Publications by authors named "Rawshani A"
Aim: To explore the impact of age on the discriminative ability of the National Early Warning Score (NEWS) 2 in prediction of unanticipated Intensive Care Unit (ICU) admission, in-hospital cardiac arrest (IHCA) and mortality within 24 hours of Rapid Response Team (RRT) review. Furthermore, to investigate 30- and 90-day mortality, and the discriminative ability of NEWS 2 in prediction of long-term mortality among RRT-reviewed patients.
Methods: Prospective, multi-centre study based on 830 complete cases.
Purpose: We examined whether end-to-end deep-learning models could detect moderate (≥50%) or severe (≥70%) stenosis in the left anterior descending artery (LAD), right coronary artery (RCA) or left circumflex artery (LCX) in iodine contrast-enhanced ECG-gated coronary CT angiography (CCTA) scans.
Methods: From a database of 6293 CCTA scans, we used pre-existing curved multiplanar reformations (CMR) images of the LAD, RCA and LCX arteries to create end-to-end deep-learning models for the detection of moderate or severe stenoses. We preprocessed the images by exploiting domain knowledge and employed a transfer learning approach using EfficientNet, ResNet, DenseNet and Inception-ResNet, with a class-weighted strategy optimised through cross-validation.
Article Synopsis
- Guidelines for cardiac arrest management were analyzed to assess the strength and quality of the evidence supporting them, revealing both strengths and significant gaps in knowledge.
- The review of the 2020 American Heart Association (AHA) Guidelines identified 254 recommendations, mostly classified under advanced life support (ALS) and basic life support (BLS), but only 1% of recommendations were based on the strongest level of evidence (LOE A).
- Only 32% of the highest class recommendations were backed by strong evidence (LOE A or B), highlighting the need for more rigorous research, especially randomized trials, to improve the quality of guidelines.
Background: Acute myocarditis/perimyocarditis presents with a variable prognosis ranging from complete recovery to end-stage heart failure (HF), sudden cardiac arrest, and death. The relationship between a prior history of myocarditis/perimyocarditis and outcomes in out-of-hospital cardiac arrest remains unclear.
Methods And Results: Using the SCRR (Swedish Cardiopulmonary Resuscitation Registry), we analyzed 54 568 cases of out-of-hospital cardiac arrest from 2010 to 2020 where cardiopulmonary resuscitation was attempted.
Background And Aims: The long-term outcomes of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease remain debated.
Methods: The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry was used to analyse 57 097 revascularized patients with NSTEMI with multivessel disease in Sweden from January 2005 to June 2022.
Article Synopsis
- * A study analyzed 15,856 ECGs from emergency patients in Sweden and trained a convolutional neural network (ResNet) to predict troponin elevation, achieving an accuracy of 71.43% and a high negative predictive value of 0.8660.
- * The model's promising performance suggests that similar neural networks could be used in emergency settings for rapid triage of patients suspected of having heart issues.
Inotropes and mortality in patients with cardiogenic shock: an instrumental variable analysis from the SWEDEHEART registry.
Eur Heart J Cardiovasc Pharmacother
October 2024
Article Synopsis
- This study examines the impact of inotropic agents on 30-day mortality rates in patients suffering from cardiogenic shock (CS), using data from the SWEDEHEART registry in Sweden.
- The research involved 16,214 CS patients, indicating that those treated with inotropes generally faced higher mortality risks compared to those who did not, with an adjusted hazard ratio of 1.72.
- The findings suggest that inotropes may be associated with increased mortality, particularly influenced by factors like age and the underlying cause of CS.
Article Synopsis
- Researchers developed a predictive model called the Pre-ECPR score to enhance patient selection for extracorporeal cardiopulmonary resuscitation (ECPR), which currently only has a favorable outcome rate of about 20%.
- The study analyzed data from 120 normothermic ECPR patients at a single hospital and found that the Pre-ECPR score, using various health indicators, outperformed existing selection criteria from the Extracorporeal Life Support Organization (ELSO).
