A new study by heart researchers at Intermountain Health finds that Utahns with heart disease, specifically those with heart failure, are especially vulnerable to the impacts of air pollution and poor air quality caused by seasonal winter inversions and wildfire smoke and should take steps to protect themselves.  

In the study, researchers found that two inflammatory markers — CCL27 (C-C motif chemokine ligand 27) and IL-18 (interleukin 18) — were elevated in heart failure patients who were exposed to poor air quality, but did not change in those without heart disease. This indicates that such air pollution events put more strain on the bodies of patients who already have heart problems.

While previous research has shown that people with some chronic health conditions, like heart failure, coronary disease, asthma, and COPD, struggle during spikes in air pollution, the new Intermountain Health study demonstrates that cardiac inflammation levels specifically rise in people with heart disease during periods of poor air quality.  

“These biomarkers rose in response to air pollution in people who already had heart disease, but not in patients who were heart disease free, showing that heart failure patients are not as able to adapt to changes in the environment,” said Benjamin Horne, PhD, principal investigator of the study and professor of research at Intermountain Health. 

 For the retrospective study, Intermountain Health researchers worked with scientists at Stanford University and the Harvard School of Public Health to examine the blood of patients enrolled in the Intermountain INSPIRE registry, which collects blood and other biological samples, medical information and laboratory data from healthy individuals and those who have been diagnosed with a variety of medical conditions. 

 Researchers specifically looked at blood tests for 115 different proteins that are signs of increased inflammation in the body.

They then examined blood draws of 44 patients with heart failure with preserved ejection fraction, and 35 people without heart disease. Some blood was drawn on days with low air pollution, where ambient PM_2.5levels were under 7 micrograms per cubic meter (μg/m³) of air; those test results were compared to draws done in other people on days when air pollution spiked to PM_2.5 levels of 20 μg/m³ or over. 

These spikes were caused by either wildfire smoke in the summer, or during a winter inversion, where air pollution is trapped when warm air holds pollution closer to the ground.

Researchers found that two inflammatory markers — CCL27 and IL-18 — were elevated in heart failure patients, but did not change in those without heart disease, indicating that such air pollution events put more strain on the bodies of patients who already have heart problems.

These findings “give us some information about mechanisms in people with heart failure who are having inflammation and suggest they’re not as capable in responding to acute inflammation as people who are healthy,” said Dr. Horne. 

He added that the results from the study suggest that heart failure patients need to take extra precautions during times when air pollution is high.

“It’s important that individuals with known heart disease, including those diagnosed with heart failure, need to be especially cautious during periods of poor air quality. This includes exercising indoors, making sure to take their prescribed medications, and avoiding areas like roadways and highways where there’s a lot more traffic and pollution,” he said. 

 Results of the study were presented at the American Heart Association’s national Scientific Session international conference in Chicago. 

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Using an innovative risk score assessment score, heart researchers at Intermountain Health in Salt Lake City say they can accurately predict whether patients being assessed for kidney transplant will likely have a future major cardiac event, like a heart attack or stroke, according to a new study.

Intermountain Health clinicians regularly review patient data through their electronic health system to determine who may have heart disease without knowing it. Now, in a major new study, Intermountain heart researchers found that using their Intermountain Risk Score (IMRS) they could also accurately predict whether patients being assessed for kidney transplant would have a major cardiac event, like a heart attack or stroke.  

“This study demonstrates that we could adapt our already existing risk score guide to help identify which of these patients might also be at risk for having a heart event, which could lead to better and more personalized treatment,” said Benjamin Horne, PhD, director of cardiovascular and genetic epidemiology at the Intermountain Health.  

Findings from the new study will be presented at the American Heart Association Scientific Sessions in Chicago on Sunday, November 17, 2024.

The Intermountain Risk Score is a well-validated, sex-specific risk prediction tool that includes factors like age and results from complete blood count and basic metabolic profile testing to predict the risk of major cardiovascular events and death.

These scores are assessed automatically based on information input into electronic health records. If a patient has a high score, their care team is alerted. 

In the Intermountain study, researchers looked specifically at the accuracy of the IMRS for patients being considered for kidney transplant.

They identified patients who were assessed for transplant surgery at Intermountain Health between June 2015 and April 2024 and found 891 patients. 200 patients did not have all of the laboratory tests needed to calculate an IMRS, so they were excluded from the next step in the study.

That left 691 patients with enough information to retroactively calculate IMRS.

Intermountain researchers found that these patients were on average 55.9 years old, and 34.3% were women.

