Saint Luke's Hospital

For patients with atrial fibrillation, the use of oral anticoagulant therapy to prevent stroke is limited by the risk of bleeding. Left atrial appendage closure is considered for patients who are unsuitable candidates for long-term anticoagulation, but its role in patients who are eligible for anticoagulants has not been established. In this ongoing, prospective, international, randomized trial involving patients with atrial fibrillation who were suitable candidates for anticoagulation, we randomly assigned patients in a 1:1 ratio to receive either device-based left atrial appendage closure (device group) or non-vitamin K antagonist oral anticoagulant (NOAC) therapy (anticoagulation group). The primary efficacy end point - a composite of death from cardiovascular causes, stroke, or systemic embolism - was tested for noninferiority (noninferiority margin, 4.8 percentage points) after 3 years of follow-up. The primary safety end point, non-procedure-relatedbleeding, was tested for superiority. Of the 3000 patients who underwent randomization, 1499 were assigned to the device group and 1501 to the anticoagulation group. The mean (±SD) age of the patients was 71.7±7.5 years, 31.9% of the patients were women, and the mean CHA2DS2-VASc score was 3.5±1.3. At 3 years, a primary efficacy end-point event had occurred in 81 patients (Kaplan-Meier estimate, 5.7%) in the device group and in 65 patients (Kaplan-Meier estimate, 4.8%) in the anticoagulation group (difference, 0.9 percentage points; 95% confidence interval [CI], -0.8 to 2.6; P<0.001 for noninferiority). Non-procedure-related bleeding occurred in 154 patients (Kaplan-Meier estimate, 10.9%) in the device group and in 260 patients (Kaplan-Meier estimate, 19.0%) in the anticoagulation group (hazard ratio, 0.55; 95% CI, 0.45 to 0.67; P<0.001 for superiority). Among patients with atrial fibrillation who were candidates for anticoagulation, device-based left atrial appendage closure was noninferior to NOAC therapy with respect to a composite of death from cardiovascular causes, stroke, or systemic embolism and was superior to NOAC therapy for non-procedure-related bleeding at 3 years. (Funded by Boston Scientific; CHAMPION-AF ClinicalTrials.gov number, NCT04394546.).

Background : Acute postoperative perforating ulcers of the small intestine (APPSUI) are an understudied but dangerous complication of abdominal and pelvic surgeries. The absence of national clinical guidelines for APPSUI management makes it difficult to choose the optimal surgical approach and postoperative patient management in case of this complication. Aim : To determine the optimal surgical approach for managing APPSUI following abdominal and pelvic surgeries. Methods: Analysis of medical records of patients who underwent emergency and elective surgeries on abdominal and pelvic organs at the I.I. Mechnikov North-Western State Medical University, City Hospital No. 40, and Toksovo Clinical Interdistrict Hospital between 2012 and 2025, followed by the development of APPSUI. Inclusion criteria: Age over 18 years; History of surgery on abdominal or pelvic organs; Development of acute perforating ulcers of the small intestine during the postoperative period within the current hospitalization. Exclusion criteria: Age under 18 years; Development of small intestine perforation in close proximity to anastomoses or intestinal stomas (0.5-1 cm); Inability to exclude small intestine perforation due to mechanical or thermal injury Generalized oncological process. Results: The study analyzed medical records of 98 patients with diagnosed APPSUI. The age range of the study sample was 28 to 88 years (mean 55.5±14.1). Gender distribution: female (n = 62; 63.3%) of the total number of patients. Analysis of hospitalization type: 76.5% of patients (n = 75) were admitted to the hospital as emergencies. The main finding : upon initial detection of APPSUI, suturing should be applied as it shows the lowest mortality rate (25%; p = 0.045). Resection of the affected area is recommended for repeated perforation and/or failure of previously sutured defect. Conclusion : Differences in mortality rates depending on the chosen surgical approach for APPSUI were identified. The lowest mortality rate is observed with the suturing method, while the highest rate is characteristic of ileostomy formation when used at initial APPSUI detection. In 29 (29.5%) patients, the first relaparotomy was scheduled, of which 13 (13.2%) had a favorable outcome. In other cases, relaparotomy was performed on demand (n = 69 (70.4%)), of which 8 (11.5%) were discharged. The statistically significant difference (p&lt;0.001) between the groups confirms lower mortality in the scheduled relaparotomy group.

