Complicated acute heart failure subsets

The reviews in this series on complicated acute heart failure syndromes bring up exciting future directions in managing these difficult subsets which often overlap. Tackling these subsets effectively is likely to go a long way in reducing mortality and hospitalisation rates

Successful use of intra-aortic counter pulsation therapy for intractable ventricular arrhythmia in patient with severe left ventricular dysfunction and normal coronary arteries

Intra-aortic balloon pumps (IABP) are commonly used in the setting of an acute myocardial infarction that is complicated by cardiogenic shock or mechanical complications such as a ventricular septal defect or papillary muscle rupture. IABP has also been shown to be useful in patients with refractory and hemodynamically unstable ventricular arrhythmias and refractory post-myocardial infarction angina. We report a case in which IABP was used in a patient with dilated cardiomyopathy and normal coronary arteries, who presented with persistent, recurrent and refractory ventricular tachycardia. His ventricular tachycardia settled immediately with the use of IABP therapy. He subsequently had an implantable defibrillator. The use of IABP is associated with favorable changes in the left ventricular wall tension and reduction in afterload, which could reduce the excitability of the myocardium, thus making it less prone to arrhythmias. The use of IABP is relatively safe and should be considered in patients with refractory ventricular arrhythmias, even if it is not associated with ischemia. (Cardiol J 2010; 17, 4: 401-403

Developing a contemporary community clinic for patients with heart failure with preserved ejection fraction within the current National Health Service model

INTRODUCTION: The diagnostic and therapeutic arsenal for heart failure with preserved ejection (HFpEF) has expanded. With novel therapies (eg, sodium-glucose co-transporter 2 inhibitors) and firmer recommendations to optimise non-cardiac comorbidities, it is unclear if outpatient HFpEF models can adequately deliver this. We; therefore, evaluated the efficacy of an existing dedicated HFpEF clinic to find innovative ways to design a more comprehensive model tailored to the modern era of HFpEF. METHODS: A single-centre retrospective analysis of 202 HFpEF outpatients was performed over 12 months before the COVID-19 pandemic. Baseline characteristics, clinic activities (eg, medication changes, lifestyle modifications, management of comorbidities) and follow-up arrangements were compared between a HFpEF and general cardiology clinic to assess their impact on mortality and morbidity at 6 and 12 months. RESULTS: Between the two clinic groups, the sample population was evenly matched with a typical HFpEF profile (mean age 79±9.6 years, 55% female and a high prevalence of cardiometabolic comorbidities). While follow-up practices were similar, the HFpEF clinic delivered significantly more interventions on lifestyle changes, blood pressure and heart rate control (p60% of hospitalisation, including causes of recurrent admissions. CONCLUSION: This study suggests that existing general and emerging dedicated HFpEF clinics may not be adequate in addressing the multifaceted aspects of HFpEF as clinic activities concentrated primarily on cardiological measures. Although the small cohort and short follow-up period are important limitations, this study reminds clinicians that HFpEF patients are more at risk of non-cardiac than HF-related events. We have therefore proposed a pragmatic framework that can comprehensively deliver the modern guideline-directed recommendations and management of non-cardiac comorbidities through a multidisciplinary approach

Bioresorbable vascular scaffolds versus conventional drug-eluting stents across time : a meta-analysis of randomised controlled trials

Background: Bioresorbable vascular scaffolds (BVS) were designed to reduce the rate of late adverse events observed in conventional drug-eluting stents (DES) by dissolving once they have restored lasting patency. Objectives: Compare the safety and efficacy of BVS versus DES in patients receiving percutaneous coronary intervention for coronary artery disease across a complete range of randomised controlled trial (RCT) follow-up intervals. Methods: A systematic review and meta-analysis was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMBASE and Web of Science were searched from inception through 5 January 2022 for RCTs comparing the clinical outcomes of BVS versus DES. The primary safety outcome was stent/scaffold thrombosis (ST), and the primary efficacy outcome was target lesion failure (TLF: composite of cardiac death, target vessel myocardial infarction (TVMI) and ischaemia-driven target lesion revascularisation (ID-TLR)). Secondary outcomes were patient-oriented composite endpoint (combining all-death, all-MI and all-revascularisation), its individual components and those of TLF. Studies were appraised using Cochrane’s Risk of Bias tool and meta-analysis was performed using RevMan V.5.4. Results: 11 919 patients were randomised to receive either BVS (n=6438) or DES (n=5481) across 17 trials (differing follow-up intervals from 3 months to 5 years). BVS demonstrated increased risk of ST across all timepoints (peaking at 2 years with risk ratio (RR): 3.47; 95% CI 1.80 to 6.70; p=0.0002). Similarly, they showed increased risk of TLF (peaking at 3 years, RR: 1.35; 95% CI 1.07 to 1.70; p=0.01) resulting from high rates of TVMI and ID-TLR. Though improvements were observed after device dissolution (5-year follow-up), these were non-significant. All other outcomes were statistically equivalent. Applicability to all BVS is limited by 91% of the BVS group receiving Abbott’s Absorb. Conclusion: This meta-analysis demonstrates that current BVS are inferior to contemporary DES throughout the first 5 years at minimum

Kolkata-Coventry comparative registry study of acute heart failure: an insight into the impact of public, private and universal health systems on patient outcomes in low–middle income cities (KOLCOV HF Study)

