HRS/ACC scientific statement: Guiding principles on the performance of intracardiac ablation procedures in ambulatory surgical centers

Ambulatory surgical centers (ASC) in the United States have emerged as an innovative model in health care delivery, potentially serving as a cost-effective, patient-centric alternative to traditional hospital-based care. Supported by Centers for Medicare & Medicaid Services policy expansions, ASCs accommodate procedures across specialties from orthopedics to interventional cardiology. By leveraging technological/procedural advancements and same-day discharge protocols, appropriately selected procedures in the field of cardiac electrophysiology (such as intracardiac ablation procedures and cardiac implantable electronic device implants) could increasingly shift to an ASC setting. This transition aligns with a growing clinical need for arrhythmia interventions and a broader push for operational efficiency. A mounting body of evidence supports the feasibility of performing intracardiac ablation procedures in the ASC setting, with an ongoing need for clinical investigation to track outcomes. Additional barriers to scalable clinical adoption exist, such as regulatory fragmentation, workforce challenges, and heterogeneity in reimbursement. As such, performance of intracardiac ablation procedures in the ASC setting will require collaboration among stakeholders (clinicians, policymakers, payers, and advocacy groups) to investigate and ensure safety and effectiveness, harmonize payment policies, prioritize equitable access, and embed rigorous quality assurance frameworks. By integrating data-driven protocols, clinical excellence, and ethical practices, ASCs could fulfill a defined adjunctive role in a value-based health care system, assuring high-quality care without compromising patient safety while improving access

Revisiting New Data on the Mortality Benefit of Rapid Correction of Hyponatremia: Déjà Vu All Over Again

Studies in the 1980s linking rapid correction of severe, chronic hyponatremia to the osmotic demyelination syndrome (ODS) led to a major controversy that eventually gave way to consensus guidelines. Efforts to limit correction to ≤8 mmol/L per day in patients at high risk of developing ODS became common practice. Recent studies have questioned these guidelines, suggesting that ODS is rare and that slow correction may increase mortality. In this review, we revisit the history of the controversy and find that these claims have persisted for 4 decades. Older studies supporting faster correction are flawed by referral bias while newer studies are limited by confounding as comorbidities influence rates of both mortality and hyponatremia correction. Although both old and new studies emphasize the rarity of magnetic resonance imaging-documented ODS after rapid correction, they were not conducted in hyponatremic patients who were at risk for ODS. Old studies reporting hyponatremic deaths due to cerebral edema overestimate its true incidence, and new studies reporting an association of mortality and slow rates of sodium correction do not document cerebral edema as a common contributor to death. Further research is required to better define the incidence of both ODS and cerebral edema in patients at risk for these complications. Until then, we conclude that the risks of rapid correction-including irreversible neurological damage-necessitate caution. Clinicians should continue to prioritize slow, controlled sodium correction to protect high-risk patients from harm

CKM-Cardiac Kidney Metabolic: A Collaborative Approach Primary Care and Specialty

CKM-Cardiac Kidney Metabolic: A Collaborative Approach Primary Care and Specialty. Dr. Lorinda Parks, Medical Director, Primary Care Institute Objectives: To learn about a new collaborative approach at RRH To appreciate the steps we can take to reduce the long term affects of metabolic disease on the heart and kidney

Long-Term Follow-Up of Giant Paraesophageal Hernia Repair With Restoration of Normal Anatomy Without Fundoplication

Background: While some have reported performing gastropexy after paraesophageal hernia repair, the risk for development of severe reflux is being defined. Although we have observed good short-term outcomes after restoration of normal anatomy in patients with predominantly obstructive symptoms, long-term outcomes are unknown. Methods: Retrospective review of patients without significant reflux (heartburn, regurgitation, pulmonary symptoms) who underwent normal anatomy restoration was performed. Standard minimally invasive paraesophageal hernia repair was performed, then the short gastric line was sutured to the left hemidiaphragm to restore normal anatomy. Patients with follow-up \u3e 3 years were included. A recurrence was defined as hernia size \u3e 2 cm or \u3e 10% of the stomach reherniated. Results: There were 81 patients. Elective repair was performed in 55 (67.9%) patients, with urgent repair performed in 25 (32.1%) patients. All procedures were performed minimally invasively with median postoperative length of stay of 4 days. At a median follow-up of 5.4 years (range, 3.0-15.4 years), obstructive symptom relief persisted. A recurrent hiatal hernia was present in 15 patients (18.5%). Reoperation was required in 1 patient after a forceful vomiting episode. There were 7 patients who reported heartburn with symptoms well controlled by antisecretory medications. No patient required reoperation for severe reflux. Conclusions: Long-term follow-up in patients with giant paraesophageal hernia who underwent restoration of normal anatomy had good symptomatic outcome without significant reflux. Hiatal hernias were common but most were asymptomatic. This approach may avoid the morbidity of fundoplication in carefully selected patients

EEG Pressure Injuries

EEG Pressure Injuries. Paula Ebert, MS, RN, CNS, ACCNS-AG, CCRN, SCRN Objectives: Understand the clinical impact of pressure injuries related to EEG Understand the implemented changes to reduce pressure injuries related to EEG Understand the multidisciplinary approach to addressing the proble

Medium distances to specialized care models at tertiary hospitals and socioeconomic neighborhood-related factors do not influence the quality of care for patients with liver cirrhosis

Background: The treatment of liver cirrhosis requires a multidisciplinary approach at expert centers. Given the disease\u27s complexity and serious consequences, care quality significantly impacts patient survival. Specialized care models at tertiary hospitals are thought to improve treatment outcomes and quality of life. This study evaluates whether proximity to an expert center influences care quality and patient outcomes and investigates the role of socioeconomic factors and social support in Germany. Methods: A retrospective evaluation was conducted on 299 patients with liver cirrhosis treated at Medical Faculty Mannheim, Heidelberg University, with 43% at Child-Pugh B stage. The analysis considered various distances to the hospital (10 and 20 km by car, straight-line distance and public transportation usage) and correlated these with patient survival. Results: The analysis showed that neither car travel distance (P = 0.221, P = 0.1894), straight-line distance (log-rank P = 0.221, cox regression P = 0.1894), nor public transportation usage (P = 0.363, P = 0.1845) up to over 50 km or more than 120 min traveling by public transportation significantly affected survival. Geographical accessibility and differing socioeconomic conditions did not impact treatment quality or survival rates. Known risk factors such as age (P = 0.007, P \u3c 0.0001), gender (P = 0.019, P = 0.0207) and Child-Pugh stage (P = 0.003, P = 0.0155) significantly influenced survival. Conclusion: Specialized care models at tertiary hospitals offer consistent high-quality care to rural populations not facing disadvantages in survival due to longer travel distances to expert hepatology centers. Socioeconomic backgrounds do not affect care quality in this care model