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Utilization and Outcomes of Temporary Percutaneous Right Ventricular Assist Devices in Cardiogenic Shock.
No full textAcute right ventricular failure (RVF) is a common finding in cardiogenic shock (CS), yet the optimal method of supporting the failing RV remains unclear. This study aimed to describe CS patients receiving percutaneous right ventricular assist devices (pRVADs) using the multicenter Cardiogenic Shock Working Group (CSWG) registry. Among 6,201 patients with CS, 152 (2.4%) received pRVADs, with ProtekDuo and Impella RP being used in 71% and 29% of cases, respectively. The average age of this group was 58.5 years, with a higher proportion of men (66.4%). Heart failure-associated CS (HF-CS) was observed in 48% of patients, while myocardial infarction-associated CS (MI-CS) was seen in 27% (HF-CS versus MI-CS: 52.8% vs. 21.3% for ProtekDuo; 36.4% vs. 40.9% for Impella RP; p = 0.01). The overall in-hospital mortality rate was 54.6%, bleeding complications were more prevalent among ProtekDuo recipients (64.8% vs. 43.2%, p = 0.008), whereas Impella RP recipients had shorter hospital stays (20.4 ± 18.7 vs. 41.9 ± 31.5 days, p \u3c 0.001). ProtekDuo was more commonly used in patients with HF-CS and was associated with higher rates of bleeding and longer hospital stays compared with Impella RP, although overall mortality was similar. Further investigation is required to determine the ideal timing and clinical conditions warranting pRVAD deployment in CS
Assessment of Atrial Size, Shape, and Contractility in Growth-Restricted and Small-for-Gestational-Age Fetuses.
No full textOBJECTIVES: The size, shape, and contractility of the heart\u27s atrial chambers have not been evaluated in fetuses with growth restriction (FGR) or who are small-for-gestational-age (SGA) as defined by the Delphi consensus protocol. This study aimed to examine the atrial chambers using speckle tracking analysis to identify any changes that may be specific for either growth disturbance.
METHODS: Sixty-three fetuses were evaluated with an estimated fetal weight \u3c 10th percentile who were classified as FGR or SGA based on the Delphi consensus protocol. The atrial cardiac cycle was defined as end-diastole, end-systole, and end-diastole, equivalent to ventricular end-systole, end-diastole, and end-systole. The atrial size, shape, and contractility were computed from 24 transverse segments and one length measurement identified from speckle tracking analysis of the endocardium at end-diastole and end-systole. The z-score for each atrial measurement was computed using the mean and standard deviation equations from a control group of 200 fetuses. The z-score values were compared between the control and FGR/SGA fetuses as well as between FGR and SGA fetuses using the Kruskal-Wallis test. A P-value of \u3c .05 was considered significant.
RESULTS: Of the 63 fetuses with an estimated fetal weight (EFW) \u3c 10th percentile, 60% (38/63) were classified as FGR and 40% (25/63) as SGA. The following abnormal atrial measurements were unique to FGR fetuses: decreased end-diastolic left atrial (LA) area, decreased LA base and mid-chamber end-diastolic width, decreased LA base sphericity index, decreased right atrial (RA) mid-chamber sphericity index, decreased LA ejection volume, and decreased LA emptying volume. The following were unique to the SGA fetuses: Increased RA mid-chamber length, decreased LA fractional area change, decreased RA reservoir strain, decreased RA basal-apical length fractional shortening, and decreased LA base width transverse fractional shortening. The significant difference was an increased LA mid-chamber length in the SGA fetuses.
CONCLUSIONS: Fetuses with an EFW \u3c 10th percentile who are classified as either SGA or FGR demonstrate unique abnormalities of atrial size, shape, and contractility, thus allowing the examiner to differentiate between FGR and SGA fetuses
Deploying Ambient Clinical Intelligence to Improve Care: A Research Article Assessing the Impact of Nuance DAX on Documentation Burden and Burnout
No full textIntroduction Occupational burnout among clinical care providers, due in part to documentation burden, has reached crisis level. This study measured the effect of using new clinical documentation software, an ‘ambient clinical intelligence’ (ACI) program, to reduce the documentation workload and improve provider well-being. Methods This was a randomised, control study with a step-wedge design. Providers were randomly assigned to use ACI early or late in the study. Medical records metadata captured time spent on documentation. Measures of burden and burnout were collected monthly. Results ACI significantly reduced documentation burden, provider frustration and burnout. Providers spent less documentation time each day, and 2.5 hours less per week of off-hours documentation. Discussion This study demonstrates that the use of ACI does indeed relieve the documentation burden and had both subjective and objective benefits. The widespread use of ACI has the potential to alleviate the crisis of physician burnout
Medical digital twins: enabling precision medicine and medical artificial intelligence.
No full textThe notion of medical digital twins is gaining popularity both within the scientific community and among the general public; however, much of the recent enthusiasm has occurred in the absence of a consensus on their fundamental make-up. Digital twins originate in the field of engineering, in which a constantly updating virtual copy enables analysis, simulation, and prediction of a real-world object or process. In this Health Policy paper, we evaluate this concept in the context of medicine and outline five key components of the medical digital twin: the patient, data connection, patient-in-silico, interface, and twin synchronisation. We consider how various enabling technologies in multimodal data, artificial intelligence, and mechanistic modelling will pave the way for clinical adoption and provide examples pertaining to oncology and diabetes. We highlight the role of data fusion and the potential of merging artificial intelligence and mechanistic modelling to address the limitations of either the AI or the mechanistic modelling approach used independently. In particular, we highlight how the digital twin concept can support the performance of large language models applied in medicine and its potential to address health-care challenges. We believe that this Health Policy paper will help to guide scientists, clinicians, and policy makers in creating medical digital twins in the future and translating this promising new paradigm from theory into clinical practice
Subcutaneous sensors for monitoring congestion and to reduce heart failure hospitalizations-a viable middle ground between deep implantable intravascular monitoring devices and wearable technologies?
No full textCongestive heart failure (CHF) remains a leading cause of hospitalization and mortality worldwide. Continuous monitoring is crucial for early detection of decompensation, potentially reducing hospital admissions and improving outcomes. Cardiac implantable electronic devices (CIEDs) have been established as useful therapeutic interventions that also support continuous monitoring in order to detect early signs of decompensation. However, prior to CIED implantation, effective continuous monitoring solutions are lacking. They exist at two extremes: deep implantable intravascular solutions such as pulmonary artery pressure sensors, which are effective but costly and complex, and wearables, which are inexpensive but lack evidence of their effectiveness and depend on ongoing active patient adherence. Subcutaneous sensors may represent a promising intermediate solution-offering continuous monitoring with lower invasiveness and cost, while maintaining higher adherence compared to wearables. This review explores the role of subcutaneous sensors in CHF management, comparing existing daily trend data to deep implantable sensors measuring direct filling pressure and CIEDs for multi-parametric risk scoring. We discuss their feasibility, limitations, and future integration into routine clinical practice
