bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting ventricular arrhythmia inducibility in ajmaline-induced brugada type I pattern: validation of the dST-Tiso interval
Authors: Iacopino S , Sorrenti P , Petretta A , Colella J , Di Vilio A , Statuto G , Filannino P , Artale P , Giacopelli D , Camastra D , Peluso G , Fabiano G , Campagna G , Fabiano E , Cecchini F
Published: November 2023

Background

The dST-Tiso is the interval between the onset of the coved ST-segment elevation and its termination at the isoelectric line in V1 and V2 electrocardiographic (ECG) leads during manifest Brugada (BrS) type I pattern. A dST-Tiso >300 ms was proposed as a predictor of ventricular arrythmia (VA) inducibility in patients with ajmaline-induced pattern.

Purpose

The aim of this study was to validate this criterion in an independent data set.

Methods

Consecutive patients with a BrS type I ECG pattern found after ajmaline administration underwent programmed ventricular stimulation (PVS). dST-Tiso was measured in all patients and tested as a predictor of positive VA inducibility.

Results

In our institution, a total of 128 patients (median age 43 years, 59% male) with drug-induced BrS Type I ECG pattern underwent PVS between January 2021 and December 2022. Thirty-two patients (25.0%) had VA inducibility that required defibrillation. Compared to non-inducible subjects, those with positive PVS were more frequently male (81% vs 51%, p=0.003), had longer PQ (165 vs. 160 ms, p=0.016) and dST-Tiso (310 vs 230 ms, p<0.001) intervals, and shorter QT interval (412 vs. 420 ms, p=0.022). The figure shows the distribution of dST-Tiso intervals for patients with not inducible and inducible VA. As a continuous variable, dST-Tiso confirmed significant association with VA inducibility with an adjusted odds ratio of 1.02 (95% CI 1.01-1.03, p<0.001) for each 1 ms increase in duration. A dST-Tiso interval >300 ms yielded a sensitivity of 75%, a specificity of 86%, positive and negative predictive values of 69% and 91%, respectively.

Conclusion

The validation of the estimation model based on the dST-Tiso interval >300 ms confirmed its high accuracy in predicting VA inducibility in drug-induced BrS type I pattern. This simple ECG marker might be related to the extent of the electrical substrate of the disease.Distribution of dST-Tiso intervals
Virtual cardiac hospital in the home following cardiac surgery delivers superior patient outcomes, reduces costs, and increases bed availability
Authors: Martin L K , Naismith C , Nguyen S , Patching K , Shaw M , Ma R , Yeoh J , Wong G , Seevanaygam S , Horrigan M C G
Published: November 2023

Introduction

Increasing patient complexity and unprecedented bed access constraints are important challenges in contemporary delivery of post-operative cardiac surgical care. Bed constraints lead to inefficient ICU discharge, excessive hospital Length Of Stay (LOS), and ineffective transitional care which results in suboptimal patient experience and hospital readmissions. The Cardiac Hospital in the Home (cHITH) model was designed to provide an early supported discharge in a virtual ward environment by an expert team of advanced practice cardiac nurses, pharmacists and cardiologists. The model utilizes wearable technology to monitor cardiac rhythm, oxygen saturation and vital signs in conjunction with daily virtual ward rounds using a standard tele health platform. Care is focused on coaching around mobilization and medical therapy, detection and management of complications and liaison with community pharmacies and providers of sub acute care. Escalation pathways for clinical deterioration were designed to support patient safety.

Results

Between March and October 2022, 123 of 197 patients were referred to cHITH of whom 103 (84%) were recruited. Where appropriate, results were compared with those from the same calendar period in 2021 and dichotomized to detect early trends in care. The cHITH group had a mean age of 62 ± 4 years with 82% males, 62% underwent isolated CABG surgery and there were no mortalities. Compared with historical results, inpatient LOS was reduced 1.6 days with 35% of care delivered in the virtual cardiac hospital. Readmission at 30 days was reduced by 42% (p<0.05)* and patient satisfaction was >90% (net promoter score). Important trends included an increase in cHITH LOS and a reduction in Total LOS.

Projections

Modelling of total hospital costs and bed-day savings was performed using real data from the medical centre. Assuming that 75% of patients would be managed in the cHITH for 3.5 days, the projected cost of cHITH care was $24.2M comparing favorably with $27.8M for usual care. When readmitted days are subtracted from total virtual care days the cHITH model of care is projected to save 975 inpatient bed days.

Conclusions

This virtual model of care has demonstrated safety, efficiency and high levels of patient satisfaction. Ongoing analysis is required to understand the broader applications of this model and to further evaluate quality, safety and efficiency metrics.Table 1.Results
AI remote ECG monitoring improves arrhythmia detection
Authors: Rosengarten J , Hart E , Ojo M , Baker M
Published: November 2023

Background

Ambulatory ECG monitoring is needed to investigate intermittent heart rhythm symptoms. Traditional monitoring approaches are resource intensive, requiring multiple patient hospital visits and time-consuming analysis, using fixed capacity monitoring equipment. Low diagnostic yield means tests are often repeated.

Purpose

We carried out a large pilot to compare ambulatory cardiac monitoring with an AI-led remote ECG monitoring service (Zio XT) with Holter monitoring. Patients were fitted with single-use Zio monitoring patches, which they wore for 14 days of continuous monitoring and then returned it by Freepost for outsourced analysis and reporting.

