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Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (25 November 2022) | Viewed by 21466

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Special Issue Editors

Dr. Luigi Tarani

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Guest Editor

Pediatric Department, “Sapienza” University of Rome, 00185 Rome, Italy
Interests: neurodevelopmental disorders
Special Issues, Collections and Topics in MDPI journals

Dr. David Planer

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Guest Editor

1. Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
2. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Interests: structural heart disease; coronary intervention; ischemic heart disease; peripheral arteries and aortic intervention

Dr. Gabby Elbaz-Greener

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Guest Editor

1. Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
2. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Interests: internal medicine; cardiology; sports medicine; hyperbaric medicine; health-system management interventional cardiology; structural heart disease

Special Issue Information

Dear Colleagues,

This last decade has seen major advances in the management of pre-hospital patients. One example is electrocardiogram-based telemedicine as a cornerstone in pre-hospital triage; other efforts have also been made for triaging patients early in the pre-hospital setting in order to expedite triage, diagnosis and treatment. Future research should focus on possibilities for enhancing early diagnosis and treatment of these patients to improve outcomes.

Furthermore, device therapies such as transcatheter aortic valve replacement and mitral clip emerged nearly 20 years ago and changed the landscape of structural heart intervention cardiology. These procedures have rapidly transitioned from an innovative procedure to standard of care. Trends in the utilization of percutaneous devices in the cath-lab took off, starting from one man just a few decades ago to exponential usage.

This Special Issue aims to focus on both pre-hospital settings of cardiovascular patients and trends and updates in cutting-edge structural heart disease. Accordingly, this section of the journal that I was kindly invited to edit may include original clinical studies, data-based original analysis and literature reviews (systematic reviews and meta-analysis).

I believe this unique combination, which covers pre-hospital settings all the way to in-hospital advanced technology, will be of interest and extremely valuable to readers.

Sincerely,

Dr. Luigi Tarani
Dr. David Planer
Dr. Gabby Elbaz-Greener
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

pre-hospital care
hospital care
emergency intervention
interventional cardiology
pulmonary emboli
congestive heart failure
TAVR
mitral clip

Published Papers (12 papers)

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Editorial

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3 pages, 455 KiB

Open AccessEditorial

Left-Side Pressure Index for All-Cause Mortality in Older Adults with HFpEF: Diagnostic Potential for HFpEF and Possible View for HFrEF

by Shiro Hoshida

J. Clin. Med. 2023, 12(3), 802; https://doi.org/10.3390/jcm12030802 - 19 Jan 2023

Cited by 2 | Viewed by 1051

Abstract

Heart failure (HF) with preserved ejection fraction (HFpEF) is thought to be driven by increased cardiac afterload, which consequentially leads to left ventricular (LV) diastolic dysfunction. The ratio of LV diastolic elastance (Ed) to arterial elastance (Ea) significantly increases in older hypertensive women without HF and is coincident with cardiac structural alterations. Ed/Ea is reported to be a prognostic factor for all-cause mortality in patients admitted with HFpEF. In this short article, I provide a possible view of this novel index as having diagnostic potential for HFpEF in clinics and playing a prognostic role in HF with reduced ejection fraction (HFrEF). Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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Research

Jump to: Editorial

14 pages, 4838 KiB

Open AccessArticle

Predicting Six-Month Re-Admission Risk in Heart Failure Patients Using Multiple Machine Learning Methods: A Study Based on the Chinese Heart Failure Population Database

by Shiyu Chen, Weiwei Hu, Yuhui Yang, Jiaxin Cai, Yaqi Luo, Lingmin Gong, Yemian Li, Aima Si, Yuxiang Zhang, Sitong Liu, Baibing Mi, Leilei Pei, Yaling Zhao and Fangyao Chen

