball classification &gt; I (12.8 vs 34.8%, p &lt; 0.001) and hybrid revascularization (0.7 vs 2.4%, p = 0.002). Logistic regression revealed that new-onset of AF in ACS patients was a predictor of congestive heart failure (odds ratio (OR) 1.75, p &lt; 0.001, confidence interval (CI) 1.47-2.09), cardiogenic shock (OR 3.08, p &lt; 0.001, CI 2.37-4.01), sustained ventricular tachycardia (OR 2.29, p &lt; 0.001, CI 1.61-3.25) and intrahospital mortality (OR 1.99, p &lt; 0.001, CI 1.51-2.63). Nevertheless, new-onset of AF was not associated with re-infarction (p = 0.361), mechanical complications (p = 0.319), atrioventricular block (p = 0.574), stroke (p = 0.131) and cardiac arrest (p = 0.060) during the hospitalization for ACS. Mortality rates at one year of follow-up showed significant differences, p &lt; 0.001, between the two groups (Figure 1). Similar results were found concerning re-admission for all causes, p = 0.021 (Figure 2), on the other causes, re-admission for cardiovascular causes do not reveal to be significant, p = 0.515.

Conclusions

New-onset of AF in ACS was a predictor of congestive heart failure, cardiogenic shock, sustained ventricular tachycardia and intrahospital mortality. AF was associated with higher mortality rates and re-admission for all causes at one year follow up.

Atrioventricular block in acute coronary syndrome: Portuguese experience

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

The atrioventricular block (AVB) occurrence in acute coronary syndrome (ACS) is a potentially life-threatening complication, that demand a rapid and efficient response regarding reperfusion time and rhythm stabilization.

Objective

Evaluate the impact and prognosis of AVB in ACS patients, as well as predictors of AVB.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-3/05/2020. Patients were divided into two groups: A – patients without AVB, and B – patients that presented AVB. Were excluded patients without a previous cardiovascular history or clinical data regarding AVB occurrence. Logistic regression was performed to assess predictors of AVB in ACS patients.

Results

From 32157 patients, 23774 was included, 23148 in group A (97.4%) and 626 in group B (2.6%). Both groups were similar regarding initial symptons until first medical contact (p = 0.410), smoker status (p = 0.222), arterial hypertension (p = 0.776), diabetes mellitus (p = 0.508), peripheral artery disease (p = 0.479), chronic kidney disease (p = 0.467) and re-infarction during the hospitalization for ACS (p = 0.145). Group A had higher body mass index (27.4 ± 4.4 vs 26.9 ± 4.6, p = 0.005), dislipidaemia (59.6 vs 51.4%, p &lt; 0.001), coronary artery disease (18.9 vs 13.0, p &lt; 0.001), heart rate (78 ± 19 vs 65 ± 25, p &lt; 0.001), systolic blood pressure (139 ± 29 vs 119 ± 32, p &lt; 0.001) and left ventricular ejection fraction (LVEF) &gt;50% (60.1 vs 51.7%, p &lt; 0.001). On the other hand, group B was elderly (66 ± 13 vs 71 ± 13, p &lt; 0.001), female (27.4 vs 32.4%, p &lt; 0.001), previous stroke (6.9 vs 10.9%, p &lt; 0.001), neoplasia (4.9 vs 6.8%, p = 0.031), ST-segment elevation myocardial infarction (46.2 vs 75.4%, p &lt; 0.001), syncope as major symptom (1.3 vs 10.0%, p &lt; 0.001), Killip-Kimball class &gt; I (15.4 vs 31.6%, p &lt; 0.001), multivessel diasease (52.1 vs 61.4%, p &lt; 0.001), heart failure complication (15.5 vs 40.6%, p &lt; 0.001), cardiogenic shock complication (3.8 vs 24.6%, p &lt; 0.001), new-onset of atrial fibrillation (4.2 vs 14.1%, p &lt; 0.001), ACS mechanical complication (0.6 vs 3.2%, p &lt; 0.001), sustained ventricular tachycardia during ACS hospitalization (1.3 vs 10.0%, p &lt; 0.001), cardiac arrest (2.7 vs 13.3%, p &lt; 0.001), stroke complication (0.6 vs 1.9%, p &lt; 0.001) and hospitalization death (3.5 vs 19.0%, p &lt; 0.001). Logistic regression revealed that female gender (odds ratio (OR) 1.422, p = 0.015, confidence interval (CI) 1.072-1.885), age ≥75 years old (OR 1.560, p = 0.002, CI 1.174-2.073), heart rate &lt;60 (OR 6.692, p &lt; 0.001, CI 5.180-8.644) and Killip-Kimball class &gt; I (OR 3.264, p &lt; 0.001, CI 2.446-5.356) were predictors of AVB in ACS patients.

