bluuebunny/crossref_metadata_2025 huggingface dataset:
Analisys of e-consults in a cardioly department. More than future
Authors: Sanchez Sanchez C , Fernandez Ruz L , Claros Ruiz J A , Delgado Prieto J L , Urbano Carrillo C
Published: November 2023

Background

Telemedicine is a new concept in the healthcare sector but due to the recent rapid technological advancements, it has been growing expeditiously, helped by the COVID-19 pandemic. In the field of cardiology, it has been gaining importance, and it can help to reduce waiting lists, which in countries like Spain can be months long. Mainly in certain procedures that do not require an anamnesis or a face-to-face physical examination by the cardiologist.

Purpose

Evaluate the main reasons for teleconsultation in our cardiology department (since its launch in 2021) from general practitioners, to develop training programs and how to optimize this type of consultation.

Methods

We conducted a retrospective study at our hospital, analyzing all teleconsultations since the cardiology program began in 2021. For each teleconsultation, we analyzed: the reason for the consultation, the response time of the cardiologist, if the patient was referred for a face-to-face consultation, and if changes were made in the treatment of the patients.

Results

We evaluated a total of 330 teleconsultations from 12 health centers whose patients corresponded to our service. The median age was 70 (±18,9) years and 55.7% were men. A growing trend in its use was observed from November 2021 to January 2023, going from 12 to 32 teleconsultations per month .The main reason for consultation was ECG doubts (47%), followed by the management of atrial fibrillation (20%) and the management of drugs in ischemic heart disease (10.6%). The rest were related to AHT control (4.5%), management of palpitations (3%) or congestion in heart failure (2%). Within the teleconsultations, 100% were resolved electronically, requiring face-to-face follow-up in only 22.4% of them. They were answered in an average of 2.1 (±2,6) days from their referral by the primary care physician and only 40% of the patients required changes in treatment. Regarding the doubts in the ECG, 73% were compatible variations from normality that did not require further follow-up. Among the questions in AF, 56% were based on doubts about anticoagulation, 13% about adverse effects in the medication, and 7% about heart rate control. 68% of teleconsultations about ischemic heart disease were about the duration of dual antiplatelet therapy.

Conclusion(s)

Teleconsultation in the field of cardiology is a very useful tool that allows contact between the cardiologist and the primary care physician in a short time without the need for the patient to attend emergency services (which are increasingly overloaded with non-urgent consultations) or wait for physical consultation for long periods of time. The field of teleconsultations should be restricted to assessments where the physical examination or patient history by the cardiologist is not essential, being limited to certain fields.
Digital follow-up program for patients undergoing atrial fibrillation ablation: a pilot single-center study
Authors: Brandao M , Teixeira R , Goncalves Almeida J , Fonseca P , Mosalina Manuel A , Ramires F , Ferreira P , Sousa M , Oliveira M , Goncalves H , Primo J , Fontes-Carvalho R
Published: November 2023

Introduction

Atrial fibrillation (AF) carries significant burden in health expenditure worldwide. Digital health technology may improve healthcare delivery, but its applicability in clinical practice and related outcomes remain a gap in evidence.

Aim

To report the implementation of a digital follow-up program (FUP) for patients submitted to AF ablation in an European center.

Methods

A digital FUP was implemented at a high-volume ablation center in 2020. The program featured a web platform for professionals, to record Clinician Reported Outcome Measurements (CROMs), during remote medical visits, and access Patient Reported Outcomes Measurements (PROMs). The program also included a mobile app for patients to report symptoms, vital signs, anthropometric and electrocardiographic data. Patients were invited to complete questionnaires at prespecified timepoints: Atrial Fibrillation Effect on qualiTy-of-life [AFEQT]; the Epworth and STOP-BANG for obstructive sleep apnea; nutritional questionnaire. Completeness rate was defined by the ratio of queries completed/queries sent at each timepoint.

The mHealth App Usability Questionnaire (MAUQ) questionnaire was sent to patients and doctors; patients also received a Patient Reported Experience Measure (PREMs) 15 days after the ablation, from which a Net Promotor Score (NPS, -100 to 100) was calculated to express user’s satisfaction. This retrospective analysis includes data collected from December 2020 to September 2022.

Results

From the 305 ablations performed in this period, 253 patients were enrolled in the digital FUP: age 60±11 years, 67% male, 78% paroxysmal AF, body mass index 27.4±4.2 kg/m2.

During a mean follow-up time of 11.9±5.8 months, 1120 CROMs were registered; 1449 PROMs were collected, including 5865 metrics reported by 90 different patients. App usage, measured by unique logins/month, was recorded in 54% of patients, of whom 13% submitted symptom checks weekly.

160 PREMs were registered; NPS scores for ablation and the app were 85.5 and 31.5, respectively [image].

Questionnaire overall completeness rate was: 54.5% for AFEQT; 14.4% for Epworth; 20.8% for STOP-BANG, that identified 55% of patients at high risk for sleep apnea. Nutritional assessment was completed by 18.7%; obese/pre-obese status was found in 21% and 48%, respectively; 18 patients were enrolled in a nutritional program.

All doctors "agreed"/"strongly agreed" to overall satisfaction with the app.

