The 'chain of survival'-including early call for help, early cardiopulmonary resuscitation (CPR) and early defibrillation-represents the most beneficial approach for favourable patient outcome after ...out-of-hospital cardiac arrest (OHCA). Despite increasing numbers of publicly accessible automated external defibrillators (AED) and interventions to increase public awareness for basic life support (BLS), the number of their use in real-life emergency situations remains low.
In this prospective population-based cross-sectional study, a total of 501 registered inhabitants of Vienna (Austria) were randomly approached via telephone calls between 08/2014 and 09/2014 and invited to answer a standardized questionnaire in order to identify public knowledge and awareness of BLS and AED-use.
We found that more than 52 percent of participants would presume OHCA correctly and would properly initiate BLS attempts. Of alarming importance, only 33 percent reported that they would be willing to perform CPR and 50 percent would use an AED device. There was a significantly lower willingness to initiate BLS attempts (male: 40% vs. female: 25%; OR: 2.03 95%CI: 1.39-2.98; p<0.001) and to use an AED device (male: 58% vs. female: 44%; OR: 1.76 95%CI: 1.26-2.53; p = 0.002) in questioned female individuals compared to their male counterparts. Interestingly, we observed a strongly decreasing level of knowledge and willingness for BLS attempts (-14%; OR: 0.72 95%CI: 0.57-0.92; p = 0.027) and AED-use (-19%; OR: 0.68 95%CI: 0.54-0.85; p = 0.001) with increasing age.
We found an overall poor knowledge and awareness concerning BLS and the use of AEDs among the Viennese population. Both female and elderly participants reported the lowest willingness to perform BLS and use an AED in case of OHCA. Specially tailored programs to increase awareness and willingness among both the female and elderly community need to be considered for future educational interventions.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Risk factors for the development of HFrEF include hypertension, coronary artery disease, diabetes, obesity, and valvular heart disease. 2 HFrEF is associated with high morbidity and mortality rates, ...with a 5-year mortality rate of around 50% and a high risk of hospitalization. 3,4 It is also a leading cause of hospitalization in people over the age of 65. Research has highlighted the significance of a board treatment foundation in HF, as the more comprehensive the approach, the greater the degree of progressive improvement in outcome. 6 Vericiguat is a novel drug that has shown promising results in the treatment of HF. 7 It is a soluble guanylate cyclase (sGC) stimulator that works by increasing the production of cyclic guanosine monophosphate (cGMP), a molecule that promotes vasodilation and reduces oxidative stress and inflammation. 8 Endothelial NO synthase induces the production of nitric oxide (NO) in response to laminar flow and shear stress. NO diffuses to nearby cells and binds to the haem group of sGC, which in turn produces cGMP, activating protein kinase G. Protein kinase G phosphorylates proteins in the heart and vessels to promote diastolic relaxation, improve coronary blood flow, inhibit inflammation, hypertrophy, and fibrosis in response to cardiac damage, and improve ventricular-arterial coupling. 8 In the heart, there are seven isoforms of phosphodiesterase (PDE) that inactivate cGMP to GMP. 9 PDE3 inhibitors like milrinone and enoximone are used in acute HF, and PDE5 inhibitors such as sildenafil and udenafil improve contractile function in systolic HF, blunt left ventricular hypertrophic remodelling, reduce myocardial infarct size, and suppress ventricular arrhythmias, although neither class of drugs improves the outcome of HF patients. 9 Natriuretic peptides (NPs), particularly atrial NP or B-type NP, act on transmembrane receptors (NR-A and NR-B) with GC activity (particulate GC) to exert their biological effects, while NR-C receptors act as clearance receptors, decreasing plasma NP concentration, together with enzymatic cleavage by vasopeptidases like neprilysin. 10 In HFrEF, impaired left ventricular systolic function leads to tissue hypoperfusion, inflammation, and oxidative stress, resulting in decreased NO bioavailability and cGMP deficiency. 11 This cGMP deficiency has deleterious effects on the heart, kidneys, and vessels (including the pulmonary circulation), which may contribute to HF progression. 12,13 HFrEF patients commonly exhibit a reduced response to NPs, which may be due to various mechanisms, including altered production or clearance of active NPs, their binding to membrane receptors, or intracellular effects. 14 sGC modulators acting on a downstream target of the NO-sGC-cGMP pathway may circumvent NP resistance more effectively than other therapeutic strategies that aim to increase NP concentration, such as the administration of pharmacological doses of recombinant B-type NP (nesiritide and ularitide), which is associated with worsening renal function and no effect on outcome. 8,15,16 The sGC activator cinaciguat increases cGMP levels by directly activating sGC, independent of NO, and has a high risk of hypotension. 8 Conversely, sGC stimulators enhance sGC sensitivity to endogenous NO, which possibly explains their neutral effects on blood pressure. 8 While the sGC stimulator riociguat requires three administrations per day due to its shorter half-life, vericiguat has a more favourable pharmacology, which makes it more feasible for daily use considering drug compliance and adherence. 2,8 Efficacy and safety of vericiguat in heart failure with reduced ejection fraction Vericiguat has undergone phase 2 (SOCRATES-REDUCED) 17 and phase 3 (VICTORIA) 7 trials in the context of HFrEF. ...despite substantial advances in managing patients with HFrEF, there remains a demand for innovative treatments, particularly directed towards those with eGFR <30 mL/min/1.73 m2 and severe HFrEF.
