BACKGROUND:Catheter-based micro-axial flow pump, Impella, has improved patient prognosis following cardiogenic shock (CS). Notably, Impella 5.5 facilitates patient activity because of the cannulation approaches to the axillary artery. OBJECTIVES:To characterize mobility level trajectory and its safety and association with prognosis in patients with CS during Impella 5.5 support using detailed physiotherapy session-level data. METHODS:We reviewed consecutive patients with CS who underwent early physiotherapy during Impella 5.5 in intensive care unit (ICU) from 2022 to 2025. Mobility level was assessed using the ICU Mobility Scale (IMS) as a primary endpoint and adverse events leading to the termination of physiotherapy were recorded during each session. The successful weaning from Impella, bridge to implantable left-ventricular assist device (iLVAD), or death while or after Impella weaning were investigated as patient prognosis. RESULTS:A total of 876 physiotherapy sessions among 30 patients were included for analysis with 550 sessions (63.3%) of out-of-bed mobilization. Forty-three events on Impella device alarm (4.9%) and 91 on decreased arterial pressure (10.4%) were observed; however, no life-threatening events occurred during physiotherapy. Overall, IMS significantly increased over time after adjustment for confounders (P < 0.001). Patients successfully weaned from Impella 5.5 showed more favorable IMS trajectories than those bridged to iLVAD, those with failure to wean, and those who died after Impella weaning (interaction P = 0.064, 0.002, and 0.015, respectively). CONCLUSIONS:Early mobilization levels increased progressively after Impella 5.5 implantation without severe adverse events. More favorable mobility trajectories were associated with better prognosis in patients with CS.
BACKGROUND:Obesity is closely related to cardiovascular outcomes. However, the prognostic value of body mass index (BMI) in patients with heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with reduced ejection fraction (HFrEF) remains unclear. OBJECTIVE:To investigate the association of BMI with 1-year heart failure readmission and 5-year all-cause mortality in patients with HFmrEF and HFrEF. METHODS:We consecutively enrolled patients hospitalized for HFrEF and HFmrEF between January 2018 and December 2020. Participants were categorized into underweight, normal weight, overweight, and obese groups by baseline BMI. Associations of BMI with readmission and mortality were analyzed using the Fine-Gray test, Cox proportional hazards model, and restricted cubic splines. RESULTS:Among 656 included patients, the readmission and mortality risk varied significantly across BMI groups (both Gray's test and log-rank P < 0.001). Compared to normal weight group, both overweight (sHR 1.60, 95% CI [1.24, 2.07]) and obese (sHR 1.83, 95% CI [1.39, 2.39]) groups showed significantly increased 1-year heart failure readmission risk. For 5-year all-cause mortality, the underweight (HR 2.30, 95% CI [1.62, 3.26]) and obese (HR 2.03, 95% CI [1.42, 2.91]) groups exhibited significantly higher risk. No significant interaction between BMI and heart failure phenotype was observed. Restricted cubic splines revealed a U-shaped relationship of BMI with mortality risk, but provided weak evidence on risk of readmission. CONCLUSION:BMI exerts divergent time- and outcome-dependent effects in HFrEF and HFmrEF. Obesity may be associated with short-term readmission risk, while underweight may be related to cachexia-associated long-term mortality.
BACKGROUND:Thoracic organ transplantation is often performed at night because of donor availability and the need to minimize cold ischemia time. Whether operative timing is independently associated with short- and long-term outcomes after heart and lung transplantation remains uncertain. METHODS:We conducted a PRISMA-guided systematic review and meta-analysis with PROSPERO registration. PubMed, Scopus, the Cochrane Library, and Web of Science were searched through November 2025 for studies comparing daytime versus nighttime heart or lung transplantation. Primary outcomes included short-term mortality (in-hospital, 30-day, and 90-day) and mid-to-long-term survival (1, 3, and 5 years). Secondary outcomes included major postoperative complications and resource utilization. Pooled risk ratios or mean differences were estimated, with prespecified subgroup and sensitivity analyses. RESULTS:Eight studies were included. Definitions of daytime and nighttime varied considerably across cohorts. Daytime transplantation was associated with a lower incidence of in-hospital mortality (RR, 0.89; 95% CI, 0.82 to 0.97; P = 0.029). However, no statistically significant differences were observed in 30-day, 90-day, or 1-, 3-, and 5-year mortality. Secondary outcomes, including ECMO support, pacemaker implantation, major complications, ICU length of stay, and overall hospital length of stay (LOS), were largely comparable between groups. A subgroup analysis suggested shorter hospital LOS after daytime heart transplantation, although this finding was not observed for lung transplantation or overall hospital LOS. Sensitivity analyses showed that the observed association with in-hospital mortality was influenced by the largest contributing cohort. CONCLUSIONS:Daytime transplantation was associated with a lower incidence of in-hospital mortality, but this association was not observed across subsequent mortality time points. Safety outcomes and resource utilization were otherwise comparable, and the available evidence did not demonstrate consistently worse outcomes following nighttime transplantation within structured thoracic transplant systems.