J. Clin. Med. 2023, 12(3), 870; https://doi.org/10.3390/jcm12030870 - 21 Jan 2023

Cited by 4 | Viewed by 2023

Abstract

Since most patients with heart failure are re-admitted to the hospital, accurately identifying the risk of re-admission of patients with heart failure is important for clinical decision making and management. This study plans to develop an interpretable predictive model based on a Chinese population for predicting six-month re-admission rates in heart failure patients. Research data were obtained from the PhysioNet portal. To ensure robustness, we used three approaches for variable selection. Six different machine learning models were estimated based on selected variables. The ROC curve, prediction accuracy, sensitivity, and specificity were used to evaluate the performance of the established models. In addition, we visualized the optimized model with a nomogram. In all, 2002 patients with heart failure were included in this study. Of these, 773 patients experienced re-admission and a six-month re-admission incidence of 38.61%. Based on evaluation metrics, the logistic regression model performed best in the validation cohort, with an AUC of 0.634 (95%CI: 0.599–0.646) and an accuracy of 0.652. A nomogram was also generated. The established prediction model has good discrimination ability in predicting. Our findings are helpful and could provide useful information for the allocation of healthcare resources and for improving the quality of survival of heart failure patients. Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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8 pages, 404 KiB

Open AccessArticle

Impact of Short-Acting Disopyramide on Left Ventricular Mechanics Evaluated by Strain Analysis in Patients with Hypertrophic Obstructive Cardiomyopathy

by Idit Yedidya, Gabby Elbaz Greener, Mordehay Vaturi, Alik Sagie, Offer Amir, Shemy Carasso and Daniel Monakier

J. Clin. Med. 2022, 11(24), 7325; https://doi.org/10.3390/jcm11247325 - 9 Dec 2022

Cited by 2 | Viewed by 904

Abstract

Background: Disopyramide is a class Ia antiarrhythmic drug that has been used for the second-line treatment of symptomatic hypertrophic obstructive cardiomyopathy (HOCM). The aim of the study was to assess the impact of short-acting disopyramide in patients with hypertrophic obstructive cardiomyopathy (HOCM) using two-dimensional speckle-tracking echocardiography. Methods: This prospective study included patients with HOCM on chronic treatment with short-acting disopyramide. Two sequential comprehensive echocardiographic examinations were performed: after temporary disopyramide suspension and 2.5 h after disopyramide intake. Results: 19 patients were included in the study. The effect of disopyramide on the left ventricle was not uniform. After the intake of disopyramide, the mean global strain peak was −17 ± 2% before disopyramide intake and −14 ± 2% after (p < 0.0001). There was a significant reduction in strain in the basal septal (p = 0.015), basal inferior (p = 0.019), basal posterior (p = 0.05), apical anterior (p = 0.0001), and apical lateral segments (p = 0.021). In all other segments, there was no significant change. Disopyramide also caused a significant accentuation of the base-apex strain gradients (p = 0.036). No change was noted in circumferential and left atrial strain. While the left ventricular ejection fraction and outflow gradients did not change, the significant reduction in global and segmental longitudinal strain demonstrated the acute negative inotropic effect of disopyramide on the myocardium in patients with HOCM. Conclusion: A strain analysis may be a useful tool to assess the negative inotropic effect of cardiovascular medication on the left ventricle in patients with HOCM. Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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20 pages, 2685 KiB

Open AccessArticle

Applying an Improved Stacking Ensemble Model to Predict the Mortality of ICU Patients with Heart Failure

by Chih-Chou Chiu, Chung-Min Wu, Te-Nien Chien, Ling-Jing Kao, Chengcheng Li and Han-Ling Jiang

J. Clin. Med. 2022, 11(21), 6460; https://doi.org/10.3390/jcm11216460 - 31 Oct 2022

Cited by 11 | Viewed by 2044

Abstract

Cardiovascular diseases have been identified as one of the top three causes of death worldwide, with onset and deaths mostly due to heart failure (HF). In ICU, where patients with HF are at increased risk of death and consume significant medical resources, early and accurate prediction of the time of death for patients at high risk of death would enable them to receive appropriate and timely medical care. The data for this study were obtained from the MIMIC-III database, where we collected vital signs and tests for 6699 HF patient during the first 24 h of their first ICU admission. In order to predict the mortality of HF patients in ICUs more precisely, an integrated stacking model is proposed and applied in this paper. In the first stage of dataset classification, the datasets were subjected to first-level classifiers using RF, SVC, KNN, LGBM, Bagging, and Adaboost. Then, the fusion of these six classifier decisions was used to construct and optimize the stacked set of second-level classifiers. The results indicate that our model obtained an accuracy of 95.25% and AUROC of 82.55% in predicting the mortality rate of HF patients, which demonstrates the outstanding capability and efficiency of our method. In addition, the results of this study also revealed that platelets, glucose, and blood urea nitrogen were the clinical features that had the greatest impact on model prediction. The results of this analysis not only improve the understanding of patients’ conditions by healthcare professionals but allow for a more optimal use of healthcare resources. Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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8 pages, 718 KiB

