Cardiogenic shock: a review of contemporary approaches and ongoing challenges.

Cardiogenic shock (CS) is a complex condition characterized by insufficient cardiac output, tissue hypoperfusion, and life-threatening organ failure. In this review, we describe the definition, pathophysiology, classification, and approach to management in CS. We highlight recent advances in understanding the phenotypic heterogeneity and classification of CS.

Medical Intensive Care Unit Overflow Into the Cardiac Intensive Care Unit: Insights From CCCTN Registry.

Background: Cardiac intensive care units (CICUs) typically manage critically ill patients with acute cardiovascular (CV) conditions but may serve patients with non-CV critical illness when medical ICU (MICU) beds are unavailable.

Objectives: The purpose of this study was to characterize the clinical profiles and outcomes of "MICU overflow" admissions to the CICU.

Methods: We used the Critical Care Cardiology Trials Network registry to compare CICU admissions without acute or major cardiac issues (MICU overflow) vs those with acute CV illness.

Differences in Care and Outcomes in Cardiogenic Shock in Cardiac Intensive Care Units in the United States and Canada: CCCTN Registry Insights.

Background: Mortality in cardiogenic shock (CS) remains high. Significant interhospital heterogeneity in critical care therapies has been described, which reflects the lack of high-quality evidence to guide optimal treatment. We aimed to describe differences in practices and clinical outcomes among patients with CS in the United States and Canada.

Optimizing Decision Support Alerts to Reduce Telemetry Duration: A Multicenter Evaluation.

Background:  Telemetry monitoring is crucial for high-risk patients but excessive use beyond practice standards increases costs. Prior studies have shown that electronic health record (EHR) alerts reduce low-value telemetry monitoring. However, specific components of these alerts that contribute to effectiveness are unknown.

The role of proprotein convertase subtillisin/kexin type 9 in placental salvage and lipid metabolism in women with preeclampsia.

Introduction: Preeclampsia is associated with decreased maternal low-density lipoprotein cholesterol (LDL-c), which is essential for fetal growth. The underlying mechanisms for decreased LDL-c in preeclampsia remain unknown. Proprotein convertase subtillisin/kexin type 9 (PCSK9) regulates serum LDL-c via LDL receptor (LDL-R) degradation.

Temporal trends of arrhythmias at delivery hospitalizations in the United States: Analysis from the National Inpatient Sample, 2009-2019.

Background: Cardiac arrhythmias are associated with increased maternal morbidity. There are limited data on trends of arrhythmias among women hospitalized for delivery.

Materials And Methods: We used the National Inpatient Sample (NIS) database to identify delivery hospitalizations for individuals aged 18-49 years between 2009 to 2019 and utilized coding data from the 9th and 10th editions of the to identify supraventricular tachycardias (SVT), atrial fibrillation (AF), atrial flutter, ventricular tachycardia (VT), and ventricular fibrillation (VF).

Critical Care Cardiology Trials Network (CCCTN): a cohort profile.

Aims: The aims of the Critical Care Cardiology Trials Network (CCCTN) are to develop a registry to investigate the epidemiology of cardiac critical illness and to establish a multicentre research network to conduct randomised clinical trials (RCTs) in patients with cardiac critical illness.

Methods And Results: The CCCTN was founded in 2017 with 16 centres and has grown to a research network of over 40 academic and clinical centres in the United States and Canada. Each centre enters data for consecutive cardiac intensive care unit (CICU) admissions for at least 2 months of each calendar year.

Racial Disparities in Prevalence of Gestational Diabetes by Maternal Nativity and Length of US Residence in an Urban Low-Income Population in the United States.

Background: Gestational diabetes mellitus (GDM) is associated with increased risk of cardiovascular disease (CVD). Racial/ethnic differences in GDM prevalence have been described, but disparities by nativity and duration of US residence are not well studied.

Methods: We analyzed data from 6088 women (mean age: 27.

Racial Differences in Delivery Outcomes Among Women With Peripartum Cardiomyopathy.