Methods

Over the course of 12 months, 3505 patients were involved in evaluation of Zio. Of these, we reviewed the detailed rhythm data of 200 consecutive patients, and compared this with a retrospective cohort of 200 consecutive standard Holter monitored patients, fitted prior to the evaluation period. All patients had been referred to cardiology for investigation of heart rhythm symptoms.

Results

The total Zio group had a mean age of 63.8 years. The 400 participants used in the analysis groups matched this (Table) and there was no significant difference in the age ranges between the two groups. Holter duration was for: 24-hr (45%), 48-hr (8%), 72-hr (20%), 5-day (2%), 7-day (26%). Significant arrhythmias (defined as SVT ≥ 30s, VT ≥ 8bts, AV Block Mob 2⁰ or 3⁰, Pause ≥ 3s, Paroxysmal AF) were detected in 49 (25.8%) Zio patients compared with 18 (9.0%) Holter patients (P<0.00001). Total number of arrhythmia findings was greater in Zio compared with Holter; P<0.05 (Table). The arrhythmia findings in Zio were comparable with those in the pilot’s total cohort. In Holter, 41% of significant arrhythmias were detected in patients monitored for 24 hrs, comparable with Zio where 46% of arrhythmias were detected within the first 24 hours of wear-time. In Zio, 15% of significant arrhythmias were detected post 7 days of the wear-time.

Conclusions

Arrhythmia detection with Zio was significantly greater compared with Holter; detecting significant arrhythmias in nearly 3 times as many patients. Longer detection enabled greater arrhythmia detection, with 3 in every 20 patients having episodes occurring after 7 days. Even when adjusting for wear time, arrhythmia detection within 7 days was superior in the Zio group. Over half (59%) of arrhythmias were detected in patients monitored for 48 hours or longer, suggesting that for an efficient service longer monitoring is needed, particularly when symptoms are intermittent. For Holter monitoring this has considerable resource utilisation implications, relating to staff (cardiac physiologist) time and capital equipment (Holter monitoring stock). Also, greater detection of arrhythmia across the wear time suggests a higher sensitivity than Holter for detecting cardiac arrhythmias.
Detection of cardiac arrhythmias following acute coronary syndrome using a connected continuous rhythm monitoring device
Authors: Charleux P , Zeitouni M , Procopi N , Devos P , Barthelemy O , Guedeney P , Granger C , Ferrante A , Laredo M , Kerneis M , Silvain J , Collet J P , Montalescot G
Published: November 2023

Background

The incidence of cardiac arrhythmias following acute coronary syndrome (ACS) is not well-known.

Purpose

To describe the incidence of clinically relevant cardiac arrhythmias following low-risk ACS, using a connected continuous rhythm monitoring device.

Methods

In a prospective, single arm and open label, observational study, patients in sinus rhythm and with a left ventricular ejection fraction > 40% discharged home after an ACS were equipped with a rhythm monitoring tee-shirt, providing a high-quality continuous 15-lead electrocardiogram signals. Patients were prompted to wear the device as much as possible, for a maximum length of 30 days. Recorded data were reviewed by two independent cardiologists. The primary endpoint was the occurrence of clinically relevant arrhythmias – defined as either new atrial fibrillation, ventricular tachycardia, accelerated idioventricular rhythm or frequent premature ventricular contractions (≥ 500/day) – detected by the device over the first 30 days after hospital discharge following the ACS.

Results

From January 2020 to August 2022, 99 patients were discharged home with a functional rhythm monitoring device, among whom 45 (55%) were ST-segment elevation myocardial infarction. The median recording duration was 13 days (range: 1-30), with a median workable signal of 9 days. Recorded data were interpretable in 82 patients. At least one clinically relevant arrhythmia occurred in 10 patients (12.2%) during follow-up. Median time to first arrhythmia was 16,5 days (IQR: 8,5-23). Paroxysmal atrial fibrillation was detected in 3 patients (3.7%), non-sustained ventricular tachycardia in 4 patients (4.9%), accelerated idioventricular rhythm in 3 patients (3.7%) and frequent premature ventricular contractions in 5 patients (6.1%) (Figure 1). None of these arrhythmias were symptomatic. No sustained ventricular tachycardia was detected.

Conclusions

Asymptomatic cardiac arrhythmias were frequent after ACS in patients considered at low risk for further events. The long-term clinical risk of these arrhythmias remains to be studied.
Correlation between non-invasive measurements and intracardiac pressures using machine learning techniques
Authors: Van Ravensberg A E , Scholte N T B , Omar Khader A , Brugts J J , Bruining N , Van Der Boon R M A
Published: November 2023

Background

Solutions targeting early recognition of congestion in heart failure (HF) patients have the potential to prevent readmissions and can thus significantly reduce the burden on HF care. A gold standard measure of congestion is the invasively measured pulmonary capillary wedge pressure (PCWP). However, the invasive nature and accessibility of this measurement limits its clinical use. Non-invasive approximation of the PCWP using biosensing wearables could be a promising replacement for HF monitoring.

Purpose

The primary aim of this retrospective study was to create a model that estimates the PCWP based on non-invasive measurements of vital signs using both traditional statistics and machine learning (ML) techniques.

