Perceived stress is associated with impaired artery elasticity: An observational study from the Vara- Skövde cohort

PLoS ONE · 2025-11-13

BACKGROUND: This study aims to determine the association between perceived mental stress and arterial elasticity. Additionally, we will investigate potential effect modifications of sex and antihypertensive medication on this association. METHODS: Cross-sectional observational study based on the Vara- Skövde Cohort. After excluding individuals with missing information on perceived stress or vascular elasticity, 1015 individuals remained. Perceived stress was evaluated with the Perceived Stress Scale-10 (PSS-10). Small Artery Elasticity Index (SAEI or C2) was estimated from a Windkessel model obtained by applanation tonometry over the arteria radialis. Impaired artery elasticity was defined as the lowest sex-specific quartile of C2. The associations between perceived stress and artery elasticity indices were investigated using linear and logistic regressions with adjustments for possible confounding in different models. Due to significant interactions tests we stratified for men and women and for individuals with and without antihypertensive medication. RESULTS: The mean age of study participants was 57 years and women reported significantly higher stress levels on PSS-10 than men [Women: 13.6 ± 5.6; Men: 12.4 ± 5.3; p < 0.01]. Among those 803 individuals who did not take antihypertensive medication, there was a significant association in linear regression between increase in PSS-10 and decrease in C2 (B: -0.2, 95% CI: -0.4- -0.02; p = 0.03) that was lost after adjustment for physical activity (B: -0.16, 95% CI: -0.35-0.03; p = 0.1). In logistic regression analyzes, each increment with 1-SD in PSS-10 was associated with 25% higher odds of having impaired artery elasticity in all models (OR=1.25, 95% CI: 1.01-1.55; p = 0.04). CONCLUSIONS: Among middle-aged adults without antihypertensive medication, higher perceived stress was associated with impaired arterial elasticity.

Temporal Trends in Specialty Palliative Care Consultation During Hospitalization for Acute Respiratory Failure Among Patients With Chronic Illness

American Journal of Respiratory and Critical Care Medicine · 2025-05-01

Abstract RATIONALE: Patients with chronic illness who develop acute respiratory failure have unique palliative care needs. Over the past decade, evolving care practices and the COVID-19 pandemic may have influenced specialty palliative care (SPC) consultation trends. This study examines specialty palliative care consultation trends for patients, particularly during the COVID-19 pandemic. METHODS: We conducted a retrospective cohort study of patients ≥ 18 years old with chronic, life-limiting illness who were hospitalized for acute respiratory failure between 1/01/2012-12/31/2022 at 2 medical centers in Seattle, WA: a tertiary referral center (n=6,841) and a level I trauma center (n= 6,937). Using linear regression with robust standard errors, we examined the rate of change in the proportion of patients who received specialty palliative care consult before and during the COVID-19 pandemic. Analyses were also adjusted for age, sex, race, ethnicity, hospital site, insurance status, mechanical ventilation, and severity of comorbid illness. RESULTS: Of the 13,778 patients studied, the mean age was 58.5 years; 63.6% were male, and 75.9% were white. A total of 9,078 patients were admitted pre-pandemic (2012-2020) and 4,700 during the pandemic (2020-2022). In the pre-pandemic period, 27.1% received SPC consultations, compared to 23.8% during the pandemic (Figure 1). During the pandemic, SPC consultations were provided to 30.9% of the 603 COVID-positive patients and 22.7% of COVID-negative patients.From 2012-2020, the proportion of patients receiving specialty palliative care consultations increased 0.87% per year (95% CI 0.46, 1.27). During the pandemic, specialty palliative care consultations decreased by 2% per year (95% CI 0.45, 3.55). Results were similar after adjustment. For COVID-positive patients, the proportion receiving SPC consultation decreased 3.87% per year (95% CI -0.91, 8.64). For COVID-negative patients, the proportion decreased 1.91% per year (95% CI 0.28, 3.54). CONCLUSIONS: While there was a significant increase in the proportion of patients receiving specialty palliative care consultation during hospitalization for acute respiratory failure in pre-pandemic years, this was driven by the low proportions in the early years. In the pandemic years, there was a significant decrease in the proportion of all patients receiving specialty palliative care. The higher proportion of COVID-positive patients receiving SPC consultations compared to COVID-negative patients may suggest greater palliative needs among this patient population.

