Coping and emotional state in the acute phase of myocardial infarction

Σκοπός: Η ψυχολογική προσαρμογή στην οξεία φάση ενός Εμφράγματος του Μυοκαρδίου (ΕΜ) αποτελεί αντισταθμιστικό μηχανισμό των ασθενών στην προσαρμογή στη νέα πραγματικότητα μιας ανάλογης απειλητικής συνθήκης. Υπάρχουν ελάχιστα δεδομένα που καταδεικνύουν τη σχέση ανάμεσα στις στρατηγικές διαχείρισης από ενδονοσοκομειακούς ασθενείς και στη συναισθηματική τους κατάσταση. Η μελέτη ερευνά τη συγκεκριμένη σχέση σε ασθενείς που έχουν υποστεί ένα ΕΜ.Μέθοδος: Εκατό άνδρες ασθενείς που έχουν υποστεί ΕΜ, ηλικίας 60.5 (Διάστημα Εμπιστοσύνης (Δ.Ε): 57.5-62.7) ετών, έδωσαν συνέντευξη μετά την οξεία φάση ΕΜ κατά την τελευταία μέρα παραμονής τους στη Στεφανιαία Μονάδα. Ιατρικές πληροφορίες δόθηκαν από τους ιατρικούς φακέλους των ασθενών. Τα ερωτηματολόγια Προσανατολισμός Διαχείρισης Προβλημάτων (COPE) και Προφίλ Ψυχολογικής Διάθεσης (POMS) χρησιμοποιήθηκαν στην αξιολόγηση του τρόπου διαχείρισης και της συναισθηματικής κατάστασης αντίστοιχα.Αποτελέσματα: Η ενεργή διαχείριση σχετίστηκε θετικά με το άγχος και το θυμό. Η συναισθηματική υποστήριξη βρέθηκε να σχετίζεται αρνητικά με τις συγκεκριμένες μεταβλητές. Η πνευματική αναζήτηση και η συμπεριφορική αποδέσμευση σχετίστηκαν θετικά με την κατάθλιψη. Σημαντική διαφορά βρέθηκε στις στρατηγικές διαχείρισης και τη συναισθηματική διάθεση συγκρινόμενες με την υποκειμενική αντίληψη της σοβαρότητας.Συμπέρασμα:Oι ασθενείς μετά απο ένα ΕΜ, αναπτύσσουν στρατηγικές διαχείρισης που σχετίζονται με την συναισθηματική διάθεση. Η σημασία αυτών των συσχετίσεων μένει να εξακριβωθεί και σε μελλοντικές μελέτες.Objective: Emotional and coping adaptation after the acute phase of a myocardial infarction (MI) is a compensatory mechanism developed for patients’ adjustment to the new reality following this life threatening situation. There are however scarce data on the relationship between hospitalized MI patients’ coping behavior and their emotional state. The study investigates the associations between coping strategies and the affective status in patients surviving a MI.Methods: One-hundred male patients surviving a MI, aged 60.5 (Confidence Intervals (CI): 57.5-62.7) years, were interviewed after the acute phase of MI, at the last day of their coronary unit stay. Medical data were obtained by their medical records. Coping Orientation to Problems Experienced (COPE) and Profile of Mood States (POMS) questionnaires were used to examine coping styles and patients’ mood state respectively.Results: Active coping was positively related to anxiety and anger. Emotional support was negatively associated with these variables. Religious coping and behavioral disengagement were positively related to depression. Significant difference was found in coping styles and mood states scores between the different perceived severity beliefs.Conclusion: Patients surviving after a MI, develop coping strategies related to their emotional state. The significance of these relations remains to be clarified in future studies

Social determinants of health in pulmonary embolism management and outcome in hospitals: Insights from the United States nationwide inpatient sample

