bluuebunny/crossref_metadata_2025 huggingface dataset:
What does routine healthcare data tell us about the diagnostic pathway for older people with heart failure in Wales: under-testing, problems with access, or poor coding?
Authors: Rees E , Best V , Akbari A , Harris D , Dicken B , Ionescu A , Jones G , Halcox J
Published: October 2024

Background

United Kingdom guidelines (NICE, NG106) for suspected chronic heart failure (HF) recommend that NT pro-BNP is performed as a first-line test. The result is also used to triage individuals; when NT pro-BNP is <400ng/L, a diagnosis of HF is less likely, echocardiography (echo) and specialist assessment should be performed within 6 weeks when the result is 400-2000ng/L, and within 2 weeks if >2000ng/L. How accurately this guidance is followed in clinical practice in Wales is not known.

Purpose

To examine how the current diagnostic pathway is recorded in routinely-collected electronic health record (EHR) data for older people in Wales with a diagnosis of heart failure.

Methods

We conducted a retrospective, population-level, observational study using linked anonymised EHR data in Wales (2015-22). We included patients aged 65y+ with a HF diagnosis in their primary or secondary care records and with a minimum of 12m pre and post-diagnosis data (for assessment of diagnostic pathway). We looked back from the point of HF diagnosis for codes associated with prior cardiovascular conditions (any time prior), symptoms (within 3 years), and key diagnostic tests (within 90 days).

Results

The final cohort comprised 51,020 individuals 65y and over with a diagnosis of heart failure between 2015-2022. Incidence and prevalence of heart failure increased across the study period (1.4-1.5% and 8.5-9.1% respectively). HF diagnosis was first evident in secondary care records in 54.9%, in primary care 36.3%, and in both data sources on the same day in 8.8%. Preceding cardiovascular diagnoses included hypertension (69.5%), atrial fibrillation (36.7%), myocardial infarction (30.5%), coronary artery disease (25.7%), and valve disease (17.7%). The most common recorded symptoms preceding diagnosis were breathlessness (41.4%), ankle oedema (9.8%), and fatigue (8.8%). Searched for symptoms were not recorded in 43.8%. In the 90 days preceding the diagnosis, 7-30% had recorded NT pro-BNP with the number of tests increasing throughout the study period (Figure 1). In the 90 days prior to HF diagnosis, 28-31% had an echo recorded. NT pro-BNP was >2000ng/L in 51.8%, 400-2000ng/L in 38.6% and <400ng/L in 9.6%.

Conclusions

In Wales, a greater number of individuals with heart failure appear to be diagnosed during hospital admission, compared with primary care. Many individuals with a code for HF in their records, do not have recorded objective evidence of cardiac dysfunction. The proportion of first-line and definitive tests appears low. It is unclear whether this is because of under-referral, difficulty accessing tests in primary care, or inaccurate coding of test referrals and results. These results are important in evaluating health service delivery and workforce planning.
Development and implementation of a guideline-based decision support system for etiological diagnosis of Sustained Monomorphic Ventricular Tachycardia (SMVT)
Authors: Zheng S , Xu X W , Hu Z , Wang M , Yao Y , Li J
Published: October 2024

Background

Guideline (GL)-based decision support systems (DSSs) play a significant role in supporting physicians in their decision-making processes by providing structured clinical guidance. While these systems have shown significant success in enhancing practitioner performance and patient outcomes in general practice, their application in the context of ventricular arrhythmias remains limited. Moreover, the clinical etiological diagnosis of ventricular arrhythmias presents various challenges for healthcare professionals, such as adherence to updated diagnostic criteria and understanding of complex arrhythmia mechanisms.

Purpose

In this study, we aim to design, implement, and evaluate a guideline-based decision support systems for etiological diagnosis of sustained monomorphic ventricular tachycardia (SMVT), which could potentially address critical challenges associated with the disease diagnosis and management.

Methods

To comprehensively capture the semantics embedded in clinical guidelines, we first developed a dedicated knowledge graph tailored to the clinical decision-making. This involved extracting entities and relationships pertinent to key decision procedures from ESC guidelines for ventricular arrhythmias, clinical textbooks or literatures. Subsequently, we translated instances within the knowledge graph into archetypes within openEHR, amplifying the interoperability of clinical information. To enhance the interpretability of the DSS, we established executable diagnostic and treatment processes to offer visual representation of clinical steps in diagnosis and treatment. Ultimately, we constructed a decision support engine to implement the GL-DSS, and its effectiveness was evaluated with anonymous real-world data.

Results

The proposed GL-DSS was found to be quite feasible and could provide etiological diagnosis for SMVT. The knowledge base for the constructed GL-DDS included more than 2000 entities and relations, which played a vital role in representing disease pathogenesis. The proposed system can map the clinical entities to a set of openEHR archetypes, thus mitigate the interoperability issues of the hospital information systems and CDSS data integration. Also, this module improved system usability and ensured that guidelines could be easily translated and updated into decision support tools. Real-word medical records from 20 patient were collected for model evaluation, the results showed that the GL-DSS covered most of the entities and relations between diseases and diagnostic evidence recorded in clinical texts and achieved a diagnosis accuracy of 80%.

