bluuebunny/crossref_metadata_2025 huggingface dataset:
Polypharmacy in older adults after transcatheter or surgical aortic valve replacement
Authors: Rodighiero J , McDonald E G , Lee T C , Piazza N , Martucci G , Langlois Y , Morin J F , Bendayan M , Piancova P , Lantagne S , Ouimet M C , Mantzanis H , Afilalo J
Published: October 2021

Background

Polypharmacy is associated with higher rates of adverse drug events and unplanned hospital visits in medical patients. Little is known about polypharmacy in frail older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement.

Purpose

To determine the prevalence and prognostic implications of polypharmacy and potentially inappropriate medications (PIM) following TAVR or SAVR.

Methods

A post hoc analysis of the McGill Frailty Registry was conducted. Patients 70 years of age or older who were discharged alive after TAVR or SAVR at two university hospitals were included. Discharge prescriptions were codified and analyzed using the MedSafer electronic tool that has been validated to flag drug interactions and PIMs considering patient-specific comorbidities. Associations with the primary outcome of 30-day all-cause readmission were examined by logistic regression after adjusting for age, sex, Charlson Comorbidity Index, and procedure type.

Results

The cohort consisted of 495 patients (52% TAVR, 21% isolated SAVR, 27% combined SAVR). The mean age was 80.1±5.5 years with 52% females. The mean number of medications was 10.2±3.7 with 90% having 5 or more medications. A total of 55 patients were readmitted within 30 days. While the total number of medications was not predictive, three specific PIMs were found to be harmful and one PIM was found to be protective for readmission: clopidogrel with warfarin or heparin (OR 3.99; 95% CI 1.47, 10.82), diltiazem with heart failure (OR 3.16; 95% CI 1.04, 36.41), doxazosin or terazosin with hypertension (OR 6.21; 95% CI 0.99, 38.88), and any proton pump inhibitor (OR 0.47; 95% CI 0.26, 0.86). Of note, the combination of clopidogrel with direct oral anticoagulants was not found to be harmful for readmission.

Conclusion

The prevalence of polypharmacy is elevated in older patients undergoing TAVR or SAVR. Specific PIMs, but not total number of medications prescribed, were found to be associated with potentially preventable readmissions.

Funding Acknowledgement

Type of funding sources: None.
Thrombotic and hemorrhagic complications during pregnancy, delivery and the postpartum period in females with prosthetic heart valves
Authors: Sefieva G G , Shadrina U M , Karelkina E V , Li O A , Bautin A E , Yakubov A V , Moiseeva O M , Vavilova T V , Irtyuga O B
Published: October 2021

Background/Introduction

Women with mechanical prosthetic heart valves are at greatest risk of developing complications.The main reason is that mechanical prosthetic heart valves require lifelong anticoagulation to reduce the high risk of associated thrombotic and hemorrhagic complications.

Purpose

The main goal of this study was to estimated risk factors and frequency of thrombotic and hemorrhagic complications during pregnancy, delivery and the postpartum period in women with prosthetic heart valves

Methods

According to retrospective cohort analyses in this study were included 70 patients with prosthetic heart valves who delivered in a specialized perinatal center from October 2010 to February 2020. All the patients were divided into two groups depending on prosthesis type: mechanical prostheses (44 deliveries in 44 patients), biological prostheses (22 deliveries in 19 patients). All patients were performed ECHO (Vivid 7, GE, USA). The average age were 30.7±5.2 years. The N-terminal brain natriuretic propeptide (NT-proBNP) concentration was determined by the quantitative electrochemiluminescence method using a Cobas E 411 analyzer (Roche, Switzerland). The activity of the anti –Xa factor was measured by chromogenic assays.

Results

In 9 (21.4%) pregnants with a mechanical valve prosthesis (MVP), prosthetic thrombosis was recorded until 2016. In 1 patient with mechanical valve prosthesis (2%) during pregnancy was complicated by an acute cerebral circulation disorder. Since 2016 there were monitored the activity of the anti –Xa factor. In 7 patients on the background of a change in anticoagulant therapy, pregnancy stopped in the early stages. Before pregnancy, 31.4% of the patients didn't have heart failure clinical manifestations, but in 12 (17.1%) patients during pregnancy had increase in NYHA Class maximum to NYHA Class III.

The average NT-proBNP concentration was 912.3±1586.6 pg / ml. The frequency of the cesarean section in both groups was high: in patients with mechanical valve prosthesis in 78.5% and in the group of patients with biological valve prostheses in 68.1% of cases. There were not registered any new cases of prosthetic thrombosis after delivery, however, 9 patients had hemorrhagic complications in the early postpartum period, which required relaparotomy and blood transfusions. Regardless of frequent complications during pregnancy and in the postpartum period, no fatal outcomes have been reported.

Conclusion

The absence of mortality over the 9-years old observation and delivery in patients with valvular prostheses demonstrates the feasibility of monitoring and delivery of this category of patients in a specialized multidisciplinary medical center with experience in managing patients during pregnancy with valvular prostheses on anticoagulant therapy.

