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Article: High Attendance Rate of Family Members During Physician Rounds Is Predictive of Worse Clinical Outcomes: A Historic Cohort Study.

Yakir, Maya / Brom, Adi / Segev, Amitai / Segal, Gad

The Israel Medical Association journal : IMAJ

2023 Volume 25, Issue 1, Page(s) 47–51

Abstract: Background: The prognosis of long-term clinical outcomes for each patient is of utmost importance.: Objectives: To evaluate the association between rates of family attendance during rounds and long-term outcomes.: Methods: We conducted a historic ... ...

Abstract	Background: The prognosis of long-term clinical outcomes for each patient is of utmost importance. Objectives: To evaluate the association between rates of family attendance during rounds and long-term outcomes. Methods: We conducted a historic cohort study. Results: We followed 200 consecutive patients for a median of 19 months. Within the group of patients that had family members present in > 75% of rounds, the 30-day re-hospitalization rate was tenfold higher (P = 0.017). The overall prognosis (including median survival length) of patients who had the highest rates of family attendance (> 75%) was significantly worse compared to patients who had lower rates (P = 0.028). High rates of family attendance were found to correlate with other established risk factors for long-term mortality, including advanced age (r = 0.231, P = 0.001) and in-hospital delirium. Conclusions: High family attendance during physician rounds in an internal medicine department is associated with worse patient prognosis.
MeSH term(s)	Humans ; Cohort Studies ; Family ; Hospitalization ; Physicians ; Teaching Rounds
Language	English
Publishing date	2023-01-11
Publishing country	Israel
Document type	Journal Article
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Article ; Online: Pericarditis recurrence is associated with milder electrocardiographic, echocardiographic, and laboratory findings.

Weiss, Tal / Itelman, Edward / Lotan, Dor / Segev, Amitai / Freimark, Dov / Arad, Michael / Wasserstrum, Yishay

Internal and emergency medicine

2024

Abstract: Recurrent pericarditis (RP) complicates approximately 30% of acute pericarditis (AP) cases. We sought to compare the prevalence and severity of objective findings seen in patients with RP. A retrospective single-center study during 2010-2019, including ... ...

Abstract	Recurrent pericarditis (RP) complicates approximately 30% of acute pericarditis (AP) cases. We sought to compare the prevalence and severity of objective findings seen in patients with RP. A retrospective single-center study during 2010-2019, including 765 patients diagnosed with AP. Clinical, electrocardiographic, echocardiographic, and laboratory findings were extracted from the local electronic health records. Recurrence during follow-up was documented in 134 patients (17.5%), with a median time to recurrence of 101 (± 59-251) days. The median age was 60 years (IQR 45-72), 68% were male. Most patients were defined as having idiopathic\viral pericarditis (64%). The clinical manifestation during the recurrent event of pericarditis was less prominent or attenuated when compared to the initial event-ECG signs (ST elevation 12% vs. 26%; p = 0.006, Knuckle sign 13% vs. 33%; p < 0.001, ST larger in lead L2 than L3 4% vs. 19%; p < 0.001), pericardial effusion moderate and above (11% vs. 30%; p = 0.02), and inflammatory markers (mean peak CRP levels 66 mg/l vs. 97 mg/l; p < 0.001). Similar results were seen in the subgroup of patients defined as having idiopathic\viral pericarditis. Up to 20% of patients who did not have ECG signs or a significant pericardial effusion in their 1st event demonstrated these findings during the recurrence, though still to a lesser extent compared with those who had these signs in their 1st event. The objective findings of AP are less pronounced during recurrent events. Future studies should focus on the role of advanced biomarkers and imaging in defining true RP events.
Language	English
Publishing date	2024-03-29
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2454173-4
ISSN	1970-9366 ; 1828-0447
ISSN (online)	1970-9366
ISSN	1828-0447
DOI	10.1007/s11739-024-03579-7
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Article ; Online: Admission Serum Magnesium Levels Is Associated with Short and Long-Term Clinical Outcomes in COVID-19 Patients.

