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Coats T, Conroy S, de Groot B, Heeren P, Lim S, Lucke J, Mooijaart S, Nickel CH, Penfold R, Singler K, van Oppen JD, Polyzogopoulou E, Kruis A, McNamara R, de Groot B, Castejon-Hernandez S, Miro O, Karamercan MA, Dündar ZD, van Oppen JD, Pavletić M, Libicherová P, Balen F, Benhamed A, Dubucs X, Hernu R, Laribi S, Singler K, Fraidakis O, Fyntanidou VP, Polyzogopoulou E, Gaal S, Jónsdóttir AB, Kelly-Friel ME, McAteer CA, Sibthorpe LD, Synnott A, Zazzara MB, Coffeng SM, de Groot B, Lucke JA, Smits RAL, Castejon-Hernandez S, Llauger L, Mir SA, Ortiz MS, Padilla EE, Rodeles SC, Rojewski-Rojas W, Fadini D, Jegerlehner NS, Nickel CH, Rezzonico S, Zucconi EC, Cakmak S, Demir HA, Dündar ZD, Güven R, Karamercan MA, Sogut O, Tayfur I, Adams JA, Bernardo J, Brown L, Burton J, Butler MJ, Claassen RI, Compton F, Cooper JG, Heyes R, Ko S, Lightbody CJ, Masoli JAH, McKenzie STG, Mawhinney D, Moultrie NJ, Price A, Raman R, Rothwell LH, Shashikala RP, Smith EJ, Sorice V, van Oppen JD, Wallace JM, Young T, Benvin A, Breški E, Ćefo A, Dumić D, Ferenac R, Jurica I, Otočan M, Zinaić PŠ, Clement B, Jacquin L, Royer B, Apfelbacher SI, Bezati S, Gkarmiri S, Kaltsidou CV, Klonos G, Korka Z, Koufogianni A, Mavros V, Nano A, Ntousopoulos A, Papadopoulos N, Sason R, Zagalioti SC, Hjaltadottir I, Sigurþórsdóttir I, Skuladottir SS, Thorsteinsdottir T, Breslin D, Byrne CP, Dolan A, Harte O, Kazi D, McCarthy A, McMillan SS, Moiloa DN, O’Shaughnessy ÍL, Ramiah V, Williams S, Giani T, Levati E, Montenero R, Russo A, Salini S, van den Berg B, Booijen AM, Sir O, Vermeulen AE, ter Voert MA, Alvarez-Galarraga AC, Azeli Y, Gómez RGG, González González R, Lizardo D, Pérez ML, Madan CN, Medina JÁ, Moreno JS, Patiño EVB, Posada DMC, Rodrigo IC, Vitucci CF, Ballinari M, Dreher T, Gianinazzi L, Espejo T, Hautz WE, Rezzonico S, Bayramoğlu B, Cakmak S, Comruk B, Dogan T, Köse F, Allen TP, Ardley R, Beith CM, Boath KA, Britton HL, Campbell MMF, Capel J, Catney C, Clements S, Collins BP, Compton F, Cook A, Cosgriff EJ, Coventry T, Doyle N, Evans Z, Fasina TA, Ferrick JF, Fleming GM, Gallagher C, Golden M, Gorania D, Glass L, Greenlees H, Haddock ZP, Harris R, Hollas C, Hunter A, Ingham C, Ip SSY, James JA, Kenenden C, Jenkinson GE, Lee E, Lovick SA, McFadden M, McGovern R, Medhora J, Merchant F, Mishra S, Moreland GB, Narayanasamy S, Neal AR, Nicholls EL, Omar MT, Osborne N, Oteme FO, Pearson J, Price R, Sajan M, Sandhu LK, Scott-Murfitt H, Sealey B, Sharp EP, Spowage-Delaney BAC, Stephen F, Stevenson L, Tyrrell I, Ukoh CK, Walsh R, Watson AM, Whiteford JEC, Allston-Reeve C, Barson TJ, Giorgi MG, Godhania YL, Inchley V, Mirkes E, Rahman S. Prevalence of Frailty in European Emergency Departments (FEED): an international flash mob study. Eur Geriatr Med 2024; 15:463-470. [PMID: 38340282 PMCID: PMC10997678 DOI: 10.1007/s41999-023-00926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/19/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Current emergency care systems are not optimized to respond to multiple and complex problems associated with frailty. Services may require reconfiguration to effectively deliver comprehensive frailty care, yet its prevalence and variation are poorly understood. This study primarily determined the prevalence of frailty among older people attending emergency care. METHODS This cross-sectional study used a flash mob approach to collect observational European emergency care data over a 24-h period (04 July 2023). Sites were identified through the European Task Force for Geriatric Emergency Medicine collaboration and social media. Data were collected for all individuals aged 65 + who attended emergency care, and for all adults aged 18 + at a subset of sites. Variables included demographics, Clinical Frailty Scale (CFS), vital signs, and disposition. European and national frailty prevalence was determined with proportions with each CFS level and with dichotomized CFS 5 + (mild or more severe frailty). RESULTS Sixty-two sites in fourteen European countries recruited five thousand seven hundred eighty-five individuals. 40% of 3479 older people had at least mild frailty, with countries ranging from 26 to 51%. They had median age 77 (IQR, 13) years and 53% were female. Across 22 sites observing all adult attenders, older people living with frailty comprised 14%. CONCLUSION 40% of older people using European emergency care had CFS 5 + . Frailty prevalence varied widely among European care systems. These differences likely reflected entrance selection and provide windows of opportunity for system configuration and workforce planning.
