bluuebunny/crossref_metadata_2025 huggingface dataset:
Delays in diagnosis and treatment initiation of ATTR cardiac amyloidosis: a real-world data analysis
Authors: Vogel J , Jura S , Buehing F , Wernhart S , Carpinteiro A , Rassaf T , Michel L
Published: October 2024

Introduction

Cardiac amyloidosis (CA) is a serious condition characterized by the accumulation of abnormal protein deposits in the heart muscle, leading to functional impairments and, ultimately, heart failure. Transthyretin amyloid cardiomyopathy (ATTR-CM) is the most common form encountered in CA diagnosis with previously underestimated prevalence. ATTR-CM poses a diagnostic challenge, with a substantial number of cases diagnosed late and at advanced stages. The availability of specific pharmacological treatment using the transthyretin-stabilizer tafamidis further emphasizes the need for timely diagnosis. Here, we aim to assess delays in diagnosis and initiation of therapy in a real-world collective of patients with ATTR-CM.

Methods

All individuals diagnosed from 01/2018 to 05/2023 with ATTR-CM at our university hospital, Germany, were systematically assessed for eligibility in this study. Specifically, we enrolled patients who were undergoing transthyretin stabilizer therapy. The investigation aimed to determine the duration, in days, from the initial suspicion of heart disease to the definitive diagnosis of ATTR-CM. It was also investigated whether the diagnosis of ATTR-CM was made more quickly over time as awareness increased. Additionally, the study assessed the time elapsed until patients received pharmacological therapy following the confirmed diagnosis. The study was approved by the local ethics committee (23-11500-BO).

Results

After screening of 194 consecutive patients, 154 were included in the analysis, while 40 patients were excluded due to insufficient records. The results of this study reveal that a median of 300 (113-962) days elapsed from the initial suspicion of amyloidosis to the final confirmation. Initial indications of CA often presented as nonspecific symptoms such as unclear dyspnea (16.2% n=25), abnormal echocardiography (75.3% n=116), or, in rare cases, incidental findings (8.4% n=13). Following the diagnosis, an additional median of 84 (46-163.5) days passed before the first prescription of a transthyretin stabilizer. To assess an improvement of ATTR-CM diagnosis over time, we stratified the data into tertiles by date of first diagnosis. The results showed a gradually decrease in medium time to diagnosis of 466 (181-1035) days in the earliest tertile (2018-2019) to 389 (141-1508) days in the most recent tertile (2022-2023) (p<0.001).

Conclusion

This study shows a major healthcare deficit and underscores the medical need for improved screening procedures and diagnostic modalities to expedite the timely diagnosis of CA, as early identification of the condition is crucial for enhancing the quality of life for patients and preventing life-threatening complications.
Prognostic impact of left atrial reverse remodeling in patients with ADHF-HFpEF regardless of atrial fibrillation -PURSUIT-HFpEF Registry-
Authors: Kondo T , Watanabe T , Yamada T , Seo M , Yano M , Hayashi T , Nakagawa A , Nakagawa Y , Yasumura Y , Sotomi Y , Hikoso S , Okada K , Nakatani D , Fukunami M , Sakata Y
Published: October 2024

Background

Left atrial (LA) dilatation is associated with increased mortality in patients with cardiovascular disease including heart failure (HF) and LA reverse remodeling (LARR) was reported to be associated with favorable outcomes in patients with HF. However, it remains to be clarified whether LARR could have prognostic value in patients with HF with preserved ejection fraction (HFpEF).

Purpose

The purpose of this study is to elucidate whether LARR is associated with clinical outcome in patients with HFpEF in relation to the presence of atrial fibrillation (AF).

Methods

We prospectively studied 492 patients with acute decompensated heart failure with preserved ejection fraction (ADHF-HFpEF) without the poor outcome during the first year postdischarge. Echocardiography was performed just before discharge and at 1 year after discharge. LARR was defined as the reduction of 15% or more in left atrial end-systolic volume (LAV). The primary outcome was rehospitalization for worsening heart failure.

Results

All study patients were divided into 2 groups according to the presence of AF at discharge (AF group, n=182 and non-AF group, n=310). During a mean follow-up period of 1.4±1.2 years, 78 patients were rehospitalized for worsening heart failure (37 patients in AF group and 41 in non-AF group). ΔLAV, the degree of reduction in LAV during the first year postdischarge, was significantly independently associated with primary outcome after multivariable adjustment both in AF group (p=0.033, HR 0.992 [0.984-0.999]) and non-AF group (p=0.021, HR 0.986 [0.974-0.998]). Kaplan-Meier analysis revealed that patients with LARR had significantly lower risk for primary outcome than those without LARR not only in the whole study patients (8% vs 20%, p=0.001) but also both in AF group (9% vs 24% p=0.013) and in non-AF group (8% vs 16% p=0.043). Among clinical characteristics during the index hospitalization, the presence of AF and prior HF hospitalization were significantly independently associated with LARR at multivariate Cox logistic regression analysis (p=0.006, OR 0.554 [0.364-0.843] and p=0.007, OR 0.491 [0.292-0.826], respectively).

