Aims
To describe and compare the outcomes of a nurse practitioner‐managed cardiac surgery follow‐up model of care with the standard model of primary care provider follow‐up for coronary artery bypass graft surgery patients.
Background
Advances in healthcare have had a favourable impact on length of stay following cardiac surgery; however, the shorter length of stay has not been accompanied by enhanced support to bridge the gap between acute care and the community setting.
Design
Prospective (2009–2010) randomized study.
Methods
Elective cardiac surgery patients (N = 200) were randomly assigned to the nurse practitioner follow‐up intervention or to the standard model of follow‐up care. The main outcomes were health‐related quality of life, patient satisfaction, symptoms, and health resource use. Outcome data were elicited via telephone interviews at 2 and 6 weeks postdischarge.
Results
Baseline differences between the two groups were non‐significant; however, at 2 weeks postdischarge, the intervention group reported significantly fewer symptoms and higher physical functioning status. At 2 and 6 weeks postdischarge, the intervention group was significantly more satisfied with the amount of help, as well as the quality of the services received. Differences in healthcare resource use were not statistically significant.
Conclusion
This evidence suggests that the nurse practitioner‐managed model of follow‐up care effectively bridges the gap between institutional and primary care in the cardiac surgery population.
Background:Acute kidney injury (AKI) following cardiac surgery leads to increased morbidity and mortality. Characterization and validation of early biomarkers of AKI may ultimately facilitate early therapeutic intervention. We have previously identified that elevated urinary hepcidin-25 is inversely and independently associated with the development of AKI in adult cardiac surgery patients. Hepcidin-25 is an antimicrobial peptide that sequesters iron intracellularly, and its elevation following human ischemia reperfusion injury may represent a renoprotective response to minimize renal injury.Objective:Our goal was to validate urinary hepcidin-25 as a non-invasive biomarker in an independent cardiac surgery cohort, within the context of clinical AKI predictors.Design:Prospective observational cohort study.Setting:Adult cardiac surgery program at St. Boniface Hospital, Winnipeg, Manitoba, Canada.Patients:Adult cardiac surgery patients undergoing cardiopulmonary bypass (CPB), n = 306.Measurements:Urine hepcidin-25, measured on post-operative day (POD) 1.Methods:A prospective, observational cohort of adult CPB patients (n = 306) was collected with serial perioperative urine samples. Urine hepcidin-25 at POD 1 was measured by competitive ELISA. Its diagnostic performance was evaluated in conjunction with clinical parameters and the Thakar clinical prediction score, using multivariate logistic regression.Results:Urinary hepcidin-25 is elevated following cardiac surgery in AKI and non-AKI patients. Elevated urinary hepcidin-25 concentration was inversely associated with AKI on both univariate (odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.45-0.83, P = .002) and multivariate analysis (OR: 0.67, 95% CI: 0.50-0.95, P = .02). A combined model with clinical risk factors demonstrated that baseline estimated glomerular filtration rate (eGFR), diabetes mellitus, and urinary hepcidin-25 concentration had an overall area under the curve (AUC) of 0.82 (0.75-0.88) for predicting subsequent AKI development, which was superior to clinical prediction alone as determined by the Thakar score.Limitations:(1) A single-center observational study. (2) Polyclonal antibody–based competitive ELISA.Conclusion:Hepcidin-25 is inversely associated with AKI in a multivariate model when combined with eGFR and diabetes mellitus, with an overall AUC of 0.82. Notably, urinary hepcidin-25 improves on clinical AKI prediction compared to the Thakar score alone.
BackgroundEvidence regarding the incremental benefit of cardiac resynchronization therapy (CRT) with a defibrillator (CRT‐D) versus without (CRT‐P) in elderly patients with heart failure is limited. We compared mortality and cardiac hospitalisation between CRT‐D and CRT‐P in the elderly.MethodsA retrospective chart review identified all consecutive patients with age ≥75 with CRT implantation over the last 10 years at a Canadian tertiary care cardiac centre. Kaplan‐Meier survival analyses and cumulative incidence curves were used to compare mortality and time to first cardiac hospitalisation, respectively, with CRT‐D versus CRT‐P over a 3 year period. Analyses were also repeated with propensity score matching based on age, sex, primary versus secondary prevention, date of implant, and Charlson Comorbidity Index.ResultsOne hundred and seventy CRT patients were identified. A total of 128 received CRT‐D while 42 received CRT‐P. Median age was 79 (IQR 77‐81), and the majority were male (83%). CRT‐P patients had a higher burden of comorbidities (Charlson score 7, IQR 6‐8) than CRT‐D patients (Charlson score 5, IQR 5‐7; P < 0.001). There was no significant difference in survival between the two groups in an unmatched comparison (P = 0.69) and with a propensity score‐matched cohort (P = 0.91). Secondary prevention CRT‐D patients had a higher risk of hospitalisation compared to primary prevention CRT‐D patients; however, there was no significant difference in hospitalisation between the CRT‐D and CRT‐P groups.ConclusionThis study suggests there is no significant difference in mortality or cardiac hospitalisation between CRT‐D and CRT‐P in elderly patients with heart failure.
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