BACKGROUND:More than 20% of patients with heart failure (HF) experience dysphagia, or difficulty swallowing. Although a previous review identified several risk factors and highlighted the bidirectional relationship between dysphagia and sarcopenia, it focused primarily on older hospitalized adults, leaving important knowledge gaps across the broader HF population. METHODS:A scoping review was conducted using four electronic databases: PubMed, CINAHL, Embase, and Google Scholar, to identify studies involving adult patients with HF and dysphagia. No restrictions were placed on publication date, study duration, or geographical region. RESULTS:Thirty-six articles met the inclusion criteria. Key mechanisms of HF-associated dysphagia (HFAD) included cardiomegaly-induced esophageal compression, esophageal dysmotility, and stricture formation. HFAD was associated with adverse outcomes, including dehydration, malnutrition, aspiration, prolonged hospitalization, non-home discharge, and mortality. Reported risk factors included advanced age, systemic inflammation, poor nutritional status, reduced functional independence, female sex, polypharmacy, prolonged hospitalization, dementia, prior cardiac surgeries, and valvular heart disease. Clinical presentations ranged from sudden to gradual onset and included dysphagia, globus sensation, and hoarseness. Reported management strategies included nutritional support, swallowing rehabilitation, HF optimization, pharmacologic therapy, procedural interventions, and follow-up monitoring. CONCLUSION:HFAD appears to be a common yet underrecognized comorbidity among individuals with HF and is associated with substantial adverse outcomes. Although early recognition and multidisciplinary management may be beneficial, evidence regarding optimal screening and treatment approaches remain limited. Further research is needed to establish standardized definitions, diagnostic criteria, screening approaches, and management pathways.
BACKGROUND:Bundle branch block (BBB) affects 11-17% of adults over 80 and is associated with mortality and heart failure. Conventional QTc formulae overestimate repolarization in wide QRS complexes, with clinicians holding symptom-management therapies based on inaccurate measurements. OBJECTIVES:This retrospective study utilized the MIMIC-IV database to examine arrhythmogenic risk by drug class and BBB phenotype. METHODS:Adult ICU admissions with BBB were stratified by drug exposure: amiodarone, high-risk anti-arrhythmics (sotalol, dofetilide, procainamide, ibutilide, quinidine, disopyramide), and common non-cardiac QT-prolonging agents (haloperidol, ondansetron, quetiapine, methadone, levofloxacin, azithromycin). The primary outcome was a composite of ventricular arrhythmia and cardiac arrest; a sensitivity analysis restricted to ventricular arrhythmia was performed. Propensity score matching (1:1) with time-varying Cox regression addressed confounding and immortal time bias. RESULTS:The matched cohort included 1722 admissions (LBBB =1252; RBBB =470). Common non-cardiac agents were not associated with the composite outcome in LBBB (HR 0.96, p = 0.83) or RBBB (HR 0.61, p = 0.24; 28 events, hypothesis-generating). Amiodarone was associated with the composite (LBBB: HR 3.63, p < 0.01; RBBB HR: 3.90, p < 0.01), but not the LBBB sensitivity analysis (HR 1.61, p = 0.19), suggesting confounding by indication. Among patients with QTc >500 ms, common agents remained non-significant. CONCLUSION:Common non-cardiac QT-prolonging medications were not associated with increased risk in patients with BBB, even with prolonged QTc. The divergence between composite and sensitivity results for amiodarone highlights the influence of confounding by indication. Medication alerts should incorporate stratification by drug class rather than QTc alone.