Conclusions

The results demonstrated that our proposed GL-DSS could completely and accurately capture the diagnostic information under the concrete EHR data. Thus, the implement decision support system could have the potential to improve clinical decision-making, patient care, and outcomes in this specialized medical domain.
Machine learning to predict incident atrial fibrillation in patients with acute stroke: FIND-AF STROKE
Authors: Nadarajah R , Wu J , Nakao Y M , Hsu J C , Helbitz A , Nakao K , Lin L Y , Gale C P
Published: October 2024

Background

Atrial fibrillation (AF)-related strokes have a high rate of recurrence, and are associated with substantial morbidity, disability, healthcare expenditure, and mortality.(1-3) Detection of AF promises opportunity to prevent recurrent stroke through conversion of antiplatelet to anticoagulant therapy,(4,5) but use of extended monitoring has cost implications.(6) Thus accurately identifying patients with stroke at high risk for AF is important but previous previous models have been developed in small, unrepresentative cohorts.(7)

Purpose

To develop and validate a simple novel decision support tool for prediction of incident AF after hospitalisation with stroke through machine learning.

Methods

We developed the model (FIND-AF STROKE) in UK secondary care and death certificate-linked primary care health record data from individuals aged ≥30 years without known AF hospitalized with a stroke or transient ischaemic attack (Jan 2, 1998 to Feb 28, 2022), randomly divided into training (80%) and testing (20%) datasets. We evaluated logistic regression and random forest models for prediction of 2-year AF risk in the testing dataset with internal bootstrap validation, and compared against the CHA2DS2VASC score. Youden index was used to set a threshold for higher and lower risk.

Results

Of 35 530 UK individuals (mean age 72.1 (SD 12.7) years, 50.9% women), 1742 (4.8%) had developed incident AF at 2 years. Using feature importance a parsimonious version of the model was created requiring only age, sex, ethnicity (white versus other) and five comorbidities.

In the testing dataset prediction performance for the random forest algorithm (area under the receiver operating characteristic (AUROC) 0.710, 95% CI 0.685 – 0.736) was superior to the CHA2DS2VASC score (0.645, 95% CI 0.617-0.672) (Figure 1).

The threshold for higher risk using the Youden index was 4.81% which resulted in a negative predictive value of 97.6%, sensitivity 0.712, specificity 0.583. Of the post-stroke patients 44% were labelled at higher risk of AF, who were older, had a higher prevalence of comorbidities, and a 3.3-fold higher incidence of AF post-stroke, than those identified as lower risk (Table 1).

Conclusions

The machine learning FIND-AF STROKE decision support tool can accurately identify individuals at risk of incident AF after stroke to enable a targeted and cost-effective approach to extended monitoring. Validation within cohorts that have undergone extended monitoring post-stroke will give a more accurate estimation of yield at different risk thresholds.Figure 1
Metaverse-based cardiac magnetic resonance simulation to overcome claustrophobia (META-MRI): a feasibility trial
Authors: Skalidis I , Arangalage D , Kachrimanidis I , Antiochos P , Olivotto I , Maurizi N
Published: October 2024

Background

Cardiac Magnetic Resonance Imaging (CMR) is crucial for diagnosing and stratifying cardiac disease, but up to 10% of patients face challenges due to claustrophobia. Conventional methods for overcoming claustrophobia have limited success. The metaverse, an immersive 3D environment using virtual and augmented reality, is under investigation for healthcare applications. A metaverse-based VR CMR simulation program was developed to assist patients with claustrophobia, but its clinical effectiveness is unexplored.

Methods

The META-MRI study involved 450 patients screened, with 32 enrolled. They were randomly assigned to intervention (Metaverse-based simulation + standard care) or control (standard care alone). The Metaverse program used a VR headset within the Aimedis metaverse platform. Training sessions occurred before scheduled CMR exams, with anxiolytic treatment when necessary. Primary endpoints included successful CMR completion, anxiety assessment using the State-Trait Anxiety Inventory (STAI), and usability through a questionnaire.

Results

Patients in the intervention group (n=16) completed Metaverse training successfully. During simulations, anxiety decreased (STAI scores: 73 ± 8 to 51 ± 11, p=0.02). Intervention group completion rate was significantly higher (81%) than the control group (37%) during real CMR exams (p=0.01). Usability scores indicated moderate satisfaction.

Discussion

The metaverse-based program significantly improved CMR completion rates and reduced anxiety levels in patients with severe claustrophobia compared to standard care alone. Traditional methods for claustrophobia have limitations, making the metaverse a promising tool. Despite promising results, further research is necessary, considering identified usability issues and economic implications.

