Characteristics, outcomes, and predictors of in-hospital mortality in patients hospitalized with acute systolic heart failure (HFrEF): Two-center registry of acute heart failure from Iran

Background: Acute Heart Failure (AHF) is a common cause of hospitalization in many countries. Rehospitalization due to AHF is also a very important economic issue for health services. Registries for AHF have been made in many countries to characterize such patients, which have provided great information about these patients for better care. To date, there is insufficient information about these patients in Iran and their rehospitalization and short-and long-term follow-up is unclear. Objectives: This study aims to describe the results of a small registry of AHF (HFrEF) patients in Iran and their short-term follow-up. Patients and Methods: This study aimed to describe the earliest results of the AHF registry, which was started from September 2015 in two hospitals (Afshar Heart Center in Yazd and Rajaie Heart Center in Tehran). All patients with diagnosis of AHF and HFrEF were enrolled into this registry. During six months, 352 patients with diagnosis of AHF and HFrEF were entered into this registry. The patients� demographic, clinical, and Para clinical data were collected during hospitalization and they were followed up for all-cause mortality and hospitalization for three months. Patients suffering from heart failure with preserved ejection fraction were excluded because of their small number and incomplete data. Results: The mean age of the patients was 55 ± 16 years and 76 were male. Besides, 77 of the patients had acute decompensation of chronic heart failure and 17 had new-onset AHF. Etiology of heart failure was ischemic heart disease in 52 of the patients. Additionally, the mean left ventricular ejection fraction was 20. Moreover, length of hospital stay was 10.5±10 days and in-hospital mortality rate was 9.7. Conclusions: This small and limited registry of patients with AHF (HFrEF) in Iran delineated these patients� characteristics with some discrepancies and similarities with western registries. Thus, a larger nationwide registry is needed for further clarification of the issue. © 2018, Iranian Cardiovascular Research Journal. All rights reserved

Characteristics, outcomes, and predictors of in-hospital mortality in patients hospitalized with acute systolic heart failure (HFrEF): Two-center registry of acute heart failure from Iran

Background: Acute Heart Failure (AHF) is a common cause of hospitalization in many countries. Rehospitalization due to AHF is also a very important economic issue for health services. Registries for AHF have been made in many countries to characterize such patients, which have provided great information about these patients for better care. To date, there is insufficient information about these patients in Iran and their rehospitalization and short-and long-term follow-up is unclear. Objectives: This study aims to describe the results of a small registry of AHF (HFrEF) patients in Iran and their short-term follow-up. Patients and Methods: This study aimed to describe the earliest results of the AHF registry, which was started from September 2015 in two hospitals (Afshar Heart Center in Yazd and Rajaie Heart Center in Tehran). All patients with diagnosis of AHF and HFrEF were enrolled into this registry. During six months, 352 patients with diagnosis of AHF and HFrEF were entered into this registry. The patients� demographic, clinical, and Para clinical data were collected during hospitalization and they were followed up for all-cause mortality and hospitalization for three months. Patients suffering from heart failure with preserved ejection fraction were excluded because of their small number and incomplete data. Results: The mean age of the patients was 55 ± 16 years and 76 were male. Besides, 77 of the patients had acute decompensation of chronic heart failure and 17 had new-onset AHF. Etiology of heart failure was ischemic heart disease in 52 of the patients. Additionally, the mean left ventricular ejection fraction was 20. Moreover, length of hospital stay was 10.5±10 days and in-hospital mortality rate was 9.7. Conclusions: This small and limited registry of patients with AHF (HFrEF) in Iran delineated these patients� characteristics with some discrepancies and similarities with western registries. Thus, a larger nationwide registry is needed for further clarification of the issue. © 2018, Iranian Cardiovascular Research Journal. All rights reserved

The Effect of Time of Complete Bed Rest and Keep the Sand Bag on the Intensity of Back Pain after Coronary Angiography

Introduction: Coronary angiography is a common procedure in diagnostic and treatment of cardiac heart disease. After angiography, the patient remains on bed rest for at least a further 6-24 hours in order to reduce the complications at the groin site. Due to this enforced supine position bed rest and immobilization, patients frequently experienced low back pain. The present study aimed to determine the effect of bed rest time and sandbag on the intensity of low back pain after transfemoral coronary angiography. Methods: In this clinical trial, 228 patients were selected using a simple sampling; they were divided randomly into 3 groups. The patients in the control group for 4 hours with and 6 hours after the removal of sand bag (totaling 10 hours) had complete bed rest. The patients in intervention group 1 for 6 hours with and 2 hours after the removal of sand bag (totaling 8 hours) and in intervention group 2 for 4 hours with and 3 hours after the removal of sand bag (totaling 7 hours) had complete bed rest. In these 3 groups, the intensity of low back pain was measured by pain numerical scale at zero, 2, 4, 6, 8, 10 and the day after angiography. Results: None of the patients in the control and experimental groups developed vascular complications and hemodynamic disturbance. Finding of the present study revealed that a significant statistical difference was existed in relation to low back pain for the patients in intervention group 2 (p<0.001). Conclusion: Based on the finding of this study, early ambulation can be safe for patients undergoing transfemoral coronary angiography without any instance of vascular complications and hemodynamic disturbance

Effect of Glucose - Insulin - Potassium (Gik) Solution on Short Term Prognosis of Unstable Angina

