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Lapum, Jennifer, Jan E. Angus, Elizabeth Peter, and Judy Watt-Watson. "Patients' discharge experiences: Returning home after open-heart surgery." Heart & Lung 40, no. 3 (May 2011): 226–35. http://dx.doi.org/10.1016/j.hrtlng.2010.01.001.
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Abd EL Aziz, Shimaa, Yousry Risk, Mahbouba Abd El-Aziz, and Hedya Mohy El-Deen. "Home Self-Care Management Program for Patients with Open Heart Surgery in Kalyubia Governorate." Menoufia Nursing Journal 2, no. 2 (November 1, 2017): 57–66. http://dx.doi.org/10.21608/menj.2017.129102.
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Puriani, Dewi, Allenidekania Allenidekania, and Yati Afiyanti. "The Experience of Uncertainty in Mothers Caring for Children at Home after Palliative Heart Surgery." Indian Journal of Palliative Care 29 (January 20, 2023): 46–50. http://dx.doi.org/10.25259/ijpc_453_20.
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Objectives: Palliative heart surgery is a compelling option for some children with congenital heart disease for which corrective heart surgery is not yet possible due to its complexity. As primary caregivers, mothers have the challenge of providing optimal care to their children at home post-surgery. This study aims to explore the experiences of mothers who are caring for children recovering from palliative heart surgery at home. The research applied descriptive, qualitative and phenomenology design. Material and Methods: This study was conducted in Jakarta. The participants were 15 mothers of palliative heart surgery patients from seven provinces in Indonesia; Jakarta, Aceh, Bali, North Sumatra, West Java, Central Java and Banten. Data were collected using semi-structured interviews through the WhatsApp video call application and analysed using the Colaizzi method. Results: Mothers often felt uncertain about how to provide the best care and felt that their needs for hospital services to assist them went unmet. Conclusions: This study has implications for the development of nursing services related to discharge planning for palliative heart surgery patients.
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Mangusan, Ralph Francis, Vallire Hooper, Sheri A. Denslow, and Lucille Travis. "Outcomes Associated With Postoperative Delirium After Cardiac Surgery." American Journal of Critical Care 24, no. 2 (March 1, 2015): 156–63. http://dx.doi.org/10.4037/ajcc2015137.
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Background Delirium after surgery is a common condition that leads to poor outcomes. Few studies have examined the effect of postoperative delirium on outcomes after cardiac surgery. Objectives To assess the relationship between delirium after cardiac surgery and the following outcomes: length of stay after surgery, prevalence of falls, discharge to a nursing facility, discharge to home with home health services, and use of inpatient physical therapy. Methods Electronic medical records of 656 cardiac surgery patients were reviewed retrospectively. Results Postoperative delirium occurred in 161 patients (24.5%). Patients with postoperative delirium had significantly longer stays (P < .001) and greater prevalence of falls (P < .001) than did patients without delirium. Patients with delirium also had a significantly greater likelihood for discharge to a nursing facility (P < .001) and need for home health services if discharged to home (P < .001) and a significantly higher need for inpatient physical therapy (P < .001). Compared with patients without postoperative delirium, patients who had this complication were more likely to have received zolpidem and benzodiazepines postoperatively and to have a history of arrhythmias, renal disease, and congestive heart failure. Conclusions Patients who have delirium after cardiac surgery have poorer outcomes than do similar patients without this complication. Development and implementation of an extensive care plan to address postoperative delirium is necessary for cardiac surgery patients who are at risk for or have delirium after the surgery.
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Bashi, Nazli, Marlien Varnfield, and Mohanraj Karunanithi. "A Smartphone App for Patients With Acute Coronary Syndrome (MoTER-ACS): User-Centered Design Approach." JMIR Formative Research 4, no. 12 (December 18, 2020): e17542. http://dx.doi.org/10.2196/17542.
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Background Postdischarge interventions are limited for patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and the need to travel from remote areas. Smartphones have become viable lifestyle technology to deliver home-based educational and health interventions. Objective The aim of this study was to develop a smartphone-based intervention for providing postdischarge support to patients with ACS. Methods The content of Mobile Technology–Enabled Rehabilitation for Patients with ACS (MoTER-ACS) was derived from a series of small studies, termed prestudy surveys, conducted in 2017. The prestudy surveys were conducted in Prince Charles Hospital, Queensland, Australia, and consisted of questionnaires among a convenience sample of patients with ACS (n=30), a focus group discussion with health care professionals (n=10), and an online survey among cardiologists (n=15). Responses from the patient survey identified educational topics of MoTER-ACS. The focus group with health care professionals assisted with identifying educational materials, health monitoring, and self-management interventions. Based on the results of the cardiologists’ survey, monitoring of symptoms related to heart failure exacerbation was considered as a weekly diary. Results The MoTER-ACS app covers multimedia educational materials to adopt a healthy lifestyle and includes user-friendly tools to monitor physiological and health parameters such as blood pressure, weight, and pain, assisting patients in self-managing their condition. A web portal that is linked to the data from the smartphone app is available to clinicians to regularly access patients’ data and provide support. Conclusions The MoTER-ACS platform extends the capabilities of previous mobile health platforms by providing a home-based educational and self-management intervention for patients with ACS following discharge from the hospital. The MoTER-ACS intervention narrows the gap between existing hospital-based programs and home-based interventions by complementing the postdischarge program for patients with ACS.
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Alrefaei, S., F. Obeid, S. Alshnaikat, R. Sirriyeh, and A. Mahmud. "PO650 Warfarin Treatment and Rate of Hospitalization In Heart Valve Surgery Patients." Global Heart 13, no. 4 (December 2018): 520. http://dx.doi.org/10.1016/j.gheart.2018.09.505.
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Savage, LS, and MJ Grap. "Telephone monitoring after early discharge for cardiac surgery patients." American Journal of Critical Care 8, no. 3 (May 1, 1999): 154–59. http://dx.doi.org/10.4037/ajcc1999.8.3.154.
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BACKGROUND: Monitoring the postoperative course of cardiac surgery patients remains essential but requires creative strategies now that length of hospitalization has been shortened to 5 days or less. OBJECTIVES: To determine patients' concerns in the early recovery period after open-heart surgery and to describe the impact of advanced practice nurses on this phase of recovery. METHOD: A cardiovascular clinical nurse specialist conducted follow-up by telephone for 342 cardiac surgery patients 7 to 14 days after discharge. Patients were asked both open-ended and direct questions. RESULTS: The major problems were leg edema (48%), appetite disturbance (35%), dyspnea (29%), sleep disturbance (12%), and wound drainage (9%). The nurse's interventions over the telephone included reassuring the patient about postoperative progress (86% of sample), giving diet information (31%), instructing about activity (29%), providing emotional support (25%), referring for medical treatment (16%), and explaining medications (13%). In response to these findings, the nursing practice council revised postoperative teaching to emphasize wound healing, sleep, and appetite issues. CONCLUSIONS: Telephone monitoring of cardiac surgery patients after early discharge can alleviate the often stressful transition to postoperative recovery at home. A cardiovascular clinical nurse specialist can provide patients and patients' family members with reassurance and ongoing reinforcement of the discharge information.
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Tregay, Jenifer, Jo Wray, Sonya Crowe, Rachel Knowles, Piers Daubeney, Rodney Franklin, David Barron, et al. "Going home after infant cardiac surgery: a UK qualitative study." Archives of Disease in Childhood 101, no. 4 (January 29, 2016): 320–25. http://dx.doi.org/10.1136/archdischild-2015-308827.
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ObjectiveTo qualitatively assess the discharge processes and postdischarge care in the community for infants discharged after congenital heart interventions in the first year of life.DesignQualitative study using semistructured interviews and Framework Analysis.SettingUK specialist cardiac centres and the services their patients are discharged to.SubjectsTwenty-five cardiologists and nurses from tertiary centres, 11 primary and secondary health professionals and 20 parents of children who had either died after discharge or had needed emergency readmission.ResultsParticipants indicated that going home with an infant after cardiac intervention represents a major challenge for parents and professionals. Although there were reported examples of good care, difficulties are exacerbated by inconsistent pathways and potential loss of information between the multiple teams involved. Written documentation from tertiary centres frequently lacks crucial contact information and contains too many specialist terms. Non-tertiary professionals and parents may not hold the information required to respond appropriately when an infant deteriorates, this contributing to the stressful experience of managing these infants at home. Where they exist, the content of formal ‘home monitoring pathways’ varies nationally, and families can find this onerous.ConclusionsService improvements are needed for infants going home after cardiac intervention in the UK, focusing especially on enhancing mechanisms for effective transfer of information outside the tertiary centre and processes to assist with monitoring and triage of vulnerable infants in the community by primary and secondary care professionals. At present there is no routine audit for this stage of the patient journey.
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Azevedo, Vitor M. P., Wilma F. Golebiovski, Guilherme D. T. Amorim, Amanda Bonfim, Regina E. Müller, Fabio Tagliari, Marcela Cedenila, Regina Maria Aquino Xavier, and Clara Weksler. "PT114 Prognostic factors for in-hospital death of Rheumatic Heart Disease Patients after valvular heart disease surgery in Brazil." Global Heart 9, no. 1 (March 2014): e189. http://dx.doi.org/10.1016/j.gheart.2014.03.1900.
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Lamberigts, Marie, Lucas Van Hoof, Tine Proesmans, Pieter Vandervoort, Lars Grieten, Peter Haemers, and Filip Rega. "Remote Heart Rhythm Monitoring by Photoplethysmography-Based Smartphone Technology After Cardiac Surgery: Prospective Observational Study." JMIR mHealth and uHealth 9, no. 4 (April 15, 2021): e26519. http://dx.doi.org/10.2196/26519.
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Background Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery, yet the precise incidence and significance of arrhythmias after discharge home need to be better defined. Photoplethysmography (PPG)-based smartphone apps are promising tools to enable early detection and follow-up of arrhythmias. Objective By using a PPG-based smartphone app, we aimed to gain more insight into the prevalence of AF and other rhythm-related complications upon discharge home after cardiac surgery and evaluate the implementation of this app into routine clinical care. Methods In this prospective, single-center trial, patients recovering from cardiac surgery were asked to register their heart rhythm 3 times daily using a Food and Drug Administration–approved PPG-based app, for either 30 or 60 days after discharge home. Patients with permanent AF or a permanent pacemaker were excluded. Results We included 24 patients (mean age 60.2 years, SD 12 years; 15/23, 65% male) who underwent coronary artery bypass grafting and/or valve surgery. During hospitalization, 39% (9/23) experienced postoperative AF. After discharge, the PPG app reported AF or atrial flutter in 5 patients. While the app notified flutter in 1 patient, this was a false positive, as electrocardiogram revealed a 2nd-degree, 2:1 atrioventricular block necessitating a permanent pacemaker. AF was confirmed in 4 patients (4/23, 17%) and interestingly, was associated with an underlying postoperative complication in 2 participants (pneumonia n=1, pericardial tamponade n=1). A significant increase in the proportion of measurements indicating sinus rhythm was observed when comparing the first to the second month of follow-up (P<.001). In the second month of follow-up, compliance was significantly lower with 2.2 (SD 0.7) measurements per day versus 3.0 (SD 0.8) measurements per day in the first month (P=.002). The majority of participants (17/23, 74%), as well as the surveyed primary care physicians, experienced positive value by using the app as they felt more involved in the postoperative rehabilitation. Conclusions Implementation of smartphone-based PPG technology enables detection of AF and other rhythm-related complications after cardiac surgery. An association between AF detection and an underlying complication was found in 2 patients. Therefore, smartphone-based PPG technology may supplement rehabilitation after cardiac surgery by acting as a sentinel for underlying complications, rhythm-related or otherwise.
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Simani-Oren, Lisa. "The Ten Commandments of Caring for Patients After Open Heart Surgery." Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional 21, no. 8 (August 2003): 551–56. http://dx.doi.org/10.1097/00004045-200308000-00012.
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Karol, Dalia. "The Power of Global Surgery: A Medical Student’s Experience At Save A Child’s Heart (SACH)." University of Ottawa Journal of Medicine 8, no. 1 (May 7, 2018): 75–77. http://dx.doi.org/10.18192/uojm.v8i1.2351.
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This elective report provides an overview of the experience of a 1st year medical student completing a global pediatric cardiac surgery elective at Save A Childs Heart (SACH), an Israeli Non-Governmental Organization (NGO). SACH provides life saving cardiac surgery to children from developing countries who would otherwise not have access to care. Children are screened in their home countries, and brought to Israel for these complex surgical procedures. This elective is unique, as it exposes medical students to leading experts in cardiac surgery, cardiology, pediatric ICU, as well as international residents and international patients.