Methods

The study cohort consisted of right-sided heart catheterizations between 23/6/2017 and 19/8/2022. The following models were used: linear regression or classification, k-nearest neighbors, random forest, gradient boosting and multilayer perceptron. The outcome measure for the regression models was the continuous PCWP as measured during the catheterization. The two outcome classes for the classification models were low (<12 mmHg) and high (≥12 mmHg) PCWP. Non-invasive mean arterial blood pressure (MAP), saturation, heart rate, weight and temperature measured at most 72 hours before or after the catheterization were collected as the features for the models. Additionally, ECG-signals acquired during the catheterization were used to calculate the heart rate variability (HRV). The data was split in a validation (20%) and training (80%) data set. The models were built based on the training set and then applied on the validation set to determine the coefficient of determination (R2) for the regression models and the AUC of the ROC for the classification models.

Results

A total of 859 catheterizations were included of which 31.2% had HF as primary diagnosis. Average age of the cohort was 59 ± 14 years and 52.2% were male. In the HF group, the features with the highest correlation with the PCWP were the HRV and gender (Table 1). All the used regression techniques resulted in low R2 values of up to 0.10 and the classification techniques in AUC of the ROC values of up to 0.61 (Table 2).

Conclusion

In the current study, PCWP could not be approximated with non-invasive measurements using traditional statistics and ML techniques. These findings support the notion that traditional measures for monitoring HF are poorly correlated with hemodynamic parameters. Perhaps repeated measurements over time could overcome the shortcomings of a single vital signs measurement for congestion evaluation. Future prospective research is needed to evaluate the potential of wearable devices measuring trends over a longer period and their potential in predicting hemodynamics.
Use of a wearable patch sensor for continuous activity and posture tracking to assess risk of early infection after transcatheter aortic valve replacement
Authors: Maier O , Dollmeyer W , Nieto N , Wolff G , Zeus T , Veulemans V , Kelm M , Jung C
Published: November 2023

Background

Early infections after transcatheter aortic valve replacement (TAVR) represent one of the most common risk factors for non-cardiac 30-day mortality. Several wearable devices have been developed to measure vital signs and physical activity in real time while allowing full mobilization of the patient. However, their use has not been evaluated in a clinical setting with patients undergoing TAVR yet.

Purpose

We aimed to evaluate the feasibility of wearable patch sensors in assessing vital signs and daily activity before and after TAVR to predict an increased risk of early infections following TAVR.

Methods

Patients at high risk for infection undergoing transfemoral TAVR under local anesthesia were enrolled between September 2022 and January 2023. Postprocedural early infections were assessed, defined as C-reactive protein rise within 5 days after the procedure inducing antibiotic treatment. Vital signs (heart rate, respiratory rate, single-lead ECG) and activity (steps, posture) were monitored by a wearable patch sensor two days before (pre-TAVR) and two days after TAVR (post-TAVR).

Results

54 patients completed 5 days of in-hospital monitoring with wearable patch sensors. The mean age was 80.3+5.2 years, 31 patients (57.4%) were male. Early infections occurred in 8 of 54 (14.8%) high-risk patients, of whom one was a urinary tract, one a pulmonary, and two access site-related etiology. Four infections remained with unknown focus.

Respiratory rate was generally higher in patients developing an early infection after TAVR in both time periods, before (early infection 22±3 vs. no infection 18±2 bpm; p=0.001) and after TAVR (early infection 24±3 vs. no infection 19±3 bpm; p<0.001).

Early infections were more prevalent in patients who showed less activity in the two days before TAVR regarding lower step count (early infection 242±360 vs. no infection 515±566; p=0.048) and high percentage of lying position during the whole day (early infection 89±12% vs. no infection 64±23%; p=0.071). Two days after TAVR, there were no significant differences in activity levels between both cohorts. Physical activity was reduced in both groups compared to the two days before TAVR, resulting in a reduced number of steps (pre-TAVR 473±546 vs. post-TAVR 267±434; p=0.039) and more daytime spent in lying position (pre-TAVR 57±19% vs. post-TAVR 73±24%; p<0.0001).

Conclusion

Wearable patch sensors are feasible to track vital signs and physical activity during hospital stay with promising opportunity for improving clinical management in TAVR patients. Early infections after TAVR are associated with decreased preprocedural mobility in high-risk patients. Therefore, these patients may be prematurely detected using wireless respiratory rate monitoring and infections prevented by intensified physiotherapy.
The R-Wave amplitude in V1 on baseline ECG correlates with the occurrence of high-degree atrioventricular block following left bundle branch block after transcatheter aortic valve replacement
Authors: Rachamim E R , Yagel O , Belhassen B , Planer D , Amir O , Elbaz-Greener G
Published: November 2023

Aims

Several procedural and ECG parameters have been associated with the occurrence of high-degree atrioventricular block (AVB) requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR). We hereunder sought to assess if the baseline R-wave amplitude in V1 ECG-lead of patients with normal QRS duration undergoing TAVR is associated with a higher patient’s risk for developing high-degree AVB following left bundle branch block (LBBB).

Methods and Results

In this retrospective single-center study in 720 consecutive patients who underwent TAVR, 141 (19.6%) patients with normal QRS duration developed a new LBBB after TAVR. The 24 (17%) patients who underwent PPI for reasons other than high-degree AVB were excluded from further analysis. In the remaining 117 study patients, 14 (12%) developed high-degree AVB requiring PPI (Group 1) while the remaining 103 (88%) patients did not (Group 2).

There were no significant differences in baseline demographic or procedural characteristics nor in PR interval, QRS duration and QRS axis between these 2 groups. The incidence of left anterior hemiblock was higher in Group 1 (3 of 14, 21.4%) than in Group 2 (9 of 103, 8.7%) but the difference was not statistically significant (p=0.156).