Segev, Amitai / Sagir, Adam / Matetzky, Shlomi / Segev, Amit / Atar, Shaul / Shechter, Michael

Nutrients

2023 Volume 15, Issue 9

Abstract: Background: In the face of the global pandemic that the coronavirus disease 2019 (COVID-19) has created, readily available prognostic markers may be of great use.: Objective: To evaluate the association between serum magnesium (sMg) levels on ... ...

Abstract	Background: In the face of the global pandemic that the coronavirus disease 2019 (COVID-19) has created, readily available prognostic markers may be of great use. Objective: To evaluate the association between serum magnesium (sMg) levels on admission and clinical outcomes in hospitalized COVID-19 patients. Methods: We retrospectively analyzed all patients admitted to a single tertiary center with a primary de novo diagnosis of COVID-19. Patients were followed for a mean of 10 ± 7 months. Demographic, clinical and laboratory data were collected and compared between five groups of patients according to sMg quintiles on hospital admission. Results: The cohort included 1522 patients (58% male, 69 ± 17 years old). A low sMg level (1st quintile) was associated with higher rates of diabetes and steroid use, whereas a high sMg level (5th quintile) was associated with dyslipidemia, renal dysfunction, higher levels of inflammatory markers and stay in the intensive care unit. All-cause in-hospital and long-term mortality was higher in patients with both low and high sMg levels, compared with mid-range sMg levels (2nd, 3rd and 4th quintiles; 19% and 30% vs. 9.5%, 10.7% and 17.8% and 35% and 45.3% vs. 23%, 26.8% and 27.3% respectively; Conclusions: Both low and high sMg levels were associated with increased mortality in a large cohort of hospitalized COVID-19 patients. However, after correction for renal dysfunction and disease severity, only low sMg maintained its prognostic ability.
MeSH term(s)	Humans ; Male ; Middle Aged ; Aged ; Aged, 80 and over ; Female ; Magnesium ; Retrospective Studies ; COVID-19 ; Hospitalization ; Kidney Diseases
Chemical Substances	Magnesium (I38ZP9992A)
Language	English
Publishing date	2023-04-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2518386-2
ISSN	2072-6643 ; 2072-6643
ISSN (online)	2072-6643
ISSN	2072-6643
DOI	10.3390/nu15092016
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Article ; Online: Failed shocks in patients with hypertrophic cardiomyopathy.

Segev, Amitai / Fishman, Boris / Wasserstrum, Yishay / Beinart, Roy / Arad, Michael / Sabbag, Avi

Heart rhythm

2023 Volume 20, Issue 6, Page(s) 940–941

MeSH term(s)	Humans ; Defibrillators, Implantable/adverse effects ; Electric Countershock ; Cardiomyopathy, Hypertrophic/complications ; Cardiomyopathy, Hypertrophic/diagnosis ; Cardiomyopathy, Hypertrophic/therapy ; Death, Sudden, Cardiac ; Risk Factors ; Risk Assessment
Language	English
Publishing date	2023-03-17
Publishing country	United States
Document type	Letter
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2023.03.017
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Article ; Online: The burden of heart failure in cardiac intensive care unit: a prospective 7 years analysis.

Grupper, Avishay / Chernomordik, Fernando / Herscovici, Romana / Mazin, Israel / Segev, Amitai / Beigel, Roy / Matetzky, Shlomi

ESC heart failure

2023 Volume 10, Issue 3, Page(s) 1615–1622

Abstract: Aims: The profiles of patients at cardiac intensive care units (CICU) have evolved towards a patient population with an increasing number of co-morbid medical conditions and acute heart failure (HF). The current study was designed to illustrate the ... ...