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Szymanski, J., A. Juraszek, M. Jasińska, M. Sobieszczańska-Małek, T. Zielinski, and M. Kusmierczyk. "REMEDIZER- An Innovative Program of Remote Home Care for Patients with Implanted Mechanical Heart Support. Single Centre Experience." Journal of Heart and Lung Transplantation 38, no. 4 (April 2019): S461—S462. http://dx.doi.org/10.1016/j.healun.2019.01.1176.
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Kang, Katherine, Ken W. T. Chau, Erin Howell, Mellise Anderson, Simon Smith, Tania J. Davis, Greg Starmer, and Josh Hanson. "The temporospatial epidemiology of rheumatic heart disease in Far North Queensland, tropical Australia 1997–2017; impact of socioeconomic status on disease burden, severity and access to care." PLOS Neglected Tropical Diseases 15, no. 1 (January 14, 2021): e0008990. http://dx.doi.org/10.1371/journal.pntd.0008990.
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Background The incidence of rheumatic heart disease (RHD) among Indigenous Australians remains one of the highest in the world. Many studies have highlighted the relationship between the social determinants of health and RHD, but few have used registry data to link socioeconomic disadvantage to the delivery of patient care and long-term outcomes. Methods A retrospective study of individuals living with RHD in Far North Queensland (FNQ), Australia between 1997 and 2017. Patients were identified using the Queensland state RHD register. The Socio-Economic Indexes for Areas (SEIFA) Score–a measure of socioeconomic disadvantage–was correlated with RHD prevalence, disease severity and measures of RHD care. Results Of the 686 individuals, 622 (90.7%) were Indigenous Australians. RHD incidence increased in the region from 4.7/100,000/year in 1997 to 49.4/100,000/year in 2017 (p<0.001). In 2017, the prevalence of RHD was 12/1000 in the Indigenous population and 2/1000 in the non-Indigenous population (p<0.001). There was an inverse correlation between an area’s SEIFA score and its RHD prevalence (rho = -0.77, p = 0.005). 249 (36.2%) individuals in the cohort had 593 RHD-related hospitalisations; the number of RHD-related hospitalisations increased during the study period (p<0.001). In 2017, 293 (42.7%) patients met criteria for secondary prophylaxis, but only 73 (24.9%) had good adherence. Overall, 119/686 (17.3%) required valve surgery; the number of individuals having surgery increased over the study period (p = 0.02). During the study 39/686 (5.7%) died. Non-Indigenous patients were more likely to die than Indigenous patients (9/64 (14%) versus 30/622 (5%), p = 0.002), but Indigenous patients died at a younger age (median (IQR): 52 (35–67) versus 73 (62–77) p = 0.013). RHD-related deaths occurred at a younger age in Indigenous individuals than non-Indigenous individuals (median (IQR) age: 29 (12–58) versus 77 (64–78), p = 0.007). Conclusions The incidence of RHD, RHD-related hospitalisations and RHD-related surgery continues to rise in FNQ. Whilst this is partly explained by increased disease recognition and improved delivery of care, the burden of RHD remains unacceptably high and is disproportionately borne by the socioeconomically disadvantaged Indigenous population.
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Xavier, R. M. D. A., V. M. P. Azevedo, R. E. Muller, F. F. Nascimento, C. M. Aquino, M. C. Yaakoub, R. B. M. Chaves, A. Migowski, and M. C. C. M. Pinheiro. "PS280 The Impact of Human Development Index on Heart Valvular Surgery Mortality of 42,352 Patients With Rheumatic Heart Disease in Brazil." Global Heart 11, no. 2 (June 2016): e62. http://dx.doi.org/10.1016/j.gheart.2016.03.217.
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Salavati, Mohsen, Gholamhossein Fallahinia, Ali Esmaeili Vardanjani, Hossein Rafiei, Saeid Mousavi, and Mehdi Torkamani. "Comparison Between Effects of Home Based Cardiac Rehabilitation Programs Versus Usual Care on the Patients’ Health Related Quality of Life After Coronary Artery Bypass Graft." Global Journal of Health Science 8, no. 4 (August 19, 2015): 196. http://dx.doi.org/10.5539/gjhs.v8n4p196.
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<p><strong>BACKGROUND & AIM:</strong> To compare home-based cardiac rehabilitation with usual care on the patients’ Health Related Quality of Life (HRQoL) after coronary artery bypass graft in patients with coronary artery bypass graft (CABG) surgery.</p> <p><strong>METHODS:</strong> In a randomized controlled clinical conducted from March 2013 to June 2013, 110 patients with CABG surgery were randomly assigned into two groups. While patients in group I, were received usual care and patients in group II, in addition to the usual care were received home-based cardiac rehabilitation programs. The 27-item MacNew Heart Disease HRQoL questionnaire was used to evaluate the patient’s HRQoL under and over 2 months after intervention.</p> <p><strong>RESULTS:</strong> At the time of 0, mean score of HRQoL was 67.86±7.5 and 64.76±8.4 in patients in group I and group II, respectively (P> 0.05). Although mean score of HRQoL in all patients in both groups increased two month after intervention, but this increase in patients in group II were higher than patients in group I (154.93±4.6 vs 134.20±8.2). This difference were statistically significant (P< 0.05).</p> <p><strong>CONCLUSION:</strong> Quality of Life (QoL) can be considered as a quality indicator of health care systems. Results of present study showed that home-based cardiac rehabilitation program improved patients HRQoL after CABG surgery.</p>
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Barker, Lawrence E. "The Total Artificial Heart." AACN Advanced Critical Care 2, no. 3 (August 1, 1991): 587–97. http://dx.doi.org/10.4037/15597768-1991-3022.
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In the early 1800s, an awareness of potential ventricular failure stimulated interest in artificial heart replacement. In 1937 the first total artificial heart (TAH) was implanted into the chest of a dog by Russian physicians. The primary driving force for mechanical cardiac assistance developed from the necessity for circulatory assistance in order to perform corrective cardiac surgery. In 1953 the first successful closure of an atrial septal defect using extracorporeal circulation was performed. During the following decade the concept of using mechanical devices to assist the failing heart was aggressively pursued. This culminated in the first implant of a TAH in a human in 1969 as a bridge to transplant. Clinical implant of the TAH as a permanent device was performed in 1982 by researchers at the University of Utah. This patient lived for 112 days. Three successive permanent implants were performed in Louisville, Kentucky, with one patient surviving for 620 days. All of these permanent TAH patients suffered from device-related complications including bleeding, infection, and thromboembolic events. It became apparent that the present configuration of the TAH with its external drive lines and large air console was not ideal for long-term support. In 1985 the first implant of the Symbion J-7-100 TAH (Jarvik-7) as a bridge to transplant was performed. This patient was supported by the device for 9 days and was successfully transplanted and discharged home. Since 1985 more than 170 patients have been bridged using the Symbion J-7 TAH with more than 70% of these patients being successfully transplanted. The incidence of thromboembolic events has dramatically reduced with better understanding of anticoagulation requirements. Infection continues to be the greatest potential complication with these patients. In spite of this, the pneumatic TAH has proved to be an adequate bridge to transplant device
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Cleary, John P., Annie Janvier, Barbara Farlow, Meaghann Weaver, James Hammel, and John Lantos. "Cardiac Interventions for Patients With Trisomy 13 and Trisomy 18: Experience, Ethical Issues, Communication, and the Case for Individualized Family-Centered Care." World Journal for Pediatric and Congenital Heart Surgery 13, no. 1 (December 17, 2021): 72–76. http://dx.doi.org/10.1177/21501351211044132.
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This report is informed by the themes of the session Trisomy 13/18, Exploring the Changing Landscape of Interventions at NeoHeart 2020—The Fifth International Conference of the Neonatal Heart Society. The faculty reviewed the present evidence in the management of patients and the support of families in the setting of trisomy 13 and trisomy 18 with congenital heart disease. Until recently medical professionals were taught that T13 and 18 were “lethal conditions” that were “incompatible with life” for which measures to prolong life are therefore ethically questionable and likely futile. While the medical literature painted one picture, family support groups shared stories of the long-term survival of children who displayed happiness and brought joy along with challenges to families. Data generated from such care shows that surgery can, in some cases, prolong survival and increase the likelihood of time at home. The authors caution against a change from never performing heart surgery to always—we suggest that the pendulum of intervention find a balanced position where all therapies including comfort care and surgery can be reviewed. Families and clinicians should typically be supported and empowered to define the best care for their children and patients. Key concepts in communication and case vignettes are reviewed including the importance of supportive relationships and the fact that palliative care may serve as an additional layer of support for decision-making and quality of life interventions. While cardiac surgery may be beneficial in some cases, surgery should not be the primary focus of initial family education and support.
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Burke, William T., Jaimin R. Trivedi, Michael P. Flaherty, and Kendra J. Grubb. "Acute Heart Failure at the Time of Transcatheter Aortic Valve Replacement Does not Increase Mortality." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 13, no. 1 (January 2018): 47–50. http://dx.doi.org/10.1097/imi.0000000000000464.
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Objective Patients presenting for transcatheter aortic valve replacement are often in acute on chronic heart failure, as indicated by elevated N-terminal pro-B-type natriuretic peptide. Many believe that elevated N-terminal pro-B-type natriuretic peptide is an indication to treat medically, reserving surgery until the patient is medically optimized. Methods A single-center transcatheter aortic valve replacement database was queried from December 2015 to November 2016 to identify patients undergoing transcatheter aortic valve replacement. Patients were divided into two cohorts based on preoperative N-terminal pro-B-type natriuretic peptide level. An analysis was then completed to assess outcomes such as length of intensive care unit stay, total length of stay, discharge to home, major complications, and mortality at 30 days. Results There were 142 patients (median age = 80 years, 44% female) with preoperative N-terminal pro-B-type natriuretic peptide data included (range = 106–73,500 pg/mL). The mean Society of Thoracic Surgeons predicative risk of mortality was 8%, and 46 patients (32%) had N-terminal pro-B-type natriuretic peptide of greater than 3000 pg/mL. N-terminal pro-B-type natriuretic peptide of greater than 3000 pg/mL was associated only with increased intensive care unit length of stay of greater than 24 hours (35% vs 9%, P = 0.0001). There was no statistical difference between cohorts with regard to total length of stay of greater than 3 days (24% vs 15%, P = 0.2), discharge to home (74% vs 83%, P = 0.3), major complication, or mortality at 30 days. Conclusions Transcatheter aortic valve replacement is an appropriate and effective treatment for patients with aortic stenosis presenting with high N-terminal pro-B-type natriuretic peptide and acute on chronic heart failure.
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&NA;. "CE Test: The Ten Commandments of Caring for Patients After Open Heart Surgery." Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional 21, no. 8 (August 2003): 557. http://dx.doi.org/10.1097/00004045-200308000-00014.
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Nghiem, Son, Clifford Afoakwah, Paul Scuffham, and Joshua Byrnes. "Hospital frailty risk score and adverse health outcomes: evidence from longitudinal record linkage cardiac data." Age and Ageing 50, no. 5 (May 15, 2021): 1778–84. http://dx.doi.org/10.1093/ageing/afab073.
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Abstract Background Despite recent evidence on the effect of frailty on health outcomes among those with heart failure, there is a dearth of knowledge on measuring frailty using administrative health data on a wide range of cardiovascular diseases (CVD). Methods We conducted a retrospective record-linkage cohort study of patients with diverse CVD in Queensland, Australia. We investigated the relationship between the risk of frailty, defined using the hospital frailty risk score (HFRS), and 30-day mortality, 30-day unplanned readmission, non-home discharge, length of hospital stay (LOS) at an emergency department and inpatient units and costs of hospitalisation. Descriptive analysis, bivariate logistic regression and generalised linear models were used to estimate the association between HFRS and CVD outcomes. Smear adjustment was applied to hospital costs and the LOS for each frailty risk groups. Results The proportion of low, medium and high risk of frailty was 24.6%, 34.5% and 40.9%, respectively. The odds of frail patients dying or being readmitted within 30 days of discharge was 1.73 and 1.18, respectively. Frail patients also faced higher odds of LOS, and non-home discharge at 3.1 and 2.25, respectively. Frail patients incurred higher hospital costs (by 42.7–55.3%) and stayed in the hospital longer (by 49%). Conclusion Using the HFRS on a large CVD cohort, this study confirms that frailty was associated with worse health outcomes and higher healthcare costs. Administrative data should be more accessible to research such that the HFRS can be applied to healthcare planning and patient care.