The R-wave amplitude in V1 was smaller in Group 1 than in Group 2 (0.029±0.04mV vs. 0.11±0.14mV, p=0.0316). In the receiver operating characteristics analysis, the cutoff for R-wave amplitude pre-TAVR was 0.03mV, area under the curve=0.7219, (p=0.0002).

Conclusion

The R-wave amplitude in lead V1 during baseline ECG in patients with normal QRS duration may predict the occurrence of high-degree AVB following new LBBB after TAVR.Figure 1.ROC AnalysisFigure 2.Representative case
Physician-to-physician universal electronic consultation program (e-consultation) in a Cardiology Department: Impact on elapsed time to cardiology care and cardiovascular outcomes
Authors: Gonzalez-Juanatey J R , Garcia Vega D , Iglesias-Alvarez D , Garcia-Acuna J M , Portela-Romero M , Rey-Aldana D , Cinza-Sanjurjo S
Published: November 2023

Background

Many health systems have initiated electronic consultation programs, although little is known about their impact on accessibility, safety and satisfaction. In 2019, we began to analyse our model1. The first results showed that it was an efficient model2 and safe, with a reduction in emergency department visits, mortality and hospitalization3. In the last 3 years we have live a lot of changes. In one hand, all models need a continuous evaluation of their results, and confirm that the outcomes are similar to the beginning. In the other hand, we lived a world pandemic and our health models have changed in these years.

In an e-consultation, the Primary Care Physician, who referred the patient, uses the shared electronic records and the Cardiologist who answer also uses the same electronic records to review all the clinical information and to send an answer. The Cardiologist can resolve directly the referral or to make an appointment with the patient in person in cases where it is necessary4.

Purpose

The aim of this study is to assess the clinical impact of the implementation of a model of ambulatory care that includes an initial electronic consultation (e-consultation), comparing it with a face-to-face single act model.

Methods

We selected patients with at least one visit to the Cardiology Service between 2010 and 2021. Using an interrupted time series regression model, we analysed the impact of incorporating the e-consultation into the healthcare model (started in 2013), evaluating: waiting time for care, hospitalizations and mortality in the first year.

Results

We analysed 61,306 patients: 66,0% attended by incorporating the e-consultation and 34,0% in the one-time face-to-face consultation model. The delay time for care in the e-consultation model (mean [SD]: 8.4 days [9.1]) was shorter than in the face-to-face model (mean [SD]: 50.6 days [72.2]), p < 0.001. The regression model for interrupted time series showed that the incorporation of e-consultation contributed a very important decrease in the delay of attention, remaining around 8 days, although with slight oscillations. The e-consultation model represented a reduction in hospitalizations (iRR [95%CI]: 0.635 [0.635-0.641]), cardiovascular hospitalizations (iRR [95%CI]: 0.857 [0.846-0.868]), Figure 1, mortality (iRR [95%CI]: 0.936 [0.923-0.951]) and cardiovascular mortality (iRR [95%CI]: 0.979 [0.964-0.996]), Figure 2.

Conclusions

An outpatient care program that includes an e-consultation has shown to reduce waiting times significantly and is a safe model with a lower rate of hospitalizations and mortality in the first year.Figure 1Figure 2
Remote heart rhythm assessment using smartphone-based photoplethysmography in primary care to detect undiagnosed atrial fibrillation in patients with chronic obstructive pulmonary disease
Authors: Khan M , Evens S E , Childe S , Hickling C , Abbott L
Published: November 2023

Introduction

Atrial fibrillation (AF) is the most common cardiac arrhythmia leading to healthcare consultation in primary care. The increased risk to develop AF when suffering from chronic obstructive pulmonary disease (COPD) has been extensively described in literature. However, it remains challenging to perform in-office, opportunistic screening for AF in COPD patients during daily routine using pulse checks or single-spot ECGs due to the increasing pressure on primary care.

Purpose

The goal of this study was to evaluate the accuracy and effectiveness of a smartphone-based photoplethysmography (PPG) technology to enable remote heart rhythm monitoring and new AF detection in patients with COPD.

Methods

Diagnosed COPD patients, without an established AF diagnosis, were identified via the electronic medical record. Patients who fulfilled these criteria and hadn’t had an ECG in the past two years were selected to take part in this study. Other inclusion criteria were access to a smartphone and the physical ability to place their fingertip on a smartphone camera. Eligible patients were contacted via text message and after providing informed consent, the study team invited them to activate a 7-day invitation code to access a medically certified smartphone application. Patients were instructed to perform PPG measurements twice daily and when experiencing symptoms. Those with possible AF based on the PPG recordings were invited for a confirmatory ECG to establish the AF diagnosis.

Results

In total, 90/270 eligible patients (30%) provided informed consent and activated the on-demand invitation code to remotely monitor their heart rhythm using a PPG-based smartphone application. Of these, 50 (55.6%) were female and the median age was 68 years old (IQR: 59-74). The newly discovered AF detection yield was 5.6% (5/90).

In-office 12-lead ECG confirmed AF in 3/5 patients (60%). The remaining patients, with a negative in-office 12-lead ECG, were invited for long-term intermittent ECG monitoring using a handheld ECG device (Zenicor). One patient accepted the proposal and paroxysmal AF was confirmed after 4 weeks of intermittent, symptom-triggered ECG monitoring. The remaining patient was not willing to perform long-term monitoring after the negative in-office ECG. However, this patient was diagnosed with paroxysmal AF as well after presentation at the emergency department while suffering from a transient ischemic attack three months after the initial AF detection using PPG technology.

