Top

BMC Infectious Diseases

Published in:

Open Access 01-12-2022 | Central Venous Catheter | Research article

Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients?

Authors: Khouloud Abdulrhman Al-Sofyani, Mohammed Shahab Uddin

Published in: BMC Infectious Diseases | Issue 1/2022

Abstract

Background

In children in the ICU, catheter-related bloodstream infections (CRBSI) have also been linked to mortality, morbidity, and healthcare costs. Although CRBSI poses many potential risks, including the need to avoid femoral access, there is debate regarding whether jugular access is preferable to femoral access in adults. Study reports support both perspectives. There is no consensus in meta-analyses. Children have yet to be examined in depth. Based on compliance with the central line bundle check lists, we aim to determine CRBSI risk in pediatric intensive care units for patients with non-tunneled femoral and internal jugular venous access.

Methods

A retrospective cohort study was conducted on patients with central venous catheters in the pediatric ICU of King Abdulaziz University Hospital between January 1st, 2017 and January 30th, 2018. For the post-match balance, we use a standardized mean difference of less than 0.1 after inverse probability treatment weighting for all baseline covariates, and then we draw causal conclusions. As a final step, the Rosenbaum sensitivity test was applied to see if any bias influenced the results.

Results

We recorded 145 central lines and 1463 central line days with 49 femoral accesses (33.79%) and 96 internal jugular accesses (66.21%). CRBSI per 1000 central line days are 4.10, along with standardized infections of 3.16. CRBSI risk differed between non-tunneled femoral vein access and internal jugular vein access by 0.074 (− 0.021, 0.167), P-value 0.06, and relative risk was 4.67 (0.87–25.05). Using our model, the actual probability was 4.14% (0.01–0.074) and the counterfactual probability was 2.79% (− 0.006, 0.062). An unobserved confounding factor was not identified in the sensitivity analysis.

Conclusions

So long as the central line bundle is maintained, a femoral line does not increase the risk of CRBSI. Causation can be determined through propensity score weighting, as this is a trustworthy method of estimating causality. There is no better way to gain further insight in this regard than through the use of randomized, double-blinded, multicenter studies.

Pronovost PJ, Cleeman JI, Wright D, Srinivasan A. Fifteen years after to err is human: a success story to learn from. BMJ Qual Saf. 2016;25(6):396–9. https://doi.org/10.1136/bmjqs-2015-004720.CrossRefPubMed

Wise ME, Scott RD, Baggs JM, Edwards JR, Ellingson KD, Fridkin SK, McDonald LC, Jernigan JA. National estimates of central line–associated bloodstream infections in critical care patients. Infect Control Hosp Epidemiol. 2013;34(6):547–54.CrossRef

Pronovost PJ, Cardo DM, Goeschel CA, Berenholtz SM, Saint S, Jernigan JA. A research framework for reducing preventable patient harm. Clin Infect Dis. 2011;52(4):507–13. https://doi.org/10.1093/cid/ciq172.CrossRefPubMedPubMedCentral

Pronovost PJ, et al. Improving patient safety in intensive care units in Michigan. J Crit Care. 2008;23(2):207–21. https://doi.org/10.1016/j.jcrc.2007.09.002.CrossRefPubMed

Benning A, et al. Large scale organisational intervention to improve patient safety in four UK hospitals: mixed method evaluation. BMJ. 2011;342(7793):369. https://doi.org/10.1136/bmj.d195.CrossRef

Lü Y, et al. A multi-center nested case-control study on hospitalization costs and length of stay due to healthcare-associated infection. Antimicrob Resist Infect Control. 2018;7(1):1–10. https://doi.org/10.1186/s13756-018-0386-1.CrossRef

Jia H, et al. Impact of healthcare-associated infections on length of stay: a study in 68 hospitals in China. Biomed Res Int. 2019. https://doi.org/10.1155/2019/2590563.CrossRefPubMedPubMedCentral

Al-Rawajfah OM, Hewitt JB, Stetzer F, Cheema J. Length of stay and charges associated with health care-acquired bloodstream infections. Am J Infect Control. 2012;40(3):227–32. https://doi.org/10.1016/j.ajic.2011.03.014.CrossRefPubMed

Alotaibi NH, Barri A, Elahi MA. Length of stay in patients with central line-associated bloodstream infection at a tertiary hospital in the Kingdom of Saudi Arabia. Cureus. 2020. https://doi.org/10.7759/cureus.10820.CrossRefPubMedPubMedCentral

10.

Huerta LE, Nelson GE, Stewart TG, Rice TW. Factors associated with recurrence and mortality in central line-associated bloodstream infections: a retrospective cohort study. Crit Care. 2018;22(1):1–8. https://doi.org/10.1186/s13054-018-2206-7.CrossRef

11.

