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Gewarges M, Mainland R, Wilkinson K, Sklar J, Gentilin A, McLean B, Hajjaj OI, Worme M, Lalonde S, Patel R, Lin Y, Callum J, Poon S. Increasing rates of screening and treatment of iron deficiency in ambulatory patients with heart failure with reduced ejection fraction: a quality improvement cohort study. BMJ Open Qual 2024; 13:e002584. [PMID: 38395465 PMCID: PMC10895242 DOI: 10.1136/bmjoq-2023-002584] [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] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Iron deficiency anaemia (IDA) is common in patients with heart failure (HF) and is associated with advanced HF and increased mortality. Intravenous iron supplementation increases exercise tolerance, improves quality of life, and decreases symptoms among patients with HF with reduced ejection fraction (HFrEF) and iron deficiency. Despite this, many patients are not screened or treated for IDA. We aimed to increase rates of screening and treatment of IDA among HF patients through the introduction of curated materials to aid HF clinicians with appropriate screening and treatment. METHODS We conducted a retrospective chart review to identify the baseline number of HFrEF patients screened and treated for IDA at two ambulatory cardiology clinics in Toronto, Ontario. A quality improvement initiative was then introduced, which consisted of education and curated materials to aid clinicians in the screening and treatment of IDA among HFrEF patients. The proportion of patients screened and treated for IDA preintervention and postintervention were compared using χ2 tests of Independence. RESULTS In the preintervention cohort, 36.3% (n=45) of patients with anaemia were screened for IDA. Among those screened, 64.4% (n=29) had IDA. Only 17.2% (n=5) of these were treated with IV iron. After implementation of the quality improvement initiative, 90.9% (n=60) of patients with anaemia were screened for IDA (p<0.001) and 90.3% (n=28) of those with IDA were treated with IV iron (p<0.001). CONCLUSION The introduction of curated materials to aid clinicians was associated with increased rates of screening and treatment of IDA among ambulatory HFrEF patients. Further work is required to identify barriers and implement strategies to increase screening and treatment rates of IDA among HFrEF patients.
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Affiliation(s)
- Mena Gewarges
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Roslyn Mainland
- Division of General Internal Medicine, Queen's University, Kingston, Ontario, Canada
| | - Katherine Wilkinson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jaime Sklar
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Gentilin
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bianca McLean
- McMaster University Michael G DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Omar I Hajjaj
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mali Worme
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Spencer Lalonde
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Raumil Patel
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jeannie Callum
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Stephanie Poon
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Nanthakumar A, Worme M, Rahman T, Alvarez J, Doufle G, Tsang W, Nesbitt G, Mulvagh SL. The "Lightbulb" Sign: A Novel Echocardiographic Finding Using Ultrasound Enhancing Agent in Fulminant COVID-19-Related Myocarditis. JACC Case Rep 2023; 28:102120. [PMID: 38204556 PMCID: PMC10774821 DOI: 10.1016/j.jaccas.2023.102120] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 01/12/2024]
Abstract
We report a case of fulminant COVID-19-related myocarditis requiring venoarterial extracorporeal membrane oxygenation where the use of an ultrasound-enhancing agent demonstrated a previously undescribed echocardiographic finding, the "lightbulb" sign. This sign potentially represents a new area for the use of an ultrasound enhancing agent in the echocardiographic diagnosis of myocarditis.
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Affiliation(s)
- Ayana Nanthakumar
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Mali Worme
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Tahseen Rahman
- Division of Cardiology, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Juglans Alvarez
- Division of Cardiothoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Ghislaine Doufle
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Wendy Tsang
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Gillian Nesbitt
- Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L. Mulvagh
- Division of Cardiology, QEII-HI Site, Dalhousie University, Halifax, Nova Scotia, Canada
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Gewarges M, Sklar J, Wilkinson K, Gentilin A, McLean B, Hajjaj O, Worme M, Lalonde S, Patel R, Lin Y, Callum J, Poon S. PUMPING IRON: A QUALITY IMPROVEMENT STUDY FOR THE TREATMENT OF IRON DEFICIENCY ANEMIA IN AMBULATORY HEART FAILURE PATIENTS. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Bertic M, Worme M, Foroutan F, Rao V, Ross H, Billia F, Alba AC. Correction to: Predictors of Survival and Favorable Neurologic Outcome in Patients Treated with eCPR: a Systematic Review and Meta-analysis. J Cardiovasc Transl Res 2022; 15:1216. [PMID: 35290594 DOI: 10.1007/s12265-022-10234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mia Bertic
- Ted Rogers Center for Heart Research, Toronto, Canada. .,Division of Cardiology, Peter Munk Cardiac Center, Toronto, Canada.