Conclusion

Remote heart rhythm assessment using smartphone-based PPG in primary care within a COPD population was feasible and resulted in the detection of newly diagnosed AF in COPD patients. All patients identified with possible AF based on PPG monitoring were confirmed and diagnosed via ECG which enabled the initiation of guideline-based AF management.
Medication intake reminders via a smartphone app improve real-world adherence to oral anticoagulation in atrial fibrillation patients
Authors: Knaepen L , Delesie M , Theunis R , Gorissen P , Vijgen J , Dendale P , Desteghe L , Heidbuchel H
Published: November 2023

Introduction

Treatment with oral anticoagulation (OAC) is one of the main pillars in managing atrial fibrillation (AF). Education and intake monitoring are recommended to improve therapy adherence to OAC. Over the past few years, the importance of smart devices has increased, opening up new potential for patient education and better patient follow-up.

Purpose

We wanted to evaluate the usage of a medication module of an in-house developed application, AF-EduApp, and its effect on patients’ therapy adherence to OAC.

Methods

The AF-EduApp multicenter study included 152 AF patients. The educational AF-EduApp contains, besides other modules, a medication module with the possibility to add a medication list. Patients also had the possibility to configure pill intake reminders which they could easily tick off. Adherence was calculated as the proportion of days that the medication was correctly taken, as indicated by the patient. This was compared with adherence measured by the Electronic Medication Event Monitoring System (MEMS, Aardex Group, Liège), which formed the primary outcome of this study. The MEMS cap registered the date and time of bottle opening and was used at baseline and after 12 months, each time for a monitoring period of 3 months (M1 respectively M2). Regimen adherence was defined as the proportion of days with the correct number of openings as recorded by MEMS.

Results

The 152 patients (Age: 68.8 ±6.7 years; Time since AF diagnosis: 5.1 ±6.6 years) used the application on 130.1 ±144.7 days during a mean follow-up of 386.8 ±108.1 days. A total of 137 patients were on OAC, of whom 87 patients set a reminder for the OAC in their medication list. If based on checking off the reminder, patients had a median therapy adherence of only 5.6% (IQR: 0.2-64.3%). This contrasts with a high regimen adherence based on MEMS: in 84 patients who completed both monitoring periods, adherence was 94.5 ±7.0% at M1 and 94.1 ±6.6% at M2 (p=0.266 between M1 and M2). At M1, there was already a trend towards a significant difference in MEMS regimen adherence between patients who did or did not set a reminder (96.3 ±4.8% vs 93.1 ±8.0%, n=84; p=0.067). At M2, patients who set a reminder took their medication significantly better than those who did not (96.2 ±5.3% vs 92.6 ±7.1%; p=0.048) (Fig 1).

Conclusion

The medication module was used by most of the patients, and 63.5% installed an intake reminder for at least their OAC therapy. However, checking off reminders is rarely done and cannot be used to judge adherence. On the other hand, patients who installed a reminder had a significantly higher real-world regimen adherence for OAC compared to patients who did not set a reminder. Medication intake reminders can contribute to improving adherence to OAC therapy.MEMS based real-world regimen adherence
Smartphone for heart sound measurement in hospital: which factors affect heart sound quality?
Authors: Luo H , Li Y , Prinzen F
Published: November 2023

Background

Smartphone has recently been utilized to measure heart sounds in general population, but not in hospitalized patients.

Purpose

To explore the factors affecting the quality of heart sounds collected from the patients using smartphone in hospital.

Methods

An App was developed for Android smartphone to use the built-in microphone for measuring heart sounds on cardiac apex for 20 – 30 seconds in patients. Heart sounds were visually assessed for the presence of the first and second heart sounds and categorized into good, uncertain or bad quality. The factors affecting the percentage of good-quality heart sound recordings were analyzed, including the patients’ baseline characteristics, medical history and blood test.

Results

Among the 296 patients enrolled, 267 (90%) patients had a good-quality heart sound recording. Good-quality heart sounds were less recorded in emergency room (76%), cardiac care unit (82%), intensive care unit (87%) and neurosurgical intensive care unit (88%). Sex, body mass index, body position (supine vs. sitting), heart rate, medical history of atrial fibrillation, coronary artery disease, heart failure or chronic obstructive pulmonary disease, did not significantly affect heart sound quality (all P > 0.05). An advanced age was related to a lower percentage of good-quality heart sounds (< 60 vs. ≥ 60 years: 94% vs. 87%, P = 0.048). Heart sound quality significantly decreased with red blood cell count, hemoglobin level and hematocrit (all P < 0.001).

Conclusions

Smartphone can be used in hospital settings for measuring heart sounds in good quality, but factors such as department of hospitalization, age and blood indicators need to be considered.Central illustration
The effectiveness of virtual reality on cardiac procedure related anxiety: a systematic review and meta-analysis
Authors: Bashir Z , Misquith C , Has P , Bukhari S
Published: November 2023

Introduction

Cardiac procedures are associated with anxiety which can lead to worse outcomes1 2. However, virtual reality (VR) may offer an innovative approach of a more informative experience enhancing procedural understanding and reducing procedure-related anxiety. Previous studies have shown benefits of VR related therapies in improving anxiety related to cardiac rehabilitation and different surgical procedures3 4.

