Variation in emergency percutaneous coronary intervention in ventilated patients in the UK: insights from a national database

Aims Pre-procedural ventilation is a marker of high risk in PCI patients. Causes include out-of-hospital cardiac arrest (OHCA) and cardiogenic shock. OHCA occurs in approximately 60,000 patients in the UK per annum. No consensus exists regarding the need/timing of coronary angiography ± revascularization without ST elevation. The aim was to describe the national variation in the rate of emergency PCI in ventilated patients. Methods and Results Using the UK national database for PCI in 2013, we identified all procedures performed as ‘emergency’ or ‘salvage’ for whom ventilation had been initiated before the PCI. Of the 92,589 patients who underwent PCI, 1342 (5.5%) fulfilled those criteria. There was wide variation in practice. There was no demonstrable relationship between the number of emergency PCI patients with pre-procedure ventilation per annum and (i) total number of PPCIs in a unit (r = −0.186), and (ii) availability of 24 h PCI, (iii) on-site surgical cover. Conclusion We demonstrated a wide variation in practice across the UK in rates of pre-procedural ventilation in emergency PCI. The majority of individuals will have suffered an OHCA. In the absence of a plausible explanation for this discrepant practice, it is possible that (a) some patients presenting with OHCA that may benefit from revascularization are being denied treatment and (b) procedures may be being undertaken that are futile. Further prospective data are needed to aid in production of guidelines aiming at standardized care in OHCA

Prevalence of Cardiovascular Disease in Patients With Potentially Curable Malignancies: A National Registry Dataset Analysis

Background: Although a common challenge for patients and clinicians, there is little population-level evidence on the prevalence of cardiovascular disease (CVD) in individuals diagnosed with potentially curable cancer. Objectives: We investigated CVD rates in patients with common potentially curable malignancies and evaluated the associations between patient and disease characteristics and CVD prevalence. Methods: The study included cancer registry patients diagnosed in England with stage I to III breast cancer, stage I to III colon or rectal cancer, stage I to III prostate cancer, stage I to IIIA non-small-cell lung cancer, stage I to IV diffuse large B-cell lymphoma, and stage I to IV Hodgkin lymphoma from 2013 to 2018. Linked hospital records and national CVD databases were used to identify CVD. The rates of CVD were investigated according to tumor type, and associations between patient and disease characteristics and CVD prevalence were determined. Results: Among the 634,240 patients included, 102,834 (16.2%) had prior CVD. Men, older patients, and those living in deprived areas had higher CVD rates. Prevalence was highest for non-small-cell lung cancer (36.1%) and lowest for breast cancer (7.7%). After adjustment for age, sex, the income domain of the Index of Multiple Deprivation, and Charlson comorbidity index, CVD remained higher in other tumor types compared to breast cancer patients. Conclusions: There is a significant overlap between cancer and CVD burden. It is essential to consider CVD when evaluating national and international treatment patterns and cancer outcomes

Tidal wetland restoration at Ketenisse polder (Schelde Estuary, Belgium): developments in the first year

Ketenisse polder is a former intertidal brackish marsh (30ha) situated in the mesohaline part of the Schelde Estuary. In the 19th century its central part was embanked as a polder. In the mid 1980’s the area was raised above intertidal level when it was used as a dumping site for the excavated soil from the Liefkenshoek tunnel. In 2002 the area was restored, it was levelled with a weak slope below mean high water level, creating the optimal starting conditions for the development of intertidal mudflats and marshes. Geomorphological changes, sediment characteristics and colonisation by phytobenthos, vegetation, zoobenthos, water birds and breeding birds at the restored site are monitored. The monitoring results of the first year after tidal restoration are presented. Sedimentation as well as erosion between 0 and 30cm was observed in the first year. Local changes in stream current patterns caused erosion on parts of the former mudflats; sheltered depressions filled up relatively fast. Median grain size showed large variation. Organic carbon content of the sediment varied between 0.5 and 15% and was closely related to sediment medium grain size. Chlorophyll a concentrations were negatively correlated with median grain size and tended to increase from the low water line to the shore. They were comparable to nearby intertidal areas and displayed similar seasonal variability with a maximum in spring. The large surface covered wtithVaucheria was indicator of initiated succession towards tidal marsh. Scirpus maritimus and transitional vegetations to Chenopodiaceae-vegetations established with increasing altitude. The Chenopodiaceae-vegetations were relicts of earlier vegetations before the tidal restoration, and will probably disappear. The macrobenthos community was dominated by Oligochaetes, which were present in 73% of all samples and attained an average density of about 40*103 ind. m-2. Other macrobenthos species found were nematods, copepods and Corophium. On the sheltered sampling stations macrobenthic densities were high compared to those on nearby intertidal areas. In the first season, 15 breeding bird species were recorded, the most common species being the Pied Avocet (Recurvirostra avosetta). The most common waterbirds were Common Shelduck (Tadorna tadorna), Greylag Goose (Anser anser), Pied Avocet (Recurvirostra avoset) and Lapwing (Vanellus vanellus), typical species for the mesohaline part of the estuary. The first year’s results suggest that Ketenisse polder has the potential to develop towards a varied and normal functional intertidal area

Management and outcomes of myocardial infarction in people with impaired kidney function in England

Background: Acute myocardial infarction (AMI) causes significant mortality and morbidity in people with impaired kidney function. Previous observational research has demonstrated reduced use of invasive management strategies and inferior outcomes in this population. Studies from the USA have suggested that disparities in care have reduced over time. It is unclear whether these findings extend to Europe and the UK. Methods: Linked data from four national healthcare datasets were used to investigate management and outcomes of AMI by estimated glomerular filtration rate (eGFR) category in England. Multivariable logistic and Cox regression models compared management strategies and outcomes by eGFR category among people with kidney impairment hospitalised for AMI between 2015–2017. Results: In a cohort of 5 835 people, we found reduced odds of invasive management in people with eGFR < 60mls/min/1.73m2 compared with people with eGFR ≥ 60 when hospitalised for non-ST segment elevation MI (NSTEMI). The association between eGFR and odds of invasive management for ST-elevation MI (STEMI) varied depending on the availability of percutaneous coronary intervention. A graded association between mortality and eGFR category was demonstrated both in-hospital and after discharge for all people. Conclusions: In England, patients with reduced eGFR are less likely to receive invasive management compared to those with preserved eGFR. Disparities in care may however be decreasing over time, with the least difference seen in patients with STEMI managed via the primary percutaneous coronary intervention pathway. Reduced eGFR continues to be associated with worse outcomes after AMI