Conclusions

Female gender, age ≥75 years old, heart rate &lt;60 and Killip-Kimball class &gt; I were predictors of AVB in ACS patients.

In-hospital outcomes of sustained ventricular tachycardia in the setting of Acute Coronary Syndrome

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

on behalf of the Investigators of " Portuguese Registry of ACS "

Introduction

Sustained ventricular tachycardia (SVT) complicates up to 20% of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of SVT.

Objective

To evaluate predictors of early onset (&lt;48h) and late onset (≥48h) SVT.

Methods

Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) were divided in two groups (G): A – pts that presented early onset SVT (ESVT), and B – pts that presented late onset SVT (LSVT). Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. Logistic regression was performed to assess predictors of SVT in ACS.

Results

Between 29851 pts with ACS, 364 (1.2%) presented SVT. ESVT – 251 pts (69%); LSVT – 91 pts (25%). LSVT G was older (74 ± 13 vs 68 ± 14, p = 0.003), was admitted directly to cat lab less frequently (10.1% vs 24.8%, p = 0.003), had longer times from first symptoms to admission (440min vs 261 min, p &lt; 0.001) and had higher rates of previous stroke (14.4% vs 6.8%, p = 0.028). LSVT G had higher rates of non-ST-elevation myocardial infarction (MI) (35.2% vs 23.1%, p = 0.025) and lower rates of ST-elevation MI (53.8% vs 71.7%, p = 0.002), although both G were similar regarding MI location (anterior – p = 0.135, inferior – p = 0.097). LSVT G had higher systolic blood pression (130 ± 33 vs 122 ± 33, p = 0.050), presented more frequently in Killip-Kimball class ≥2 (52.5% vs 35.5%, p = 0.005) and with atrial fibrillation (21.2% vs 12.4%, p = 0.045), and had higher brain-natriuretic peptide (1075 vs 329, p &lt; 0.001). LSVT G was treated more frequently with diuretics (80.0% vs 47.8%, p &lt; 0.001), amiodarone (62.2% vs 48.8%, p = 0.029), digoxin (8.9% vs 2.4%, p = 0.013) and levosimendan (11.1% vs 2.8%, p = 0.004). ESVT G had higher rates of performed coronarography (88.4% vs 79.1%, p = 0.028) but lower rate of 3 vessels disease (58.5% vs 70.8%, p = 0.017). LSVT G had higher rates of severe (&lt;30%) left ventricle dysfunction (32.9% vs 15.4%, p &lt; 0.001) and need to non-invasive ventilation (23.1% vs 6.8%, p &lt; 0.001). Regarding in-hospital complications, ESVT G had higher rates of heart failure (34.7% vs 19.1%, p = 0.006), atrioventricular block (15.7% vs 1.1%, p &lt; 0.001), atrial fibrillation (20.4% vs 7.7%, p = 0.006) and major haemorrhage (5.2% vs 0.0%, p = 0.024). LSVT G had higher rates of in-hospital death (44.4% vs 20.9%, p &lt; 0.001) and in-hospital stay (14 days vs 7 days, p &lt; 0.001). The G were similar regarding re-infarction (p = 0.216), shock (p = 0.179), mechanical complications (p = 1.00), cardiac arrest (p = 0.097) and stroke (0.348) rates. Logistic regression confirmed ESVT was predictive in-hospital heart failure (p = 0.010, OR 2.67) and de novo AF (p = 0.001, OR 5.56), whether LSVT was predictive of in-hospital death (p = 0.002, OR 2.70).

Conclusion

LSVT was associated with higher rates of in-hospital complications, but ESVT was associated with higher in-hospital mortality.

Protocol for a systematic review assessing ambulatory vital sign monitoring impact on deterioration detection and related clinical outcomes in hospitalised patients

INTRODUCTION

Ambulatory monitoring systems (AMS) can facilitate early detection of clinical deterioration, and have the potential to improve hospitalised patient outcomes. The objective of this systematic review is to assess the impact of vital signs monitoring on detection of deterioration and related outcomes in hospitalised patients using AMS, in comparison with standard care.