Funding Acknowledgement

Type of funding sources: None.
Long-term prognostic impact of renin-angiotensin system blockade in tako-tsubo syndrome
Authors: Cespon Fernandez M , Nunez Gil I , Jamhour K , Abu-Assi E , Aritza Conty D , Vedia O , Almendro Delia M , Sionis A , Martin Garcia A C , Corbi Pascual M , Martinez Selles M , Uribarri A , Guillen M , Garcia Acuna J M , Raposeiras Roubin S ,   RETAKO investigators
Published: October 2021

Introduction

Medical therapy in TakoTsubo Syndrome (TTS) remains mainly empirical, given the lack of randomized studies evaluating different pharmacological strategies.

The prognostic benefit of angiotensin-converting-enzyme inhibitors and angiotensin II receptor blocker (ACEI/ARB) is not well established. The clinical data published so far are often based on small sample registries and offer opposite results, both in terms of survival and TTS recurrence.

Expert recommendations seem favorable to the prescription of ACEI and ARB. Nevertheless, clinical investigation is encouraged for validating the observed results.

Purpose

The aim of our study was to evaluate the long-term prognostic impact of renin-angiotesin blockers (ACEI or ARB) in terms of mortality and TTS recurrence.

Methods

The data analyzed in this study were obtained from the nationwide registry “RETAKO”. It included TTS post-discharge survivors, between January 1, 2003, and July 31, 2018. A total of 1062 patients were included for analysis. Cox regression analysis and inverse probability weighting (IPW) propensity score analysis were performed to asses the prognostic benefit of ACEI/ARB. Primary endpoint was a composite outcome of all-cause mortality and TTS recurrence.

Results

A total of 1062 TTS patients were included. ACEI or ARB were used in 639 patients (60.2%). During a mean follow-up of 2.7±3.5 years, there were 101 deaths (3.9 per 100 patients/year) and 34 recurrences of TTS (1.3 per 100 patients/year). We found no significant difference in follow-up mortality or TTS recurrence in unadjusted and adjusted Cox regression analysis (Hazard Ratio [HR] 0.69, 95% Confidence Interval [CI] 0.47–1.02) between patients treated and untreated with ACEI/ARB. After performing propensity score matching, differences in long term prognosis (all-cause mortality or recurrence) remained no statistically significant (HR 0.73, 95% CI 0.45–1.18).

Conclusions

In this observational study, we found that ACEI and ARB therapy was not significantly associated with improved long term survival free of recurrence in post-discharged TTS patients.

Funding Acknowledgement

Type of funding sources: None. Incidence of primary endpoint
Dabigatran as first-line treatment for heparin-induced thrombocytopenia in the intensive cardiac care setting
Authors: Szyda Ł.S , Klosinska M K , Poninska N P , Mrozowska-Peruga E M P , Kasprzak J D K
Published: October 2021

Introduction

Heparin-induced thrombocytopenia (HIT) is a rare immune-mediated disorder related to the use of unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) which is associated with increased risk of vascular thrombosis. HIT constitute a relevant and not so uncommon clinical issue in the intensive cardiac care unit setting. Parenteral non-heparin anticoagulants are recommended for the treatment of HIT. The efficacy of dabigatran, direct oral anticoagulant, is poorly documented in this indication. In laboratory-confirmed HIT only few cases with short-term use and early conversion to and from another anticoagulant were reported.

Purpose

The purpose of our study was to evaluate the efficacy and safety of dabigatran as a first-line and the only one anticoagulant used in the treatment of HIT.

Methods

We prospectively enrolled 5 patients with the diagnosis of HIT who were hospitalized in our intensive cardiac care unit in 2017–2021. Heparin was stopped immediately on the suspicion of HIT and off-label dabigatran therapy was initiated the same day. There were no conversion to another non-heparin anticoagulant – dabigatran was used continuously from suspicion of HIT for at least 3 months. In all patients we used latex immunoassay to confirm the diagnosis of HIT. Lower-extremity compression ultrasonography was performed to exclude thrombosis. We distinguished HIT with thrombosis (HITT) and isolated HIT (HIT without thrombosis). The minimal follow-up period on dabigatran treatment was 3 months and the maximal 4 years.

Results

All the patients were male with the median age of 73 years (interquartile range, 52–78 years) and all were exposed to both, UFH and LMWH. The median platelet (PLT) count before exposition to heparin was 182000/μl (interquartile range, 171000/μl–321000/μl). Platelet count fall >50% was observed after a median time of 9 days (interquartile range, 7–11 days) after exposition to heparin and a median PLT count nadir was 87000 μl/l (interquartile range, 25000/μl–103000/μl). Two patients had intermediate and three high probability of HIT. HITT was diagnosed in one patient. The manifestation of HITT was upper-extremity arterial thrombosis and pulmonary embolism. Four patients were diagnosed with isolated HIT. PLT count recovery >15ehab724.2982/μl was observed after a median time of 3 days on dabigatran treatment (interquartile range, 2–7 days). In the patient with HITT, a complete resolution of upper-limb arterial thrombosis was observed. At the minimal observation period end point (3 months) all the patients survived without bleeding or new thrombotic event. Moreover, neither bleeding nor recurrence of HIT occurred during the total follow-up period.

Conclusion

Dabigatran is safe and efficient as first-line treatment for HIT and can be used as the only one anticoagulant in this challenging, clinical scenario.