Olaechea PM, et al. Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients. Rev Esp Quimioter. 2013;26:21–9.PubMed

12.

Wheeler DS, et al. A hospital-wide quality-improvement collaborative to reduce catheter-associated bloodstream infections. Pediatrics. 2011. https://doi.org/10.1542/peds.2010-2601.CrossRefPubMed

13.

Osme SF, et al. Costs of healthcare-associated infections to the Brazilian public Unified Health System in a tertiary-care teaching hospital: a matched case–control study. J Hosp Infect. 2020;106(2):303–10. https://doi.org/10.1016/j.jhin.2020.07.015.CrossRefPubMed

14.

Graves N, Harbarth S, Beyersmann J, Barnett A, Halton K, Cooper B. Estimating the cost of health care-assodated infections: Mind your p’s and q’s. Clin Infect Dis. 2010;50(7):1017–21. https://doi.org/10.1086/651110.CrossRefPubMed

15.

Benenson S, Cohen MJ, Schwartz C, Revva M, Moses AE, Levin PD. Is it financially beneficial for hospitals to prevent nosocomial infections? BMC Health Serv Res. 2020;20(1):1–9. https://doi.org/10.1186/s12913-020-05428-7.CrossRef

16.

Crist J. Never say never: never events in medicare. Health Matrix. 2010;20:437.PubMed

17.

Laupland KB, Lee H, Gregson DB, Manns BJ. Cost of intensive care unit-acquired bloodstream infections. J Hosp Infect. 2006;63(2):124–32. https://doi.org/10.1016/j.jhin.2005.12.016.CrossRefPubMed

18.

Ziegler MJ, Pellegrini DC, Safdar N. Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection. 2015;43(1):29–36. https://doi.org/10.1007/s15010-014-0689-y.CrossRefPubMed

19.

McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123–33. https://doi.org/10.1056/nejmra011883.CrossRefPubMed

20.

Lorente L, Henry C, Martín MM, Jiménez A, Mora ML. Central venous catheter-related infection in a prospective and observational study of 2595 catheters. Crit Care. 2005. https://doi.org/10.1186/cc3824.CrossRefPubMedPubMedCentral

21.

Parienti JJ, et al. Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA. 2008;299(20):2413–22. https://doi.org/10.1001/jama.299.20.2413.CrossRefPubMed

22.

Lee KH, Cho NH, Jeong SJ, Kim MN, Han SH, Song YG. Effect of central line bundle compliance on central line-associated bloodstream infections. Yonsei Med J. 2018;59(3):376–82. https://doi.org/10.3349/ymj.2018.59.3.376.CrossRefPubMedPubMedCentral

23.

Gupta P, et al. Bundle approach used to achieve zero central line-associated bloodstream infections in an adult coronary intensive care unit. BMJ Open Qual. 2021. https://doi.org/10.1136/bmjoq-2020-001200.CrossRefPubMedPubMedCentral

24.

Tang HJ, Lin HL, Lin YH, Leung PO, Chuang YC, Lai CC. The impact of central line insertion bundle on central line-associated bloodstream infection. BMC Infect Dis. 2014;14(1):356. https://doi.org/10.1186/1471-2334-14-356.CrossRefPubMedPubMedCentral

25.

Palmer BES, Caldwell AK, Matthew B. Avoiding the femoral vein in central venous cannulation: an outdated practice. ACP Hospitalist. 2018 https://acphospitalist.org/archives/2018/08/perspectives-avoiding-the-femoral-vein-in-central-venous-cannulation-an-outdated-practice.htm

26.

Parienti J-J, et al. Intravascular complications of central venous catheterization by insertion site. N Engl J Med. 2015;373(13):1220–9. https://doi.org/10.1056/nejmoa1500964.CrossRefPubMed

27.

Parienti JJ, et al. Meta-analysis of subclavian insertion and nontunneled central venous catheter-associated infection risk reduction in critically ill adults. Crit Care Med. 2012;40(5):1627–34. https://doi.org/10.1097/CCM.0b013e31823e99cb.CrossRefPubMed

28.

Timsit JF, et al. Jugular versus femoral short-term catheterization and risk of infection in intensive care unit patients: causal analysis of two randomized trials. Am J Respir Crit Care Med. 2013;188(10):1232–9. https://doi.org/10.1164/rccm.201303-0460OC.CrossRefPubMed

29.

Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2012;40(8):2479–85. https://doi.org/10.1097/CCM.0b013e318255d9bc.CrossRefPubMed

30.