Open AccessArticle

Protective Effects of BNT162b2 Vaccination on Aerobic Capacity Following Mild to Moderate SARS-CoV-2 Infection: A Cross-Sectional Study Israel

by Yair Blumberg, Michael Edelstein, Kamal Abu Jabal, Ron Golan, Neta Tuvia, Yuval Perets, Musa Saad, Tatyana Levinas, Dabbah Saleem, Zeev Israeli, Abu Raya Alaa, Gabby Elbaz Greener, Anat Amital and Majdi Halabi

J. Clin. Med. 2022, 11(15), 4420; https://doi.org/10.3390/jcm11154420 - 29 Jul 2022

Cited by 1 | Viewed by 1689

Abstract

Patients previously infected with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may experience post-acute adverse health outcomes, known as long COVID. The most reported symptoms are fatigue, headache and attention/concentration issues, dyspnea and myalgia. In addition, reduced aerobic capacity has been demonstrated in both mild and moderate COVID-19 patients. It is unknown whether COVID-19 vaccination mitigates against reduced aerobic capacity. Our aim was to compare the aerobic capacity of vaccinated and unvaccinated individuals previously infected with SARS-CoV-2. Methods: Individuals aged 18 to 65 years with laboratory-confirmed mild to moderate COVID-19 disease were invited to Ziv Medical Centre, Israel, three months after SARS-CoV-2 infection. We compared individuals unvaccinated at the time of infection to those vaccinated in terms of aerobic capacity, measured using symptom-limited cardiopulmonary exercise test (CPET). Results: We recruited 28 unvaccinated and 22 vaccinated patients. There were no differences in baseline demographic and pulmonary function testing (PFT) parameters. Compared with unvaccinated individuals, those vaccinated had higher V’O₂/kg at peak exercise and at the anaerobic threshold. The V’O₂/kg peak in the unvaccinated group was 83% of predicted vs. 100% in the vaccinated (p < 0.002). At the anaerobic threshold (AT), vaccinated individuals had a higher V’O₂/kg than those unvaccinated. Conclusions: Vaccinated individuals had significantly better exercise performance. Compared with vaccinated individuals, a higher proportion of those unvaccinated performed substantially worse than expected on CPET. These results suggest that vaccination at the time of infection is associated with better aerobic capacity following SARS-CoV-2 infection. Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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13 pages, 9495 KiB

Open AccessArticle

The Obesity Paradox in Real-World Nation-Wide Cohort of Patients Admitted for a Stroke in the U.S.

by Guy Rozen, Gabby Elbaz-Greener, Gilad Margolis, Ibrahim Marai, Edwin K. Heist, Jeremy N. Ruskin, Shemy Carasso, Ariel Roguin, Edo Y. Birati and Offer Amir

J. Clin. Med. 2022, 11(6), 1678; https://doi.org/10.3390/jcm11061678 - 17 Mar 2022

Cited by 11 | Viewed by 1944

Abstract

Background: Obesity has been associated with increased incidence and severity of various cardiovascular risk factors and increased risk for stroke. However, the evidence of its effect on outcomes in stroke victims have been equivocal. We aimed to investigate the distribution of BMI in a nation-wide cohort of individuals, admitted for a stroke, and the relationship between BMI and in-hospital mortality. Methods: Data from the U.S. National Inpatient Sample (NIS) was collected, to identify hospitalizations for stroke, between October 2015 and December 2016. The patients were sub-divided into six groups based on their BMI: underweight, normal weight, overweight, obese I, obese II and extremely obese groups. Various sociodemographic and clinical parameters were gathered, and incidence of mortality and the length of hospital stay were analyzed. Multivariable analysis was performed to identify independent predictors of in-hospital mortality. Results: A weighted total of 84,185 hospitalizations for stroke were included in the analysis. The approximate mean patients aged was 65.5 ± 31 years, the majority being female (55.3%) and white (63.1%). The overall in-hospital mortality during the study period was 3.6%. A reverse J-shaped relationship between the body mass index and in-hospital mortality was documented, while patients with elevated BMI showed significantly lower in-hospital mortality compared to the underweight and normal weight study participants, 2.8% vs. 7.4%, respectively, p < 0.001. Age and several comorbidities, as well as the Deyo Comorbidity Index, were found to predict mortality in a multivariable analysis. Conclusion: A reverse J-shaped relationship between body mass index and in-hospital mortality was documented in patients admitted for a stroke in the U.S. during the study period. The above findings support the existence of an “obesity paradox” in patients hospitalized following a stroke, similar to that described in other cardiovascular conditions. Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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11 pages, 1173 KiB

