Older age was not independently associated with short-term or longer-term survival among V-A ECMO patients, but may reflect greater comorbidity, suggesting that age alone may not disqualify patients from V-A ECMO therapy.

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Background Lack of sleep has been associated with an increased risk for cardiovascular disease (CVD) and all-cause mortality, but the mechanisms are not fully understood. Prior research has often been conducted in select populations and has not consistently adjusted for confounders, especially psychosocial factors. Objective The aims of this study were to assess the association between sleep habits and established risk factors for CVD and to evaluate potential interactions by race and gender. Methods Participants were part of a CVD screening and educational outreach program in New York City. Free-living men older than 40 years and women older than 50 years (n = 371, mean age = 60 years, 57% women, 60% racial/ethnic minorities) were systematically assessed for CVD risk (including traditional, lifestyle, and psychosocial risk factors) and completed a standardized questionnaire regarding sleep habits (including sleep duration and snoring). Lipids were analyzed by validated finger-stick technology. Stress at work and at home was assessed using a validated screening tool from the INTERHEART study. Associations between participants’ sleep habits and CVD risk factors/demographic factors were assessed using multivariable logistic regression. Results The proportion of participants who reported sleeping less than 6 hours per night on average was 28%, and 52% of participants reported snoring. Sleeping less than 6 hours per night was significantly (P < .05) associated with female gender, being single, increased stress at home, increased financial stress, and low-density lipoprotein cholesterol (LDL-C) level. Gender modified the association between sleep duration and LDL-C level (P = .04): Sleeping less than 6 hours per night was significantly associated with reduced LDL-C level among women and increased LDL-C level among men. Snoring was significantly associated with low high-density lipoprotein cholesterol (HDL-C) level (<40 mg/dL for men/<50 mg/dL for women), being married, increased stress at work and at home, less than 30 minutes of exercise per day, less than 5 servings of fruits and vegetables per day, and being overweight/obese (body mass index ≥25 kg/m2). The association between snoring and low HDL-C level remained significant in logistic regression models adjusted for demographic confounders (odds ratio, 1.83; 95% confidence interval, 1.06–3.19) but not after adjustment for body mass index greater than 25 kg/m2. Conclusions Sleeping less than 6 hours per night was associated with several traditional and psychosocial CVD risk factors, and snoring was associated with low HDL-C level, likely mediated through overweight/obesity. These data may have significance for health care providers to identify individuals who may be at increased CVD risk based on sleep habits.

Background Patients who have undergone cardiac surgery, especially those with greater comorbidities, may be cared for by family members or paid aides. Objective The purpose of this study was to evaluate the association between caregiving among post-operative cardiac patients and clinical outcomes at 1-year. We hypothesized that patients with a caregiver would have longer length-of-stays, and higher rehospitalization or death rates 1-year after surgery. Methods We studied 665 consecutively admitted cardiac surgery patients as part of the NHLBI-sponsored Family Cardiac Caregiver Investigation To Evaluate Outcomes (FIT-O). Participants (mean age 65 years; 35% female; 21% racial/ethnic minorities) completed an interviewer-assisted questionnaire to determine caregiver status. Outcomes were documented by a hospital-based information system; demographics/comorbidities by electronic records. Associations between caregiving and outcomes were evaluated by logistic regression, adjusted for demographic and comorbid conditions. Results At baseline, 28% of patients (n=183) had a caregiver (8% paid; 20% informal only). Having a caregiver was associated with longer (>7 days) post-operative length-of-stay in univariate analysis among patients with paid (OR=3.00;95%CI=1.57–5.74) or informal (OR=1.55;95%CI=1.04–2.31) caregivers versus none; the association remained significant for patients with paid (OR=2.13;95%CI=1.00–4.55), but not informal (OR=1.12; 95%CI=0.70–1.80) caregivers after adjustment. Having a paid caregiver was significantly associated with rehospitalization/death at 1-year in univariate analysis (OR=2.09;95%CI=1.18–3.69), informal caregiving was not (OR=1.39;95%CI=0.94–2.06). Increased odds of rehospitalization/death associated with paid caregiving attenuated after adjustment (OR=1.39;95%CI=0.74–2.62). Conclusions Post-operative cardiac patients who had a paid caregiver had significantly longer length-of-stay independent of comorbidity. The increased risk of rehospitalization/death associated with paid caregiving was explained by demographics and comorbidity. These data suggest caregiver status assessment may be a simple method to identify cardiac patients at risk for adverse outcomes.