- The Pre-ECPR score achieved a strong predictive ability (AUC of 0.87) for identifying patients likely to have good outcomes, significantly boosting the chances of successful ECPR treatment over traditional methods.
Article Synopsis
- Brain injury is the main cause of death after cardiac arrest and leads to severe disabilities in survivors, impacting patients, families, and society.
- This study aimed to investigate the relationship between neurologic recovery at hospital discharge and long-term survival, comparing patients with complete recovery to those with varying levels of disabilities.
- An analysis of 9,390 cardiac arrest survivors showed that 78.5% achieved complete recovery, and those with complete recovery had a significantly higher 5-year survival rate (73.8%) compared to those with moderate (64.7%) and severe disabilities (54.2%).
Unlabelled: Out-of-hospital cardiac arrest (OHCA) is a critical condition with low survival rates. In patients with a return of spontaneous circulation, brain injury is a leading cause of death. In this study, we propose an interpretable machine learning approach for predicting neurologic outcome after OHCA, using information available at the time of hospital admission.
View Article and Find Full Text PDFObjective: Major adverse limb events (MALEs) are frequent in patients with lower extremity peripheral arterial disease (PAD). However, routine care MALE rate estimations after revascularisation are scarce. This study aimed to determine post-procedural MALE rates in revascularised patients with PAD and identify predictors of post-procedural MALEs.
View Article and Find Full Text PDFCoronary angiography following transcatheter aortic valve replacement: Insights from the SWEDEHEART registry.
Catheter Cardiovasc Interv
September 2024
Article Synopsis
- * Out of 9806 TAVR patients analyzed from 2008 to 2022, 566 required coronary angiography afterward, with younger age and more extensive coronary disease linked to higher risks.
- * The findings suggest that while the need for coronary angiography post-TAVR is low, procedural complexity increases with certain valve types and in patients with previous valve replacements, emphasizing the need for good coronary access in future TAVR procedures.
Background: A prediction model that estimates mortality at admission to the intensive care unit (ICU) is of potential benefit to both patients and society. Logistic regression models like Simplified Acute Physiology Score 3 (SAPS 3) and APACHE are the traditional ICU mortality prediction models. With the emergence of machine learning (machine learning) and artificial intelligence, new possibilities arise to create prediction models that have the potential to sharpen predictive accuracy and reduce the likelihood of misclassification in the prediction of 30-day mortality.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates the characteristics and survival rates of patients with Type 1 diabetes (T1D) and those without T1D who experienced out-of-hospital cardiac arrest (OHCA) in Sweden from 2010 to 2020.
- It included a total of 54,568 cases, identifying 448 patients with T1D using specific diagnostic coding.
- Results showed no significant differences in survival outcomes, such as discharge status and neurological function, between the two groups, suggesting that T1D does not adversely affect survival rates in OHCA cases when other factors are considered.
Article Synopsis
- Takotsubo syndrome (TTS) is a serious condition mimicking heart attacks, often triggered by stress, and has high rates of morbidity and mortality.
- This study utilized data from the Swedish Coronary Angiography and Angioplasty Registry between 2015-2022, employing machine learning (specifically gradient boosting) to identify factors predicting 30-day mortality in TTS patients.
- Results revealed that the treating hospital was the strongest predictor of mortality, followed by factors like the clinical reason for angiography, creatinine levels, Killip class, and patient age, highlighting the need for tailored treatments based on these predictors.
Article Synopsis
- * Analysis of data from the Swedish Registry of Cardiopulmonary Resuscitation involving 5,788 cases from 2018 to 2022 showed that asystole had a higher survival rate (24%) compared to PEA (17%), with both rhythms having similar aetiologies mainly linked to cardiac ischemia and respiratory failure.
- * The duration of cardiopulmonary resuscitation (CPR) was identified as the most crucial factor predicting survival, with PEA cases requiring longer CPR
Objectives: Recently, ILCOR unveiled the ground-breaking global initiative " (IHCA).
Aim: To generate a baseline of how well the ten steps currently function in Sweden, in order to better target educational interventions.