| | - Mali Worme
- Ted Rogers Center for Heart Research, Toronto, Canada.,Division of Cardiology, Peter Munk Cardiac Center, Toronto, Canada
| | | | - Vivek Rao
- Ted Rogers Center for Heart Research, Toronto, Canada.,Division of Cardiac Surgery, Peter Munk Cardiac Center, Toronto, Canada
| | - Heather Ross
- Ted Rogers Center for Heart Research, Toronto, Canada.,Division of Cardiology, Peter Munk Cardiac Center, Toronto, Canada.,Division of Cardiac Surgery, Peter Munk Cardiac Center, Toronto, Canada
| | - Filio Billia
- Ted Rogers Center for Heart Research, Toronto, Canada.,Division of Cardiology, Peter Munk Cardiac Center, Toronto, Canada
| | - Ana C Alba
- Ted Rogers Center for Heart Research, Toronto, Canada.,Division of Cardiology, Peter Munk Cardiac Center, Toronto, Canada
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Bertic M, Worme M, Foroutan F, Ross H, Rao V, Alba A, Billia F. Predictors of Mortality in Patients with Cardiac Arrest Treated with ECPR. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Worme M, Grant K, Allan K, Snobelen P, Korley-Myron J, Dorian P. GREATER TORONTO AREA HEART MAP CHALLENGE: THE FIRST CROWD-SOURCED AUTOMATED EXTERNAL DEFIBRILLATOR REGISTRY IN CANADA. Can J Cardiol 2020. [PMCID: PMC7529423 DOI: 10.1016/j.cjca.2020.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Liu S, Worme M, Yanagawa B, Kumar N, Buller CE, Cheema AN, Bagai A. Treatment of Drug-Eluting Stent In-Stent Restenosis With Drug-Eluting Balloons: A Systematic Review and Meta-Analysis. J Invasive Cardiol 2018; 30:360-366. [PMID: 30108189] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the efficacy of drug-coated balloon (DEB) for the treatment of drug-eluting stent (DES) in-stent restenosis (ISR). METHODS A comprehensive literature search was performed. The primary outcome was the composite of death, myocardial infarction (MI), and target-lesion revascularization (TLR) at longest available follow-up (range, 12-36 months). Outcomes for DEB vs balloon angioplasty (BA) and DEB vs DES were analyzed separately using a random-effect Mantel-Haenszel model, as per an a priori protocol. RESULTS The study cohort comprised 1526 patients (746 DEB, 537 DES, 243 BA). DEB was associated with lower composite outcome compared with BA alone (19% vs 47%; risk ratio [RR], 0.31; 95% confidence interval [CI], 0.11-0.84; P=.02), driven primarily by lower TLR (17% vs 34%; RR, 0.66; 95% CI, 0.46-0.95; P=.03), with no difference in death or MI. There was no difference in the composite outcome between DEB and DES (20% vs 17%; RR, 1.2; 95% CI, 0.82-1.74; P=.35); DEB was associated with higher TLR (17.4% vs 11.3%; RR, 1.48; 95% CI, 1.08-2.03; P=.01), but lower all-cause mortality (2.2% vs 5.7%; RR, 0.43; 95% CI, 0.22-0.82; P=.01), with no difference in MI or stent thrombosis. CONCLUSIONS DEB was associated with a lower TLR rate than BA alone, but associated with a higher TLR rate than implantation of another DES. However, additional DES use was associated with an increase in mortality, a finding that requires further investigation.
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Affiliation(s)
| | | | | | | | | | | | - Akshay Bagai
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada.
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Worme M, Chada R, Lavallee L. An unexpected case of Ramsay Hunt syndrome: case report and literature review. BMC Res Notes 2013; 6:337. [PMID: 23985267 PMCID: PMC3847606 DOI: 10.1186/1756-0500-6-337] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 08/21/2013] [Indexed: 11/26/2022] Open
Abstract
Background Ramsay Hunt Syndrome (RHS) is a rare, severe complication of varicella zoster virus (VZV) reactivation in the geniculate ganglion. Facial paralysis is one of the features and without treatment, it fully recovers in as little as 20% of cases; this is much improved if treatment is started within 72 hours. This case is noteworthy in that coexistence of facial palsy with cervical dermatome involvement by VZV is not typical of RHS. Yet, it has been reported before. Case presentation A 54 year old Caucasian woman presented with right ear discomfort, difficulty hearing and a vesicular rash along the pinnae, 8 days after the eruption of a similar rash in the right C2-C4 dermatomes. 2 days later, she awoke with a partial right-sided facial paralysis, which improved with treatment (valacyclovir and prednisone). Conclusions This case is most pertinent to Family Practice, Otolaryngology and Neurology. It highlights the possible co-existence of RHS with cervical VZV reactivation and encourages physicians to monitor for this complication even before geniculate ganglion reactivation occurs. RHS is a rare disease that can present with vague symptoms. A high index of suspicion and close follow up are essential. Early intervention with antivirals and corticosteroids has shown significantly improved outcomes in these patients.
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Affiliation(s)
- Mali Worme
- 3474 St, Famille, Apt 2, Montreal, Quebec H2X 2K8, Canada.
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