METHODS AND ANALYSIS

A systematic search was conducted on 27 August 2020 in MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, CENTRAL and Health Technology Assessment databases, as well as grey literature. Search results will be reviewed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist for systematic reviews. Studies comparing the use of ambulatory monitoring devices against standard care for deterioration detection and related clinical outcomes in hospitalised patients will be included and further clinical and other outcomes will also be explored. Deterioration-related outcomes may include (but not limited to) unplanned intensive care admissions, rapid response team activation and unscheduled emergency interventions, as defined by the included studies. Two reviewers will independently extract study data and assess the quality and risk of bias of included studies. Where possible, a meta-analysis will be conducted and quantitative results presented. Alternatively, a narrative synthesis will be reported.

ETHICS AND DISSEMINATION

Ethical approval is not required for this study as no primary data will be collected. This study is part of our virtual High Dependency Unit project and will be disseminated through peer-reviewed publications, public and scientific conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42020188633.

Cardiovascular risk factors as predictors of new onset atrial fibrillation during hospitalization for Acute Coronary Syndromes

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

Cardiovascular risk factors (CVRF) are a growing health problem in developed countries, being directly associated with acute coronary syndrome (ACS) occurrence and atrial fibrillation (AF). Nevertheless, new onset of AF in context of ACS is a clinical problem with prognostic and therapeutic implications.

Objective

Evaluate the impact of the CVRF in new onset AF during the hospitalization for ACS.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without new onset of AF during the hospitalization for ACS and B – with new onset of AF during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, coronary artery disease, neoplasia, dyslipidemia, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of new onset AF in these patients.

Results

14037 patients were included, 637 in group B (4.8%). Both groups were similar regarding diabetes mellitus (p = 0.116), coronary artery disease (p = 0.264) and neoplasia (p = 0.327). Curiously the group A exhibited higher body mass index (27.5 ± 4.3 vs 27.2 ± 4.4, p &lt; 0.001), smokers (28.1 vs 18.5%, p &lt; 0.001) and dyslipidemia (62.8 vs 56.7%, p &lt; 0.001). On the other hand, group B presented more females (26.4 vs 35.0%, p &lt; 0.001), arterial hypertension (70.0 vs 74.9%, p = 0.002), peripheral arterial disease (5.4 vs 8.4%, p &lt; 0.001) and chronic kidney disease (6.7 vs 9.5%, p &lt; 0.001). Logistic regression revealed that body mass index, smoker status, diabetes, dyslipidemia, coronary artery disease, neoplasia, chronic kidney disease and peripheral arterial disease were not predictors of AF during the hospitalization for ACS. Nonetheless, female gender (odds ratio (OR) 1.23, p = 0.025, confidence interval (CI) 1.03-1.47), obesity (OR 1.39, p = 0.004, CI 1.11-1.74) and arterial hypertension (OR 1.22, p = 0.049, CI 1.01-1.50) were predictors of new onset of AF during hospitalization for ACS. Conclusions: Female gender, obesity and arterial hypertension were predictors of new onset of AF in during hospitalization for ACS.

Acute heart failure: does etiology matter?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients (pts) with acute heart failure (AHF) are a heterogeneous population. The etiology of the heart disfunction may play a role in prognosis. Risk stratification at admission may help predict in-hospital complications and needs.

Objective

To explore predictors of in-hospital mortality (IHM), post discharge early mortality [1-month mortality (1mM)] and late mortality [1-year mortality (1yM)] and early and late readmission, respectively 1-month readmission (1mRA) and 1-year readmission (1yRA), in our center population, using real-life data.

Methods

Based on a single-center retrospective study, data collected from patients (pts) admitted in the Cardiology department with AHF between 2010 and 2017. Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. The pts were divided in 3 groups: ischemic etiology (IE), valvular etiology (VE) and other etiologies (OE), which included hypertensive and idiopathic cardiomyopathies). Statistical analysis used non-parametric tests and Kaplan-Meyer survival analysis.

Results

We included 300 pts admitted with AHF. Mean age was 67.4 ± 12.6 years old and 72.7% were male. 37.7% had previous history of revascularization procedures, 66.9% had hypertension, 41% were diabetic and 38% had dyslipidaemia. The heart failure was of IE in 45%, VE in 22.7% and of OE in 32.3% of the cases.