Open AccessArticle

The Ratio of Hemoglobin to Red Cell Distribution Width: A Strong Predictor of Clinical Outcome in Patients with Heart Failure

by Eldad Rahamim, Donna R. Zwas, Andre Keren, Gabby Elbaz-Greener, Mahsati Ibrahimli, Offer Amir and Israel Gotsman

J. Clin. Med. 2022, 11(3), 886; https://doi.org/10.3390/jcm11030886 - 8 Feb 2022

Cited by 16 | Viewed by 2372

Abstract

Background: Hemoglobin (Hb) is a standard and widely available clinical parameter that predicts clinical outcomes in heart failure (HF) patients. Red cell distribution width (RDW) is also a routinely measured clinical parameter that is predictive of clinical outcomes in HF. The ratio between Hb and RDW has yet to be evaluated in HF. Methods: We evaluated the predictive value of the Hb/RDW ratio on clinical outcomes in patients with HF. All patients diagnosed with chronic HF at a health maintenance organization were evaluated for Hb/RDW ratio and followed for cardiac-related hospitalizations and death. Results: The study cohort included 6888 HF patients. The mean Hb/RDW ratio was 0.85 ± 0.18; median was 0.85 (interquartile range 0.72–0.98). Patients with a lower Hb/RDW ratio were more likely to be women and had more comorbidities. The overall two year-mortality rate was 23.2%. Decreasing quantiles of the Hb/RDW ratio were associated with reduced survival rates and reduced event-free survival from death or cardiovascular-hospitalizations. Multivariable Cox regression analysis after adjustment for significant predictors demonstrated that low Hb/RDW ratio was a significant predictor of mortality, with a graded increased risk as Hb/RDW ratio decreased. Lower Hb/RDW ratio was also a significant independent predictor of the combined endpoint of death or cardiovascular hospitalizations. A sensitivity analysis evaluating Hb/RDW ratio as a continuous parameter using restricted cubic splines demonstrated a continuous increase in the mortality risk with decreasing Hb/RDW ratio, p < 0.0001 for the linear model. Conclusions: Hb/RDW ratio is a significant prognostic tool for predicting HF mortality and cardiovascular hospitalizations. Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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10 pages, 786 KiB

Open AccessArticle

Trends in Transfemoral Aortic Valve Implantation Related Thrombocytopenia

by Haitham Abu Khadija, Gera Gandelman, Omar Ayyad, Lion Poles, Michael Jonas, Offir Paz, Jacob George and Alex Blatt

J. Clin. Med. 2022, 11(3), 726; https://doi.org/10.3390/jcm11030726 - 29 Jan 2022

Cited by 4 | Viewed by 1903

Abstract

Background: TAVI related thrombocytopenia (TAVI-rTP) is still very common. The aim of this study was to compare the incidence, characteristics and impact of reduced platelet counts (RPC) after TAVI between an earlier and contemporary period. Methods: the patients enrolled were those experiencing severe symptomatic aortic stenosis who underwent TAVI between January 2010 and December 2019. The exclusion criteria were no available blood tests and periprocedural death. Results: 334 patients (mean age 81.9 ± 6.7 years) were enrolled. For the earlier period, the mean RPC was 33 ± 15%, and in the contemporary period (2016–2019) it was 26 ± 14%. In the early group, we found that 62% of the patients had decreased platelet counts of more or equal to 30% in comparison to 33% in the contemporary period. The time of the procedure and the amount of the contrast that had been used in the later period were associated with significant RPCs (p value = 0.002 and 0.028, respectively). An RPC of 30% or more was associated with the increased risks of life-threatening bleeding, vascular complications and death within 30 days. Conclusion: contemporary TAVI-rTP continued to be a common phenomenon in our cohort. However, severe thrombocytopenia was significantly less frequent. An RPC of 30% or more is associated with a poor 30-day outcome. Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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9 pages, 1236 KiB

