An Integrated Approach to Critically Ill Cardiac Patients: Environmental Risk Factors, Prognostication, and Long-Term Outcomes with Device-Based Follow-Up
Nagy Bettina
Cardiovascular Medicine and Research Division
Dr. Merkely Béla
SE Városmajori Klinikák Tanterme
2026-07-29 14:00:00
Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases
Dr. Merkely Béla
Dr. Zima Endre István
Dr. Kolossváry Endre
Dr. Ujvárosy Dóra
Dr. Járai Zoltán
Dr. Szilveszter Bálint
Dr. Kolossváry Márton József
The dissertation investigates multiple clinically related aspects of sudden cardiac arrest and advanced cardiovascular care. The first two studies focus specifically on population-level vulnerability to out-of-hospital cardiac arrest and early post-resuscitation intensive care management, while the third study addresses long-term follow-up and remote monitoring in a broader high-risk heart failure population treated with cardiac implantable electronic devices. Together, these studies provide a comprehensive perspective on factors influencing outcomes in critically ill cardiovascular patients.
The population-based analysis demonstrated that both extreme heat and extreme cold are associated with an increased incidence of out-of-hospital cardiac arrest in the Hungarian population. The temporal patterns of these associations differed, with heat-related effects appearing shortly after exposure and cold-related effects showing a more delayed and prolonged course. These findings support the concept that temperature-related risk is heterogeneous and context dependent, and they add region-specific evidence from a continental climate setting to the existing literature.
In the acute post-resuscitation phase, the RAPID score was developed and internally validated as an early risk stratification tool for patients treated with targeted temperature management after cardiac arrest. The model relies on routinely available clinical parameters obtained during the first hours of intensive care and demonstrated good discriminatory performance. The results suggest that early, post-cardiac arrest-specific risk assessment based on simple clinical variables is feasible and may complement clinical judgment during the initial phase of intensive care.
The third study focused on long-term follow-up and remote monitoring in patients with chronic heart failure and implantable cardiac devices. During a period of restricted access to in-person care, remote monitoring allowed continuity of follow-up without deterioration in device-derived heart failure parameters or patient-reported symptoms. These findings indicate that telecardiology can provide a reliable adjunct to conventional outpatient care and may help maintain clinical stability in high-risk patients under constrained healthcare conditions.
