Borkthomas2112

Hyperkalemia is a potentially life-threatening condition associated with the use of heart failure (HF) medications, which can lead to increased morbidity and mortality. Novel approaches for hyperkalemia prevention are needed, especially in limited-resource settings. Despite multiple studies showing the beneficial impact of pharmaceutical-counseling in several outcomes, there is a knowledge-gap regarding its impact on hyperkalemia prevention.

A case-control study was performed in patients from the Adult Heart Failure Clinic Registry in our institution. Nintedanib molecular weight Cases were selected using a definition of serum potassium K+ ≥5.5mmol/L. To study the association between hyperkalemia and relevant risk factors, we performed a multivariate logistic regression analysis using the Least Absolute Shrinkage and Selection Operator (LASSO) method for variable selection. We also fitted a Classification and Regression Tree (CART) to establish complex interactions and effect modifiers between the selected variables.

We matched 483ess its effectiveness.

Risk prediction with the Global Registry of Acute Coronary Events (GRACE) risk model is guideline-recommended in acute coronary syndrome (ACS) patients. However, the performance of more contemporary scores derived from ACTION (Acute Coronary Treatment and Intervention Outcomes Network) and National Cardiovascular Data (NCDR) registries remains incompletely understood. We aimed to compare these models in German ACS patients.

A total of 1567 patients with (Non-)ST-segment elevation myocardial infarction (NSTEMI 1002 patients, STEMI 565 patients) undergoing invasive management at University Hospital Düsseldorf (Germany) from 2014 to 2018 were included. Overall in-hospital mortality was 7.5% (NSTEMI 3.7%, STEMI 14.5%). Parameters for calculation of GRACE 1.0, GRACE 2.0, ACTION and NCDR risk models and in-hospital mortality were assessed and risk model performance was compared. The GRACE 1.0 risk model for prediction of in-hospital mortality discriminated risk superior (c-index 0.84) to its successor GRACE 2.0 (c-index 0.79, p

= 0.0008). The NCDR model performed best in discrimination of risk in ACS overall (c-index 0.89; p

< 0.0001; p

< 0.0001) and showed superior performance compared to GRACE in NSTEMI and STEMI subgroups (p

both < 0.02). ACTION and GRACE risk models performed comparable to each other (both c-index 0.84, p

= 0.68), with advantages for ACTION in NSTEMI patients (c-index 0.87 vs. 0.84 (GRACE); p

= 0.02). ACTION and GRACE 2.0 showed the most accurate calibration of all models.

In a contemporary German patient population with ACS, modern NCDR and ACTION risk models showed superior performance in prediction of in-hospital mortality compared to the gold-standard GRACE model.

In a contemporary German patient population with ACS, modern NCDR and ACTION risk models showed superior performance in prediction of in-hospital mortality compared to the gold-standard GRACE model.

Catheter ablation of the specialized atrioventricular junction (AVJ) with a right-side approach is an effective therapy for refractory atrial fibrillation with fast ventricular rate. Our aim is to assess the efficacy of the procedure in a single center experience and investigate the histologic findings of AVJ after catheter ablation.

A) Analysis of AVJ ablation efficacy in a consecutive series of patients with refractory atrial fibrillation; B) Histopathologic study of the conduction system by serial section technique and clinical-electrophysiologic correlation in four patients who underwent AVJ ablation.

A) Right-sided AVJ ablation was successful in all 87 consecutive patients (mean procedural time 19.2±17.9min). Energy applications ranged from 1 to 27 (mean 5.8±5.1) with eight patients (9%) requiring > 15 applications. B) Fibrotic disruption of atrioventricular (AV) node and/or His bundle interruption was found in three cases with previous AVJ ablation. In the case requiring a left side approach, the compact AV node and common His bundle appeared undamaged whereas extensive fibrosis of the summit of the ventricular septum, branching His bundle and proximal bundle branches was found. Noteworthy, a continuity between the septal and anterior tricuspid valve leaflets was present.

Our data confirm that the ideal site for ablation of the specialized AVJ is the AV node. In selected cases with unsuccessful AV node ablation, a shift towards the His bundle is needed. A continuity between the septal and anterior leaflets of the tricuspid valve may protect the His bundle as to require multiple shocks and prolong the procedure.

Our data confirm that the ideal site for ablation of the specialized AVJ is the AV node. In selected cases with unsuccessful AV node ablation, a shift towards the His bundle is needed. A continuity between the septal and anterior leaflets of the tricuspid valve may protect the His bundle as to require multiple shocks and prolong the procedure.

There is paucity of data on Atrial Fibrillation (AF) management and associated clinical outcomes among Asian Americans. This study sought to investigate baseline risk factor profiles, racial disparities in clinical management and adverse clinical outcomes among White and Asian Americans.

We used National Cardiovascular Data Registry (NCDR®) Practice Innovation and Clinical Excellence (PINNACLE) registry and linked Centers of Medicare and Medicaid Services data to identify Asian and White patients with AF between January 1, 2013-June 30, 2018. We compared rates of baseline risk factors, management strategies (rate versus rhythm control), anticoagulation use and rates of adverse events between racial groups. The two race groups were compared using hierarchical multivariable adjusted regression models to account for site and confounders.

In total, 1,359,827 patients (18,793 Asians and 1,341,034 Whites) were included in our analysis. Compared to White Americans, Asian Americans were more likely to use a rate control strategy (Odds Ratio [OR] 1.20, 95% Confidence Interval [CI] 1.15-1.25) and lower odds of rhythm control strategy (atrial ablations, cardioversions, or use of antiarrhythmic drugs) (OR 0.83, 95% CI 0.80-0.87) in adjusted analysis. Use of oral anticoagulants and direct oral anticoagulants were similar. There were no significant race-based differences in likelihood of all-cause mortality, stroke, and bleeding requiring hospitalization. Analyses performed using propensity score matching were consistent with the main results.

Asian Americans with AF have a lower likelihood of being managed with rhythm control strategies. Overall use of OAC and AF related adverse events remain similar between the two racial groups.

Asian Americans with AF have a lower likelihood of being managed with rhythm control strategies. Overall use of OAC and AF related adverse events remain similar between the two racial groups.