Funding Acknowledgement

Type of funding sources: None.
Prediction of acute myocardial infarction or death in acute chest pain patients with machine learning models or first troponin T alone
Authors: Olsson De Capretz P , Bjorkelund A , Mokhtari A , Bjork J , Ohlsson M , Ekelund U ,   AIR Lund chest pain
Published: October 2021

Background

Machine learning approaches are increasingly being explored for use in healthcare systems, but there is a trade-off between increased accuracy and decreased explainability with more complex models. We aimed to evaluate the diagnostic performance for acute myocardial infarction (AMI) or death within 30 days of index visit. Machine learning models were trained using demographic factors, ECG and blood markers, and to compare them to a single high sensitivity TnT (hs-cTnT) value.

Methods

Using records from 9519 ED patients from two hospitals in Skåne, Sweden, we created machine learning models based on both logistic regression and artificial neural networks. Inputs in the models varied and included sex and age, first hs-cTnT value at the ED, glucose, creatinine, hemoglobin, and ECG signal data. The models were adapted to meet the following criteria for safe rule-out of 30-day myocardial infarction or death: Negative predictive value (NPV) >99.5% and sensitivity >99%. For rule-in of myocardial infarction or death, a positive predictive value (PPV) of >70% was set. The models were then compared to the performance of a first hs-cTnT <5 ng/L for rule-out, and >51 ng/L for rule-in. The patient population was split by arrival date and models were trained on the initial 50% of patients. Thresholds were selected from the subsequent 25%, and tests were performed on the final 25% (2379 patients).

Results

The best model, a convolutional neural network, identified 1309 (55%) patients for rule-out and 125 (5.3%) for rule-in, with the required NPV, sensitivity and PPV. In comparison, a single hs-cTnT value identified 1123 (47.2%) patients for rule-out and 158 (6.6%) for rule-in, but failed to reach the required sensitivity and PPV levels.

Conclusions

These results indicate that more complex models are able to safely identify a large proportion of patients for early rule-out or rule-in without the need for serial troponin tests. In future studies attempts should be made to improve the explainability of these models.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): VR; grant no. 2019-00198
Is virtual cardiology training here to stay in the post-COVID era?
Authors: Luther V , Kailey B , Dev D S
Published: October 2021

Background

In April 2020, face-face UK cardiology training was paused due to COVID-19. We adapted by utilising a video-conferencing platform to continue some form of education on a national scale (CardioWebinar). We studied the effectiveness of delivering virtual Cardiology education 1 year into the COVID pandemic.

Methods

Expert speakers throughout the UK were sought after via social media and “word of mouth”. Weekly webinars were organised and advertised (Canva posters) on social media (Twitter), as well as via the British Cardiovascular Society and British Junior Cardiologists' Association (BJCA) media links. Each webinar was scheduled mid-week at 17:30 (UK). Interested attendees registered for free using an online ticketing platform (Eventbrite). Webinars were delivered using an online video conferencing platform (Zoom) which required a £14.99 monthly subscription. Each webinar consisted of a 40-minute presentation followed by Q&A (20mins). All webinars were recorded and later accessible for free on the BJCA TV Gallery. A Learning Management System (LMS) collected feedback after each session and generated certificates of attendance.

We systematically reviewed the LMS feedback from 6 consecutive webinars delivered between Jan-Feb 2021. We further surveyed our most recent (March 2021) attendees via an extended questionnaire exploring their experiences of our virtual education.

Results

55 CardioWebinars have been delivered since April 2020. The speakers have been predominantly Consultant Cardiologists from the UK. Some of the recordings have had >1000 views. Other than the video platform subscription, no cost was incurred in the delivery of this entire programme.

We collected feedback from 392 respondents (∼65 live attendees per webinar) from each session between Jan-Feb 2021. The sessions were rated as “very good-excellent” by 97%. We collected a further 145 extended responses from March 2021 attendees. 90% rated the whole series as “very good –excellent” in supporting their cardiology education during the Covid pandemic, and 84% felt the programme sufficiently covered even the more challenging areas of the curriculum (e.g. aortopathies). 90% of the respondents felt that their work-life schedule allowed them to join the live webinars. The respondents where predominantly from the UK (91%), though included an international audience (9%). Whilst 74% of attendees were cardiology trainees, the remaining 26% included physiologists, nurses, consultants and other junior doctors. 99% felt that virtual education should continue to play a formal part in their training after the COVID pandemic.

Conclusion

Webinars allow everyone interested in cardiac care across the world the opportunity to hear experts teach, and without a travel cost. They are cheap and easy to organise. This study suggests that webinars will remain an integral part of the post-COVID era.

Funding Acknowledgement

Type of funding sources: None.
A new clinical decision support tool based on personalized evidence-based medicine improves outcomes of anticoagulation therapy in patients with atrial fibrillation: an analysis from the AF registry
Authors: Pokushalov E , Losik D , Kozlova S , Konradi A , Sekacheva M , Ponomarenko A , Krivosheev Y , Mikheenko I , Kretov E , Steinberg J S
Published: October 2021

Background

New clinical decision support system (CDSS) MedicBK use algorithms for presents treatment suggestions in frame of guideline-based therapy and personalized evidence-based medicine (EBM) therapy.

Objective

We hypothesized that clinicians with access to CDSS (MedicBK) would provide more personalized EBM anticoagulation treatment and improve outcomes.