There were no significant differences between groups regarding body mass index, Killip-Kimball class, systolic blood pressure at admission, blood tests aspects at admission (namely, creatinine, sodium or urea), inotropes’ usage or need of non-invasive or invasive ventilation. However, IE group had higher percentage of males comparing to VE e OE (83.0% vs 55.9% vs 70.1%, respectively, p &lt; 0.001), higher rates of prior revascularization procedures (68.9%, vs 19.1%, vs 7.2%, p &lt; 0.001) and higher rates of traditional cardiovascular risk factors, namely hypertension (74.1% vs 55.9% vs 57.7%, p = 0.014), diabetes mellitus (48.1% vs 27.9% vs 27.8%, p = 0.002) and dyslipidaemia (48.9% vs 30.9% vs 40.2%, p = 0.022). OE group was younger compared to IE and VE (63.9 ± 13.5 vs 68.9 ± 11.1 vs 69.5 ± 13.0 years old, respectively, p = 0.003). VE group had less left ventricle disfunction comparing to IE and VE groups (left ventricle ejection fraction 40.8 ± 14.1 vs 32.2 ± 9.8 vs 31.6 ± 12.8%, respectively, p &lt; 0.001).

The groups showed no significant differences regarding IHM (IE 5.2% vs VE 8.8% vs OE 2.1%, p = 0.146), 1mRA (IE 8.1&, VE 7.4%, OE 3.1%, p = 0.276) or 1yRA (IE 55.6%, VE 54.4%, OE 47.4%, p = 0.449). However, VE group had higher rates of 1mM (VE 13.2% vs IE 8.9% vs OE 3.1%, p = 0.05) and 1yM compared to IE and OE (33.8% vs 30.4% vs 17.5%, respectively, p = 0.34). These aspects are represented in Kaplan Meier survival curves.

Conclusion

In our population, the etiology of heart failure was predictor of early and late post-discharge mortality but not readmission.

Effect of exercise training on amyloid-like protein aggregates among patients with heart failure

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): MG and CS were supported by a PhD FCT grant (SFRH/BD/128893/2017) and by an individual grant from CAPES [BEX 0554/14-6], respectively. This work was financially supported by the project POCI-01-0145-FEDER-030011, funded by FEDER, through COMPETE2020-POCI, and by national funds, through FCT/MCTES (PTDC/MEC-CAR/30011/2017). iBiMED is a research unit supported by the Portuguese Foundation for Science and Technology (REF: UID/BIM/04501/2020) and FEDER/Compete2020 funds).

Introduction

Amyloid-like protein aggregates play a decisive role in the pathology of heart failure. Alterations in protein homeostasis, in particular, the clearance of toxic amyloid-like aggregates are emerging therapeutic targets in cardiovascular medicine. The clinical benefits of cardiac rehabilitation and exercise training are widely accepted in heart failure; however, little is known about the potential benefit of exercise training in amyloid-like protein aggregates.

Purpose

To assess the effects of a moderate-intensity exercise training program on amyloid-like protein aggregates levels among patients with heart failure with reduced ejection fraction.

Methods

Eighteen subjects participated in the study; eight patients (age: 66.6 ± 5.9 years; FEVE: 38.4 ± 8.9%) with heart failure with reduced ejection fraction participated in a 3-month exercise training program (2 x 60 min sessions per week of moderate-intensity aerobic and resistance exercise). Ten healthy subjects (age: 68. 4 ± 3.1 years) were recruited to an age-matched reference group.  Amyloid-like protein aggregates were assessed before and after 3 months of exercise training. Clinical data, medication, anthropometrics, and cardiorespiratory fitness were also assessed. Thioflavin T (ThT) dye fluorescence was used to quantify the plasma levels of amyloid-like aggregates and the Fourier transform infrared spectroscopy (FTIR) was applied to evaluate the conformation of cross-β-sheet structures characteristic of amyloid protein aggregates.

Results

Exercise program improved cardiorespiratory fitness by 14.0 ± 17.1% (17.4 ± 3.2 to 19.7 ± 2.9 ml/kg/min) and reduced NT-proBNP levels by 16.5% (34.2) (median concentration of 632 pg/mL (720.8) to 517.5 pg/mL (707.0)) in the heart failure patients. A slight decrease of amyloid-like aggregates levels was observed in post-exercise training samples (a reduction of 3.1%); interestingly, after the exercise training program, the heart failure patients showed levels of amyloid-like aggregates similar to the reference group (1132.0 ± 114.2 vs. 1094.8 ± 132.9 a.u.). Additionally, the PLS-R multivariate analysis of the amide I region of the FTIR spectra revealed enrichment of antiparallel β-sheets (1693 cm-1) assigned to amyloid-like oligomers in the samples of heart failure patients before, but not after, the exercise program. Of note, oligomeric species, as intermediates of amyloid assembly, can contribute to the increase of amyloid burden, but also, some have been reported to be highly reactive and toxic to cells, being key elements of amyloid pathogenesis.

