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Hemodynamic profiles during pulmonary artery pressure sensor implantation: Risk stratification in chronic HFrEF
No full textBackground: Invasive hemodynamics may facilitate outpatient identification of ambulatory advanced HF. We analyzed cardiac failure risk stratified by four hemodynamic profiles recorded during implantation of the pulmonary artery pressure (PAP) sensor, CardioMEMS™ HF system.
Methods: This multicenter, retrospective cohort study included HFrEF patients who underwent PAP sensor implantation from 2015 to 2022. Hemodynamic profiles were categorized using the Stevenson HF classification, defining cold (impaired systemic perfusion) as cardiac index \u3c2.2L/min/m2; and wet (hemodynamic congestion) as pulmonary capillary wedge pressure ≥18mmHg. The primary endpoint was 1-year cardiac failure, including all-cause mortality, inotrope dependence, need for durable VAD or heart transplantation.
Results: Among 512 patients (median age 71 years, 28% female, 77% NYHA class III, median NT-proBNP 2554 pg/mL), the hemodynamic profiles were as follows: 30% Warm-Dry, 22% Warm-Wet, 21% Cold-Dry, and 27% Cold-Wet. Overall, 118 patients (23%) experienced cardiac failure, of which 57 required chronic inotrope, durable VAD implantation, or heart transplantation and 61 died with medical therapy. One-year event-free survival differed across the profiles: Warm-Dry (90%), Warm-Wet (74%), Cold-Dry (80%), and Cold-Wet (61%) (P
Conclusion: At time of PAP sensor placement, an abnormal hemodynamic profile - especially Cold-Wet - was associated with increased cardiac failure risk, indicating subgroups who might have already progressed to ambulatory advanced heart failure
Major Themes and Inferences From the Community Health Needs Assessment (CHNA) for the County of Milwaukee, Wisconsin
No full textIterative Process for Improving Compliance With Synoptic Operative Reports in a Large Healthcare System
No full textWhen stroke strikes early: Unusual causes of intracerebral hemorrhage in young adults
No full textBackground/Objectives: Intracerebral hemorrhage (ICH) is primarily a disease of older adults, commonly linked to chronic hypertension and cerebral amyloid angiopathy. In young adults, however, ICH is rare and often driven by distinct structural, hematologic, or vascular causes.
Methods: Using the National Inpatient Sample (2016-2022), we identified hospitalizations with a primary diagnosis of ICH (ICD-10-CM: I61.x). Patients younger than 18 years were excluded. Patients were stratified into 18-39 vs. ≥40 years. Comorbidities were defined using validated ICD-10 codes (E08-E13 for diabetes mellitus, I10-I15 for hypertension), excluding transient hyperglycemia (R73.x). Weighted analyses using NIS discharge weights compared demographics, comorbidities, rare etiologies, and outcomes, including in-hospital mortality, length of stay (LOS), and total hospital charges. Survey-weighted multivariable logistic regression identified independent predictors of mortality.
Results: Among 76,264 ICH hospitalizations, 4012 (5.3%) occurred in patients \u3c 40 years. Compared with older adults, younger patients had lower prevalence of hypertension (47.8% vs. 84.1%) and diabetes (10.2% vs. 60.4%) but higher rates of substance use (27.7% vs. 15.6%). Rare etiologies were more frequent, including arteriovenous malformation/aneurysm (14.0% vs. 3.6%), Moyamoya disease (1.4% vs. 0.2%), sickle cell disease (1.1% vs. 0.1%), and pregnancy-related ICH (0.05%). In-hospital mortality was lower among young adults (15.7% vs. 21.7%, p \u3c 0.001), though LOS was longer (12.1 vs. 8.7 days, p \u3c 0.001), and mean hospital charges were higher (125,000, p \u3c 0.001).
Conclusions: Young-adult ICH is uncommon but etiologically distinct, often associated with vascular malformations, hemoglobinopathies, and substance use. Despite lower mortality, these patients experience longer and more resource-intensive hospitalizations, underscoring a substantial clinical and economic burden
Coordination of care between a primary care physician and a chiropractic resident for the management of meralgia paresthetica: A case report
No full textObjective: The purpose of this case report is to describe the collaborative management between a primary care physician and a chiropractic resident in a large private-sector integrated healthcare system for the evaluation and treatment of a patient with meralgia paresthetica.
Clinical Features: A 46-year-old male presented to a Family Medicine department within a large integrated healthcare system’s outpatient clinic for an annual physical and evaluation in which he reported the presence of upper left anterior thigh numbness of 2 days duration.
Intervention and Outcome: The primary care physician and chiropractic resident collaborated on differential diagnosis and agreed upon a coordinated plan of care inclusive of a referral for chiropractic management. A case appropriate history and problem focused physical examination was conducted, which revealed clinical findings consistent with meralgia paresthetica. A treatment plan consisting of anti-inflammatory medication, therapeutic exercise, soft tissue mobilization techniques, patient education, and ergonomic instruction was initiated as part of an evidence-informed approach. The patient responded favorably to collaborative care and demonstrated improved patient reported outcomes as assessed with a verbal numerical rating scale.
Conclusion: The combined management demonstrated key themes of effective healthcare collaboration and resulted in the resolution of the patient\u27s condition
Patient management after flow diversion for unruptured intracranial aneurysms: A literature review and DELPHI consensus
No full textBackground: Unruptured intracranial aneurysms are a common and can have devastating outcomes if ruptured. Flow diversion has expanded treatment options, especially for wide-necked and blister aneurysms. Yet, optimal follow-up retreatment strategies in case of treatment failure remain unclear. A DELPHI consensus was initiated to understand current practice in aneurysm management after flow diverter treatment.
Methods: This DELPHI consensus was conducted during the 5 T Think Tank, following a scoping literature review. Experts discussed the results, responded to iterative questionnaires, which started with four open-ended questions, and concluded with ten closed-ended questions.
Results: Of the 40 attendees, 24 participants (60%) identified as experts in flow diversion and participated in the DELPHI process, which involved a literature search and three DELPHI rounds. Consensus was reached on performing the first assessment of the flow diverter during the procedure using cone-beam CT (77.8%), and on timing of the first follow up (at 6 months, 70.8%). For follow-up timing, an annual (57%) or semi-annual (43%) schedule was favored. No preference emerged for the follow-up imaging modality, with slight preferences for MRA (29%), followed by DSA (25%), DSA + MRA (21%), CTA (17%), and DSA + CTA (8%). Aneurysm growth (\u3e 2 mm) was identified as a key criterion for retreatment. It was thought that combining clinical and angiographic metrics should be a key research priority, as it could potentially improve retreatment decision making compared to a purely angiographic outcome.
Conclusion: This DELPHI consensus highlights the complexity of decision-making for unruptured intracranial aneurysms. Despite these challenges, there was consensus among international experts on follow-up timing and decision drivers for retreatment
