Development of the Mexican Heart Team: The Long and Winding Road

Cardiology ◽  
2016 ◽  
Vol 135 (1) ◽  
pp. 53-55
Author(s):  
J. Alfredo Merino-Rajme ◽  
Lilian G. Delgado-Espejel ◽  
Julieta D. Morales-Portano ◽  
Marco A. Alcántara-Meléndez ◽  
J. Francisco García-García ◽  
...  
Keyword(s):  
Heart Failure ◽  
Developing Country ◽  
Cause Of Death ◽  
Optimal Strategy ◽  
Multidisciplinary Approach ◽  
Mortality Rates ◽  
Heart Team ◽  
Current Article

Heart failure (HF) is the leading cause of death worldwide. Efforts to decrease HF mortality rates include a multidisciplinary approach management. Although evidence suggests that this has been an optimal strategy for treating HF, the model remains not widely implanted. The current article explores the rationale behind the formation of a Heart Team in a developing country and its development despite the lack of an allocated budget.

scholarly journals Trends in heart failure-related cardiovascular mortality in rural versus urban United States counties, 2011–2018: A cross-sectional study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0246813
Author(s):  
Jacob B. Pierce ◽  
Nilay S. Shah ◽  
Lucia C. Petito ◽  
Lindsay Pool ◽  
Donald M. Lloyd-Jones ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Cause Of Death ◽  
Negative Binomial ◽  
The United States ◽  
Mortality Rates ◽  
County Level ◽  
Physician Density ◽  
Rural And Urban ◽  
Related Mortality

Background Adults in rural counties in the United States (US) experience higher rates broadly of cardiovascular disease (CVD) compared with adults in urban counties. Mortality rates specifically due to heart failure (HF) have increased since 2011, but estimates of heterogeneity at the county-level in HF-related mortality have not been produced. The objectives of this study were 1) to quantify nationwide trends by rural-urban designation and 2) examine county-level factors associated with rural-urban differences in HF-related mortality rates. Methods and findings We queried CDC WONDER to identify HF deaths between 2011–2018 defined as CVD (I00-78) as the underlying cause of death and HF (I50) as a contributing cause of death. First, we calculated national age-adjusted mortality rates (AAMR) and examined trends stratified by rural-urban status (defined using 2013 NCHS Urban-Rural Classification Scheme), age (35–64 and 65–84 years), and race-sex subgroups per year. Second, we combined all deaths from 2011–2018 and estimated incidence rate ratios (IRR) in HF-related mortality for rural versus urban counties using multivariable negative binomial regression models with adjustment for demographic and socioeconomic characteristics, risk factor prevalence, and physician density. Between 2011–2018, 162,314 and 580,305 HF-related deaths occurred in rural and urban counties, respectively. AAMRs were consistently higher for residents in rural compared with urban counties (73.2 [95% CI: 72.2–74.2] vs. 57.2 [56.8–57.6] in 2018, respectively). The highest AAMR was observed in rural Black men (131.1 [123.3–138.9] in 2018) with greatest increases in HF-related mortality in those 35–64 years (+6.1%/year). The rural-urban IRR persisted among both younger (1.10 [1.04–1.16]) and older adults (1.04 [1.02–1.07]) after adjustment for county-level factors. Main limitations included lack of individual-level data and county dropout due to low event rates (<20). Conclusions Differences in county-level factors may account for a significant amount of the observed variation in HF-related mortality between rural and urban counties. Efforts to reduce the rural-urban disparity in HF-related mortality rates will likely require diverse public health and clinical interventions targeting the underlying causes of this disparity.

scholarly journals Mortality Associated with Idiopathic Pulmonary Fibrosis in Northeastern Italy, 2008–2020: A Multiple Cause of Death Analysis

