Objective The mechanism(s) for septic cardiomyopathy in humans is not known. To address this, we measured mRNA alterations in hearts from patients who died from systemic sepsis, in comparison to changed mRNA expression in non-failing and failing human hearts. Design Identification of genes with altered abundance in septic cardiomyopathy, ischemic heart disease (IHD), or dilated cardiomyopathy (DCM), in comparison to non-failing hearts. Setting Intensive care units (ICUs) at Barnes-Jewish Hospital, St. Louis, Missouri. Patients 20 sepsis patients, 11 IHD, 9 DCM, 11 non-failing donors. Interventions None other than those performed as part of patient care. Measurements and Main Results mRNA expression levels for 198 mitochondrially-localized energy production components, including Krebs cycle and electron transport genes, decreased by 43±5% (mean±s.d.). mRNAs for 9 genes responsible for sarcomere contraction and excitation-contraction coupling decreased by 43±4% in septic hearts. Surprisingly, the alterations in mRNA levels in septic cardiomyopathy were both distinct from and more profound than changes in mRNA levels in the hearts of patients with end stage heart failure. Conclusions The expression profile of mRNAs in the heart of septic patients reveals striking decreases in expression levels of mRNAs that encode proteins involved in cardiac energy production and cardiac contractility, and is distinct from that observed in patients with heart failure. Although speculative, the global nature of the decreases in mRNA expression for genes involved in cardiac energy production and contractility suggests that these changes may represent a short-term adaptive response of the heart in response to acute change in cardiovascular homeostasis.

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Objectives: Multiple studies have reported the safety of same day discharge (SDD) post-electrophysiology (EP) procedures, while patient satisfaction associated with this approach has not been well- studied. We sought to evaluate whether SDD would be associated with a comparable patient satisfaction rate compared with next day discharge (NDD) in various EP procedures. Furthermore, we aimed to assess patient preferences regarding discharge timing. Methods: A cohort of patients was identified using our institutional record of all outpatient EP lab procedures from August 2013 to November 2014. From this list, 6 groups were created based on discharge timing “SDD/NDD” and procedure “Ablation (A)/Pacemaker (P)/ICD (I)”. All operators offered SDD and were included. We excluded generator change and lead extraction procedures. Patients who stayed more than one night were also excluded. Post-discharge phone surveys were conducted starting from the most recent procedure until the target number was reached. The research team gathering surveys was blind to patient characteristics. The survey was composed of 24 questions, 10 of which were for Post-Discharge Coping Difficulty Scale (PDCDS). Results: We surveyed 132 patients, 53F/79M, 66 SDD/66 NDD with mean age (SD) of 63 (15). We had 29 patients in each A group, 17 in each I group, and 20 in each P group. Patients’ rating of overall satisfaction and readiness for discharge, as well as, calculated PDCDS outcomes were not significantly different in SDD vs. NDD for all procedures, I+A only, and A only ( p >.05). Patient characteristics and procedural complications between groups did not differ significantly, though different operators did differ in numbers of SDD or NDD procedures. No significant interactions were found between various covariates and study outcomes including age, gender, BMI, number of home medications, operator, and type of procedure. Approximately1/3 of patients (43/132) were given the choice of the two discharge strategies by the operator. The majority of them (93%; 40/43) opted for SDD and rated “the opportunity for this choice” with a mean of 9.1 (1-10 scale, 10 excellent) in comparison to a mean of 6.7 for those who were not given the choice ( p <. 0001). Only 12% (8/66) of SDD patients wished they had the alternative discharge strategy (P < .0001), in comparison to 38% of NDD patients (25/66) ( p <. 07). Overall, 51% (67/132) of all patients preferred SDD if they were to undergo similar procedure in the future. Conclusions: SDD strategy resulted in similar patient satisfaction to NDD strategy across different EP procedures and operators. Patients significantly appreciated the choice of SDD. The SDD group was more willing to repeat their discharge experience. This further supports following SDD strategy, whenever possible, to improve quality of care; in addition to the cost savings and increased efficiency associated with this approach.