Methods

2683 patients at high risk for stroke and 1-year follow-up were enrolled in study and analyzed by CDSS and core laboratory. The primary endpoint was the quantify the performance of the CDSS (MedicBK) algorithm. Secondary endpoints include the following: outcomes for all-cause mortality, thromboembolism (TE), bleeding, and the composite endpoints.

Results

From 2683 patients, 1971 patients were core laboratory-classified as guideline adherent and 824 of them were personalized evidence-based therapy adherent. All 1971 (100%) patients were also detected as guideline adherent by CDSS, whereas only 748 (90.8%) were classified as personalized EBM adherent. The sensitivity for identifying patients with guideline and personalized EBM therapy adherence is therefore 100% and 90.8%. 712 and 1935 patients classified as guideline and personalized EBM therapy non-adherent by the core laboratory. All of them CDSS confirmed the absence of adherence, resulting in a specificity of 100%. The PPV and NPV of detecting with or without adherence to guideline, respectively, are 100% (1971 of 1971 pts) and 100% (712 of 712 pts). The PPV and NPV of detecting personalized EBM therapy adherence or non-adherence, respectively, are 100% (748 of 748 pts) and 96.1% (1859 of 1935 pts).

The composite endpoint of cardiovascular death, any thromboembolism (TE) or bleeding was significantly lower in personalized EBM adherent patients during 1-year follow-up (P=0.02) and increased risk by >40% [HR 1.454 (95% CI 1.037; 2.040)], and non-guideline adherent and non-personalized EBM adherent treatment by >110% [HR 2.113 (95% CI 1.453; 3.074)].

Conclusion

MedicBK appears to be promising to improve adherence to guideline and personalized EBM therapy in general practice. Personalized EBM anticoagulation management is associated with significantly better outcomes.

Funding Acknowledgement

Type of funding sources: None.
Assessment of cognitive dysfunction using the Montreal Cognitive Assessment test: rate, severity and comparison with the Clock test alone in a population of patients referred for TAVI
Authors: Monnin C , Besutti M , Ecarnot F , Guillon B , Chatot M , Chopard R , Yahia M , Meneveau N , Schiele F
Published: October 2021

Background

Although not recommended in routine practice, the detection and quantification of Cognitive Dysfunction (CD) in older patients might have an impact on clinical decisions. We assessed the rate and severity of CD in an unselected population of patients referred for Transcatheter Aortic Valve Implantation (TAVI) using the Montreal Cognitive Assessment (MoCA) and using the Clock Drawing Test (ClockT) alone.

Methods

The MoCA was performed before TAVI by an experienced operator. The ClockT was scored out of 10 points according to the Rouleau rating scale. CD was defined according to the MoCA score: No CD if score ≥26, mild CD if score 18–25, moderate if 10–17 and severe if <10. Inter-observer reliability of scoring on the ClockT was estimated with the Bland-Altman method. Agreement between MoCA scores and the ClockT for ruling out and for detecting CD were measured with the Kappa coefficient.

Results

MoCA was performed in 83 consecutive patients referred for TAVI, median age 85 years. The mean time required for assessment was 11±2 min for the MoCA and 3±2 min for the ClockT. The mean MoCA score was 21±4.5: CD was excluded in 17 (20%) pts, mild CD was found in 50 (60%), moderate in 15 (18%) and severe in one (1%). The median ClockT score was 8 (interquartile 6; 9), with excellent inter-observer concordance (Kappa= 0.84). Overall, 51% of the variance of the MoCA score was explained by the ClockT alone according to multiple regression. A ClockT <7 detected a group with significantly lower MoCA score, compared to pts with higher ClockT scores (figure).

Conclusion

Among patients referred for TAVI, CD can be excluded using the MoCA test in 20%, while moderate or severe CD is observed in 18%. The ClockT alone is faster to implement, reliable to interpret and enabled detection of patients with moderate CD when Rouleau scoring was <7.

Funding Acknowledgement

Type of funding sources: None.
Continuous monitoring of advanced hemodynamic parameters shows early cardiovascular changes in a cohort of 492 COVID-19 hospitalized patients
Authors: Nachman D , Eisenkraft A , Maor Y , Constantini K , Goldstein G , Levy R , Halberthal M , Horowitz N A , Golan R , Rosenberg E , Lavon E , Cohen O , Shapira G , Shomron N , Gepner Y
Published: October 2021

Background

COVID-19 exerts deleterious cardiopulmonary effects, leading to worse prognosis in the most effected.

Purpose

The aim of this retrospective multi-center observational cohort study was to analyze the trajectories of key advanced hemodynamic parameters amongst hospitalized COVID-19 patients according to different risk populations using a chest-patch wearable providing continuous remote patient monitoring.

Methods

The study was conducted in five COVID-19 isolation units. Patients admitted to the units were connected to a photoplethysmography based noninvasive remote advanced hemodynamic monitor after completing a basic risk factor survey. Physiological parameters were measured every 15 minutes during the hospitalization, including cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), heart rate, blood pressure (BP), respiratory rate, blood oxygen saturation (SpO2), and body temperature.

Results

492 COVID-19 patients (179 females, average age 58.7 years) were included in the final analysis, with more than 3 million measurements collected during an average of 75.3 hours. Overall, within the first five days of hospitalizations we found a significant increase in SVR, and a significant decrease in SpO2, DBP, CO and CI (p<0.01 for all). The changes were more prominent in high risk populations- males, older age and obesity and had a temporal correspondence to changes in respiratory parameters.