Abstract	Aims: The profiles of patients at cardiac intensive care units (CICU) have evolved towards a patient population with an increasing number of co-morbid medical conditions and acute heart failure (HF). The current study was designed to illustrate the burden of HF patients admitted to CICU, and evaluate patient characteristics, in-hospital course and outcomes of CICU patients with HF compared with patients with acute coronary syndrome (ACS). Methods and results: A prospective study including all consecutive patients admitted to the CICU at a tertiary medical centre between 2014 and 2020. The main outcome was a direct comparison between HF and ACS patients in processes of care, resource use, and outcomes during CICU hospitalization. A secondary analysis compared ischaemic versus non-ischaemic HF aetiology. Adjusted analysis evaluated parameters associated with prolonged hospitalization. The cohort included 7674 patients with a total annual CICU admissions of 1028-1145 patients. HF diagnosis patients represented 13-18% of the annual CICU admissions and were significantly older with higher incidence of multiple co-morbidities compared with patients with ACS. HF patients also required more intensive therapies and demonstrated higher incidence of acute complications as compared with ACS patients. Length of stay at the CICU was significantly longer among HF patients compared with patients with ACS (either STEMI or NSTEMI) (6.2 ± 4.3 vs. 4.1 ± 2.5 vs. 3.5 ± 2.1, respectively, P < 0.001). HF patients represented a disproportionately higher amount of total CICU patient days during the study period, as the total length of hospitalization of HF patients was 44-56% out of the total cumulative days in CICU of patients with ACS every year. In hospital mortality rates were also significantly higher among patients with HF compared with STEMI or NSTEMI (4.2% vs. 3.1% vs. 0.7%, respectively, P < 0.001). Despite several differences in baseline characteristics between patients with ischaemic versus non-ischaemic HF, which can be attributed mainly to disease aetiology, hospitalization length and outcomes were similar among the groups regardless of HF aetiology. In multivariable analysis for the risk of prolonged hospitalization in the CICU adjusted to potential significant co-morbidities associated with poor outcomes, HF was found to be an independent and significant parameter associated with the risk of prolonged hospitalization with an OR of 3.5 (95% CI 2.9-4.1, P < 0.001). Conclusions: Patients with HF in CICU have higher severity of illness with a prolonged and complicated hospital course, all of which can substantially increase the burden on clinical resources.
MeSH term(s)	Humans ; Prospective Studies ; Non-ST Elevated Myocardial Infarction ; ST Elevation Myocardial Infarction ; Heart Failure/epidemiology ; Heart Failure/therapy ; Heart Failure/diagnosis ; Intensive Care Units ; Acute Coronary Syndrome/complications ; Acute Coronary Syndrome/epidemiology
Language	English
Publishing date	2023-02-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2814355-3
ISSN	2055-5822 ; 2055-5822
ISSN (online)	2055-5822
ISSN	2055-5822
DOI	10.1002/ehf2.14320
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Article ; Online: Levetiracetam Interaction with Direct Oral Anticoagulants: A Pharmacovigilance Study.

Abou Kaoud, Mohammed / Nissan, Ran / Segev, Amitai / Sabbag, Avi / Orion, David / Maor, Elad

CNS drugs

2023 Volume 37, Issue 12, Page(s) 1111–1121

Abstract: Background: Levetiracetam is widely used in post-stroke epilepsy. However, it is suspected to possess P-glycoprotein (P-gp) induction properties, and therefore, a potentially significant interaction with direct oral anticoagulants (DOACs). We aimed to ... ...

Abstract	Background: Levetiracetam is widely used in post-stroke epilepsy. However, it is suspected to possess P-glycoprotein (P-gp) induction properties, and therefore, a potentially significant interaction with direct oral anticoagulants (DOACs). We aimed to search for ischemic stroke signals with levetiracetam and the DOACs. Methods: In this retrospective pharmacovigilance study, we used the FAERS database to identify ischemic stroke events associated with DOACs and concomitant use of levetiracetam. We evaluated disproportionate reporting by the adjusted reporting odds ratio (adjROR) and the lower bound of the shrinkage 95% confidence interval. When shrinkage is positive, an increased risk of a specific adverse event occurrence is emphasized over the sum of the individual risks when these same drugs are used separately. Results: We identified 1841 (1.5%), 3731 (5.3%), 338 (4.9%), and 1723 (1.3%) ischemic stroke reports with apixaban, dabigatran, edoxaban, and rivaroxaban, respectively. The adjROR of the interaction effect was 3.57 (95% CI 2.81-4.58) between DOACs and levetiracetam. The shrinkage analysis detected an interaction between each of the DOACs and levetiracetam. The logistic model and shrinkage analysis failed to detect an interaction when queried for hemorrhagic stroke. A significant signal in the classical enzyme inducer, carbamazepine, strengthened our results (adjROR; 8.47, 95% CI 5.37-13.36). Conclusions: Our study shows a strong signal for the levetiracetam interaction with the DOACs. Our findings suggest implementation of a drug monitoring strategy.
MeSH term(s)	Humans ; Anticoagulants/adverse effects ; Levetiracetam/adverse effects ; Retrospective Studies ; Pharmacovigilance ; Atrial Fibrillation/drug therapy ; Pyridones/adverse effects ; Ischemic Stroke/drug therapy ; Administration, Oral
Chemical Substances	Anticoagulants ; Levetiracetam (44YRR34555) ; Pyridones
Language	English
Publishing date	2023-11-22
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	1203800-3
ISSN	1179-1934 ; 1172-7047
ISSN (online)	1179-1934
ISSN	1172-7047
DOI	10.1007/s40263-023-01052-1
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Article: The clinical course of patients with previous acute and recurrent pericarditis receiving the BNT162b2 vaccine.

Wasserstrum, Yishay / Nadav, Sofia / Segev, Amitai / Lotan, Dor / Freimark, Dov / Arad, Michael

International journal of cardiology. Heart & vasculature

2022 Volume 42, Page(s) 101084

Abstract: Background: Vaccines against SARS-COV2 have been crucial in efforts against COVID19, yet there have been reports of pericarditis following vaccination with mRNA-based vaccines.: Methods: We questioned consecutive patients with a history of acute ... ...

Abstract	Background: Vaccines against SARS-COV2 have been crucial in efforts against COVID19, yet there have been reports of pericarditis following vaccination with mRNA-based vaccines. Methods: We questioned consecutive patients with a history of acute pericarditis (AP) evaluated in the pericardial disease clinic during 3-11/2020 in a single tertiary center. Patients with significant myocardial involvement or pericarditis secondary to another systemic disease were excluded. Results: We included 64 patients in the final analysis. Mean age was 53.1 (±18), and 26 (41%) were female. At least 1 recurrence of AP was documented in 47 (73%) cases, 32 (50%) had ≥ 3 recurrences prior to vaccination. AP was considered to be idiopathic\viral in 45 (70%) cases, 20 (31%) cases were post-injury. All patients received at least 2 doses of the vaccine, and 48 patients (75%) received a 3rd dose. Two cases of breakthrough COVID19 infections were documented. Overall, 12 patients (19%) reported any adverse events. Of which, 2 had recurrent pericarditis. There was a trend for a younger age in those patients who had adverse events (median age 45 [IQR 36-61] vs. 60 [38-71], p = 0.08). no other significant difference was seen. Conclusion: In patients with a history of acute\recurrent pericarditis, the use of BNT162b2 was mostly uneventful, but some mild disease recurrences did occur.
Language	English
Publishing date	2022-07-18
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	2818464-6
ISSN	2352-9067
ISSN	2352-9067
DOI	10.1016/j.ijcha.2022.101084
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Article ; Online: Ventricular arrhythmias in patients with hypertrophic cardiomyopathy: Prevalence, distribution, predictors, and outcome.

Segev, Amitai / Wasserstrum, Yishay / Arad, Michael / Larrañaga-Moreira, Jose M / Martinez-Veira, Cristina / Barriales-Villa, Roberto / Sabbag, Avi

Heart rhythm

2023 Volume 20, Issue 10, Page(s) 1385–1392

Abstract: Background: Hypertrophic cardiomyopathy (HCM) carries an increased risk of sudden cardiac death. Ventricular fibrillation (VF) is thought to be the common culprit arrhythmia.: Objective: The purpose of this study was to describe the incidence and ... ...