Material And Methods: A survey was created using an online form application (Google Forms) and sent to CPR coordinators and physicians in charge of CPR at all 74 Swedish hospitals participating in the Swedish Registry for Cardiopulmonary Resuscitation (SRCR).
Article Synopsis
- The study investigates long-term trends and risk factors for peripheral arterial complications in individuals with type 2 diabetes compared to the general population, using data from the Swedish National Diabetes Register from 2001 to 2019.
- It includes a large sample size of 655,250 people with diabetes, analyzing the incidence rates of various complications over the years, such as lower extremity artery disease and diabetic foot disease.
- Key findings reveal that risk factors like hemoglobin A1c levels, systolic blood pressure, smoking, and lipid levels significantly influence these complications, with higher risk for those not meeting target levels.
Article Synopsis
- This study analyzed long-term trends and risk factors for non-coronary complications in individuals with type 1 diabetes compared to matched controls using a large dataset from the Swedish National Diabetes Register.
- Between 2001 and 2019, the incidence rates of complications like large artery disease and diabetic foot syndrome decreased significantly in those with type 1 diabetes, while certain risk factors like education and blood sugar levels had a substantial impact on these outcomes.
- Interestingly, people with type 1 diabetes who maintained cardiometabolic risk factors at target levels showed lower risks for some complications, but had a significantly higher risk for diabetic foot disease if all risk factors were present.
Article Synopsis
- - The study aims to enhance a machine learning model that predicts survival chances for patients experiencing out-of-hospital cardiac arrest (OHCA), addressing a significant health issue with only 10% survival post-ICU treatment.
- - Researchers analyzed over 55,600 OHCA cases from the Swedish Cardiopulmonary Resuscitation Registry, evaluating various predictive models like LightGBM and XGB, focusing on their ability to reduce false negatives and improve overall prediction accuracy.
- - The refined model achieved a high receiver operating characteristic score (AUC ROC of 0.96), demonstrating strong calibration and reliability, especially in low likelihood survival scenarios (0-10%), and is accessible for use at www.gocares.se. *
Aims: Previous studies have indicated a poorer survival among women following out-of-hospital cardiac arrest (OHCA), but the mechanisms explaining this difference remain largely uncertain.This study aimed to assess the survival after OHCA among women and men and explore the role of potential mediators, such as resuscitation characteristics, prior comorbidity, and socioeconomic factors.
Methods And Results: This was a population-based cohort study including emergency medical service-treated OHCA reported to the Swedish Registry for Cardiopulmonary Resuscitation in 2010-2020, linked to nationwide Swedish healthcare registries.
Article Synopsis
- Type 2 diabetes (T2D) and peripheral artery disease (PAD) are linked to higher mortality rates, with this study examining the mortality risks of those with T2D after developing PAD compared to individuals without T2D.
- The research included over 150,000 individuals with T2D and 346,000 matched controls, utilizing national registries to analyze risk factors, comorbidities, and outcomes through statistical models.
- Results indicated that people with T2D experienced higher rates of all-cause and cardiovascular mortality following PAD onset, with adjusted hazard ratios showing a significant increase in mortality risk for those with T2D.
Article Synopsis
- Takotsubo syndrome (TS) is a heart condition that imitates a heart attack, often triggered by stress, leading to weakened heart muscles; the study aimed to explore how different medications impact mortality rates in TS patients.
- The analysis included 1,724 TS patients from the SWEDEHEART registry, predominantly older women, with a significant portion presenting types of acute coronary syndrome and most showing non-obstructive coronary artery disease.
- Findings indicated that certain medications, like intravenous inotropes and diuretics, increased 30-day mortality, while long-term use of angiotensin-converting enzyme inhibitors and statins improved survival rates.
Background: In neurologic prognostication of comatose survivors from cardiac arrest, two independent predictors of poor outcome are the loss of the Pupillary light reflex (PLR) and the loss of the N20 response from Somatosensory Evoked potentials (SSEP). The PLR can be quantitatively assessed by pupillometry. Both tests depend on the midbrain, in which a dysfunction reflects a severe hypoxic injury.
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