AbstractIntroductionThe initial rhythm during cardiac arrest is a prognostic indicator of survival. However, there is limited data on underlying etiology according to initial rhythm.PurposeTo evaluate the correlation between the initial cardiac rhythm during cardiac arrest and the presence of a culprit lesion on invasive coronary angiography.MethodThis is a single-center study covering a period of 3 years (January 1, 2020 to December 31, 2022) involving all patients who had a cardiac arrest with a known initial cardiac rhythm and who underwent invasive coronary angiography.ResultsWe recorded 50 patients; 39 (78%) were men. The mean age was 61.7 ± 12.9 years. There were 42 (84%) cases of out-of-hospital cardiac arrest and 8 (16%) cases of in-hospital cardiac arrest; 17 (34%) patients had a history of ischemic heart disease. The initial cardiac rhythm was shockable (ventricular fibrillation or ventricular tachycardia) in 37 (74%) patients and non-shockable (asystole) in 13 (26%) patients. The mean duration of no-flow was 3.7 ± 5.6 minutes; that of low-flow was 26.3 ± 21.3 minutes. ST segment elevation was noted in 25 (51%) patients after return of spontaneous circulation. On invasive coronary angiography, a lesion judged to be the culprit was found in 27 (54%) patients. Overall mortality was 58% (29/50): 21 (72.4%) deaths occurred in the first week; 7 (24.1%) between the 1st week and the 1st month; and 2 (6.9%) beyond the 1st month. Five factors appeared to be associated with the mortality in univariate analyses: low-flow > 15 min: OR = 6.22, 95% CI [1.76-26.89], p = 0.004; use of adrenaline: OR = 6.86, 95% CI [1.76-26.73], p = 0.005; cardiogenic shock: OR = 5.55, 95% CI [1.62-19.02], p = 0.006; use of noradrenaline: OR = 4.26, 95% CI [1.28-14.14], p = 0.017; no-flow > 5 min: OR = 6.7, 95% CI [1.30-34.33], p = 0.022. After adjustment, only cardiogenic shock remained associated with mortality: adjusted OR = 9.50, 95% CI [1.08-84], adjusted p = 0.0428. The initial cardiac rhythm was not predictive of the presence of a culprit coronary lesion. Of the 27 patients with a culprit lesion on invasive coronary angiography, 22/37 (59.5%) had an initial shockable rhythm and 5/13 (38.5%) had an initial non-shockable rhythm p = 0.10. The initial heart rhythm was also not predictive of mortality: 20/37 (54.1%) in the case of an initial shockable rhythm versus 9/13 (69.2%) in the case of an initial non-shockable rhythm: p = 0.27.ConclusionThe initial heart rhythm was not predictive of either the presence of culprit coronary lesion on invasive coronary angiography or of short-term mortality.

2024-12-01·The European Journal of Health Economics

Cost awareness among intensivists in their daily clinical practice: a prospective multicentre study

Article

作者: Verdier, Philippe ; Lambert, Céline ; Ravan, Ramin ; Lehut, Timothée ; Ocquidant, Philippe ; Bauer, Ulrich ; Chabanne, Russell ; Lautrette, Alexandre ; Futier, Emmanuel ; Mourgues, Charline ; Mortier, Romain