Purpose

To evaluate the effectiveness of VR in improving cardiac procedure related anxiety compared to standard of care in patients undergoing any type of cardiac procedure. PROSPERO ID CRD 42023395395

Methods

A comprehensive search strategy was used to search the online databases (MEDLINE, EMBASE, CINAHL, Web of Sciences, and COCHRANE) for randomized controlled trials (RCTs) on VR, cardiac procedures, and anxiety. Risk of bias was analyzed using revised Cochrane risk of bias tool for RCTs5. Effect estimate was reported as standardized mean difference (SMD) with a 95% confidence interval. Random effect model was used to generate effect estimate if heterogeneity was significant (I2>60%), otherwise fixed effect model was used. Sensitivity analysis was performed based on the type of anxiety questionnaire used and p-value of <0.05 was taken as statistically significant. Statistical analysis was conducted using Stata SE version 17.0 (College Station, TX, USA) and RevMan5.

Results

A total of 171 study participants were part of four studies included in the meta-analysis. Three studies were part of narrative synthesis. Mean age was between 44±11 years and 83±6.4 years. VR group did not show significant improvement in anxiety compared to standard of care (SMD 0.11, 95% CI -0.90, 1.11). However, significant improvement in anxiety was seen in VR group on sensitivity analysis after including studies that utilized validated anxiety assessment State-Trait Anxiety Inventory (STAI) questionnaire6 only ( (SMD -0.39, 95% CI -0.74, -0.05). Egger’s regression test did not identify any significant publication bias (p=0.64).

Conclusion

Our findings suggest that VR significantly improves anxiety related to cardiac procedures when assessed using validated anxiety questionnaire. Two out of three studies included in the narrative synthesis also showed improvement in anxiety levels, despite using non-standardized questionnaires. However, further studies are needed to investigate the effectiveness of novel VR technology in reducing cardiac procedure-related anxiety while comparing the use of standardized and non-standardized anxiety assessment tools.Forest Plot for Anxiety OutcomeSensitivity take-one-out analysis.
Impacts of social determinant of health on cardiovascular event and mortality risk in community-dwelling population without cardiovascular disease: results of the China PEACE million persons project
Authors: Cai A , Chen C L , Ou Y Q , Wang J B , Nie Z Q , Feng Y Q
Published: November 2023

Aim

To evaluate the impacts of social determinant of health (SDOH) on major adverse cardiovascular event (MACE) and mortality risk in community-dwelling population.

Methods

The China PEACE million persons project is a nationwide, government-funded and population-based cardiovascular disease (CVD) screening study. This was a sub-cohort study of the project that included community-dwelling adults free of CVD from Guangdong Province. Metrics of SDOH, including education attainment, economic stability, health care access, social support and environment/neighborhood, were collected using self-report questionnaires. Each favorable metric was assigned 1 point, and individuals with 0-3 points were defined as low SDOH and those with 4-5 points were defined as high SDOH. MACE (including coronary heart disease/myocardial infarction, stroke, heart failure and cardiovascular death) and all-cause death were identified by linking hospital records.

Results

Among the cohort (n=38571, median age 54 years and women 60.5%), proportion of individuals with low SDOH was 68.9%. After a median follow-up of 3.6 years, compared to the high SDOH group, the low SDOH group had significantly higher event rate of MACE (7.2% vs 5.0%, P<0.001) and all-cause death (1.6% vs 0.9%, P<0.001). After adjusted for covariates, in reference to the high SDOH group, the adjusted hazard ratio (HR) for MACE in the low SDOH group was 1.18 (95% confidence interval [CI] 1.08-1.30) and for all-cause death was 1.35 (95% CI 1.09-1.68).

Conclusion

Low SDOH was associated with an increased risk of MACE and all-cause death. Concerted efforts are needed to reduce health disparities between individuals with low versus high SDOH.Graphical abstract
Outdoor artificial light at night and cardiovascular disease in adults: a Chinese nationwide cohort study
Authors: Hu X , Ou Y , Zhou Y , Dong G , Dong H
Published: November 2023

Background

Although the electric light is a significant promotion in the human progress and civilization, its adverse effects of outdoor artificial light at night (ALAN) are being extensively studied. However, the association of outdoor ALAN and cardiovascular disease (CVD) has never been confirmed in large nationwide studies, especially in urban areas with high exposure levels and in rural areas with low exposure levels, respectively.

Purpose

To explore the association between outdoor ALAN and CVD.

Methods

This national study enrolled 12,686 adults ≥ 40 years across China. The outdoor ALAN exposure (nW/cm2/sr) with the resolution of the 500 meters around each participant's location was obtained from satellite image data via Visible Infrared Imaging Radiometer Suite day-night band on board the Joint Polarorbiting Satellite System. CVD was defined by a doctor's record of diagnoses, including heart disease and stroke. Poisson regression model and restricted cubic spline models were used to estimate the relationship between outdoor ALAN and CVD in urban and rural areas, respectively. Subgroup analysis was also conducted using Poisson models for each subgroup.

