ISSN 1671-5411 CN 11-5329/R

2023 Vol. 20, No. 4

Characteristics and in-hospital mortality of elderly patients with heart failure in Spanish hospitals
Alberto Esteban-Fernández, Manuel Anguita-Sánchez, Juan Luis Bonilla-Palomas, María Anguita-Gámez, María García, José Luis Bernal, Náyade Del Prado, Cristina Fernández-Pérez, Julián Pérez-Villacastin, Juan José Gómez-Doblas, Francisco Javier Elola
2023, 20(4): 247-255. doi: 10.26599/1671-5411.2023.04.005
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 BACKGROUND  The prevalence of heart failure (HF) increases with age, and it is one of the leading causes of hospitalization and death in older patients. However, there are little data on in-hospital mortality in patients with HF ≥ 75 years in Spain.  METHODS  A retrospective analysis of the Spanish Minimum Basic Data Set was performed, including all HF episodes discharged from public hospitals in Spain between 2016 and 2019. Coding was performed using the International Classification of Diseases, 10th Revision. Patients ≥ 75 years with HF as the principal diagnosis were selected. We calculated: (1) the crude in-hospital mortality rate and its distribution according to age and sex; (2) the risk-standardized in-hospital mortality ratio; and (3) the association between in-hospital mortality and the availability of an intensive cardiac care unit (ICCU) in the hospital.  RESULTS  We included 354,792 HF episodes of patients over 75 years. The mean age was 85.2 ± 5.5 years, and 59.2% of patients were women. The most frequent comorbidities were renal failure (46.1%), diabetes mellitus (35.5%), valvular disease (33.9%), cardiorespiratory failure (29.8%), and hypertension (26.9%). In-hospital mortality was 12.7%, and increased with age [odds ratio (OR) = 1.07, 95% CI: 1.07–1.07, P < 0.001] and was lower in women (OR = 0.96, 95% CI: 0.92–0.97, P < 0.001). The main predictors of mortality were the presence of cardiogenic shock (OR = 19.5, 95% CI: 16.8–22.7, P < 0.001), stroke (OR = 3.5, 95% CI: 3.0–4.0, P < 0.001) and advanced cancer (OR = 2.6, 95% CI: 2.5–2.8, P < 0.001). In hospitals with ICCU, the in-hospital risk-adjusted mortality tended to be lower (OR = 0.85, 95% CI: 0.72–1.00, P = 0.053).  CONCLUSIONS  In-hospital mortality in patients with HF ≥ 75 years between 2016 and 2019 was 12.7%, higher in males and elderly patients. The main predictors of mortality were cardiogenic shock, stroke, and advanced cancer. There was a trend toward lower mortality in centers with an ICCU.
Evaluation of metoprolol standard dosing pathway in Chinese patients with acute coronary syndrome: a prospective multicenter single-arm interventional study
Xiao-Yun YIN, Yun-Mei ZHANG, Ai-Dong SHEN, Jing-Ping WANG, Zhe-Xun LIAN, Yi-Bing SHAO, Wen-Qi ZHANG, Shu-Ying ZHANG, Yang ZHENG, Kang CHENG, Biao XU, Cheng-Xing SHEN, Rong-Chong HUANG, Jin-Cheng GUO, Guo-Sheng FU, Dong-Kai SHAN, Dan-Dan LI, Yun-Dai CHEN
2023, 20(4): 256-267. doi: 10.26599/1671-5411.2023.04.001
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 OBJECTIVE  To evaluate the feasibility and tolerability of metoprolol standard dosing pathway (MSDP) in Chinese patients with acute coronary syndrome (ACS).  METHODS  In this multicenter, prospective, open label, single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals. A total of 998 hospitalized patients aged ≥ 18 years and diagnosed with ACS were included. The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines. The primary endpoint was the percentage of patients achieving the target dose at discharge (V2). The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge (V4), and percentage of patients experiencing bradycardia (heart rate < 50 beats/min), hypotension (blood pressure < 90/60 mmHg) and transient cardiac dysfunction at V2 and V4.  RESULTS  Of the 998 patients, 29.46% of patients achieved the target dose (≥ 95 mg/d) at V2. The total population was divided into two groups: target group (patients achieving the target dose at V2) and non-target group (patients not achieving the target dose at V2). There was significant difference in the reduction of heart rate from baseline to discharge in the two groups (-4.97 ± 11.90 beats/min vs. -2.70 ± 9.47 beats/min, P = 0.034). There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2 (0 vs. 0, P = 1.000) and V4 (0.81% vs. 0.33%, P = 0.715). There was no significant difference in the proportion of hypotension between the two groups at V2 (0.004% vs. 0.004%, P = 1.000) and V4 (0 vs. 0.005%, P = 0.560). No transient cardiac dysfunction occurred in two groups during the study. A total of five adverse events (1.70%) and one serious adverse event (0.34%) were related to the pathway in target group.  CONCLUSIONS  In Chinese ACS patients, the feasibility and tolerability of the MSDP have been proved to be acceptable.