Conclusion(s)

The left atrial reverse remodeling could have the prognostic impact in patients with ADHF-HFpEF regardless of the presence of atrial fibrillation.Kaplan-Meier curves in AF and non-AF
Gradual hypertensive response in aortic alterations and myocardial inflammatory activation in progressing HFpEF in mice
Authors: Torma D , Rinta-Harri M , Ruotsalainen A K , Yla-Herttuala S
Published: October 2024

Introduction

Hypertension is the most common comorbidity in patients affected by heart failure with preserved ejection fraction (HFpEF). Early effects of pressure overload and its contribution to the gradual development of cardiac and vascular pathology leading to HFpEF are not well recognized, as patients are diagnosed when the disease has already advanced and show symptoms. Several hypertensive HFpEF mouse models possessing the hallmarks of the clinical-like phenotype are available. Nonetheless, initial and gradual pathological manifestations of hypertensive HFpEF have not been comprehensively described.

Purpose

This study aimed to investigate the gradual progression of HFpEF phenotype development in mice from the early manifestation of cardiac and vascular pathology to global cardiac dysfunction to multiorgan syndrome in response to hypertension.

Methods

Hypertensive HFpEF was induced by angiotensin II infusion in C57BL/6JOlaHsd 18-20-week-old male mice that were given low, moderate and high doses (0.5mg/kg/day - 1.5 mg/kg/day) subcutaneously for 4 weeks. Cardiac physiology and alterations in haemodynamics were assessed with echocardiography of heart and aorta, weekly ECG monitoring, and blood pressure measurements from the mouse tail. Extensive histology and immunohistochemistry analyses of cardiac tissue, microvasculature, lungs and kidneys were performed.

Results

In the low dose group, loss of aortic wall flexibility and presence of aortic root dilatation were detected. This group also demonstrated initiation of concentric remodelling process with the upsurge in macrophage infiltration in myocardium, but the signs of diastolic dysfunction were not yet present. The high dose group exhibited characteristic HFpEF features with diastolic dysfunction, left ventricular hypertrophy and fibrosis. Pathology in cardiac conduction system was noticed in all groups, with prominent ECG waveform abnormalities already on week one. However, only the high dose group experienced non-recovery in impulse propagation, accompanied by significant prolongation of ventricular depolarization.

Conclusion

This study demonstrates that change in aortic root dimensions and aortic wall dynamics are the first hypertension-sensitive alterations together with myocardial inflammatory cell infiltration that may contribute to myocardial remodelling and subsequent development of HFpEF and systemic effects. Hypertensive angiotensin II-induced HFpEF is a relevant mouse model, recapitulating not only hallmarks of cardiac pathology but also an extensive range of vascular and multiorgan alterations, demonstrating similarities with the clinical phenotype.
Differences in the optimization of pharmacological treatment in patients with heart failure and reduced ejection fraction and advanced chronic kidney disease
Authors: Recio Mayoral A , Anguita Gamez M , Gonzalez Manzanares R , Muniz Garcia J , Elola Somoza F J , Bonilla Palomas J L , Cequier Fillat A , Romero Rodriguez N , Rodriguez Padial L , Anguita Sanchez M
Published: October 2024

Introduction

Chronic kidney disease is very prevalent in patients with HF, makes their treatment difficult and worsens their prognosis, especially when it is advanced CKD (glomerular filtration rate <30 mL/min/m2). Renal insufficiency increases the risk of drug intolerance and an increase in serious side effects, which can lead to underuse, with consequent negative effects on patient prognosis.

Purpose

To analyze in a contemporary registry of HF patients followed in specialized HF units in Spain the achievement of dose targets for the most used drugs in HF with reduced ejection fraction (HFrEF) and the impact of advanced CKD.

Methods

We analyzed 914 patients with HFrEF consecutively included between 2019 and 2021 in the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology in 45 centers. We evaluated the proportion of patients treated with ACEI, ARA, ARNI, MRA, beta-blockers and SGLT2 inhibitors at the registry inclusion visit, the causes of non-prescription, and the achievement of the maximum dose recommended in the ESC clinical practice guidelines or the maximum tolerated dose in these patients, comparing the GFR groups, greater or less than 30 ml/min/m2.

Results

Of the 914 patients, 8.9% had a GFR<30 mL/min/m2. Their age was 76.9±9.7 years, 39.7% women, mean LVEF 32.8±9-6%. Patients with GFR<30 received in a significantly lower proportion all HF drugs except diuretics, ARBs and potassium chelators: sacubitril-valsartan 30.5% vs 59.2%; MRAs 31.7 vs 77.8%; SGLT2 inhibitors 34.1 vs 52.9% (p<0.001; Figure 1). The main reason for non-use was intolerance/contraindication for beta-blockers and "other" for the rest of the drugs (Figure 1). The proportion of patients in whom the maximum recommended, or maximum tolerated dose was reached was low in both groups, less than 40-50% for all drugs except MRA. There were no significant differences between the two groups in relation to the degree of renal dysfunction, although there was a tendency for the recommended doses to be obtained more frequently in the group with lower GFR (Figure 2).

Conclusions

In our contemporary cohort of real-life patients with HFrEF and advanced CKD, the use of recommended drugs for HF was significantly lower than in those patients with better renal function. However, where they were used, maximum recommended or tolerated doses were achieved in a higher proportion of patients. This indicates that with adequate selection it is possible to achieve the objectives proposed by the clinical practice guidelines in this complex group of patients.
Survival benefit of guideline-directed medical therapy in elderly patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis
Authors: Tan E , Chan M W , Li F , Ho V W T , Lin W Q , Yeo T C , Chai P , Wong R , Kong W , Sia C H
Published: October 2024

Background

Heart failure is a major cause of mortality in the elderly and heart failure-related mortality in elderly patients has increased since 2012. The evidence of guideline-directed medical therapy (GDMT), the four pillars of treatment of heart failure with reduced ejection fraction (HFrEF), remains insufficient in this population.