Conclusions

 Our preliminary results indicate that 3 months of exercise training may have significant effects on amyloid-like oligomers, and start hindering the formation of the larger ThT-positive aggregates among patients with heart failure.

Abstract Figure.

Cardiovascular risk factors as predictors of heart failure during hospitalization for Acute Coronary Syndromes

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

Cardiovascular risk factors (CVRF) are a growing health problem in developed countries. These patients have a higher prevalence of acute coronary syndromes (ACS) and as a consequence ACS complication, like heart failure (HF). HF after an ACS is a common complication and CVFR can influence its manifestation.

Objective

Evaluate the impact of the CVRF in HF during the hospitalization for ACS.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without new onset of HF during the hospitalization for ACS and B – with new onset of HF during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, neoplasia, dyslipidemia, coronary artery disease, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of new onset HF in these patients.

Results

14717 patients were included, 2287 in group B (15.5%). Both groups were similar regarding body mass index (27.5 ± 4.3 vs 27.2 ± 4.4, p = 0.254). Curiously the group A exhibited higher prevalence of smoking status (29.8 vs 16.6%, p &lt; 0.001). On the other hand, group B presented more females (25.0 vs 35.7%, p &lt; 0.001), arterial hypertension (68.7 vs 78.2%, p &lt; 0.001), diabetes mellitus (28.5 vs 43.1%, p &lt; 0.001), dyslipidemia (62.2 vs 64.3%, p = 0.023), coronary artery disease (19.6 vs 25.6%, p &lt; 0.001), neoplasia (4.4 vs 7.0%, p &lt; 0.001), peripheral arterial disease (5.2 vs 15.8%, p &lt; 0.001) and chronic kidney disease (4.6 vs 10.0%, p &lt; 0.001). Logistic regression revealed that body mass index, diabetes, arterial hypertension, neoplasia and dyslipidemia were not predictors of HF during the hospitalization for ACS. Nevertheless, female gender (odds ratio (OR) 1.37, p &lt; 0.001, confidence interval (CI) 1.22-1.54), chronic kidney disease (OR 1.59, p &lt; 0.001, CI 1.33-1.90) and peripheral arterial disease (OR 1.54, p &lt; 0.001, CI 1.27-1.86) were predictors of new onset of HF during hospitalization for ACS. Curiously, smoking seems to have a protective effect (OR 0.68, p &lt; 0.001, CI 0.59-0.78) in new onset HF in ACS patients.

Conclusions

Chronic kidney disease and peripheral arterial disease were predictors of new onset of HF in during hospitalization for ACS.

Predictors of early and late re-hospitalization and mortality in non-ST elevation myocardial infarction

Funding Acknowledgements

Type of funding sources: None.

Introduction

Regarding prognosis, acute coronary syndromes (ACS) are heterogeneous. Non-ST elevation myocardial infarction (NSTEMI) is a subtype of ACS. In-hospital (IH) and post-hospitalization (PH) risk stratification is crucial.

Objective

To identify predictors of IH and PH mortality (early and late), as well as predictors of early and late re-admission (RA) in our center population suffering NSTEMI, using real-life data.

Methods

Based on a single-center retrospective study, data collected from admissions between 1/01/2018 and 11/12/2019. Patients (pts) who survived the ACS and were discharged from the hospital were included. Concerning prognosis, we assessed 1-month M and RA (1mM and 1mRA), 6-month M and RA (6mM and 6mRA), 1-year M and RA (1yM and 1yRA).

Results

268 pts with ACS, 59.7% were males and mean age was 66.4 ± 12.5 years old. NSTEMI was the diagnosis in 66.4% and ST elevation myocardial infarction (STEMI) in 31%. Mean creatinine was 1.2 ± 1ml/min, mean sodium was 138 ± 3mmol/L, mean blood urea nitrogen (BUN) was 21 ± 12mg/dL and mean haemoglobin (Hb) was 13.6 ± 1.9g/dL. 88.2% of the pts presented in Killip-Kimball class (KKC) 1, 5.7% in KKC 2, 5.7% in KKC 3 and 0.4% in KKC IV; furthermore, 4.1% of the pts presented de novo AF. Concerning coronary artery disease, 250 were submitted to coronary angiography – 18.8% had no lesions or non-significant lesions (stenosis &lt;50%), 34.8% had one significant lesion, 23.2% had 2 significant lesions and 23.2% had 3 or more. Regarding left ventricle (LV) function, 70.5% of the pts had no LV dysfunction, 15.7% had mild LV impairment (LVI), 9.3% moderate LVI and 4.5% had severe LVI. 8.4% of the patients experienced IH complications, such as auriculoventricular block, heart failure, ventricular tachycardia, stroke, cardiorespiratory arrest and major haemorrhage, during hospitalization. 1mM rate was 1.9% and 1yM rate was 7.8%.