Of those 691 patients, 171 experienced a major cardiac event over a five-year follow-up period. Researchers found that IMRS was effective in predicting these outcomes, showing the potential use of calculating such a score in people being evaluated for kidney transplant.

The score can be “a really valuable piece of information, but some of these patients were missing lab tests that would have enabled us to calculate it,” said Dr. Horne, referring to the 200 people in this retrospective study who did not have enough laboratory tests to be included. 

“This is the first step in assessing if we can make a risk score specifically keyed to the risk of people who are going to have a rental transplant, and make sure we collected all the appropriate data so we can do so,” he said.

Next steps include validating the risk score in another patient population, determining whether modifying the risk score by adding data routinely collected in kidney patients improves its ability to assess risk for kidney transplant patients, and then conducting a prospective clinical trial of using the risk score in modifying clinical care processes to determine whether personalized care improves patient outcomes.

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Cuando se trata de un accidente cerebrovascular, cada segundo cuenta. Para los pacientes con accidentes cerebrovasculares isquémicos, recibir medicamentos lo antes posible para disolver los coágulos y restablecer el flujo sanguíneo al cerebro es fundamental porque cada minuto que pasa significa que más células cerebrales son privadas de oxígeno y posiblemente se pierdan.   

Si bien la práctica basada en evidencia a menudo se entiende claramente, la coordinación necesaria para mejorar la administración oportuna de los medicamentos para disolver coágulos presenta desafíos de implementación únicos para los sistemas de atención médica.

Ahora un nuevo estudio de investigadores de neurología y científicos de implementación de Intermountain Health demuestra que cuando se implementa un protocolo de accidentes cerebrovasculares en todo el sistema con un grado de adaptación local en un sistema de salud, el tiempo de tratamiento para los pacientes con accidentes cerebrovasculares en todos los hospitales afectados mejora significativamente, lo que les brinda a los pacientes una mayor posibilidad de supervivencia y recuperación. 

Para el estudio, los líderes de neurología de Intermountain trabajaron para ayudar a cada uno de los hospitales de Intermountain, rurales y urbanos, grandes y pequeños, a personalizar la implementación de protocolos para que se adapten al entorno único y la población de pacientes de ese hospital. 

Casi todos los hospitales participantes notaron una caída drástica en la brecha entre la llamada de ayuda de un paciente y la administración del medicamento para disolver coágulos, tPA. Varios hospitales mejoraron en más de 20 minutos, lo que se traduce en muchas células cerebrales salvadas.

Los hallazgos del nuevo estudio que examina la implementación en todo el sistema están publicados este mes en la revista Circulation: Cardiovascular Quality and Outcomes.

“Queremos proporcionar la misma atención de accidentes cerebrovasculares de alta calidad en todo nuestro sistema de atención médica, ya sea que acuda a nuestro hospital urbano insignia o a un hospital rural pequeño que tal vez solo atienda a pacientes que necesitan un medicamento tPA una o dos veces al año”, dijo Kathleen McKee, MD, coautora principal del estudio y directora médica adjunta de investigación de neurociencias en Intermountain Healthcare. “Esta investigación muestra que nos estamos acercando a esa realidad”. 

“La administración de atención de accidentes cerebrovasculares agudos es compleja en un departamento de emergencias. Esto puede presentar desafíos para los médicos clínicos que buscan brindar atención de alta calidad para cada paciente. En este estudio, descubrimos que definir principalmente ‘qué’ debía ocurrir en todos los departamentos de emergencias, y a la vez proporcionarle a cada sitio flexibilidad o adaptación a sus circunstancias locales condujo a una mejor atención en todos los sitios”, señaló Andrew Knighton, PhD, un científico de implementación y coautor principal del estudio.   

El estudio involucró a 21 departamentos de emergencias de Intermountain Health en Utah y Idaho, de los cuales cuatro eran centro especializados de accidentes cerebrovasculares. Para el estudio, cada hospital recibió estrategias de implementación de atención de accidentes cerebrovasculares agudos para proporcionar el medicamento tPA a los pacientes adecuados lo antes posible, ya que una investigación anterior demostró que el tPA administrado dentro de las seis horas de un accidente cerebrovascular aumenta significativamente las probabilidades de que alguien sobreviva a un accidente cerebrovascular y reduce las probabilidades de discapacidad. 