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Almramhi, Khalid, Mohammed Aljehani, Mohammed Bamuflih, Saad Alghamdi, Sultan Banser, Abdullah Almousa, SALEH ALABDULWAHAB, and Khalid Al-Ebrahim. "Frequency and Risk Factors of Unplanned 30-Day Readmission After Open Heart Surgeries: A Retrospective Study in a Tertiary Care Center." Heart Surgery Forum 25, no. 4 (August 21, 2022): E608—E615. http://dx.doi.org/10.1532/hsf.4875.
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Background: Unplanned 30-day readmission post-cardiac surgery imposes higher risks for complications, increased costs, and unfavorable events for the care provider and patient. This study was to determine the unplanned readmission rate, determinants, and most common events within 30 days post-cardiac surgery. Recommendations to prevent or minimize these complications are included. Methods: Setting and design – a retrospective record review was conducted among all adult patients, who underwent open heart surgery between 2010 and 2020 at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. Using Google Forms, we manually collected data from hospital records. Statistical analysis used: binomial logistic regression model (using the backward stepwise method). Regression outcomes were expressed as odds ratios (ORs) and 95% CIs. A P-value of < 0.05 indicated statistical significance. Results: Among 400 patients who underwent cardiac surgery, 343 patients were included in the study, including 53 unplanned readmissions, which was a rate of 16.3% (95% CI, 12.8 to 20.6%). The most frequently reported reasons for readmission were sternal wound infections (7.3%), pleural effusion (2.0%), and heart failure (1.7%). Female gender, high postoperative LDH and urea were the most important risk factors. Conclusion: Discharge planning, patient education, and cardiac surgery nurse home visit constitute the most important factors to minimize 30 days of unplanned readmission.
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Zhang, Qi-Liang, Jian-Feng Liu, Wen-Peng Xie, Hua Cao, and Qiang Chen. "The Effect of WeChat on Parental Care Burden, Anxiety, and Depression in Children after CHD Surgery during COVID-19 Pandemic." Applied Clinical Informatics 12, no. 04 (August 2021): 768–73. http://dx.doi.org/10.1055/s-0041-1733850.
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Abstract Objectives This study aimed to explore the effect of applying WeChat in the follow-up and health education of children after congenital heart disease (CHD) surgery during the coronavirus disease 2019 (COVID-19) epidemic. Methods Data from 135 children were retrospectively analyzed. The care burden, anxiety, depression, and satisfaction of the parents of patients at home were analyzed and compared. Results One month after discharge, the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Zarit Burden Interview (ZBI), and Patient Satisfaction Questionnaire-18 scores of the WeChat follow-up group were significantly better than those of the outpatient follow-up group (p < 0.05). Compared with the discharge time, the SAS, SDS, and ZBI scores were significantly improved in the WeChat follow-up group but not in the outpatient follow-up group (p < 0.05). Conclusion During the COVID-19 epidemic, the application of WeChat to the follow-up management of children after CHD surgery can effectively reduce care burden and relieve anxiety and depression in parents at home. It can also improve the satisfaction of parents with medical treatment.
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Wang, Gang, Changqing Gao, Qi Zhou, and Tingting Chen. "Anesthesia Management for Robotically Assisted Endoscopic Coronary Artery Bypass Grafting on Beating Heart." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5, no. 4 (July 2010): 291–94. http://dx.doi.org/10.1097/imi.0b013e3181ed20ca.
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Objective To outline the initial anesthetic experience for robotically assisted coronary artery bypass grafting surgery on beating heart using the da Vinci surgical system. Methods Between February 2007 and September 2009, 76 patients received the surgery with the da Vinci S Surgical System. The crucial issue of anesthesia for the surgery is to deal with the hemodynamic compromise, hypoxia and hypercarbia relevant to one-lung ventilation (OLV), and intrathoracic insufflation of CO2 with positive pressure (CO2 pneumothorax). Results After initiation of OLV and CO2 pneumothorax, PaO2 and mixed venous saturation showed a significant decrease. Meanwhile, the SpO2 decreased to 92% in 14 of the 76 patients. In these patients, application of continuous positive airway pressure setting 5 to 15 cm H2O to the collapsed lung resulted in an increase in PaO2 from 59 ± 12 to 115 ± 23 mm Hg (P < 0.05). Moreover, at the beginning of CO2 pneumothorax, the most dramatic fall in mean arterial pressure and cardiac index was showed with an increase in mean pulmonary artery pressure and heart rate. The hemodynamic compromise was counteracted by transfusion and inotropes/vasopressors. Postoperatively, the average extubation time was 7.5 ± 3.1 hours, and median intensive care unit length of stay was 21 hours. One patient remained in the intensive care unit for 3 days for treatment of a postoperative pneumonia. There were two cases of new onset postoperative atrial fibrillation. All patients were discharged home 4 to 7 days after surgery. Conclusions Anesthetic management for the procedures requires detailed knowledge of OLV and CO2 pneumothorax in addition to expertise required in conventional cardiac surgery.
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Cujec, Bibiana, Hude Quan, Yan Jin, and David Johnson. "The Effect of Age upon Care and Outcomes in Patients Hospitalized for Congestive Heart Failure in Alberta, Canada." Canadian Journal on Aging / La Revue canadienne du vieillissement 23, no. 3 (2004): 253–65. http://dx.doi.org/10.1353/cja.2004.0030.
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ABSTRACTWe describe the age-specific outcomes for patients hospitalized with newly diagnosed congestive heart failure using administrative hospital abstracts from Alberta, Canada, from April 1, 1994, to March 31, 2000. Seniors (aged 65 years and older) constituted about 85 per cent of the 16,162 patients. Both co-morbidity and severity of illness tended to increase with age. The use of special care unit admissions, coronary artery diagnostic services (cardiac catheterization), and revascularization procedures (percutanenous transluminal coronary angioplasty/stenting, coronary artery bypass surgery) peaked in the 50-to 64-year age group and decreased with increasing age. Specialist/sub-specialist care, prescriptions of beta blockers and angiotensin-converting enzyme inhibitors / angiotensin receptor blockers decreased with age in seniors. Adjusted in-hospital, 1-year mortality and crude, age-specific 5-year mortality were significantly greater in those 75 years and older. Outcomes and process of care in patients with newly diagnosed congestive heart failure were not uniformly distributed with age. The elderly had greater mortality but received less therapy.
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Caraffa, Raphael, Lorenzo Bagozzi, Alessandro Fiocco, Olimpia Bifulco, Matteo Nadali, Matteo Ponzoni, Massimiliano Carrozzini, et al. "Coronavirus disease 2019 (COVID-19) in the heart transplant population: a single-centre experience." European Journal of Cardio-Thoracic Surgery 58, no. 5 (October 19, 2020): 899–906. http://dx.doi.org/10.1093/ejcts/ezaa323.
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Abstract OBJECTIVES Few anecdotal cases have been reported in the literature regarding heart transplant recipients and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report our experience with 6 patients hospitalized in Northern Italy during the outbreak. METHODS Of the 396 living heart transplant recipients from 1985 to 2020 included in the study, 6 patients developed the novel 2019 coronavirus disease. Risk factors, last follow-up characteristics, onset presentation, in-hospital course of disease and blood examinations data were collected for these patients. RESULTS All patients were symptomatic and had positive results from a nasopharyngeal swab test for SARS-CoV-2. Of the 6 patients, 5 were hospitalized and 1 remained self-quarantined at home. Two patients died and 3 were discharged home. Two patients were admittted to the intensive care unit . Immunosuppressive therapy was modified with a median reduction comprising doses that were 50% cyclosporine and 50% mycophenolate. All patients received a medium-dose of corticosteroids as a bolus medication in addition to their therapy. All hospitalized patients received hydroxychloroquine; 2 patients received ritonavir/lopinavir. Broad-spectrum antibiotics for prophylaxis were administered to all. One patient had an ischaemic stroke and died of sepsis. CONCLUSIONS In the absence of any strong evidence regarding the treatment of heart transplant recipients infected with SARS-CoV-2, we faced a new challenge in managing viral infection in an immunosuppressed population. Because immunomodulation interaction with the infection seems to be crucial for developing severe forms of the disease, we managed to reduce immunosuppressive therapy by adding medium doses of corticosteroids. Despite the limited number of affected patients, this report suggests that special considerations should be given to treating coronavirus disease in the heart transplant recipient population.
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Rahman, Md Toufiqur, and Akm Monwarul Islam. "APSC2015-1071 Prevalence of Coronary Artery Disease in Patients Undergoing Open Heart Surgery for Non-Coronary Lesions in A Superspecialized Centre." Global Heart 10, no. 2 (June 2015): e18. http://dx.doi.org/10.1016/j.gheart.2015.03.073.
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Ručinskas, Kęstutis, Saulius Miniauskas, Gintaras Rasimavičius, Rimantas Bubulis, Stanislovas Stankevič, Vaclovas Jurkuvėnas, Gitana Žemaitytė, Vytė Valerija Maneikienė, Vytautas Sirvydis, and Aleksandras Taucevičius. "Širdies nepakankamumo gydymas implantuojant dirbtinį skilvelį INCOR." Lietuvos chirurgija 5, no. 3 (January 1, 2007): 0. http://dx.doi.org/10.15388/lietchirur.2007.3.2230.
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Kęstutis Ručinskas1, Saulius Miniauskas1, Gintaras Rasimavičius1, Rimantas Bubulis2, Stanislovas Stankevič2, Vaclovas Jurkuvėnas2, Gitana Žemaitytė3, Vytė Valerija Maneikienė3, Vytautas Sirvydis1, Aleksandras Taucevičius41 Vilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto ligoninės Santariškių klinikų Anesteziologijos,intensyviosios terapijos ir skausmo gydymo centras, Santariškių g. 2, LT-08661 Vilnius3 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g. 2, LT-08661 Vilnius4 Vilniaus universiteto Širdies ir kraujagyslių ligų klinika, Santariškių g. 2, LT-08661 VilniusEl paštas: kestutis.rucinskas@santa.lt Dirbtinis implantuojamas pastovios tėkmės kairysis skilvelis INCOR Vilniaus universiteto Širdies chirurgijos centre naudojamas nuo 2003 metų. Pacientams, kuriems nustatytas kraštutinis širdies nepakankamumas, implantuota 14 dirbtinių skilvelių. Po prijungimo 9 pacientai buvo išrašyti į namus, 4 iš jų sulaukė širdies persodinimo operacijos. Šiuo metu ambulatoriškai stebimi 4 pacientai, kuriems implantuotas INCOR skilvelis. Bendras pacientų stebėjimo laikas yra daugiau kaip 8,5 metų. Dirbtinio skilvelio INCOR implantacija yra labai efektyvus atrinktos grupės pacientų širdies nepakankamumo gydymo būdas. Pagrindiniai žodžiai: širdies nepakankamumas, dirbtinis skilvelis, širdies persodinimas Treatment of heart failure by implanting an INCOR left ventricular assist device Kęstutis Ručinskas1, Saulius Miniauskas1, Gintaras Rasimavičius1, Rimantas Bubulis2, Stanislovas Stankevič2, Vaclovas Jurkuvėnas2, Gitana Žemaitytė3, Vytė Valerija Maneikienė3, Vytautas Sirvydis1, Aleksandras Taucevičius41 Cardial Surgery Centre, Vilnius University, Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University Hospital „Santariškių klinikos“, Anesthesiology,Intensive Care and Pain Management Center, Santariškių str. 2, LT-08661 Vilnius, Lithuania 3 Cardial Surgery Centre of Vilnius University Hospital „Santariškių klinikos“,Santariškių str. 2, LT-08661 Vilnius, Lithuania4 Vilnius University, Clinic of Cardiovascular Diseases,Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: kestutis.rucinskas@santa.lt Continuous blood flow ventricular assist devices, INCOR, are used at Vilnius University Cardial Surgery Centre since 2003. Fourteen of them were implanted to terminal heart failure patients. After the procedure, 9 patients were discharged home and 4 received heart transplant. At the present time, four patients with INCOR are being observed at home. The cumulative time of the patients with the INCOR assist device is 8.5 years. Effective treatment for a selected group of patients with heart failure is ventricular assist device INCOR implantation. Key words: heart failure, assist device, heart transplantation
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Mamun, Md Al, Md Masudul Haque, Md Abdul Aleem, Khondker Iqbal Karim, Dilip Kumar Bhowmick, and AKM Akhtaruzzaman. "Effect of propofol or oral midazolam and thiopental sodium as induction agent for day care surgery- a comparative study." Journal of the Bangladesh Society of Anaesthesiologists 25, no. 1 (August 3, 2014): 9–13. http://dx.doi.org/10.3329/jbsa.v25i1.60954.