BACKGROUND The role of social determinants in the treatment and course of acute pulmonary embolism (PE) is understudied. OBJECTIVE To investigate the association between social determinants of health with in-hospital management and early clinical outcomes following acute PE. METHODS We identified hospitalizations of adults with acute PE discharge diagnosis from the nationwide inpatient sample (2016-2018). Multivariable regression was used to investigate the association between race/ethnicity, type of expected primary payer, and income with the use of advanced PE therapies (thrombolysis, catheter-directed treatment, surgical embolectomy, extracorporeal membrane oxygenation), length of stay, hospitalization charges, and in-hospital death. RESULTS A total of 1,124,204 hospitalizations with a PE diagnosis were estimated from the 2016-2018 nationwide inpatient sample, corresponding to a hospitalization rate of 14.9/10,000 adult persons-year. The use of advanced therapies was lower in Black and Asian/Pacific Islander (vs. White patients: adjusted odds ratio [OR$_{adjusted}$], 0.87; 95% confidence interval [CI], 0.81-0.92 and OR$_{adjusted}$ 0.76; 95% CI, 0.59-0.98) and in Medicare- or Medicaid-insured (vs. privately-insured; OR$_{adjusted}$, 0.73; 95% CI, 0.69-0.77 and OR$_{adjusted}$, 0.68; 95% CI, 0.63-0.74), although they had the greatest length of stay and hospitalization charges. In-hospital mortality was higher in the lowest income quartile (vs. highest quartile; OR$_{adjusted}$, 1.09; 95% CI, 1.02-1.17). Among high-risk PE, patients of other than the White race had the highest in-hospital mortality. CONCLUSION We observed inequalities in advanced therapies used for acute PE and higher in-hospital mortality in races other than White. Low socioeconomic status was also associated with lesser use of advanced treatment modalities and greater in-hospital mortality. Future studies should further explore and consider the long-term impact of social inequities in PE management

Cross-Lingual Knowledge Transfer for Clinical Phenotyping

Clinical phenotyping enables the automatic extraction of clinical conditions from patient records, which can be beneficial to doctors and clinics worldwide. However, current state-of-the-art models are mostly applicable to clinical notes written in English. We therefore investigate cross-lingual knowledge transfer strategies to execute this task for clinics that do not use the English language and have a small amount of in-domain data available. We evaluate these strategies for a Greek and a Spanish clinic leveraging clinical notes from different clinical domains such as cardiology, oncology and the ICU. Our results reveal two strategies that outperform the state-of-the-art: Translation-based methods in combination with domain-specific encoders and cross-lingual encoders plus adapters. We find that these strategies perform especially well for classifying rare phenotypes and we advise on which method to prefer in which situation. Our results show that using multilingual data overall improves clinical phenotyping models and can compensate for data sparseness.Comment: LREC 2022 submmision: January 202

Use of levosimendan in acute heart failure

Peer reviewe

Cost-of-Illness Analysis of Long-Term Health Care Resource Use and Disease Burden in Patients With Pulmonary Embolism: Insights From the PREFER in VTE Registry

Background As mortality from pulmonary embolism (PE) decreases, the personal and societal costs among survivors are receiving increasing attention. Detailing this burden would support an efficient public health resource allocation. We aimed to provide estimates for the economic and disease burden of PE also accounting for long-term health care use and both direct and indirect costs beyond the acute phase. Methods and Results This is a cost-of-illness analysis with a bottom-up approach based on data from the PREFER in VTE registry (Prevention of Thromboembolic Events-European Registry in Venous Thromboembolism). We calculated direct (clinical events and anticoagulation) and indirect costs (loss of productivity) of an acute PE event and its 12-month follow-up in 2020 Euros. We estimated a disability weight for the 12-month post-PE status and corresponding disability adjusted life years presumably owing to PE. Disease-specific costs in the first year of follow-up after an incident PE case ranged between 9135 Euros and 10 620 Euros. The proportion of indirect costs was 42% to 49% of total costs. Costs were lowest in patients with ongoing cancer, mainly because productivity loss was less evident in this already burdened population. The calculated disability weight for survivors who were cancer free 12 months post-PE was 0.017, and the estimated disability adjusted life years per incident case were 1.17. Conclusions The economic burden imposed by PE to society and affected patients is considerable, and productivity loss is its main driver. The disease burden from PE is remarkable and translates to the loss of roughly 1.2 years of healthy life per incident PE case