Conclusions

This is the first comprehensive continuous advanced hemodynamic profiling of COVID-19 patients. Worse hemodynamic status was prominent in high risk populations.

Funding Acknowledgement

Type of funding sources: None.
Is natural patient preconsultation data medically relevant for outpatient and primary care in cardiology?
Authors: Martins J , Couvert I , Ielissof C , Tettoni C , Boiron F , Ah-Leung T , Akkouche L , Mann H , Jamal F
Published: October 2021

Digital cardiology may improve the organization and efficiency of outpatient care. The patient direct contribution to medical data is an important cornerstone to save medical time, shorten the decision-making process and improve prevention. However, the medical impact of potential errors in this natural data is unclear.

Purpose

We aimed to evaluate and quantitate the errors and differences between data completed by patient and trained medical teams using a preconsultation medical form in cardiology.

Methods

476 consecutive patients scheduled for an outpatient cardiology consultation (January 2020) were included in the study in one medical center (among a database of more than 13000 patients). All patients had access to a secure digital platform and were encouraged to fill a preconsultation form (risk factors, symptoms and prior medical results). This data was completed and corrected, if necessary, during the medical consultation by a trained outpatient care team and compared to the information provided by patients. An error was defined as either a missing or a wrong value, and a percentage was calculated for each parameter.

Results

387 patients (83%) were included in the analysis (72 did not fill the preconsultation form, 8 did not show up for the appointment). The filling rate averaged 83.6±12%. The global error % averaged 16.5±5% (13.4% missing values). The following parameters had an error % of more than 10%: results of prior cardiac tests (echocardiography 43%, exercise test 25%, arterial Doppler 24%), history of renal failure (32%), Blood pressure value (23%), cholesterol level (20%), family cardiac history (15%), personal cardiac history (12%), history of diabetes (11%). All other parameters had an error % of less than 5% (symptoms, smoking, alcohol consumption, BMI). Despite these significant missing or erroneous data, the availability of this information allowed significant improvement of the care path and more than 80% of patients reported improved commitment and understanding of medical decisions.

Conclusion

Actively including patient in the medical care process is an important issue and is made easy using e-cardiology tools. The results of this study should be considered when building digital medical platforms. Some of the parameters with important errors should be verified from multiple sources before using them in the future decision-making algorithms.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): izyCardio digital e-cardiology companyCardioParc medical centers
Atrial fibrillation screening: feasible approaches and implementation challenges across Europe
Authors: Engler D , Hanson C , Desteghe L , Boriani G , Diederichsen S Z , Freedman B , Pala E , Potpara T , Witt H , Heidbuchel H , Neubeck L , Schnabel R B ,   AFFECT-EU
Published: October 2021

Background

Atrial fibrillation (AF) screening has the potential to increase early detection and possibly reduce complications of AF. Guidelines recommend screening, but the most appropriate approaches are unknown.

Purpose

We aimed to explore the views of stakeholders across Europe about the opportunities and challenges of implementing four different AF screening scenarios.

Method

This qualitative study included 21 semi-structured interviews with healthcare professionals and regulators potentially involved in AF screening implementation in nine European countries. Data were analysed using thematic analysis.

Results

Three themes evolved. 1) Current approaches to screening: there are no national AF screening programmes, with most AF detected in symptomatic patients. Patient-led screening exists via personal devices, creating screening inequity by the reach of screening programmes being limited to those who access healthcare services. 2) Feasibility of screening approaches: single time point opportunistic screening in primary care using single lead ECG devices was considered the most feasible approach and AF screening may be possible in previously unexplored settings such as dentists and podiatrists. Software algorithms may aid identification of patients suitable for screening and telehealth services have the potential to support diagnosis. However, there is a need for advocacy to encourage the use of telehealth to aid AF diagnosis, and training for screening familiarisation and troubleshooting.

3) Implementation requirements: sufficient evidence of benefit is required. National rather than pan-European screening processes must be developed due to different payment mechanisms and health service regulations.

There is concern that the rapid spread of wearable devices for heart rate monitoring may increase workload due to false positives in low risk populations for AF. Data security and inclusivity for those without access to primary care or personal devices must be addressed.

Conclusions

There is an overall awareness of AF screening. Opportunistic screening appears to be most feasible across Europe. Challenges that need to be addressed concern health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit, and a tailored approach adapted to national realities.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020 Screening ScenariosGraphical abstract
Fast track triage for COVID-19 based on a population study: the SODA score
Authors: Lopez-Pais J , Lopez-Otero D , Gonzalez Ferrero T , Cacho Antonio C , Antunez Muinos P , Perez-Poza M , Jimenez Ramos V , Sestayo Fernandez M , Bastos Fernandez M , Sanmartin Pena X , Varela Roman A , Portela Romero M , Lopez Lago A , Perez De Juan Romero M A , Gonzalez Juanatey J R ,   CARDIOVID
Published: October 2021

Background

Healthcare systems are under prominent stress due to the COVID-19 pandemic. A fast and simple triage is mandatory to screen patients who will benefit from early hospitalization, from those that can be managed as outpatients. There is a lack of all-comers scores, and no score has been proposed for western-world population.