Aim

The objective of this study was to assess the survival benefit of the four pillars of GDMT in elderly patients aged ≥ 65-years-old with HFrEF.

Methods

MEDLINE, EMBASE and the Cochrane Library were searched from inception to 21 July 2023. The inclusion criteria were studies comparing survival between patients ≥ 65-years-old with left ventricular systolic dysfunction receiving and not receiving GDMT. Pooled prevalence, hazard ratio (HR) and risk ratio (RR) were calculated with 95% confidence interval (CI). Heterogeneity was explored through subgroup analyses based on the number of GDMT, age cut-off, sample size, ejection fraction cut-off, study type and study publication date.

Results

Thirty studies with 86,941 patients from 1994 to 2019 were included. The GDMT group received three drug classes in three studies, two drug classes in four studies, and at least one class in the remaining studies. There were no reported studies on elderly patients receiving four classes of GDMT. Over 5% of the elderly HFrEF patients were frail (Pooled prevelance 7%, 95%CI 2.0–14.0, I2 98%). Frail elderly patients were less likely to receive GDMT (RR 0.63, 95%CI 0.45–0.89, I2 50%, p = 0.009). There was a survival benefit of GDMT in elderly patients with HFrEF (HR 0.70, 95%CI 0.65-0.76, I2 75%, p < 0.001). Elderly patients receiving BB were more likely to develop bradycardia (RR 3.96, 95%CI 2.71-5.80, p < 0.001, I2 0%). There was no difference in the incidence of hypotension, acute renal impairment, and hypoglycemia between the GDMT and control group. The funnel plot appeared asymmetrical which suggests possible publication bias.

Conclusion

The use of GDMT in elderly HFrEF patients was associated with a survival benefit. Frailty may interfere with the implementation of GDMT. High quality studies are needed to guide the safety and efficacy of GDMT, and the development of guidelines on HFrEF management the in elderly according to frailty status.Forrest plot of overall survival
The predisposing factors to heart failure diagnosis and early mortality among young adults in Africa: a narrative review
Authors: Mohammed F , Potter H
Published: October 2024

Introduction

Heart failure (HF) is a major health concern mainly diagnosed among elderly individuals. Primarily, researchers have focused on this age group, nevertheless, compared to individuals from other regions of the world, Africans presents with HF two decades sooner (52 versus 79 years). Even though it manifests early, young persons (18–35 years old) are also diagnosed with HF with prognoses comparable to the older group. Less is known about how much study is concentrated on this age range, although globally, young adults of African origin make up the majority of those with an early onset of heart failure. Additionally, obtaining information about how HF impacts African youth remains challenging.

Purpose

To determine the cause of Africans' early HF diagnosis as well as the risk factors for HF diagnosis and early mortality among young adults.

Methodology

Three electronic databases— MEDLINE Ovid, Scopus, and CINAHL Plus—were searched using the Boolean operators. The first retrieved hits were checked for relevancy by titles and abstracts. Then, publications were fully screened for inclusion in the review based on the pre-established criteria. Also, reference lists of the articles were snowballed for pertinent studies. The scientific integrity of the studies was evaluated using a guided, in-depth peer-reviewed article on how to critically analyse clinical research and the Critical Appraisal Skill Programme (CASP) tool cohort checklist. Pertinent information regarding the study was analysed using a narrative review methodology. Eleven (11) articles out of the 135 pulled from the databases met the requirements for inclusion in the review after a thorough screening. One article was eliminated upon critical evaluation of the research's methodology, and an eligible article was discovered from snowballing reference lists. Therefore, only 11 articles qualified for this review study.

Results

Findings from the review show that HF is diagnosed earlier among Africans due to the early presentation of the major causes of HF before the age of 30 years. Rheumatic heart disease, cardiomyopathy, ischemic heart disease, HTN, and pulmonary illnesses (COPD, TB, and pulmonary arterial hypertension) are known aetiologies. More so, young adults who are diabetic, obese, have hyperlipidaemia or smoke cigarettes are more likely to develop HF. Furthermore, socioeconomic status, alcohol use, smoking, renal dysfunction, higher serum levels of brain natriuretic peptide (BNP) and creatine kinase (Isomer MB), cardiogenic shock, and decreased ejection fraction were the predictors of death with significant p-values (0.05).

Conclusion

Although HF affects young African adults disproportionately causing them to live lower quality of life and shorter lives, no research before this has been conducted. Therefore, further study is required to understand how HF affects this target age range (18 to 35 years) and to develop a long-term plan to fight this illness before it worsens.
Prognostic implications of genotype findings in non-ischemic dilated cardiomyopathy: a network meta-analysis
Authors: Anastasiou V , Papazoglou A S P , Gossios T G , Zegkos T Z , Daios S D , Moysidis D V M , Koutsiouroumpa O K , Parcharidou D P , Tziomalos G T , Katranas S K , Rouskas P R , Karamitsos T K , Ziakas A Z , Kamperidis V K , Efthimiadis G K E
Published: October 2024

Background

Evidence on the relative impact of diverse genetic backgrounds associated with non-ischemic dilated cardiomyopathy (DCM) remains contradictory.

