Because electronic medical record systems may affect productivity of clinical practice, we examined the effects of different types of medical record systems on consultation time and total fee claims for outpatient consultation for cardiovascular cases. We investigated consultation time (i.e., the sum of practice time and work-up time) and total fee claims by 13 cardiovascular physicians for 862 outpatients. The means of consultation time and total fee claims were calculated for 3 types of medical records: electronic, paper-based, and hybrid. No difference in mean consultation time was seen between the electronic and paper-based medical record groups (paper based, 11.4±0.3 min/case; electronic, 12.7±0.8 min/case; hybrid, 13.5±0.5 min/case). In contrast, the electronic group had the highest mean practice time (10.9±0.6 min/case) and the lowest mean work-up time (1.7±0.4 min/case). There was no difference in total fee claims between the 3 medical record groups. The total fee claims per practice time was lower for the electronic group than the paper-based (67.5±52.8 vs. 108.8±108.1 points/min, P<0.001). The findings suggest that physicians using the electronic medical record system can be more directly involved with patients due to higher productivity, as reflected in the lower work-up time.
Background:Congestion is one of the main predictors of poor outcome in patients with heart failure (HF); thus, a simple tool to evaluate plasma volume (PV), which can be used for risk stratification of HF patients, is necessary. We sought to compare the prognostic values of commonly used formulas for the estimation of PV and relative PV status (PVS) in patients admitted with acute decompensated HF (ADHF).
Methods and Results:We analyzed 384 consecutive ADHF patients who survived to discharge. The PV was calculated by 3 commonly used formulas (Strauss, Kaplan, and Hakim), and the relative PVS was calculated using the Hakim formula at both admission and discharge. The primary endpoint was a composite of all-cause mortality and hospitalization for worsening HF. The secondary endpoints were pump failure death (PFD) and sudden cardiac death (SCD). During a median follow-up of 743 days, 175 patients reached the primary endpoint, 28 patients had PFD, and 20 patients had SCD. Multivariate Cox analysis revealed that among the PV indices, only the PVS values at admission and discharge were independent predictors of the primary endpoint. In addition, the PVS values at admission and discharge were independent predictors of PFD and SCD in the multivariate analysis.
Conclusions:Among the indices of PV, the calculated PVS may be the most useful for predicting prognosis in ADHF patients.
Background:The precise mechanisms underlying elevation of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in healthy subjects have not been fully clarified.
Methods and Results:In 2,844 Japanese healthy subjects with serum NT-proBNP <125 pg/mL, (1) brachial-ankle pulse wave velocity and (2) second peak of the peripheral systolic blood pressure minus diastolic blood pressure (pulse pressure 2 [PP2]), as markers of cardiac afterload; (3) fibrosis 4 score (FIB-4 score, a marker of liver fibrosis), as a marker of cardiac preload; and (4) ratio of the pre-ejection time to ejection time (PEP/ET), as a marker of cardiac systolic function, were measured. At the first examination, after the adjustments, log-transformed serum NT-proBNP was associated with PP2 and FIB-4 score, but not with PEP/ET. These parameters were successfully measured again after a 3-year interval in 1,978 subjects. On Pearson’s correlation analysis, change in PP2 and FIB-4 score during the study period was significantly correlated with change in serum NT-proBNP (r=0.05, 0.09, respectively; P<0.01).
Conclusions:In apparently healthy Japanese subjects, both increased cardiac preload and increased cardiac afterload, but not impaired cardiac systolic function, may be associated with elevated serum NT-proBNP.
Background:This study compared the myocardial performance of infants born to mothers with gestational diabetes mellitus (IGDM) and without GDM (controls) under the new GDM definitions.
Methods and Results:The subjects consisted of 36 IGDM and 39 control infants. GDM diagnosis was based on oral glucose tolerance test during pregnancy or the presence of diabetes prior to the current pregnancy. Between-group infant cardiac function was determined and compared using 2-D speckle tracking analysis, intraventricular pressure difference (IVPD) and IVP gradient (IVPG), using color M-mode Doppler imaging. IVPD and IVPG were higher in IGDM than in the controls, particularly the mid–apical IVPG. The global circumferential strain (GCS) and endocardial GCS were higher in IGDM than in controls. Increased maternal glycated hemoglobin was correlated with reduced transmural and epicardial GCS in the IGDM. Maternal maximum fasting blood sugar had a mild, positive correlation with IVPD and IVPG.
Conclusions:Ventricular sucking force, measured as the IVPD, IVPG, and endocardial GCS, were higher in IGDM than in the controls. A hyperglycemic environment during pregnancy leads to impaired cardiac performance in IGDM, compared with control infants. IGDM might have favorable systolic and diastolic cardiac performance due to cardiac metabolic adaptations occurring before poor glucose control causes impaired cardiac performance.
Background:Recent progress in the development of pulmonary hypertension (PH)-specific pharmaceutical agents has improved mortality and morbidity remarkably. Today, these PH-specific drugs have become a standard treatment for PH.
Methods and Results:We herein summarize the treatment options and longitudinal clinical outcomes of 21 patients with PH who received PH-specific drugs at the present institution. Sixteen patients began treatment with a single PH-specific drug; 9 of them needed additional PH-specific drugs, but the other 7 were still taking the same drug at the last follow-up. Five patients began treatment with a combination of 2 or 3 PH-specific drugs, and their drugs were not discontinued. Most patients (17/21) were taking a phosphodiesterase type 5 (PDE5) inhibitor at the last follow-up. During the 6.5±4.4 years’ follow-up, 5 patients died, but only 1 death was related to PH. At 5 and 10 years, the estimated PH-related death-free and lung transplantation-free survival rate was 100% (95% CI: 100–100%) and 87.5% (95% CI: 38.7–98.1%), respectively. The estimated 5- and 10-year estimated overall survival rates were 77.9% (95% CI: 50.8–91.3%) and 68.2% (95% CI: 37.4–86.2%), respectively.
Conclusions:PDE5 inhibitors played a central role in the treatment options. The long-term prognosis of PH was favorable at the present institution.