Publications by authors named "Nicholas Phreaner"
Background: Patients treated in tertiary cardiac intensive care units (CICUs) often arrive via transfer from other hospitals. This "transfer population" is poorly described and has been largely excluded from trials in critical care.
Objectives: The aim of this study was to characterize patients who are transferred from other hospitals to advanced CICUs.
Background: Chronic thromboembolic disease (CTED) is characterized by pulmonary vascular thromboembolic occlusions without elevation in pulmonary artery pressures or pulmonary vascular resistance at rest. Many patients have dyspnea on exertion despite normal resting hemodynamics and symptomatic improvement after pulmonary thromboendarterectomy surgery. We hypothesize that the safety and efficacy of pulmonary thromboendarterectomy in CTED will be similar to that in chronic thromboembolic pulmonary hypertension (CTEPH), which currently has a better characterized risk-benefit profile.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates sex-related differences in characteristics and outcomes of patients with cardiogenic shock (CS), particularly focusing on heart failure-related CS (HF-CS) versus acute myocardial infarction-related CS.
- Among patients with HF-CS, women had shorter lengths of stay in the Cardiac Intensive Care Unit (CICU) but were less likely to receive critical interventions like pulmonary artery catheters and mechanical support.
- In-hospital mortality rates were higher for women with HF-CS compared to men, even after controlling for factors like age and overall health status, highlighting a disparity in treatment and outcomes based on sex.
Patients With Acute Coronary Syndromes Admitted to Contemporary Cardiac Intensive Care Units: Insights From the CCCTN Registry.
Circ Cardiovasc Qual Outcomes
August 2022
Article Synopsis
- The study analyzed admissions for acute coronary syndrome (ACS) in cardiac intensive care units (CICUs) to understand patient characteristics and outcomes.
- Out of over 10,000 CICU admissions, nearly 30% were for ACS, showing significant differences in admission reasons and mortality rates compared to non-ACS patients.
- Most ACS admissions were for monitoring only, with a very low mortality rate and short hospital stays, indicating that many ACS patients may not require intensive care after initial evaluation.
Article Synopsis
- Acute heart failure (HF) is a significant complication in COVID-19 patients, particularly linked to inflammation, and can be categorized into de novo or acute-on-chronic HF based on prior history.
- In a study of 901 ICU admissions for COVID-19, 80 patients (8.9%) experienced acute HF, with most cases being de novo HF presentations.
- Patients with acute HF exhibited higher levels of cardiac injury biomarkers and faced greater severity of illness and mortality compared to those without acute HF, underscoring the critical link between severe COVID-19 and heart complications.
Article Synopsis
- Heart failure-related cardiogenic shock (HF-CS) is becoming more common in cardiac intensive care units, and this study focused on whether the chronicity of heart failure affects clinical profiles in these patients.
- Researchers analyzed data from 28 centers involving 1,405 admissions for HF-CS between 2017-2020, finding that 26.3% were classified as de novo HF-CS and 73.7% as acute-on-chronic HF-CS.
- Patients with de novo HF-CS exhibited fewer comorbidities but had more severe shock symptoms and a higher risk of in-hospital mortality compared to those with acute-on-chronic HF-CS, indicating the need for further research on the underlying mechanisms and treatment responses in these
Background: A subset of patients with takotsubo cardiomyopathy will develop significant dynamic left ventricular outflow tract (LVOT) obstruction leading to cardiogenic shock. However, traditional therapies for cardiogenic shock that focus on increased inotropy and afterload reduction can be detrimental in this situation.
Case Summary: We describe a 71-year-old woman who presented to the emergency department with typical, substernal chest pain found to be hypotensive with ST-elevations in the lateral leads.
Article Synopsis
- The study aimed to improve risk assessment and treatment selection for patients experiencing cardiogenic shock by using a structured staging system from the 2019 Society for Cardiovascular Angiography and Interventions.
- A total of 1,991 patients were identified across five clinical stages (A to E), revealing varying mortality rates, with stage E patients having the highest risk.
- The findings confirmed that the staging system enhances mortality prediction beyond existing assessment tools, highlighting significant differences in outcomes based on the severity of cardiogenic shock.
Incidence, underlying conditions, and outcomes of patients receiving acute renal replacement therapies in tertiary cardiac intensive care units: An analysis from the Critical Care Cardiology Trials Network Registry.
Am Heart J
April 2020
Background: The prevalence of renal disease in cardiac intensive care units (CICUs) is increasing, but little is known about the utilization, concurrent therapies, and outcomes of patients requiring acute renal replacement therapy (RRT) in this specialized environment.
Methods: In the Critical Care Cardiology Trials Network, 16 centers submitted data on CICU admissions including acute RRT (defined as continuous renal replacement therapy and/or acute intermittent dialysis).
Results: Among 2,985 admissions, 178 (6.
Article Synopsis
- Temporary mechanical circulatory support (MCS) devices are used to help patients with shock that doesn't respond to medication, but previous studies mainly focused on single devices or specific shock causes, limiting understanding of overall practices in cardiac intensive care units (CICUs).* -
- The CCCTN network collected data from 16 CICUs in North America over a year, revealing that 34% of 585 patients with cardiogenic shock or mixed shock received temporary MCS, with significant differences in device usage across centers.* -
- Intraaortic balloon pumps (72%) were the most common device, showing better patient conditions compared to other MCS types, suggesting that while the use of temporary MCS varies widely, patient
Demographics, Care Patterns, and Outcomes of Patients Admitted to Cardiac Intensive Care Units: The Critical Care Cardiology Trials Network Prospective North American Multicenter Registry of Cardiac Critical Illness.
JAMA Cardiol
September 2019
Article Synopsis
- - The study reveals significant changes in cardiac intensive care units (CICUs) and emphasizes the need for research to support evidence-based redesigns, as highlighted by professional societies.
- - Conducted across 16 advanced CICUs in the US and Canada, the research analyzed data from 3310 admissions over a year to identify patient demographics, diagnoses, and outcomes.
- - Among 3049 participants, most were older adults with a high burden of noncardiovascular health issues, with common diagnoses including acute coronary syndrome and heart failure; over half required advanced therapies or monitoring during their care.
Epidemiology of Shock in Contemporary Cardiac Intensive Care Units.
Circ Cardiovasc Qual Outcomes
March 2019
Background Clinical investigations of shock in cardiac intensive care units (CICUs) have primarily focused on acute myocardial infarction (AMI) complicated by cardiogenic shock (AMICS). Few studies have evaluated the full spectrum of shock in contemporary CICUs. Methods and Results The Critical Care Cardiology Trials Network is a multicenter network of advanced CICUs in North America.
View Article and Find Full Text PDFEffect of catheter movement and contact during application of radiofrequency energy on ablation lesion characteristics.
J Interv Card Electrophysiol
November 2013
Background: The efficient delivery of radiofrequency (RF) energy through an endocardial ablation catheter is affected by variable tissue contact due to cardiac motion with myocardial contraction and respiration. In addition, many operators intentionally move an ablation catheter during the delivery of radiofrequency energy when targeting specific arrhythmias that require lines of conduction block such as atrial flutter and atrial fibrillation. We sought to characterize and quantify any effects of catheter movement and intermittent ablation catheter contact on lesion characteristics.
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