Results

At a median follow-up of 7 years, 1,732 cases of CVD were identified. The mean age of the participants was 58 years and 49% were males. In urban areas, outdoor ALAN exposure at the highest quartile (Q4) increased the incidence of CVD among participants by 34% compared to those exposure at the lowest quartile (Q1) (incident rate ratio, IRR: 1.34,95% CI: 1.07—1.69, p = 0.01), adjusting for age, sex, BMI, education, smoke ever, alcohol consumption, physical activity and household consumption. In rural areas, compared with those at the Q1 of outdoor ALAN exposure, exposure at the Q4 reduced the incidence of CVD by 17% (IRR: 0.83, 95% CI: 0.70—0.98, p = 0.028) after full adjustment. Dose-response relationship indicated that outdoor ALAN levels were linearly associated with decreased CVD in rural area (p for non-linearity = 0.370), while the association between outdoor ALAN levels and CVD was shown as an inverse "U" shape in urban area (p for non-linearity ≤ 0.001). Subgroup analysis shown that the CVD risk of middle-aged people, people with history of alcohol consumption, or people with low levels of physical activity were susceptible to outdoor ALAN exposure.

Conclusions

Outdoor ALAN exposure was associated with the risk of CVD, which was heterogeneous with different levels of exposure range. In rural areas with low outdoor ALAN exposure settings, outdoor ALAN exposure was negatively correlated with the risk of developed CVD, while the association was reverse in urban areas with high outdoor ALAN exposure settings. We call for a reduction in the use of high-intensity ALAN and to pay attention to the effects of emotional, psychological, and biological changes associated with outdoor ALAN exposure on cardiovascular health.Figure 1
Heatwaves and cardiovascular emergencies in our city, in Italy: pre-Covid-19, Covid-19 and post-Covid-19 characteristics and associated risk during heat days
Authors: Nawaro J , Gianquintieri L , Pagliosa A , Sechi G M , Caiani E G
Published: November 2023

Background

Recent research reports both direct and indirect impact of the coronavirus disease 2019 (COVID-19) on cardiovascular (CV) health. Existing case-studies mostly focus on the immediate effects, leaving the long-term consequences of the pandemic in this field as yet unrecognised.

Purpose

The aim of this study was to analyse the changes in CV emergencies’ characteristics during COVID-19 (C, 2020-21) and post-COVID-19 (post-C, 2022) periods in reference to pre-COVID-19 (pre-C, 2017-19) and to provide the associated relative risk (RR) during heat days (i.e., with apparent temperature > 95th percentile of the annual distribution) compared to non-heat days.

Methods

Ambulance dispatches for CV problems in our city, Italy during May-September in pre-C, C, and post-C were considered. Their characteristics, i.e., mean daily quantity, patients’ age and gender distribution and emergency severity (i.e., fatal, requiring transportation to a hospital, non severe) distribution were compared using Student’s t-test and Fisher’s exact test. For each period, the RR of CV emergencies during heat days in reference to non-heat days was calculated, dividing the number of emergencies in heat days by their number in randomly selected subset of non-heat days, accounting for vacation period.

Results

In total, 64,881 CV emergencies were reported. In both C and post-C, compared to pre-C, a significant reduction of around 3% in events in women, and of almost 5% in events that required transportation to a hospital, was observed (Table 1). In pre-C, the average daily number of emergencies was 72.8, reduced to 66.5 in C, and back to the pre-pandemic level (72.7) in post-C. Also, the age of patients in post-C was reduced. Interestingly, stratifying by the severity of the emergencies, significant increase in the age for fatal emergencies in both C and post-C was found, together with an age decrease for events resulting in hospital admission. The RR of having a CV emergency in heat days was similar in pre-C, C, and post-C periods (1.11 (95% CI: [1.06; 1.15]), 0.98 ([0.94; 1.03]), and 1.07 ([1.01; 1.14], respectively), with the RR being the highest for fatal emergencies, lower for non severe ones and the lowest for those requiring transportation to a hospital (Figure 1).

Conclusions

The risk of having a CV emergency is higher in heat days than in non-heat days, in particular for fatal emergencies. The COVID-19 pandemic had a significant impact on CV emergencies, including a temporary decrease in demand for the emergency medical service, also in extreme weather, and a long-term decrease in the mean age of the patients and in the fraction of emergencies requiring transportation to a hospital. Monitoring the trends in upcoming years will be crucial to fully comprehend the impact of the pandemic on CV emergency service demand, as well as of heatwaves.Table 1Figure 1
Association of prehospital tracheal intubation with outcomes comparing to supraglottic airway device during out-of-hospital cardiac arrest by drowning: nationwide cohort study in Japan
Authors: Yoshimura S , Kiguchi T , Ikeda N , Takegawa M , Nakamori N , Miyamae N , Sumida Y , Kitamura T , Iwami T
Published: November 2023

Background/Introduction

Drowning is the third leading cause of unintentional injury death, which causes more than 500,000 deaths annually worldwide. Several studies have examined the impact of tracheal intubation for outcomes in out-of-hospital cardiac arrest (OHCA) patients, however few studies examined it in OHCA patients by drowning.

Purpose

To compare survival outcomes among adults OHCA patients by drowning between tracheal intubation and supraglottic airway device.

Methods

This study compared the outcome of OHCA patients by drowning according to the airway management using Japanese nationwide, population-based registry (All-Japan Utstein Registry). From 2014 to 2020, consecutive adult OHCA patients were included. Patients who received tracheal intubation during cardiopulmonary resuscitation (CPR) were matched with patients treated with supraglottic airway device on the basis propensity scores in a 1:1 ratio, with a 0.2 caliper width. Propensity score was calculated by logistic regression model using following variables; year, prefectural preference of ETI use, age, sex, witnessed status, those who witnessed (By family, citizen, EMS, others), AED use, bystander-initiated CPR, prehospital involvement of physician, defibrillation by EMS, administration of adrenaline, time from call to CPR, first rhythm documented by EMS. The outcome measures were return of spontaneous circulation, survival at one month, and favorable neurological outcome defined as cerebral performance status 1 or 2.