Abstract Background Post-infarction cardiac rupture (CR) such as ventricular septal rupture (VSR), free wall rupture (FWR), atrial septal rupture (ASR) or papillary muscle rupture (PMR) is a rare but ...dreaded complication in patients with acute myocardial infarction (AMI) associated with a very poor prognosis with reported mortality rates between 60 and 100%. Therefore suitable risk stratification for secondary prevention seems crucial, but data on long-term survival und risk prediction in this especially vulnerable patient collective remains scarce. Methods Out of 11 641 patients presenting with AMI a total of 28 individuals suffering post-infarction CR were identified and stratified in “acute survivors of CR” (n = 10) and “non-survivors of CR” (n = 18). Cox regression hazard analysis was used to assess prognosticators on long-term survival. Results Ten patients (35.7%) survived the initial event. After a median follow-up time of 9 years 2 (20%) of the survivors died, both due to cardiovascular causes. Younger age (p = 0.023) and higher systolic blood pressure at admission (p = 0.018) turned out to be significant predictors of long-term survival. Systolic blood pressure 48 hours after CR proved to be a strong and independent predictor for survival with an adjusted hazard ratio per one standard deviation of 0.89 (95% CI: 0.72-0.99; 0.048). Conclusion Hemodynamic stabiliziation and severity of cardiogenic shock were detected as clinically most common among patients suffering post-infarction CR and proved to be of major importance for survival. If survival of the initial event was achieved, satisfying long-term mortality could be reached.
Laypersons' efforts to initiate basic life support (BLS) in witnessed Out-of-Hospital Cardiac Arrest (OHCA) remain comparably low within western society. Therefore, in order to shorten no-flow times ...in cardiac arrest, several police-based first responder systems equipped with automated external defibrillators (Pol-AED) were established in urban areas, which subsequently allow early BLS and AED administration by police officers. However, data on the quality of BLS and AED use in such a system and its impact on patient outcome remain scarce and inconclusive. A total of 85 Pol-AED cases were randomly assigned to a gender, age and first rhythm matched non-Pol-AED control group (n = 170) in a 1:2 ratio. Data on quality of BLS were extracted via trans-thoracic impedance tracings of used AED devices. Comparing Pol-AED cases and the control group, we observed a similar compression rate per minute (p = 0.677) and compression ratio (p = 0.651), mirroring an overall high quality of BLS administered by police officers. Time to the first shock was significantly shorter in Pol-AED cases (6 minutes IQR: 2-10 vs. 12 minutes IQR: 8-17; p<0.001). While Pol-AED was not associated with increased sustained return of spontaneous circulation (p = 0.564), a strong and independent impact on survival until hospital discharge (adj. OR: 1.85 95%CI: 1.06-3.23; p = 0.030) and a borderline significance for the association with favorable neurological outcome (adj. OR: 1.58 95%CI: 0.96-2.89; p = 0.052) were observed. We were able to demonstrate an early start and a high quality of BLS and AED use in Pol-AED assessed OHCA cases. Moreover, the presence of Pol-AED care was associated with better patient survival and borderline significance for favorable neurological outcome.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
To assess real-world data on the clinical implementation of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in cardiovascular ...patients and to investigate barriers to prescribe these agents.
Methods
Patients presenting with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) between 01/2014 and 04/2020 were included in the present analysis and followed prospectively. All first-time prescriptions of SGLT2i and GLP-1RA were identified.
Results
Among 1498 patients with CAD and T2DM, 17.6% of patients received an SGLT2i and 5.5% a GLP-1RA. The prescription of SGLT2i (+38.7%;
p
< 0.001) and GLP-1RA (+8%;
p
= 0.007) significantly increased during the observation period. Considering remuneration criteria for SGLT2i therapy, lowering the GFR cut-off to 30 ml/min/1.73 m
2
would allow additional 26.6% of patients to qualify for an SGLT2i therapy. While SGLT2i therapy was inversely associated with CV mortality (adjusted hazard ratio of 0.18 95% CI: 0.05–0.76;
p
= 0.019), GLP-1RA therapy showed a trend for risk reduction.
Conclusion
The present analysis revealed an infrequent prescription of SGLT2i and GLP-1RAs in patients with T2DM and CAD in clinical practice. Remuneration regulations that better reflect the inclusion criteria of the CV outcome trials would allow more patients at high risk to receive these CV protective drugs. Most importantly, while GLP-1RA therapy showed a trend for risk reduction of cardiovascular mortality, the use of SGLT2i had a strong inverse impact on cardiovascular mortality from a long-term perspective.