AbstractBackgroundBetter cost-awareness is a prerogative in achieving the best benefit/risk/cost ratio in the care. We aimed to assess the cost-awareness of intensivists in their daily clinical practice and to identify factors associated with accurate estimate of cost (50–150% of the real cost).MethodsWe performed a prospective observational study in seven French ICUs. We compared the estimate of intensivists of the daily costs of caring with the real costs on a given day. The estimates covered five categories (drugs, laboratory tests, imaging modalities, medical devices, and waste) whose sum represented the overall cost.ResultsOf the 234 estimates made by 65 intensivists, 70 (29.9%) were accurate. The median overall cost estimate (€330 [170; 620]) was significantly higher than the real cost (€178 [124; 239], p < 0.001). This overestimation was found in four categories, in particular for waste (€40 [15; 100] vs. €1.1 [0.6; 2.3], p < 0.001). Only the laboratory tests were underestimated (€65 [30; 120] vs. €106 [79; 138], p < 0.001). Being aware of the financial impact of prescriptions was factor associated with accurate estimate (OR: 5.05, 95%CI:1.47–17.4, p = 0.01). However, feeling able to accurately perform estimation was factor negatively associated with accurate estimate (OR: 0.11, 95%CI: 0.02–0.71, p = 0.02).ConclusionFrench intensivists have a poor awareness of costs in their daily clinical practice. Raising awareness of the financial impact of prescriptions, and of the cost of laboratory tests and waste are the main areas for improvement that could help achieve the objective of the best care at the best cost.

2022-10-03·European Heart Journal

Women in cardiology leadership of randomized clinical trials and participation of women in late-breaking clinical trials: has the COVID-19 pandemic changed a thing or not exactly?

作者: Trofenciuc, M ; Siller-Matula, J ; Alasnag, M ; Cader, F A ; Parapid, B ; Milin Lazovic, J ; Bond, R M ; Hachemi, H ; Waksman, R ; Kanjuh, V ; Katsa, J ; Kataria, R ; Asanin, M ; Mischie, A ; Kass Wenger, N

AbstractIntroductionDespite considerable developments made in the representation of women in cardiology (WIC) recently, there still remain substantial disparities in the representation of women participants in clinical trials, as well as women physicians and scientists in clinical trial leadership. Under-representation of women in Randomized Clinical Trials (RCTs) remains the bane of the modern medicine, impeding the development of sex-specific guidelines in cardiovascular diseases. Female leadership in clinical trials has been shown to enhance the inclusion of women as trial participants. Furthermore, while the COVID-19 pandemic has impacted women in academia, there is no data thus far reporting the impact of the pandemic in terms of presenters and leadership of late-breaking clinical trials (LBCT) in cardiology during this period.PurposeWe aimed to determine inclusion of WIC in LBCTs leadership and their correlation to inclusion of women in reported RCTs.MethodsIn our comprehensive analysis, we included all LBCTs presented at major international cardiovascular meetings reported over the period of January 2020 to February 2022. Data were derived from the original presentation at the meeting and/or simultaneous/ subsequent publication of manuscript. Sex of the presenter (woman or man), was assessed by either original videos of the presentation at the meeting, or based on pronoun use in the biographies derived from institutional profiles. The presence or absence of reporting of sex distribution of study participants were also recorded from original presentation at the meeting and/or published manuscript. Proportion of women included in each trial was sourced from either original publication or calculated from any similar data shown during the presentations.ResultsA total of 400 of RCTs from 19 meetings were included with a total of 400 presenters/principal investigators recorded – 32 (8%) women and 368 (92%) men. There were no significant differences between 2020 and 2021 [15 (7.2%) women in 2021 vs. 17 (19.3%) in 2020 (P=0.446)]. Proportions of women included in RCTs with WIC (37.3%) vs. non-WIC (38.7%) presenters were comparable (p=0.559), while 45% of RCTs didn't report sex distribution of participants. Except for 2 meetings (CRT 2020 and 2022), all others were virtual.ConclusionWIC representation as RCTs presenters was significantly low, despite the opportunity of virtual attendance afforded during the COVID-19 pandemic. Modest inclusion of women irrespective of sex of RCT leadership emphasizes multi-level problems that require more actionable solutions: i.e. implicit bias training started as early as medical school, continuing education on necessity for diversity, equity and inclusion, patient and public involvement, and comprehensive guidance on trial design, such that future RCT participants reflect the populations intended to treat.Funding AcknowledgementType of funding sources: None.

100 项与 Centre Hospitalier de Montluçon 相关的药物交易

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100 项与 Centre Hospitalier de Montluçon 相关的转化医学

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