Abstract	Background: Hypertrophic cardiomyopathy (HCM) carries an increased risk of sudden cardiac death. Ventricular fibrillation (VF) is thought to be the common culprit arrhythmia. Objective: The purpose of this study was to describe the incidence and predictors of sustained ventricular arrhythmias (VTAs) in HCM patients. Methods: We retrospectively analyzed all patients with HCM and an implantable cardioverter-defibrillator (ICD) from a prospectively derived registry in 2 tertiary medical centers. Clinical, electrocardiographic, echocardiographic, ICD interrogation, and genetic data were collected and compared, first between patients with and without VTAs and then between patients with only VF and those with ventricular tachycardia (VT) with or without VF. Results: Of the 1328 HCM patients, 207 (145 [70%] male; mean age 33 ± 16 years) were implanted with ICDs. Over a mean follow-up of 10 ± 6 years, 37 patients with ICDs (18%) developed sustained VTAs. These were associated with a family history of sudden cardiac death and a personal history of VTAs (P = .036 and P = .001, respectively). Sustained monomorphic VT was the most common arrhythmia (n = 26, 70%) and was linked to decreased left ventricular (LV) ejection fraction and increased LV end-systolic and end-diastolic diameters. Antitachycardia pacing (ATP) successfully terminated 258 (79%) of the 326 VT events. Mortality rates were comparable between patients with and without VTAs (4 [11%] vs 29 [17%]; P = .42) and between those with and without ICDs (24 [16%] vs 85 [20%]; P = .367). Conclusion: VT rather than VF is the most common arrhythmia in patients with HCM; it is amenable to ATP and is associated with lower LV ejection fraction and higher LV diameters. Therefore, ATP-capable devices may be considered in HCM patients with these LV features.
MeSH term(s)	Humans ; Male ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Female ; Retrospective Studies ; Prevalence ; Tachycardia, Ventricular/epidemiology ; Tachycardia, Ventricular/etiology ; Tachycardia, Ventricular/therapy ; Ventricular Fibrillation/epidemiology ; Ventricular Fibrillation/etiology ; Ventricular Fibrillation/therapy ; Defibrillators, Implantable/adverse effects ; Death, Sudden, Cardiac/epidemiology ; Death, Sudden, Cardiac/etiology ; Death, Sudden, Cardiac/prevention & control ; Cardiomyopathy, Hypertrophic/complications ; Cardiomyopathy, Hypertrophic/diagnosis ; Cardiomyopathy, Hypertrophic/epidemiology ; Adenosine Triphosphate
Chemical Substances	Adenosine Triphosphate (8L70Q75FXE)
Language	English
Publishing date	2023-06-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2023.06.015
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Article ; Online: Serum Magnesium Is Associated with Long-Term Survival of Non-ST-Elevation Myocardial Infarction Patients.

Segev, Amitai / Shechter, Michael / Tsur, Avishai M / Belkin, David / Cohen, Hofit / Sharon, Amir / Morag, Nira Koren / Grossman, Ehud / Maor, Elad

Nutrients

2023 Volume 15, Issue 19

Abstract: Background: Low serum magnesium (sMg) is associated with cardiovascular risk factors and atherosclerotic disease.: Objective: To evaluate the association between sMg levels on admission and clinical outcomes in hospitalized non-ST-elevation ... ...