Purpose
The benefit of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and type 2 diabetes mellitus (T2DM) has been ...unequivocally proven in randomized, controlled trials. However, real-world evidence assessing the implementation of SGLT2i in clinical practice and their benefit in HF outside of highly selected study populations is limited.
Methods
Patients with HF and T2DM admitted to the cardiology ward of the Medical University of Vienna between 01/2014 and 04/2020 were included in the present analysis. All first-time prescriptions of SGLT2i were identified. The outcome of interest was cardiovascular mortality. The median follow-up time was 2.3 years.
Results
Out of 812 patients with T2DM and HF (median age 70.4 IQR 62.4–76.9 years; 70.3% males), 17.3% received an SGLT2i. The frequency of SGLT2i prescriptions significantly increased over the past 6 years (+ 36.6%,
p
< 0.001). In propensity score–adjusted pairwise analyses, SGLT2i treatment was inversely associated with long-term cardiovascular mortality in patients with HFrEF presenting with an adjusted HR of 0.33 (95%CI: 0.13–0.86;
p
= 0.024).
Conclusion
Despite large outcome trials showing a cardiovascular benefit, SGLT2i remain underutilized in clinical practice in patients with T2DM and HF. National and European Medical Agency remuneration regulations would allow more patients at high risk to receive these cardiovascular protective drugs. Most importantly, an SGLT2i therapy was associated with a survival benefit in patients with HFrEF.
Deleterious inflammatory responses are seen to be the trigger of heart failure in myocarditis and therapies directed towards immunomodulation have been assumed to be beneficial. The objective of the ...present review was to systematically assess the effect of immunomodulation in lymphocytic myocarditis. Studies were included if diagnosis of lymphocytic myocarditis was based on EMB as well as on the exclusion of other etiologies of heart failure and if the patients had at least moderately decreased left ventricular ejection fraction (< 45%). All immunomodulatory treatments at any dose that target the cause of myocarditis leading to cardiomyopathy were included. Retrieval of PUBMED, SCOPUS, Cochrane Central Register of Controlled Trials, and LILACs from January 1950 to January 2016 revealed 444 abstracts of which nine studies with a total of 612 patients were included. As primary effectivity endpoint, a change in left ventricular ejection was chosen. No benefits of corticosteroids or intravenous immunoglobulin alone were reported. Immunoadsorption and subsequent IVIG substitution was associated with a greater improvement in left ventricular ejection fraction (LVEF) in one study. Single studies found a beneficial effect of interferon and statins on LVEF. We performed a meta-analysis for the combination of corticosteroids with immunosuppressants and found a non-significant increase of LVEF of + 13.06% favoring combined treatment (95%CI 1.71 to + 27.84%,
p =
0.08). The current evidence does not support the routine use of immunosuppression in traditional lymphocytic myocarditis. Nevertheless, in histologically proven virus-negative myocarditis of high-risk patients, combined immunosuppression might be beneficial. Future research should focus on translation of these effects to clinical outcome.
Abstract Aim Cardiac arrest centers have been associated with improved outcome for patients after cardiac arrest. Aim of this study was to investigate the effect on outcome depending on admission to ...high-, medium- or low volume centers. Methods Analysis from a prospective, multicenter registry for out of hospital cardiac arrest patients treated by the emergency medical service of Vienna, Austria. The frequency of cardiac arrest patients admitted per center/year (low <50; medium 50–100; high >100) was correlated to favorable outcome (30-day survival with cerebral performance category of 1 or 2). Results Out of 2238 patients (years 2013–2015) with emergency medical service resuscitation, 861 (32% female, age 64 (51;73) years) were admitted to 7 different centers. Favorable outcome was achieved in 267 patients (31%). Survivors were younger (58 vs. 66 years; p < 0.001), showed shockable initial heart rhythm more frequently (72 vs. 35%; p < 0.001), had shorter CPR durations (22 vs. 29 min; p < 0.001) and were more likely to be treated in a high frequency center (OR 1.6; CI: 1.2–2.1; p = 0.001). In multivariate analysis, age below 65 years (OR 15; CI: 3.3–271.4; p = 0.001), shockable initial heart rhythm (OR 10.1; CI: 2.4–42.6; p = 0.002), immediate bystander or emergency medical service CPR (OR 11.2; CI: 1.4–93.3; p = 0.025) and admission to a center with a frequency of >100 OHCA patients/year (OR 5.2; CI: 1.2–21.7; p = 0.025) was associated with favorable outcome. Conclusions High frequency of post-cardiac arrest treatment in a specialized center seems to be an independent predictor for favorable outcome in an unselected population of patients after out of hospital cardiac arrest.
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