Publications by authors named "Sean VAN Diepen"
Background: Mortality in cardiogenic shock (CS) remains high. Significant inter-hospital heterogeneity in critical care therapies have 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 (US) and Canada.
View Article and Find Full Text PDFBackground: The objective of this study was to assess the health outcomes for patients who present to the emergency department (ED) with cardiac chest pain after the implementation of an accelerated diagnostic protocol using a high-sensitivity troponin assay (hs-TnI).
Methods: This prospective before-after cohort study used population-based linked health administrative data for adult patients who presented to a Canadian urban ED with chest pain of suspected cardiac origin over a 2-year study period. The primary outcome was ED length of stay (LOS).
The Top 10 European Heart Journal: Acute Cardiovascular Care Papers in Cardiogenic Shock and Resuscitation of 2024.
Eur Heart J Acute Cardiovasc Care
December 2024
Endurance-trained athletes exhibit a greater diffusing capacity for carbon monoxide (DLCO) at rest and during exercise as compared with untrained individuals; however, the mechanism(s) are unclear. The supine position translocates blood centrally and can be used to investigate DLCO responses independent of metabolic rate. We hypothesized that endurance-trained individuals would have a greater DLCO response to postural change at rest as compared with untrained and that the supine position would elicit a greater DLCO response as compared with the upright position during exercise in both groups.
View Article and Find Full Text PDFHeartfelt discoveries for winter nights: December's game-changers in acute cardiovascular care.
Eur Heart J Acute Cardiovasc Care
December 2024
Article Synopsis
- - The rates of illness and death are high for patients experiencing cardiac arrest, as traditional CPR methods don't effectively maintain blood flow.
- - Extracorporeal cardiopulmonary resuscitation (eCPR) using venoarterial extracorporeal membrane oxygenation is suggested as a better way to improve blood circulation during cardiac arrest.
- - This article presents a debate on the benefits and drawbacks of current eCPR research, highlighting uncertainties and proposing ideas for future studies.
A warm November rain: illuminating new approaches in cardiogenic shock management.
Eur Heart J Acute Cardiovasc Care
December 2024
Article Synopsis
- * Mixed CS has become the second most common type of shock in coronary intensive care units, yet there's a lack of high-quality research to inform standard care practices and classifications.
- * The text proposes a new framework for classifying mixed CS and highlights the need for invasive hemodynamic measures to improve the understanding and management of this condition in clinical settings.
Background: Cardiogenic shock remains highly associated with early mortality, with mortality often exceeding 50%. We sought to determine the association between prognostic factors and in-hospital and 30-day mortality in cardiogenic shock.
Methods: We performed a systematic review and meta-analysis of prognostic factors in cardiogenic shock, searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for records up to June 5, 2023.
Article Synopsis
- Aerobic exercise training is thought to not affect lung structure or function, but the study explores the link between pulmonary vascular health and exercise capacity (VO2peak).
- Researchers examined data from participants in the CanCOLD study, looking at factors like CT blood vessel volumes and pulmonary diffusing capacity in different groups (never-smokers, ever-smokers, and those with COPD).
- The findings indicate that aspects of pulmonary vascular structure and function are significantly related to VO2peak, even in individuals with COPD, suggesting these associations extend beyond just airflow limitations.
Resilience and renewal: charting the future of cardiovascular care in a changing world.
Eur Heart J Acute Cardiovasc Care
October 2024
Should renin-angiotensin system inhibitors be stopped or not before non-cardiac surgery?
Eur Heart J Acute Cardiovasc Care
September 2024
Epidemiology of cardiogenic shock using the Shock Academic Research Consortium (SHARC) consensus definitions.
Eur Heart J Acute Cardiovasc Care
October 2024
Article Synopsis
- The Shock Academic Research Consortium (SHARC) created standardized definitions for cardiogenic shock (CS) to improve classification in clinical settings and studies.
- A study using these definitions observed a total of 8,974 patients, finding that 65% had isolated CS, with significant variations in causes such as acute myocardial infarction and heart failure.
- Results indicated that patients with mixed CS had the highest mortality rate (48%), while acute-on-chronic heart failure presented the lowest (25%), highlighting the need for targeted treatment strategies based on CS subtypes.
Article Synopsis
- The study investigates current management practices for patients using temporary mechanical circulatory support (tMCS) devices like intra-aortic balloon pumps and Impella in North American cardiac intensive care units.
- An online survey was conducted, with a response rate of 84% from 37 centers, focusing on hemodynamic monitoring, hemocompatibility, and weaning/removal of the devices.
- Results showed significant variability in how these practices are implemented, indicating a need for standardized guidelines to improve patient outcomes with tMCS.
Article Synopsis
- The study examines the characteristics and outcomes of adult congenital heart disease (ACHD) patients admitted to cardiac intensive care units (CICUs) in North America from 2017 to 2022, revealing limited previous knowledge in this area.
- Out of 23,299 CICU admissions, only 441 (1.9%) were for ACHD, which tended to be younger patients who had more admissions related to heart failure and medical issues compared to non-ACHD patients.
- Despite longer hospital stays for ACHD patients, their in-hospital mortality rates were similar to those of non-ACHD patients, indicating the need for more focused research on managing specific complexities related to ACHD in the CICU.*
Article Synopsis
- This study examines different patient phenotypes along the transition from preshock to cardiogenic shock (CS) to understand their prognostic implications and outcomes.* -
- It classifies nearly 2,500 admissions into four categories and finds that in-hospital mortality rates vary significantly, from 3.6% for isolated low cardiac output to 24.0% for SCAI stage C CS.* -
- Results indicate that patients in the earlier stages of shock can still experience a high risk of deteriorating, suggesting the need for improved definitions and severity assessments in CS.*
Article Synopsis
- Acute right ventricular failure (RVF) often occurs in various diseases and can lead to serious health issues, particularly when accompanied by cardiogenic shock (CS).
- Right-sided temporary mechanical circulatory support (tMCS) devices are utilized to relieve heart stress and improve blood circulation in affected patients, although there is no agreed-upon protocol for their use.
- This review aims to outline the current treatments for acute RVF, the decision-making process for using tMCS devices, key management elements like fluid levels and anticoagulation, and guidelines for gradually discontinuing tMCS support.
Background: Cardiogenic shock due to acute myocardial infarction (AMI-CS) is associated with significant short- and long-term morbidity and mortality. Despite this, little is known about associated cost.
Objectives: The purpose of this study was to evaluate the health care costs and resource use associated with AMI-CS using administrative data from the province of Ontario, Canada.
Article Synopsis
- This study evaluated how an accelerated diagnostic protocol (ADP) for cardiac chest pain affects the length of stay (LOS) in a Canadian emergency department over two years.
- It involved adults with chest pain and noted a decrease in testing intervals for non-high-risk patients, aiming to streamline processes.
- Results showed a significant LOS reduction for discharged patients (-33 minutes) while overall changes in LOS, consultations, and adverse cardiac events were not statistically significant.