2021 ◽  
Vol 18 (14) ◽  
pp. 7249
Author(s):  
Alessandro Marcon ◽  
Elena Schievano ◽  
Ugo Fedeli
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Cause Of Death ◽  
Age Groups ◽  
Mortality Rates ◽  
Annual Percent Change ◽  
Northeastern Italy ◽  
Mortality Ratio ◽  
The Impact ◽  
Related Mortality

Mortality from idiopathic pulmonary fibrosis (IPF) is increasing in most European countries, but there are no data for Italy. We analysed the registry data from a region in northeastern Italy to assess the trends in IPF-related mortality during 2008–2019, to compare results of underlying vs. multiple cause of death analyses, and to describe the impact of the COVID-19 epidemic in 2020. We identified IPF (ICD-10 code J84.1) among the causes of death registered in 557,932 certificates in the Veneto region. We assessed time trends in annual age-standardized mortality rates by gender and age (40–74, 75–84, and ≥85 years). IPF was the underlying cause of 1310 deaths in the 2251 certificates mentioning IPF. For all age groups combined, the age-standardized mortality rate from IPF identified as the underlying cause of death was close to the European median (males and females: 3.1 and 1.3 per 100,000/year, respectively). During 2008–2019, mortality rates increased in men aged ≥85 years (annual percent change of 6.5%, 95% CI: 2.0, 11.2%), but not among women or for the younger age groups. A 72% excess of IPF-related deaths was registered in March–April 2020 (mortality ratio 1.72, 95% CI: 1.29, 2.24). IPF mortality was increasing among older men in northeastern Italy. The burden of IPF was heavier than assessed by routine statistics, since less than two out of three IPF-related deaths were directly attributed to this condition. COVID-19 was accompanied by a remarkable increase in IPF-related mortality.

scholarly journals Unusual Presentation of Kratom Overdose With Rhabdomyolysis, Transient Hearing Loss, and Heart Failure

2021 ◽  
Vol 9 ◽  
pp. 232470962110050
Author(s):  
Vikram Sangani ◽  
Naseem Sunnoqrot ◽  
Kurdistan Gargis ◽  
Akshay Ranabhotu ◽  
Abbas Mubasher ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hearing Loss ◽  
Cardiac Death ◽  
Multidisciplinary Approach ◽  
Kidney Injury ◽  
Lethal Effect ◽  
Limited Information ◽  
Emergency Physicians ◽  
Behavioral Impairment ◽  
Elevated Creatinine

Kratom mainly grows in Southeast Asia. It is widely used for pain management and opioid withdrawal, which is available online for cheaper prices. Alkaloids extracted from kratom such as mitragynine and 7-hydroxy mitragynine exhibit analgesic properties by acting through µ receptors. Commonly reported side effects of kratom include hypertension, tachycardia, agitation, dry mouth, hallucinations, cognitive and behavioral impairment, cardiotoxicity, renal failure, cholestasis, seizures, respiratory depression, coma, and sudden cardiac death from cardiac arrest. Rhabdomyolysis is a less commonly reported lethal effect of kratom. Limited information is available in the literature. In this article, we present a case of a 45-year-old female who is overdosed with kratom and presented with lethargy, confusion, transient hearing loss, and right lower extremity swelling and pain associated with weakness who was found to have elevated creatinine phosphokinase. She was diagnosed with rhabdomyolysis, compartment syndrome, multiorgan dysfunction including acute kidney injury, liver dysfunction, and cardiomyopathy. She underwent emergent fasciotomy and required hemodialysis. Her renal and liver function subsequently improved. We described the case and discussed pharmacology and adverse effects of kratom toxicity with a proposed mechanism and management. We conclude that it is essential for emergency physicians, internists, intensivists, cardiologists, and nephrologists to be aware of these rare manifestations of kratom and consider a multidisciplinary approach.

scholarly journals Case report: Buddy wire technique to facilitate atrial septal crossing during transcatheter transseptal mitral valve implantation