Aims

To develop a fast-track risk score valid for every COVID-19 patient at diagnosis.

Methods

Single-center, retrospective study based on all the inhabitants of a healthcare area. Logistic regression was used to identify simple and wide-available risk factors for adverse events (death, intensive care admission, invasive mechanical ventilation, bleeding >BARC3, acute renal injury, respiratory insufficiency, myocardial infarction, acute heart failure, pulmonary emboli, or stroke).

Results

Of the total healthcare area population, 447.979 inhabitants, 965 patients (0.22%), were diagnosed with COVID-19. A total of 124 patients (12.85%) experienced adverse events. The novel SODA score (based on sex, peripheral O2 saturation, presence of diabetes, and age) demonstrated good accuracy for adverse events prediction (area under ROC curve 0.858, CI: 0.82–0.98). A cut-off value of <2 points identifies patients with low risk (positive predictive value [PPV] for absence of events: 98.9%) and a cut-off of >5 points, high-risk patients (PPV 58.8% for adverse events).

Conclusions

This quick and easy score allows fast-track triage at the moment of diagnosis for COVID-19 using four simple variables: age, sex, SpO2, and diabetes. SODA score could improve preventive measures taken at diagnosis in high-risk patients and also relieve resources by identifying very low-risk patients.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Receiver Operating Characteristic curve of SODA score to predict: A, adverse events (death, ICU admission, invasive mechanical ventilation, bleeding >BARC3, acute renal injury, respiratory insufficiency, myocardial infarction, acute heart failure, pulmonary emboli or stroke). Area under curve 0.858, CI: 0.82–0.98, p<0.001. B, mortality. Area under curve 0.89, CI: 0.58–0.94, p<0.001.Figure 2. Percentage of adverse events in each punctuation of the SODA score (green) and percentage of patients without adverse events (blue). Adverse events: death, ICU admission, invasive mechanical ventilation, bleeding >BARC3, acute renal injury, respiratory insufficiency, myocardial infarction, acute heart failure, pulmonary emboli, or stroke.
The McGill World Restart a Heart 2020 Campaign: a student-led, patient-engaged, large-scale online simulation program
Authors: Levett J Y , Allard S B , Chamass E , Chami S , Ehlebracht A , Elbaz S , Essebag A , Skiadopoulos C , Bhanji F ,   The McGill WRAH 2020 Campaign Committee
Published: October 2021

Background

Cardiac arrest is a leading cause of death, with the majority of cases occurring in homes or public places. Up to 55% are witnessed by family members, colleagues or friends, yet most victims don't receive cardiopulmonary resuscitation (CPR), which can triple the odds of survival. Mortality therefore remains high at over 90%. Enhancing bystander CPR skills is a crucial public health investment.

Objective

Engage the Canadian and global community in a thought-provoking and immersive experience to explore cardiac arrests, destigmatize bystander CPR, and enhance resuscitation knowledge and skills. Partner with patients, leverage innovative technologies, and social media, to develop a digital scalable simulation/educational exercise.

Methods

Interprofessional healthcare students from the Faculty coordinated a University World Restart a Heart (WRAH) 2020 Campaign as part of a global initiative. Amplified by social media influencers, the Campaign team produced a bilingual digital Campaign with succinct and high-impact videos including survivor and non-survivor family perspectives, digital live events, a patient education guide for families of cardiac arrest patients, and an open access eModule. Our Steering Committee comprised University leadership, intensive and emergency care physicians, a cardiac arrest survivor, and the communications team from the Faculty, Centre for Simulation and Interactive Learning, and University Health Centre.

Results

The Campaign garnered an international audience with over 74,636 impressions across social media platforms (Facebook, Instagram, and Twitter), 42,600 views of Campaign videos, and 1,500 views of hour-long webinars. Campaign ambassadors had a combined viewership of over 500,000 followers, and included astronaut physicians, Olympic athletes, adult and pediatric cardiac arrest survivors, and social media influencers. The Campaign launched an innovative bystander resuscitation eModule that delivers scalable screen-based simulation. The patient education guide, in collaboration with the University Health Centre's Patient Education Office, focuses on the chain of survival and expectations for acute management, hospitalization and recovery.

Conclusion

Tens of thousands of individuals reached through the University WRAH 2020 Campaign are now empowered to initiate CPR, which may help reduce the morbidity and mortality of cardiac arrests.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The McGill Fund.
A United States national analysis of basic demographics and commodities in sudden cardiac arrest
Authors: Ji S , Yepes I
Published: October 2021

Background

Cardiac arrest is a condition associated with high mortality rate and can cause significant social-economical burden in United States. Our study aim is to analyze the basic demographic of patients admitted for cardiac arrest and the incidence of complications following cardiac arrest.

Methods

Using the National Inpatient Sample from 2016–2018, we identified all the hospital admissions with a primary diagnosis code at discharge for cardiac arrest during the study period. We identified the basic characteristics including age, gender, race and admitting hospital status. The set primary outcome was inpatient mortality, length of stay (LOS) and total costs of admission. The secondary outcomes were the incidence of acute kidney injury, acute blood loss anemia, acute embolism and thrombosis of deep veins of lower extremity (DVT), pulmonary embolism, non-traumatic intracranial hemorrhage, and thromboembolic stroke. Multivariable logistic regression model analysis was performed to address potential confounders. The Charlson Comorbidity Index (CCI) was used to adjust for the severity of each patient's co-morbidities.