Abstract	Background: Low serum magnesium (sMg) is associated with cardiovascular risk factors and atherosclerotic disease. Objective: To evaluate the association between sMg levels on admission and clinical outcomes in hospitalized non-ST-elevation myocardial infarction (NSTEMI) patients. Methods: A retrospective analysis of all patients admitted to a single tertiary center with a primary diagnosis of NSTEMI. Patients with advanced chronic kidney disease were excluded. Clinical data were collected and compared between lower sMg quartile patients (Q1; sMg < 1.9 mg/dL) and all other patients (Q2-Q4; sMg ≥ 1.9 mg/dL). Results: The study cohort included 4552 patients (70% male, median age 69 [IQR 59-79]) who were followed for a median of 4.4 (IQR 2.4-6.6) years. The median sMg level in the low sMg group was 1.7 (1.6-1.8) and 2.0 (2.0-2.2) mg/dL in the normal/high sMg group. The low sMg group was older (mean of 72 vs. 67 years), less likely to be male (64% vs. 72%), and had higher rates of comorbidities, including diabetes, hypertension, and atrial fibrillation (59% vs. 29%, 92% vs. 85%, and 6% vs. 5%; Conclusions: Low sMg is independently associated with higher risk of long-term mortality among patients recovering from an NSTEMI event.
MeSH term(s)	Humans ; Male ; Aged ; Female ; Non-ST Elevated Myocardial Infarction/diagnosis ; Non-ST Elevated Myocardial Infarction/epidemiology ; Magnesium ; Retrospective Studies ; Comorbidity ; Diabetes Mellitus ; Risk Factors
Chemical Substances	Magnesium (I38ZP9992A)
Language	English
Publishing date	2023-10-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2518386-2
ISSN	2072-6643 ; 2072-6643
ISSN (online)	2072-6643
ISSN	2072-6643
DOI	10.3390/nu15194299
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Article ; Online: The safety of sodium glucose transporter 2 inhibitors and trends in clinical and hemodynamic parameters in patients with left ventricular assist devices.

Fardman, Alexander / Kodesh, Afek / Siegel, Allison Joyce / Segev, Amitai / Regev, Ehud / Maor, Elad / Berkovitch, Anat / Kuperstein, Rafael / Morgan, Avi / Nahum, Eyal / Peled, Yael / Grupper, Avishay

Artificial organs

2024

Abstract: Background: The safety and impact of sodium glucose transporter 2 inhibitors (SGLT2-I) in patients with left ventricular assist devices (LVAD) are unknown.: Methods: A retrospective analysis of all consecutive patients who underwent LVAD Heart Mate 3 ...

Abstract	Background: The safety and impact of sodium glucose transporter 2 inhibitors (SGLT2-I) in patients with left ventricular assist devices (LVAD) are unknown. Methods: A retrospective analysis of all consecutive patients who underwent LVAD Heart Mate 3 (HM3) implantation at a single medical center and received SGLT2-I therapy following surgery was conducted. LVAD parameters, medical therapy, laboratory tests, echocardiography, and right heart catheterization (RHC) study results were recorded and compared before and after initiation of SGLT2-I. Results: SGLT2-I medications were initiated in 29 (21%) of 138 patients following HM3 implantation (23 (79%) received Empagliflozin and 6 (21%) Dapagliflozin). The mean age at the time of LVAD implantation was 62 ± 6.7 years, 25 (86%) were male, and 23 (79%) had diabetes mellitus. The median time from HM3 implantation to SGLT2-I initiation was 108 days, IQR (26-477). Following SGLT2-I therapy, the daily dose of furosemide decreased from 47 to 23.5 mg/day (mean difference = 23.5 mg/d, 95% CI 8.2-38.7, p = 0.004) and significant weight reduction was observed (mean difference 2.5 kg, 95% CI 0.7-4.3, p = 0.008). Moreover, a significant 5.6 mm Hg reduction in systolic pulmonary artery pressure (sPAP) was measured during RHC (95% CI 0.23-11, p = 0.042) in a subgroup of 11 (38%) patients. LVAD parameters were similar before and after SGLT2-I initiation (p > 0.2 for all). No adverse events were recorded during median follow-up of 354 days, IQR (206-786). Conclusion: SGLT2-I treatment is safe in LVAD patients and might contribute to reduction in patients sPAP.
Language	English
Publishing date	2024-02-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	441812-8
ISSN	1525-1594 ; 0160-564X
ISSN (online)	1525-1594
ISSN	0160-564X
DOI	10.1111/aor.14733
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