No abstract

Holter electrocardiography (ECG) assists in the diagnosis of arrhythmias. Its use in the inpatient setting has been described solely for the evaluation of stroke and syncope. Our aim was to assess its diagnostic value for other conditions in the internal medicine department. We included all hospitalized patients between 2018 and 2021 in a tertiary referral center. The primary outcome was a diagnostic Holter recording a new arrhythmia that led to a change in treatment. Overall, 289 patients completed a 24-h inpatient Holter ECG for conditions other than syncope or stroke, with 39 (13%) diagnostic findings. The highest diagnostic value was found in patients admitted for pre-syncope (19%), palpitations (18%), and unexplained heart failure exacerbation/dyspnea (17%). A low diagnostic yield was found for the evaluation of chest pain (5%). Heart failure with preserved ejection fraction (adjusted OR 2.3, 95% CI 1.1–5.4, p = 0.04), and baseline ECG with either a bundle branch block (AOR 4.2, 95% CI 1.9–9.2, p < 0.01) or atrioventricular block (first or second degree, AOR 5, 95% CI 2.04–12.3, p < 0.01) were among the independent predictors for a diagnostic test. Inpatient Holter ECG monitoring may have value as a diagnostic tool for selected patients with conditions other than syncope or stroke.

Objective: To evaluate the association between prenatal maternal anemia (hemoglobin, Hb<11 g/dl) and long-term respiratory morbidity of the offspring. Methods: A retrospective population-based cohort analysis was performed at the Soroka University Medical Center (SUMC), a single regional tertiary medical center. All singletons born between the years 1991-2014 and discharged alive were included in the study. Offspring with congenital malformations were excluded. The three study groups were defined based on maternal Hb levels, measured upon postpartum discharge: <7.0 (severe anemia), 7.0-11.0 (mild to moderate anemia), and ≥11.0 g/dl (unexposed). Respiratory morbidity diagnosis was based on predefined ICD-9 codes of lung disease definitions, based on the medical records of the hospitalized offspring in SUMC. A Kaplan-Meier survival curve was formed to compare the cumulative respiratory morbidity during the study follow-up period between the study groups, and a multivariable Cox survival analysis was used to control for cofounders. Results: During the study period, 214,305 deliveries met the inclusion criteria. Of those, 807 (0.3%) mothers had severe anemia, 105,196 (49.1%) mothers had mild-moderate anemia, and the remaining were not anemic (108,302, 50.5%). Respiratory hospitalization incidence was found to be significantly higher among the offspring born to anemic mothers (6.2%; 5.3% and 5.1%; p = 0.020, p for trend=0.007 in severe, mild-to-moderate and non-anemic mothers, respectively). The association between maternal anemia and respiratory-related hospitalization of the offspring remained significant among the mild-moderate anemic group after adjusting for confounders in the Cox proportional hazards model (adjusted hazard ratio=1.1; 95% CI 1.05-1.14; p < 0.01). As to the association between severe maternal anemia and offspring morbidity no significant differences were found (p= 0.133), although a linear hazard dose-response ratio was found between the mild-moderate and severe anemic groups (aHR=1.09, aHR 1.24, respectively). Conclusion: Maternal anemia was found to be associated with long-term respiratory morbidity of the offspring.