Aim: This study examines the factors associated with femoral vascular complications (FVCs) following cardiac catheterisation. Methods: In a study using a case control design, patients with an FVC (pseudoaneurysm or retroperitoneal bleed) were examined over 5 years. Multivariable logistic regression was used to determine associations with FVCs. Results are reported as adjusted odds ratios (AOR) and 95% confidence intervals (CIs). Results: Seventy-eight (0.65%) patients experienced FVCs (mean age: 65 years, sex: 50% female). Factors that increased the likelihood of experiencing FVC were being female (AOR 2.9, 95% CI 1.3–6.1), smoking (AOR 7.4, 95% CI 3.5–16), having diabetes mellitus (AOR 7.5, 95% CI 3.4–16), having hypertension (AOR 2.9, 95% CI 1.2–6.9), taking anticoagulant medication (AOR 16, 95% CI 5.5–45) having an elevated body mass index (AOR 1.1, 95% CI 1.0–1.2) and the use of vascular closure devices (AOR 3.4, 95% CI 0.61–19). Use of a compression device reduced the likelihood of FVCs developing (AOR 0.6, 95% CI 0.3–1.0). Conclusion: Sex, cardiovascular disease risk factors, and procedural factors remain important in developing FVCs.
Abstract Background To examine and identify gaps in care perceived as essential by patients; this study examined outpatients’: (1) views on what characterizes essential care and (2) experiences of care received, in relation to cardiac catheterization and subsequent cardiovascular procedures. Methods Cross-sectional descriptive study. Surveys were posted to outpatients who had undergone elective cardiac catheterization in the prior 6 months at an Australian hospital. Participants completed a 65-item survey to determine: (a) aspects of care they perceive as essential to patients receiving care for a cardiac condition (Important Care Survey); or (b) their actual care received (Actual Care Survey). Numbers and percentages were used to calculate the most frequently identified essential care items; and the experiences of care received. Items rated as either ‘Essential’/‘Very important’ by at least 80% of participants were determined. A gap in patient-centred care was identified as being any item that was endorsed as essential/very important by 80% or more of participants but reported as received by <80% of participants. Results Of 582 eligible patients, 264 (45%) returned a completed survey. A total of 43/65 items were endorsed by >80% of participants as essential. Of those, for 22 items, <80% reported the care as received. Gaps were identified in relation to general practitionerconsultation (1 item), preparation (1 item) subsequent decision making for treatment (1 item), prognosis (6 items), and post-treatment follow-up (1 item). Conclusions Areas were identified where actual care fell short of patients’ perceptions of essential care.
Abstract We report a case of profound systemic hypoxemia complicating left ventricular assist device (LVAD) insertion due to right to left shunting through a patent foramen ovale (PFO) in association with a Chiari network. The patient was successfully managed with percutaneous closure of the interatrial defect using an Amplatzer PFO occlusion device and judicious reduction in LVAD flows.
Abstract Background The aim of the current study is to assess the natural history and prognostic value of elevated left ventricular end-diastolic pressure (LVEDP) in patients with ST-segment elevation myocardial infarction (STEMI) after reperfusion with thrombolysis; we utilize data from the Thrombolysis in Myocardial Infarction (TIMI) II study. Methods A total of 3339 patients were randomized to either an invasive (n = 1681) or a conservative (n = 1658) strategy in the TIMI II study following thrombolysis. To make the current cohort as relevant as possible to modern pharmaco-invasively managed cohorts, patients in the invasive arm with TIMI flow grade ≥ 2 (N = 1201) at initial catheterization are included in the analysis. Of these, 259 patients had a second catheterization prior to hospital discharge, and these were used to define the natural history of LVEDP in reperfused STEMI. Results The median LVEDP for the whole cohort was 18 mmHg (IQR: 12–23). Patients were divided into quartiles by LVEDP measured during the first cardiac catheterization. During a median follow up of 3 (IQR: 2.1–3.2) years, quartile 4 (highest LVEDP) had the highest incidence of mortality and heart failure admissions. In the cohort with paired catheterization data, the LVEDP dropped slightly from 18 mmHg (1QR: 12–22) to 15 mmHg (IQR: 10–20) (p = 0.01) from the first to the pre-hospital discharge catheterization. Conclusions LVEDP remains largely stable during hospitalisation post-STEMI. Elevated LVEDP is a predictor of death and heart failure hospitalization in STEMI patients undergoing successful thrombolysis. Graphic abstract
Modern cancer therapies have led to improved survival rates for many cancers. Rates of cardiovascular diseases (CVD) and risk factors are increased in cancer patients and survivors compared with the general population, and CVD has emerged as a leading cause of long-term morbidity and mortality in
Abstract Aims Data on diuretic use in pregnancy are limited and inconsistent, and consequently it remains unclear whether they can be used safely. Our study aims to evaluate the perinatal outcomes after in‐utero diuretic exposure. Methods and results The Registry Of Pregnancy And Cardiac disease (ROPAC) is a prospective, global registry of pregnancies in women with heart disease. Outcomes were compared between women who used diuretics during pregnancy versus those who did not. Multivariable regression analysis was used to assess the impact of diuretic use on the occurrence of congenital anomalies and foetal growth. Diuretics were used in 382 (6.7%) of the 5739 ROPAC pregnancies, most often furosemide (86%). Age >35 years (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2–2.0), other cardiac medication use (OR 5.4, 95% CI 4.2–6.9), signs of heart failure (OR 1.7, 95% CI 1.2–2.2), estimated left ventricular ejection fraction <40% (OR 2.9, 95% CI 2.0–4.2), New York Heart Association class >II (OR 3.4, 95% CI 2.3–5.1), valvular heart disease (OR 6.3, 95% CI 4.7–8.3) and cardiomyopathy (OR 3.9, 95% CI 2.6–5.7) were associated with diuretic use during pregnancy. In multivariable analysis, diuretic use during the first trimester was not significantly associated with foetal or neonatal congenital anomalies (OR 1.3, 95% CI 0.7–2.6), and diuretic use during pregnancy was also not significantly associated with small for gestational age (OR 1.4, 95% CI 1.0–1.9). Conclusions Our study does not conclusively establish an association between diuretic use during pregnancy and adverse foetal outcomes. Given these findings, it is essential to assess the risk–benefit ratio on an individual basis to guide clinical decisions.
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