Conclusion

This feasibility trial demonstrates the effectiveness of a metaverse-based simulation program in enhancing compliance with CMR exams for patients with severe claustrophobia. The strategy, combined with standard care, led to reduced anxiety and increased CMR completion. Further investigation with larger cohorts is required to validate these findings, addressing usability concerns and assessing the cost-effectiveness of incorporating the metaverse into routine clinical practice.Clinical and demographic characteristics
Digital devices for heart rhythm monitoring in atrial fibrillation patients scheduled for elective electrical cardioversion. Kardiover study
Authors: Benezet Mazuecos J , Alonso P , Lozano J M , Salas J , Gonzalez Lorenzo O , Rodriguez-Manero M , Narvaez I , Lozano A , Miracle A , Crosa J , Barrio I
Published: October 2024

Introduction

the management of patients with recent-onset atrial fibrillation (AF) is to achieve sinus rhythm (SR) by electrical or pharmacological cardioversion (CV). However, frequently SR is spontaneously restored, making scheduled admission and/or transesophageal echocardiogram (TEE) unnecessary and therefore causing misutilization of healthcare resources. Emerging medical technology has allowed for accurate heart rhythm monitoring.

Objective

to evaluate the diagnostic ability of a smart device ECG monitor to detect spontaneous conversion to SR in AF patients, preventing unnecessary admission and providing an earlier management.

Methods

A prospective multicenter study (Kardiover study) was designed including patients with paroxysmal, persistent or first diagnosed AF scheduled for elective electrical CV in cardiology departments of 7 hospitals in Spain. Patients were asked to submit ECG recordings to a central Corelab daily, twice a day and whenever they present symptoms, until CV (spontaneous or scheduled) and a week afterwards. Whenever a spontaneous conversion to SR was detected, investigators were contacted to confirm SR and abort admission, likewise when AF recurrence after CV was detected. Patients’ satisfaction was evaluated using a test for perceived utility and value, convenience, and accessibility.

Results

A total of 74 patients were enrolled (age 62 ± 10 years). Twenty-two patients (30%) showed spontaneous conversion to SR correctly detected by the devices. 86% of the spontaneous CV occurred during the first week. Among 52 patients admitted for CV, 45 (88%) were discharged in SR. During follow up after conversion to SR (spontaneous or electrical), recurrences of AF occurred in 24 patients (34%). At the end of the follow-up 51 patients (69%) remained in SR. Due to the early detection of spontaneous conversion to SR, a total of 22 admissions and 16 TEE were prevented and these resources used for other patients. Patients’ adherence to the protocol in regard to ECG recording transmissions was high, the CoreLab received 93% of the expected transmissions. Patient’s overall satisfaction was also high with a punctuation of 9.1 over 10 in the feedback test.

Conclusion

Digital devices for heart rhythm monitoring can optimize the management of AF patients scheduled for CV, preventing unnecessary admissions and providing a more rational use of healthcare resources.Baseline characteristicsStudy design and results
Assessing adherence to remote monitoring recommendations for cardiovascular implantable electronic devices: a retrospective analysis
Authors: Bertini M , Panchetti L , Lavalle C , La Greca C , Amellone C , Dello Russo A , Calo' L , Cocchiara L , Santobuono V E , Pepi P , Savarese G , Taravelli E , Santini L , Valsecchi S , D'onofrio A
Published: October 2024

Background

The recently published Expert Consensus Statement on the Practical Management of Remote Device Clinic offers evidence-based recommendations for managing patients with cardiovascular implantable electronic devices (CIEDs).

Purpose

This study evaluates adherence to remote monitoring (RM) recommendations in current clinical practice using data from a RM database.

Methods

According to RM guidelines, patient connectivity should be maintained. If continuous connection is ensured, it is reasonable to schedule in-person visits every 24 months, with alert-based RM potentially replacing structured intermittent device follow-up. Data from 6553 CIED patients followed on the LATITUDE (Boston Scientific) remote network at 26 Italian centers between 2010 and 2023 were analyzed. Median RM duration was 40 months (25th-75th percentile: 23-67).

Results

Enrollment of patients at centers significantly increased over the observation period (Figure). As of the January 2024 data extraction, 4723 patients had transmitted data in the last 12 months. Among these, 639 (14%) were NOT MONITORED (i.e. interrupted connectivity), with no significant differences among CIED types (Pacemaker: 13%; ICD: 12%; CRT-P: 7%; CRT-D: 13%; S-ICD: 18%). Scheduled device transmissions occurred at least once every 3 months in 96% of patients. The volume of in-office device interrogations and remote transmissions is detailed in Figure. In 2023, among the 4084 MONITORED patients, 6600 in-office device interrogations were conducted, and 64296 remote transmissions were reviewed. Of these, 34267 (53%) were scheduled, 15091 (24%) were patient-initiated, and only 14938 (23%) were triggered by alerts.

Conclusions

In current clinical practice, RM adoption is increasing, alongside the volume of in-office and remote visits. Solutions must be implemented to ensure transmission continuity in a substantial percentage of patients. Additionally, there persists a significant reliance on frequent scheduled transmissions and in-office visits. Centers stand to gain from implementing the guideline-recommended alert-based RM strategy, reducing the considerable burden of nonactionable remote and in-office visits among patients with continuous connectivity.
Feasibility of novel robot-assisted, remotely-performed echocardiographic examination
Authors: Guppy-Coles K , Johnstone M , Armstrong J , Lo A , West C , Atherton J , Scott A C
Published: October 2024

Background

Access to echocardiography services outside metropolitan areas is persistently limited. We sought to determine the feasibility and efficiency of performing remotely-controlled, semi-automated robot-assisted echocardiographic examinations (robot-assisted echo) by cardiac sonographers as a potential avenue to provide standard echocardiographic specialist services to remote and rural areas as well as permit expedited diagnoses enabling earlier management of disease.