Conclusions

The digital FUP was feasible and aided comorbidities assessment. Strategies to improve patient’s engagement and digital literacy are warranted. Further studies are needed to evaluate the platform’s impact on clinical outcomes.
Detection of aortic stenosis using built-in microphones of commercially available smartphones
Authors: Altstidl J M , Altstidl T R , Anneken L , Gaede L , Eskofier B M , Achenbach S
Published: November 2023

Background

According to recent data, asymptomatic patients with severe aortic stenosis benefit from early treatment. Hence, widely applicable methods to identify patients with severe aortic stenosis in an asymptomatic state may be desirable in the future. While the diagnosis of aortic stenosis is currently based on echocardiography, population-wide use is not feasible due to resource constraints. With recent technological advances in built-in microphones of commercially available smartphones, digital auscultation may provide a viable alternative.

Methods

As part of this study, a smartphone application to perform digital auscultation was developed. To ensure high-quality recordings real-time signal analysis is implemented. The 8 kHz sampling rate of the signal encompasses all typical frequencies of cardiac auscultation while keeping resource usage minimal. To prevent frequency leakage the signal is attenuated using a Blackman-Harris window. After applying Fast Fourier Transformation to the windowed signal, frequencies around 100 Hz and 250 Hz are amplified to match the frequency response of traditional stethoscopes. The resulting signal amplitudes are then visualized. The application provides functionality for storing metadata about each patient in addition to the raw audio recordings.

To verify the feasibility of using the described application to detect severe aortic stenosis, this study aims to enroll 50 persons with no valvular heart disease and 50 persons with severe aortic stenosis. Initial audio recordings by the smartphone application and of a digital stethoscope are compared by visualizing the frequency spectrum using the Mel Frequency Cepstral Coefficients.

Results

The peaks of the first and second heart sound at around 50 Hz are both clearly identifiable, as is the crescendo-decrescendo murmur typically associated with aortic stenosis in the frequency range of 100-600 Hz (Figure 1). This is true for both smartphone and stethoscope recordings, even though the built-in microphone of smartphones results in a lower signal-to-noise ratio. Nevertheless, the quality of the signal is robust enough to clearly indicate the presence of aortic stenoses.

Conclusions

The initial findings of this study indicate that a smartphone application using built-in microphones is a promising approach for identifying severe aortic stenoses. This approach has the potential to be a reliable and cost-effective screening tool for early detection. Further development of automated algorithms may enhance the tool's effectiveness and accessibility.Figure 1
Recognition of heart failure with micro electro-mechanical sensors using commercially available smartphone, the REFLECS study
Authors: Haddad F , Saraste A , Santalahti K , Pankaala M , Kaisti M , Kandolin R , Simonen P , El Nammas W , Jafarian Dehkordi K , Koivisto T , Mahaffey K W , Blomster J I
Published: November 2023

Background

Heart failure (HF) is the leading cause of hospitalization in people over the age of 65 years. More recently, cardiac motion sensor technology has emerged as a promising technology to detect HF.

Methods

In this multicenter study, we examined whether accelerometer and gyroscope signals from motion sensors collected using commercially available smartphones can classify HF status. Participants were enrolled from Finland and the United States. Participants hospitalized with acute decompensated HF were assessed in the acute state and re-assessed in the stabilized state prior to discharge. Outpatient participants were assessed in the stable state. In a pre-specified pooled data analysis, state specific algorithms to detect HF were first derived using logistic regression and validated using boostrap aggregation method (10 repeats) followed by sensitivity analysis in participants with HF with reduced or preserved ejection fractions, participants in atrial fibrillation and according to age, sex or body mass index.

Results

A total of 217 HF participants had a total of 474 assesment: acute state = 174; stabilized state = 128; stable state = 172. 786 controls were included. The mean age of all participants with HF was 67 years, mean ejection fraction (EF) 39% and mean NT-proBNP 5778 ng/l. 74% had HF with reduced EF (HFrEF) and 38% had atrial fibrillation. Across all three HF states, the algorithm had an AUC of 0.95, sensitivity of 85%, specificity 90%, and an accuracy of 89%. The performance of the algorithm was not affected by HF state, ejection fraction, age, sex, body mass index (BMI) or presence of atrial fibrillation.

Conclusion

A simple commercially available smartphone based assessment of cardiac function with motion sensors shows distinct features in participants in decompensated, stabilized and stable HF states in comparison to controls.Heart failure detection ROC curves
Real-time interactive 3d simulation of Atrial Fibrillation for education
Authors: Finlay M , Hurmusiadis V
Published: November 2023

Background

The mechanistic understanding of atrial fibrillation (AF) has burgeoned over the past decades. However, the interplay between triggers, reentry, drivers and therapies is rarely fully appreciated despite being ultimately fundamental to patient care. Readily accessible, high-fidelity interactive simulation has the potential to address this knowledge gap across healthcare providers.

Objective

To develop a, interactive simulation system to allow deep understanding of AF mechanisms and therapies.

Methods

An application for e-Training was developed to be accessible on consumer smartphones and tablets, based on a validated electromechanical simulation model of the heart, with real-time interactive 3D image output. A virtual heart is represented in normal and arrhythmic states, enabled with simulated models for administering antiarrhythmic drugs, performing Pulmonary Vein Isolation (PVI), AV Node ablation, ventricular pacing, DC Cardioversion, plus the formation of atrial thrombus leading to a stroke event. Electrogram and ECG signals are generated from the underlying simulation and respond realistically to drugs, pacing and ablation. A self-study tutorial introduces the arrhythmia and treatment procedures. Learning outcomes are assessed with MCQ tests and receive Continuous Professional Development CPD credits.