BACKGROUND:New-onset atrial fibrillation or flutter (NOAF) is common during sepsis, but its prognostic significance in sepsis-associated myocardial injury remains unclear. OBJECTIVES:We examined its association with mortality using a time-varying analytic approach and assessed whether this association differed by onset timing. METHODS:We conducted a single-centre retrospective cohort study of adult intensive care unit patients with coded sepsis and elevated high-sensitivity cardiac troponin T. Patients with pre-existing atrial fibrillation or atrial flutter were excluded. New-onset atrial fibrillation or flutter during the intensive care unit stay was modelled as a time-varying exposure in Cox models. Early onset was defined as within 48 h of intensive care unit admission and late onset as beyond 48 h. RESULTS:Among 599 patients, 125 developed new-onset atrial fibrillation or flutter. In the fully adjusted model, the time-varying exposure was associated with higher in-hospital mortality (hazard ratio 1.69, 95% confidence interval 1.14-2.52) and intensive care unit mortality (hazard ratio 1.70, 95% confidence interval 1.07-2.70). Late-onset events were associated with higher in-hospital and intensive care unit mortality, whereas early-onset events showed no clear association with either outcome. In landmark analysis, early-onset events were not associated with subsequent in-hospital mortality. CONCLUSION:NOAF during the ICU stay was associated with higher mortality in patients with sepsis-associated myocardial injury. Late-onset NOAF was associated with mortality, whereas early-onset NOAF showed no clear association.
BACKGROUND:Home-based physical activity (PA) programmes may help address barriers to regular PA and benefit individuals with interstitial lung disease (ILD) and their informal carer (IC). However, research on ICs perspectives regarding these interventions remains limited. OBJECTIVE:Explore the impact of a home-based PA programme (iLiFE) for individuals with ILD, from the perspective of their IC. METHODS:A qualitative study nested in the iLiFE trial (NCT04224233) was conducted. Data of IC on PA levels - steps/day with accelerometer, support needs with Carer Support Needs Assessment Tool (CSNAT) and quality of life with World Health Organization Quality of Life Assessment - short version (WHOQoL-Bref) were collected to characterise the sample. Short, individual, semi-structured interviews were conducted with ICs. Interviews were audio recorded, transcribed and analysed thematically. RESULTS:Nine ICs (72±8years, 5 [55.6%] male) participated. They were physically inactive (3819±1782steps/day); their main need in CSNAT was "knowing who to contact if they are concerned about their relative"; and presented poor/unsatisfactory quality of life (WHOQol-Bref Physical domain: 49±10points; Psychological domain: 58±10points; Social domain: 63±18points; Environmental domain: 51±14points). Thematic analysis revealed that, from ICs' perspective, iLiFE programme improved ICs well-being, couple relationships, ILD patients' health, and reduced caregiving burden. Despite patient's fatigue, participants valued health professionals support and expressed interest in extending the programme duration. CONCLUSION:Home-based PA programmes, not specifically targeted at ICs of ILD individuals, may have some positive impact on their perceived well-being and burden of care. Further research on empowering ICs is needed, given their fundamental role in ILD management.
BACKGROUND:Pleural effusions occur in 50% to 80% of patients with heart failure (HF), and their presence carries approximately 50% 1-year mortality. Indwelling pleural catheters (IPCs) provide palliative drainage for recurrent effusions and have proven benefit in malignant pleural effusions. However, evidence for IPC use in HF-related effusions remains limited to small studies showing dyspnea relief and acceptable safety. More generalizable outcomes data are needed to guide clinical decision-making in this population. OBJECTIVES:To evaluate safety and clinical outcomes after IPC placement for refractory HF-related pleural effusions. METHODS:We conducted a retrospective cohort study using the TriNetX Research Network. Adults with HF who underwent IPC placement for pleural effusion were identified using ICD-10-CM and procedure codes. Outcomes included IPC-related complications, all-cause mortality up to 1 year, additional pleural interventions, catheter removal, and hospital or emergency department visits within 90 days after IPC placement. RESULTS:Among 1017 patients who underwent IPC placement, pneumothorax was the most common complication (14.7% by 90 days), whereas empyema (4.0%) and cellulitis (1.3%) were less frequent. By 90 days, only 9.7% required repeat thoracentesis, and 14.3% underwent IPC removal. All-cause mortality was 43.2% at 1 year. Within 90 days after IPC placement, 26.9% had an emergency department visit and 67.0% had hospital inpatient or observation care services, compared with 50% and 75%, respectively, before IPC placement. CONCLUSIONS:IPC placement was associated with low repeat drainage needs and a possible reduction in acute care utilization. Complications were generally manageable and prolonged catheter dependence was common.