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Polyzogopoulou E, Parissis J, Bistola V. Ultrasound-based diagnosis of acute heart failure in the emergency department. Emergencias 2024; 36:85-87. [PMID: 38597615 DOI: 10.55633/s3me/012.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, Athens, Grecia
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, Athens, Grecia
| | - Vasiliki Bistola
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, Athens, Grecia
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Reed MJ, Karuranga S, Kearns D, Alawiye S, Clarke B, Möckel M, Karamercan M, Janssens K, Riesgo LGC, Torrecilla FM, Golea A, Fernández Cejas JA, Lupan-Muresan EM, Zaimi E, Nuernberger A, Rennét O, Skjaerbaek C, Polyzogopoulou E, Imecz J, Groff P, Camilleri R, Cimpoesu D, Jovic M, Miró Ò, Anderson R, Laribi S. Management of syncope in the Emergency Department: a European prospective cohort study (SEED). Eur J Emerg Med 2024; 31:136-146. [PMID: 38015745 DOI: 10.1097/mej.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND IMPORTANCE In 2018, the European Society of Cardiology (ESC) produced syncope guidelines that for the first-time incorporated Emergency Department (ED) management. However, very little is known about the characteristics and management of this patient group across Europe. OBJECTIVES To examine the prevalence, clinical presentation, assessment, investigation (ECG and laboratory testing), management and ESC and Canadian Syncope Risk Score (CSRS) categories of adult European ED patients presenting with transient loss of consciousness (TLOC, undifferentiated or suspected syncope). DESIGN Prospective, multicentre, observational cohort study. SETTINGS AND PARTICIPANTS Adults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin. MAIN RESULTS Between 00:01 Monday, September 12th to 23:59 Sunday 25 September 2022, 952 patients presenting to 41 EDs in 14 European countries were enrolled from 98 301 ED presentations (n = 40 sites). Mean age (SD) was 60.7 (21.7) years and 487 participants were male (51.2%). In total, 379 (39.8%) were admitted to hospital and 573 (60.2%) were discharged. 271 (28.5%) were admitted to an observation unit first with 143 (52.8%) of these being admitted from this. 717 (75.3%) participants were high-risk according to ESC guidelines (and not suitable for discharge from ED) and 235 (24.7%) were low risk. Admission rate increased with increasing ESC high-risk factors; 1 ESC high-risk factor; n = 259 (27.2%, admission rate=34.7%), 2; 189 (19.9%; 38.6%), 3; 106 (11.1%, 54.7%, 4; 62 (6.5%, 60.4%), 5; 48 (5.0%, 67.9%, 6+; 53 (5.6%, 67.9%). Furthermore, 660 (69.3%), 250 (26.3%), 34 (3.5%) and 8 (0.8%) participants had a low, medium, high, and very high CSRS respectively with respective admission rates of 31.4%, 56.0%, 76.5% and 75.0%. Admission rates (19.3-88.9%), use of an observation/decision unit (0-100%), and percentage high-risk (64.8-88.9%) varies widely between countries. CONCLUSION This European prospective cohort study reported a 1% prevalence of syncope in the ED. 4 in 10 patients are admitted to hospital although there is wide variation between country in syncope management. Three-quarters of patients have ESC high-risk characteristics with admission percentage rising with increasing ESC high-risk factors.
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Affiliation(s)
- Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Suvi Karuranga
- European Society for Emergency Medicine, Antwerp, Belgium
| | - David Kearns
- University of Edinburgh Medical School, Edinburgh, UK
| | - Salma Alawiye
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
| | - Ben Clarke
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
| | - Martin Möckel
- Department of Emergency and Acute Medicine, Campus Mitte and Virchow, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Mehmet Karamercan
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Kelly Janssens
- St Vincents University Healthcare Group, Dublin, Ireland
| | | | | | - Adela Golea
- Emergency Unit, University of Medicine and Pharmacy Cluj, University Emergency County Hospital, Cluj Napoca, Romania
| | | | - Eugenia Maria Lupan-Muresan
- Emergency Medicine Discipline, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Edmond Zaimi
- University Hospital Centre, Mother Teresa of Tirana, Tirana, Albania
| | | | | | | | | | | | - Paolo Groff
- Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Diana Cimpoesu
- University of Medicine and Pharmacy Grigore T Popa, Iasi, Romania
| | - Miljan Jovic
- General Hospital, Health Centre, Zaječar, Serbia
| | - Òscar Miró
- Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | | | - Said Laribi
- Emergency Medicine Department, CHU Tours, Tours University, Tours, France
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Manolis AJ, Kallistratos MS, Koutsaki M, Doumas M, Poulimenos LE, Parissis J, Polyzogopoulou E, Pittaras A, Muiesan ML, Mancia G. The diagnostic approach and management of hypertension in the emergency department. Eur J Intern Med 2024; 121:17-24. [PMID: 38087668 DOI: 10.1016/j.ejim.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 03/08/2024]
Abstract
Hypertension urgency and emergency represents a challenging condition in which clinicians should determine the assessment and/or treatment of these patients. Whether the elevation of blood pressure (BP) levels is temporary, in need of treatment, or reflects a chronic hypertensive state is not always easy to unravel. Unfortunately, current guidelines provide few recommendations concerning the diagnostic approach and treatment of emergency department patients presenting with severe hypertension. Target organ damage determines: the timeframe in which BP should be lowered, target BP levels as well as the drug of choice to use. It's important to distinguish hypertensive emergency from hypertensive urgency, usually a benign condition that requires more likely an outpatient visit and treatment.
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Affiliation(s)
- A J Manolis
- Metropolitan Hospital, 2nd Department of Cardiology, Ethnarchou Makariou 9, Praeus, Greece
| | - M S Kallistratos
- Metropolitan Hospital, 2nd Department of Cardiology, Ethnarchou Makariou 9, Praeus, Greece.