Results

A total of 44,655 patients was admitted for cardiac arrest during the study period. Mean age was 64 years; 56% were men; 63% were white, 20.7% were black, 9.2% were latino, 2.8% were Asian or pacific Islander. The total in-hospital mortality was 73.5%. The average length of stay was 4.2 days and the average total costs of admission was 83,516 dollars. Among the seven demographic characteristics: age, gender, race, hospital size, hospital region, hospital teaching status, insurance type; only hospital teaching status and hospital size were found to significantly impact the mortality. Acute kidney injury was the most common complication in post-cardiac arrest patient (42%), followed by acute blood loss anemia (3.6%), pulmonary embolism (2.3%) and DVT (2.1%). Thromboembolic stroke (0.2%) and non-traumatic intracranial hemorrhage (0.1%) are less common. During subgroup analysis, acute kidney injury was also found out to be a predictive factor of increased mortality (OR 1.64, p<0.001).

Conclusion

Cardiac arrest remains one of the conditions with highest mortality rate. In our study, age, gender or race dit not impact on the outcome of cardiac arrest. Among all the complications from cardiac arrest, acute kidney injury was the most common one and was associated with higher mortality rate.

Funding Acknowledgement

Type of funding sources: None.
Protocol design and preliminary evaluation of the REAL-Health Triple Aim, an open-cohort CVD-care optimisation initiative
Authors: Rison S C G , Dostal I , Ahmed Z , Raisi-Estabragh Z , Carvalho C , Lobo M , Patel R , Antoniou M , Boomla K , McManus R J , Robson J P
Published: October 2021

Introduction

Effective treatment of cardiovascular disease (CVD) in primary care could be improved. We aim to assess the efficacy of a scalable treatment optimisation programme in unselected community populations in South East England, with the triple aim of improved blood pressure control in people with hypertension, increased high-intensity statin use in people with CVD and reduced gastrointestinal bleeding in patients on antithrombotic medication.

Method

This observational study comprises an open cohort of approximately 200,000 adults at high cardiovascular risk registered with general practitioners in five South East England Clinical Commissioning Groups (CCGs). An intervention programme is planned in four of these CCGs with a further non-intervention CCG acting as a control group. The intervention will consist of: clinical guidelines and educational outreach; virtual patient-reviews software; peer-performance “dashboards” and, where available, financial incentives.

The study will examine 3 primary outcomes: 1. Diagnosed hypertension with a blood pressure <140/90mmHg; 2. Diagnosed CVD on a high-intensity statin; 3. A cardiovascular indication for antithrombotic therapy with one or more factors for increased risk of gastrointestinal bleeding (e.g. age ≥65) on gastroprotection. A further 17 secondary outcomes related to these three aims will be assessed.

Analysis

We will use an interrupted time series analysis over 18 months, representing the pre-implementation, implementation and the post-implementation phases with comparison to the control CCG and applicable national Quality and Outcomes Framework and national prescribing statistics (e.g. OpenPrescribing). Secondary outcomes include an equity impact analysis with results stratified by age, gender, ethnic group and index of deprivation.

Preliminary data

We present preliminary data on Key Performance Indicators (KPIs) collected from 191 GP practices including [percentage achievement on 01/09/2019, on 01/09/2020]: 1. Patients with hypertension and most recent blood pressure ≤140/90mmHg [68.7%, 60.6%]. 2. Patients eligible for treatment with a high-intensity statin on such treatment [53.8%, 55.8%]. 3. Patients on antithrombotics with ≥1 risk factors for gastrointestinal bleeding on gastroprotection [59.0%, 60.1%]. We also present our virtual patient-review software tool and outcome visualisation dashboard.

Conclusion

The REAL-Health Triple Aim initiative is a large-scale primary care cardiovascular risk reduction initiative which was launched almost contemporaneously with the United Kingdom's first SARS-CoV-2 related lockdown. Preliminary data justify the need for the Triple Aim initiative and give us an insight on the impact of the pandemic on its implementation.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Barts CharityBritish Heart Foundation
Increase of serum cyclophilin C levels in the follow-up of coronary artery disease: a biomarker and possible clinical predictor
Authors: Gonzalez Juanatey C , Bayon J , Ocaranza-Sanchez R , Santas-Alvarez M , Abellas-Sequeiros A , Alfonso A , Botana L
Published: October 2021

Background

Traditional cardiovascular risk factors and a large number of biomarkers are well known in their association with the diagnosis and prognosis of coronary artery disease (CAD). Cyclophilin C (CypC) is a subfamily of immunophilins that modulates macrophage activation and redox homeostasis.

Purpose

This study is aimed at investigating the changes in serum CypC levels and their relationship with cardiovascular events at 12 months of follow-up in CAD patients.

Methods

The study included a total of 125 subjects (40 patients with acute CAD, 40 patients with chronic CAD and 45 control volunteers). We analyzed plasma CypC levels from baseline to 6 and 12 months for a better understanding of its behaviour in atherosclerosis.