Leveraging Electronic Health Record Review to Identify Root Causes of Unplanned Intensive Care Unit Admissions

American Journal of Respiratory and Critical Care Medicine · 2025-05-01

Abstract RATIONALE: Unplanned ICU admissions from acute care are common and often indicate adverse events. These admissions carry a high risk of death and are linked to poor communication and lower family satisfaction with care. There has been considerable focus on predicting these events but less attention to understanding their root causes. Traditional root cause analysis, which involves interviews of staff as well as review of the electronic health record (EHR), is a labor-intensive approach to assessing unplanned ICU admissions, and it is impractical for developing an understanding of these events on a significant scale. Our goal was to develop a process that could provide insight into root causes using only information available in the EHR. METHODS: We conducted a prospective cohort study of patients with unplanned ICU admissions at 3 sites (an academic medical center, a safety-net hospital, and a community hospital in Seattle, WA). We used purposive sampling based on patient demographics (age, sex, race/ethnicity) and system factors (hospital site, provider service) to select admissions for review. We interviewed personnel involved in each unplanned ICU admission and independently reviewed the EHR for each case. The Prevention and Recovery Information System for Monitoring and Analysis model was used to categorize contributory factors, with the following categories: technical, organizational, human, and patient. Factors identified in interviews were compared to those found through EHR review alone, allowing us to pinpoint similarities and differences across each approach. RESULTS: We interviewed 68 clinicians and conducted EHR reviews for 31 unplanned ICU admissions (Table 1). Insights from interviews and EHR reviews helped refine descriptions of contributing factors and led to the development of an additional contributor that was added to the existing classification system: human communication. In both interviews and EHR reviews, human factors (e.g., critical thinking, monitoring) and patient disease were frequently identified as potential contributors to unplanned ICU admissions. Compared to interviews, EHR reviews were less likely to identify organizational factors as potential contributors, particularly those related to organizational culture. Similarities and differences across each approach informed the development of a highly structured protocol for EHR review, designed to address gaps encountered when using the EHR alone. CONCLUSIONS: The EHR can be used to identify potential contributors to unplanned ICU admissions. Given the relatively shorter time required for EHR review compared to a traditional root cause analysis, using the EHR alone for event review may offer a more efficient approach to analysis.

Abstract 62: Symptoms Experienced at End-of-Life in Patients with Severe Acute Brain Injury

Stroke · 2025-01-30

Background: Palliative care has made important strides in the management of end-of-life symptoms for patients with cancer, though we have little understanding of end-of-life symptoms in patients with stroke and severe acute brain injury. As acute stroke management advances and more patients survive the acute phase of SABI, we aim to improve our understanding of their symptoms at end-of-life. Objectives: To describe symptoms in the last week of life of patients with SABI, as reported by family members, using a validated symptom inventory scale. Methods: This study is part of an ongoing prospective observational study of hospitalized patients with SABI and their family members at two academic institutions. Eligible patients were adults (&gt;=18) admitted with ischemic stroke, intracerebral hemorrhage, or coma after cardiac arrest as the primary reason for hospitalization and who met at least one severity criteria (e.g. ≥NIHSS 10 on day 2). Family members completed a post-death survey that included the validated 22-item integrated Palliative outcome scale (iPOS). A symptom was defined to be prevalent if reported as “severely” or “overwhelmingly”. Given the novel use of iPOS in stroke, we also explored factors associated with missingness of iPOS items. Results: We enrolled 303 patients and 352 family members. Of these, 165 patients were known to have died, with 149 having at least one family member complete a post-death survey. Descriptive characteristics are shown in Table 1. Median days from admission to death were 10, from death to survey completion 56. Of the 149 families, 138 (93%) responded to the iPOS question about patient pain while only 64% responded about hallucinations. Among responders, ≥60% reported poor patient mobility and difficulty communicating, and &gt;50% reported patient fatigue and difficulty remembering things (Figure 1). All 22 iPOS items were completed for only 79 (&lt;50%) participants. Family members who are older or have lower health literacy are more likely to miss at least one item (Table 2). Discussion: According to family members, over 20% of patients with SABI at end-of-life suffer from severe pain and shortness of breath, while over 50% have severe fatigue and poor mobility. While family response rate to some symptom items, e.g. patient pain, is high, less than half completed all 22 iPOS items. More work is needed to further understand symptoms and develop interventions to ensure high quality end-of-life care after SABI.