Results

The AFib Sim app has received CPD accreditation in the UK and has so far been used at the Universities of Oxford, Cambridge and Leeds medical schools. All trainees and medical students followed the self-study tutorials and took the interactive MCQ test, which are embedded within the AFib Sim app. Development was based on Unity 3D and was made available on iOS, Android, macOS, MS Windows and WebGL platforms.

Conclusion

This project meets an urgent training need whilst expanding expertise and market scope into clinical training. The impact on clinical training was high and the societal benefit came from better and quicker trained staff.

Learning Objective

Upon completion of this session, the attendee will be able understand how a simulation of Atrial Fibrillation can be used for training and deepening the clinical understanding of atrial fibrillation.
Clinician-created video education for patients with atrial fibrillation: a randomised clinical trial
Authors: Mcintyre D , Kovoor J , Chow C K , Quintans D , Marschner S , Thomas S , Kovoor P , Thiagalingam A
Published: November 2023

Background

Improved health literacy is associated with better health outcomes.(1) Atrial fibrillation (AF) is a complex condition and patient understanding of AF is poor.(2) There is little time during routine care to provide education on AF. Clinic waiting time provides an opportunity to deliver education that improves AF knowledge and engagement with clinical care.

Purpose

Assess the efficacy and feasibility of remotely-delivered clinician-created education for patients with AF.

Methods

Single-centre randomised clinical trial (ANZCTRN 12620000729921, registered 13/07/2020) conducted in adults over 18 years of age awaiting outpatient cardiac clinic appointments with electrocardiogram-confirmed AF, CHA²DS²VASc > 0 and an active electronic mailing address or mobile phone. Those with insufficient English proficiency to comprehend video content were excluded. Eligible participants were recruited remotely and randomised 1:1 to an internet-based intervention of 4 animated videos narrated by treating cardiologists totalling 15 minutes with the option to review videos weekly, or usual care. Recruiting staff, outcome assessors and those responsible for statistical analysis were blinded to treatment allocation. The primary outcome was Jessa AF Knowledge Questionnaire (JAKQ) score (a 16-item validated questionnaire consisting of general AF and anticoagulation-specific questions(2)) at 90 days post recruitment adjusted for baseline performance, AF diagnosis, educational level, age and sex. A sample size of 200, allowing for 15% attrition and a standard deviation of 18 described previously(2) was prospectively calculated to have 90% power (2-sided, type 1 error of 5%) to detect an 8.95% difference in 90-day AF knowledge.

Results

Between November 2020 and July 2022, 208 patients were randomised (104 intervention, 104 control). Mean (standard deviation) age was 65.0 (12) years, and 65.2% were male. Most (56.2%) had paroxysmal AF and 6.4% had first episode AF. Intervention participants were more likely to correctly answer JAKQ questions at 90 days (odds ratio [OR] 1.23 [95% confidence interval (CI) 1.01, 1.49]). Highly engaged participants were more likely to have higher JAKQ scores (OR 1.46 [95% CI 1.14, 1.88] among those who watched videos on 3 or more weeks compared to control). Video satisfaction was high (figure 2). There was no significant difference in satisfaction with care or education provided in clinic OR 1.32 [95% CI 0.71, 2.44]).

Conclusions

A clinician-created, low-cost, remotely-delivered educational intervention among patients with AF awaiting cardiac clinic appointments was highly acceptable and improved AF knowledge at 90 days. Increased intervention exposure correlated with higher knowledge scores. Future delivery of this intervention could investigate impact on medication adherence, AF burden, and patient-reported quality of life outcomes.Figure 1Figure 2
Assessing the potential for precision medicine of glucose-lowering drugs in type 2 diabetes mellitus: a meta-regression analysis considering body weight variability from 120 randomized trials
Authors: Vargas K G , Ruetten T , Siemens B , Brockmeyer M , Parco C , Hoss A , Wolff G , Roden M , Kelm M , Kuss O
Published: November 2023

Background

Thus far, randomized controlled trials (RCTs) of glucose-lowering drugs reporting on treatment effects on body weight (BW) as cardiovascular risk factor in type 2 diabetes mellitus have not included precision medicine approaches. However, taking into account treatment response heterogeneity, their potential may be analyzed from published data of RCTs using meta-regression analyses. Both treatment response variation and predictors are required conditions for precision medicine to work.

Purpose

To assess the potential benefits of precision medicine by quantifying the variation of body weight as patient response to treatment, and to identify predictors which could explain this variation.

Methods

We used four recent systematic reviews on RCTs comparing pharmacological treatment of type 2 diabetes (included but not limited to sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists and thiazolidinediones) to placebo. RCTs reporting on BW at baseline and after follow-up to allow for calculation of its logarithmic standard deviation (Log(SD)) in treatment and placebo groups were included. Meta-regression models accounting for treatment means, differing sample sizes, and correlation across treatment from the same trial were used. A separate meta-regression model to evaluate interactions of treatment and individual predictor variables (age, male sex, pre-randomization BW, duration of disease, duration of treatment, year of study and drug class) was applied.

Results

120 randomized trials with a total of 43,663 participants were included. The median BW after treatment was 85.2 kg in the placebo groups and 86.2 kg in the therapy groups. A slightly greater treatment response heterogeneity was shown in the therapy groups with a median Log(SD)=2.83 compared to 2.79 from the placebo. After full adjustment in the meta-regression model the difference in BW Log(SD)s was -0.020 (95% CI: -0.063; 0.022) (Figure 1). Scatter plots adjusted for different sample sizes did not show any interaction (i.e. slope divergence) between predictors and the respective treatment (therapy or placebo). Figure 2 demonstrates this using pre-randomization BW as an example.

