bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing stroke and mortality risk in heart failure: the CHA2DS2-VASc score's prognostic value in patients with and without atrial fibrillation - a systematic review and meta analysis
Authors: Abouzid M , Kamel I , Saleh A , Williams L , Margenat A , Hariharan R
Published: October 2024

Background

Heart failure (HF) is a common cardiovascular disorder that is linked to substantial morbidity and mortality. The CHA2DS2-VASc score, originally designed to assess the risk of stroke in patients with atrial fibrillation, has demonstrated potential as a prognostic indicator for adverse outcomes in patients with heart failure. This systematic review and meta-analysis aimed to assess the predictive accuracy of the CHA2DS2-VASc score in determining the occurrence of stroke and increased mortality rates in patients with heart failure.

Methods

A thorough search of electronic databases, such as PubMed, EMBASE, and the Cochrane Library, was performed to find pertinent papers published until the search cutoff date. Included studies examined the correlation between the CHA2DS2-VASc score and the likelihood of stroke or death in patients with heart failure. The assessment of the quality of the included studies was conducted using recognized criteria, and data were collected for quantitative synthesis.

Findings

The meta-analysis encompassed four studies (45864 patients), revealing a consistent and substantial correlation between elevated CHA2DS2-VASc scores and heightened risks of both stroke and mortality in heart failure patients. More precisely, patients with CHA2DS2-VASc scores ≥4 had a greater risk of stroke compared to those with scores <4 (odds ratio 0.38, 95% confidence interval 0.33-0.43, p-value < 0.00001). The combined data showed homogeneity (p-value = 0.24, I2 = 29%). Similarly, patients with CHA2DS2-VASc scores ≥4 had a higher risk of mortality compared to those with scores <4 (OR 0.49, 95% CI 0.30-0.80, P = 0.05). However, the combined data showed significant heterogeneity (P < 0.00001, I2 = 96%).

Conclusion

The CHA2DS2-VASc score is a useful predictive tool for identifying heart failure patients who are hospitalized and at a high risk of both stroke and high mortality. The results of this study provide evidence for the practicality of using the CHA2DS2-VASc score for risk stratification in patients with heart failure. Additional investigation is necessary to confirm these findings and examine the incorporation of the CHA2DS2-VASc score into risk assessment algorithms for tailored patient management.Figure:Risk of strokeFigure:Risk of mortality
Utility of mobile phone app-assisted screening for heart failure and heart stress in primary care
Authors: Trifunovic-Zamaklar D , Mladenovic Z , Stefanovic M , Tadic S , Apostolovic S , Maric Kocijancic J , Vranic I , Petrovic O , Milic G , Milovancev A , Filipovic T , Popovic M , Paunovic I , Neskovic A N , Stankovic I
Published: October 2024

Background

As heart failure (HF) still has a similar prognosis to some of the most common cancers, a timely diagnosis of HF is of paramount importance. We sought to determine whether a mobile phone app can facilitate screening for HF in primary care.

Material and methods

The national echocardiographic society conducted a multicenter screening programme for HF in which general practitioners from 13 primary care centres used a mobile phone app to decide whether patients without a prior HF diagnosis should be referred to one of the 6 university hospitals for transthoracic echocardiography (TTE) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing. The app would recommend further testing (TTE and NT-proBNP) to patients with symptoms potentially associated with HF, atrial fibrillation, pathologic electrocardiogram (ECG), previous myocardial infarction or exposure to cardiotoxic cancer therapies, or at least two other risk factors listed in Figure (left panel). Patients with signs of HF were not eligible for the programme. The algorithms proposed in the 2021 ESC guidelines were used to diagnose HF across the entire spectrum of left ventricular ejection fraction (EF).

Results

Of the 930 screened outpatients (mean age 66±11 years, age range 21-91 years, 61% female), 318 symptomatic patients (34.2%) were diagnosed with new HF (Figure). HF with preserved (HFpEF) was diagnosed more frequently than HF with mildy reduced (HFmrEF) and reduced EF (HFrEF). Heart stress, defined as elevated plasma NT-proBNP in asymptomatic individuals with risk factors irrespective of the presence or absence of structural heart disease or cardiac dysfunction, was found in 22.3% (Figure, right panel). In multivariate regression analysis, advanced age, atrial fibrillation, pathological ECG, long-standing history of arterial hypertension and chronic kidney disease were independently associated with HF, while other risk factors were not (Figure, middle panel).

Conclusions

Screening in primary care based on symptoms and risk factors, facilitated by a mobile phone app, resulted in a new HF diagnosis in approximately one third of screened patients, with the majority of them having HFpEF. Recalibration of the referral criteria might further improve the performance of the app for screening purposes.
Incidence of left ventricular dysfunction in the general population of the Amazon Basin and diagnostic potential of lung ultrasound
Authors: Holm A E , Wegener A , Gomes L C , Lima K O , Matos L O , Kaagard M D , Vieira I V M , Souza R M , Marinho C R F , Biering-Sorensen T , Silvestre O M , Brainin P
Published: October 2024

Background

B-lines by lung ultrasound (LUS) are associated with left ventricular (LV) dysfunction and may be useful for diagnostics in resource-limited settings.

Purpose

To assess the incidence of LV dysfunction in the general population of the Amazon Basin and to evaluate the diagnostic potential of LUS. We defined LV dysfunction as LV ejection fraction <45% and LUS was assessed across eight chest zones. B-lines were calculated as the sum of all zones.