Cardiopulmonary exercise testing during follow-up after acute pulmonary embolism

BACKGROUND Cardiopulmonary exercise testing (CPET) may provide prognostically valuable information during follow-up after pulmonary embolism (PE). Our objective was to investigate the association of patterns and degree of exercise limitation, as assessed by CPET, with clinical, echocardiographic and laboratory abnormalities and quality of life (QoL) after PE. METHODS In a prospective cohort study of unselected consecutive all-comers with PE, survivors of the index acute event underwent 3- and 12-month follow-ups, including CPET. We defined cardiopulmonary limitation as ventilatory inefficiency or insufficient cardiocirculatory reserve. Deconditioning was defined as peak O$_{2}$ uptake (V'$_{O_{2}}$ ) <80% with no other abnormality. RESULTS Overall, 396 patients were included. At 3 months, prevalence of cardiopulmonary limitation and deconditioning was 50.1% (34.7% mild/moderate; 15.4% severe) and 12.1%, respectively; at 12 months, it was 44.8% (29.1% mild/moderate; 15.7% severe) and 14.9%, respectively. Cardiopulmonary limitation and its severity were associated with age (OR per decade 2.05, 95% CI 1.65-2.55), history of chronic lung disease (OR 2.72, 95% CI 1.06-6.97), smoking (OR 5.87, 95% CI 2.44-14.15) and intermediate- or high-risk acute PE (OR 4.36, 95% CI 1.92-9.94). Severe cardiopulmonary limitation at 3 months was associated with the prospectively defined, combined clinical-haemodynamic end-point of "post-PE impairment" (OR 6.40, 95% CI 2.35-18.45) and with poor disease-specific and generic health-related QoL. CONCLUSIONS Abnormal exercise capacity of cardiopulmonary origin is frequent after PE, being associated with clinical and haemodynamic impairment as well as long-term QoL reduction. CPET can be considered for selected patients with persisting symptoms after acute PE to identify candidates for closer follow-up and possible therapeutic interventions

Awareness of venous thromboembolism among patients with cancer: Preliminary findings from a global initiative for World Thrombosis Day

BACKGROUND Cancer-associated venous thromboembolism (CAT) has detrimental impact on patients' clinical outcomes and quality of life. Data on CAT education, communication, and awareness among the general cancer population are scanty. METHODS We present the preliminary results of an ongoing patient-centered survey including 27 items covering major spheres of CAT. The survey, available in 14 languages, was promoted and disseminated online through social networks, email newsletters, websites, and media. RESULTS As of September 20, 2022, 749 participants from 27 countries completed the survey. Overall, 61.8% (n = 460) of responders were not aware of their risk of CAT. Among those who received information on CAT, 26.2% (n = 56) were informed only at the time of CAT diagnosis. Over two thirds (69.1%, n = 501) of participants received no education on signs and symptoms of venous thromboembolism (VTE); among those who were educated about the possible clinical manifestations, 58.9% (n = 119) were given instructions to seek consultation in case of VTE suspicion. Two hundred twenty-four respondents (30.9%) had a chance to discuss the potential use of primary thromboprophylaxis with health-care providers. Just over half (58.7%, n = 309) were unaware of the risks of bleeding associated with anticoagulation, despite being involved in anticoagulant-related discussions or exposed to anticoagulants. Most responders (85%, n = 612) valued receiving CAT education as highly relevant; however, 51.7% (n = 375) expressed concerns about insufficient time spent and clarity of education received. CONCLUSIONS This ongoing survey involving cancer patients with diverse ethnic, cultural, and geographical backgrounds highlights important patient knowledge gaps. These findings warrant urgent interventions to improve education and awareness, and reduce CAT burden

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase 3 randomized trials. The EXPosurE Registry RiociguaT in patients with pulmonary hypertension (EXPERT) study was designed to monitor the long-term safety of riociguat in clinical practice. Methods: EXPERT was an international, multicenter, prospective, uncontrolled, non-interventional cohort study of patients treated with riociguat. Patients were followed for at least 1 year and up to 4 years from enrollment or until 30 days after stopping riociguat treatment. Primary safety outcomes were adverse events (AEs) and serious adverse events (SAEs) coded using Medical Dictionary for Regulatory Activities preferred terms and System Organ Classes version 21.0, collected during routine clinic visits and collated via case report forms. Results: In total, 956 patients with CTEPH were included in the analysis. The most common AEs in these patients were peripheral edema/edema (11.7%), dizziness (7.5%), right ventricular (RV)/cardiac failure (7.7%), and pneumonia (5.0%). The most common SAEs were RV/cardiac failure (7.4%), pneumonia (4.1%), dyspnea (3.6%), and syncope (2.5%). Exposure-adjusted rates of hemoptysis/pulmonary hemorrhage and hypotension were low and comparable to those in the long-term extension study of riociguat (Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase-Stimulator Trial [CHEST-2]). Conclusion: Data from EXPERT show that in patients with CTEPH, the safety of riociguat in routine practice was consistent with the known safety profile of the drug, and no new safety concerns were identified