Feasibility and clinical benefits of the double-ProGlide technique for hemostasis after cryoballoon atrial fibrillation ablation with uninterrupted oral anticoagulants
Jia-Yin SUN, Chang-Bo XUAN, Hai-Liang YU, Hai-Yang WANG, Hong-Ya HAN, Zhi-Ming ZHOU, De-An JIA, Dong-Mei SHI, Yu-Jie ZHOU, Shi-Wei YANG
2023, 20(4): 268-275. doi: 10.26599/1671-5411.2023.04.004
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 OBJECTIVE  To access the efficacy and safety of the double-ProGlide technique for the femoral vein access-site closure in cryoballoon ablation with uninterrupted oral anticoagulants (OAC), and its impact on the electrophysiology laboratory time as well as hospital stay after the procedure in this observational study.  METHODS  Patients with atrial fibrillation undergoing cryoballoon ablation with uninterrupted OAC at Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China from May 2019 to May 2021 were enrolled in this study. From October 2020, double-ProGlide technique was consistently used for hemostasis (ProGlide group), and before that conventional manual compression was utilized (manual compression group). The occurrence of vascular and groin complications was accessed during the hospital stay and until the three-month follow-up.  RESULTS  A total of 140 participants (69.30% of male, mean age: 59.21 ± 10.29 years) were evaluated, 70 participants being in each group. Immediate hemostasis was achieved in all the patients with ProGlide closure. No major vascular complications were found in the ProGlide group while two major vascular complications were occurred in the manual compression group. The incidence of any groin complication was obviously higher in subjects with manual compression than patients with ProGlide devices (15.71% vs. 2.86%, P = 0.009). In addition, compared with the manual compression group, the ProGlide group was associated with significantly shorter total time in the electrophysiology laboratory [112.0 (93.3–128.8) min vs. 123.5 (107.3–158.3) min, P = 0.006], time from sheath removal until venous site hemostasis [3.8 (3.4–4.2) min vs. 8.0 (7.6–8.5) min, P < 0.001], bed rest time [8.0 (7.6–8.0) h vs. 14.1 (12.0–17.6) h, P < 0.001] and hospital stay after the procedure [13.8 (12.5–17.8) h vs. 38.0 (21.5–41.0) h, P < 0.001].  CONCLUSIONS  Utilization of the double-ProGlide technique for hemostasis after cryoballoon ablation with uninterrupted OAC is feasible and safe, which has the clinical benefit in reducing the total electrophysiology laboratory time and the hospital stay length after the procedure.
Minimally invasive valve surgery: pushing boundaries over the eighty
Cristina Barbero, Dario Brenna, Antonio Salsano, Marco Pocar, Erik Cura Stura, Claudia Calia, Viviana Sebastiano, Mauro Rinaldi, Davide Ricci
2023, 20(4): 276-283. doi: 10.26599/1671-5411.2023.04.006
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 BACKGROUND  Mean age of patients with valves diseases is significantly increasing, and, in the near future, cardiac surgeons will have to deal with a considerable number of patients aged more than 80 years. The remarkable results gained by the minimally invasive approach have encouraged its application in more complex and fragile patients, such as older people. This study aimed to identify the rate of early mortality and major complications, and independent predictors for mid-term mortality in octogenarians undergoing minimally invasive valve surgery. METHODS  Octogenarian patients undergoing right mini-thoracotomy mitral and/or tricuspid valve surgery between 2006 and 2020 were included. Primary endpoint was to identify independent predictors for mid-term mortality, and secondary endpoints were operative morality, stroke, independent predictors for early composite outcome, and quality of life at follow-up. RESULTS  Analysis was performed on 130 patients. Stroke occurred in one patient (0.8%), while operative mortality was 6% (eight patients). One-year and five-year survival were 86% and 64%, respectively. Logistic regression identified age and creatinine level as independent predictors of mid-term mortality, survival analysis showed that age ≥ 84 years and creatinine level ≥ 1.22 mg/dL were the cut-off points for worst prognosis. Female gender and hypertension were found to be independent predictors of early composite outcome. CONCLUSIONS  Results of the present study show that age alone should not be considered a contraindication for minimally invasive valve surgery. Identifying patients who are most likely to have survival and functional benefits after surgery is decisive to achieve optimal health outcomes and prevent futile procedures.