| | - M Koutsaki
- Asklepeion General Hospital, Cardiology Department, Vasileos Pavlou 1 street, Voula Greece
| | - M Doumas
- Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - L E Poulimenos
- Asklepeion General Hospital, Cardiology Department, Vasileos Pavlou 1 street, Voula Greece
| | - J Parissis
- Second Department of Cardiology, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - E Polyzogopoulou
- Second Department of Cardiology, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - A Pittaras
- Metropolitan Hospital, 2nd Department of Cardiology, Ethnarchou Makariou 9, Praeus, Greece
| | - M L Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia & 2a Medicina ASST Spedali Civili di Brescia, 25121 Brescia, Italy
| | - G Mancia
- University of Milano-Bicocca (Emeritus Professor), Milan, Italy
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Ventoulis I, Kamperidis V, Abraham MR, Abraham T, Boultadakis A, Tsioukras E, Katsiana A, Georgiou K, Parissis J, Polyzogopoulou E. Differences in Health-Related Quality of Life among Patients with Heart Failure. Medicina (Kaunas) 2024; 60:109. [PMID: 38256370 PMCID: PMC10818915 DOI: 10.3390/medicina60010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Heart failure (HF) is characterized by a progressive clinical course marked by frequent exacerbations and repeated hospitalizations, leading to considerably high morbidity and mortality rates. Patients with HF present with a constellation of bothersome symptoms, which range from physical to psychological and mental manifestations. With the transition to more advanced HF stages, symptoms become increasingly more debilitating, interfere with activities of daily living and disrupt multiple domains of life, including physical functioning, psychological status, emotional state, cognitive function, intimate relationships, lifestyle status, usual role activities, social contact and support. By inflicting profuse limitations in numerous aspects of life, HF exerts a profoundly negative impact on health-related quality of life (HRQOL). It is therefore not surprising that patients with HF display lower levels of HRQOL compared not only to the general healthy population but also to patients suffering from other chronic diseases. On top of this, poor HRQOL in patients with HF becomes an even greater concern considering that it has been associated with unfavorable long-term outcomes and poor prognosis. Nevertheless, HRQOL may differ significantly among patients with HF. Indeed, it has consistently been reported that women with HF display poorer HRQOL compared to men, while younger patients with HF tend to exhibit lower levels of HRQOL than their older counterparts. Moreover, patients presenting with higher New York Heart Association (NYHA) functional class (III-IV) have significantly more impaired HRQOL than those in a better NYHA class (I-II). Furthermore, most studies report worse levels of HRQOL in patients suffering from HF with preserved ejection fraction (HFpEF) compared to patients with HF with reduced ejection fraction (HFrEF) or HF with mildly reduced ejection fraction (HFmrEF). Last, but not least, differences in HRQOL have been noted depending on geographic location, with lower HRQOL levels having been recorded in Africa and Eastern Europe and higher in Western Europe in a recent large global study. Based on the observed disparities that have been invariably reported in the literature, this review article aims to provide insight into the underlying differences in HRQOL among patients with HF. Through an overview of currently existing evidence, fundamental differences in HRQOL among patients with HF are analyzed based on sex, age, NYHA functional class, ejection fraction and geographic location or ethnicity.
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Affiliation(s)
- Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Vasileios Kamperidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St Kiriakidi 1, 54636 Thessaloniki, Greece;
| | - Maria Roselle Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, CA 94117, USA; (M.R.A.); (T.A.)
| | - Theodore Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, CA 94117, USA; (M.R.A.); (T.A.)
| | - Antonios Boultadakis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
| | - Efthymios Tsioukras
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Aikaterini Katsiana
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Konstantinos Georgiou
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
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Osterwalder J, Polyzogopoulou E, Hoffmann B. Point-of-Care Ultrasound-History, Current and Evolving Clinical Concepts in Emergency Medicine. Medicina (Kaunas) 2023; 59:2179. [PMID: 38138282 PMCID: PMC10744481 DOI: 10.3390/medicina59122179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Point-of-care ultrasound (PoCUS) has become an indispensable standard in emergency medicine. Emergency medicine ultrasound (EMUS) is the application of bedside PoCUS by the attending emergency physician to assist in the diagnosis and management of many time-sensitive health emergencies. In many ways, using PoCUS is not only the mere application of technology, but also a fusion of already existing examiner skills and technology in the context of a patient encounter. EMUS practice can be defined using distinct anatomy-based applications. The type of applications and their complexity usually depend on local needs and resources, and practice patterns can vary significantly among regions, countries, or even continents. A different approach suggests defining EMUS in categories such as resuscitative, diagnostic, procedural guidance, symptom- or sign-based, and therapeutic. Because EMUS is practiced in a constantly evolving emergency medical setting where no two patient encounters are identical, the concept of EMUS should also be practiced in a fluid, constantly adapting manner driven by the physician treating the patient. Many recent advances in ultrasound technology have received little or no attention from the EMUS community, and several important technical advances and research findings have not been translated into routine clinical practice. The authors believe that four main areas have great potential for the future growth and development of EMUS and are worth integrating: 1. In recent years, many articles have been published on novel ultrasound applications. Only a small percentage has found its way into routine use. We will discuss two important examples: trauma ultrasound that goes beyond e-FAST and EMUS lung ultrasound for suspected pulmonary embolism. 2. The more ultrasound equipment becomes financially affordable; the more ultrasound should be incorporated into the physical examination. This merging and possibly even replacement of aspects of the classical physical exam by technology will likely outperform the isolated use of stethoscope, percussion, and auscultation. 3. The knowledge of pathophysiological processes in acute illness and ultrasound findings should be merged in clinical practice. The translation of this knowledge into practical concepts will allow us to better manage many presentations, such as hypotension or the dyspnea of unclear etiology. 4. Technical innovations such as elastography; CEUS; highly sensitive color Doppler such as M-flow, vector flow, or other novel technology; artificial intelligence; cloud-based POCUS functions; and augmented reality devices such as smart glasses should become standard in emergencies over time.
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Affiliation(s)
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece;
| | - Beatrice Hoffmann
- Department of Emergency Medicine BIDMC, One Deaconess Rd., WCC2, Boston, MA 02215, USA
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Velliou M, Sanidas E, Diakantonis A, Ventoulis I, Parissis J, Polyzogopoulou E. The Optimal Management of Patients with Atrial Fibrillation and Acute Heart Failure in the Emergency Department. Medicina (Kaunas) 2023; 59:2113. [PMID: 38138216 PMCID: PMC10744575 DOI: 10.3390/medicina59122113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
Atrial fibrillation (AF) and acute heart failure (AHF) are two closely interrelated conditions that frequently coexist in a manifold manner, with AF serving either as the causative factor or as the consequence or even as an innocent bystander. The interplay between these two clinical conditions is complex, given that they share common pathophysiological pathways and they can reciprocally exacerbate each other, thus triggering a vicious cycle that worsens the prognosis and increases the thromboembolic risk. The optimal management of AF in the context of AHF in the emergency department remains a challenge depending on the time onset, as well as the nature and the severity of the associated symptoms. Acute rate control, along with early rhythm control, when indicated, and anticoagulation represent the main pillars of the therapeutic intervention. The purpose of this review is to elucidate the pathophysiological link between AF and AHF and accordingly present a stepwise algorithmic approach for the management of AF in AHF patients in the emergency setting.