BACKGROUND:Pericardial effusion (PE) is a heterogeneous clinical condition arising from diverse cardiovascular and systemic disorders, ranging from incidental findings to life-threatening cardiac tamponade. Although its etiology has been examined in prior studies, most were limited to single-center cohorts with small sample sizes, and comprehensive nationwide data remain limited. OBJECTIVES:To clarify the etiologies and in-hospital outcomes of PE requiring invasive drainage using a nationwide Japanese administrative database. METHODS:We retrospectively analyzed hospitalized patients with PE who underwent pericardiocentesis or pericardiotomy between April 2021 and March 2022, using the Diagnosis Procedure Combination database. Etiologies were classified according to underlying disease, and in-hospital mortality was assessed across major etiological categories. RESULTS:A total of 3778 patients met the inclusion criteria. The most common etiologies were cardiac disease (30.5%), malignant disease (25.9%), and vascular disease (16.9%). Among cardiac causes, valvular disease (26.7%) and acute myocardial infarction (22.5%) were predominant. Lung cancer (53.8%) and malignant lymphoma (8.5%) were the leading malignant etiologies, while aortic dissection (66.8%) and aortic aneurysm (26.1%) were the common vascular causes. Patients with vascular diseases, particularly aortic dissection, exhibited the highest in-hospital mortality (42.5%). Acute myocardial infarction demonstrated the highest mortality among cardiac etiologies (47.7%). Idiopathic PE was rare, accounting for only 0.6% of cases. CONCLUSIONS:Cardiac, malignant, and vascular diseases are the predominant etiologies of pericardial effusion requiring invasive intervention. The findings underscore the high mortality associated with vascular and ischemic cardiac causes, highlighting the importance of risk stratification and decision-making in PE management.
BACKGROUND:Limited studies compare the efficacy of different modes of telecare interventions for smoking cessation, especially in low-middle-income countries where smoking prevalence is highest. OBJECTIVES:This study aimed to evaluate the effectiveness of synchronous telecare compared to use of a cell phone application on smoking cessation rates, withdrawal syndrome, and psychological distress. METHODS:This study followed a parallel pilot randomized control trial design and was performed remotely utilizing digital platforms. 51 participants recruited in Brazil were randomly divided into two groups: the Synchronous Telecare Group [STG(n = 29)] and the Application Group [AppG(n = 22)]. Participants in the STG underwent treatment over the Google Meet platform. Participants in the AppG underwent treatment using solely the Smokerstop® cell phone application. Treatment lasted 10 weeks from baseline assessment. The primary outcome measure was abstinence rate, assessed via biweekly questionnaire. Relapse frequency, nicotine dependence, withdrawal syndrome, and psychological distress were assessed as secondary outcomes. Chi-square analyses were used to compare abstinence and relapse rates. Comparison analyses employed the unpaired student's t-test and the Mann-Whitney test in accordance with normality of the data. RESULTS:No differences were found between groups in abstinence rate (AppG:44.84%, STG:45.45%, p = 1.00) or relapse frequency (AppG: 1.00±1.11, STG: 0.79±1.08, p = 0.43). No differences in WSWS and HADS scores were found between groups following intervention. CONCLUSIONS:These results may aid in informing public health strategies, when supported by larger randomized control trials, to improve access to virtual smoking cessation treatments in regions of high smoking prevalence and limited healthcare resources, therefore contributing to global tobacco control.