Introduction: Survival gaps in acute heart failure (AHF) continue to expand globally. Multinational heart failure (HF) registries have highlighted variations between countries. Whether discrepancies in HF practice and outcomes occur across different health systems (ie, private, public or universal healthcare) within a city or between countries remain unclear. Insight into organisational care is also scarce. With increasing public scrutiny of health inequalities, a study to address these limitations is timely. Method: KOLCOV-HF study prospectively compared patients with AHF in public (Nil Ratan Sircar Hospital (NRS)) versus private (Apollo Gleneagles Hospital (AGH)) hospitals of Kolkata, India, and one with universal health coverage in a socioeconomically comparable city of Coventry, England (University Hospitals Coventry & Warwickshire (UHCW)). Data variables were adapted from UK’s National HF Audit programme, collected over 24 months. Predictors of in-hospital mortality and length of hospitalisation were assessed for each centre. Results: Among 1652 patients, in-hospital mortality was highest in government-funded NRS (11.9%) while 3 miles north, AGH had significantly lower mortality (7.5%, p=0.034), similar to UHCW (8%). This could be attributed to distinct HF phenotypes and differences in clinical and organisational care. As expected, low blood pressure was associated with a significantly greater risk of death in patients served by public hospitals UHCW and NRS. Conclusion: Marked differences in HF characteristics, management and outcomes exist intra-regionally, and between low–middle versus high-income countries across private, public and universal healthcare systems. Physicians and policymakers should take caution when applying country-level data locally when developing strategies to address local evidence-practice gaps in HF

Early initiation of post-sternotomy cardiac rehabilitation exercise training (SCAR): study protocol for a randomised controlled trial and economic evaluation

Introduction: Current guidelines recommend abstinence from supervised cardiac rehabilitation (CR) exercise training for 6 weeks post-sternotomy. This practice is not based on empirical evidence, thus imposing potentially unnecessary activity restrictions. Delayed participation in CR exercise training promotes muscle atrophy, reduces cardiovascular fitness and prolongs recovery. Limited data suggest no detrimental effect of beginning CR exercise training as early as 2 weeks post-surgery, but randomised controlled trials are yet to confirm this. The purpose of this trial is to compare CR exercise training commenced early (2 weeks post-surgery) with current usual care (6 weeks post-surgery) with a view to informing future CR guidelines for patients recovering from sternotomy. Methods and analysis: In this assessor-blind randomised controlled trial, 140 cardiac surgery patients, recovering from sternotomy, will be assigned to 8 weeks of twice-weekly supervised CR exercise training commencing at either 2 weeks (early CR) or 6 weeks (usual care CR) post-surgery. Usual care exercise training will adhere to current UK recommendations. Participants in the early CR group will undertake a highly individualised 2–3 week programme of functional mobility, strength and cardiovascular exercise before progressing to a usual care CR programme. Outcomes will be assessed at baseline (inpatient), pre-CR (2 or 6 weeks post-surgery), post-CR (10 or 14 weeks post-surgery) and 12 months. The primary outcome will be change in 6 min walk distance. Secondary outcomes will include measures of functional fitness, quality of life and cost-effectiveness. Ethics and dissemination: Recruitment commenced on July 2017 and will complete by December 2019. Results will be disseminated via national governing bodies, scientific meetings and peer-reviewed journals. Trial registration number: NCT03223558; Pre-results

Skuteczne leczenie komorowych zaburzeń rytmu serca za pomocą kontrapulsacji wewnątrzaortalnej u pacjenta z ciężką dysfunkcją skurczową lewej komory i angiograficznie prawidłowymi tętnicami wieńcowymi

Kontrapulsacja wewnątrzaortalna (IABP) jest powszechnie stosowaną metodą leczenia zawału serca powikłanego wstrząsem kardiogennym lub mechanicznymi uszkodzeniami, takimi jak: pęknięcie przegrody komorowej lub mięśnia brodawkowatego. Pacjenci odnoszą również korzyść ze stosowania IABP w opornych na leczenie i hemodynamicznie niestabilnych komorowych zaburzeniach rytmu i w niepoddającej się terapii dławicy pozawałowej. W prezentowanym doniesieniu przedstawiono przypadek kliniczny pacjenta z kardiomiopatią rozstrzeniową i angiograficznie prawidłowymi tętnicami wieńcowymi. U chorego wystąpił uporczywy, nawrotowy i niepoddający się leczeniu częstoskurcz komorowy. Po zastosowaniu IABP częstoskurcz natychmiast ustąpił. W konsekwencji pacjentowi wszczepiono kardiowerter defibrylator. Stosowanie IABP przynosi pożądane obniżenie naprężenia ściany lewej komory i obciążenia następczego (afterload). Zmiany te mogą zmniejszać pobudliwość komórek miokardium i w konsekwencji prowadzą do zmniejszenia ryzyka wystąpienia arytmii. Leczenie za pomocą IABP jest relatywnie bezpieczne i należy je rozważyć u chorych z opornymi na terapię komorowymi zaburzeniami rytmu serca, również tymi niezwiązanymi z niedokrwieniem. (Folia Cardiologica Excerpta 2010; 5, 6: 371–374

A SYSTEM AND METHOD FOR API BASED FILE PROCESSING

Various embodiments of the present invention provide a system and method for defining, implementing, and / or executing batch processing of API transaction services and products. The system is configured to receive a plurality of file processing requests associated with API traffic from one or more clients and batch, one or more jobs associated with the plurality of file processing requests for the API traffic. Further, the system is configured to pick and initiate the process of executing the API call associated with the API transitions. Furthermore, it splits the input file into plurality of chunks and invokes the API call associated with the corresponding chunk and receives responses from API transitions as well as store the same in chunks. The processor within the system is configured to consolidate the plurality of responses stored in the chunks and write the response to an output file