Aim

This study sought to synthesize the available data regarding long-term outcomes of different gene groups in DCM.

Methods

Electronic databases were systematically screened to identify studies reporting prognostic data on pre-specified gene groups. Those included pathogenic/likely pathogenic (P/LP) variants, truncating titin variants (TTNtv), lamin A/C mutations (LMNA), and desmosomal proteins. Outcomes were divided into composite adverse events (CAEs), major ventricular arrhythmic events (MVAEs) and heart failure events (HFEs). Random effects meta-analyses were conducted to quantify the pooled odds ratio (ORs) for each gene group. A frequentist network meta-analysis was executed to allow indirect within-gene group comparisons.

Results

Twenty-six studies comprising 7,255 genotyped DCM individuals were included. Patients with P/PL variants had a higher risk for CAEs [OR, 2.10 (95% CI, 1.67-2.65)], MVAEs [OR, 1.86 (95% CI, 1.52-2.26)], and HFEs [OR, 2.01 (95% CI, 1.08-3.73)] than genotype negative patients. The presence of TTNtv was linked to a higher risk for CAEs [OR, 1.78 (95% CI, 1.20-2.63)], but not MVAEs or HFEs. LMNA and desmosomal groups suffered a higher risk for CAEs, MVAEs, and HFEs compared to non-LMNA and non-desmosomal groups respectively (Picture 1). When genes were indirectly compared, the presence of LMNA resulted in a more detrimental effect that TTNtv, with respect to all composite outcomes but no significant difference was found between LMNA and desmosomal genes. Desmosomal genes harbored a higher risk for MVAEs compared to TTNtv (Picture 2).

Conclusion

Different genetic substrates associated with DCM result in divergent natural histories. Routine utilization of genetic testing should be employed to refine risk stratification and inform therapeutic strategies in DCM.Natural history of DCM based on genotypeNetwork meta-analysis of gene variants
Real-world evidence for patient phenotypes in heart failure with preserved ejection fraction
Authors: Balitzki J , Schaper S , Roessig L , Sandner P , Thum T , Bauersachs J , Mondritzki T
Published: October 2024

Background

Heart failure (HF) with preserved ejection fraction (HFpEF) presents a high mortality risk due to its heterogeneous and multifactorial nature, coupled with limited treatment options. The incompletely understood pathophysiology is influenced by various comorbidities, resulting in different clinical phenotypes. Identifying these could be crucial for tailored HFpEF treatments. While previous studies focused on small, well-characterized patient populations, electronic health records (EHRs) offer the potential to unveil HFpEF phenotypes in larger real-world patient groups.

Purpose

We aimed to establish a sizable, unselected HFpEF patient population using real-world data. Employing cluster analysis, we intended to uncover distinct groups with varied disease aetiology and medical needs based on comorbidity profiles and prognoses.

Methods

From EHRs of n = 1,610,101 HF patients, we identified an HFpEF cohort of n = 32,009 patients, by applying thresholds for the LVEF and data availability, and by excluding confounding conditions. Clustering by the relative frequency of common comorbidities aimed to reveal patient populations with unique prognoses, comorbidity profiles, and clinical and demographic characteristics.

Results

Six clusters of different sizes, comorbidity prevalence, clinical presentation, and all-cause mortality were identified. About 50% of patients (n = 15,445) were predominantly hypertensive, with varying extents of coronary heart disease and diabetes mellitus (DM), and a 5-year mortality of about 30%. Around 22% (n = 7,089) exhibited a cardiometabolic comorbidity profile, with an increased prevalence of obesity and sleep apnea, but also DM and hypertension, and a 5-year mortality of 22.5%. Over 15% of patients (n = 5,298) had a 5-year mortality rate of 45.0%, marked by highest rates of anaemia and chronic kidney disease (CKD) but also DM, elevated N-terminal prohormone of brain natriuretic peptide levels, and a reduced estimated glomerular filtration rate.

Conclusion

Despite the favourable prognosis, a significant proportion of patients represent a cardiometabolic HFpEF phenotype with notable unmet medical needs regarding cohort size and multimorbidity. Patients simultaneously suffering from CKD, anaemia, and the highest mortality rates may represent a previously underrecognized phenotype. Our study demonstrates that distinct medical needs can be identified in a large, unselected real-world HFpEF cohort. In contrast to clinical trials, this approach enabled access to a broader patient population, revealing novel phenotypes to be targeted by precision medicine in the future.
The association between heart failure diagnosis and the incidence of cancer: a longitudinal analysis of the United Kingdom Biobank
Authors: Gomez Ochoa S A , Levinson R T
Published: October 2024

Background

Heart failure (HF) and cancer represent prevalent chronic conditions with a high burden of disease worldwide. Several studies have shown a high frequency of coexistence of these two entities, highlighting a potential bidirectional association. However, few longitudinal studies have explored whether patients with HF have a significantly increased risk of cancer and if comorbidity profiles affect this risk.

Purpose

To explore the association between incident HF diagnosis and cancer development in UK Biobank participants after adjustment by potential confounders.