Methods

Two accredited cardiac sonographers (Cardiac Investigations Unit) undertook 6 hours virtual training, and 10 hours hands-on robot-assisted echo simulation training; using a novel, semi-automated robotic arm system to remotely manipulate an ultrasound probe to acquire echocardiographic images. Sonographers then performed remotely-performed robot-assisted echo examinations on staff volunteers, and consenting inpatients in whom echocardiography was clinically indicated. Cameras, probe pressure sensors and an ultrasound platform remote console were utilised to support remote operation. Traditional echocardiography (manipulation of probe by hand) was also performed as a reference. Feasibility to obtain a comprehensive robot-assisted echo was compared to traditional echocardiography. Sonographer learning curve and efficiency (image acquisition time and offline measurement time) was also investigated.

Results

Total cohort was n=78 (age 51±15yrs; 57% male) with 63% patients. All participants had robot-assisted echo and traditional echocardiograms performed within 72hrs. Average feasibility (%) of robot-assisted echo as (a) 11 averaged assessments and (b) 38 averaged measures was 92±9 (a) and 86±11 (b), compared to (a) 99±1 and (b) 97±7 by traditional examination (all respectively). Sonographer learning curve was identified via 1:1 block subcohort analysis, with averaged assessment feasibility (n=33:31) being 86±19 (first block) to 98±3 (last block) and averaged measurement feasibility (n=32:31) being 77±11 (first block) to 92±7 (last block), all respectively. In the staff participant cohort (n=31), average image acquisition efficiency in robot-assisted echo was poorer than that of traditional examination (47+9 minutes compared to 19+2 minutes; p<0.0001), respectively. Average efficiency of offline measurement time was 13+7 minutes by robot-assisted echo; comparable (p=0.33) to traditional examination at 12+6 minutes. There was no learning curve effect on image acquisition efficiency; 42+10 vs 51+7 minutes (1:1; n=16:15; p=0.007).

Conclusion

Remotely-performed, robot-assisted echo using a commercially-available ultrasound platform performed by briefly-trained, cardiac sonographers is feasible, with reasonable efficiency even though less efficient in image acquisition compared to traditional echocardiograms. Further investigation of performance as a remote service is warranted in larger, clinically-indicated populations.
Smartphone motion sensor based detection of atrial fibrillation in populations referred to cardiology
Authors: Blomster J , Dehkordi K J , Tapiovaara T , Lahdenoja O , Hurnanen T , Taghavi F , Santalahti K , Pankaala M
Published: October 2024

Introduction

The motion sensors of a common smartphone when placed on chest can be used to detect vibrations caused by cardiac motion. The concept has been shown to detect atrial fibrillation (AFib) in clinical setting with 96% accuracy.

Purpose

We sought to examine how the smartphone motion sensor based AFib detection performs in various populations referred to cardiology pooled from 3 different studies addressing arrhythmias, heart failure or suspected coronary artery disease.

Methods

From a total of 1 524 patient recordings 748 recordings were from men (49%). The mean age of the patients was 64 years (range 20-94 years) and mean BMI was 28.9kg/m2 (range 15.2-63.7kg/m2). The signals were collected by placing a smartphone on chest of the patients in supine position and then analyzed with the CardioSignal solution. From the recordings two 60 second strips were analyzed. A simultaneous 5-lead or 1-lead ECG data was collected for reference. The ECG signals were analyzed for quality and rhythm diagnostics by 2 physicians blinded for the motion sensor AFib detection result. Finally, a head-to-head comparison was conducted for the motion sensor AFib detection result and the ECG data.

Results

From the 1524 patient recordings the final analysis set included 237 individuals with AFib, whereas the rest had sinus rhythm. The sensitivity to detect AFib was 91.9% and specificity 98.7%. The positive predictive value was 91.0% (88.3% to 94.2%) and the negative predictive value 98.3% (95.2% to 99.1%). The accuracy was 97.0% (94.7% to 97.7%).

Conclusions

A smartphone-based assessment of AFib using the embedded motion sensors seem to yield very good detection results, especially specificity. The accuracy of the results is comparable to available ECG and PPG based AFib detection solutions.
Engagement of adults with congenital heart disease in research: overcoming barriers relating to social deprivation
Authors: Webb-Mitchell R , Constantine A , Van Bulck L , Goossens E , Kovacs A , Luyckx K , Moons P , Dimopoulos K , Coats L
Published: October 2024

Background

In adult congenital heart disease (ACHD), social deprivation is associated with adverse health outcomes, such as increased inpatient admissions and major adverse cardiovascular events (1). Research studies on this topic often rely on patients engaging with surveys, and the characteristics of non-respondents in relation to social deprivation remain unknown.

Purpose

We assessed the association between social deprivation and response to a research survey in the ACHD population.