2020 ◽  
Author(s):  
Ashvarya Mangla ◽  
Ameer Musa ◽  
Clifford J Kavinsky ◽  
Hussam S Suradi
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Heart Valve ◽  
Interatrial Septum ◽  
Chronic Obstructive ◽  
Mitral Valve Stenosis ◽  
Heart Team ◽  
Transcatheter Heart Valve ◽  
Valve Implantation ◽  
Buddy Wire

Abstract Background Transcatheter mitral valve-in-valve implantation (MVIV) has emerged as a viable treatment option in patients at high risk for surgery. Occasionally, despite appropriate puncture location and adequate dilation, difficulty is encountered in advancing the transcatheter heart valve across interatrial septum. Case summary We describe a case of a 79-year-old woman with severe chronic obstructive pulmonary disease (COPD), prior surgical bioprosthetic aortic and mitral valve replacement implanted in 2007, atrial fibrillation, and Group II pulmonary hypertension who presented with progressively worsening heart failure symptoms secondary to severe bioprosthetic mitral valve stenosis and moderate-severe mitral regurgitation. Her symptoms had worsened over several months, with multiple admissions at other institutions with treatment for both COPD exacerbation and heart failure. Transoesophageal echocardiogram demonstrated preserved ejection fraction, normal functioning aortic valve, and dysfunctional mitral prosthesis with severe stenosis (mean gradient 13 mmHg) and moderate-severe regurgitation. After a multi-disciplinary heart team discussion, the patient underwent a transcatheter MVIV implantation. During the case, inability in advancing the transcatheter heart valve (THV) across interatrial septum despite adequate septal balloon pre-dilation was successfully managed with the support of a stiff ‘buddy wire’ anchored in the left upper pulmonary vein using the same septal puncture. The patient tolerated the procedure well and was discharged home. Discussion Operators should be aware of potential strategies to advance the THV when difficulty is encountered in crossing the atrial septum despite adequate septal preparation. One such strategy is the use of stiff ‘buddy wire’ for support which avoids the need for more aggressive septal dilatation.

scholarly journals Healthcare-related impact of gout in hospitalized patients in Spain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Diego Benavent ◽  
Diana Peiteado ◽  
María Ángeles Martinez-Huedo ◽  
María Hernandez-Hurtado ◽  
Alejandro Balsa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Kidney Disease ◽  
Mortality Rates ◽  
Progressive Increase ◽  
Cerebrovascular Diseases ◽  
Hospitalized Patients ◽  
Data Set ◽  
Private Hospitals ◽  
Risk Of Mortality ◽  
General Mortality

AbstractTo analyze the epidemiology, clinical features and costs of hospitalized patients with gout during the last decade in Spain. Retrospective observational study based on data from the Minimum Basic Data Set (MBDS) from the Spanish National Health Service database. Patients ≥ 18 years with any gout diagnosis at discharge who had been admitted to public or private hospitals between 2005 and 2015 were included. Patients were divided in two periods: p1 (2005–2010) and p2 (2011–2015) to compare the number of hospitalizations, mean costs and mortality rates. Data from 192,037 patients with gout was analyzed. There was an increase in the number of hospitalized patients with gout (p < 0.001). The more frequent comorbidities were diabetes (27.6% of patients), kidney disease (26.6%) and heart failure (19.3%). Liver disease (OR 2.61), dementia (OR 2.13), cerebrovascular diseases (OR 1.57), heart failure (OR 1.41), and kidney disease (OR 1.34) were associated with a higher mortality risk. Women had a lower risk of mortality than men (OR 0.85). General mortality rates in these hospitalized patients progressively increased over the years (p < 0.001). In addition, costs gradually rose, presenting a significant increase in p2 even after adjusting for inflation (p = 0.001). A progressive increase in hospitalizations, mortality rates and cost in hospitalized patients with gout was observed. This harmful trend in a preventable illness highlights the need for change and the search for new healthcare strategies.

scholarly journals Monitoring progress with national and subnational health goals by integrating verbal autopsy and medically certified cause of death data