Methods

We conducted a retrospective cohort study in UK Biobank. HF and cancer diagnoses were determined using diagnoses and patient reports. We evaluated breast, liver, lung, prostate, colorectal, uterus, and hematological cancer. Individuals with a history of HF or cancer diagnosed before the baseline assessment were excluded. The primary exposure was incident HF diagnosis after enrollment, and the primary outcome was incident cancer during follow-up. Multivariate Cox proportional hazard regression models using time-varying covariates were used to calculate hazard ratios (HR) for the explored associations with overall cancer and by major cancer type. A Bonferroni-corrected p-value < 0.003 was considered statistically significant to control for family-wise error rate.

Results

476,652 patients were analyzed (mean age: 56.3 years; 57.8% females). Over a median follow-up of 13.7 years, 12,461 (2.6%) developed HF, and 34,452 (7.2%) were diagnosed with cancer. Incident HF was significantly associated with increased overall cancer risk (HR 1.34, 95% CI 1.22–1.48. p<0.001), as well as lung (HR 1.30, 95% CI 1.18–1.43), and hematological cancers (HR 1.54, 95% CI 1.25–1.91. p<0.001) (Figure).

Conclusion

Despite sharing multiple comorbidities and risk factors, incident HF remained significantly associated with a higher cancer risk even after multivariable adjustment by relevant confounders. Nevertheless, confounding bias and especially detection bias, cannot be ruled out in the present analysis. Further research is necessary to validate these findings and elucidate the mechanisms underlying this association.Figure
Assessment of right ventricular ejection fraction cut-point for predicting mortality and heart failure hospitalization in asian patients with heart failure and reduced ejection fraction (HFrEF)
Authors: Buraphat P , Boonyasirinant T
Published: October 2024

Background

Left ventricular ejection fraction (LVEF) has been well established as a predictor of morbidity and mortality in heart failure patients (HF). Meta-analyses have confirmed that right ventricular systolic dysfunction (RVSD) identified by cardiac MR predicts adverse outcomes in HF patients. However, the cut-point and predictive value of right ventricular ejection fraction (RVEF) in Asian patients remain unknown.

Objectives

To evaluate the RVEF cut-point for RVSD and demonstrate the association between RVSD by cardiac MR and a composite endpoint consisting of HF hospitalisation and/or all-cause mortality in HFrEF patients (LVEF ≤40%).

Materials & Methods

A retrospective chart review of 370 consecutive HFrEF patients who underwent cardiac MR between 01 June 2009 and 31 December 2013 was done. The primary outcome was defined as all-cause mortality and/or HF hospitalisation. Receiver Operating Characteristic (ROC) analysis was done to explore the most accurate RVEF as a cut-point for RVSD. Multivariate Cox regression analysis was calculated.

Results

Patients were followed for a total of 1,989 patient-years with an average of 5.4 ± 2.9 years. The primary outcome occurred in 112 patients (30.3%). ROC analysis demonstrated that RVEF <48% provided the most accurate prognostic value (specificity 52%, sensitivity 70%) with an area under the curve of 0.62 (95% CI 0.55 – 0.69). Multivariate Cox analysis showed that RVSD was a significant independent risk factor (hazard ratio 1.71; 95% CI 1.10 – 2.66; p=0.018) for the primary outcome, in addition to age (p<0.001), New York Heart Association functional class (p<0.001), and diabetes mellitus (p=0.014), regardless of LVEF.

Conclusions

In Asian HFrEF patients, RVSD defined by RVEF <48% by cardiac MR can predict adverse events and provide a prognostic parameter for risk stratification.
Evaluating health system resilience testing; what makes this practice successful?
Authors: Zimmermann J , Haywood P , Karanikolos M , Cylus J
Published: October 2024

Issue

Health system resilience is an important and desirable attribute of health systems. We have evaluated the operationalization of our step-by-step guide for conducting a resilience test.

Description of the problem

Preparedness planning is often siloed and does not take the entire health system into account. The objective was to develop a new methodology for policy making that is adaptable to any health system context and shock scenario. Resilience testing uses a mixed-method approach to assess resilience by understanding health system strengths and weaknesses in relation to a hypothetical shock scenario. A programme logic model, semi-structured interviews and an online questionnaire were used to evaluate the methodology and to answer the following questions: Can resilience tests be used to identify strengths and weaknesses in different health system contexts? What are the determinants for successful resilience testing?

Results

Three resilience tests were conducted in Finland, Greece and the Asturias region of Spain. All resilience tests identified health system strengths and weaknesses. 97% of participants agreed that the test identified broader vulnerabilities. However, 76% thought that a different scenario would identify different strengths and vulnerabilities. 94% of participants agreed or strongly agreed that the test was a valuable exercise. The semi-structured interviews consistently found that successful resilience testing requires neutral facilitation and carefully selected test participants.

Lessons

Resilience test results have been used in 2 out of 3 cases to develop health policy. Resilience testing needs to be initiated and supported by the ministry of health to ensure results are considered in the policy making process.

Key messages

• Health system resilience tests can identify health system strengths, weaknesses, and steps towards remedial policy action to improve resilience in different European health system contexts.