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Affiliation(s)
- Maria Velliou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece; (M.V.); (A.D.); (J.P.)
| | - Elias Sanidas
- Department of Cardiology, Laiko General Hospital, 11527 Athens, Greece;
| | - Antonis Diakantonis
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece; (M.V.); (A.D.); (J.P.)
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece;
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece; (M.V.); (A.D.); (J.P.)
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece; (M.V.); (A.D.); (J.P.)
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Parissis J, Georgiou C, Bistola V, Karavidas A, Vassilikos VP, Kanakakis J, Davlouros P, Tziakas DN, Alexanian IP, Kochiadakis G, Triposkiadis F, Karvounis H, Gourlis D, Papoutsidakis N, Polyzogopoulou E, Vlachopoulos C. Rationale and Design of Heart Failure Prevalence and Evolution of Heart Failure in Diabetes Mellitus Type II Patients at High Risk (HF-LanDMark Study). J Clin Med 2023; 12:6319. [PMID: 37834963 PMCID: PMC10573953 DOI: 10.3390/jcm12196319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/17/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Patients with diabetes mellitus (DM) are at increased risk for heart failure (HF). Accurate data regarding the prevalence of HF stages among diabetics in Greece are scarce. (2) Aim: The present study will examine the prevalence and evolution of HF stages among patients with type II DM (T2DM) diagnosed in the past 10 years, with no previous history of HF and at high CV risk, in Greece, as well as will explore the potential determinants of the development of symptomatic HF in these patients. (3) Methods: Through a non-interventional, epidemiological, single-country, multi-center, prospective cohort study design, a sample of 300 consecutive patients will be enrolled in 11 cardiology departments that are HF centers of excellence. Patients will be either self-referred or referred by primary or secondary care physicians and will be followed for up to 24 months. Demographic, clinical, echocardiography, electrocardiography, cardiac biomarkers (troponin, NT-proBNP) and health-related quality of life questionnaire data will be recorded as well as clinical events, including mortality, HF hospitalizations and HF-related healthcare resource utilization. The primary outcomes are the proportion of patients diagnosed with symptomatic HF (ACC/AHA Stage C) at enrolment in the overall study population and the proportions of patients with HF stages A, B and C, as well as by NYHA functional classification in the overall study population. (4) Conclusions: The HF-LanDMark study is the first epidemiological study that will assess the prevalence of HF among T2DM patients in Greece that could potentially enhance prompt therapeutic interventions shown to delay the development of HF in the T2DM patient population (HF-LanDMark, Clinical Trials.gov number, NCT04482283).
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Affiliation(s)
- John Parissis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12461 Athens, Greece; (C.G.); (E.P.)
| | - Christos Georgiou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12461 Athens, Greece; (C.G.); (E.P.)
| | - Vasiliki Bistola
- Heart Failure Unit, 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12461 Athens, Greece
| | - Apostolos Karavidas
- Department of Cardiology, “G. Gennimatas” General Hospital, 11527 Athens, Greece;
| | - Vassilios P. Vassilikos
- 3rd Cardiology Department, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece;
| | - John Kanakakis
- Department of Clinical Therapeutics, University of Athens Medical School, 11527 Athens, Greece;
| | - Periklis Davlouros
- Department of Cardiology, School of Medicine, University of Patras, 26504 Patras, Greece;
| | - Dimitrios N. Tziakas
- Cardiology Department, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Ioannis P. Alexanian
- Second Department of Cardiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece;
| | - George Kochiadakis
- Department of Cardiology, Heraklion University Hospital, 71500 Iraklio, Greece;
| | - Filippos Triposkiadis
- Department of Cardiology, Larissa University General Hospital, 41334 Larissa, Greece;
| | - Haralambos Karvounis
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Dimitrios Gourlis
- AstraZeneca Greece, Agisilaou 6-8, 15123 Maroussi, Greece; (D.G.); (N.P.)
| | | | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12461 Athens, Greece; (C.G.); (E.P.)
| | - Charalambos Vlachopoulos
- First Cardiology Department, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece;
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Arfaras-Melainis A, Ventoulis I, Polyzogopoulou E, Boultadakis A, Parissis J. The current and future status of inotropes in heart failure management. Expert Rev Cardiovasc Ther 2023; 21:573-585. [PMID: 37458248 DOI: 10.1080/14779072.2023.2237869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Heart failure (HF) is a complex syndrome with a wide range of presentations and acuity, ranging from outpatient care to inpatient management due to acute decompensated HF, cardiogenic shock or advanced HF. Frequently, the etiology of a patient's decompensation is diminished cardiac output and peripheral hypoperfusion. Consequently, there is a need for use of inotropes, agents that increase cardiac contractility, optimize hemodynamics and ensure adequate perfusion. AREAS COVERED Inotropes are divided into 3 major classes: beta agonists, phosphodiesterase III inhibitors and calcium sensitizers. Additionally, as data from prospective studies accumulates, novel agents are emerging, including omecamtiv mecarbil and istaroxime. The aim of this review is to summarize current data on the optimal use of inotropes and to provide an expert opinion regarding their current and future use in the management of HF. EXPERT OPINION The use of inotropes has long been linked to worsening mortality, tachyarrhythmias, increased myocardial oxygen consumption and ischemia. Therefore, individualized and evidence-based treatment plans for patients who require inotropic support are necessary. Also, better quality data on the use of existing inotropes is imperative, while the development of newer and safer agents will lead to more effective management of patients with HF in the future.