In the PROACTIVE-HF trial, remote heart failure (HF) management using comprehensive vital signs and seated mean pulmonary artery pressure (mPAP) was safe and resulted in a low reported rate of HF hospitalization (HFH) and all-cause mortality (HFH/D) through 12 months. In this report, we extend the results from the PROACTIVE-HF study through 2 years, stratified by ejection fraction (EF). PROACTIVE-HF was a prospective, multicenter, open-label, single-arm trial evaluating the safety and efficacy of patient management using the Cordella PA pressure sensor system in patients with New York Heart Association class III symptoms, regardless of EF. In the first 24 months, the incidence of HF events (HFE)/D was 0.89 (95% CI 0.81-0.99) events per patient, driven by HFH. Patients with HF with reduced EF had greater HFE/D rates than those with HF with preserved EF (1.0 vs 0.8 events per patient, P = .048). For patients with HF experiencing moderate-to-severe symptoms, management using the Cordella PA sensor system was associated with low event rates and improved health status at 2 years, regardless of EF. Comprehensive remote monitoring of vital signs, seated PAP, and patient-reported symptoms via a digital platform supports sustained benefit for high-risk patients with HF.

Introduction: The Ventilator Rounding Tool (VRT) is an evidence-based practice tool promoting ICU liberation by addressing pain, sedation & delirium. The COVID-19 pandemic created a setback for care with many patients needing deep sedation, leading nurses to learning the misconception that deep sedation is “standard of care.” The aim of this study was to evaluate outcomes pre and post re-introduction of the VRT and nursing education. Methods: Adult patients in the Medical/Surgical/Trauma ICU (MSTICU) who required mechanical ventilation were included. Baseline data from October 2023-July 2024 was compared to post-intervention from August 2024-June 2025. In our MSTICU, nurses utilize an institution specific sedation algorithm for titrating sedatives. The intervention of this study was pharmacist-led education on the institution sedation algorithms with a focus on light sedation in concordance with a multidisciplinary team plan to reinforce the VRT. The primary outcome was total duration of continuous infusion (CI) sedatives (propofol and/or fentanyl). Additional outcomes included ICU length of stay (LOS), ventilator days, amount of as needed sedative administration, & the incidence of delirium. Results: The study included 573 patients, 239 in the pre-intervention group and 334 in the post intervention group. The median duration of CI sedatives was 32 (14 -71) hours in the pre-intervention group vs. 25 (11 – 54.3) hours in the post intervention group (p=0.037). The median amount of as-needed sedative (fentanyl & hydromorphone) was 120 mg (45 –262.5) mg in morphine equivalent dose (MED) in the pre-intervention group vs. 105 (45 -232.5) mg in MED in the post intervention group (p=0.53). Median number of ventilator days was 1.8 days in the pre-intervention group vs. 1.63 days in the post intervention group (p=0.095). Median ICU LOS was 5 (3 –7) days in the pre group vs. 4 (3 – 7) days in the post group (p=0.027). The incidence of delirium was 62.3% in the pre group vs. 53.3% in the post group (p=0.031). Conclusions: Re-engaging nurses with education on promoting light sedation & the VRT led to significantly reduced time on continuous sedatives & ICU LOS. It was also associated with lower rates of delirium. Study results support the positive impact of multidisciplinary teamwork on patient outcomes.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for glycemic control in type 2 diabetes, have emerged as transformative agents with broad therapeutic applications across multiple organ systems. This review explores the expanding role of GLP-1 RAs in managing cardiometabolic diseases, including obesity, heart failure (particularly with preserved ejection fraction), chronic kidney disease (CKD), and metabolic dysfunction-associated steatotic liver disease (MASLD). Robust clinical trial data support the efficacy of GLP-1 RAs in promoting weight loss, improving cardiovascular outcomes, and preserving renal function, with additional trials underway to further strengthen and expand the evidence base. Despite the growing utility of GLP-1 RAs, challenges related to cost, access, adherence, and implementation persist, particularly for indications beyond diabetes. However, innovations such as oral formulations and combination therapies may help improve accessibility and sustained use. As clinical guidelines evolve, targeted integration of GLP-1 RAs into care models may transform the prevention and treatment landscape for complex, chronic diseases.

An accurate interpretation of hemodynamics measured by right heart catheterization (RHC) is crucial for guiding the management of heart failure and pulmonary hypertension. We evaluated the concordance and variability between site-reported and core laboratory-adjudicated interpretations of invasive hemodynamic measurements.