Methods

We included all individuals in the UK who were invited to participate in the APPROACH-IS II study (2), which assessed patient-reported outcomes in ACHD. A validated index of relative deprivation was derived from household postcodes, based on the 2019 Index of Multiple Deprivation (IMD) scores for geographic units in England (3). A lower IMD decile indicates a greater degree of deprivation. We compared patient engagement rates between 2 centres utilising different recruitment approaches: a Southern centre (South) relying on recruitment during mainly telephone or video consultations, and a Northern centre (North) recruiting patients during face-to-face clinic appointment, with the help of an ACHD clinical and research nurse specialist.

Results

In total, 593 patients were asked to take part in APPROACH-IS II in the UK: 324 patients from the Southern centre and 269 patients from the Northern centre, of whom 130(40.1%) and 209(77.7%) responded, respectively (p<0.0001). In the South, patients approached were homogeneously spread amongst IMD deciles (6.0[4.0-9.0]) and respondents were significantly less deprived (higher IMD decile) than non-respondents (7.0[5.0-9.0] vs 6.0[4.0-8.0], p=0.02). Indeed, the response rate in areas of higher deprivation (IMD decile<=4) was significantly lower than in the least deprived areas (IMD >=8) (31.3% vs 47.0%, p=0.03). In the North, the distribution of deprivation in patients was skewed towards lower IMD deciles, with a significantly higher proportion of patients from areas of higher deprivation (Figure A, 26 vs 99(30.6%) in the South, p<0.0001). There was no difference in IMD decile between respondents and non-respondents in the North (Figure B, 5.0[2.0-7.0] vs 4.0[2.0-7.0], p=0.26). When comparing patients living in the most deprived areas (IMD <=4), there was a large and significant difference in response rate between centres (p<0.0001).

Conclusions

In our population, deprivation appears to have a significant impact on the likelihood of patients engaging with clinical research. An enhanced approach, involving face-to-face contact and the involvement of a dedicated clinical nurse specialist, can improve recruitment to research studies and abolish the effect of socioeconomic status on patient engagement.Figure 1A and B
Association between life's essential 8 score and 5-year all-cause and cardiovascular mortality in people with prediabetes: based on a cohort study
Authors: Li X , Chen Y , Liu B , Liu B , Lu L , Guo R
Published: October 2024

Background

The Life's Essential 8 (LE8) score, which evaluates cardiovascular health (CVH) status, is linked to premature mortality in individuals with diabetes. However, the relationship between LE8 score and the risk of all-cause and cardiovascular mortality in individuals with prediabetes remains unclearly.

Purpose

This study aims to investigate the association between LE8 score and both all-cause and cardiovascular mortality among prediabetic patients within the United States population.

Methods

Our retrospective cohort study was based on the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2016. We selected prediabetic patients with blood glucose levels between normal and type 2 diabetes range from this database. The CVH status of these patients was categorized into low group (0-49), medium group (50-79), and high group (80-100) based on the LE8 score, which was assessed on a scale of 0 to 100. We constructed a multivariable Cox proportional hazards model to explore the relationship between LE8 score and mortality, and used restricted cubic spline curves to assess their non-linear correlation. Additionally, we conducted stratified analyses by age, gender, BMI, comorbid hypertension, and ASCVD in different populations to investigate the association between LE8 score and mortality.

Results

This study enrolled a total of 4,912 individuals with prediabetes (577 with low LE8 scores, 3,549 with medium LE8 scores, and 786 with high LE8 scores). Compared to the other groups, prediabetic patients with high LE8 scores exhibited younger age, lower BMI levels, a smaller proportion of Non-Hispanic Black individuals, higher education levels, and fewer clinical comorbidities. After adjusting for covariates using Cox proportional regression risk models, we observed that a low LE8 score was significantly associated with an increased rate of cardiovascular mortality (HR 4.13; 95% CI = 1.16-14.72) and all-cause mortality (HR 3.42; 95% CI = 1.73-6.74) in prediabetic patients. Restricted cubic splines demonstrated a linear trend between high LE8 scores and decreased risks of all-cause and cardiovascular mortality (P>0.05). Stratified analysis indicated that compared to the group with high LE8 scores, the group with low LE8 scores had a significantly higher risk of death within subgroups defined by age (≥65), gender, BMI<30, presence of hypertension, and absence of ASCVD.

Conclusions

In the American population, as the LE8 score increases, the risk of all-cause and cardiovascular mortality decreases for individuals with prediabetes over a 5-year period. Maintaining an ideal LE8 score will provide long-term benefits for individuals with prediabetes.Cox proportional regression modelRestricted cubic spline curves
Type 2 diabetes rather than the presence of significant coronary stenoses is associated with quality of life in angiographied coronary patients
Authors: Ratz M , Vogel J , Elsner P , Plattner T , Vonbank A , Mader A , Larcher B , Leiherer A , Muendlein A , Frick M , Drexel H , Saely C H
Published: October 2024

Chronic medical conditions such as type 2 diabetes (T2DM) or coronary artery disease (CAD) and their treatment have a crucial impact on patients’ daily life. The EQ-5D-5L questionnaire is a validated and widely used tool to measure the health-related quality of life (HRQL). We investigated and compared the HRQL in patients with or without T2DM and CAD.

