Objective
Cardiac disease induced post-traumatic stress symptoms (CDI-PTSS) have been associated with negative consequences for patients’ mental and physical health. Identifying risk factors as well ...as potential buffers is necessary for understanding the development and maintenance of CDI-PTSS. The current study focused on the mediating and moderating role played by patients’ perceptions of their partners’ ways of providing support (active engagement, overprotection, and protective buffering) in the development and stabilization of CDI-PTSS levels over time.
Method
Male patients (N = 106) were recruited at hospitalization (T1) and completed the study’s questionnaires at two time points: approximately four months after hospital discharge (T2) and approximately eight months after discharge (T3).
Results
Structual equation modeling was used to test the study hypotheses. All three forms of T2 perceived partner support were positively associated with T2 CDI-PTSS levels which, in turn, were positively associated with T3 CDI-PTSS levels. The linear association between T2 and T3 CDI-PTSS was positive but decreased as perceived partner protective buffering levels increased.
Conclusions
In the context of CDI-PTSS, perceived partner support seems to have a different effect than it has in non-traumatic illness contexts. Interventions for couples coping with CDI-PTSS should be designed accordingly.
The literature on coping with illness has for many years viewed only the patients as the focal point of attention and support, and only recently have the needs of patients’ caregivers been ...acknowledged as well. In addition, studies that have focused on factors contributing to caregiving partners’ burden in the context of chronic illness have assessed mostly intrapersonal variables of either the patient or the partner, thus overlooking the dyadic and interpersonal nature of caregiving. In the current longitudinal study, we examined the contribution of interpersonal factors, such as patients’ and partners’ relationship satisfaction and social support perceptions, to caregiving partners’ burden in the context of cardiac illness. Couples comprising male patients and female caregiving partners (N = 131) completed measures of relationship satisfaction, provided support, and received support upon patients’ admission to a cardiac rehabilitation program after an acute cardiac event (Time 1), and 3 months later (Time 2), upon program completion. Caregiving partners also completed a measure of burden at both measurement times. Path analyses revealed that partners’ relationship satisfaction, provided support, and received support, were all associated with lower levels of different dimensions of burden at both timepoints, as well as over time. Patients’ contribution to their partners’ burden was salient cross-sectionally but not over time. The findings shed light on the substantial role played by interpersonal factors in the caregiving process. Our findings suggest that both patients and partners should be regarded as caregivers and care receivers to each other.
The experience of an acute coronary event (ACE), including early care and evaluation, can be a distressing and traumatic experience for patients and their romantic partners, who also act as ...caregivers. We hypothesized that, among partners who were present during the ACE, those who were also present during (1) transportation to the hospital and (2) initial medical treatment would experience greater (a) anxiety early post-event and (b) posttraumatic stress symptoms (PSS) related to the event 4 months later. The associations between partner presence with patient anxiety and PSS were also explored.
Participants were ACE patients and their partners recruited between March 2015 and December 2016 from the Intensive Cardiac Care Unit (ICCU) of the Sheba Medical Center in Israel (
= 143; all patients were males and partners were females). Partners self-reported whether or not they were present during the cardiac event, the hospital drive, and initial care. Patients and partners self-reported anxiety in-hospital and PSS, keyed to the ACE, an average of 4 months later. Data were analyzed using General Estimating Equations (GEE) and Multilevel Modeling.
Neither patient anxiety nor PSS differed according to partner presence during the drive to the hospital. In contrast, partners had higher anxiety when they were not present at all (difference = 3.65,
= 0.019) and when present during the event and during the drive (difference = 2.93,
= 0.029) as compared to when they were present for the event but not for the drive. Partners who were present during the event, but not the drive, had lower PSS than those who were present for both the event and the drive (difference = -4.64,
= 0.026).
Partners who accompany patients on the drive to the hospital may inadvertently put themselves at risk for greater distress following their loved one's cardiac event. Future research should enroll couples in an acute care context to inform couple-targeted tailored interventions to reduce distress in patients and their caregiving partners.