Cada hospital trabajó con un equipo central de Intermountain Health para proponer qué estrategias de implementación funcionarían mejor para el despliegue del protocolo dentro de su departamento de emergencias. Esto provocó que cada departamento de emergencias propusiera soluciones de implementación únicas adaptadas específicamente a sus necesidades y las de sus pacientes para la administración oportuna de tPA. 

En el estudio, los investigadores registraron la eficacia de la implementación del programa de atención de accidentes cerebrovasculares agudos desde enero de 2018 hasta febrero de 2020. Durante ese tiempo, los departamentos de emergencias de dichos hospitales tuvieron 855,474 encuentros con pacientes, con 5,325 activaciones de código de accidente cerebrovascular. De esos pacientes, 615 recibieron tPA en menos de tres horas de la aparición de los síntomas. 

El equipo de investigación midió los tiempos puerta-aguja, o el tiempo desde que un paciente llega al departamento de emergencias hasta que la aguja intravenosa administra tPA.   

El estudio demostró que el porcentaje de tiempos puerta-aguja por debajo de los 60 minutos aumentó del 72.5% al 86.1%. Los investigadores también hallaron la mayor mejora en los departamentos de emergencias de centros no especializados en accidentes cerebrovasculares rurales y fronterizos. 

“Esto sugiere que pueden existir diferencias contextuales adicionales entre los departamentos de emergencias de centros no especializados en accidentes cerebrovasculares que deben comprenderse mejor, tal vez impulsadas por las diferencias en los volúmenes de pacientes, el liderazgo y la toma de decisiones de los sitios, las dinámicas de los equipos y los recursos”, señaló Knighton.

En general, los investigadores de Intermountain indicaron que el estudio demuestra que se puede utilizar un enfoque centralizado pero personalizado a nivel local para mejorar la atención de accidentes cerebrovasculares agudos en departamentos de emergencias muy diversos. 

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Intermountain Health and Picterus AS, a Norwegian health technology company, have entered a partnership to study a new smartphone-based application that can estimate bilirubin levels in newborn babies using the smartphone’s camera. 

This new technology is exciting for health providers. More than 33,000 babies are born in Intermountain hospitals and tested for hyperbilirubinemia each year. Three of five newborns will experience jaundice, which is the yellowing of the skin because of increased bilirubin levels in the body. Left untreated, severe jaundice can cause brain damage or hearing loss. 

Intermountain Health tests every baby born in their facilities at least once for jaundice with many babies requiring repeat blood draws both while in the facility and once sent home. They will be testing the new app and technology to evaluate its accuracy in measuring bilirubin in babies, without having to draw blood with a prick, as is done now. 

Researchers say the goals of the study are to find inexpensive, bloodless, painless, way to measure bilirubin levels in babies. 

If proven accurate, this technology will eventually enable parents and families to manage hyperbilirubinemia at home. Medical providers will then be able to provide guidance for families without the cost and inconvenience of taking babies to the clinic and to the lab. 

The app and technology include a laminated calibration card that is placed on the chest of the baby. About six pictures are taken of the card and the baby, automatically loaded onto a server, evaluated, and then sent back to the phone with measurements. 

“This technology is exciting to us because it makes it possible to measure the bilirubin in a baby without taking blood. Right now, the only way to measure bilirubin levels in babies is to take them to a laboratory and draw blood,” said Tim Bahr, MD, an Intermountain Health neonatologist, who is leading the study. “By having this technology available on a smartphone, we will eventually empower parents to make these measurements without having to leave their homes with an easily accessible and affordable tool.” 

“We do know that parents are pretty good at taking pictures of their babies,” he added. 

Intermountain researchers will study the app on about 300 term babies at Intermountain Utah Valley Hospital in Provo, Intermountain McKay-Dee Hospital in Ogden, and Intermountain Medical Center in Murray. 

Babies in the study will have their bilirubin measured with the new technology, as well as regular measurements (blood draws). About 150 of these babies will have a second measurement within two to five days after discharge when jaundice typically peaks. Additionally, 100 babies born pre-term babies will also be measured with the new technology. 

“We are very excited see the potential impact our tool could have on infant care in the United States. We are looking forward to ongoing collaboration and further development.” said Tormod Thomsen, chief executive officer of Picterus AS. 

“Bilirubin and jaundice management has long been based in the hospital and the clinic,” said Dr. Bahr. “Taking a newborn to the clinic or laboratory for frequent blood tests in the first days of life can be a huge inconvenience and burden on families. We hope to simplify this care and move more of it into the home. This is a win for families and for our healthcare system.”  

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New smartphone-based application being studied that will estimate bilirubin levels in newborn babies using the smartphone’s camera.