We included 481 consecutive patients undergoing coronary angiography for the evaluation of established or suspected stable CAD in a tertiary care setting in Central Europe. Patients’ HRQL was measured using the EQ-5D-5L, comprising the EQ index calculated from the domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.

A response rate of 88.1% was achieved. From our patients, 166 (34.5%) had T2DM according to ADA criteria, and 254 (52.8%) had significant CAD with stenoses ≥50% at angiography. Patients with T2DM showed significantly lower EQ index values than patients without T2DM (0.891 [IQR=0.783-0.970]) vs. 0.943, [IQR=0.861-1.0], p=0.002)). Regarding the different dimensions of the questionnaire, patients with T2DM reported to have significantly more problems with anxiety and depression (p=0.002) and mobility (p<0.001) than non-diabetic patients. EQ index values in contrast did not differ significantly between patients with vs. those without significant CAD. Accordingly, in analysis of covariance T2DM (F=7.38, p=0.007) but not significant CAD (F=1.74, p=0.183) predicted EQ index values after adjustment for age, sex and body-mass-index.

We conclude that T2DM rather than the presence of significant CAD is associated with quality of life in angiographied coronary patients.
How can the detection of AF be improved? Insights from patient journeys and primary care clinicians
Authors: Apenteng P , Nanton V , Lobban T , Lilford R
Published: October 2024

Background

Atrial fibrillation (AF) is underdiagnosed and it is estimated that a third of people with AF remain undiagnosed. AF is complex to detect because it can be intermittent and some patients are asymptomatic. When symptoms are present they can be non-specific. In the absence of a screening programme to detect AF it is important to identify ways to improve its detection of AF in order to reduce the risk of AF-related stroke.

Purpose

We conducted a qualitative study in primary care to explore the patient path to diagnosis of AF and identify ways to improve detection

Methods

We recruited patients with a recent diagnosis of AF (< 6 months) and interviewed them to understand their path to diagnosis. We interviewed GPs and practice nurses to explore their experience of detecting AF in primary care. The interviews were audio-recorded and transcribed, and the data were analysed using framework analysis.

Results

Thirty patients and ten primary care clinicians were interviewed. The presence and nature of symptoms experienced by patients and how they interpreted these were significant in the pathways to diagnosis. Patients with acute symptoms presented to A &E and had a quick diagnosis while asymptomatic patients were diagnosed incidentally. Patients with non-specific symptoms generally did not perceive the symptoms as serious, and many delayed seeing a healthcare professional. Their experiences in primary care aligned with findings from interviews with primary care clinicians, who acknowledged AF may not necessarily be the initial suspicion when a patient presents with certain non-specific symptoms. Primary care clinicians described narratives of good practice in the form of opportunistic pulse palpation, as well as challenges of detecting AF in primary care. These included lack of access to 24-hour ambulatory ECG in primary care and limited opportunities to detect AF due to healthcare assistants taking on more responsibilities.

Conclusions

A number of opportunities to improve the detection of AF can be drawn from these findings. Public education about AF, its signs and symptoms would increase patient knowledge and presentation to healthcare professionals. Standardizing good practice of opportunistic pulse palpation in primary care and training healthcare assistants to perform this is also indicated. Access to 24-hour ambulatory ECG in primary care will reduce delays in diagnosis. Further research on which patients are likely to have undiagnosed AF will facilitate detection in primary care.
Prevecardio: a single-visit population screening model for detection and prevention of 10-year cardiovascular risk
Authors: Flores Soler J , Vila Costa I , Bengoa Terrero C , Fernandez Perez C , Garcia Gonzalez F , Bas Villalobos M , Perez-Villacastin Dominguez J , Villares J
Published: October 2024

Introduction

Cardiovascular diseases (CVDs) are a major contributor to global mortality. The early detection of cardiovascular risk factors, coupled with timely intervention strategies, is essential for CVD prevention. PreveCardio was developed as an innovative, single-visit population screening model designed to facilitate the early identification and management of cardiovascular risk factors within a population of 1 million in a European capital city region totaling 6 million inhabitants.

Purpose

This study aimed to ascertain the prevalence of cardiovascular risk factors within the general population and to evaluate the effectiveness of the PreveCardio model in estimating 10-year cardiovascular risks and promoting preventive interventions.

Methods

In this cross-sectional prevalence study, individuals aged 50 to 75 from a health network were randomly selected and invited to participate in a comprehensive health check. The 30-minute screening consisted of lifestyle evaluations, anthropometric measurements, and blood tests for lipid profiles and glycated haemoglobin. The methodology was designed to provide participants with immediate feedback on their results, cardiovascular health and practical guidance for risk management.

Results

From the 8,492 individuals solicited, 3,546 took part in the screening: 56,83% were female, mean age 61,17 ± 7,33 y.o. Picture 1 shows the population's percentages with various modifiable cardiovascular risk factors, including 20% with active smoking, 30% with sedentarism, 16% with risky alcohol consumption, 49% with non-adherence to the Mediterranean diet, 40% with overweight, and 30% with obesity. The screening revealed new diagnoses of LDL-hypercholesterolemia in 47% participants, high levels of blood pressure in hypertension range in 49%, prediabetes in 30% and diabetes in 2% (Picture 2). After use SCORE2 and SCORE-OP risk prediction algorithms, PreveCardio is estimated to potentially prevent between 39 to 202 fatal and non-fatal cardiovascular events over 10 years. Predictive modelling based on PreveCardio data projected that expanding the screening across the capital region could prevent at least 26,260 cardiovascular events over 10 years.