Abstract Background The prognosis of an incidental finding of intraventricular conduction delay in individuals without ischemic heart disease is debatable. Intraventricular conduction delay present ...electrocardiographically as bundle branch block or nonspecific intraventricular conduction delay. We aimed to assess the long term survival of an incidental intraventricular conduction delay finding in a cohort of individuals without ischemic heart disease followed-up for three decades. Methods A randomized stratified cohort of the adult Israeli population underwent medical examinations and ECG between 1976-1982. Ischemic heart disease patients were excluded, and the cohort was followed for all-cause mortality for a median of 30.4 years. Major intraventricular conduction delay was defined as having complete bundle branch block or nonspecific intraventricular conduction delay, and minor intraventricular conduction delay was defined as having incomplete bundle branch block. Cox-proportional hazard model was performed, comparing individuals by ECG finding, adjusting for demographic, clinical and electrocardiographic variables. Results Of 2,465 subjects, 2,385 (96.8%) were without intraventricular conduction delay, 38 (1.5%) had minor intraventricular conduction delay and 42 (1.7%) had major intraventricular conduction delay. All-cause mortality rates were higher among minor and major intraventricular conduction delay groups (57.9% and 66.7%, p=0.43 and p=0.04 respectively) compared to no intraventricular conduction delay (52.1%). Controlling for sex, age and BMI, intraventricular conduction delay was not associated with all-cause mortality: HRs=0.82 (95%CI: 0.52-1.25) and 1.06 (95%CI: 0.72-1.54) for minor and major intraventricular conduction delay, respectively. Conclusions Intraventricular conduction delay was not found to be an independent risk factor for all-cause mortality in individuals without ischemic heart disease.
The aim of this study was to evaluate the significance of increased left atrial (LA) volume determined within the first 48 h of admission as a long-term predictor of outcome in patients with acute ...myocardial infarction (MI).
The LA volume reflects left ventricular (LV) diastolic properties. Whereas other LV Doppler diastolic characteristics are influenced by acute changes in LV function, LA volume is stable and reflects diastolic properties before MI.
Clinical and echocardiographic parameters were prospectively collected in 395 consecutive patients with acute MI. Patients with LA volume index (LAVI) >32 ml/m2(normal + 2 standard deviations) were compared with those with LAVI ≤32 ml/m2. Independent clinical and echocardiographic prognostic risk factors for five years' mortality were determined by the Cox proportional hazard model.
Left atrial volume index >32 ml/m2was found in 63 patients (19%) who had a higher incidence of congestive heart failure on admission (24% vs. 12%, p < 0.01), a higher incidence of mitral regurgitation, increased LV dimensions, and reduced LV ejection fraction when compared with patients with LAVI ≤32 ml/m2. Their five-year mortality rate was 34.5% versus 14.2% (p < 0.001). Significant independent risk predictors of five years' mortality were age (10 years) (odds ratio OR 1.45; 95% confidence interval CI1.14 to 1.86), Killip class ≥2 on admission (OR 2.30; 95% CI 1.29 to 4.09), LAVI >32 ml/m2(OR 2.22; 95% CI 1.25 to 3.96), diabetes (OR 1.94; 95% CI 1.15 to 3.28), and LV restrictive filling pattern (OR 1.89; 95% CI 1.09 to 3.31).
In patients with acute MI, increased LA volume, determined within the first 48 h of admission, is an independent predictor of five-year mortality with incremental prognostic information to clinical and echocardiographic data.
In this Data in Brief article, we provide data of the cohort and statistical methods of the research- “Incidental abnormal ECG findings and long-term cardiovascular morbidity and all-cause mortality: ...a population based prospective study” (Goldman et al., 2019). Extended description of statistical analysis as well as data of cohort baseline characteristics and baseline ECG incidental abnormal findings of 2601 Israeli men and women without known cardiovascular disease (CVD) is presented. The cohort is part of the Israel study of Glucose Intolerance, Obesity and Hypertension (GOH) (Dankner et al., 2007). Furthermore, we provide the data on the performance assessment of the 23 - year CVD-risk and the 31- year all-cause mortality prediction models, which includes Receiver Operating Characteristic (ROC) curves, reclassification-based measures and calibration curve.