Marschall J, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(7):753–71. https://doi.org/10.1086/676533.CrossRefPubMed

31.

Kumar A. Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. Yearb Crit Care Med. 2009;2009(20):128–9. https://doi.org/10.1016/s0734-3299(08)79028-2.CrossRef

32.

Gahlot R, Nigam C, Kumar V, Yadav G, Anupurba S. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci. 2014;4(2):161. https://doi.org/10.4103/2229-5151.134184.CrossRef

33.

García X, et al. Differential time to positivity of blood cultures: a valid method for diagnosing catheter-related bloodstream infections in the intensive care unit. Med Intensiva. 2012;36(3):169–76. https://doi.org/10.1016/j.medin.2011.09.010.CrossRefPubMed

34.

CDC. Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-central Line Associated Bloodstream Infection) Table of Contents. 2021. https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf accessed 27 Jan 2021. pp. 1–50

35.

Panos A, Mavridis D. TableOne: an online web application and R package for summarising and visualising data. Evid Based Ment Health. 2020;23(3):127–30. https://doi.org/10.1136/ebmental-2020-300162.CrossRefPubMed

36.

Ho DE, Imai K, King G, Stuart EA. MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Softw. 2011;42(8):1–28. https://doi.org/10.18637/jss.v042.i08.CrossRef

37.

Zhang Z, Kim HJ, Lonjon G, Zhu Y. Balance diagnostics after propensity score matching. Ann Transl Med. 2019;7(1):16–16. https://doi.org/10.21037/atm.2018.12.10.CrossRefPubMedPubMedCentral

38.

Curtis LH, Hammill BG, Eisenstein EL, Kramer JM, Anstrom KJ. Using inverse probability-weighted estimators in comparative effectiveness analyses with observational databases. Med Care. 2007;45(10 SUPPL. 2):103–7. https://doi.org/10.1097/mlr.0b013e31806518ac.CrossRef

39.

Ridgeway G, et al. Toolkit for weighting and analysis of nonequivalent groups: a guide to the twang package. https://cran.r-project.org/package=twang 2021. pp. 1–31.

40.

Parast L, et al. Optimizing variance-bias trade-off in the TWANG package for estimation of propensity scores. Health Serv Outcomes Res Methodol. 2017;17(3–4):175–97. https://doi.org/10.1007/s10742-016-0168-2.CrossRefPubMed

41.

Sjölander A. Estimation of causal effect measures with the R -package stdReg. Eur J Epidemiol. 2018;33(9):847–58. https://doi.org/10.1007/s10654-018-0375-y.CrossRefPubMedPubMedCentral

42.

Deubner DC, Tyroler HA, Cassel JC, Hames CG, Becker C. Attributable risk, population attributable risk, and population attributable fraction of death associated with hypertension in a biracial population. Circulation. 1975;52(5):901–8. https://doi.org/10.1161/01.CIR.52.5.901.CrossRefPubMed

43.

Tennant PWG, et al. Use of directed acyclic graphs (DAGs) to identify confounders in applied health research: review and recommendations. Int J Epidemiol. 2021;50(2):620–32. https://doi.org/10.1093/ije/dyaa213.CrossRefPubMed

44.

Keele L. An overview of rbounds : An R package for Rosenbaum bounds sensitivity analysis with matched data. Citeseer, pp. 1–15. https://www.researchgate.net/publication/251969933 2010.

45.

O’Grady N, et al. Guideline Intravascular Catheter-related Infection, 2011. Cent. Dis. Control Prev. no. October, pp. 1–80. https://www.cdc.gov/infectioncontrol/guidelines/bsi/ 2017

46.

O’Grady NP, et al. ‘Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011. https://doi.org/10.1093/cid/cir257.CrossRefPubMedPubMedCentral

47.

HSE Health Protection Surveillance Centre. Prevention of intravascular catheter-related infection in Ireland update of 2009 national guidelines. 2014.

48.

Prevention of Central Line-Associated Bloodstream Infections: Aseptic Insertion and Site Selection. pp. 1–43.

49.

Timsit JF, et al. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care. 2020. https://doi.org/10.1186/s13613-020-00713-4.CrossRefPubMedPubMedCentral

50.

Reyes JA, Habash ML, Taylor RP. Femoral central venous catheters are not associated with higher rates of infection in the pediatric critical care population. Am J Infect Control. 2012;40(1):43–7. https://doi.org/10.1016/j.ajic.2011.02.011.CrossRefPubMed

51.

Lakshmi KS, Jayashree M, Singhi S, Ray P. Study of nosocomial primary bloodstream infections in a pediatric intensive care unit. J Trop Pediatr. 2007;53(2):87–92. https://doi.org/10.1093/tropej/fml073.CrossRefPubMed

52.