KKC (p = 0.001), BUN (p = 0.007), LV function (p= 0.001) and de novo AF (p = 0.46) were predictors of 1mM. Age (p = 0.004), KKC (p = 0.031), BUN (p = 0.002), sodium (p = 0.037), creatinine (p = 0.001), Hb (p = 0.003), LV function (p &lt; 0.001), de novo AF (p &lt; 0.001) and occurrence of IH complications (p &lt; 0.001) were predictors of 1yM. Age (p = 0.010), male gender (p = 0.19), Hb (p = 0.031), de novo AF (p &lt; 0.001) and occurrence of IH complications (p = 0.001) were predictors of 1mRA. Age (p = 0.004), smoking (p = 0.040), hypertension (p = 0.040), glycemia at admission (p = 0.031), Hb (p = 0.004), LV function (p = 0.019), de novo AF (p &lt; 0.001) and occurrence of IH complications (p &lt; 0.001) were predictors of 1yRA.

Conclusion

This study suggests that de novo AF and occurrence of IH complications are very important prognosis factors regarding early and late mortality and readmission rates.

Acute Coronary Syndrome - reinfarction predictors and outcomes

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

on behalf of the Investigators of " Portuguese Registry of ACS "

Introduction

Reinfarction (RI) is a potential complication of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of RI in the setting of ACS.

Objective

To evaluate predictors and prognosis of RI in the setting of ACS.

Methods

Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) without data on previous cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without RI; GB - pts with RI during hospitalization. Logistic regression and survival analysis were performed.

Results

Between 25718 pts with ACS, RI occurred in 223 (0.87%). Regarding epidemiological factors and past history, GB was older (70 ± 12 vs 67 ± 14, p &lt; 0.001), had higher rates of hypertension (77.4% vs 70.6%, p = 0.028), previous stroke (12.1% vs 7.2%, p = 0.005), peripheric arterial disease (10.0% vs 5.5%, p = 0.004) and chronic obstructive pulmonary disease (8.6% vs 4.4%, p = 0.003). GB had higher rates of non-ST-elevation myocardial infarction (MI) (54.3% vs 45.9%, p = 0.012) and GA had higher rates of ST-elevation MI (42.4% vs 35.9%, p = 0.049). The groups were similar regarding blood pressure (p = 0.285), heart rate (p = 0.796) and Killip-Kimball class at admission, but GB had higher levels of brain natriuretic peptide (392 vs 180, p = 0.005). GB had higher rates of multivessel disease (62.8% vs 51.6%, p = 0.002), left ventricle dysfunction (50.0% vs 39.1%, p = 0.002), higher needs of mechanical ventilation (6.3% and vs 1.9%, p &lt; 0.001) non-invasive ventilation (5.4% vs 1.7%, p &lt; 0.001). Logistic regression confirmed that peripheric arterial disease (p = 0.011, OR 1.93, CI 1.17-3.19), multivessel disease (p = 0.003, OR 1.69, CI 1.20-2.39) and lower left ventricle function (p &lt; 0.001, OR 2.42, CI 1.69-3.47) were predictors of RI in the setting of ACS. Event-free survival was similar between groups (p = 0.399).

Conclusion

RI in the setting of ACS was associated multivessel disease and left ventricle disfunction, however, 1-year prognosis was similar to pts who didn’t suffer RI.

Physical activity and its clinical correlates in chronic thromboembolic pulmonary hypertension

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fundação para a Ciência (FCT) Coordenação de Aperfeiçoamento de Pessoal de Nível (CAPES)

Background

 Limited data is available on physical activity (PA) levels in chronic thromboembolic pulmonary hypertension (CTEPH) patients, as well as on the impact of using different tools to assess PA such as questionnaires and accelerometers. 

Purpose

 We aimed to quantify PA levels of CTEPH patients and study its clinical correlates, as well as to compare PA levels measured by the International Physical Activity Questionnaire (IPAQ) with measures from accelerometers.

Methods

 This is a cross-sectional study (n = 50). Physical activity levels were measured using accelerometers and questionnaire (IPAQ). Clinical parameters evaluated were walked distance on the 6-minute-walking test (6MWT), pulmonary vascular resistance, N-terminal brain natriuretic peptide and quality of life (HRQoL) using the Cambridge Pulmonary Hypertension Outcome Review questionnaire.

Results

 Accelerometer-derived data showed that CTEPH patients spent 60% of the recorded time in sedentary behaviours and only 2% in moderate-to-vigorous PA (MVPA). MVPA was mildly correlated with 6MWT (r = 0.359; p= 0.023) and symptom domain of HRQoL (r=-0.371; p = 0.044) but not with NT-proBNP, pulmonary vascular resistance or functional domain of HRQoL. Time spent in sedentary behaviour was lower in self-reported measurement (279 ± 165min/day) compared to accelerometry (446 ± 117min/day, p &lt; 0.001). Self-reported MVPA was significantly higher than the one registered by the accelerometer (411 ± 569 vs. 131 ± 108 min/week, p = 0.027). Bland-Altman analysis indicated poor agreement between the two methods. 

Conclusions

 Our results showed that CTEPH patients spend most of their days in sedentary behaviors and only a small amount of time in MVPA. MVPA was associated with symptoms domain of HRQoL and submaximal functional capacity. In addition, we showed a poor agreement between self-reported and accelerometer-derived PA in CTEPH patients, with the former overestimating the overall PA activity.

Acute heart failure: is ACTION-ICU useful?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients (pts) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes.

Objective

To validate ACTION-ICU score in AHF as predictor of in-hospital M (IHM), post discharge early M [1-month mortality (1mM)] and 1-month readmission (1mRA), in our center population, using real-life data.

Methods

Based on a single-center retrospective study, data collected from pts admitted in the Cardiology department with AHF between 2010 and 2017. Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used non-parametric tests, logistic regression analysis and ROC curve analysis.

Results

We included 300 pts admitted with AHF. Mean age was 67.4 ± 12.6 years old and 72.7% were male. 37.7% had previous history of revascularization procedures, 66.9% had hypertension, 41% were diabetic and 38% had dyslipidaemia. Mean heart rate was 95.5 ± 27.5bpm, mean systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, mean urea level at admission was 68.8 ± 40.7mg/dL, mean sodium was 137.6 ± 4.7mmol/L, mean glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. Mean ACTION-ICU score was 10.4 ± 2.3. Inotropes’ usage was necessary in 32.7% of the pts, 11.3% of the pts needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the pts were readmitted 1 month after discharge.

Older age (p &lt; 0.001), lower SBP (p = 0,035), presenting in KKC 4 (p &lt; 0.001, OR 8.13) and need of inotropes (p &lt; 0.001) were predictors of IHM in our population. Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p &lt; 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the studied variables were predictive of need of IV. LVEF (OR 0.924, p &lt; 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p &lt; 0.001, CI 0.971-0.988), higher urea (OR 1.01, p &lt; 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors inotropes’ usage.

ACTION-ICU was able to predict IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV.

ROC curve analysis revealed ACTION-ICU performs well when predicting IHM (Area under curve (AUC) 0.729, confidence interval (CI) 0.59-0.87), inotropes’ usage (AUC 0.619, CI 0.54-0.70) and 1mM (AUC 0.705, CI 0.58-0.84).

Conclusion

In our population, ACTION-ICU score was able to predict IHM, 1mM and inotropes’s usage.

Acute heart failure: predicting early in-hospital outcomes

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients (P) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (M) of P admitted with AHF. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes.

Objective

To validate ACTION-ICU score in AHF and to compare ACTION-ICU to GWTG-HF as predictors of in-hospital M (IHM), early M [1-month mortality (1mM)] and 1-month readmission (1mRA), using real-life data.

Methods

Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with AHF between 2010 and 2017. P without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used chi-square, non-parametric tests, logistic regression analysis and ROC curve analysis.

Results

Among the 300 P admitted with AHF included, mean age was 67.4 ± 12.6 years old and 72.7% were male. Systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. ACTION-ICU score was 10.4 ± 2.3 and GWTG-HF was 41.7 ± 9.6. Inotropes’ usage was necessary in 32.7% of the P, 11.3% of the P needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the P were readmitted 1 month after discharge.

Older age (p &lt; 0.001), lower SBP (p = 0,035) and need of inotropes (p &lt; 0.001) were predictors of IHM in our population. As expected, patients presenting in KKC 4 had higher IHM (OR 8.13, p &lt; 0.001). Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p &lt; 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the variables were predictive of IV. LVEF (OR 0.924, p &lt; 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p &lt; 0.001, CI 0.971-0.988), higher urea (OR 1.01, p &lt; 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors of inotropes’ usage.