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Affiliation(s)
- Angelos Arfaras-Melainis
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Ptolemaida, Greece
| | - Effie Polyzogopoulou
- Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Boultadakis
- Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Parissis
- Emergency Department, Heart Failure Unit, Attikon University Hospital, Athens, Greece
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10
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Polyzogopoulou E, Velliou M, Verras C, Ventoulis I, Parissis J, Osterwalder J, Hoffmann B. Point-of-Care Ultrasound: A Multimodal Tool for the Management of Sepsis in the Emergency Department. Medicina (Kaunas) 2023; 59:1180. [PMID: 37374384 DOI: 10.3390/medicina59061180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Sepsis and septic shock are life-threatening emergencies associated with increased morbidity and mortality. Hence, early diagnosis and management of both conditions is of paramount importance. Point-of-care ultrasound (POCUS) is a cost-effective and safe imaging modality performed at the bedside, which has rapidly emerged as an excellent multimodal tool and has been gradually incorporated as an adjunct to physical examination in order to facilitate evaluation, diagnosis and management. In sepsis, POCUS can assist in the evaluation of undifferentiated sepsis, while, in cases of shock, it can contribute to the differential diagnosis of other types of shock, thus facilitating the decision-making process. Other potential benefits of POCUS include prompt identification and control of the source of infection, as well as close haemodynamic and treatment monitoring. The aim of this review is to determine and highlight the role of POCUS in the evaluation, diagnosis, treatment and monitoring of the septic patient. Future research should focus on developing and implementing a well-defined algorithmic approach for the POCUS-guided management of sepsis in the emergency department setting given its unequivocal utility as a multimodal tool for the overall evaluation and management of the septic patient.
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Affiliation(s)
- Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | - Maria Velliou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | - Christos Verras
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
- National Centre of Emergency Care (EKAB), 11527 Athens, Greece
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | | | - Beatrice Hoffmann
- Department of Emergency Medicine BIDMC, One Deaconess Rd, WCC2, Boston, MA 02215, USA
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11
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Karamercan MA, Dündar DZ, Slagman A, Ergin M, Janssens KAC, Fabbri A, Bjornsen LP, Somodi S, Adam VN, Polyzogopoulou E, Demir HA, Laribi S. Epidemiology of geriatric patients presenting to emergency departments in Europe: EGERS study. Eur J Emerg Med 2023; 30:117-124. [PMID: 36719188 DOI: 10.1097/mej.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND IMPORTANCE Patients aged 65 and above constitute a large and growing part of emergency department (ED) visits in western countries. OBJECTIVE The primary aim of this European prospective study was to determine the epidemiologic characteristics of elderly patients presenting to EDs across Europe. Our secondary objective was to determine the hospitalization rate, characteristics, and in-hospital mortality rates of geriatric patients presenting to EDs. DESIGN SETTING AND PARTICIPANTS An observational prospective cohort study over seven consecutive days between 19 October and 30 November 2020, in 36 EDs from nine European countries. Patients aged 65 years and older presenting to EDs with any complaint during a period of seven consecutive days were included. OUTCOME MEASURES Data were collected on demographics, the major presenting complaint, the presenting vital signs, comorbidities, usual medication, and outcomes after the ED, including disposition, in-hospital outcome, and the final hospital diagnosis. The patients were stratified into three groups: old (65-74 years), older (75-84 years), and oldest age (>85 years). MAIN RESULTS A total of 5767 patients were included in the study. The median age of the patients was 77 (interquartile range: 71-84) years. The majority presented with a non-traumatic complaint (81%) and about 90% of the patients had at least one comorbid disease and were on chronic medication. An ED visit resulted in subsequent hospital admission in 51% of cases, with 9% of patients admitted to an intensive care unit. Overall in-hospital mortality was 8%, and ED mortality was 1%. Older age was associated with a higher female proportion, comorbidities, need for home care service, history of previous falls, admission rates, length of ED, and hospital stay. CONCLUSION The characteristics of ED elderly patients and their subsequent hospital stay are reported in this prospective study.
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Affiliation(s)
- Mehmet A Karamercan
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara
| | - Defne Z Dündar
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara
| | - Ana Slagman
- Division of Emergency and Acute Medicine, Campus Virchow Klinikum and Charité Campus Mitte, Charite Universitatmedizin, Berlin, Germany
| | - Mehmet Ergin
- Department of Emergency Medicine, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | | | - Andrea Fabbri
- Dipartimento Emergenza, Azienda USL della Romagna, Forli, Italy
| | - Lars P Bjornsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sándor Somodi
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Visnja N Adam
- Department of Anesthesiology, Resuscitation and Intensive Care, Clinical Hospital Sveti Duh, Zagreb, Croatia
| | - Effie Polyzogopoulou
- Emergency Medicine Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Hüseyin A Demir
- Department of Emergency Medicine, Sanliurfa Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
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12
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Polyzogopoulou E, Bezati S, Karamasis G, Boultadakis A, Parissis J. Early Recognition and Risk Stratification in Cardiogenic Shock: Well Begun Is Half Done. J Clin Med 2023; 12:2643. [PMID: 37048727 PMCID: PMC10095596 DOI: 10.3390/jcm12072643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Cardiogenic shock is a complex syndrome manifesting with distinct phenotypes depending on the severity of the primary cardiac insult and the underlying status. As long as therapeutic interventions fail to divert its unopposed rapid evolution, poor outcomes will continue challenging health care systems. Thus, early recognition in the emergency setting is a priority, in order to avoid delays in appropriate management and to ensure immediate initial stabilization. Since advanced therapeutic strategies and specialized shock centers may provide beneficial support, it seems that directing patients towards the recently described shock network may improve survival rates. A multidisciplinary approach strategy commands the interconnections between the strategic role of the ED in affiliation with cardiac shock centers. This review outlines critical features of early recognition and initial therapeutic management, as well as the utility of diagnostic tools and risk stratification models regarding the facilitation of patient trajectories through the shock network. Further, it proposes the implementation of precise criteria for shock team activation and the establishment of definite exclusion criteria for streaming the right patient to the right place at the right time.