Conclusions

We found no major treatment response heterogeneity in RCTs of glucose-lowering drugs reporting on body weight in type 2 diabetes. In addition, none of the considered predictors were able to explain a potential variation in treatment response. The precision medicine approach may thus be of limited value in this setting.
Statin non-adherence findings from the My Experience of Taking Statin Medicines Questionnaire (mySTATINmed)
Authors: Kampouraki E , Wardman D , Mcfarlane L , Khatib R
Published: November 2023

Background

Non-­adherence to statins among patients with hyperlipidaemia is estimated to be around 50%. We designed and tested a modified version of the MYMEDS© tool (1), called The My Experience of Taking Statin Medicines (mySTATINmed) questionnaire. The aim was to identify actual and potential modifiable barriers to adherence for use in clinical practice to support patients on statins.

Methods

The mySTATINmed was integrated within SystmOne, the most commonly used primary care records system in Leeds, and was sent to patients registered with the 32 participating Leeds GP Practices via text message. Patients completed the questionnaire remotely and the response was saved within their medical records. The questionnaire explored patient perspectives on the main modifiable factors that are likely to be associated with statin non­-adherence. Five domains were included within the questionnaire; understanding and satisfaction with statins, concerns, practicalities, fitting the statin into daily routine and self-reported adherence within the last month.

Results

The mySTATINmed questionnaire was responded by 466 patients [59% males; age mean±SD (range): 65±11 (21-86) years] across 29 GP Practices in Leeds (91% of eligible). There were more males (62% v 55%), but no significant difference in age, in the adherent compared to the non-adherent group.

Overall, 57% of patients reported a high level of understanding and satisfaction with statins. Half of the respondents demonstrated some level of concern with their statin treatment. Being on too many medicines concerned 32% of statin users. The news related to statins have affected the perception of 14% of respondents. At least one practical problem was reported by 22% of patients, most commonly because they forget to bring their statin when they travel or leave home. Almost 23% of patients had some level of inconvenience fitting their statin into their daily routine and 21% reported that they sometimes forget to take their statin. The mySTATINmed detected an overall self-reported non-adherence within the last month of treatment of 27%, however 46% of participants displayed some level of actual or potential barriers to adherence based on their responses.

Around 36% felt it was not their decision to start their statin and 20% did not have the opportunity to ask questions or openly express concerns. Patients reported not having enough information about expected side effects (43%) and how statins work (41%). Adherent patients consistently demonstrated a better understanding and experience with statins (Table 1).

Conclusions

The mySTATINmed is a simple tool, integrated within SystmOne, which successfully identified many modifiable actual and potential barriers to statin adherence that can be addressed in clinical practice. It allows generation of longitudinal data, safely stored within individual medical records, to better understand modifiable barriers to statin adherence and non-adherence levels.
Mortality prediction in patient with atrial fibrillation and 0 or 1 nongender-related CHA2DS2-Vasc risk factor using machine learning: a French nationwide study
Authors: Bisson A , Lemrini Y , Romiti G F , Proietti M , Angoulvant D , Bentounes S , El-Bouri W , Lip G Y H , Fauchier L
Published: November 2023

Background

Atrial fibrillation is associated with important mortality included in patients with low or intermediate thromboembolic risk. Usual clinical risk scores are challenged in this specific population and predict only modestly mortality. Machine learning approach helps to identify new risk factors and outperform existing tools for the prediction of outcomes in atrial fibrillation patients.

Purpose

This study aimed to developpe a machine learning model for the prediction death occurrence within the year following atrial fibrillation diagnosis and to assess performances in patients with 0 or 1 nongender-related CHA2DS2-Vasc risk factor compared to previously described clinical scores.

Methods

We used for this purpose a nationwide cohort of 2,435,541 newly diagnosed atrial fibrillation patients seen in all the French hospitals from 2011 to 2019. Among 110 variables, the 18 most predictive variables were identified and selected using a Random Forest algorithm as adding any other variable did not improve prediction (Figure 1). Three machine learning models (logistic regression, random forests, deep neural networks) were trained to predict mortality within the first year on a train set (70% of the cohort). The best model was selected to be evaluate on the validation set (30% of the cohort). We finally compared our best model with previously published scores in patients with 0 or 1 nongender-related CHA2DS2-Vasc risk factor using the C index.

Results

Among atrial fibrillation patients, 373,155 (15.32%) had 0 or 1 nongender-related risk factor. Within the first year following AF diagnosis, 23,857 patients (6.39%) died after a mean time of 86 (SD 26) days. After training, the best machine learning model selected was a deep neural network with a C index of 0.915 (95% CI, 0.905- 0.925) on the validation set. Compared to traditional clinical risk scores, the deep neural network model was significantly superior to the CHA2DS2-VASc and HAS-BLED scores, and dedicated scores such as Charlson Comorbidity Index and Hospital Frailty Risk Score to predict death within the year following AF diagnosis (C indexes: 0.521; 0.633; 0.849; 0.800 respectively. P<0.0001) (Figure 2, Panel A). The ability to predict AF was improved as shown by the net reclassification index and integrated discriminatory improvement increase (P<0.0001, respectively) and decision curve analysis (Figure 2, Panel B).