• Successful health system resilience testing requires carefully selected facilitators and test participants as well as support from the Ministry of Health.
Effectiveness of a school- and primary care-based HPV vaccination intervention (the PrevHPV study)
Authors: Bocquier A , Michel M , Chevreul K , Gilberg S , Gauchet A , LeDuc-Banaszuk A S , Gagneux-Brunon A , Mueller J E , Giraudeau B , Thilly N
Published: October 2024

Background

HPV vaccine coverage (VC) remains lower than expected in many countries, particularly France. We developed and evaluated the PrevHPV multicomponent intervention to improve HPV VC among French adolescents. The components were ‘education and motivation’ of adolescents in schools, ‘at-school vaccination’, and ‘general practitioners’ (GPs) training’. We evaluated the effectiveness of the intervention two months after it ended.

Methods

We carried out a pragmatic cluster randomized controlled trial with incomplete factorial design in 14/25 French school districts (July 2021-April 2022). The cluster was the municipality (n = 91). The outcome was HPV VC (≥ 1 dose) two months after the intervention ended among 11-14-year-olds living in participating municipalities (data from the French national reimbursement database and from the trial). We performed two types of analyses: (1) without considering the dose of intervention received, using a linear model with one fixed effect per component, adjusted for baseline HPV VC; (2) a post hoc on-treatment analysis, rerunning the linear model by replacing the fixed effects with a quantitative ‘dose of intervention’ variable calculated for each component using data collected during the trial.

Results

For the three intervention components, estimates of the effect on VC at two months were greater for the on-treatment analyses than for the analysis that did not consider the intervention dose. For the ‘at-school vaccination’ component, the estimate increased from 5.50 percentage points (pp; p < 0.001) to 11.25 pp (p < 0.001). The ‘GPs’ training’ component reached significance (from -1.46 pp, p = 0.150 to 3.56 pp, p = 0.049). In both types of analyses, no significant effect was observed for ‘education and motivation’ (from -0.08 pp, p = 0.950 to 2.58 pp, p = 0.241).

Conclusions

Increasing HPV VC among adolescents requires the involvement of various stakeholders and could be achieved by combining interventions in both schools and primary care settings.

Key messages

• The PrevHPV study is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France.

• Offering free HPV vaccination at school significantly increased HPV VC; providing GPs with training and a dcision-aid tool helped increase HPV VC if the GPs completed the training.
Estimated number of COVID-19 deaths averted by vaccination in Belgium
Authors: Stouten V , Van Evercooren I , Vernemmen C , Braeye T , Billuart M , Catteau L , Bustos Sierra N , Vermeiren E , Nasiadka L , van Loenhout J
Published: October 2024

Background

Vaccination campaigns have been rolled out globally to limit the impact of COVID-19 on severe health outcomes, including mortality. We aimed to estimate the number of averted deaths by COVID-19 vaccination in the Belgian population aged ≥65 years, between January 2021 and January 2023.

Methods

Nationwide data on COVID-19 infections, vaccinations and all-cause mortality were individually linked. We estimated Vaccine Effectiveness against COVID-19 mortality (VE) in persons having received a vaccine dose in the last 6 months using a Cox proportional hazards model adjusted for age, sex, time since vaccination, previous infection, comorbidities, province and income. COVID-19 death was defined as a death within 1-7 weeks after a positive SARS-CoV-2 laboratory-test. Based on obtained VE estimates, vaccine coverage and national COVID-19 mortality data, we estimated the number of averted deaths (expected deaths without vaccinating minus the reported deaths).

Results

By January 31st 2023, 11,033 COVID-19 deaths have been reported in Belgium. The average vaccine coverage was 48% during alpha, 85% during delta and 63% during omicron dominance. VE was estimated at 0-59 days after vaccination, for 65-79 year and ≥80 year-olds respectively, at 65% (58%-60%) and 35% (28%-41%) during Alpha, at 84% (82%-87%) and 79% (77%-81%) during Delta and at 83% (80%-85%) and 71% (68%-73%) during Omicron dominance. We estimated 10,042 deaths averted (range: 8,917-11,188) among the Belgian population aged ≥65 years, representing a 48% reduction (range 45%-50%) in the expected deaths. Out of 10,042 averted deaths, the majority was averted during Delta (47%; 4,670) or Omicron dominance (43%; 4,366), compared to during Alpha dominance (10%; 1,006).

Conclusions

Vaccinating against COVID-19 led to an important reduction in COVID-19-related mortality among the Belgian population ≥65 years, in particular during Delta and Omicron dominance, underscoring the effectiveness of vaccines against mortality.

Key messages

• Vaccinating against COVID-19 led to an important reduction of 48% in COVID-19-related mortality among the Belgian population ≥65 years, in particular during Delta and Omicron dominance.

• Vaccine effectiveness against COVID-19 mortality was estimated as high in the Belgian population ≥65 years (range: 71-84%) during Delta and Omicron dominance, also among elderly over 80 years.
Who are the superheroes? A cross-sectional study on the determinants of healthy ageing
Authors: Mosconi G , Stival C , Amerio A , Fanucchi T , Iacoviello L , Lugo A , Vigezzi G P , Gallus S , Odone A
Published: October 2024