BACKGROUND Sixty-four million people around the world have heart failure (HF). Self-care, a naturalistic, patient-centered decision-making process, is essential to reduce exacerbations and hospitalizations in this population. Minimal research exists regarding the relationship between food insecurity and HF self-care, despite the importance of diet in HF self-care. Research into predictors of heart failure self-care from a socioecological perspective is also limited. Socioecological determinants of health, such as emotional support, instrumental support, health literacy, and food insecurity, may impact HF self-care in ways that are not well understood. AIM This study aimed to explore the relationship between emotional support, instrumental support, health literacy, food insecurity, and measures of HF self-care (maintenance, symptom perception, management). Emotional and instrumental support were measured separately to determine their unique contribution to the variance in HF self-care when combined with health literacy and food insecurity. METHODS A cross-sectional, descriptive, correlational survey of 88 participants with HF was conducted. The MSPSS measured emotional support (average of five items) and instrumental support (average of four items); higher scores indicate greater perceived support. The USAFSSM measured food insecurity (0-10, 0 = high food security). The STOFHLA measured health literacy (0-36, >22 = adequate). The SCHFI v7.2 measured the three components of HF self-care individually (0-100, >70 = adequate). Research questions were answered using descriptive statistics and multiple regression. RESULTS Emotional support, food insecurity, and health literacy, when combined, significantly contributed 15% of the total variance in self-care maintenance (p=.003), 22% of the total variance in symptom perception (p<.001), and 11% of the total variance in self-care management (p=.02). Within this model, emotional support independently contributed 13.18% to the variance in self-care maintenance (p<.001), 13.99% to the variance in symptom perception (p<.001), and 7.78% to the total variance in self-care management (p=.001). Food insecurity explained 6% of the variance in symptom perception in this model (p=.01).The second model, which combined instrumental support, food insecurity, and health literacy, significantly contributed 12% of the total variance in self-care maintenance (p=.013), 19% of the total variance in symptom perception (p<.001), 10% of the total variance in self-care management (p=.04). Instrumental support had a unique contribution of 9.86% to the total variance in self-care maintenance (p=.003), contributed 10.63% to the variance in symptom perception (p=.002), and uniquely contributed 6.5% to the variance in self-care management (p=.02). Food insecurity independently contributed 6.92% to the total variance of self-care perception in this model (p=.01). CONCLUSIONS Emotional support was slightly more influential in HF self-care than instrumental support, which has been recognized in previous research. Symptom perception may be higher in those with food insecurity due to greater symptom burden. Emotional and instrumental support may protect against the negative effects of low health literacy and food insecurity. Potential interventions should aim to improve patient’s social support, particularly emotional support, while continuing to address the educational and material needs of this population. Similarly, future studies should continue to explore potential mediating and moderating socioecological determinants of health related to HF self-care.
BACKGROUND Promoting mobility prevents functional decline, supports discharge readiness, and decreases length of stay. This project occurred at a >1,000 bed academic medical center with tertiary and quaternary services, on a 17-bed cardiology stepdown unit caring for acute HF, cardiogenic shock, and advanced HF (LVAD and transplant candidates). The aim was to establish mobility practice standards via leader-led mobility rounds, identify and address barriers, and assess impact on patient outcomes. The Banner Mobility Assessment tool (BMAT) standardized mobility assessment and guided the level-specific mobility. PURPOSE The aim was to establish mobility practice standards via leader led mobility rounds, identify and address barriers, and assess impact on patient outcomes. SETTING/POPULATION This project occurred at a >1,000 bed academic medical center with tertiary and quaternary services, on a 17 bed cardiology stepdown unit caring for acute HF, cardiogenic shock, and advanced HF (LVAD and transplant candidates). METHOD/PROCESS A total of 205 patients, randomly selected each week from hospitalized HF patients, were included in this pre–post quality improvement study evaluating the implementation of weekly mobility rounds aligned with heart failure guidelines for early, progressive mobility. Baseline data were collected over a 2 month period, followed by a 13 month intervention during which weekly audits captured BMAT scores, mobility performed per BMAT level, frequency, barriers, and countermeasures. Performance metrics were posted on the improvement board and reviewed during weekly multidisciplinary huddles. Balancing measures included fall rates and discharge disposition. OUTCOME MEASURES Mobility ≥3 times/day increased from 49% at baseline (n=28) to 80% post intervention (n=177). Fall with injury rates decreased from 0.89 to 0.31. Rehab discharges decreased from 9.5% at baseline to 5.9%. Average observed length of stay decreased from 7.1 to 6.9 days. PRACTICAL IMPLICATIONS Standardized mobility rounds substantially improved mobility frequency and patient safety, demonstrating that evidence-based protocols and nursing-led engagement effectively advance mobility practices for heart failure care.
