在医院外心脏骤停的老年幸存者中植入心脏转换器-除器
Mason Marcus1, Paul S Chan2, Anping Chang3
1University of Texas-Southwestern Medical Center Dallas TX USA.
Journal of the American Heart Association
|September 18, 2024
概括
不到三分之一的医院外心脏骤停幸存者有可震动的节律接受了可植入心脏转换器-除器 (ICD). 不管患者因素如何,ICD的使用在各医院都存在显著差异,这凸显了改善二次预防策略的必要性.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 目前的指导方针建议植入式心脏转换器-除器 (ICD) 用于医院外心脏骤停 (OHCA) 幸存者的二次预防.
- 在这个人群中使用ICD的当代数据仍然有限.
研究的目的:
- 检查当代的二次预防ICD植入率在OHCA幸存者中具有可震动的节奏.
- 为了确定与ICD植入相关的患者层面的因素.
- 为了量化医院ICD植入率的变化.
主要方法:
- 对3226名OHCA幸存者 (年龄≥65岁) 的分析,他们来自与医疗保险相关的2013-2019年心脏骤停登记以提高生存率 (CARES) 的震动节奏.
- 使用多变量层次回归模型来评估患者变量与ICD植入和医院变量之间的关联.
- 结果包括在出院前,90天后和6个月内植入ICD.
主要成果:
- 总体而言,30.9%的符合条件的幸存者在出院前接受了ICD.
- 年龄较大,女性性别,糖尿病和急性心肌梗塞的呈现与ICD植入的几率较低有关.
- 在种族/种族和ICD植入之间没有发现显著的关联.
- 观察到ICD植入率的医院变化很大,在调整为病例组合后,几率有62%的差异.
结论:
- 只有不到三分之一的OHCA幸存者在出院前接受了二次预防ICD.
- 患者因素,但不是种族或种族,与ICD植入有关.
- 医院之间存在ICD植入的明显差异,即使在调整患者特征后也是如此.
相关概念视频
Cardiopulmonary Resuscitation I: Adult
Cardiopulmonary resuscitation, or CPR, is a life-saving emergency procedure performed when a person's heart has stopped beating or they are no longer breathing. The foundation of CPR is Basic Life Support (BLS), which focuses on the early recognition of cardiac arrest, the immediate start of high-quality chest compressions, and the timely use of an automated external defibrillator (AED).Assessing Responsiveness and Checking the Carotid PulseWhen approaching an unresponsive person, first ensure...
Cardiopulmonary Resuscitation III: AED Use
Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
Cardiopulmonary Resuscitation IV: Pharmacological Management
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
Heart Failure VI: Adjunct Therapies
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
Cardiomyopathy II: Dilated Cardiomyopathy
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
Cardiomyopathy V: Interprofessional Care
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...