The Impact of Renal Dysfunction on Outcomes in the ExTRACT–TIMI 25 Trial Keith A. A. Fox, Elliott M. Antman, Gilles Montalescot, Stefan Agewall, Bhupathi SomaRaju, Freek W. A. Verheugt, Jose ...Lopez-Sendon, Hanoch Hod, Sabina A. Murphy, Eugene Braunwald The ExTRACT–TIMI 25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment–Thrombolysis In Myocardial Infarction 25) trial provided the opportunity to evaluate the risk of varying degrees of renal dysfunction on outcomes in patients with ST-segment elevation myocardial infarction. A powerful and direct relationship was observed between the severity of renal dysfunction and death, stroke, intracranial hemorrhage, and major and minor bleeding (p < 0.001 for each comparison). There was a progressive increase in the magnitude of the treatment benefit with enoxaparin (death or nonfatal MI, p < 0.01) with better renal function. Future studies should take account of renal dysfunction in assessing the balance between efficacy and safety of antithrombotic regimens.
Patients with non–ST elevation myocardial infarction who are managed noninvasively at presentation or are catheterized but without revascularization represent a heterogeneous and understudied ...population. We evaluated the clinical characteristics, management strategies, and outcomes of patients with non–ST elevation myocardial infarction (NSTEMI) who were enrolled in the prospective biannual Acute Coronary Syndrome Israeli Surveys from 2004 to 2013. Patients were divided into 3 groups: no catheterization (no angio), catheterization with revascularization (angio-revascularized), and catheterization without revascularization (angio-nonrevascularized) groups. The study included 3,198 patients with NSTEMI. Coronary angiography was performed in 2,525 (79%) during the index hospitalization, of whom 1899 (59%) underwent revascularization. Evidence-based therapies were administered during the index hospitalization at a significantly higher rate to those in the angio-revascularized group compared with the other 2 groups. Multivariate analysis showed that compared with those in the angio-revascularized and angio-nonrevascularized groups, patients in the no angio group experienced a significantly higher risk for 1-year mortality (hazard ratio 2.04 p ≤0.0001 and 1.21 p = 0.01, respectively). The risk associated with no revascularized was consistent in each risk subset analyzed, including an older age, and increased creatinine levels. In conclusion, our data, from a large real-world contemporary experience, suggest that patients with NSTEMI who do not undergo coronary revascularization during the index hospitalization represent a greater risk and undertreated group with increased risk for long-term mortality.
The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology ...in a chest pain unit versus routine care in an internal medicine department.
Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (p<0.001). During hospitalization, 298 accelerated diagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (p<0.001). Throughout the 90-day follow-up, diagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (p<0.001). Ultimately, most patients in both groups had non-invasive imaging testing. Accelerated diagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain 8 (3%) vs. 24 (9%), p<0.01, and acute coronary syndromes 1 (0.3%) vs. 9 (3.2%), p<0.01, during the follow-up period. The accelerated diagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis OR = 0.28 (CI 95% 0.14-0.59). Cost per patient was similar in both groups ($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9).
An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Mild therapeutic hypothermia has proved beneficial after out-of-hospital cardiac arrest in the adult population, when the initial rhythm is ventricular fibrillation (VF). In this study, data from 110 ...consecutive patients with out-of-hospital cardiac arrest due to VF (n = 86) or to non-VF rhythm (n = 24), admitted to an intensive cardiac care unit with restoration of spontaneous circulation and who remained unconscious on admission, were analyzed. Patients were cooled using an external cooling system. Of the patients with VF, 66% had favorable outcomes (Glasgow-Pittsburgh Cerebral Performance Category 1 or 2), and 30% died. Of the patients with non-VF, 8% had favorable outcomes (p <0.001 vs VF), and 63% died (p = 0.004 vs VF). In patients with VF, those with poor outcomes were older than those with favorable outcomes (odds ratio OR 1.61, 95% confidence interval CI 1.03 to 2.7, p = 0.001) and had previous ejection fractions <35% (OR 7.72, 95% CI 1.8 to 33, p = 0.002). Outcomes were also worse when patients presented to the emergency room with seizures (OR 20.96, 95% CI 2.48 to 177.42, p = 0.003) or hemodynamic instability (OR 14.4, 95% CI 3.47 to 60, p <0.0001). In the non-VF group, the 2 patients with good outcomes were younger than those with unfavorable outcomes (39 ± 16 vs 65 ± 12 years, respectively, p = 0.04), with good left ventricular function on presentation (100% vs 4.5%, p = 0.0001) and with short asystole and/or short time from collapse to restoration of spontaneous circulation. In conclusion, mild therapeutic hypothermia in the adult population is more effective in patients with VF compared to those with non-VF. Good prognostic factors for patients with non-VF could be young age, good left ventricular function, and short anoxic time.
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