BACKGROUND An expanding research base of systematic reviews has evaluated the effect of palliative care (PC) interventions delivered by primary or specialty PC providers for patients with heart failure (HF) and their caregivers. However, the overall evidence base has not been systematically examined. AIM This umbrella review synthesizes the evidence regarding PC interventions among patients with HF to: 1) Describe interventions based on the PC domains in the AHA/ACC/HFSA HF guidelines, 2) Examine the effect of interventions on patient-centered and healthcare utilization outcomes, and 3) Provide recommendations for practice, policy and future research. METHODS Using the Joanna Briggs Institute methodology for umbrella reviews, we comprehensively searched for systematic reviews in MEDLINE, CINAHL, and Embase databases with no date restrictions. Published, peer-reviewed reviews were included. RESULTS The search identified 19 reviews (high-quality, 11 with meta-analyses), of 104 nonoverlapping primary studies (low quality). Primary and specialty PC was associated with improvements in quality of life, depression, advanced care planning, and reduced hospitalizations. The effect of PC on reducing symptom burden was inconclusive. Limited evidence demonstrated improvements in anxiety, satisfaction with care, caregiver burden, and hospital length of stay. PC did not significantly impact mortality rates or hospice referral. CONCLUSIONS The concordance of the overall evidence was high, and although the quality of primary studies was overall low, findings confirm that primary and specialty PC offer meaningful benefits for patients with HF. Future research is required on caregiver outcomes, medically complex illness trajectories, intervention timing and fidelity, standardized outcome measurements, and longitudinal study designs with larger sample sizes.
BACKGROUND Patients with heart failure (HF) consistently report fatigue as one of the most common and distressing symptoms; however, its assessment remains challenging, as many available instruments emphasize symptom severity rather than capturing the multiple domains through which fatigue affects daily functioning. This highlights the need for multidimensional measures that reflect the complexity of fatigue in HF. The Modified Fatigue Impact Scale (MFIS) uniquely assesses the impact of fatigue across physical, cognitive, and psychosocial domains, distinguishing it from other self-report fatigue measures and making it a valuable tool for evaluating fatigue-related interventions across diverse health contexts. Despite this potential, the MFIS has not yet been validated for use in individuals with HF. AIM This study aimed to evaluate the reliability, construct validity, and internal structure of the MFIS in an HF population. METHODS A total of 63 community-dwelling adults aged 18 years or older with HF were enrolled in the study. Individuals with COVID-19 or other conditions known to induce fatigue were excluded. Data were collected using REDCap between 2023 and 2025. Participants completed the MFIS, the Dutch General Fatigue Scale (DUFS), the Dutch Exertion Fatigue Scale (DEFS), and the WHO-5 Well-Being Index. Internal consistency reliability was evaluated using coefficient alpha. Construct validity was assessed through correlations with DUFS, DEFS, and WHO-5 scores, as well as known-groups comparisons. MFIS scores were compared across New York Heart Association (NYHA) and Medical Research Council (MRC) functional classes using independent t-tests and Cohen’s d. Structural validity was examined using graded Item Response Theory (IRT) analysis with the Partial Credit Model. The institutional review board determined that the study was exempt. RESULTS Participants had a mean age of 65.7 (11.7) years, and 50.8% were male. Most were classified as NYHA class I/II (77.8%) and MRC grade 0/1 (69.9%). The mean MFIS total score was 40.1 (17.3). Internal consistency was excellent for the total scale (α = 0.965) and across domains (α = 0.936–0.958). MFIS demonstrated statistically significant correlations with DUFS (r = 0.68–0.77), DEFS (r = 0.58–0.67), and WHO-5 (r = –0.54 to –0.62). MFIS scores were significantly higher among participants in NYHA class III/IV and MRC grades 2–4, with moderate-to-large effect sizes ranging from –0.633 to –1.073. IRT analysis indicated good item–person targeting (–5.38 to 6.05 logits), item-step difficulties ranging from –9.90 to 9.31 logits, ordered thresholds, and predominantly acceptable item fit (0.60–1.30). CONCLUSIONS Results from this pilot study indicate that the MFIS demonstrates adequate psychometric properties for assessing fatigue among community-dwelling adults. Further research with larger, more diverse samples is warranted to substantiate these findings.
