Comment on: Safety and feasibility of hemodynamic pulmonary artery pressure monitoring using the CardioMEMS device in LVAD management

The called burden of cardiac heart failure (CHF) on healthcare systems and economies remains large and a major factor contributing to this burden is the high hospital admission rate for acute decompensated heart failure. These repeated heart failure hospitalizations (HFH) not only exert a high burden on healthcare systems, but also impact patient quality of life and have been associated with impaired prognosis and reduced life expectancy. The need for remote monitoring has become extremely important, mainly based on devices capable of measuring intracardiac filling pressures. If we assume that hemodynamic congestion precedes clinical congestion, the hemodynamic monitoring could be able to detect early signs of congestion and enables clinicians to intervene in a pre-symptomatic phase avoiding hospital admission. Dr. Veenis JF and colleagues present the results of implanting the CardioMEMS device in 10 patients who underwent heartmate 3 implantation. The authors describe the study design based on an earlier publication by the same author. The authors argue that the use of this device will allow the monitoring of patients pre, during hospitalization and after implantation, with a possible reduction in the number of readmissions for allowing the diagnosis and treatment of complications related to ventricular failure and volume overload.

SMOOTHING THE MOVE FROM POST-ACUTE TO HOME CARE FOR OLDER CARDIAC PATIENTS: A SOCIAL WORK TRANSITIONS INITIATIVE

Transitioning across medical settings (e.g. from hospital to post-acute (PA) or PA to homecare (HC)) is a difficult time with numerous challenges, as critical information passes across sites, new systems are quickly established, and caretakers change. Older cardiac heart failure (CHF) patients, often with comorbidities and having fewer social supports, are especially vulnerable to rehospitalizations at that time. This study examines the impact of a Social Work Transitions (SWT) intervention, designed to ease older cardiac patients’ transition from a PA to HC setting, on rehospitalization rates. The SWT model for CHF patients was developed in a large healthcare system with a continuum of services for older adults including PA and HC. Once a patient enters PA from the hospital a transitions social worker (SW) remains the patient’s primary support and contact through PA discharge and the transition to HC. In HC, that same SW ensures needed services occur, conducts home visits, and provides additional follow-up via phone calls. Study 1: compared HC rehospitalization rates of CHF patients receiving SWT (N=28) with those not receiving SWT (N=26). This natural control group arose during the initial program months, as SW turnover occurred and some CHF patients were not accompanied by a transitions SW. SWT patients had half the rehospitalizations (25%) as controls (54%). Study 2 tracked 30 day rehospitalizations rates for the first 17 study months (N=257). Program rehospitalization rates (16.7%) were below the CMS benchmark (21%). These findings support using the SWT program to prevent unnecessary rehospitalizations in CHF patient.

Effects of aliskiren on hemodynamic parametersin daunorubicin -induced acute cardiomyopathy in rats

Daunorubicin ((DNR)) used in oncological practice against a wide variety of solid organ tumors and hematologic malignancies, including leukemia, lymphoma, breast cancer, lung cancer, multiple myeloma and sarcoma. however clinical use of this agent is limited due to cardiomyopathy and cardiac heart failure. one of the important player in the development of cardic hypertrophy and reperfusion injury is renin-angiotensin system. Aliskiren (ALK) a recent drug of a direct inhibitor of the renin enzyme. It Protect cardiomyopathy by the inhibition of the renin activity. Present study is towards the evaluation of protective effcets of ALK 50 and 100 mg/kg/day in rats. The systolic, diastolic, mean BP and heart rate were significantly (P< 0.01) increased in DNR control group as compared to normal control group. Thus the results provide clear evidence that the ALK pretreatment offered significant protection against DNR-induced Hemodynamic parameters changes. Keywords: Daunorubicin, Cardiomyopathy, Aliskiren, Telmisartan and Hemodynamic parameters

ASSESSMENT OF CARDIAC HEART FAILURE AND CARDIAC ARTERY DISEASE BY THE HIGHER ORDER SPECTRA

Cardiac diseases are major reason of death in the world populace and the numeral of cases is upsurging every year. Due to cardiac artery disease (CAD), the strength of heart muscles becomes weak and heart pumping is disturbed which may eventually lead to abnormal heart beat and heart failure. Therefore, the beginning stage detection of CAD and cardiac heart failure (CHF) are of prime importance. In this work, we have used a non-invasive diagnosis method as higher order spectra (HOS) for assessment of cardiac diseases. The method indicates whether or not a cardiac heart disease is present, by assessing the cardiac health of subjects using extracted features from heart rate variability (HRV) signals. This assessment is based on 10 spectra nonlinear features. These features were extracted from HRV signals by using the HOS method. For this study, the R-R interval data (i.e. HRV signals) were taken from the standard database of cardiac heart failure (CHF), CAD patients, healthy young (YNG) and Self recorded of healthy young (SELF_YNG) subjects. Statistical assessments were performed on the group of database sets as YNG-CAD, YNG-CHF, SELF_YNG-CAD and Self_YNG-CHF subjects. A Wilcoxon rank sum test ([Formula: see text]-value) was used to statistically compare the features extracted by HOS for group of data sets. It indicates whether or not the same features of individual classes of HRV data sets are dissimilar. The results depicted that the all features are very significant ([Formula: see text]) except the phase entropy (PHE) feature which is not significant for CAD-CHF, SELF_YNG-CAD and SELF_YNG-CHF group of subjects. While in the case of YNG-CAD group of subjects, features like first-order spectral moment of amplitudes of diagonal elements (H3), PHE and logarithmic amplitudes of diagonal elements (H2) are significant ([Formula: see text]) and excluding these features, the remaining features are very significant except MM and H1 which are not significant. The results also depicted that the mean value of sum of logarithmic amplitude (H1), H2, normalized entropy (P1), normalized squared entropy (P2) and PHE features of healthy YNG subjects are having higher values than that of CAD and CHF patients. While weighted center of bi-spectrum (WCOB2) and FLAT spectrum features are lower than CAD and CHF patients compared to YNG subjects. In case of CAD and CHF patients, all the features of CAD patients are having higher values compared to CHF except P1, P2 and WCOB1.