Results

Serum CypC levels were shown to be gradually increased in CAD patients [(30.63 pg/mL ± 3.77 at baseline, 38.70 pg/mL ± 6.41 at 6 months (p=0.25) and 47.27 pg/mL ± 5.65 at 12 months (p=0.007)]. In addition, serum CypC levels during the follow-up were a significant predictor of CAD (c- statistic 0.76 at 6 months and 0.89 at 12 months; p<0.001). Despite it, there was no significant association between CypC and cardiovascular events, but serum CypC levels tended to be higher in patients suffering cardiovascular events during the follow-up (29.02 pg/mL ± 6.39 vs 79.96 pg/mL ± 22.18; p=0.029). In this regard, plasma levels of hsCRP >2.3 mg/L plus NT-proBNP >300pg/mL together were significant predictors of cardiovascular events during the follow-up in CAD patients with CypC levels >17.5 pg/mL (p=0.048).

Conclusions

Taken together, our results suggest that serum CypC levels increase during the follow-up in CAD patients and could be a novel biomarker with a possible prognostic value in combination with hsCRP and NT-proBNP.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III. Spain
LncRNA Bigheart stimulates Regulator of calcineurin 1 (Rcan1) expression in an auto-amplification loop that stimulates calcineurin-NFAT signalling in heart failure
Authors: Mangraviti N , Ruhle F , Martens L , Kinet V , Hegenbarth J C , Seyer S , Olieslagers S , Stoll M , De Windt L J
Published: October 2021

Background

Cardiac hypertrophy precedes many heart diseases and understanding its molecular basis remains one of the greatest challenges in cardiovascular medicine. Recent studies highlighted the sporadic involvement of long noncoding RNAs (lncRNAs) in cardiac development and disease but our understanding of lncRNAs in heart failure is still limited.

Results

Expression profiling of lncRNAs in failing mouse hearts revealed dysregulation of “Bigheart”, a novel lncRNA that is evolutionary conserved. Bigheart overexpressed using a serotype 9 adeno-associated virus (AAV) in neonatal rat cardiomyocytes (NRCMs) induced spontaneous hypertrophy, while silencing this lncRNA with specific siRNAs blunted the hypertrophic response in agonist-stimulated cardiomyocytes. GapmeR-mediated silencing of Bigheart prevented transverse aortic constriction (TAC)-induced pathological cardiac remodeling in the mouse in vivo. Mechanistically, analysis of the Bigheart genomic locus revealed several binding sites for the transcription factor nuclear factor of activated T-cells (NFAT), a downstream transcription factor of the pro-hypertrophic calcineurin-NFAT signaling cascade. The sensitivity of Bigheart transcriptional induction for calcineurin-NFAT signalling was further demonstrated by luciferase assays using a Bigheart promoter-luciferase construct. Finally, RNA-sequencing of Gapmer-silenced mouse hearts and chromatin isolation by RNA purification (ChIRP) coupled to mass spectrometry (MS), revealed that Bigheart interacts with heterogeneous nuclear ribonucleoproteins (hnRNPs) and High Mobility Group Box 1 (HMGB1) acts in trans to stimulate the transcription of Regulator of calcineurin 1 (Rcan1), a facilitator of calcineurin-NFAT signaling.

Conclusions

These results indicate that lncRNA Bigheart constitutes a positive feedforward loop in hypertrophic signaling and a promising target to attenuate maladaptive cardiac hypertrophy

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Maastricht university
Smooth muscle cell specific ablation of CXCL12 downregulates endothelial CXCR7 leading to defective coronary arteries and cardiac hypertrophy
Authors: Messner M , Ghadge S K , Seiringer H , Maurer T , Staggl S , Zeller T , Mueller C , Wenninger W J , Geyer S H , Sopper S , Krogsdam A , Poelzl G , Bauer A , Zaruba M M
Published: October 2021

Aims

The chemokine CXCL12 plays a fundamental role in cardiovascular development, cell trafficking, and myocardial repair. Human genome-wide association studies even have identified novel loci downstream of the CXCL12 gene locus associated with coronary artery disease and myocardial infarction. Nevertheless, cell and tissue specific effects of CXCL12 are barely understood. Since we detected high expression of CXCL12 in smooth muscle (SM) cells, we generated a SM22-alpha-Cre driven mouse model to ablate CXCL12 (SM-CXCL12−/−).

Methods and results

SM-CXCL12−/− mice revealed high embryonic lethality (50%) with developmental defects, including aberrant topology of coronary arteries. Postnatally, SM-CXCL12−/− mice developed severe cardiac hypertrophy associated with fibrosis, apoptotic cell death, impaired heart function, and severe coronary vascular defects characterized by thinned and dilated arteries. Transcriptome analyses showed specific upregulation of pathways associated with hypertrophic cardiomyopathy, collagen protein network, heart-related proteoglycans, and downregulation of the M2 macrophage modulators. CXCL12 mutants showed endothelial downregulation of the CXCL12 co-receptor CXCR7. Treatment of SM-CXCL12−/− mice with the CXCR7 agonist TC14012 attenuated cardiac hypertrophy associated with increased pERK signaling.

Conclusion

Our data suggest a critical role of smooth muscle-specific CXCL12 in arterial development, vessel maturation, and cardiac hypertrophy. Pharmacological stimulation of CXCR7 might be a promising target to attenuate adverse hypertrophic remodeling.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FWF-Austria