Prevalence and incidence of heart failure among community in China during a three-year follow-up
Lu FU, Jun-Rong JIANG, Wei-Dong LIN, Hui-Yi LIU, Shu-Yu JIN, Xing-Dong YE, Yan-Lin CHEN, Si-Jia PU, Yang LIU, Shang-Fei HE, Shu-Lin WU, Hai DENG, Yu-Mei XUE
2023, 20(4): 284-292. doi: 10.26599/1671-5411.2023.04.008
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 BACKGROUND  Epidemiological surveys on heart failure (HF) in Chinese community are relatively lacking. This study aimed to estimate the prevalence and incidence of HF among community residents in southern China.  METHODS  Baseline data of this prospective study was collected from 2015 to 2017 among 12,013 permanent residents aged ≥ 35 years in Guangzhou, China. The same survey process was carried out for individuals aged ≥ 65 years after a three-year follow-up. RESULTS  The overall prevalence of HF in community residents aged ≥ 35 years was 1.06%. Male had significantly higher risk of HF prevalence [odds ratio (OR) = 1.50, P = 0.027]. The gender-adjusted risk of HF was 1.48 times higher per 10 years aging. HF prevalence was statistically associated with atrial fibrillation, valvular heart disease, hypertension and chronic obstructive pulmonary disease after adjusting for age and gender (OR = 8.30, 5.17, 1.11, 2.28, respectively; all P < 0.05). HF incidence in individuals aged ≥ 65 years were 847 per 100,000 person-years. Baseline atrial fibrillation, valvular heart disease, and diabetes mellitus were risk factors for HF incidence for individuals aged ≥ 65 years adjusting for age and gender (OR = 5.05, 3.99, 2.11, respectively; all P < 0.05). Besides, residents with new-onset atrial fibrillation and myocardial infarction were at significantly higher risk of progression to HF (OR = 14.41, 8.54, respectively; all P < 0.05).  CONCLUSIONS  Both pre-existing and new-onset cardiovascular diseases were associated with HF incidence in southern China. Management of related cardiovascular diseases may be helpful to reduce the incidence of HF.
Safety of butylphthalide and edaravone in patients with ischemic stroke: a multicenter real-world study
Shu-Xian LYU, Dong-Fang QIAN, Yu-Fei FENG, Cheng-Wu SHEN, Lu-Bo GUO, Jian-Tao LYU, Peng-Fei JIN, Ting LI, Si-Yuan TAN, Zi-Xuan ZHANG, Lin HUANG, Xue ZHONG, Le-Qun SU, Xin HU, Xin HUANG, Xue-Yan CUI
2023, 20(4): 293-308. doi: 10.26599/1671-5411.2023.04.002
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 BACKGROUND  Butylphthalide (NBP) and edaravone (EDV) injection are common acute ischemic stroke medications in China, but there is a lack of large real-world safety studies on them. This study aimed to determine the incidence of adverse events, detect relevant safety signals, and assess the risk factors associated with these medications in real-world populations.  METHODS  In this study, data of acute ischemic stroke patients were extracted from the electronic medical record database of six tertiary hospitals between January 2019 and August 2021. Baseline confounders were eliminated using propensity score matching. The drugs’ safety was estimated by comparing the results of 24 laboratory tests standards on liver function, kidney function, lipid level, and coagulation function. The drugs’ relative risk was estimated by logistic regression. A third group with patients who did not receive NBP or EDV was constructed as a reference. Prescription sequence symmetry analysis was used to evaluate the associations between adverse events and NBP and EDV, respectively.  RESULTS  81,292 patients were included in this study. After propensity score matching, the NBP, EDV, and third groups with 727 patients in each group. Among the 15 test items, the incidence of adverse events was lower in the NBP group than in the EDV group, and the differences were statistically significant. The multivariate logistic regression equation revealed that NBP injection was not a promoting factor for abnormal laboratory test results, whereas EDV had statistically significant effects on aspartate transaminase, low-density lipoprotein cholesterol and total cholesterol. Prescription sequence symmetry analysis showed that NBP had a weak correlation with abnormal platelet count. EDV had a positive signal associated with abnormal results in gamma-glutamyl transferase, alanine aminotransferase, aspartate aminotransferase, prothrombin time, and platelet count.  CONCLUSIONS  In a large real-world population, NBP has a lower incidence of adverse events and a better safety profile than EDV or other usual medications.
How to effectively manage the refractory coronary thrombus? A systemic mini-review
Song ZHANG, Dang-Hui SUN, Shuang LI, Yue LI
2023, 20(4): 309-313. doi: 10.26599/1671-5411.2023.04.003
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The main management principle for patients with coronary thrombus should be “more removal and less implantation”. Routine thrombus aspiration (TA) is ineffective for intracoronary thrombus or high residual thrombus burden after TA and may result in a refractory coronary thrombus. It is unwise to implant a stent in the vessel with high residual thrombus, which is associated with no-reflow, impaired microvascular perfusion, and consequently worse clinical outcomes. Therefore, increasing the efficiency of TA during percutaneous coronary intervention procedures, especially under some conditions of refractory coronary thrombus, is very important to restore myocardial reperfusion and improve microvascular dysfunction early. In the present work, we aimed to demonstrate the factors that may affect TA efficiency and introduce several highly effective approaches to treat refractory coronary thrombus.
A rare cause of pulmonary hypertension in an elderly woman
Shing Ching, Chiu Sun Yue
2023, 20(4): 314-316. doi: 10.26599/1671-5411.2023.04.007
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Tricuspid valve avulsion
Abhinav Karan, Anamarys Blanco, Emil Missov, Srinivasan Sattiraju
2023, 20(4): 317-318. doi: 10.26599/1671-5411.2023.04.009
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