Conclusion(s)

PreveCardio has established itself as a viable and effective model for the early detection of cardiovascular risk factors in a general population. It holds significant promise for public health impact by potentially reducing the incidence of CVD through comprehensive screening and proactive intervention.
Practicing what you preach. Do cardiology trainees in the United Kingdom follow the lifestyle advice that they would give to patients?
Authors: Jenner W , Brown O I , Camm C F
Published: October 2024

Background

The role of lifestyle factors in determining the risk of cardiovascular disease is well established. As a result, lifestyle modification is recommended as part of numerous European Society of Cardiology guidelines. However, it remains uncertain how closely cardiologists adhere to guidelines in their personal life. Poor lifestyle among clinicians can contribute to poor health and may increase absenteeism and potentially reduce the quality of patient care.

Purpose

To establish whether cardiology trainees in the UK follow appropriate guideline-directed lifestyle advice in their personal life.

Methods

All cardiology trainees within the UK were eligible to participate in the 2023 British Junior Cardiologists' Association (BJCA) training survey and the survey was advertised through national and local campaigns. The survey contained questions on smoking status, alcohol intake, healthy diet, partaking in regular exercise, frequency of adequate quality of sleep, and demographic questions. Responders were eligible for inclusion if they consented to participate in health and wellbeing survey questions, and if they had completed four demographic questions.

Results

Of the 398 responders to the 2023 BJCA survey, 212 consented to answer health and wellbeing questions (66% male, age 34±4 years, 42% had dependents) and were included. Responders included trainees representing all four UK nations. Very few cardiology trainees were current smokers either of cigarettes/cigars (n=2, 1%), or e-cigarettes (n=2, 1%), with 12 (6%) being ex-smokers. Few trainees (n=13, 6%) consumed alcohol above the UK recommended maximum of 14 units per week (Fig 1A). However, only 14% (n=29) regularly achieved 30 minutes of moderate or 15 minutes of intense exercise on at least 5 days each week (Fig 1B). Most trainees (n=167, 80%) only obtained adequate sleep on four or fewer nights each week (Fig 1C). Only 37% (n=78) of trainees agreed or strongly agreed that they were able to maintain a healthy diet most days (Fig 1D).

Conclusions

Most UK cardiology trainees followed guidance related to smoking and alcohol intake. However, far fewer trainees followed healthy lifestyle guidance relating to exercise, sleep, and diet. Whether these findings are similar across other ESC nations should be investigated. Further work is required to establish the impact of healthy living on clinician working activity and subsequent quality of patient care. Training bodies should consider how occupational factors may contribute to a trainee’s adverse healthy living.
Association between wearable activity trackers usage and levels of physical activity among Athens Medical Society members
Authors: Lampsas S , Marinos G , Lamprinos D , Sarantos S , Gounaridi M I , Goliopoulou A , Pantelidis P , Theofilis P , Anastasiou A , Gialamas I , Kalogera S , Pililis S , Katsarou O , Siasos G , Oikonomou E
Published: October 2024

Introduction

Wearable Activity Trackers (WAT) provide real-time feedback on activity levels and play a pivotal role in fostering an active lifestyle. Moreover, WAT can encourage doctors’ awareness to be more conscious of their daily physical activity whose exercise habits range between different medical specialties.

Purpose

The aim of this study is to evaluate the influence of WAT usage on physicians’ exercise habits according to the recommendations of ESC Guidelines.

Methods

This cross-sectional study comprised 742 physicians of the Athens Medical Society (AMS), Greece. The study instrument was a self-administered questionnaire mailed in October 2023 to evaluate physicians’ usage of WAT, baseline characteristics of population, specialty, and physical exercise habits. European Society of Cardiology (ESC) Guidelines recommend at least 150 min/week of moderate-intensity exercise in all healthy adults. Subjects were divided in two groups according to their usage of WAT or not in their everyday life: 1. Daily usage of WAT (Group A); 2. No regular or even on usage of WAT (Group B).

Results

A considerably high proportion of the total population use WAT daily (38%). Between Group A and Group B there was no difference in age (49±12 years vs. 51±13 years, p=0.07), male sex prevalence (55% vs. 49%, p=0.08) and BMI (25.7± 4.6 kg/m2 vs. 25.2± 4.1 kg/m2, p=0.11). Interestingly, there was statistically significant difference in mean exercise endurance training time between Group A and Group B (301±304 min. vs. 209±268 min., p<0.001) (Figure 1) and in the proportion of the doctors who follow the ESC Recommendations (63.5% vs. 47.2%, p<0.001). Furthermore, most of the physicians who use WAT have awareness for ESC Guidelines (59% vs. 47%, p<0.001), and most of them apply diet to lose weight (36% vs. 29%, p=0.04). Finally, WAT were mostly used by 4 main specialties: Cardiology (47%), Endocrinology (44%), Surgery (35%) and Internal Medicine (25%), with cardiologists reporting the higher use (p=0.045).