Stevens V, Geiger K, Concannon C, Nelson RE, Brown J, Dumyati G. Inpatient costs, mortality and 30-day re-admission in patients with central-line-associated bloodstream infections. Clin Microbiol Infect. 2014;20(5):O318–24. https://doi.org/10.1111/1469-0691.12407.CrossRefPubMed

53.

Blot K, Bergs J, Vogelaers D, Blot S, Vandijck D. Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. Clin Infect Dis. 2014;59(1):96–105. https://doi.org/10.1093/cid/ciu239.CrossRefPubMedPubMedCentral

54.

Furuya EY, Dick A, Perencevich EN, Pogorzelska M, Goldmann D, Stone PW. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS ONE. 2011;6(1):1–6. https://doi.org/10.1371/journal.pone.0015452.CrossRef

55.

Agency for Healthcare Research and Quality, ‘Guidelines to Prevent Central Line-Associated Blood Stream Infections’, U.S. Dep. Heal. Hum. Serv., p 1, 2014. https://www.ahrq.gov/professionals/education/curriculum-tools/clabsitools/clabsitoolsap3.html.

56.

Griffin BA, et al. Corrigendum to “Expanding outcomes when considering the relative effectiveness of two evidence-based outpatient treatment programs for adolescents” [J. Subst. Abuse Treat. 118 (2020) 108075] (Journal of Substance Abuse Treatment (2020) 118, (S074054722030. J Subst Abuse Treat. 2020;118: 108126. https://doi.org/10.1016/j.jsat.2020.108126.CrossRefPubMedPubMedCentral

57.

Hunter SB, Ramchand R, Griffin BA, Suttorp MJ, McCaffrey D, Morral A. The effectiveness of community-based delivery of an evidence-based treatment for adolescent substance use. J Subst Abuse Treat. 2013;43(2):211–20. https://doi.org/10.1016/j.jsat.2011.11.003.CrossRef

58.

Parast L, Griffin BA. Quantifying the bias due to observed individual confounders in causal treatment effect estimates. Stat Med. 2020;39(18):2447–76. https://doi.org/10.1002/sim.8549.CrossRefPubMedPubMedCentral

59.

Hoorn EJ. 乳鼠心肌提取 HHS public access. Physiol Behav. 2017;176(1):100–6. https://doi.org/10.1111/biom.12887.Doubly.CrossRef

60.

Greenland S, Pearl J, Robins JM. Causal diagrams for epidemiologic research. Epidemiology. 1999;10(1):37–48. https://doi.org/10.1097/00001648-199901000-00008.CrossRefPubMed

61.

Staplin N, et al. Use of causal diagrams to inform the design and interpretation of observational studies: an example from the study of heart and renal protection (SHARP). Clin J Am Soc Nephrol. 2017;12(3):546–52. https://doi.org/10.2215/CJN.02430316.CrossRefPubMed

62.

La Torre FPF, Baldanzi G, Troster EJ. Risk factors for vascular catheter-related bloodstream infections in pediatric intensive care units. Rev Bras Ter Intensiva. 2018;30(4):436–42. https://doi.org/10.5935/0103-507X.20180066.CrossRefPubMedPubMedCentral

63.

Kendirli T, et al. Central line-associated bloodstream infections in pediatric intensive care unit. Turk J Pediatr Emerg Intensive Care Med. 2017;4(2):42–6. https://doi.org/10.4274/cayd.86580.CrossRef

64.

Abdelmoneim HM, Ibrahim HM, Ahmed AR, Mohammed KA. Incidence of central line-associated blood steam infection in pediatric intensive care unit (PICU). Egypt J Hosp Med. 2020;78(1):136–41. https://doi.org/10.21608/ejhm.2020.68483.CrossRef

65.

Niedner MF, et al. Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit. Infect Control Hosp Epidemiol. 2011;32(12):1200–8. https://doi.org/10.1086/662621.CrossRefPubMed

66.

Edwards JD, et al. Central line-associated blood stream infections in pediatric intensive care units: longitudinal trends and compliance with bundle strategies. Am J Infect Control. 2015;43(5):489–93. https://doi.org/10.1016/j.ajic.2015.01.006.CrossRefPubMedPubMedCentral

67.

Patrick SW, et al. Health care-associated infections among critically ill children in the US, 2007–2012. Pediatrics. 2014;134(4):705–12. https://doi.org/10.1542/peds.2014-0613.CrossRefPubMed

68.

Miller MR, et al. Reducing PICU central line—associated bloodstream infections: 3-year results. Pediatrics. 2011. https://doi.org/10.1542/peds.2010-3675.CrossRefPubMedPubMedCentral

69.