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Background Day care surgery is widely acceptable and gaining popularity for more than a decade. Early recovery and cost effectiveness is an integral part of day care surgery in developing country.
Objective To compare the cost effectiveness & recovery score after oral midazolam and thiopental sodium or propofol induction in day care surgery.
Methods A total number of sixty patients, thirty in each group of ASA grade I & II were selected. In group -A patient receiving propofol 2mg/kg for induction and group B were given oral midazolam 0.25mg/ kg thirty minutes before induction with thiopental sodium 2.5mg/kg. Perioperative heart rate, BP, recovery score and time to ready to go home were monitored. Average cost of induction was calculated in both groups.
Result Recovery scores in group A & B were 8.8 ±1.75 and 8.01 ±1.03 respectively after thirty minutes of reversal. The cost of group B (BDT 37.88±1.37) was significantly lower (P<0.05) than that of group A (BDT 142.00 ± 6.00).
Conclusion Preoperative oral midazolam & low dose thiopental sodium induction is relatively cost effective than propofol induction in day care surgery.
JBSA 2012; 25(1): 9-13
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Saleem, Maryam, Usman Zeeshan, Dur I. Shahwar, Madiha Zafar, and Umar Iqbal. "Outcomes of Propofol or Thiopental Sodium and Oral Midazolam as an Induction Agent for Day Care Surgery." Pakistan Journal of Medical and Health Sciences 16, no. 9 (September 30, 2022): 504–6. http://dx.doi.org/10.53350/pjmhs22169504.
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Background: The increasing popularity of outpatient surgery has prompted the search for new anesthetic agent that can provide safe and effective anesthesia with a rapid and smooth recovery. Day care surgical procedure is extensively accepted and has been attaining recognition for over a time. The cost effectiveness and early recovery are an essential part of day-care surgical treatment in evolving countries. Aim: To compare the recovery score and cost-effectiveness after oral induction of midazolam and thiopental sodium with propofol alone in day-care surgical procedure. Methods: Eighty patients were selected, 40 in each ASA grade I and II group. In A group; patients were administered propofol at dose of 2 mg / kg for induction, and in group B; 0 2.5 mg / kg thiopental sodium and 0.25 mg / kg midazolam orally were given 30-mints prior to induction. Perioperative heart rate, time to ready to go home, blood pressure and recovery score were observed. The average induction cost was determined in group A and B. Results: After 30 minutes of reversal, the score of recovery in groups A and B were 8.90 ± 1.82 and 8.02 ± 1.01, correspondingly. The group B has significantly lesser cost (PKR 90.25±10.73) in comparison to the group A (PKR 700.0 ± 100.0) (p <0.05). Conclusions: Preoperative induction of oral midazolam and low doses of thiopental sodium is comparatively cost effective compared to induction of propofol in day-care surgical procedure. Keywords: Oral midazolam, Day care surgery, Propofol and Thiopental sodium.
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Kahraman, Ümit, Defne Güneş Ergi, Burcu Yağmur, Çağatay Engin, Tahir Yağdı, Sanem Nalbantgil, and Mustafa Özbaran. "Outcomes of patients with left ventricular assist device infected with SARS-CoV-2." Turkish Journal of Thoracic and Cardiovascular Surgery 30, no. 2 (April 1, 2022): 199–205. http://dx.doi.org/10.5606/tgkdc.dergisi.2022.23414.
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Background: The aim of this study was to describe clinical characteristics, course, and outcomes of the novel coronavirus disease 2019 (COVID-19) in heart failure patients with left ventricular assist device. Methods: Between November 2020 and August 2021, a total of 20 patients (18 males, 2 females; mean age: 57.0+10.0 years; range, 30 to 71 years) with left ventricular assist device and who were diagnosed by the COVID-19 polymerase chain reaction testing were included. For each patient, disease-related factors were evaluated including presence of hospitalization, home quarantine, presence of lung damage, antiviral medication strategy, symptomatology and complications following COVID-19. Results: Seven patients 35% patients died in our cohort following the COVID-19. All these patients experienced variety of complications following COVID-19 including subarachnoid hemorrhage and right heart failure. Three patients were already hospitalized due to COVID-19 and decompensated progressively, resulting in death on Days 14, 4, and 7 after the initial diagnosis. Conclusion: COVID-19 seems to be an important cause of mortality in patients with LVAD who have borderline cardiopulmonary function. Great care should be taken to avoid interruption in routine follow-ups with these patients, since they present a more sensitive population.
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Jacobs, Fleur, Jai Scheerhoorn, Eveline Mestrom, Jonna van der Stam, R. Arthur Bouwman, and Simon Nienhuijs. "Reliability of heart rate and respiration rate measurements with a wireless accelerometer in postbariatric recovery." PLOS ONE 16, no. 4 (April 28, 2021): e0247903. http://dx.doi.org/10.1371/journal.pone.0247903.
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Recognition of early signs of deterioration in postoperative course could be improved by continuous monitoring of vital parameters. Wearable sensors could enable this by wireless transmission of vital signs. A novel accelerometer-based device, called Healthdot, has been designed to be worn on the skin to measure the two key vital parameters respiration rate (RespR) and heart rate (HeartR). The goal of this study is to assess the reliability of heart rate and respiration rate measured by the Healthdot in comparison to the gold standard, the bedside patient monitor, during the postoperative period in bariatric patients. Data were collected in a consecutive group of 30 patients who agreed to wear the device after their primary bariatric procedure. Directly after surgery, a Healthdot was attached on the patients’ left lower rib. Vital signs measured by the accelerometer based Healthdot were compared to vital signs collected with the gold standard patient monitor for the period that the patient stayed at the post-anesthesia care unit. Over all patients, a total of 22 hours of vital signs obtained by the Healthdot were recorded simultaneously with the bedside patient monitor data. 87.5% of the data met the pre-defined bias of 5 beats per minute for HeartR and 92.3% of the data met the pre-defined bias of 5 respirations per minute for RespR. The Healthdot can be used to accurately derive heart rate and respiration rate in postbariatric patients. Wireless continuous monitoring of key vital signs has the potential to contribute to earlier recognition of complications in postoperative patients. Future studies should focus on the ability to detect patient deterioration in low-care environments and at home after discharge from the hospital.
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Maciolek, Kimberly, Zewditu E. Asfaw, Dorothy J. Krienbring, Susan E. Arnsdorf, and Husam H. Balkhy. "Robotic Endoscopic Off-Pump Total Pericardiectomy in Constrictive Pericarditis." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 11, no. 2 (March 2016): 134–37. http://dx.doi.org/10.1097/imi.0000000000000258.
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Objective Although rare, constrictive pericarditis is a serious condition with debilitating symptoms and often severe heart failure. Total pericardiectomy is the most effective treatment and is traditionally performed via median sternotomy. With the increasing use of minimally invasive techniques, there have been reports of partial pericardiectomy via thoracoscopy but with suboptimal exposure and difficulty identifying both phrenic nerves. Robotic surgery offers both small incisions and enhanced visualization. We present four cases of robotic endoscopic off-pump total pericardiectomy for constrictive pericarditis. Methods Four patients underwent off-pump total pericardiectomy with robotic assistance for constrictive pericarditis. All had constrictive physiology demonstrated by right heart catheterization and/or echo-cardiogram. One was also found to have coronary artery disease and underwent concurrent totally endoscopic coronary artery bypass grafting left internal mammary artery to left anterior descending artery. Ports were placed in the left second, fourth, and sixth intercostal spaces. The left lung was isolated and deflated with CO2 insufflation, aiding in exposure. With the use of electrocautery, the pericardium was removed first posterior to the left phrenic nerve, then anteriorly all the way to the right phrenic nerve, and caudally from the diaphragmatic reflection to the great vessel cephalad. A stabilizer in the subcostal fourth robotic arm was used to assist in the dissection. Results Two of four patients were extubated within 6 hours after surgery and transferred to the floor on postoperative day 1. Both were discharged home by postoperative day 5. Two of four patients had preoperative sequelae from chronic constriction and necessitated longer hospital and intensive care unit stays but had improvement in symptoms and were discharged home within 3 weeks. Conclusions Total pericardiectomy for constrictive pericarditis can be performed using a robotic approach. In contrast to thoracoscopy, it offers better visualization of both phrenic nerves, avoids injury, and allows a thorough pericardial dissection. In our experience, the robotic left chest approach has proven more efficacious in removing the posterior pericardium than is allowed with median sternotomy.
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Tolstova, E. M., N. S. Zaytseva, O. V. Zaytseva, S. R. Kuzina, D. V. Khaspekov, E. V. Efimova, I. V. Turishchev, and T. Yu Belyaeva. "Respiratory disorders in a child with multiple malformations." Meditsinskiy sovet = Medical Council, no. 1 (March 3, 2022): 236–42. http://dx.doi.org/10.21518/2079-701x-2022-16-1-236-242.
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Concomitant congenital malformations are an actual problem in pediatrics. Association of tracheobronchial tree anomalies and congenital heart disease (CHD) could be the cause of the patient’s condition deterioration before and after cardiac surgery. We present a clinical case of a patient with multiple malformations with a long-term and poorly corrected broncho-obstructive syndrome, combined with pneumonia and hypoventilation. After surgery for tetralogy of Fallot at 3 months, the boy needed mechanical ventilation for a long time due to bilateral pneumonia complicated by bilateral pneumothorax. At 7 months, a respiratory infection required hospitalization in the intensive care unit. When pneumonia resolved, the boy was discharged home with continued oxygen support using an oxygen concentrator. The reason for the patient’s prolonged respiratory failure could be explained by prolonged hypoventilation due to narrowing of the left main bronchus and consecutive congenital pneumonia, repeated aspirations, and postoperative mechanical ventilation-associated pneumonia with bilateral pneumothorax. At the age of 1 year 3 months in the Department of Thoracic Surgery of St. Vladimir’s biodegradable stent in the left main bronchus was installed. The bronchus lumen was restored. The boy did not need oxygen support, and his physical and motor development indicators improved. Thus, in patients with tetrad of Fallot, a thorough assessment of the condition of the tracheobronchial tree is advisable in order to develop an appropriate treatment plan if needed. The collaboration of specialists in various fields of care for pediatric patients is the basis for a favorable prognosis in terms of the full growth and development of patients with multiple malformations.
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Zhang, Chao, Mohamed Soliman-Hamad, Roxanne Robijns, Niels Verberkmoes, Frank Verstappen, and Wijnand A. IJsselsteijn. "Promoting Physical Activity With Self-Tracking and Mobile-Based Coaching for Cardiac Surgery Patients During the Discharge–Rehabilitation Gap: Protocol for a Randomized Controlled Trial." JMIR Research Protocols 9, no. 8 (August 19, 2020): e16737. http://dx.doi.org/10.2196/16737.
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Background Home-based cardiac rehabilitations (CRs) with digital technologies have been researched and implemented to replace, augment, and complement traditional center-based CR in recent years with considerable success. One problem that technology-enhanced home-based CR can potentially address is the gap between cardiac interventions and formal CR programs. In the Netherlands and some other countries (eg, Australia), patients after cardiac interventions stay at home for 3-4 weeks without much support from their physicians, and often engage in very little physical activity (PA). A home-based exercise program enabled by digital technologies may help patients to better prepare for the later center-based CR programs, potentially increasing the uptake rate of those programs. Objective In a randomized controlled trial (RCT), we will evaluate the effectiveness of a home-based walking exercise program enhanced by self-tracking and mobile-based coaching (treatment condition), comparing it with a version of the same program without these technologies (control condition). The added value of the digital technologies is justified if patients in the treatment group walk more steps on average (primary outcome) and show better physical fitness in a bicycle ergometer test and higher self-efficacy toward PA (secondary outcomes). Methods Based on a power analysis, we will recruit 100 cardiac patients and assign them evenly to the 2 parallel groups. Eligible patients are those who are scheduled in the postanesthesia care unit, know the Dutch language, have basic literacy of using smartphones, and are without medical conditions that may increase risks associated with PA. In a face-to-face meeting with a nurse practitioner, all patients are prescribed a 3-week exercise program at home (2 walking exercises per day with increasing duration), based on national and international guidelines and tailored to their physical conditions after cardiac intervention. Their physical activities (daily steps) will be measured by the Axivity AX3 accelerometer worn at hip position. Patients in the treatment group will also be supported by a Neo Health One self-tracking device and a mobile platform called Heart Angel, through which they are monitored and coached by their nurses. After the study, all patients will perform a bicycle ergometer test and return the devices within 1 week. In addition, 5 questionnaires will be sent to the patients by emails to assess their self-efficacy toward PA and other psychological states for exploratory analyses (at discharge, at the end of each monitoring week, and 1 week after the study). To minimize bias, the randomization procedure will be performed after introducing the exercise program, so the nurse practitioners are blind to the experimental conditions until that point. Results The study protocol has been approved by the Medical Research Ethics Committees United on February 26, 2018 (NL 62142.100.17/R17.51). By the end of 2018, we completed a small pilot study with 8 patients and the results based on interviews and app usage data suggest that a larger clinical trial with the targeted population is feasible. We expect to complete the RCT by the end of 2021, and statistical analyses will follow. Conclusions Results of the RCT will help us to test the hypothesized benefits of self-tracking and mobile-based coaching for cardiac patients in home-based exercise programs during the discharge–rehabilitation gap. If the results are positive, cost-effectiveness analysis will be performed based on the insights of the study to inform the translation of the technology-enhanced program to clinical practice. We also note limitations of the trial in the discussion. Trial Registration Registered at Netherlands Trial Register NL8040; https://www.trialregister.nl/trial/8040 International Registered Report Identifier (IRRID) PRR1-10.2196/16737
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Barrett-Lee, J., S. Barbur, J. Johns, J. Pearce, and RR Elliot. "Hip fractures in centenarians: a multicentre review of outcomes." Annals of The Royal College of Surgeons of England 103, no. 1 (January 2021): 59–63. http://dx.doi.org/10.1308/rcsann.2020.0203.