Open AccessArticle

Temporal Trends and Outcome of Patients with Acute Coronary Syndrome and Prior Myocardial Infarction

by Katia Orvin, Alon Shechter, Doron Zahger, Vitaly Shklovski, Tal Ovdat, Roy Beigel, Ran Kornowski and Alon Eisen

J. Clin. Med. 2021, 10(23), 5580; https://doi.org/10.3390/jcm10235580 - 27 Nov 2021

Cited by 3 | Viewed by 1642

Abstract

Patients who have previously had a myocardial infarction (MI) are considered a high-risk group with increased risk for cardiovascular (CV) events. During the last decade, the outcome of acute coronary syndrome (ACS) patients has improved due to advances in medical therapy and interventional techniques. We aimed to examine temporal trends and outcomes of patients with prior MI admitted due to ACS from the Acute Coronary Syndrome Israeli Survey (ACSIS). Included were 16,934 ACS patients, of whom 31.4% had prior MI. For temporal trend analysis, the cohort was divided into an early period (2000–2008) and late period (2010–2018). For patients with prior MI, patients in the late period had a higher rate of CV risk factors and were treated more frequently with revascularization and guidelines-directed medical therapy. Recurrent MI (6.7% vs. 12%, p < 0.001), MACE (10.6% vs. 21%, p < 0.001) and 1-year mortality (10.7% vs. 14.6%, p < 0.001) were significantly lower in the late period. However, the mortality rate for patients with prior MI remained higher compared with patients without prior MI (10.7% vs. 6.8% p < 0.001) with an overall higher mortality rate in the STEMI group. Thus, despite significant improvement in outcome measures in the contemporary era, ACS patients with prior MI are still at increased risk for recurrent ischemic CV events and mortality. Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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12 pages, 1951 KiB

Open AccessArticle

The Impact of COVID-19 Pandemic on Management and Outcome in Patients with Heart Failure

by Zahi Abu Ghosh, Donna R. Zwas, Andre Keren, Gabby Elbaz-Greener, Vered Israeli, Offer Amir and Israel Gotsman

J. Clin. Med. 2021, 10(23), 5577; https://doi.org/10.3390/jcm10235577 - 27 Nov 2021

Cited by 2 | Viewed by 2063

Abstract

Background: The COVID-19 pandemic has adversely affected the provision of health care and disease management around the world. COVID-19 carries a high morbidity and mortality rate in elderly and people with comorbidities, including heart failure (HF). The present study addressed the clinical management and outcomes of HF patients during the pandemic. Methods: We evaluated the clinical management and survival rate of HF patients during the COVID-19 pandemic in Israel (March 2020–April 2021). Results: The cohort included 6748 patients with a diagnosis of HF during the study period. During this period, 843 HF patients (12.5%) were infected with COVID-19, and 194 died from COVID-19, a 23% mortality rate. Patients infected with COVID-19 had a higher percentage of diabetes and obesity. Predictors of mortality included age, male sex, reduced functional capacity, renal dysfunction, and absence of renin–angiotensin system inhibition. During the pandemic, there was a marked decrease in the usage of medical services in the cohort. Cardiovascular hospitalizations, all hospitalization, and emergency room visits were significantly decreased compared to the two years prior to the pandemic, particularly during the lockdowns. There was also an initial decrease in HF clinic visits. Mortality rates were very similar during the pandemic compared to previous years. There was a decline in non-COVID-19 deaths, which were replaced with deaths due to COVID-19. This may result from competing effects and reduced exposure to respiratory infections and other insults due to social distancing. Conclusions: Mortality rates in HF patients infected with COVID-19 were high. The COVID-19 pandemic resulted in the reduced usage of health services but without increased overall mortality. Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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15 pages, 2283 KiB

Open AccessArticle

Immediate Post-Procedural and Discharge Assessment of Mitral Valve Function Following Transcatheter Edge-to-Edge Mitral Valve Repair: Correlation and Association with Outcomes

by Doron Sudarsky, Fabio Kusniec, Liza Grosman-Rimon, Ala Lubovich, Wadia Kinany, Evgeni Hazanov, Michael Gelbstein, Edo Y. Birati and Shemy Carasso