BACKGROUND:Computed tomography (CT)-defined bone mineral density (BMD) is a promising quantitative imaging marker that reflects the overall condition of patients, which was demonstrated in several diseases. OBJECTIVE:The present multicentric study aimed to demonstrate the prognostic role of BMD in patients with acute PE. METHODS AND RESULTS:The investigated patient sampled was comprised of 829 patients (355 female, 42.8%) with a mean age of 64.1 ± 15.8 years. The primary endpoint of this study was 30-day mortality. The simplified pulmonary embolism index (sPESI) was calculated as a clinical prognostic score. Logistic binary regression analyses were used to test the associations between BMD and 30-day mortality. A total of 94 patients (11.3%) died within the 30-day observation period. A weak inverse association was identified between BMD and sPESI score (r = -0.21, p <0.0001). Low BMD showed an association with 30-day mortality with an odds ratio (OR) of 2.26 (95% confidence interval [CI], 1.24 - 4.10; p = 0.008 in univariable analysis) and 2.39 (95% CI, 1.24 -4.44; p = 0.007) in multivariable analysis. CONCLUSION:Using the threshold value of 75 HU, bone mineral density is a prognostic factor in patients with acute pulmonary embolism. However, this threshold value is lower than the values previously proposed for diagnosing osteoporosis.
Background Negative emotions, including anger, depressive symptoms, and chronic psychosocial stress, are increasingly linked to residual atherosclerotic cardiovascular disease (ASCVD) risk through neuroautonomic, inflammatory, endothelial, and thrombotic pathways. Objectives To synthesize epidemiologic, mechanistic, and interventional evidence relating anger and depressive affect to myocardial infarction (MI) risk, and to outline clinically actionable translational opportunities. Methods We conducted a literature review of adult human studies identified through searches of MEDLINE/PubMed, Embase, PsycINFO, CINAHL, Web of Science, and the Cochrane Library from January 1990 to October 2025. After screening 1180 titles/abstracts and reviewing 146 full-text reports, 70 sources were included and narratively synthesized. Results Across cohorts and meta-analyses, depressive symptoms or major depressive disorder are associated with higher incident CHD/MI risk after multivariable adjustment, though effect sizes vary and residual confounding is possible. Case-crossover studies show a short-term increase in MI risk following intense anger episodes. Mechanistic evidence supports plausible pathways including autonomic surges, HPA-axis dysregulation, endothelial dysfunction, inflammatory signaling (e.g., IL-6/NLRP3), and catecholamine-related thrombogenicity. Interventions—β-blockers, SSRIs, cognitive behavioral therapy (CBT), and mindfulness-based stress reduction (MBSR)— improve emotional symptoms and selected surrogate vascular/inflammatory measures; evidence for reduction in hard cardiovascular outcomes remains limited and mixed. Conclusion Negative emotions are consistently associated with MI risk and align with biologically plausible mechanisms overlapping with residual inflammatory and autonomic risk. Integrating validated emotion screening and scalable interventions into prevention and rehabilitation warrants rigorous evaluation with equity- and privacy-centered implementation.
BACKGROUND:Early arterial blood gas abnormalities may aid risk stratification, but the joint prognostic value of early hypoxemia, hypercapnia, and acid-base status remains uncertain in adult ICU admissions requiring invasive mechanical ventilation during the ICU stay. OBJECTIVES:To evaluate associations of first-day oxygenation and carbon dioxide measures with 30-day mortality. METHODS:We conducted a multicenter retrospective cohort study using a Taiwan critical care registry from 2018 to 2020. Among 11,912 adult ICU admissions with invasive mechanical ventilation during the ICU stay, 4960 had complete first-day arterial blood gas data and interpretable 30-day vital status. Hypoxemia was defined as PaO2/FiO2 <200 mmHg and hypercapnia as PaCO2 >45 mmHg. Multivariable logistic regression adjusted for age, sex, comorbidities, treatment-limitation indicators, and nonrespiratory SOFA score. Additional analyses modeled PaO2/FiO2 and PaCO2 continuously and incorporated pH, severe hypercapnia, palliative care exclusion, and care-unit effects. RESULTS:Overall 30-day mortality was 1141/4960 (23.0%). Compared with the group without a predefined arterial blood gas abnormality, isolated hypoxemia (adjusted odds ratio [aOR], 1.63; 95% CI, 1.33-2.00) and combined hypoxemia-hypercapnia (aOR, 1.67; 95% CI, 1.21-2.32) were associated with higher mortality, whereas isolated hypercapnia was not (aOR, 0.86; 95% CI, 0.54-1.39). As a continuous variable, lower PaO2/FiO2 remained associated with mortality after nonrespiratory SOFA adjustment, whereas PaCO2 did not show a harmful adjusted association. CONCLUSIONS:Early hypoxemia carried the most consistent mortality signal. Isolated mild hypercapnia should be interpreted cautiously with pH, severity threshold, and illness-severity context.