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Introduction Advances in healthcare have resulted in an increasing UK population, with the proportion of elderly individuals expanding significantly, including centenarians. Hospitals can expect to see growing numbers of so-called ‘super-elderly’ patients with trauma, a majority of whom will have hip fractures. We performed a multicentre review of hip fracture outcomes in centenarians to assess whether being an outlier in age correlates with poorer prognosis. Methods Centenarians admitted to Basingstoke, Southampton, Dorset, and Salisbury district hospitals with hip fractures between January 2014 and June 2019 were included. Electronic records were searched to obtain demographics, functional status, and admission details. Results A total of 60 centenarians were included, with a median age of 101 years (range 100–108 years), 85% of whom were female; 29 were admitted from their own home or sheltered housing and 31 from nursing or residential care; 33 had some outdoor mobility, 26 only mobilised indoors, and 1 had no mobility. Common comorbidities were renal and heart disease and dementia. Of the total, 56 underwent surgery, 51 within 36 hours. In terms of accommodation, 63.4% returned to their pre-injury level of independence. At 30 days, three months, and one year, mortality rates were 27% (n = 16), 40% (n = 24) and 55% (n = 33), respectively. Conclusion Trauma in the elderly population is an area of growing interest, yet few studies address centenarians with hip fractures. This work demonstrates that mortality rates within one year of injury were high, but almost half survived beyond a year. Two-thirds of patients regained their pre-injury level of independence, suggesting that functional recovery may not be as poor as previously reported.
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Brown, Katherine L., Jo Wray, Rachel L. Knowles, Sonya Crowe, Jenifer Tregay, Deborah Ridout, David J. Barron, et al. "Infant deaths in the UK community following successful cardiac surgery: building the evidence base for optimal surveillance, a mixed-methods study." Health Services and Delivery Research 4, no. 19 (May 2016): 1–176. http://dx.doi.org/10.3310/hsdr04190.
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BackgroundWhile early outcomes of paediatric cardiac surgery have improved, less attention has been given to later outcomes including post-discharge mortality and emergency readmissions.ObjectivesOur objectives were to use a mixed-methods approach to build an evidenced-based guideline for postdischarge management of infants undergoing interventions for congenital heart disease (CHD).MethodsSystematic reviews of the literature – databases used: MEDLINE (1980 to 1 February 2013), EMBASE (1980 to 1 February 2013), Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1981 to 1 February 2013), The Cochrane Library (1999 to 1 February 2013), Web of Knowledge (1980 to 1 February 2013) and PsycINFO (1980 to 1 February 2013). Analysis of audit data from the National Congenital Heart Disease Audit and Paediatric Intensive Care Audit Network databases pertaining to records of infants undergoing interventions for CHD between 1 January 2005 and 31 December 2010. Qualitative analyses of online discussion posted by 73 parents, interviews with 10 helpline staff based at user groups, interviews with 20 families whose infant either died after discharge or was readmitted urgently to intensive care, and interviews with 25 professionals from tertiary care and 13 professionals from primary and secondary care. Iterative multidisciplinary review and discussion of evidence incorporating the views of parents on suggestions for improvement.ResultsDespite a wide search strategy, the studies identified for inclusion in reviews related only to patients with complex CHD, for whom adverse outcome was linked to non-white ethnicity, lower socioeconomic status, comorbidity, age, complexity and feeding difficulties. There was evidence to suggest that home monitoring programmes (HMPs) are beneficial. Of 7976 included infants, 333 (4.2%) died postoperatively, leaving 7634 infants, of whom 246 (3.2%) experienced outcome 1 (postdischarge death) and 514 (6.7%) experienced outcome 2 (postdischarge death plus emergency intensive care readmissions). Multiple logistic regression models for risk of outcomes 1 and 2 had areas under the receiver operator curve of 0.78 [95% confidence interval (CI) 0.75 to 0.82] and 0.78 (95% CI 0.75 to 0.80), respectively. Six patient groups were identified using classification and regression tree analysis to stratify by outcome 2 (range 3–24%), which were defined in terms of neurodevelopmental conditions, high-risk cardiac diagnosis (hypoplastic left heart, single ventricle or pulmonary atresia), congenital anomalies and length of stay (LOS) > 1 month. Deficiencies and national variability were noted for predischarge training and information, the process of discharge to non-specialist services including documentation, paediatric cardiology follow-up including HMP, psychosocial support post discharge and the processes for accessing help when an infant becomes unwell.ConclusionsNational standardisation may improve discharge documents, training and guidance on ‘what is normal’ and ‘signs and symptoms to look for’, including how to respond. Infants with high-risk cardiac diagnoses, neurodevelopmental conditions or LOS > 1 month may benefit from discharge via their local hospital. HMP is suggested for infants with hypoplastic left heart, single ventricle or pulmonary atresia. Discussion of postdischarge deaths for infant CHD should occur at a network-based multidisciplinary meeting. Audit is required of outcomes for this stage of the patient journey.Future workFurther research may determine the optimal protocol for HMPs, evaluate the use of traffic light tools for monitoring infants post discharge and develop the analytical steps and processes required for audit of postdischarge metrics.Study registrationThis study is registered as PROSPERO CRD42013003483 and CRD42013003484.FundingThe National Institute for Health Research Health Services and Delivery Research programme. The National Congenital Heart Diseases Audit (NCHDA) and Paediatric Intensive Care Audit Network (PICANet) are funded by the National Clinical Audit and Patient Outcomes Programme, administered by the Healthcare Quality Improvement Partnership (HQIP). PICAnet is also funded by Welsh Health Specialised Services Committee; NHS Lothian/National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children, National Office of Clinical Audit Ireland, and HCA International. The study was supported by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. Sonya Crowe was supported by the Health Foundation, an independent charity working to continuously improve the quality of health care in the UK.
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Tashtish, Nour, Sadeer G. Al-Kindi, Mohamad Karnib, Erica Zanath, Steven Mitchell, Christopher Di Felice, Michael Zacharias, et al. "Causes and predictors of 30-day readmissions in patients with cardiogenic shock requiring extracorporeal membrane oxygenation support." International Journal of Artificial Organs 43, no. 4 (October 23, 2019): 258–67. http://dx.doi.org/10.1177/0391398819882025.
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Background: Cardiogenic shock is associated with significant mortality, morbidity, and healthcare cost. Utilization of extracorporeal membrane oxygenation in cardiogenic shock has increased in the United States. We sought to identify the rates and predictors of hospital readmissions in patients with cardiogenic shock after weaning from extracorporeal membrane oxygenation. Methods: Using the 2016 Nationwide Readmission Database, we identified all patients (⩾18 years) with cardiogenic shock (ICD-10 CM R57.0) that have been implanted with extracorporeal membrane oxygenation (ICD-10-PSC of 5A15223) and were discharged alive (January–November 2016). We explored the rates, causes, and predictors of all-cause readmissions within 30 days. Results: Out of 69,040 admissions with cardiogenic shock, 1641 (2.4%) underwent extracorporeal membrane oxygenation (581 were implanted during or after cardiac surgery). A total of 734 (44.7%) patients of all extracorporeal membrane oxygenations survived to discharge, and 661 were available for analysis. Out of those, 158 (23.9%) were readmitted within 30 days of discharge. More than 50% of these readmissions happened within the first 11 days. Out of 158 patients who were readmitted, 12 (7.4%) died during the readmission hospitalization. Leading causes of readmission were cardiovascular (31.6%) (heart failure: 24.1%, arrhythmia: 20.6%, neurovascular: 10.3%, hypertension: 10.3%, and endocarditis: 6.8%), followed by complications of medical/device care (17.7%), infection (11.3%), and gastrointestinal/liver (10.1%) complications. Factors associated with readmissions include the following: discharge to skilled nursing facility or with home healthcare (odds ratio: 2.10; 95% confidence interval: 1.18–3.74), durable ventricular assisted device implantation, asthma, and chronic liver disease. Conclusion: Patients with cardiogenic shock who underwent extracorporeal membrane oxygenation had a readmission rate. Identifying patients at high risk of readmissions might help improve outcomes.
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Lim, Sangtaeck, Gaurav Gangoli, Erica Adams, Robert Hyde, Michael S. Broder, Eunice Chang, Sheila R. Reddy, et al. "Increased Clinical and Economic Burden Associated With Peripheral Intravenous Catheter–Related Complications: Analysis of a US Hospital Discharge Database." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 56 (January 2019): 004695801987556. http://dx.doi.org/10.1177/0046958019875562.
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The burden of complications associated with peripheral intravenous use is underevaluated, in part, due to the broad use, inconsistent coding, and lack of mandatory reporting of these devices. This study aimed to analyze the clinical and economic impact of peripheral intravenous–related complications on hospitalized patients. This analysis of Premier Perspective® Database US hospital discharge records included admissions occurring between July 1, 2013 and June 30, 2015 for pneumonia, chronic obstructive pulmonary disease, myocardial infarction, congestive heart failure, chronic kidney disease, diabetes with complications, and major trauma (hip, spinal, cranial fractures). Admissions were assumed to include a peripheral intravenous. Admissions involving surgery, dialysis, or central venous lines were excluded. Multivariable analyses compared inpatient length of stay, cost, admission to intensive care unit, and discharge status of patients with versus without peripheral intravenous–related complications (bloodstream infection, cellulitis, thrombophlebitis, other infection, or extravasation). Models were conducted separately for congestive heart failure, chronic obstructive pulmonary disease, diabetes with complications, and overall (all 7 diagnoses) and adjusted for demographics, comorbidities, and hospital characteristics. We identified 588 375 qualifying admissions: mean (SD), age 66.1 (20.6) years; 52.4% female; and 95.2% urgent/emergent admissions. Overall, 1.76% of patients (n = 10 354) had peripheral intravenous–related complications. In adjusted analyses between patients with versus without peripheral intravenous complications, the mean (95% confidence interval) inpatient length of stay was 5.9 (5.8-6.0) days versus 3.9 (3.9-3.9) days; mean hospitalization cost was $10 895 ($10 738-$11 052) versus $7009 ($6988-$7031). Patients with complications were less likely to be discharged home versus those without (62.4% [58.6%-66.1%] vs 77.6% [74.6%-80.5%]) and were more likely to have died (3.6% [2.9%-4.2%] vs 0.7% [0.6%-0.9%]). Models restricted to single admitting diagnosis were consistent with overall results. Patients with peripheral intravenous–related complications have longer length of stay, higher costs, and greater risk of death than patients without such complications; this is true across diagnosis groups of interest. Future research should focus on reducing these complications to improve clinical and economic outcomes.
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Memon, Ali, Patrick Lec, Andrew Lenis, Vidit Sharma, Erika Wood, George Schade, and Wayne Brisbane. "Relationship Between Mobile Digital Sensor Monitoring and Perioperative Outcomes: Systematic Review." JMIR Perioperative Medicine 4, no. 1 (February 25, 2021): e21571. http://dx.doi.org/10.2196/21571.
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Background Monitoring surgical recovery has traditionally been confined to metrics measurable within the hospital and clinic setting. However, commercially available mobile sensors are now capable of extending measurements into a patient’s home. As these sensors were developed for nonmedical applications, their clinical role has yet to be established. The aim of this systematic review is to evaluate the relationship between data generated by mobile sensors and postoperative outcomes. Objective The objective of this study is to describe the current use of mobile sensors in the perioperative setting and the correlation between their data and clinical outcomes. Methods A systematic search of EMBASE, MEDLINE, and Cochrane Library from inception until April 2019 was performed to identify studies of surgical patients monitored with mobile sensors. Sensors were considered if they collected patient metrics such as step count, temperature, or heart rate. Studies were included if patients underwent major surgery (≥1 inpatient postoperative day), patients were monitored using mobile sensors in the perioperative period, and the study reported postoperative outcomes (ie, complications and hospital readmission). For studies including step count, a pooled analysis of the step count per postoperative day was calculated for the complication and noncomplication cohorts using mean and a random-effects linear model. The Grading of Recommendations, Assessment, Development, and Evaluation tool was used to assess study quality. Results From 2209 abstracts, we identified 11 studies for review. Reviewed studies consisted of either prospective observational cohorts (n=10) or randomized controlled trials (n=1). Activity monitors were the most widely used sensors (n=10), with an additional study measuring temperature, respiratory rate, and heart rate (n=1). Low step count was associated with worse postoperative outcomes. A median step count of around 1000 steps per postoperative day was associated with adverse surgical outcomes. Within the studies, there was heterogeneity between the type of surgery and type of reported postoperative outcome. Conclusions Despite significant heterogeneity in the type of surgery and sensors, low step count was associated with worse postoperative outcomes across surgical specialties. Further studies and standardization are needed to assess the role of mobile sensors in postoperative care, but a threshold of approximately 1000 steps per postoperative day warrants further investigation.
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Davies, Megan, Teresa Brooks, and Stephen Morris. "P34 Medicines optimisation for infants and children attending a children’s cardiology ward for day case diagnostic cardiac catheter procedures." Archives of Disease in Childhood 107, no. 5 (April 20, 2022): e25.36-e25. http://dx.doi.org/10.1136/archdischild-2022-nppg.41.
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IntroductionInfants and children with congenital heart defects are reliant on medicines to treat the symptoms of heart failure whilst they wait for corrective or palliative surgery. Medicines optimisation for this group of patients is a complex and challenging concept. This is because there are many factors that need to be considered to ensure the effective and safe use of these medicines.Infants and children undergo significant physiological and pharmacological changes over a relatively short period of time.1 In addition, this group of patients also present challenges for the safe administration of these medicines at home.2 Failure to optimise these medicines may result in reduced symptom control with negative effects on health outcomes for the family and child.The aim of this service evaluation was to identify whether patients attending for day case diagnostic catheter procedures on the children’s cardiology ward could benefit from having their medicines optimised during their hospital visit.MethodData was collected prospectively over a period of 7 months from August 2019 to March 2020. Patients were included if they attended the children’s cardiology ward for a day case diagnostic cardiac catheter during the study period. In addition, they needed to be taking at least one long-term medicine at home.A pharmacist with experience in children’s medicines conducted a medication review with the family during their attendance. This included a consultation about which medicines were being taken at home, and listening to the experience that the family had from using their medicines. Medicines were then reviewed using up to date information such as weight, test results and medicines information resources. Anonymous data was kept using a Microsoft Excel® spreadsheet.ResultsIn total, 175 patients were assessed for inclusion during the study period. 57 families were found to be administering a long-term medicine at home and had their medicines reviewed. Subsequently, 13 patients had their medicines optimised.The most common recommendation was to increase the dose of a medicine for an up to date weight or because of failure to control symptoms (n=11). This was frequently seen with medicines such as aspirin, captopril and diuretics.In addition, more subtle and unexpected interventions regarding medication safety at home were also identified (n=2). For example, one family were found to be ten times under dosing their child due to an unidentified change in strength of liquid medication from primary care. Another family described their difficulty with crushing and dispersing tablets to administer using a nasogastric tube. This resulted in a block tube that required an additional hospital visit to have a new tube inserted. Additional action was taken to report and rectify these medication errors.ConclusionThis project has demonstrated the value that can be gained from a pharmacist providing ongoing reviews of medicines used by families when they attend a children’s cardiology centre. Day case admissions in a specialist hospital may be seen as low priority to professionals. However, this is an ideal opportunity to provide support to families who use medicines at home.ReferencesKearns GL, Abdel-Rahman SM, Alander SW, et al. Developmental pharmacology--drug disposition, action, and therapy in infants and children. New England Journal of Medicine 2003;349:1157-1167.NHS England and NHS Improvement. The NHS patient safety strategy. Safer culture, safer systems, safer patients. 2019. [Cited: 14th August 2021]. Available at: https://www.england.nhs.uk/patient-safety/the-nhs-patient-safety-strategy/
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Talner, Norman S. "Report of the New England Regional Infant Cardiac Program, by Donald C. Fyler, MD, Pediatrics, 1980;65(suppl):375–461." Pediatrics 102, Supplement_1 (July 1, 1998): 258–59. http://dx.doi.org/10.1542/peds.102.s1.258.
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The New England Regional Infant Cardiac Program (NERICP) is a voluntary association of all hospitals in the New England states which offer definitive care for infants with heart disease. With the purpose of improving infant cardiac care, the program began in 1968 and continues to the present. Specific activities include professional education to improve case finding and earlier referral; identification and subsidy of appropriate transportation facilities; improved communication with participating hospitals; subsidy of follow-up where needed; provision for room and board for indigent parents when their baby has been moved some distance from home; and continuing nursery nurse education in the recognition of infants with heart disease. All participating hospitals agree to tabulation of their entire experience with infants with heart disease (3626 infants in 9 years). Case histories of surviving infants have been updated systematically. The period of July 1968 to June 1974 was selected for this detailed analysis because data from this period form the basis of an ongoing long-term follow-up study and have been reverified several times. This analysis is continued to the first year of life. More recent data, July 1974 to June 1977, are discussed separately and italicized numerical data from 1974 to 1977 have been added to tables where the results may be of interest. In the early years, case finding rose by 20% and has continued to increase gradually. By 1976, there were 2.4 NERICP infants per 1000 live births identifiable in the New England states. Surveys of state vital statistics showed a 50% decrease in infants who died with heart disease who did not reach a participating hospital. Neonates are admitted to participating hospitals earlier; admissions of infants less than 2 days old increased from 20% to 34% in 1977. Of infants admitted in 1977, more than 50% were in the first week of life. During the period of study from 1969 to 1974, there was a consolidation of hospital services for infants with heart disease. Of the initial 11 participating hospitals in 1969, by 1974, there were 5 hospitals offering a full range of cardiac services, 3 hospitals offering limited surgical services, 2 hospitals no longer performing cardiac catheterizations or cardiac surgery in infants, and 1 hospital that had discontinued all pediatric cardiology. Despite expected differences in case findings, the patient material and management of patients among the various hospitals were surprisingly comparable. There was little variation in the kinds of heart disease encountered over the years, among the states, and among the hospitals. There was a significantly higher mortality among infants whose birth weight was less than 2.0 kg and among infants who had additional, severe noncardiac anomalies. Mortality was significantly higher for infants admitted in the first days or weeks of life and cardiac surgery resulted in higher mortalities in this age group. Among the many specific anatomic diagnostic categories, there was little change in outcome during the years 1969 to 1974. Subsequently, immediate and 30-day survival from surgical procedures showed improvement whether viewed by age at surgery, diagnosis, operative procedure, or years. The introduction of early reparative surgery, as opposed to early palliative surgery followed by late repair, occurred in 1973. Subsequent data showed an increasing number of “open heart” procedures in infants with steadily improving 30-day mortality. A similar fall in mortality for closed heart procedures was documented. Results of palliation versus repair for ventricular septal defects, transposition of the great arteries, and tetralogy of Fallot were investigated. The average number of days of hospitalization, the number of cardiac catheterizations, and the numbers of cardiac operations were evaluated. By using hospital charges for 1975, the estimated cost for care of an average cardiac infant for the first year of life ranged from $3800 to $7200 (average $6699). Among the hospitals, the payments by state agencies for hospital costs in the first year of life were estimated to range from $4300 to $8000 per patient for the same year. Because NERICP can provide detailed data on a consecutive series of infants from a finite geographic area, epidemiologic information can be gleaned (Am J Epidemiol 1976; 104:527, Am J Epidemiol 1979; 109:433). Similarly, detailed experience with the various anatomic cardiac lesions was extracted and presented as a guideline for expected average experience for regions outside of New England.
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Cheng, Davy C. H., Jacek Karski, Charles Peniston, Ganesh Raveendran, Buvanendran Asokumar, Jo Carroll, Tirone David, and Alan Sandler. "Early Tracheal Extubation after Coronary Artery Bypass Graft Surgery Reduces Costs and Improves Resource Use." Anesthesiology 85, no. 6 (December 1, 1996): 1300–1310. http://dx.doi.org/10.1097/00000542-199612000-00011.
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Background Economics has caused the trend of early tracheal extubation after cardiac surgery, yet no prospective randomized study has directly validated that early tracheal extubation anesthetic management decreases costs when compared with late extubation after cardiac surgery. Methods This prospective, randomized, controlled clinical trial was designed to evaluate the cost savings of early (1-6 h) versus late tracheal extubation (12-22 h) in patients after coronary artery bypass graft (CABG) surgery. The total cost for the services provided for each patient was determined for both the early and late groups from hospital admission to discharge home. All costs applicable to each of the services were classified into direct variables, direct fixed costs, and overhead (an indirect cost). Physician fees and heart catheterization costs were included. The total service cost was the sum of unit workload and overhead costs. Results One hundred patients having elective CABG who were younger than 75 yr were studied. Including all complications, early extubation (n = 50) significantly reduced cardiovascular intensive care unit (CVICU) costs by 53% (P < 0.026) and the total CABG surgery cost by 25% (P < 0.019) when compared with late extubation (n = 50). Forty-one patients (82%) in each group were tracheally extubated within the defined period. In the early extubation group, the actual departmental cost savings in CVICU nursing and supplies was 23% (P < 0.005), in ward nursing and supplies was 11% (P < 0.05), and in respiratory therapy was 12% (P < 0.05). The total cost savings per patient having CABG was 9% (P < 0.001). Further cost savings using discharge criteria were 51% for CVICU nursing and supplies (P < 0.001), 9% for ward nursing and supplies (P < 0.05), and 29% for respiratory therapy (P < 0.001), for a total cost savings per patient of 13% (P < 0.001). Early extubation also reduced elective case cancellations (P < 0.002) without any increase in the number of postoperative complications and readmissions. Conclusions Early tracheal extubation anesthetic management reduces total costs per CABG surgery by 25%, predominantly in nursing and in CVICU costs. Early extubation reduces CVICU and hospital length of stay but does not increase the rate or costs of complications when compared with patients in the late extubation group. It shifts the high CVICU costs to the lower ward costs. Early extubation also improves resource use after cardiac surgery when compared with late extubation.
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Joseph, Ranjit, Amanda Strickland, James Burner, Sean Yates, William Tharpe, and Ravindra Sarode. "A Single Center Retrospective Analysis of Outcomes Following the Use of 4-Factor Prothrombin Complex Concentrate for Warfarin Reversal in Real-Life Settings." Blood 124, no. 21 (December 6, 2014): 1561. http://dx.doi.org/10.1182/blood.v124.21.1561.1561.