People who reach old age while enjoying good physical and mental health are, in a sense, ‘superheroes’ (of health): in fact, they not only have a relatively low impact on health care spending but are also advantaged in playing an active role in society and achieving their aspirations (and perhaps helping others to do so). The aim of this study was to assess the prevalence and determinants of being ‘physical superheroes’ (i.e., lacking the 10 major chronic conditions plus obesity), ‘mental superheroes’ (i.e., lacking major mental symptoms) and ‘superheroes’ (i.e., both mental and physical superheroes). We used data from a telephone-based cross-sectional study (LOST in Lombardia) conducted in November 2020 (i.e., during the COVID-19 pandemic) on a representative sample of 4,400 adults aged ≥65 years from the Lombardy region, Northern Italy. All the participants provided data both during and before the COVID-19 pandemic. Mental and physical superheroes were 59.0% and 17.6%, respectively. Superheroes were 12.8% overall, 15.1% among men and 11.1% among women; 20.2% among individuals aged 65-69 years, 11.3% among 70-74, 10.0% among 75-79, and 8.3% among ≥80 years. Multivariable analysis showed that, besides female sex, higher age, and disadvantaged socio-economic status, ever tobacco smoking (adjusted odds ratio, aOR=0.71), alcohol drinking (aOR=0.77), and physical inactivity (p for trend<0.001) were inversely related to being superheroes. Participants with feelings of hopelessness showed an extremely low presence of “superheroes” (OR = 0.17). The COVID-19 pandemic reduced by 16.3% the proportion of superheroes. Given a steadily ageing population, public health policies should aim to ensure that people reach old age in the best possible state of health by preventing risky behaviours and paying special attention to inequalities derived from economic and social factors.
Preventing unintentional injuries due to home and leisure time accidents in children: the parents’ beliefs matters (CHILD Vigilance project - CHIVI)
Authors: Alves T , Papadakaki M , Strukcinskiene B , Silva S , Braz P , Aniceto C , Vagionaki K , Chliaoutakis J , Matias-Dias C
Published: October 2024

Background

The CHILD Vigilance project is a European study supported by the Injury Prevention section of the European Public Health Association and aims at contributing to the epidemiological knowledge of injuries and accidents in Greece, Portugal and Lithuania, through increasing knowledge on parents’ and caregivers’ safety perceptions.

Methods

A descriptive, observational, cross-sectional study was developed in these countries between February and April 2023, under the CHILD Vigilance project. Information was collected online via a questionnaire exploring parents’ and/or caregivers’ knowledge, attitudes and risk perception towards prevention of unintentional injuries in children and adolescents.

Results

A total of 916 valid responses were obtained, involving 1229 children (51.4% male; mean age 7.8 years). Falls were perceived as the most common type of unintentional injuries in pre-schoolers and school-age children (47,8% in Greece; 63,5% in Portugal; 74,8% in Lithuania). Country differences were observed in terms of the most commonly perceived types of injury in adolescents, which were road traffic crashes in Greece and Portugal (41.2% and 39.5% respectively) vs poisonings in Lithuania (38.1%). Some differences were also observed between these countries as to the most common causes of death. In Greece and Lithuania diseases were reported as the main cause of death in pre-schoolers (62.5%; 35.1%) and in children attending primary education (55.1%; 29.7%), while injuries were identified as a cause only in the oldest group of children. In Portugal on the other hand, injuries were identified as the most frequent cause of death in all groups, pre-schoolers (40.5%), children attending primary education (47.1%) and in the oldest (55.1%).

Conclusions

The study emphasizes the need to address misperceptions, improve safety attitudes and invest more efforts in managing harmonised injury outcomes across global initiatives.
Accessibility of digital healthcare in 2023: insights from a Dutch national survey study
Authors: Van Tuyl L , Keuper J , Standaar L , Alblas E , Keij B
Published: October 2024

Background

Digital technology is reshaping healthcare, offering potential improvements in accessibility, efficiency and quality. However, to realize potential benefits, ensuring equal access for all is crucial. We investigated digital healthcare usage and studied differences in use across age groups and educational backgrounds in the Netherlands.

Methods

Surveys were conducted among general healthcare users (n = 837, any citizen living in the Netherlands with access to healthcare) and healthcare users with chronic conditions (n = 1437). We studied their digital skills (can you independently use a computer, tablet or smartphone; digital applications; email and apps?) and their use of digital selfcare (did you use websites for health-related information or treatment?). Findings are stratified for educational level (low/medium/high) and age (15 -39, 40-64, over 65 years). Data collection occurred between April and August 2023, focusing on the twelve months preceding the survey.

Results

The majority of respondents use digital devices independently (range: 78-91%), but these percentages vary between subgroups, from 48-65% for users with lower education vs 86-99% for users with higher education. Similar differences exist across age groups: 98-100% of users aged 15-39 use a computer, tablet or smartphone, in contrast with 59-78% in the over 65 years age group. Similarly, the use of websites for health information is 22-31% among lower educated users to 68-70% among higher educated users; and 36-48% among those ≥65 years to 73-75% among respondents aged 15-39.

Conclusions

Substantial variation exists in the use of digital tools and digital selfcare across ages and educational levels. These findings underscore the urgency of addressing inequalities in access to digital healthcare, serving as a call to action for policymakers, healthcare providers, and developers to collectively strive for an accessible (digital) healthcare system for all.

Key messages

• Differences in use of digital tools and digital selfcare among people of different ages and educational levels warrants the need for co-creation and tailored development and implementation.