Conclusion

Patients with atrial fibrillation and 0 or 1 nongender-related CHA2DS2-Vasc risk factor remain at risk of mortality within the first year of the diagnosis. A ML approach may help clinicians to better risk stratify AF patients with low or intermediate thromboembolic risk at high risk of mortality.Figure 1.Feature importanceFigure 2.ROC and decision curves
Influence of socioeconomic status on the presence of obstructive coronary artery disease and cardiovascular outcomes in patients undergoing invasive coronary angiography
Authors: Chung J
Published: November 2023

Background

Although it has been documented that low socioeconomic status (SES) is associated with increased risk of mortality and cardiovascular disease (CVD), this issue has not been addressed in patients at high CVD risk. This study was performed to investigate the association of the patient’s SES with the presence of obstructive coronary artery disease (CAD) and long-term cardiovascular outcomes who undergo invasive coronary angiography (ICA).

Methods

A total of 9,530 patients who underwent ICA for the evaluation and treatment of CAD (66.0 ± 12.3 years and 60.2% male) were retrospectively reviewed. The patients were divided into two groups according to the health insurance type: those with low SES who had the Medical aid program (Medical aid beneficiary [MAB] group; n = 1,436) and those with high SES who had the National Health Insurance program (National Health Insurance beneficiary [NHIB] group; n = 8,094). The primary outcome was a composite of cardiac death, acute myocardial infarction, coronary revascularization, and ischemic stroke.

Results

Of the study patients, 1,436 (15.1%) were in the MAB group. The prevalence of cardiovascular risk factors was higher in the MAB group compared to the NHIB group. However, the prevalence of obstructive CAD was similar between the two groups (62.8% vs. 64.2%; p = 0.306). During a median follow-up period of 3.5 years (interquartile range, 1.0-5.9 years), the incidence of the composite cardiovascular event was significantly higher in the MAB group than in the NHIB group (20.2% vs. 16.2%, p < 0.001). In multivariable Cox regression analysis, compared to the NHIB group, the MAB group was independently associated with worse clinical outcomes even after controlling for potential confounders (adjusted odds ratio, 1.28; 95% confidence interval, 1.07-1.54; p = 0.006).

Conclusions

Although CAD prevalence was similar, MABs showed an increased risk of composite cardiovascular events than NHIBs in Korean adults undergoing ICA. This provides additional evidence for the association between low SES and an increased risk of CVD, even in high-risk subjects.
An italian real-world analysis of obstructive hypertrophic cardiomyopathy through a large administrative healthcare database
Authors: Maggioni A P , Ronconi G , Dondi L , Dondi L , Calabria S , Dell Anno I , Piccinni C , Pedrini A , Esposito I , Addesi A , Martini N
Published: November 2023

Background

The obstructive hypertrophic cardiomyopathy (HCM) is still not curable. Pharmacological treatments and removal of excess cardiac tissue are recommended to manage symptoms.

Purpose

The study aimed to identify and describe patients with obstructive HCM, from the perspective of the Italian National Health Service (INHS).

Methods

From the Fondazione ReS (Ricerca e Salute) database (∼5 million inhabitants/year), adults with ≥1 in-hospital main/secondary diagnosis of obstructive HCM (ICD9-CM code: 425.1) and surgical resection between 01/01/2013 and 12/31/2018 (accrual period), were identified. They are characterized by age, sex, comorbidities and implantation of cardiac devices/revascularization performance, at the baseline. Within 2 years from 01/01/2019 (index date), mortality and related causes, pharmacological therapy (obstructive HCM-related drugs, other cardiovascular "CV" and non-CV drugs), overnight hospitalizations due to CV causes of interest (i.e., obstructive HCM/heart failure/coronary artery disease/hypertension/cerebrovascular disease), other CV, and non-CV diagnoses, local outpatient specialist care, and healthcare integrated costs charged to the INHS, were assessed.

Results

Out of 640 adults (incidence 16.2x100,000 inhabitants; 55% males; mean age 70±14) with obstructive HCM, 60 (9.4%) underwent resection. The most common comorbidities were hypertension (95%), arrhythmia (53%), and dyslipidaemia (50%). A mean of 2 implantations of cardiac devices/revascularizations are performed in 36% (229/640) patients with obstructive HCM. Within 2 years, 65/640 (10.2%) patients died. Among in-hospital deaths (40/65): 2.5% are due to obstructive HCM, 27.5% to CV and 70% to non-CV causes. During follow-up: ∼90% of patients received ≥1 obstructive HCM-related drug (∼80% β-blockers), 88% ≥1 other CV drug and ∼92% ≥1 non-CV medication. Within the 1st and 2nd follow-up years, respectively, 28% and 22% are hospitalized at least once: 14% and 10% for CV causes of interest, ∼2% for other CV events, and 17% and 13% for non-CV causes; on average, ∼10 days of in-hospital stay. From 85% to 80% of patients received ≥1 local outpatient specialist service, during 1st and 2nd years, respectively. On average, the 1st and 2nd year, respectively, the INHS spent per patient €4362 and €3791: pharmaceuticals accounted for 35% and 40% (mostly concomitant drugs), hospitalizations for 57% and 52%, specialist care for 9% and 8% of the total cost.