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Abstract Introduction Reversal of vitamin K antagonists (VKA) is required in patients presenting with acute major bleeding or requiring urgent surgery. Recent clinical trials lead to FDA approval of a 4 Factor-PCC (4F-PCC, Kcentra) for urgent VKA reversal. The thromboembolic events (TEE) are most concerning side effects of PCC; these studies showed similar TEE as compared to plasma. However, clinical trials had many exclusion criteria that would not apply in real-life practice. Therefore, we performed a retrospective analysis of real-life patients undergoing urgent VKA reversal with 4F-PCC to evaluate TEE and all-cause mortality. Methods A retrospective chart review was performed for patients who received 4F-PCC between April 2013 to July 2014 at 3 UT Southwestern hospitals to look for TEE and deaths. Patients were identified from pharmacy and transfusion services information systems. We recorded patients’ demographics, indications for VKA and PCC, and coagulation parameters before and after PCC administration. TEE was defined as any arterial or venous event detected by imaging, elevation in cardiac biomarkers, and clinical documentation. Results Fifty-two patients (age 27-89, 32 males) received PCC for VKA reversal for acute major bleeding or prior to urgent surgical procedure. Thirty-four (65.4%) patients had acute bleeding and 18 (34.6%) patients required urgent surgery. The median length of hospital stay was 8.5 days. The median time from pre-PCC INR to PCC administration was 2 h and 48 min. The median PCC dose was 33 IU/kg. Median pre-PCC INR was 3.1 (range 1.5-14), post-PCC INR was 1.3 (range 0.9-1.9), and at 24 hours 24h-INR was 1.2 (range 0.9-3.5). Vitamin K was given to 46/52 patients (mean dose 6.5 mg; 30 IV, 9 oral and 3 subcutaneous). There were 2 TEE (3.8%). One occurred in a patient with antiphospholipid antibody syndrome who presented with gastro-intestinal bleed. Exploratory laparotomy on day 2 post-PCC revealed necrotic bowel. Repeat CT abdomen on day 3 showed a new occlusion of an accessory renal artery along with ischemic changes in the liver, spleen and colon. The patient was in septic shock and was made comfort measures; care was withdrawn 4 days post-PCC. This TEE was possibly related to PCC. The second patient had non-ischemic cardiomyopathy and mural thrombus and received 30.4 IU/kg of PCC for an INR of 1.5 prior to a heart transplant. She developed a lower extremity deep vein thrombosis 7 days post-PCC, while she was on heparin drip for intra-aortic balloon pump and thus was unrelated to PCC. Twelve patients died. Six died during the same hospitalization; 3 died within 3 days of PCC administration due to massive subdural hematomas, metastatic pancreatic cancer, and massive retroperitoneal hemorrhage complicated with septic shock and multi-organ failure. The remaining 3 died on post-PCC days 4, 5 and 48 due to septic shock resulting in multi-organ failure, hemorrhagic shock following cardiac surgery, and rejection of heart transplant, respectively. Six patients died following discharge; 4 in hospice care between 11 to 90 days post-PCC, 1 committed suicide at 9 days post-PCC, and 1 patient with multiple comorbidities died at home 3 months post-PCC. Conclusion This is the first retrospective analysis studying TEE and all-cause mortality following 4F-PCC for warfarin reversal in the real world setting. Our data show that 4F-PCC is safe for warfarin reversal when appropriately administered. Risks and benefits of using 4F-PCC should be addressed, especially in patients with a hypercoagulable state. Disclosures Sarode: CSL Behring: Consultancy.
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Ni, Ruping, Maobai Liu, Shunmin Huang, and Jing Yang. "Effects of eHealth Interventions on Quality of Life and Psychological Outcomes in Cardiac Surgery Patients: Systematic Review and Meta-analysis." Journal of Medical Internet Research 24, no. 8 (August 16, 2022): e40090. http://dx.doi.org/10.2196/40090.
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Background Patients undergoing heart surgery may experience a range of physiological changes, and the postoperative recovery time is long. Patients and their families often have concerns about quality of life (QoL) after discharge. eHealth interventions may improve patient participation, ensure positive and effective health management, improve the quality of at-home care and the patient's quality of life, and reduce rates of depression. Objective The purpose of this study was to evaluate the effects of eHealth interventions on the physiology, psychology, and compliance of adult patients after cardiac surgery to provide a theoretical basis for clinical practice. Methods We conducted systematic searches of the following 4 electronic databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Mean (SD) values were used to calculate the pooled effect sizes for all consecutive data, including QoL, anxiety, and depression. Where the same results were obtained using different instruments, we chose the standardized mean difference with a 95% CI to represent the combined effect size; otherwise, the mean difference (MD) with a 95% CI was used. Odds ratios were used to calculate the combined effect size for all dichotomous data. The Cohen Q test for chi-square distribution and an inconsistency index (I2) were used to test for heterogeneity among the studies. We chose a fixed-effects model to estimate the effect size if there was no significant heterogeneity in the data (I2≤50%); otherwise, a random-effects model was used. The quality of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). Results The search identified 3632 papers, of which 19 met the inclusion criteria. In terms of physical outcomes, the score of the control group was lower than that of the intervention group (MD 0.15, 95% CI 0.03-0.27, I2=0%, P=.02). There was no significant difference in the mental outcomes between the intervention and control groups (MD 0.10, 95% CI –0.03 to 0.24, I2=46.4%, P=.14). The control group’s score was lower than that of the intervention group for the depression outcomes (MD –0.53, 95% CI –0.89 to –0.17, I2=57.1%, P=.004). Compliance outcomes improved in most intervention groups. The results of the sensitivity analysis were robust. Nearly half of the included studies (9/19, 47%) had a moderate to high risk of bias. The quality of the evidence was medium to low. Conclusions eHealth improved the physical component of quality of life and depression after cardiac surgery; however, there was no statistical difference in the mental component of quality of life. The effectiveness of eHealth on patient compliance has been debated. Further high-quality studies on digital health are required. Trial Registration PROSPERO CRD42022327305; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327305
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Linkins, Lori Ann, Connor Warne, and Mark A. Crowther. "Comparison of Incidence and Investigation of In-Hospital Pulmonary Embolism In Patients Receiving Dalteparin Prophylaxis Following Elective Knee Replacement at Two Hospitals." Blood 116, no. 21 (November 19, 2010): 4388. http://dx.doi.org/10.1182/blood.v116.21.4388.4388.
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Abstract Abstract 4388 Background: The incidence of in-hospital pulmonary embolism (PE)in patients who received dalteparin prophylaxis following elective total knee replacement (TKR) at a tertiary care centre was reported to be surprisingly high at 4.6% (Kerr et al, Thromb Haemost 2010, 103:123-128). Objective: To compare the incidence and investigation of in-hospital PE between two centres that used dalteparin prophylaxis following elective TKR. Method: Charts of consecutive patients who underwent elective TKR and received dalteparin prophylaxis between January and June 2008 were retrospectively reviewed. A standardized case report form was used to abstract data on patient age, gender, type of surgery, risk factors for venous thromboembolism (VTE)(i.e. active cancer, prior history of VTE, hormonal therapy), results of imaging studies performed for suspected VTE, and in-hospital death. Electronic records were reviewed for 90 days after the date of surgery to capture subsequent studies for VTE performed at the same institution. Because the original study identified postoperative day 3 (POD#3) as the day that the majority of investigations were ordered for PE, a subgroup of 100 patients were randomly selected at each site, and data were abstracted on vital statistics which may have raised suspicion of PE: requirement for at least 2 litres of oxygen to keep oxygen saturation ≥ 92% or heart rate > 100 beats per minute or systolic blood pressure < 100 mmHg (These values were selected based on data from the original study). Results: The protocol at both hospitals dictated that the first dose of dalteparin (5,000 units subcut) was to be given on POD#1. At Hospital A only, 54 patients (12%) received dalteparin 2,500 units subcut 6 hours after surgery (personal practice of one surgeon). None of the in-hospital PEs were fatal. The incidence of VTE (non-fatal and fatal) after discharge is less reliable because patients may have presented for medical attention at centres other than the hospital where they underwent surgery or died at home. In the POD#3 substudy, the proportion of patients investigated for in-hospital PE was 11% and 3%, at Hospital A and Hospital B, respectively and the proportion of patients investigated for PE who were diagnosed with PE was 54% (6/11) and 0, respectively. The proportion of patients with at least one vital statistic which may have raised suspicion of PE on POD#3(hypoxia, tachycardia, hypotension) was similar at the two sites (45% vs 43%). Conclusion: The higher incidence of in-hospital PE in one of two hospitals using the same method of thromboprophylaxis following elective TKR was likely the result of a more aggressive approach to investigation. The clinical importance of detecting these emboli is uncertain. Disclosures: Crowther: Pfizer: Consultancy; Leo Pharma: Research Funding; Boehringer Ingelheim: Research Funding.
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Lingamaneni, Prasanth, Binav Baral, Krishna Rekha Moturi, Trilok Shrivastava, Omnia Darweesh, and Shweta Gupta. "Sixty-day unplanned readmissions after robot-assisted versus open-radical prostatectomy." Journal of Clinical Oncology 39, no. 6_suppl (February 20, 2021): 244. http://dx.doi.org/10.1200/jco.2021.39.6_suppl.244.
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244 Background: Options for clinically localized prostate cancer include radical prostatectomy, radiation therapy and active surveillance. Robot-assisted radical prostatectomy (RARP) is increasingly being used, and now accounts for the majority of radical prostatectomies performed in the United States. The aim of our study was to evaluate differences in the patient population undergoing open versus robot-assisted prostatectomy, and to compare 60-day readmissions after index hospitalization for radical prostatectomy. Methods: We utilized the Nationwide Readmission database (NRD) to obtain data on patients with prostate cancer admitted in 2016 and 2017 for radical prostatectomy in the United States. We used T-test to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Multivariable logistic regression was used evaluate risk factors for 60-day unplanned readmissions. Results: A total of 115,551 patients met the inclusion criteria, of which 80.1% underwent RARP. Patients undergoing RARP were slightly older (64.8 vs 63.1 years, p < 0.0001), more likely to have private insurance (51.7% vs 44.3%, p < 0.0001) and undergo surgery at a teaching hospital (83% vs 74.6%, p < 0.0001). Importantly, open prostatectomy (OP) patients had higher rates of co-morbidities, including, hypertension, diabetes mellitus, chronic kidney disease, obstructive lung disease, heart failure, coronary artery disease and malnutrition (p < 0.01 for these co-morbidities). Hospital stay was longer in those who underwent OP (3.1 vs 1.7 days, p < 0.0001), and they were more likely to be discharged to nursing facility (3.0% vs 0.4%, p < 0.0001) or with home health care (10.9% vs 4.8%, p < 0.0001). Hospitalization charges were higher in the RARP population ($60k vs 57k, p = 0.04). Inpatient mortality was low in both groups (0.3% for OP and ~0% for RARP, p < 0.001). 60-day readmission rate was higher in those who underwent OP (9.3% vs 5.0%, p > 0.0001). Overall, the three leading causes for readmission included sepsis (10.6%), post-procedure infection (8.4%) and venous thromboembolism (VTE, 8.3%). Even after adjustment for age and comorbidities, those who underwent OP had higher risk of all-cause readmission (aOR 1.39, 95% CI 1.25-1.53, p < 0.001) and readmissions for sepsis (aOR 1.36, 95% CI 1.02-1.81, p = 0.03) and post-procedure infection (aOR 1.38, 95% CI 1.06-1.81, p = 0.02). Risk of readmission for VTE was similar in both groups. Conclusions: Nationwide, there are differences in demographics and comorbid illness burden in prostate cancer patients selected for open and robot-assisted radical prostatectomy. Better short-term outcomes in the RARP cohort may be partially attributed to lower comorbidity burden in this group. However, despite adjustment for comorbidities, higher risk for all-cause readmissions and readmissions for infectious complications persisted in the OP group.
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Ochi, Eisuke, Katsunori Tsuji, Tomomi Narisawa, Yoichi Shimizu, Aya Kuchiba, Akihiko Suto, Kenjiro Jimbo, et al. "Abstract P4-11-11: Effect of home-based smartphone-supported high-intensity interval training on cardiorespiratory fitness in breast cancer survivors: A randomized controlled trial of the habit-B program." Cancer Research 82, no. 4_Supplement (February 15, 2022): P4–11–11—P4–11–11. http://dx.doi.org/10.1158/1538-7445.sabcs21-p4-11-11.