A Randomized Trial of a Resilience-Building Intervention in Adult Outpatients With Congenital Heart Disease

JACC Advances · 2025-09-13 · 1 citations

BACKGROUND: Interventions are needed to address growing concerns regarding poor psychosocial and mental health in adult congenital heart disease (ACHD). Strengthening patients' resilience is one proposed pathway, given its ability to improve quality of life in other patient populations. OBJECTIVES: The objective of this study was to evaluate feasibility and efficacy of a resilience-building intervention in ACHD. METHODS: We conducted a clinical trial of outpatients with moderate or complex ACHD, randomized to receive a cognitive-behavioral intervention (Promoting Resilience in Stress Management [PRISM]) vs usual care. Participants completed surveys at randomization and 3 months. We evaluated feasibility using enrollment and retention rates. We evaluated PRISM's effect on the primary outcome (change in self-reported resilience) and exploratory outcomes using linear regression adjusted for baseline measurement. RESULTS: We enrolled 78 patients from March 2023 to April 2024. Patients were randomized to treatment (PRISM; n = 40, age 36 ± 11 years; 50% female; 58% self-reported White race/ethnicity) vs control (n = 38, age 40 ± 12 years; 74% female; 79% White). Over three-quarters of participants randomized to treatment completed PRISM (80%) and follow-up measures. Of controls, 35/38 (92%) completed follow-up measures. Resilience scores at 3 months were higher in the treatment group (n = 30, 30.1 ± 8.1) compared to control (n = 35, 28.7 ± 5.8); this difference was not statistically significant. Mean quality of life at follow-up was significantly higher in the treatment group (79 ± 14 vs 73 ± 14; 95% CI: 0.8-12.7; P = 0.03). Program feedback was positive. CONCLUSIONS: This study demonstrates intervention feasibility with modifications. Although we did not demonstrate efficacy, participants were engaged and provided valuable feedback, suggesting value in ACHD. (Assessing and Promoting Resilience in Patients With Adult Congenital Heart Disease [PRISMACHD]; NCT04738474).

Corrigendum to “Improving communication about goals of care for hospitalized patients with serious illness: Study protocol for two complementary randomized trials”[Contemporary Clinical Trials 2022;120:106879].

Contemporary Clinical Trials · 2025-05-14

Prehospital treatment decisions for critically ill patients with dementia

Alzheimer s & Dementia · 2024-12-01

Abstract Rationale Prior work has shown a preference among most people with dementia and their families for comfort‐focused care near the end‐of‐life. Nonetheless, intubation and mechanical ventilation are increasing over time without concurrent trends in improved survival, including among those with advanced dementia. A better understanding of prehospital decision‐making about intubation for people with dementia will guide efforts to increase goal‐concordant care at onset of critical illness. Methods We identified eligible patients using the UW Medicine electronic health record (EHR) applying the following inclusion criteria: (1) age ≥ 55, (2) ICD‐code indicating dementia, (3) admission to a medicine service between 2011 and 2021, (4) treatment by paramedics, and (5) National Early Warning Score ≥7 indicating critical illness. We performed automated and manual abstraction of demographic and clinical variables from the EHR. We conducted a qualitative content analysis of emergency medical services (EMS) treatment narratives for patients with dementia, abstracting the number of cases in which there was documentation of: (1) the patient’s history of dementia, (2) presence of a surrogate decision‐maker, and (3) discussion of advance directives. Results In a preliminary sample of 81 patients, the mean age was 80 years (SD 12) and 42% were female. About half (48%) were residing in a nursing home and 73% had clinical markers of advanced dementia. The mean Glasgow Coma Score at time of EMS assessment was 11 (SD 3.9). The most common documented reasons for EMS activation were respiratory complaints (30%), altered mentation (20%), and suspected sepsis (19%). Awareness of patients’ history of dementia was documented in about a third (31%) of cases, the presence of a surrogate decision‐maker in 21% of cases, and assessment of whether the patient had an advance directive in 22% of cases. Conclusion Content analysis of EMS treatment narratives for critically ill patients with dementia suggests challenges faced by paramedics in eliciting patients’ treatment preferences, including having limited access to a surrogate decision‐maker with knowledge of the patient’s medical history, values and goals, and existing advance directives. Future work should elicit paramedic perspectives on challenges faced in providing goal‐concordant care for this patient population.

Temporal Trends in Hospital Readmissions Among Patients With Chronic Illness After Hospitalization for Acute Respiratory Failure

2024-04-30