Conclusion

Despite the low prevalence of obstructive HCM, this study shows its high overall burden on the INHS, particularly due to concomitant pharmacological treatments and overnight hospitalizations.
Opportunistic identification of atrial fibrillation during unscheduled contact with emergency ambulance services in England: a qualitative exploration
Authors: Wilkinson C , Moloney S , Mcclelland G , Todd A , Doran T , Price C
Published: November 2023

Background

Atrial fibrillation (AF) is an important risk factor for stroke which commonly affects people attended by Emergency Medical Services (EMS). There may be an opportunity for. EMS clinicians to find new incidental cases of AF suitable for oral anticoagulation (OAC) amongst the population who do not require conveyance to hospital following urgent ambulance review.

Purpose

This study explored whether it was acceptable to propose a formal pathway for identification and subsequent referral of non-conveyed EMS patients with incidental AF to their general practitioner (GP) for consideration of OAC prescription. The perspectives of patients, paramedics, and field experts were included.

Methods

This qualitative study included four online focus groups involving 18 members of the public and one-to-one online interviews in England with 11 health care and service providers (6 paramedics, 5 field experts providing multiple expertise in cardiology, general practice, public health, academic research, healthcare policy, and primary care commissioning) between June and September 2022. A semi-structured topic guide was used, with purposive sampling to maximise the diversity of perspective and experience in all participant groups. Data were audio-recorded, transcribed anonymously and analysed thematically.

Results

All participant groups supported formalising the opportunistic detection of AF during EMS review, but each had concerns and caveats. Of paramount concern to all groups was that any change in practice must not create delays in the emergency response system since incidental AF is non-urgent and other community pathways are in place for detection and management.

Public participants were also concerned about how the diagnosis would be communicated to the patient, and opinion was split between whether this should be ‘on the scene’ or in a subsequent GP appointment. Paramedics reported that they frequently identify incidental AF, but that there is variation in practice regarding whether (and how) this is communicated to the GP. There was a concern that the finding of AF was not easily visible within the existing EMS report and may be missed. Paramedics also focussed on safety-netting of patients not being conveyed to hospital and of a need for an ‘active’ reporting process to ensure that the finding of AF was acted upon. In general, field experts felt that a formal pathway would be useful but relatively low impact, and favoured a simple intervention that did not overly complicate existing AF pathways.

Conclusions

There is support amongst the public and professionals for the development of a formal pathway to ensure ongoing follow-up and care for people with AF incidentally detected in the community by EMS. This novel case finding opportunity has the potential to improve AF detection, oral anticoagulation rates, and reduce the risk of stroke.
The role of seasonal influenza immunisation in cardiovascular care: a survey of cardiologists
Authors: Monagle S R , Spear E , Thakur U , Pol D , Tan S , Bellamy K , Hickman J , Jackson B , Chan J , Nicholls S J , Nelson A J
Published: November 2023

Background

Seasonal influenza immunisation reduces cardiovascular events by 30% in those with atherosclerotic cardiovascular disease (ASCVD) and up to 50% in those with recent acute coronary syndrome. However, uptake in high-risk patients remains poor. Clinician recommendation has been shown to increase adoption of influenza immunisation in the general population; thus, cardiologists are well-placed to promote uptake in patients with cardiovascular disease.

Purpose

To describe the attitudes and behaviours of Australian cardiologists regarding seasonal influenza immunisation.

Methods

We used an exploratory sequential mixed methods design. Semi-structured interviews of 10 cardiologists were performed to identify themes for quantitative evaluation in an online survey. Multiple choice and Likert scale questions explored (a) attitudes and behaviours regarding influenza immunisation, (b) engagement with colleagues and professional bodies and (c) preventative care in cardiology. The survey was administered to 63 cardiologists between November 2020 and January 2021 and respondents received an honorarium for their time.

Results

The majority of respondents were general cardiologists (50/63) – compared with subspecialist cardiologists, and had spent an average of 21 years in practice. Less than half of the cardiologists surveyed asked patients about their vaccination status always or most of the time (46%, 29/63). Only one quarter (25.4%, 16/63) of cardiologists recommended influenza immunisation to all of their patients while higher proportions recommended it among patients with ASCVD (49.2%, 31/63), heart failure (69.8%, 44/63) and those over the age of 65 years (68.3%, 44/63). Just over half of the cardiologists (57.1%, 36/63) agreed that influenza immunisation was important/very important for prevention of cardiac events, however this was of lower priority compared with other components of preventive care including smoking cessation (100% agreed important, 63/63), anti-hypertensives (96.8%, 61/63), statins (94.3%, 60/63), exercise (80.9%, 51/63), anticoagulants (74.6%, 47/63), SGLT2 inhibitors (69.8%, 44/63) and diet (68.2%, 43/63). Three quarters of cardiologists (76.2%, 48/63) believed that the clinician predominantly responsible for ensuring that patients received the immunisation was the general practitioner, with only a minority (12.7%, 8/63) reporting that it was the role of the cardiologist.

Conclusions

Despite a relative risk reduction exceeding that of statins and antihypertensives for patients with CVD, influenza immunisation is not prioritized or recommended by many cardiologists. Efforts at increasing awareness and advocacy among cardiologists may assist in broadening uptake among high-risk patients with cardiovascular disease.
Prospective associations of non-HDL cholesterol with premature structural and functional cardiac damage progression in British youth: the ALSPAC study
Authors: Agbaje A O
Published: November 2023

Background

Non high-density lipoprotein (non-HDL) cholesterol from childhood has been associated with signs of cardiac damage and subclinical atherosclerosis in middle age adults. Cumulative non-HDL cholesterol has been associated with subclinical atherosclerosis during growth from mid-adolescence through young adulthood. Due to the scarcity of repeated measures of cardiac structure and function, there is limited knowledge regarding the independent associations of non-HDL cholesterol with premature cardiac damage in youth.