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Abstract Background: A strategy for maintaining and/or improving cardiorespiratory fitness (CRF) in the growing population of cancer survivors is of major clinical importance in the COVID-19 era. With the aim of increasing CRF, recent studies have focused on the use of high-intensity interval training (HIIT) in supervised experimental settings, which appeared to be more beneficial than usual care in cancer survivors at all stages of treatment and aftercare. However, the effect of unsupervised HIIT on increasing CRF in breast cancer survivors is not known. Purpose: To determine whether the newly developed habit-B program, which involves home-based smartphone-supported HIIT using body-weight exercises, improves CRF in early-stage breast cancer survivors. We hypothesized that the habit-B program would improve VO2peak compared with a control group. Methods: This single-center, 12-week, parallel-group, single-blind, randomized controlled trial involved 50 women with stage I-IIa breast cancer, aged 20 to 59 years, who had completed initial treatment except for hormone therapy. Participants wore a smartwatch and were randomized to either the exercise or control group from May 27, 2019 through November 30, 2020. The planned sample size was 60 patients to detect the increase of 2.0 ml/kg/min change in VO2peak with a standard deviation of 2.6 ml/kg/min, one-sided significance level of 2.5% and 80% power. The exercise group underwent home-based HIIT using a smartphone and a Fitbit Versa thrice weekly for 12 weeks (three times per week). The primary outcome was the 12-week change in peak oxygen uptake (VO2peak; mL/kg/min) between the groups. Other outcomes included muscle strength, 6-min walk test, resting heart rate, physical activity, fatigue, safety, and quality of life. Results: Of the 50 participants, 44 (exercise group, n=23; control group, n=21) completed the CRF assessment and 6 did not because of issues related to the COVID-19 pandemic. The change in VO2peak increased significantly in the exercise group (0.9 [95%CI, 0.1 to 1.7]) compared with the control group (-0.8 [95%CI, -1.5 to -0.1]) (mean difference, 1.7 [95% CI, 0.7 to 2.7], p < .01). Leg strength also increased significantly in the exercise group compared with the control group (mean difference, 13.5 [95% CI, 2.9 to 24.1], p < .01). Changes in other outcomes were not significantly different between the groups. Conclusion: A home-based HIIT intervention can lead to improved cardiorespiratory fitness and muscle strength in early-stage breast cancer survivors; however, a multicenter pragmatic clinical trial is required to confirm the benefits of the habit-B program. Table 1.Demographic and medical characteristicsCharacteristicshabit-B (n = 25)Control (n = 25)Age, mean (SD), y48 (6)49 (5)Body mass index, mean (SD), kg/m221.0 (2.2)20.9 (2.0)Diastolic blood pressure, mean (SD), mmHg78 (8)81 (10)Systolic blood pressure, mean (SD), mmHg119 (13)129 (11)Alcohol consumption, n (%)≤weekly8 (32)5 (20)1–6 drinks per week15 (60)19 (76)Daily2 (8)1 (4)Highest Education, n (%)Junior high school0 (0)1 (4)High school3 (12)0 (0)College or more22 (88)24 (96)Employment status, n (%)Full- or part-time worker21 (84)21 (84)On leave1 (4)0 (0)Housewife3 (12)4 (16)Time the patient can use for herself, n (%)<14 hours/week10 (40)5 (20)14–25 hours/week8 (32)11 (44)>25 hours/week7 (28)9 (36)Past history of medical illness, n (%)6 (24)6 (24)Breast cancer stageI18 (72)18 (72)IIA7 (28)7 (28)TumorEstrogen receptor positive24 (96)25 (100)Progesterone receptor positive24 (96)24 (96)HER2 positive1 (4)0 (0)Receiving hormone therapy, n (%)24 (96)23 (92)Tamoxifen, n (%)18 (72)18 (72)Anastrozole, n (%)1 (4)4 (16)Other, n (%)5 (20)1 (4)Receiving radiotherapy, n (%)11 (44)12 (48)Time since surgery, mean (SD) months5 (4)6 (4) Table 2.Changes in cardiorespiratory fitness and muscle strength from baseline to week 12habit-B (n = 21)Control (n = 23)Between-group differenceMean (SD)Mean (SD)Mean (95% CI)ESpPrimary endpointVO2peak (ml/kg/min)Baseline25.0 (3.0)24.9 (4.6)Week 1225.9 (2.8)24.1 (4.0)Within-group difference0.9 (1.7)-0.8 (1.6)1.7 (0.7 to 2.7)1.06<0.01Secondary endpointCardiorespiratory fitness6-min walk test (m)Baseline586 (43)603 (59)Week 12615 (42)631 (68)Within-group difference30 (30)29 (40)1 (-21 to 23)0.260.93VO2peak (L/min)Baseline1.33 (0.18)1.32 (0.29)Week 121.39 (0.23)1.29 (0.26)Within-group difference0.06 (0.11)-0.03 (0.09)0.10 (0.03 to 0.16)0.95<0.01Muscle strengthGrip strength (kgw)Baseline22.4 (3.8)23.3 (4.2)Week 1223.2 (4.2)23.7 (3.4)Within-group difference0.8 (2.0)0.4 (2.1)0.4 (-0.9 to 1.6)0.260.53Leg press one-repetition maximum (kg)Baseline93.6 (24.3)98.7 (40.6)Week 12106.6 (26.7)98.2 (30.9)Within-group difference13.0 (15.9)-0.5 (18.1)13.5 (2.9 to 24.1)0.790.01Chair stand test (s)Baseline14.4 (3.2)13.7 (2.5)Week 1213.5 (2.9)13.3 (2.5)Within-group difference-0.9 (2.7)-0.4 (1.8)-0.5 (-1.9 to 0.9)-0.210.50 Citation Format: Eisuke Ochi, Katsunori Tsuji, Tomomi Narisawa, Yoichi Shimizu, Aya Kuchiba, Akihiko Suto, Kenjiro Jimbo, Shin Takayama, Taro Ueno, Naomi Sakurai, Yutaka J Matsuoka. Effect of home-based smartphone-supported high-intensity interval training on cardiorespiratory fitness in breast cancer survivors: A randomized controlled trial of the habit-B program [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-11.
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Shafrir, A. L., L. A. Wise, J. R. Palmer, Z. O. Shuaib, L. M. Katuska, P. Vinayak, M. Kvaskoff, K. L. Terry, and S. A. Missmer. "Validity of self-reported endometriosis: a comparison across four cohorts." Human Reproduction 36, no. 5 (February 17, 2021): 1268–78. http://dx.doi.org/10.1093/humrep/deab012.
Full textAbstract:
Abstract STUDY QUESTION How accurately do women report a diagnosis of endometriosis on self-administered questionnaires? SUMMARY ANSWER Based on the analysis of four international cohorts, women self-report endometriosis fairly accurately with a > 70% confirmation for clinical and surgical records. WHAT IS KNOWN ALREADY The study of complex diseases requires large, diverse population-based samples, and endometriosis is no exception. Due to the difficulty of obtaining medical records for a condition that may have been diagnosed years earlier and for which there is no standardized documentation, reliance on self-report is necessary. Only a few studies have assessed the validity of self-reported endometriosis compared with medical records, with the observed confirmation ranging from 32% to 89%. STUDY DESIGN, SIZE, DURATION We compared questionnaire-reported endometriosis with medical record notation among participants from the Black Women’s Health Study (BWHS; 1995-2013), Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (E3N; 1990-2006), Growing Up Today Study (GUTS; 2005–2016), and Nurses’ Health Study II (NHSII; 1989–1993 first wave, 1995–2007 second wave). PARTICIPANTS/MATERIALS, SETTING, METHODS Participants who had reported endometriosis on self-administered questionnaires gave permission to procure and review their clinical, surgical, and pathology medical records, yielding records for 827 women: 225 (BWHS), 168 (E3N), 85 (GUTS), 132 (NHSII first wave), and 217 (NHSII second wave). We abstracted diagnosis confirmation as well as American Fertility Society (AFS) or revised American Society of Reproductive Medicine (rASRM) stage and visualized macro-presentation (e.g. superficial peritoneal, deep endometriosis, endometrioma). For each cohort, we calculated clinical reference to endometriosis, and surgical- and pathologic-confirmation proportions. MAIN RESULTS AND THE ROLE OF CHANCE Confirmation was high—84% overall when combining clinical, surgical, and pathology records (ranging from 72% for BWHS to 95% for GUTS), suggesting that women accurately report if they are told by a physician that they have endometriosis. Among women with self-reported laparoscopic confirmation of their endometriosis diagnosis, confirmation of medical records was extremely high (97% overall, ranging from 95% for NHSII second wave to 100% for NHSII first wave). Importantly, only 42% of medical records included pathology reports, among which histologic confirmation ranged from 76% (GUTS) to 100% (NHSII first wave). Documentation of visualized endometriosis presentation was often absent, and details recorded were inconsistent. AFS or rASRM stage was documented in 44% of NHSII first wave, 13% of NHSII second wave, and 24% of GUTS surgical records. The presence/absence of deep endometriosis was rarely noted in the medical records. LIMITATIONS, REASONS FOR CAUTION Medical record abstraction was conducted separately by cohort-specific investigators, potentially introducing misclassification due to variation in abstraction protocols and interpretation. Additionally, information on the presence/absence of AFS/rASRM stage, deep endometriosis, and histologic findings were not available for all four cohort studies. WIDER IMPLICATIONS OF THE FINDINGS Variation in access to care and differences in disease phenotypes and risk factor distributions among patients with endometriosis necessitates the use of large, diverse population samples to subdivide patients for risk factor, treatment response and discovery of long-term outcomes. Women self-report endometriosis with reasonable accuracy (>70%) and with exceptional accuracy when women are restricted to those who report that their endometriosis had been confirmed by laparoscopic surgery (>94%). Thus, relying on self-reported endometriosis in order to use larger sample sizes of patients with endometriosis appears to be valid, particularly when self-report of laparoscopic confirmation is used as the case definition. However, the paucity of data on histologic findings, AFS/rASRM stage, and endometriosis phenotypic characteristics suggests that a universal requirement for harmonized clinical and surgical data documentation is needed if we hope to obtain the relevant details for subgrouping patients with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by Eunice Kennedy Shriver National Institute of Child Health and Development grants HD48544, HD52473, HD57210, and HD94842, National Cancer Institute grants CA50385, R01CA058420, UM1CA164974, and U01CA176726, and National Heart, Lung, and Blood Institute grant U01HL154386. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. AS, SM, and KT were additionally supported by the J. Willard and Alice S. Marriott Foundation. MK was supported by a Marie Curie International Outgoing Fellowship within the 7th European Community Framework Programme (#PIOF-GA-2011-302078) and is grateful to the Philippe Foundation and the Bettencourt-Schueller Foundation for their financial support. Funders had no role in the study design, conduct of the study or data analysis, writing of the report, or decision to submit the article for publication. LA Wise has served as a fibroid consultant for AbbVie, Inc for the last three years and has received in-kind donations (e.g. home pregnancy tests) from Swiss Precision Diagnostics, Sandstone Diagnostics, Kindara.com, and FertilityFriend.com for the PRESTO cohort. SA Missmer serves as an advisory board member for AbbVie and a single working group service for Roche; neither are related to this study. No other authors have a conflict of interest to report. Funders had no role in the study design, conduct of the study or data analysis, writing of the report, or decision to submit the article for publication. TRIAL REGISTRATION NUMBER N/A.
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Sarkar, Shreya, Jeffrey MacLeod, Ansar Hassan, Keith Brunt, and Jean-François Légaré. "Abstract 15964: Improving the Care of Frail or Vulnerable Patients Undergoing Cardiac Surgery." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.15964.
Full textAbstract:
Background: Increasingly frail/ vulnerable patients are undergoing cardiac surgery. The purpose of this study was, Phase 1: Create a hospital record-based Frailty Index (FI) to better quantify frailty in cardiac surgery &, Phase 2: Implement a novel Telehealth Home monitoring Enhanced- Frailty After Cardiac Surgery (THE-FACS) intervention to improve outcomes. Methods: Phase 1: A 21clinical deficit-based retrospective FI was created using New Brunswick Heart Centre registry, patients grouped into terciles & evaluated for prolonged hospitalization, discharge disposition. Phase 2: Vulnerable patients were recruited prospectively to test the applicability of THE-FACS, which used a tablet device to monitor patient responses daily for 30 days. Trained cardiac surgery follow-up (F/U) nurses monitored the data & contacted patients only if the algorithm triggered an alert. Primary outcomes of interest were prolonged hospitalization, non-home discharge & hospital readmission. Results: Phase 1: A FI was constructed with records from 3463 cardiac surgery patients. The most frail patients (n= 898, 26 %) had prolonged hospitalization (7 days vs. 5 days; p< 0.001), non-home discharge (49 % vs. 17 %; p< 0.001), higher 30 day readmission (18 % vs. 10 %; p< 0.001) & mortality (4.8 % vs. 0.7 %; p< 0.001). Multivariable analysis showed that FI was an independent predictor of composite outcome. Phase 2: Vulnerable patients (64 from 86 approached) were prospectively recruited, representing 34 % of potential surgeries (86/ 254). Several patients required prolonged hospitalization (15/ 64) or non-home discharge (12/ 64). THE-FACS was used in the remaining 35/ 64 patients. 21/ 35 patients completed the 30 day F/U, largely due to technical difficulties with the system. There were few ER visits (10 %) & no readmission, with THE-FACS being easy (100 %), satisfactory (95 %) & amenable to re-use (67 %). Conclusions: Our study highlights that frailty, affecting ~1/3 rd of patients undergoing cardiac surgery, significantly impacts outcomes. Findings from our pilot, THE-FACS, support the feasibility of targeted interventions in some vulnerable patients. However, our results suggest frequent technical challenges & inability to use early in many patients due to delayed discharge.