Author Archives: Amy

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Clinical Informationist at EUH Branch Library

What role does inflammation play in congestive heart failure?

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Chapater 26  Pathophysiology of heart failure.  In:  Hurst’s the Heart [AccessMedicine].
This section includes a section entitled, “Inflammatory Responses: The Inflammatory Hypothesis.”

“Heart Failure/physiopathology”[majr] AND inflammat*
Filters (Limits):  English, Review articles

This search includes the following references:
The role of monocytes and inflammation in the pathophysiology of heart failure.
Wrigley BJ, Lip GY, Shantsila E.
Eur J Heart Fail. 2011 Nov;13(11):1161-71. Epub 2011 Sep 27. Review.
PMID:21952932

Immune modulation in heart failure: past challenges and future hopes.
Flores-Arredondo JH, García-Rivas G, Torre-Amione G.
Curr Heart Fail Rep. 2011 Mar;8(1):28-37. Review.
PMID:21221862

Reviewed JKN 4/14

Does the use of a thoracic impedance device during resuscitation improve patient outcomes compared to resuscitations without use of such a device?

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There is some evidence that use of an impedance threshold device added to active compression-decompression device  may result in small improvement in survival but impedance device added to standard cardiopulmonary resuscitation (CPR) does not improve survival.

Aufderheide TP, et al. Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial. Lancet. 2011 Jan 22;377(9762):301-11. RESQ Trial
1,653 adult patients with out-of-hospital cardiac arrest randomized to resuscitation with compression-decompression device plus impedance threshold device compared to standard CPR. RESULTS:  Survival to discharge without neurologic impairment was similar for both groups.

Aufderheide TP, et al. A trial of an impedance threshold device in out-of-hospital cardiac arrest. N Engl J Med. 2011 Sep 1;365(9):798-806. ROC PRIMED Trial
9,220 patients with out-of-hospital cardiac arrest randomized to standard CPR with active impedance threshold device (ITD) compared to standard CPR with sham ITD. RESULTS:  Survival to hospital discharge with normal Rankin score was 6% for the sham ITD group compared to 5.8% for the active ITD group.  Rates for return of spontaneous circulation and survival to hospital admission were also similar for both groups.

Also see Cardiac Arrest (Treatment>Other Management>Prehospital care>Improving chest compressions).  In:  DynaMed

Cabrini L, et al. Impact of impedance threshold devices on cardiopulmonary resuscitation: a systematic review and meta-analysis of randomized controlled studies. Crit Care Med. 2008 May;36(5):1625-32.
Systematic review of older, RCTs

Reviewed JKN 4/14

How do postsurgical outcomes compare for general v. local anesthesia for implantation and testing of implantable cardioverter defibrillators (ICD)?

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A search of PubMed for “Defibrillators, Implantable”[MAJR] AND (local anesthesia OR sedation) AND (outcome OR complications OR safety OR satisfaction) identified several studies.

Studies comparing local anesthesia/sedation v. general anesthesia

Can we implant cardioverter defibrillator under minimal sedation?
Marquié C, Duchemin A, Klug D, Lamblin N, Mizon F, Cordova H, Boulo M, Lacroix D, Pol A, Kacet S.
Europace. 2007 Jul;9(7):545-50.
Measured patient-reported level of pain.

Electrophysiologist-implanted transvenous cardioverter defibrillators using local versus general anesthesia.
Manolis AS, Maounis T, Vassilikos V, Chiladakis J, Cokkinos DV.
Pacing Clin Electrophysiol. 2000 Jan;23(1):96-105.
Measured rate of post-surgical complications

Local anaesthesia versus general anaesthesia for cardioverter-defibrillator implantation.
Stix G, Anvari A, Podesser B, Pernerstorfer T, Mayer C, Laufer G, Schmidinger H.
Wien Klin Wochenschr. 1999 May 21;111(10):406-9.
Measured rate of post-surgical complications

Intravenous sedation for placement of automatic implantable cardioverter-defibrillators.
Pinosky ML, Reeves ST, Fishman RL, Alpert CC, Dorman BH, Kratz JM.
J Cardiothorac Vasc Anesth. 1996 Oct;10(6):764-6.
Measured length of stay and rate of post-surgical complications

Studies describing outcomes for procedures performed under locatl anesthetic/sedation

Safety and acceptability of implantation of internal cardioverter-defibrillators under local anesthetic and conscious sedation.
Fox DJ, Davidson NC, Royle M, Bennett DH, Clarke B, Garratt CJ, Hall MC, Zaidi AM, Patterson K, Fitzpatrick AP.
Pacing Clin Electrophysiol. 2007 Aug;30(8):992-7. Erratum in: Pacing Clin Electrophysiol. 2007 Nov;30(11):1423

Additional descriptive studies

Reviewed JKN 4/14

What are the outcomes and care issues for patients undergoing intra-aortic balloon pump through the subclavian artery?

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PubMed
intra-aortic balloon pump AND (axillary OR axillo-subclavian OR subclavian)
Includes several papers describing results in small series of patients undergoing this procedure. Outcomes reported include survival to intended endpoint of the bridge, mortality, device-related infections, bleeding, etc.  You can add terms for specific outcomes and/or specific patient populations to the search to focus your results.

AACN Procedure Manual for Critical Care, 6th ed., provides details on the procedure, equipment, outcomes, etc. It references this case report/review, which is included in the PubMed search above.
Heart Lung Circ. 2006 Apr;15(2):148-50.
Intraaortic balloon pump insertion through the subclavian artery. Subclavian artery insertion of IABP.  Marcu CB, Donohue TJ, Ferneini A, Ghantous AE

Note: The AACN Manual is available in print at the EUH Branch Library.

SEARCH METHODS
The results above were achieved by a search of DynaMed, Joanna Briggs, AACN Procedure Manual for Critical Care, and PubMed using combinations of these concepts:
intra-aortic balloon pump
axillary OR axillo-subclavian OR subclavian
clinical trials
complications OR outcomes

Neither DynaMed nor Joanna Briggs JBI had specifics on this method of the intraaortic balloon pump.

Reviewed by John Nemeth 4/14

For patients with coronary artery disease, does patient education affect lifestyle/behavior or patient satisfaction?

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Many of the papers describe multi-faceted interventions that include patient education as one component.

Cardiac Rehabilitation: Interventions. In: Joanna Briggs JBI+Connect. Updated September 2, 2014.

Arch Gerontol Geriatr. 2008; 46 (2): 227-44
In this trial of 173 patients age ≥ 65 years and post CABG randomized to a multi-faceted intervention by a multidisciplinary team of professionals and which included education or usual care, the intervention group was more likely to engage in physical activity

Schadewaldt V, et al. Nurse-led clinics as an effective service for cardiac patients: results from a systematic review.  Int J Evid Based Healthc. 2011 Sep;9(3):199-214.
Review of seven randomized studies on nurse-led clinics, but the major intervention was patient education and behavior counseling.   Clinics were associated with limited effects on behaviors, such as smoking cessation and diet adherence.

PubMed search:  (“coronary artery disease” OR coronary artery bypass) AND (rehabilitation OR “secondary prevention”) AND patient education AND (behavior OR lifestyle OR satisfaction) AND (clinical trial OR randomized)
Other clinical trials on patient education interventions. To see quasi-experimental studies, change modify the search above replacing the terms for study type with these terms:  (comparative study OR before and after study OR pilot) or remove all terms for the study methodology from the search.

CINAHL search:  (cornoary artery disease OR corornary artery bypass) AND patient education AND (rehabilitation OR “secondary prevention”) AND (satisfaction OR lifestyle OR behavior)
Identified papers, such as Barnason S, et al. A comparison of patient teaching outcomes among postoperative coronary artery bypass graft (CABG) patients. Prog Cardiovasc Nurs. 1995; 10(4): 11-20.
While this is an older study, it does reference a tool for measuring patient satisfaction that might be useful.

Reviewed by John Nemeth 4/14

Is hemoglogin A1c associated with wound healing in the orthopedic population?

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Bottom line:  For patients undergoing orthopedic procedures, there is some evidence suggesting an association between perioperative HbA1c levels and complications involvoing the surgical site.

PubMed search:  (orthopedic procedures OR orthopedic surgery) AND (hemoglobin A1c OR hba1c)
The following references from the search results provided data on HbA1c in patients undergoing orthopedic procedures.

Jamsen (2010):  prospective cohort study of 1565 elective knee surgeries for which preoperative plasma glucose was recorded. Patients followed 20 months.  Mean HbA1c

Younger (2009):  Case-control study matching 21 patients with failed transmetatarsal amputation (TMA) with 21 successful TMAs.  HbA1c was the factor most closely associated with success of the TMA.

Marchant (2009):  Retrospective study of >1 million patients undergoing joint replacement surgery 1988-2005 as recorded in the Nationwide Inpatient Sample.  Patients with controlled diabetes mellitus (determined by combination of patient-measured blood glucose and HbA1c) had increased risk of  wound infection (adjusted odds ratio = 2.28 compared to patients with controlled diabetes mellitus.

Lamloum (2009):  Retrospective study of 318 consecutive diabetic patients undergoing surgery at an orthopedic hospital.   Table 3 compares rates of surgical site infections (SSI) for patients with HbA1c < 7.0 compared to rate for patients with HbA1c ≥ 7.0.  High HbA1c was associated with higher rate of SSI

Reviewed by John Nemeth 4/14

Does patient education for cardiac rehabilitation patients affect mortality (all-cause or CV-related), cardiovascular morbidity, revascularization, or hospitalization?

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•    DynaMed.  Coronary Artery Disease.  Use the navigation pane on the left side of the page to select Treatment>Counseling.  Cites this systematic review.

Cochrane Database Syst Rev. 2011 Dec 7;(12):CD008895.  Brown JP, et al.  Patient education in the management of coronary heart disease.

Reviews 13 RCTs of educational interventions in over 68,000 CAD patients.  Interventions used various methods.  Results for effect on health-related quality of life were inconsistent.  No statistically significant evidence for reduction of mortality, cardiac morbidity, revascularization, or hospitalization.  Educational interventions varied in format.  See the review for descriptions of individual interventions.

•    Joanna Briggs JBI+Connect.  Cardiac Rehabilitation: Interventions

JBI also cites the Brown (2011) review above, as well as:

Kummel M, et al. Effects of an intervention on health behaviors of older coronary artery bypass (CAB) patients. Arch Gerontol Geriatr. 2008; 46 (2): 227-44
RCT of 117 patients randomized to usual care or an intervention consisting of multiple sessions of health counseling, guidance, and adjustment education.  Intervention positively impacted physical activity and functional abilities.  No evaluation of effect on mortality or morbidity.

Reviewed by John Nemeth 4/14