Logistic regression showed that GWTG-HF predicted IHM (OR 1.12, p &lt; 0.001, CI 1.05-1.19), 1mM (OR 1.10, p = 1.10, CI 1.04-1.16) and inotropes’s usage (OR 1.06, p &lt; 0.001, CI 1.03-1.10), however it was not predictive of 1mRA, need of IV or NIV. Similarly, ACTION-ICU predicted IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV. ROC curve analysis revealed that GWTG-HF score performed better than ACTION-ICU regarding IHM (AUC 0.774, CI 0.46-0-90 vs AUC 0.731, CI 0.59-0.88) and 1mM (AUC 0.727, CI 0.60-0.85 vs AUC 0.707, CI 0.58-0.84).

Conclusion

In our population, both scores were able to predict IHM, 1mM and inotropes’s usage.

Acute Coronary Syndrome follow up: Portuguese experience

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

Acute coronary syndrome is a major health problem, with several acute and chronic complications. So, it is imperative identifying factors that can be associated with better and worse prognosis during the follow up these patients.

Objective

Evaluate predictors of mortality, cardiovascular readmission and all causes of readmission at 1 year follow up in ACS patients.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Logistic regression was performed to assess predictors of mortality, cardiovascular readmission and all causes of readmission at 1 year follow up in ACS patients.

Results

1492 patients were included, 141 die during the first year. Age &gt; 75 years old (odds ratio (OR) 2.557, p &lt; 0.001, confidence interval (CI) 1.727-3.785), heart rate &lt; 60 (OR 2.686, p = 0.008, CI 1.296-5.569), cardiogenic shock (OR 6.726, p = 0.012, CI 1.512-29.915), creatinine &gt;2mg/dL (OR 1.956, p = 0.023, CI 1.099-3.480), left ventricular ejection fraction &lt;50% (OR 1.911, p = 0.001, CI 1.284-2.844), nitrate (OR 1.589, p = 0.020, CI 1.074-2.351), ivabradine (OR 1.831, p = 0.011, CI 1.146-2.924), aldosterone antagonists (OR 1.632, p = 0.020, CI 1.079-2.468), diuretic (OR 1.625, p = 0.023, CI 1.069-2.472) and mechanical complication d (OR 55.518, p &lt; 0.001, CI 11.516-267.655) were predictors of mortality of 1 year of follow up. Regarding cardiovascular readmission was registered in 291 patients, of a total 1412. Were predictors of cardiovascular readmission previous history of heart failure (OR 1.467, p = 0.003, CI 1.135-1.895), cardiogenic shock (OR 3.447, p = 0.039, CI 1.068-11.128), acetylsalicylic acid previous to ACS (OR 1.751, p = 0.008, CI 1.285-2.385), multivessel disease (OR 1.667, p = 0.002, CI 1.206-2.306), left ventricular ejection fraction &lt;50% (OR 1.489, p = 0.003, CI 1.145-1.938), nitrate (OR 1.812, p &lt; 0.001, CI 1.403-2.341), aldosterone antagonists (OR 1.572, p = 0.004, CI 1.155-2.140) and sustained ventricular tachycardia (OR 55.518, p &lt; 0.001, CI 11.516-267.655). On the other hand 411 patients was readmitted (all causes), in 1455 patients with follow up. Were predictors of all causes of readmission previous history of heart failure (OR 1.347, p = 0.025, CI 1.039-1.747), previous chronic obstructive pulmonary disease (OR 1.456, p = 0.041, CI 1.016-2.087), atrial fibrillation (OR 1.439, p = 0.027, CI 1.041-1.988), acetylsalicylic acid previous to ACS (OR 1.473, p = 0.001, CI 1.161-1.869), left ventricular ejection fraction &lt;50% (OR 1.456, p = 0.001, CI 1.166-1.819), nitrate (OR 1.478, p &lt; 0.001, CI 1.192-1.831), aldosterone antagonists (OR 1.493, p = 0.003, CI 1.148-1.943) and sustained ventricular tachycardia (OR 3.792, p = 0.004, CI 1.540-9.337). Conclusions: Left ventricular ejection fraction &lt;50%, nitrate as discharge therapeutic and aldosterone antagonists as discharge therapeutic were predictors of mortality, cardiovascular readmission and readmission for all causes at 1 year follow up.