Aims Biomarkers are not recommended until now to guide the management of patients with heart failure (HF). Soluble suppression of tumorigenicity 2 (sST2) appears as a promising biomarker. The current study considered pre-discharged sST2 values as a guide for medical management in patients admitted for acute HF decompensation, in an attempt to reduce hospital readmission. Methods and results STADE-HF was a blinded prospective randomized controlled trial and included 123 patients admitted for acute HF. They were randomized into the usual treatment group (unknown sST2 level) or the interventional treatment group, for whom sST2 level was known and used on Day 4 of hospitalization to guide the treatment. The primary endpoint was the readmission rate for any cause at 1 month. It occurred in 10 patients (19%) in the usual group and 18 (32%) in the sST2 group without statistical difference (P = 0.11). Post hoc analysis in the whole group shows that the mean duration of hospitalization was lower in patients with low sST2 (<37 ng/mL) at admission vs. high sST2 (8.5 ± 9.5 vs. 14.8 ± 14.9 days, respectively, P = 0.003). In addition, a decrease in sST2 greater than 18% is significantly associated with a lower readmission rate. Conclusions Soluble suppression of tumorigenicity 2-guided therapy over a short period of time does not reduce readmissions. However, sST2 was clearly associated with duration of hospitalization, and the decrease in sST2 was associated with decreased rehospitalizations. Long-term outcome using sST2-guided therapy deserves further investigations.
UNSTRUCTURED
Aims: Virtual reality Hypnosis (VRH) has been used successfully in different clinical settings to treat anxiety and the sensation of pain. We aimed to investigate the feasibility and safety of VRH in patients undergoing electrophysiology and stimulation procedures under conscious sedation.
Methods: During a two-month period, VRH support was proposed to patients undergoing interventions. Data were compared with a control group (n=61) enrolled during the following three-month period. In the intervention group (n=25), the dedicated VR hypnosis programme was projected during the procedure. In both groups, pain and comfort were measured at the end of the procedure and at discharge, using visual analogue scales (VASs; 0-10).
Results: Baseline characteristics were comparable in both groups. There was no difference in procedure duration (46 (±29) vs 56 (±32) min, p=0,18) nor in hypnotic / antalgic consumption (1.95 (±1.44) vs 2.00 (±1.22) mg, p=0,83 and 3.78 (±2.87) vs 3.58 (±2.48) μg, p=0,9) for the control and VR groups respectively. In a multivariate analysis, the use of VR was independently associated with lower comfort during the procedure, assessed by post-operative VAS (OR 15.00 (IC95%4.77;47.16), p<0.01). There was no influence of VR use on pain or drug consumption.
Conclusions: In our experience, VR hypnosis in the EP lab doesn’t improve comfort during the procedure, compared to conventional human care. It has no influence on pain or drug consumption.
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