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Affiliation(s)
- Effie Polyzogopoulou
- Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece
| | - Sofia Bezati
- Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece
| | - Grigoris Karamasis
- Second Department of Cardiology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Antonios Boultadakis
- Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece
| | - John Parissis
- Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece
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Matsiras D, Bezati S, Ventoulis I, Verras C, Parissis J, Polyzogopoulou E. Gut Failure: A Review of the Pathophysiology and Therapeutic Potentials in the Gut-Heart Axis. J Clin Med 2023; 12:2567. [PMID: 37048650 PMCID: PMC10095379 DOI: 10.3390/jcm12072567] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Despite considerable advances in the field, heart failure (HF) still poses a significant disease burden among affected individuals since it continues to cause high morbidity and mortality rates. Inflammation is considered to play a key role in disease progression, but the exact underlying pathophysiological mechanisms involved have not yet been fully elucidated. The gut, as a potential source of inflammation, could feasibly explain the state of low-grade inflammation seen in patients with chronic HF. Several derangements in the composition of the microbiota population, coupled with an imbalance between favorable and harmful metabolites and followed by gut barrier disruption and eventually bacterial translocation, could contribute to cardiac dysfunction and aggravate HF. On the other hand, HF-associated congestion and hypoperfusion alters intestinal function, thereby creating a vicious cycle. Based on this evidence, novel pharmaceutical agents have been developed and their potential therapeutic use has been tested in both animal and human subjects. The ultimate goal in these efforts is to reverse the aforementioned intestinal derangements and block the inflammation cascade. This review summarizes the gut-related causative pathways implicated in HF pathophysiology, as well as the associated therapeutic interventions described in the literature.
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Affiliation(s)
- Dionysis Matsiras
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, 12462 Athens, Greece
| | - Sofia Bezati
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, 12462 Athens, Greece
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece
| | - Christos Verras
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, 12462 Athens, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, 12462 Athens, Greece
- Emergency Medicine Department, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, 12462 Athens, Greece
- Emergency Medicine Department, National and Kapodistrian University of Athens, 15772 Athens, Greece
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14
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Bezati S, Velliou M, Ventoulis I, Simitsis P, Parissis J, Polyzogopoulou E. Infection as an under-recognized precipitant of acute heart failure: prognostic and therapeutic implications. Heart Fail Rev 2023:10.1007/s10741-023-10303-8. [PMID: 36897491 PMCID: PMC9999079 DOI: 10.1007/s10741-023-10303-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
As the prevalence of heart failure (HF) continues to rise, prompt diagnosis and management of various medical conditions, which may lead to HF exacerbation and result in poor patient outcomes, are of paramount importance. Infection has been identified as a common, though under-recognized, precipitating factor of acute heart failure (AHF), which can cause rapid development or deterioration of HF signs and symptoms. Available evidence indicates that infection-related hospitalizations of patients with AHF are associated with higher mortality, protracted length of stay, and increased readmission rates. Understanding the intricate interaction of both clinical entities may provide further therapeutic strategies to prevent the occurrence of cardiac complications and improve prognosis of patients with AHF triggered by infection. The purpose of this review is to investigate the incidence of infection as a causative factor in AHF, explore its prognostic implications, elucidate the underlying pathophysiological mechanisms, and highlight the basic principles of the initial diagnostic and therapeutic interventions in the emergency department.
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Affiliation(s)
- Sofia Bezati
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.
| | - Maria Velliou
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, Ptolemaida, 50200, Greece
| | - Panagiotis Simitsis
- National and Kapodistrian University of Athens, 2nd Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.,Emergency Medicine Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.,Emergency Medicine Department, National and Kapodistrian University of Athens, Athens, Greece
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15
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Abstract
INTRODUCTION Sodium-glucose cotransporter 2 (SGLT2) inhibitors constitute a class of oral antiglycemic agents that have emerged as a new therapeutic strategy for heart failure (HF) with reduced ejection fraction (HFrEF) and, potentially, for HF with preserved ejection fraction (HFpEF). AREAS COVERED Ongoing efforts to clarify the exact mechanisms of action of SGLT2 inhibitors (SGLT2i) reveal that glycosuria and osmotic diuresis, resulting from the blockade of renal receptors, is not the sole pathophysiological mechanism. Nevertheless, the underlying mechanisms, accounting for their cardiovascular beneficial effects which have been clearly demonstrated in clinical trials, remain unclear. The aim of this review is to summarize the primary outcomes of large-scale studies regarding the use of SGLT2i in HF and provide an overview of the potential pathways involved in the SGLT2i-mediated cardioprotection. EXPERT OPINION SGLT2i exhibit favorable pleiotropic effects, which extend beyond their primary indication as pharmaceutical agents intended for glycemic control. Given their unique pathophysiological profile, these agents have revolutionized the management of HF, while in the near future, it is possible that evolving research in the field may unfold further perspectives on their potential use in the treatment of other chronic conditions.
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Affiliation(s)
- Maria Velliou
- Emergency Medicine Department, Attikon University Hospital, Athens, Greece
| | | | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Ptolemaida, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, Athens, Greece.,Heart Failure Clinic, Attikon University Hospital, Athens, Greece
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16
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Verras C, Ventoulis I, Bezati S, Matsiras D, Parissis J, Polyzogopoulou E. Point of Care Ultrasonography for the Septic Patient in the Emergency Department: A Literature Review. J Clin Med 2023; 12:jcm12031105. [PMID: 36769753 PMCID: PMC9917776 DOI: 10.3390/jcm12031105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/17/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
The point-of-care ultrasound (POCUS) has been effectively used in intensive care units for the management of septic patients. Since it is a time- and cost-effective non-invasive imaging modality, its use in the emergency department (ED) has been advocated for by medical experts. This review summarizes the existing literature regarding the breadth of POCUS as a supplementary tool to the holistic approach of septic patients in the ED setting. A literature search was conducted via PubMed (MEDLINE), Cochrane Library, and Scopus databases, analyzing studies which examined the use of POCUS in the ED for non-traumatic, septic, and/or undifferentiated hypotensive patients, resulting in 26 studies. The first cluster of studies investigates the efficiency of POCUS protocols in the differential diagnosis and its reliability for distributive/septic shock and sepsis management. In the second cluster, POCUS use results in faster sepsis cause identification and improves therapeutic management. The third cluster confirms that POCUS aids in the accurate diagnosis and management, even in rare and complicated cases. The results of the present review support the well-documented utility of POCUS and highlight the importance of POCUS incorporation in the comprehensive management of the septic patient in the ED setting.