Conclusion

This study underscores the widespread adoption of WAT among physicians, highlighting their potential to positively influence exercise habits and adherence to ESC Guidelines. Physicians using WAT demonstrated increased exercise endurance training time, greater awareness of ESC Guidelines, and a higher propensity to implement weight loss diets compared to non-users. Additionally, variations in WAT usage and awareness of ESC Guidelines across medical specialties emphasize the need for targeted interventions to promote physical activity and enhance overall health among healthcare professionals.
Economic evaluation of fractional flow reserve-guided versus intravascular ultrasound-guided percutaneous coronary intervention
Authors: Wang J , Hu X , Zhao T , Zhang J , Fu Z
Published: October 2024

Background

The randomized, controlled FLAVOUR trial demonstrated that the clinical outcomes of the fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) strategy were non-inferior to the intracoronary ultrasound (IVUS)-guided PCI strategy.

Purpose

This study aimed to compare the difference in economic implications and health-related quality of life between the two strategies.

Methods

A total of 890 patients with intermediate stenosis in 9 sites in China from the FLAVOUR trial were included. Direct medical costs were calculated using a combination of resource-based and event-based methods. Health utility was defined as quality-adjusted life years and assessed based on the 19-item Seattle Angina Questionnaire. The primary analysis was a cost-utility analysis. Probabilistic sensitivity, one-way sensitivity, and subgroup analyses were performed.

Results

At two years, the average total cost per patient was Chinese yuan (CNY) 36,287±19,531 in the IVUS-guided group and CNY 29,237±19,239 in the FFR-guided group (ΔIVUS-FFR=CNY 7,050, p<0.001). The difference was driven primarily by the cost of initial admission (ΔIVUS-FFR=CNY 6,284, p<0.001). Quality-adjusted life years gained showed no significant differences between the two groups (FFR vs. IVUS: 1.639±0.086 years vs. 1.638±0.128 years, p=0.872). The probabilistic sensitivity and one-way sensitivity analyses revealed robust results. The subgroup analysis found that the cost reductions attributed to FFR guidance decreased in several subgroups, including patients with diabetes and those with high anatomical complexity.

Conclusions

In patients with intermediate stenosis, FFR-guided PCI is associated with significant cost savings compared with IVUS-guided PCI at two years and shows no differences in health-related quality of life outcomes.Central Illustration
Implementing dynamic atrioventricular delay optimization for cardiac resynchronization therapy: an economic analysis in the EU5 countries
Authors: Kellmann T , Bozzari I , Furneri G , Vincenzi L , Gennaro D , Ihara Z
Published: October 2024

Background

Heart failure (HF) poses an escalating public health challenge, contributing significantly to patient morbidity, mortality and healthcare expenditures [1,2]. Cardiac resynchronization therapy (CRT) is a well-established intervention that improves functional capacity and enhances quality of life while mitigating symptoms, hospitalizations, and mortality in HF patients [3]. Nevertheless, the reaction to CRT varies among individuals; some experience positive responses and others show resistance to the therapy, with unfavourable outcomes and increased healthcare costs [4]. The introduction of the dynamic atrioventricular (AV) optimization algorithm aims to enhance CRT response by enabling dynamic optimization of the AV delay [4].

Purpose

Despite the strong clinical evidence supporting the effectiveness of dynamic AV optimization algorithm, a comprehensive assessment of its economic implications is still lacking. This study aims to evaluate the economic impact of activating dynamic AV optimization algorithm in patients undergoing CRT treatment across the Big 5 European countries (EU5; France, Germany, Spain, Italy, and the UK).

Methods

The study examines two scenarios over a 3-year timeframe: a) current scenario, where dynamic AV optimization algorithm activation is limited to a small segment of the population, and b) future scenario, where dynamic AV optimization algorithm activation is progressively expanded per year from 15% to 50%. Treatment efficacy data, measured in terms of HF hospitalization and mortality rates, were sourced from Varma et al. studies [1,4]. Hospitalization and mortality costs were extracted from national DRG tariffs and relevant literature [5–14]. It is important to note that there is no additional cost for algorithm activation if the device is already equipped with it.

Results

In this hypothetical analysis of 1,000 patients, around 30% undergo CRT implantation compatible with dynamic AV optimization algorithm activation. The treatment cost of patients with the algorithm ON is reduced by -15% compared to patients with the algorithm OFF, considering a weighted average across the EU5 countries (France: -11%, Germany: -16%, Italy: -14%, Spain -17%, UK: -16%), as shown in Table 1. The steady increase in algorithm activation led to an annual expenditure reduction equal to €21,109, calculated on the weighted average across the EU5 countries (France: €15,549, Germany: €33,753, Italy: €13,844, Spain: €20,385, UK: £13,423). When compared to the current scenario, the future scenario saved €36,468 on average across the EU5 countries. Further country-specific cost savings are shown in Table 2.

Conclusion

The conducted economic analysis gives confidence in dynamic AV optimization algorithm, positioning it as a valuable and economically sustainable asset for enhancing CRT treatment outcomes in patients with HF.