2021 ◽  
Vol 6 (5) ◽  
pp. e005387
Author(s):  
Tim Adair ◽  
Sonja Firth ◽  
Tint Pa Pa Phyo ◽  
Khin Sandar Bo ◽  
Alan D Lopez
Keyword(s):  
Cause Of Death ◽  
Verbal Autopsy ◽  
Integration Method ◽  
Mortality Rates ◽  
Vital Statistics ◽  
Death Registration ◽  
Chronic Respiratory Diseases ◽  
Health Goals ◽  
Specific Mortality ◽  
Four Causes

IntroductionThe measurement of progress towards many Sustainable Development Goals (SDG) and other health goals requires accurate and timely all-cause and cause of death (COD) data. However, existing guidance to countries to calculate these indicators is inadequate for populations with incomplete death registration and poor-quality COD data. We introduce a replicable method to estimate national and subnational cause-specific mortality rates (and hence many such indicators) where death registration is incomplete by integrating data from Medical Certificates of Cause of Death (MCCOD) for hospital deaths with routine verbal autopsy (VA) for community deaths.MethodsThe integration method calculates population-level cause-specific mortality fractions (CSMFs) from the CSMFs of MCCODs and VAs weighted by estimated deaths in hospitals and the community. Estimated deaths are calculated by applying the empirical completeness method to incomplete death registration/reporting. The resultant cause-specific mortality rates are used to estimate SDG Indicator 23: mortality between ages 30 and 70 years from cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. We demonstrate the method using nationally representative data in Myanmar, comprising over 42 000 VAs and 7600 MCCODs.ResultsIn Myanmar in 2019, 89% of deaths were estimated to occur in the community. VAs comprised an estimated 70% of community deaths. Both the proportion of deaths in the community and CSMFs for the four causes increased with older age. We estimated that the probability of dying from any of the four causes between 30 and 70 years was 0.265 for men and 0.216 for women. This indicator is 50% higher if based on CSMFs from the integration of data sources than on MCCOD data from hospitals.ConclusionThis integration method facilitates country authorities to use their data to monitor progress with national and subnational health goals, rather than rely on estimates made by external organisations. The method is particularly relevant given the increasing application of routine VA in country Civil Registration and Vital Statistics systems.

scholarly journals Analysis of the Gastro-Intestinal Tract of Marine Mammals: A Multidisciplinary Approach with a New Multi-Sieves Tool

Animals ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1824
Author(s):  
Giorgia Corazzola ◽  
Matteo Baini ◽  
Carla Grattarola ◽  
Cristina Panti ◽  
Federica Marcer ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Marine Mammals ◽  
Intestinal Tract ◽  
Multidisciplinary Approach ◽  
Sample Collection ◽  
Important Data ◽  
New Device ◽  
Specific Protocol ◽  
Specific Analysis ◽  
Gastro Intestinal Tract

Organs and content of the gastro-intestinal tract (GIT) of marine mammals are relevant for a variety of investigations and provide data to researchers from different fields. Currently used protocols applied to the GIT for specific analysis limit the possibility to execute other investigations and important information could be lost. To ensure a proper sample collection and a multidisciplinary investigation of the GIT of marine mammals, a new multi-sieves tool and a specific protocol have been developed. This new device and approach allowed the simultaneous sampling of the GIT and its content for the main investigations concerned. The samples collected during these preliminary trials were suitable to perform all the different research procedures considered in this work. The obtained results show that with a few and easy procedural adjustments, a multidisciplinary sampling and evaluation of the GIT of marine mammals is possible. This will reduce the risk of losing important data aimed at understanding the cause of death of the animal, but also biology and ecology of marine mammals, and other important data for their conservation and habitats management.