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Affiliation(s)
- Christos Verras
- Emergency Department, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
- Correspondence: ; Tel.: +30-6936585677
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50100 Kozani, Greece
| | - Sofia Bezati
- Emergency Department, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Dionysis Matsiras
- Emergency Department, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - John Parissis
- Emergency Department, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Effie Polyzogopoulou
- Emergency Department, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
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17
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Polyzogopoulou E, Amoiridou P, Abraham TP, Ventoulis I. Acute liver injury in COVID-19 patients hospitalized in the intensive care unit: Narrative review. World J Gastroenterol 2022; 28:6662-6688. [PMID: 36620339 PMCID: PMC9813941 DOI: 10.3748/wjg.v28.i47.6662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/14/2022] [Accepted: 12/05/2022] [Indexed: 12/19/2022] Open
Abstract
In recent years, humanity has been confronted with a global pandemic due to coronavirus disease 2019 (COVID-19), which has caused an unprecedented health and economic crisis worldwide. Apart from the respiratory symptoms, which are considered the principal manifestations of COVID-19, it has been recognized that COVID-19 constitutes a systemic inflammatory process affecting multiple organ systems. Across the spectrum of organ involvement in COVID-19, acute liver injury (ALI) has been gradually gaining increasing attention by the international scientific community. COVID-19 associated liver impairment can affect a considerable proportion of COVID-19 patients and seems to correlate with the severity of the disease course. Indeed, COVID-19 patients hospitalized in the intensive care unit (ICU) run a greater risk of developing ALI due to the severity of their clinical condition and in the context of multi-organ failure. The putative pathophysiological mechanisms of COVID-19 induced ALI in ICU patients remain poorly understood and appear to be multifactorial in nature. Several theories have been proposed to explain the occurrence of ALI in the ICU setting, such as hypoperfusion and ischemia due to hemodynamic instability, passive liver congestion as a result of congestive heart failure, ischemia-reperfusion injury, hypoxia due to respiratory failure, mechanical ventilation itself, sepsis and septic shock, cytokine storm, endotheliitis with concomitant coagulopathy, drug-induced liver injury, parenteral nutrition and direct cytopathic viral effect. It should be noted that no specific therapy for COVID-19 induced ALI exists. Therefore, the therapeutic approach lies in preventive measures and is exclusively supportive once ALI ensues. The aim of the current review is to scrutinize the existing evidence on COVID-19 associated ALI in ICU patients, explore its clinical implications, shed light on the underlying pathophysiological mechanisms and propose potential therapeutic approaches. Ongoing research on the particular scientific field will further elucidate the pathophysiology behind ALI and address unresolved issues, in the hope of mitigating the tremendous health consequences imposed by COVID-19 on ICU patients.
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Affiliation(s)
- Effie Polyzogopoulou
- Department of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens 12462, Greece
| | - Pinelopi Amoiridou
- Department of Intensive Care, AHEPA University Hospital, Thessaloniki 54621, Greece
| | - Theodore P Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, CA 94117, United States
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Ptolemaida 50200, Greece
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18
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Apostolou E, Rafouli-Stergiou P, Liori S, Bistola V, Polyzogopoulou E, Doumanis G, Cholevas N, Frogoudaki A, Ikonomidis I, Parissis J. In-hospital prognosis of patients with primary and secondary acute heart failure diagnosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Secondary acute heart failure (AHF) during hospitalization for another primary diagnosis is a frequent in-hospital complication.
Purpose
This analysis aims to describe differences in prognosis of these patients in comparison with patients admitted for AHF (primary AHF diagnosis) and also identify factors associated with in-hospital mortality.
Methods
This is a sub-analysis of the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF), which enrolled 4953 patients from 9 countries. All parameters univariately associated with in-hospital mortality in the primary and secondary AHF groups were included in the multivariate logistic regression model.
Results
Secondary AHF diagnosis was observed in 24.1% (N=1196) of the total study cohort. These patients demonstrated almost double all-cause in-hospital mortality rates compared to patients with primary AHF (16.9% versus 8.9%, p<0.001).
In patients with primary AHF, negative prognostic factors included older age (>75 years) (OR 2.01, 95% CI 1.24–3.26, p=0.004), acute coronary syndromes (ACS) (OR 2.71, 95% CI 1.57–4.69, p<0.001), chronic renal disease (OR 2.02, 95% CI 1.13–3.61, p=0.017), presence of cold extremities (OR 2.04, 95% CI 1.23–3.40, p=0.006), in-hospital treatment with CPAP (OR 2.55, 95% CI 1.20–5.41, p=0.014), dobutamine (OR 2.55, 95% CI 1.52–4.28, p<0.001), dopamine (OR 3.03, 95% CI 1.74–5.27, p<0.001) and noradrenaline (OR 4.76, 95% CI 2.32–9.76, p<0.001). Favorable predictors were systolic blood pressure ≥100 mmHg on admission (OR 0.54, 95% CI 0.31–0.94, p=0.031), in-hospital treatment with ACEIs (OR 0.07, 95% CI 0.03–0.16, p<0.001), ARBs (OR 0.30, 95% CI 0.13–0.70, p=0.005) and vitamin-K antagonists (OR 0.06, 95% CI 0.007–0.44, p=0.006).
In secondary AHF, independent predictors of in-hospital mortality included left ventricular ejection fraction (LVEF) <40% (OR 2.36, 95% CI 1.17–4.75, p=0.016), age >75 years (OR 2.23, 95% CI 1.09–4.54, p=0.026), ACS (OR 3.55, 95% CI 1.50–8.39, p=0.004), diabetes (OR 2.26, 95% CI 1.23–4.16, p=0.008), pre-admission treatment with digoxin (OR 7.27, 95% CI 1.83–28.87, p=0.005), in-hospital medication with dobutamine (OR 2.43, 95% CI 1.28–4.61, p=0.006), dopamine (OR 2.29, 95% CI 1.12–4.67, p=0.022) and noradrenaline (OR 4.14, 95% CI 1.76–9.76, p=0.001). Covariates independently associated with survival benefit in secondary AHF were pre-admission treatment with diuretics (OR 0.29, 95% CI 0.09–0.88, p=0.030) and in-hospital treatment with ACEIs (OR 0.17, 95% CI 0.07–0.39, p<0.001) and aspirin (OR 0.27, 95% CI 0.11–0.69, p=0.006).