Results

Of the 11, 703 eligible patients, 4467 (38.2%) and 7236 (61.8%) received tracheal intubation and supraglottic airway device during CPR, respectively. After propensity score matching, 3566 patients in each cohort were matched. The return of spontaneous circulation was higher in those with tracheal intubation compared with those with supraglottic airway device: 207/3566 (5.8%) versus 167/3566 (4.7%) (odds ratio 1.25, 95% confidence interval[CI] 1.02 to 1.55). There was no difference between the groups in one-month survival and favorable neurological outcome: 32/3566 (0.90%) versus 34/3566 (0.95%) (odds ratio 0.94, 95% CI 0.58 to 1.53), and 9/3566 (0.25%) versus 8/3566 (0.22%) (odds ratio 1.13, 95% CI 0.43 to 2.92), respectively.

Conclusions

In the propensity score matched study for adult OHCA by drowning, tracheal intubation was associated with the return of spontaneous circulation, whereas it was not associated with survival and favorable neurological outcome at one month compared to those with supraglottic airway device. Further studies such as to investigate the heterogeneity of the effect of intubation during the resuscitation might be mandated for the improvement of the outcome among the OHCA patients by drowning.Out-of-hospital cardiac arrest outcomes
Association of air quality improvement and frailty progression: A national study across China
Authors: Liu M Q , Hu X M , Ou Y Q
Published: November 2023

Introduction

More and more evidence shows that air pollution has an adverse effect on frailty. However, it’s little known about the effect of air pollution on frailty progression.

Purpose

With a strict clean air action implemented in China, we aimed to investigate whether improvements in air quality can alleviate the frailty progression.

Methods

This study involved 12891 participants with geocoded environmental data from the national wide China Health and Retirement Longitudinal Study (CHARLS) between wave 1 (2011) to wave 3 (2015). Average exposure to air pollutants (PM1, PM2.5, PM10, NO2, and O3) were estimated by satellite-based spatiotemporal approaches and matched with the residence. Air pollution improvements was defined as absolute changes of air pollutants (Δambient air pollutants = ambient air pollutants in 2011 – ambient air pollutants in 2015). Frailty progression was calculated by frailty index (FI) change (ΔFI=FI 2015-FI 2011) which was based on 53 items of the questionnaire covering physical limitations, psychological symptoms, comorbidities, history of trauma and cognitive impairment from wave 1 to wave 3. Multivariate logistic regression models were used to analyze the associations of air pollution improvements and the frailty progression, and restricted cube splines were used to exam possible nonlinear relationships between them.

Results

Compared to the lowest (Q1) quartile of PM1 exposure reduction, the highest (Q4) reduction was associated with the lowest risk for frailty progression after fully adjusting for confounders [aOR (95% CI)=0.75（0.68∼0.84）]. Similar protective effects of frailty progression were observed with the improvement of the air quality in PM2.5, PM10, and NO2 index, with aORs ranging 0.72-0.79 (Q4 vs Q1 of level reduction), while the reduction in O3 level appeared to be less related to changes in frailty progression [aOR=0.94（0.85∼1.04）]. The restricted cubic spline showed a dose response for the protective effect of improving of air quality and frailty progression.

Conclusions

The air quality improvement in PM1, PM2.5, PM10, and NO2, could alleviate the progression of frailty, while a reduction in O3 may not. This study is the first to examine the association between air pollution and the progression of frailty, sheading lights into the prevention of frailty in a national wide population.Odds ratios (95% CI) for main outcomeThe restricted cubic spline
Trends in cardiovascular care in Japan from 2010 to 2019 in relation to population density
Authors: Miyamoto Y , Kanaoka K , Nakai M , Sumita Y , Iwanaga Y
Published: November 2023

Background

As Japan faces a declining birthrate and an ageing population, it is also necessary to transfer the population from urban areas to rural areas to prevent depopulation in rural areas. On the other hand, it is necessary to verify whether cardiovascular medical care systems are equalized regardless of population density.

Purpose

The aim of this study is to describe the evolution of healthcare in Japan by population density.

Methods

This descriptive study used data obtained from the Japanese Registry of All Cardiac and Vascular Diseases database from 2010 to 2019. The nationwide 10-year trend in cardiovascular medical care systems was described in total and according to quartiles of hospitals based on population density.

Results

The number of patients admitted to cardiovascular facilities and the number of cardiologists showed a 1.26-fold and 1.18-fold increase from 2010 to 2019, respectively (P for trend <0.01 for both). The very high population density category had a lower number of hospitals and cardiology beds per population, whereas the very low population density category had a lower number of cardiologists per population. A greater increase in the number of patients was observed in the higher population density category (P for interaction<0.01). The difference in the number of hospitalized patients per cardiologist decreased among the population density categories.

Conclusion

Based on population density, the highest increase in the number of patients and cardiologists per hospital was observed in the higher population density category; however, the difference in the number of patients per cardiologist decreased among the categories.

Figure legend

Hospital-level trends in cardiovascular medical care systems according to population density. (A, B, and C) The number of patients to cardiologists according to population density. (D)