Introduction: Unstable angina as a clinical condition includes a major group of patients manifested with acute coronary syndrome. Misdiagnosis of this clinical syndrome causes myocardial infarction (MI) and death. Conventional and advanced forms of treatment are used with the aim of rapid stabilization of unstable angina. Although infusion of glucose - insulin - potassium (GIK) solution has had good results in acute MI, no major trial has studied its effect in unstable angina. The main goal of this study was evaluation of the effectiveness of GIK solution on prognosis of hospitalized unstable angina patients. Methods: This randomized clinical trial included patients with class II and III unstable angina (two groups of 94 patients, each ) with a mean age of 62.47±13.20 years and Female /Male ratio of 1.35 admitted in the CCU’s of Yazd from September 2003 to May 2004 . Results: There was no significant difference between the study and control groups regarding mean age, sex ratio and unstable angina class (P=0.15, P=0.77 and P=0.76). The study group had significant reduction in recurrent chest pain and duration of hospitalization (P=0.001 and P=0.02). The most common adverse effect of GIK solution was pain at infusion site. Conclusion: Use of GIK solution causes early stabilization of unstable angina patients without any significant or life threatening adverse effect

Evaluation of Different Mi Situation Such As Emotional Stress, Physical Activity, Rest, … at Time of Mi Presentation

Introduction: Previous studies have shown that various factors such as emotional stress can trigger of MI in susceptible persons. More studies are needed to evaluate the characteristics of patients regarding to emotional stress, heavy work, routine activity, infection or rest before occurrence of MI. Methods: We studied 608 consecutive hospitalized in CCUs from May 2000 to October 2001. For patients, questionnaires including demographic, clinical and paraclinical characteristics were completed and data analyzed. Results: In this study rest (33.4%) and ordinary activity (32.4%) were more prevalent among the MI situations and infection had the lowest prevalence (0.7%). In patients higher than 45 years we had similar results, but in age group younger than 45 year ordinary activity (30.6%) and after heavy work (20.8%) had the highest prevalence before occurring of MI. In Diabetic patients, MI developed in sleep situation more frequently.(17.8%),(P=0.03) 52.5% of MI mortality occurred in rest situation.(P=0.009) Conclusion: Rest had the highest prevalence of MI compared to other situations but in age group younger than 45 years MI after heavy work had the highest prevalence. Autonomic neuropathy may be one of the reason of higher prevalence of MI in sleep situation

Relation between admission blood glucose levels and in-hospital and one year mortality in non-diabetic acute myocardial infarction patients

Introduction: Several studies have evaluated the association of admission blood glucose levels and short and long term mortality after myocardial infarction and have had different results. The aim of this study was evaluation of association between admission blood glucose levels and in-hospital and one year mortality in non-diabetic patients with AMI. Methods: In this study, demographic, clinical and Para clinical data of 120 non-diabetic patients with AMI on admission was collected and analyzed. The patients were followed for one year. Blood glucose level ≥ 140 mg/dl was defined as hyperglycemia. Results: 78% of patients were men. The mean age and admission blood glucose level was 63+13 years and 146+76mg/dl, respectively. Death due to cardio vascular causes was seen in 20% of patients in hospital and 9.8% during the one year follow up. The mean admission blood glucose level in patients who died in hospital was significantly more than live patients and also had an influence on the in-hospital outcome. Every 100mg/dl increase in blood glucose level was associated with 11% increase in in-hospital mortality risk in non-diabetic patients. Conclusion: Our results demonstrate that admission blood glucose level is a good marker for diagnosing patients with worse prognosis after AMI. We suggest that later studies should focus on optimal control of hyperglycemia with insulin in patients with AMI

IS OPIUM ADDICTION A RISK FACTOR FOR ACUTE MYOCARDIAL INFARCTION?

There is a misconception among our people that opioids may prevent or have ameliorating effects in the occurrence of cardiovascular diseases. In this study we evaluated 556 consecutive male patients hospitalized due to acute myocardial infarction (MI) in city of Yazd, from May 2000 to October 2001 and compared the characteristics of opium addicts to non opium users. Prevalence of opium addiction in MI patients was 19% in comparison with 2-2.8% in general population. There were not any differences in prevalence of traditional risk factors between opium users and non-users. Overall, in-hospital mortality was 18.6 percent among opium users and 6.2 percent among non-opium users (unadjusted odd ratio, 1.3; 95% confidence interval, 0.7 to 2.7, P = 0.2). After adjustment for the differences in the baseline features (age and other risk factors), odds ratio increased to 2.2 (95 percent confidence interval, 0.9 to 5.1). It seems that opium addiction may work as a risk factor in cardiovascular disease

Radiation exposure of interventional cardiologists for different types of procedures in catheterization lab, is it more concern about extremities?

Introduction: Angiography and angioplasty expose cardiologists to a high level of X-ray comparing other radiographic methods, due to the high dose of radiation and the presence of the physician beside the patient bed during the procedure. Therefore, this study was designed to measure the absorbed dose in some important organs and extremities in cardiologists during different angiography and angioplasty procedures in catheterization lab. Methods: The entrance skin dose and extremity absorbed dose of the physicians in 100 angiography and angioplasty procedures were measured by TLD chips. The points on the physicians’ body, which were measured in this study, included: thyroid, right and left chest, right and left wrists, and left leg. The correlation of entrance skin dose in these six points to the exposure parameters is also evaluated. Results: The left leg has maximum dose and maximum correlation with total DAP for all three physicians in all procedure types. There was a weak correlation between left wrist absorbed dose and number of views among three physicians. Also, the maximum annual absorbed dose of the physicians in the left leg was lower than 150 mSv. Conclusion: According to the results of this study, it can be stated that periodic leg and hand dosimetry during operation is necessary for interventional cardiologists. Results also showed that, regardless of the type of procedure, the characteristics of device output, especially DAP, have a direct role in the absorbed dose of the organs and extremities, especially those outside the shield