Conclusion
Patients with secondary AHF experienced a more complicated in-hospital course with worse prognosis, compared to primary AHF. LVEF <40%, age >75 years, ACS, diabetes, pre-admission treatment with digitalis, in-hospital medication with dobutamine, dopamine and noradrenaline were identified as independent negative prognostic factors of in-hospital mortality in secondary AHF patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Apostolou
- Attikon University Hospital - 2nd Department of Cardiology - Heart Failure Unit, Athens, Greece
| | - P Rafouli-Stergiou
- Attikon University Hospital - 2nd Department of Cardiology - Heart Failure Unit, Athens, Greece
| | - S Liori
- Attikon University Hospital - 2nd Department of Cardiology - Heart Failure Unit, Athens, Greece
| | - V Bistola
- Attikon University Hospital - 2nd Department of Cardiology - Heart Failure Unit, Athens, Greece
| | - E Polyzogopoulou
- Attikon University Hospital - 2nd Department of Cardiology - Heart Failure Unit, Athens, Greece
| | - G Doumanis
- Attikon University Hospital - 2nd Department of Cardiology - Heart Failure Unit, Athens, Greece
| | - N Cholevas
- Attikon University Hospital - 2nd Department of Cardiology - Heart Failure Unit, Athens, Greece
| | - A Frogoudaki
- Attikon University Hospital - 2nd Department of Cardiology - Heart Failure Unit, Athens, Greece
| | - I Ikonomidis
- Attikon University Hospital - 2nd Department of Cardiology - Heart Failure Unit, Athens, Greece
| | - J Parissis
- Attikon University Hospital - 2nd Department of Cardiology - Heart Failure Unit, Athens, Greece
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Harjola V, Parissis J, Bauersachs J, Brunner‐La Rocca H, Bueno H, Čelutkienė J, Chioncel O, Coats AJ, Collins SP, Boer RA, Filippatos G, Gayat E, Hill L, Laine M, Lassus J, Lommi J, Masip J, Mebazaa A, Metra M, Miró Ò, Mortara A, Mueller C, Mullens W, Peacock WF, Pentikäinen M, Piepoli MF, Polyzogopoulou E, Rudiger A, Ruschitzka F, Seferovic P, Sionis A, Teerlink JR, Thum T, Varpula M, Weinstein JM, Yilmaz MB. Acute coronary syndromes and acute heart failure: a diagnostic dilemma and high‐risk combination. A statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2020; 22:1298-1314. [DOI: 10.1002/ejhf.1831] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Veli‐Pekka Harjola
- Emergency Medicine University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital Helsinki Finland
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology Medical School Hannover Hannover Germany
| | | | - Hector Bueno
- Centro Nacional de Investigaciones Cardiovasculares Madrid Spain
- Cardiology Department Hospital Universitario 12 de Octubre Madrid Spain
- Universidad Complutense de Madrid Madrid Spain
| | - Jelena Čelutkienė
- Institute of Clinical Medicine, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine Vilnius University Vilnius Lithuania
| | - Ovidiu Chioncel
- University of Medicine Carol Davila/Institute of Emergency for Cardiovascular Disease Bucharest Romania
| | | | - Sean P. Collins
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN USA
| | - Rudolf A. Boer
- Department of Cardiology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | | | - Etienne Gayat
- Département d'Anesthésie – Réanimation – SMUR Hôpitaux Universitaires Saint Louis – Lariboisière, INSERM – UMR 942, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot Paris France
| | - Loreena Hill
- School of Nursing and Midwifery Queen's University Belfast UK
| | - Mika Laine
- Cardiology, Heart and Lung Center University of Helsinki, Helsinki University Hospital Helsinki Finland
| | - Johan Lassus
- Cardiology, Heart and Lung Center University of Helsinki, Helsinki University Hospital Helsinki Finland
| | - Jyri Lommi
- Cardiology, Heart and Lung Center University of Helsinki, Helsinki University Hospital Helsinki Finland
| | - Josep Masip
- Consorci Sanitari Integral University of Barcelona Barcelona Spain
- Hospital Sanitas CIMA Barcelona Spain
| | - Alexandre Mebazaa
- Département d'Anesthésie – Réanimation – SMUR Hôpitaux Universitaires Saint Louis – Lariboisière, INSERM – UMR 942, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot Paris France
- U942 Inserm, AP‐HP Paris France
- Investigation Network Initiative Cardiovascular and Renal Clinical Trialists (INI‐CRCT) Nancy France
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia Italy
| | - Òscar Miró
- Emergency Department Hospital Clínic, University of Barcelona Catalonia Spain
| | - Andrea Mortara
- Department of Cardiology Policlinico di Monza Monza Italy
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology University of Basel, University Hospital Basel Basel Switzerland
| | - Wilfried Mullens
- Department of Cardiology Ziekenhuis Oost Limburg, Genk – Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University Diepenbeek Belgium
| | - W. Frank Peacock
- Henry JN Taub Department of Emergency Medicine Baylor College of Medicine Houston TX USA
| | - Markku Pentikäinen
- Cardiology, Heart and Lung Center University of Helsinki, Helsinki University Hospital Helsinki Finland
| | | | | | - Alain Rudiger
- Cardio‐Surgical Intensive Care Unit University and University Hospital Zurich Zurich Switzerland
| | - Frank Ruschitzka
- University Heart Center University Hospital Zurich Zurich Switzerland
| | - Petar Seferovic
- Department of Internal Medicine Belgrade University School of Medicine and Heart Failure Center, Belgrade University Medical Center Belgrade Serbia
| | - Alessandro Sionis
- Cardiology Department Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona Barcelona Spain
| | - John R. Teerlink
- Section of Cardiology San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco CA USA
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS) Hannover Medical School Hannover Germany
| | - Marjut Varpula
- Cardiology, Heart and Lung Center University of Helsinki, Helsinki University Hospital Helsinki Finland
| | - Jean Marc Weinstein
- Cardiology Division Soroka University Medical Centre Beer‐Sheva Israel
- Faculty of Health Sciences Ben Gurion University of the Negev Beer‐Sheva Israel
| | - Mehmet B. Yilmaz
- Department of Cardiology Cumhuriyet University Faculty of Medicine Sivas Turkey
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