BackgroundDespite a variety of national efforts to improve transitions of care for patients at risk for rehospitalization, 30-day rehospitalization rates for patients with heart failure have remained largely unchanged.MethodsThis is a retrospective review of 73 patients enrolled in our hospital-based, physican-directed Heart Failure Transitional Care Program (HFTCP). This study evaluated the 30- and 90- day readmission rates before and after enrollment in the program. The Transitionalist’s services focused on bedside consultation prior to hospital discharge, follow-up home visits within 72 hours of discharge, frequent follow-up phone calls, disease-specific education, outpatient intravenous diuretic therapy, and around-the-clock telephone access to the Transitionalist.ResultsThe pre-enrollment 30-day readmission rates for acute decompensated heart failure (ADHF) and all-cause readmission was 26.0% and 28.8%, respectively, while the post-enrollment rates for ADHF and all-cause readmission were 4.1% (P < 0.001) and 8.2% (P = 0.002), respectively. The pre-enrollment 90-day all-cause and ADHF readmission rates were 69.8%, and 58.9% respectively, while the post-enrollment rates for all-cause and ADHF were 27.3% (P < 0.001) and 16.4% (P < 0.001) respectively.ConclusionsOur physician-implemented HFTCP reduced rehospitalization risk for patients enrolled in the program. This program may serve as a model to assist other hospital systems to reduce readmission rates of patients with HF.

Objectives: This study used cardiac CT to identify and name the different shapes of individual left atrial appendage (LAA) lobes and identified correlations between the size and shape of the LAA ostium and the volume of the LAA in a population of normal individuals. Background: The anatomy of the LAA appendage has become the subject of current research, because appendage occlusion devices have emerged for patients with atrial fibrillation. The development of cardiac computed tomography (CT) allows researchers to identify and observe cardiac anatomy, including various shapes of the LAA lobes. Methods: This study was a retrospective review of 102 consecutive patients from March 2009 to November 2010 who underwent cardiac CT using the GE 64-slice Light Speed VCT CT scanner. For each patient, the LAA ostium was measured, and the shape of the ostium was observed and described. After the LAAs were reconstructed 3-dimensionally, each LAA was categorized by its shape and number of lobes. Results: No significant difference was observed between the average LAA volume between males and females. LAA appendages with circular ostium (n = 61) were observed to have a larger mean volume than those with elliptical ostium (n = 39). Predictors of LAA volume were identified. The most common number of lobes was 2 (n = 61), followed by 1 (n = 27), 3 (n = 10), and 4 (n = 2). Eight unique LAA morphologies were identified and a name was assigned to each morphology. Based on the shape and number of lobes observed, the most common LAA lobe shape was hook (n = 55), followed by wing, arrowhead, flame, double wing, finger, sea horse, double hook, knob, spiral, and double knob. Conclusion: This study used * Corresponding author. D. S. Beutler et al. 183D cardiac CT to identify and name the morphology of individual LAA lobes as one of eight different types. The Beutler-Loli naming system formulates a basis to improve understanding of the complex structure of LAA anatomy and to facilitate a system for researchers and clinicians to communicate more precisely about the LAA.

Heparin is associated with adverse effects in some patients during extracorporeal circulation. A potential alternate anticoagulation strategy explored in this investigation involved mitigation of coagulation by removing clotting factors from blood by adsorption on a protamine-immobilized Sepharose matrix (PSM). Human or porcine plasmas treated with PSM in vitro were tested for clotting factors I (fibrinogen), II (prothrombin), VIII, and X, and proteins C and S, and for prothrombin time (PT), activated partial thromboplastin time (APTT), and total protein concentration. Bovine blood treated with PSM was also perfused through a hollow-fiber cartridge to assess thrombogenic potential in a shear flow system. PT increased with increasing protamine-Sepharose-to-plasma ratios and with increasing mixing time. When the PT and APTT of treated plasma were prolonged three to six times the baseline, Factors II and X were significantly removed (>90%), Factors I and VIII were partly removed (<35%), and total protein concentration remained >80% of the initial value. When blood depleted of clotting factors was perfused through hollow-fiber cartridges without an anticoagulant, cartridge patency was prolonged compared with cartridges perfused with untreated blood. This investigation demonstrated that inhibition of blood coagulation by removal of key clotting proteins is feasible.

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Background Overdose of cardiovascular medications is increasingly associated with morbidity and mortality. We present a case of substantial atenolol, chlorthalidone, and lisinopril overdose treated by multiple modalities with an excellent outcome. Conclusion Aggressive medical intervention did not provide sufficient hemodynamic stability in this patient with refractory cardiogenic and distributive shock. Impella® percutaneous left ventricular assist device and extracorporeal membrane oxygenation provided support while the effects of the overdose subsided. We present concentrations demonstrating removal of atenolol with continuous venovenous hemodiafiltration. This is the first report of esophagogastroduo denoscopy decontamination of this overdose with a large pill fragment burden.