Edwards JR, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control. 2009;37(10):783–805. https://doi.org/10.1016/j.ajic.2009.10.001.CrossRefPubMed

70.

National Healthcare Safety Institute. Your Guide to the Standardized Infection Ratio (SIR). pp. 1–14, 2010.

71.

Gustafson TL. Three uses of the standardized infection ratio (SIR) in infection control. Infect Control Hosp Epidemiol. 2006;27(4):427–30. https://doi.org/10.1086/503019.CrossRefPubMed

72.

Dudeck MA, et al. National Healthcare Safety Network (NHSN) report, data summary for 2009, device-associated module. Am J Infect Control. 2011;39(5):349–67. https://doi.org/10.1016/j.ajic.2011.04.011.CrossRefPubMed

73.

Goetz AM, Wagener MM, Miller JM, Muder RR. Risk of infection due to central venous catheters: effect of site of placement and catheter type. Infect Control Hosp Epidemiol. 1998;19(11):842–5. https://doi.org/10.2307/30141562.CrossRefPubMed

74.

Collignon P, Soni N, Pearson I, Sorrell T, Woods P. Sepsis associated with central vein catheters in critically ill patients. Intensive Care Med. 1988;14(3):227–31. https://doi.org/10.1007/BF00717995.CrossRefPubMed

75.

Ruesch S, Walder B, Tramèr MR. Complications of central venous catheters: internal jugular versus subclavian access—a systematic review. Crit Care Med. 2002;30(2):454–60. https://doi.org/10.1097/00003246-200202000-00031.CrossRefPubMed

76.

Pitiriga V, et al. Central venous catheter-related bloodstream infection and colonization: the impact of insertion site and distribution of multidrug-resistant pathogens. Antimicrob Resist Infect Control. 2020;9(1):1–9. https://doi.org/10.1186/s13756-020-00851-1.CrossRef

77.

Topal S, et al. Central venous catheter types and association with bloodstream infection in the pediatric intensive care unit: experience of two years. J Dr Behcet Uz Child s Hosp. 2021;11(3):247–54. https://doi.org/10.5222/buchd.2021.78736.CrossRef

78.

Sagana R, Hyzy RC. Achieving zero central line-associated bloodstream infection rates in your intensive care unit. Crit Care Clin. 2013;29(1):1–9. https://doi.org/10.1016/j.ccc.2012.10.003.CrossRefPubMed

79.

Derderian SC, Good R, Vuille-dit-Bille RN, Carpenter T, Bensard DD. Central venous lines in critically ill children: thrombosis but not infection is site dependent. J Pediatr Surg. 2019;54(9):1740–3. https://doi.org/10.1016/j.jpedsurg.2018.10.109.CrossRefPubMed

80.

Silvetti S, Aloisio T, Cazzaniga A, Ranucci M. Jugular vs femoral vein for central venous catheterization in pediatric cardiac surgery (PRECiSE): study protocol for a randomized controlled trial. Trials. 2018;19(1):1–7. https://doi.org/10.1186/s13063-018-2717-1.CrossRef

81.

Cepeda MS, Boston R, Farrar JT, Strom BL. Comparison of logistic regression versus propensity score when the number of events is low and there are multiple confounders. Am J Epidemiol. 2003;158(3):280–7. https://doi.org/10.1093/aje/kwg115.CrossRefPubMed

82.

Rosenbaum PR. Two R packages for sensitivity analysis in observational studies. Obs Stud. 2015;1(2):1–17. https://doi.org/10.1353/obs.2015.0000.CrossRef

Title: Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients?
Authors: Khouloud Abdulrhman Al-Sofyani
Mohammed Shahab Uddin
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Central Venous Catheter
Published in: BMC Infectious Diseases / Issue 1/2022
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-022-07571-4

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

Clinical performance of quantitative PCR for the molecular identification of skeletal tuberculosis from formalin-fixed paraffin-embedded tissues

Identification of SARS-CoV-2 variants using viral sequencing for the Centers for Disease Control and Prevention genomic surveillance program

Clinical clustering with prognostic implications in Japanese COVID-19 patients: report from Japan COVID-19 Task Force, a nation-wide consortium to investigate COVID-19 host genetics

The tryptophan catabolite or kynurenine pathway in COVID-19 and critical COVID-19: a systematic review and meta-analysis

Predictors of critical care, mechanical ventilation, and mortality among hospitalized patients with COVID-19 in an electronic health record database

Low incidence of COVID-19 case severity and mortality in Africa; Could malaria co-infection provide the missing link?

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage