Research Spotlight

Tecson, K. M., K. Bass, J. Felius, S. A. Hall, A. K. Jamil and S. A. Carey (2019). “Patient “Activation” of Patients Referred for Advanced Heart Failure Therapy.” Am J Cardiol 123(4): 627-631.

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Advanced heart failure (HF) is a devastating chronic illness requiring complex treatment regimens and patient engagement. Having the information, motivation, and skills to live with a medical condition are conceptualized by the term, “activation.” Patients referred for advanced HF therapy and their unpaid family caregiver were invited to participate in this study by completing the 10-item patient activation measure (PAM) questionnaire. Anxiety and depression were assessed via the hospital anxiety and depression scale. We compared activation, anxiety, and depression between those selected versus not selected for advanced HF therapy (left ventricular assist device or heart transplantation). We analyzed those who subsequently underwent advanced HF therapy in regards to activation and 1-year survival. There were 133 (68%) patients selected for therapy. Neither depression nor anxiety differed by selection status, but PAM levels did (p=0.02). Those not selected for therapy were approximately 4 times more likely to have lower activation than those who were selected (8% vs 2%). Of the 133 selected patients, 110 (84%) subsequently underwent advanced HF therapy and 15 (14%) of those died within 1 year. Survival was independent of baseline anxiety (p=0.92) and depression (p=0.70), as well as patient and caregiver PAM (p=0.50 and 0.77, respectively). In conclusion, patients with higher activation were more likely to be selected for advanced HF therapy.

Rossler, K. L., G. Sankaranarayanan and A. Duvall (2019). “Acquisition of Fire Safety Knowledge and Skills With Virtual Reality Simulation.” Nurse Educ 44(2): 88-92.

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BACKGROUND: Prelicensure nursing students seeking to enter perioperative nursing need preparatory fire safety knowledge and skills training to participate as a member of an operating room (OR) team. PURPOSE: This pilot study examined the effectiveness of the Virtual Electrosurgery Skill Trainer (VEST) on OR fire safety skills among prelicensure nursing students. METHODS: An experimental pretest-posttest design was used in this study. Twenty nursing students were randomized to a control or an intervention group. Knowledge and skills acquisition of OR fire safety were assessed. RESULTS: There were no statistically significant findings in knowledge for either group. Fisher exact test demonstrated significant relationships between the skills performance criteria of following emergency procedures for a fire and demonstrating PASS (pull-aim-squeeze-sweep) technique (P = .001). CONCLUSIONS: Academic and hospital educators may consider incorporating virtual reality simulation to teach fire safety education or reinforce general fire safety practices to nursing students and novice nurses.

Tajti, P., K. Alaswad, D. Karmpaliotis, F. A. Jaffer, R. W. Yeh, M. Patel, E. Mahmud, J. W. Choi, M. N. Burke, A. H. Doing, P. Dattilo, C. Toma, A. J. C. Smith, B. F. Uretsky, E. Holper, S. Potluri, R. M. Wyman, D. E. Kandzari, S. Garcia, O. Krestyaninov, D. Khelimskii, M. Koutouzis, I. Tsiafoutis, J. J. Khatri, W. Jaber, H. Samady, B. Jefferson, T. Patel, S. Abdullah, J. W. Moses, N. J. Lembo, M. Parikh, A. J. Kirtane, Z. A. Ali, D. Doshi, I. Xenogiannis, L. I. Stanberry, B. V. Rangan, I. Ungi, S. Banerjee and E. S. Brilakis (2019). “Procedural Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusions Via the Radial Approach: Insights From an International Chronic Total Occlusion Registry.” JACC Cardiovasc Interv 12(4): 346-358.

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OBJECTIVES: This study examined the frequency and outcomes of radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND: Radial access improves the safety of PCI, but its role in CTO PCI remains controversial. METHODS: We compared the clinical, angiographic, and procedural characteristics of 3,790 CTO interventions performed between 2012 and 2018 via radial-only access (RA) (n = 747) radial-femoral access (RFA) (n = 844) and femoral-only access (n = 2,199) access at 23 centers in the United States, Europe, and Russia. RESULTS: Patients’ mean age was 65 +/- 10 years, and 85% were men. Transradial access (RA and RFA) was used in 42% of CTO interventions and significantly increased over time from 11% in 2012 to 67% in 2018 (p < 0.001). RA patients were younger (age 62 +/- 10 years vs. 64 +/- 10 years and 65 +/- 10 years; p < 0.001), less likely to have undergone prior coronary artery bypass graft surgery (18% vs. 39% and 35%; p < 0.001), and less likely to have undergone prior PCI (60% vs. 63% and 66%; p = 0.005) compared with those who underwent RFA and femoral-only access PCI. RA CTO PCI lesions had lower J-CTO (Multicenter CTO Registry in Japan) (2.1 +/- 1.4 vs. 2.6 +/- 1.3 and 2.5 +/- 1.3; p < 0.001) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) complication (2.3 +/- 1.9 vs. 3.2 +/- 2.0 and 3.2 +/- 1.9; p < 0.001) scores. The mean sheath size was significantly smaller in the RA group (6.6 +/- 0.7 vs. 7.0 +/- 0.6 and 7.3 +/- 0.8; p < 0.0001), although it increased with lesion complexity. Antegrade dissection re-entry (20% vs. 33% and 32%; p < 0.001) was less commonly used with RA, whereas use of retrograde techniques was highest with RFA (47%). The overall rates of technical success (89% vs. 88% vs. 86%; p = 0.061), procedural success (86% vs. 85% vs. 85%; p = 0.528), and in-hospital major complication (2.47% vs. 3.40% vs. 2.18%; p = 0.830) were similar in all 3 groups, whereas major bleeding was lower in the RA group (0.55% vs. 1.94% and 0.88%; p = 0.013). CONCLUSIONS: Transradial access is increasingly being used for CTO PCI and is associated with similar technical and procedural success and lower major bleeding rates compared with femoral-only access interventions. (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO]; NCT02061436).

Roberts, W. C. (2019). “Hazards of Mitral Valve Replacement for Mitral Stenosis Caused by Massive Mitral Annular Calcium With or Without Aortic Valve Replacement for Aortic Stenosis.” Am J Cardiol 123(4): 650-657.

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Mitral annular calcium (MAC) is common in older adults in the Western World and if extensive may cause mitral stenosis. The purpose of this report is to describe outcomes of 12 patients having mitral valve replacement for mitral stenosis secondary to massive MAC. Operatively excised deposits of calcium removed from the mitral annular area and the accompanying stenotic mitral valves were examined and then the patients’ medical records were examined to confirm the diagnosis and the degree of valvular dysfunction. A total of 12 patients with massive MAC causing mitral stenosis and receiving mitral valve replacement with or without aortic valve replacement for aortic stenosis were observed in 2013 to 2015. Of the 12 patients, 7 died from 5 to 44 days (mean 19) after the valve operation and all had “stormy” postoperative courses; one survived 150 days and another, 600 days; the remaining 3 were improved by the operation and are alive 22, 27, and 59 months postoperatively. In conclusion, the high mortality in these patients suggests that mitral valve replacement in the setting of massive MAC be considered with caution.

Roberts, W. C. (2019). “From the Editor Pellagra, Osler, Roberts, Goldberger, the Atherosclerotic Diet, Niacin, the Beginning of the Atherosclerotic Epidemic, and the First Lipid-Altering Drug.” Am J Cardiol 123(4): 697-700

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[An appreciation of Drs. Joseph Goldberger, Conrad A. Elvehjem, and Tom Spies for their work in the etiology and treatment of pellagra during the period 1914-1938; no abstract available.]