J. Clin. Med. 2021, 10(22), 5448; https://doi.org/10.3390/jcm10225448 - 22 Nov 2021

Cited by 2 | Viewed by 1507

Abstract

The correlation between residual mitral regurgitation (rMR) grade or mitral valve pressure gradient (MVPG), at transcatheter edge-to-edge mitral valve repair (TEEMr) completion and at discharge, is unknown. Furthermore, there is disagreement regarding rMR grade or MVPG from which prognosis diverts. We retrospectively studied 82 patients that underwent TEEMr. We tested the correlation between rMR or MVPG and evaluated their association, with outcomes. Moderate or less rMR (rMR ≤ 2) at TEEMr completion was associated with improved survival, whereas mild or less rMR (rMR ≤ 1) was not. Patients with rMR ≤ 1 at discharge demonstrated a longer time of survival, of first heart failure hospitalization and of both. The correlation for both rMR grade (r = 0.5, p < 0.001) and MVPG (r = 0.51, p < 0.001), between TEEMr completion and discharge, was moderate. MR ≤ 2 at TMEER completion was the strongest predictor for survival (HR 0.08, p < 0.001) whereas rMR ≤ 1 at discharge was independently associated with a lower risk of the combined endpoint (HR 4.17, p = 0.012). MVPG was not associated with adverse events. We conclude that the assessments for rMR grade and MVPG, at the completion of TEEMr and at discharge, should be distinctly reported. Improved outcome is expected with rMR ≤ 2 at TEEMr completion and rMR ≤ 1 at discharge. Higher MVPG is not associated with unfavorable outcomes. Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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9 pages, 1184 KiB

Open AccessArticle

Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers

by Gabby Elbaz-Greener, Shemy Carasso, Elad Maor, Lior Gallimidi, Merav Yarkoni, Harindra C. Wijeysundera, Yitzhak Abend, Yinon Dagan, Amir Lerman and Offer Amir

J. Clin. Med. 2021, 10(22), 5355; https://doi.org/10.3390/jcm10225355 - 17 Nov 2021

Cited by 1 | Viewed by 1428

Abstract

(1) Introduction: Most studies rely on in-hospital data to predict cardiovascular risk and do not include prehospital information that is substantially important for early decision making. The aim of the study was to define clinical parameters in the prehospital setting, which may affect clinical outcomes. (2) Methods: In this population-based study, we performed a retrospective analysis of emergency calls that were made by patients to the largest private emergency medical services (EMS) in Israel, SHL Telemedicine Ltd., who were treated on-site by the EMS team. Demographics, clinical characteristics, and clinical outcomes were analyzed. Mortality was evaluated at three time points: 1, 3, and 12 months’ follow-up. The first EMS prehospital measurements of the systolic blood pressure (SBP) were recorded and analyzed. Logistic regression analyses were performed. (3) Results: A total of 64,320 emergency calls were included with a follow-up of 12 months post index EMS call. Fifty-five percent of patients were men and the mean age was 70.2 ± 13.1 years. During follow-up of 12 months, 7.6% of patients died. Age above 80 years (OR 3.34; 95% CI 3.03–3.69, p < 0.005), first EMS SBP ≤ 130 mm Hg (OR 2.61; 95% CI 2.36–2.88, p < 0.005), dyspnea at presentation (OR 2.55; 95% CI 2.29–2.83, p < 0001), and chest pain with ischemic ECG changes (OR 1.95; 95% CI 1.71–2.23, p < 0.001) were the highest predictors of 1 month mortality and remained so for mortality at 3 and 12 months. In contrast, history of hypertension and first EMS prehospital SBP ≥ 160 mm Hg were significantly associated with decreased mortality at 1, 3 and 12 months. (4) Conclusions: We identified risk predictors for all-cause mortality in a large cohort of patients during prehospital EMS calls. Age over 80 years, first EMS-documented prehospital SBP < 130 mm Hg, and dyspnea at presentation were the most profound risk predictors for short- and long-term mortality. The current study demonstrates that in prehospital EMS call settings, several parameters can be used to improve prioritization and management of high-risk patients. Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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