• Differences in use of digital tools and digital selfcare among people of different ages and educational levels warrants the need for co-creation and tailored development and implementation.
Sustainability in the Next Generation Hospital. Needs and Requirements collection from healthcare infrastructures supply chain stakeholders with One Health approach
Authors: Brambilla A , Mangili S , Dolcini M , Capolongo S
Published: October 2024

Technological, demographic, epidemiological, environmental and social changes require investment in new sustainable hospital infrastructure; there is a lack of guidelines and interaction between Stakeholders. In February 2022, the Joint Research Platform Healthcare Infrastructures (JRP HI) was established consisting of Hospital Strategic Directions and Industrial Partners in Italy. Starting from the WHO Techincal Brief “Hospitals of the Future”, a national survey was carried out via web-survey and semi-structured interviews with a sample of 30 stakeholders to collect the main drivers and constraints for innovation and the framework from a One Health perspective and in terms of sustainability. The main needs to be addressed through the guidelines refer to digitalization (27%), flexibility (32%), environmental sustainability (36%) and economic sustainability (27%) as well as flow management (18%) and hospital infection (14%). The participants consider SDG-3 ‘Good Health and Wellbeing’ to be the most relevant for development activities. Hospital managers prioritize SDG-8 ‘Decent Work and Economic Growth’ (23%); vice-versa the industrial partners suggest SDG-11 ‘Sustainable Cities and Communities’ and SDG- 13 ‘Climate Actions’ (32%) as topics to be addressed. Furthermore, 57% of the respondents state that they lack adequate training, budget or leadership to apply innovative strategies in the day-to-day management of the healthcare organization. The survey highlighted a lack of initiatives, budget, and standardization for enhancing environmental sustainability in healthcare infrastructures. The sustainability of building systems depends on factors such as energy consumption, alternative energy sources, thermal comfort, water usage, waste management, ventilation, lighting efficiency, air quality, and construction materials. Ensuring the adoption of monitoring systems and harmonized standards of performance measurement is crucial for increasing the environmental sustainability.
Intersecting Pathways: Understanding Dementia, Hearing Loss, and Health Disparities
Authors: Stonkute D
Published: October 2024

Background

Dementia is a major public health concern, affecting care dependency and disability in older ages. In Europe, around 14.1 million people live with dementia, a number that is expected to increase to 15.9 million by 2040. Hearing loss (HL), followed by education, has been proposed as the most important modifiable risk factor for dementia. This study aims to investigate how sex, educational attainment and HL intersect to influence dementia-free life expectancy (DemFLE) in older adults.

Methods

Using population register data covering all Finnish residents aged 50 years or older from 2010 to 2019, we apply discrete-time multistate Markov models. Transition probabilities between states, such as HL and dementia, are estimated with multinomial logit models stratified by sex and education. Multistate life tables are used to compute sex- and education-specific DemFLE.

Results

We identified 316,361 individuals with a diagnosis of dementia and 317,115 individuals with a diagnosis of HL, representing 1,449,873 and 2,738,970 person-years respectively. 14% of individuals with HL were eventually diagnosed with dementia, compared to only 8% of individuals without HL. We hypothesise that DemFLE will vary significantly by sex and education, with additional modulation by the presence of HL. Specifically, we expect that the presence of HL will further reduce DemFLE, and that the magnitude of this reduction will be relatively greater among those with lower educational attainment.

Conclusions

This study contributes to the emerging literature on the impact of hearing loss on dementia. While both dementia and hearing loss are irreversible health conditions, hearing loss can be managed by hearing aids. If we find evidence that hearing loss is associated with different levels of risk of dementia by educational attainment, it would suggest avenues for effective interventions and public health policies to ensure more equal ageing processes in the population.

Key messages

• Hearing loss may intersect with education and sex in the risk of dementia, providing evidence for the importance of addressing hearing health inequalities in dementia prevention efforts.

• Understanding the interactions between hearing loss, education and sex can inform policies to promote healthy ageing and reduce the burden of dementia on individuals and health systems.
Feta safe than sorry - gastroenteritis outbreak associated with contaminated cheese
Authors: McGuire F , Ward M , Smyth E , Murphy E
Published: October 2024

A gastroenteritis outbreak among attendees at a catered HSE event was notified. No faecal samples were obtained - all cases had recovered. An outbreak control team was convened. A retrospective cohort study hypothesised that “people who attended the HSE event and subsequently became unwell did so as a result of consuming food at the event”. Epidemiological, environmental, and microbiological investigations commenced. An outbreak-specific food questionnaire was distributed. The food business was inspected, obtaining food samples. Survey responses were analysed.The attack rate was 25%. Associations were identified between illness and specific foods. Multivariable regression highlighted: feta salad (OR = 36.22 [95% CI 2.24-585.52] p = 0.01), and turkey (OR = 12.57 [95% CI 1.12-140.58] p = 0.04). Most (93%) turkey consumers had consumed feta salad. Microbiology of unopened feta cheese, sourced by the caterer from a supermarket, was positive for E coli at 1.7 x 105. The Food Safety Authority of Ireland corroborated separate illness complaints from a family consuming the product. The supermarket voluntarily withdrew the product internationally.This outbreak prompted a cross-sectoral food safety investigation. Despite no pathogen detection in a faecal samples, epidemiological evidence led to the withdrawal of contaminated feta by the supermarket, removing over 1000 units from the market, emphasising the importance of epidemiology in protecting public health.

Key messages

• Epidemiological investigation resulted in mass contaminated cheese withdrawal internationally.

• Cross-sectoral work is important to safeguard public health.