scholarly journals Why do frail patients with chronic heart failure die and become hospitalised?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Sze ◽  
P Pellicori ◽  
J Zhang ◽  
J Weston ◽  
A.L Clark
Keyword(s):  
Heart Failure ◽  
Cause Of Death ◽  
Hospital Admissions ◽  
Average Length ◽  
Significant Proportion ◽  
Length Of Hospital Stay ◽  
Clinical Frailty Scale ◽  
Frail Patients ◽  
Increased Risk

Abstract Background Frailty is common in patients with heart failure (HF) and is associated with increased morbidity and mortality. A better understanding of the causes of hospitalisations and death in frail patients might help to tailor interventional strategies for these at-risk patients. Purpose We studied the cause of death and hospitalisations in ambulatory patients with HF and frailty. Methods We assessed frailty using the clinical frailty scale (CFS) in consecutive HF patients attending a routine follow-up visit. Those with CFS ≥5 were classified as frail. Mortality and hospitalisations were ascertained from medical records (updated systematically using an NHS electronic database), discharge letters, autopsy reports and death certificates. We studied the primary cause of death and hospitalisations within one year of enrolment. Results 467 patients (67% male, median (IQR) age 76 (69–82) years, median (IQR) NT-proBNP 1156 (469–2463) ng/L) were enrolled. 206 (44%) patients were frail. Frail patients were more likely to not receive or receive suboptimal doses of ACEi/ARB and Beta-blockers; while non-frail patients were more likely to be treated with optimal doses. At 1-year follow up, there were 56 deaths and 322 hospitalisations, of which 46 (82%) and 215 (67%) occurred in frail patients. Frailty was associated with an increased risk of all-cause mortality (HR (95% CI): 4.27 (2.60–7.01)) and combined mortality/ hospitalisation (HR (95% CI): 2.85 (2.14–3.80)), all p&lt;0.001. 57% (n=26) of frail patients died of cardiovascular causes (of which 58% were due to HF progression); although deaths due to non-cardiovascular causes (43%, n=20), especially severe infections, were also common (26%, n=12). (Figure 1) The proportion of frail patients who had non-elective hospital admissions within 1 year was more than double that of non-frail patients (46% (n=96) vs 21% (n=54); p&lt;0.001). Compared to non-frail patients, frail patients had more recurrent (≥2) hospitalisations (28% (n=59) vs 9% (n=24); p&lt;0.001) but median (IQR) average length of hospital stay was not significantly different (frail: 6 (4–11) vs non-frail: 6 (2–12) days, p=0.50). A large proportion of hospitalisations (64%, n=137) in frail patients were due to non-cardiovascular causes (of which 34%, 30% and 20% were due to infections, falls and comorbidities respectively). Of cardiovascular hospitalisations (36%, n=78), the majority were due to decompensated HF (67%, n=46). (Figure 1) Conclusion Frailty is common in patients with HF and is associated with an increased risk of mortality and recurrent hospitalisations. A significant proportion suffered non-cardiovascular deaths and hospitalisations. This implies that interventions targeted at HF alone can only have limited impact on outcomes in frail patients. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Cardioinformatics: the nexus of bioinformatics and precision cardiology

2019 ◽  
Author(s):  
Bohdan B Khomtchouk ◽  
Diem-Trang Tran ◽  
Kasra A Vand ◽  
Matthew Might ◽  
Or Gozani ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cancer Research ◽  
Computational Biology ◽  
Cause Of Death ◽  
Cancer Mortality ◽  
Unmet Need ◽  
Mortality Rates ◽  
Cardiovascular Medicine ◽  
Biology Research

Abstract Cardiovascular disease (CVD) is the leading cause of death worldwide, causing over 17 million deaths per year, which outpaces global cancer mortality rates. Despite these sobering statistics, most bioinformatics and computational biology research and funding to date has been concentrated predominantly on cancer research, with a relatively modest footprint in CVD. In this paper, we review the existing literary landscape and critically assess the unmet need to further develop an emerging field at the multidisciplinary interface of bioinformatics and precision cardiovascular medicine, which we refer to as ‘cardioinformatics’.

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