Background: Peripartum cardiomyopathy (PPCM) is a rare idiopathic cardiomyopathy associated with pregnancy that occurs more frequently among Black women. However, less is known about the association of race/ethnicity with outcomes at the time of delivery in women with PPCM.

Methods: We used data from the 2016-2018 National Inpatient Sample (NIS) database to identify women with a diagnosis of PPCM based on International Classification of Diseases, 10th revision (ICD-10) codes.

The Association of Preterm Birth With Maternal Nativity and Length of Residence Among Non-Hispanic Black Women.

Background: Preterm birth (PTB) is associated with future cardiovascular disease (CVD) risk and disproportionally affects non-Hispanic Black (NHB) women. Limited data exist on the influence of length of US residence on nativity-related disparities in PTB. We examined PTB by maternal nativity (US born vs foreign born) and length of US residence among NHB women.

Presentation and outcomes of sepsis in the cardiac intensive care unit.

The prevalence of sepsis is increasing in subspecialty intensive care units, including the cardiac intensive care unit (CICU). The clinical characteristics and outcomes of CICU patients with sepsis are not well understood. We conducted a retrospective cohort study of sepsis patients in the CICU compared to other ICUs using the PROGRESS registry.

Prevention Starts in the Womb: Opportunities for Addressing Cardiovascular Risk Factors During Pregnancy and Beyond.

Early identification and mitigation of sex-specific cardiovascular disease risk factors is a potential trajectory-changing strategy to improve lifelong cardiovascular health in women. These sex-specific risk factors include adverse pregnancy outcomes, polycystic ovarian syndrome, and premature menopause. We start by discussing the impact and management of risk factors for adverse pregnancy outcomes as an upstream intervention for cardiovascular disease risk reduction and then address the long-term effect and mitigation of sex-specific risk factors for cardiovascular disease.

The Effect of Chaplain Patient Navigators and Multidisciplinary Family Meetings on Patient Outcomes in the ICU: The Critical Care Collaboration and Communication Project.

Objectives: To assess the effectiveness of a chaplain patient navigator in improving outcomes and reducing costs in the ICU setting.

Design: A randomized controlled trial at a large, urban, academic community hospital in Baltimore, Maryland.

Setting/patients: All patients admitted to the Johns Hopkins Bayview Medical Center Cardiac and Medical ICUs between March 2015 and December 2015.

Interconception Care for Primary Care Providers: Consensus Recommendations on Preconception and Postpartum Management of Reproductive-Age Patients With Medical Comorbidities.

Severe maternal morbidity and mortality continue to increase in the United States, largely owing to chronic and newly diagnosed medical comorbidities. Interconception care, or care and management of medical conditions between pregnancies, can improve chronic disease control before, during, and after pregnancy. It is a crucial and time-sensitive intervention that can decrease maternal morbidity and mortality and improve overall health.

Cardiovascular and Obstetric Delivery Complications in Pregnant Women With Valvular Heart Disease.

Women with valvular heart disease may be more likely to have adverse obstetric and cardiovascular complications during pregnancy. Most current recommendations focus on stenotic lesions with less guidance regarding regurgitant lesions. We aimed to compare adverse events at delivery for women with various stenotic and regurgitant valvular diseases.

Incidence of essential hypertension but not echocardiographic abnormalities at four years with a history of preeclampsia with severe features.

Introduction: Women with preeclampsia are more likely to have abnormal echocardiographic parameters at the time of diagnosis and are more likely to have hypertension and other cardiovascular diseases (CVD) later in life. Screening for future CVD in preeclamptic women would assist in appropriately risk stratifying and identifying high risk women for preventive management; however, the timing of screening and the screening factors are unknown.

Objective: The objectives of this project are to 1) assess incidence of essential hypertension 4 years after pregnancy in preeclampsia with severe features (PEC) 2) identify predictive echocardiographic variables at the time of PEC diagnosis and 3) assess the rate of echocardiographic abnormalities 4 years after developing PEC.