Purpose

To investigate the longitudinal association of changes in non-HDL cholesterol with structural and functional cardiac damage progression during growth from adolescence through young adulthood.

Methods

From the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort, 1595 adolescents aged 17 years who had fasting plasma non-HDL cholesterol computed from the difference between total cholesterol and HDL cholesterol at 17- and 24-year clinic visits were included. Repeated echocardiography measured LVM indexed for height2.7 (LVMI2.7), relative wall thickness (RWT), LV diastolic function from mitral E/A ratio (LVDF), and LV filling pressure from E/e´ ratio (LVFP) were available at baseline and follow-up. LVMI2.7 ≥51g/m2.7, RWT ≥0.44, LVDF <1.5, and LVFP ≥8 were categorised as LV hypertrophy, high RWT, LVD dysfunction, and high LVFP, respectively. Multivariable adjusted associations were examined using generalized linear mixed-effect models and generalized logit mixed-effect models and adjusted for sex, and time-varying covariates measured at both baseline and follow-up such as age, insulin, high-sensitivity C-reactive protein, heart rate, systolic blood pressure, glucose, fat mass, lean mass, smoking status, family history of hypertension/diabetes/high cholesterol/vascular disease, socioeconomic status, sedentary time, light physical activity, and moderate to vigorous physical activity.

Results

Among 1595 adolescents (mean [SD] age at baseline, 17.74 [0.38] years; 955 [59.8%] females]) mean non-HDL cholesterol values increased in males from 2.34mmol/L to 2.82mmol/L and in females from 2.60mmol/L to 2.77mmol/L, over 7 years. The prevalence of LV hypertrophy increased in males from 3.6% to 11.9% and in females from 1.6% to 4% over 7 years. The prevalence of LVD dysfunction increased in males from 7.8% to 16.6% and in females from 10.3% to 15.4%. In a fully adjusted model, 1 mmol increase in non-HDL cholesterol was significantly associated with higher odds of LV hypertrophy progression (odds ratio 1.21; [95% CI, 1.11 – 1.33], p<0.0001), high RWT (1.16; [1.07 – 1.29], p=0.005), and high LVFP (1.15; [1.06 – 1.25], p=0.001) but not LVD dysfunction (1.05 [0.95 – 1.18], p=0.342), over 7 years.

Conclusion

Increased non-HDL cholesterol during growth from adolescence through young adulthood was prospectively associated with worsening structural and functional cardiac damage in asymptomatic youth.
Reduction in acute coronary events without excess out of hospital cardiac arrest during the COVID-19 lockdown of 2020 in new South Wales, Australia
Authors: Fathieh S , Madronio C , Faddy S , Negishi K
Published: November 2023

Background

The COVID-19 pandemic has seen a significant reduction in reported ACS cases, raising concerns of avoidance behaviour contributing to increased OHCA incidence; exploring this phenomenon can help identify potential mediating factors for these changes and better understand its impact on cardiovascular health.

Purpose

Australia's successful COVID-19 lockdown provides a unique opportunity to study whether it affected the incidence of ACS and OHCAs, shedding light on the impact of pandemic-related behavioural modifications on cardiovascular health.

Method

Using data from the NSW Government database for ACS and NSW Ambulance dispatch data for OHCA, along with climate, traffic, and air quality data, we estimated the excess number of cases using an interrupted time-series analysis that adjusted for seasonal variations, day of the week and temperature. As a sensitivity analysis, we also conducted a two-stage time series analysis for the excess OHCA.

Results

During COVID-19’s first lockdown period (15th March to 1st July 2020), there were reductions in both ACS (-1259 [95% CI -1530, -989]) and OHCA (-69[-235, -92]) (Fig1). In this period there was a clear changes in anthropogenic activities with reductions in traffic (5670±1380 in 2020 versus 9150±1220 in 2018 and 8640±2370 in 2019) and flights (207±169 versus 884±152 and 902±103).These reductions were accompanied with improvement in PM2.5 (5.1±2.1μg/m3 versus 9.0±3.2 in 2018 and 8.2±3.2 in 2019), PM10 (13.3±5.4μg/m3 versus 20.9±8.6 and 17.7±6.0), and NO2 (7.4±2.7 ppb versus 8.4±3.3 and 9.0±2.8) (Fig2).

Conclusion

During the first COVID-19 lockdown in NSW, there was a significant reduction in the number of ACS cases without any associated excess in OHCA. This may be caused, at least partly, by the improved air quality from the behavioural changes.Excess ACS (STEMI & NSTEMI) and OHCAChanges in Traffic and Flights Activitie
Mortality after cardiovascular surgery and percutaneous coronary intervention prior to versus during the COVID-19 pandemic
Authors: Chu A , Wang X , Paterson J M , Hillmer M , Malikov K , Lee D S
Published: November 2023

Background

The COVID-19 pandemic disrupted the usual delivery of health care services globally. However, little is known about its specific impact on cardiovascular procedure rates and outcomes.

Purpose

To compare rates of isolated coronary artery bypass graft (CABG) surgery, isolated open valve surgery (iValve) and percutaneous coronary intervention (PCI), and 30-day all-cause mortality among patients undergoing these procedures before versus during the COVID-19 pandemic.

Methods

We undertook a retrospective cohort study of patients aged 18 years and older in Ontario, Canada, comparing procedure and outcome event rates between April 1, 2018 and March 31, 2020 (pre-pandemic) with those between April 1, 2020 and March 31, 2022 (pandemic). Procedures were identified from hospital records, available for all patients hospitalized in the province, and were calculated per 100,000 population. Deaths were identified from the Ontario Health Insurance Plan Registered Persons Database. Multivariable logistic regression models were used to compute mortality rates adjusted for relevant sociodemographic and clinical characteristics. Additionally, we estimated the number of procedures needed to result in one excess death as the difference between the two periods divided by the pre-pandemic rate.

Results

During the study period, 24,823, 7,768 and 86,549 patients underwent CABG, iValve and PCI respectively. Between the pre-pandemic and pandemic periods, CABG, iValve and PCI rates declined 18.8%, 19.3% and 14.7%, respectively (Figure). Overall, the 30-day mortality rates were 1.9%, 2.4% and 2.6% following CABG, iValve and PCI, respectively. Adjusted 30-day mortality after CABG increased from 1.92 per 100 procedures (95% CI 1.69-2.15) pre-pandemic to 2.25 (2.01-2.49) during the pandemic (p=0.043). Adjusted 30-day mortality also increased among patients receiving iValve [from 2.25 (1.78, 2.71) to 3.29 (2.76, 3.82); p=0.016] and PCI [from 2.41 (2.28, 2.54) to 2.74 (2.60, 2.88); p<0.001]. These differences translate to an estimated excess of one death per 303 CABG surgeries, 96 iValve surgeries and 303 PCIs during the pandemic period.

Conclusions

In Ontario, Canada, CABG, iValve and PCI rates decreased during the COVID-19 pandemic and had not fully returned to pre-pandemic levels by two years following its initiation. While 30-day mortality rates following cardiovascular procedures significantly increased during the pandemic, the incremental number of additional deaths was small.
How reliable are single day electrocardiogram measurements to detect excessive supraventricular ectopic activity?
Authors: Maneheim A , Persson A P , Slusarczyk M , Healey J , Engstrom G , Johnson L
Published: November 2023

Background

Excessive Supraventricular Activity (ESVEA) is widely recognized as a significant risk marker for incident atrial fibrillation, but the diagnostic reliability of ESVEA measured by 24-hour electrocardiogram (ECG) is unknown.

Objectives

To study the variability of ESVEA over 14 days using mobile cardiac telemetry (MCT).

Methods

We included US patients aged 17-100 years with ≥14 full days of ambulatory full-disclosure ECG using an MCT device during 2017, without atrial fibrillation during any of the recording days. ESVEA was defined as the presence of ≥720 premature atrial complexes and/or a ≥20 beat long supraventricular tachycardia, and calculated for each recording day.

Results

The study population consisted of 9,899 patients (median age 70 (interquartile range 59-77) years, 57% female). ESVEA was very common: 45% (n= 4,453) had ESVEA on at least one day. Of the patients with ESVEA, it occurred on one day only in 28% and on all registered days in 18%. The median number of ESVEA positive days was 4 (IQR 1-12). On the first monitoring day, 20% were ESVEA positive, resulting in a sensitivity of 44.64% and a negative predictive value of 68.84% of a single day measurement of ESVEA.

Conclusions

ESVEA occurs in almost half of an MCT population, but less than half of the patients with any occurrence of ESVEA are detected on the first monitored day. Reliable diagnosis of supraventricular ectopy requires longer monitoring durations.
Global burden of myocarditis from 1990 to 2019 and projections until 2030
Authors: Chen A , Chen Z W , Xia Y , Lu D B , Yang Z , Che X Y , Qian J Y , Ge J B
Published: November 2023

Background

Myocarditis remains a major public health challenge worldwide, which might be increasing with the pandemic of coronavirus disease 2019.

Purpose

This study aimed to examine the myocarditis burden at the global level, and predict the future trend until 2030.

Methods

Incident cases, deaths, disability-adjusted life years (DALYs), and their corresponding age-standardized rates, as metrics of myocarditis burden, were obtained from the Global Burden of Disease Study 2019. The estimated annual percentage changes (EAPCs) were calculated to reveal temporal trends from 1990 to 2019. Bayesian age-period-cohort model was used to make projections.

Results

Increases were noted in incident cases (62.19%) and deaths (65.4%) of myocarditis, with a slight decrease of DALYs (-0.42%). Age-standardized death rate (ASDR) showed a stable trend over time [EAPC: -0.09, 95% confidence interval (CI): -0.38 to 0.2], decreases were noted in age-standardized incidence rate (ASIR) (EAPC: -0.23, 95% CI: -0.26 to -0.21) and age-standardized DALY rate (EAPC: -1.19, 95% CI: -1.33 to -1.04). Males bore more myocarditis burden than females. Almost a third (29.94%) of myocarditis patients resided in countries with a middle sociodemographic index (SDI). Higher ASIRs were observed in regions with higher SDI levels. People aged less than 20 years in low and low-middle SDI quintiles developed myocarditis and died from it earlier than those in other quintiles. Global ASIR and ASDR were predicted to continuously decrease until 2030.

Conclusion

These findings suggested considerable heterogeneity in the epidemiologic patterns of myocarditis, guiding the policymakers to formulate optimal strategies and resource allocation for myocarditis.Abstract Picture 1