Methods and results

We conducted echocardiography and LUS in 514 individuals from a population sample in the Amazon Basin (mean age 41 years, 40% men). No patients had known heart failure, renal insufficiency or lung disease. A total of 14 individuals (3%) had LV dysfunction, corresponding to an incidence of 27.2 per 1,000 individuals. The mean number of B-lines in the general population was 0.2 (range 0 to 17 B-lines). Individuals with LV dysfunction presented with a significantly higher number of B-lines (P=0.006) and more frequently had >=3 B-lines (8% vs 2%, P=0.018) compared to those with normal LV function. Identification of >=3 B-lines yielded a sensitivity of 58% and specificity of 93% (AUC 0.72, negative predictive value 99%, positive predictive value 19%) for detecting LV dysfunction. Per 1 unit increase in B-lines, LV ejection fraction decreased by 9% (95%CI: -15% to -3%, P=0.010) and the relationship persisted to be significant after adjusting for age, sex, body mass index, heart rate and creatinine (-8%, 95%CI: -15% to -2%, P=0.016).

Conclusion

The incidence of LV dysfunction in the Amazon Basin was 27.2/1,000 individuals and B-lines by LUS was able to detect LV dysfunction with reasonable diagnostic accuracy. Moreover, a higher number of B-lines was associated with decreasing LV ejection fraction. Our findings indicate that LUS may supplement conventional cardiac diagnostics for assessing LV function, especially in rural environments with restricted access to imaging tools.B-lines and LV ejection fraction
The added value of cardiopulmonary exercise testing in the diagnosis of heart failure with preserved ejection fraction
Authors: Massa L , Baratto C , Perego G B , Losito M , Bursi F , Parati G , Guazzi M , Caravita S
Published: October 2024

Background

Diagnosing heart failure with preserved ejection fraction (HFpEF) is challenging. Two validated algorithms, the HFA-PEFF and H2FPEF scores, have been proposed to guide our clinical practice. Many patients are categorized into an intermediate probability for HFpEF, representing a diagnostic "gray zone." This necessitates further evaluation, including right heart catheterization (RHC) at rest and possibly during exercise, to confirm or exclude the diagnosis. RHC, while informative, is resource-consuming and requires execution in specialized centers. Cardiopulmonary exercise testing (CPET) may offer a non-invasive and cost-effective alternative for differential dyspnea diagnosis.

Purpose

To evaluate the role of CPET in the diagnostic algorithm of unexplained dyspnea/suspected HFpEF.

Methods

This single-center retrospective study analyzed patients with a left ventricular ejection fraction (LVEF) ≥ 50% who underwent CPET for unexplained dyspnea from 2016 to 2020. We assessed HFpEF probability using the H2FPEF score and the HFA-PEFF algorithm. We hypothesized that specific CPET parameters (VO2 peak< 80% of predicted and/or VE/VCO2 slope > 35) might provide complementary information to the HFpEF probability scores. Additionally, we hypothesized that CPET could help identifying HFpEF in patients with intermediate probability in a subcohort of patients who underwent exercise RHC.

Results

Out of 103 patients, 61 (59%) were categorized as intermediate probability of HFpEF according to the HFA-PEFF score, and 59 (57%) according to the H2FPEF score. CPET results (VO2 peak and VE/VCO2 slope) were not associated with the pre-test probability of HFpEF as defined by either of the two scores. Exercise RHC was performed in 26 (43%) and in 27 (46%) patients with intermediate HFA-PEFF score and intermediate H2FPEF score, respectively. Among these patients with intermediate HFpEF probability, VO2 peak < 80% and/or VE/VCO2 slope > 35 had a good specificity and positive predictive value for HFpEF, as compared with exercise RHC (Table).

Conclusions

CPET provides complementary information to HFA-PEFF and H2FPEF scores. In particular, our results suggest that CPET may reclassify as HFpEF over 25% of patients with an intermediate HFpEF probability according to either the HFA-PEFF score or the H2FPEF score, potentially obviating the need for RHC. Thus, CPET might be incorporated into the HFpEF diagnostic algorithms.Table
The diagnostic value of endomyocardial biopsy in the era of precision medicine: data from over 8,000 patients with comprehensive biopsy diagnostics
Authors: Escher F , Baumeier C , Aleshcheva G , Gross U , Schultheiss H P
Published: October 2024

Background

Endomyocardial biopsy (EMB) is an important diagnostic tool for evaluating various cardiac diseases such as myocarditis and storage disorders as well as for the monitoring heart transplant patients. Despite advances in non-invasive imaging techniques to characterize myocardial tissue, EMB remains the gold standard for definitive diagnosis and initiation of specific therapy. Here we report EMB laboratory results from over 8,000 patients and demonstrate the diagnostic utility of EMB.

Methods and results

We retrospectively reviewed EMB analyses performed at our institution. EMBs for monitoring graft rejection were not included in this study. Clinical data, suspected clinical diagnoses and EMB-based laboratory results were collected. Histopathological, immunohistochemical and molecular biology biopsy findings were recorded and reviewed for degree of concordance with clinical diagnosis. In total, EMBs from N=8,085 consecutive patients with unexplained heart failure were analyzed. The comprehensive EMB analysis revealed that N=616 (7.6%) patients had cardiac storage disease, most of whom had cardiac amyloidosis (N=606). N=357 (4.4%) patients were diagnosed with acute forms of myocarditis, including N=95 cases with active myocarditis, N=148 cases with giant cell myocarditis, N=95 cases with sarcoidosis and N=19 cases with eosinophilic myocarditis. A total of N=3,392 (42%) patients were found to have inflammatory heart disease such as inflammatory cardiomyopathy and borderline myocarditis, whereby a differentiation of the inflammatory infiltrates revealed considerable differences in the quality of inflammation. Viral genomes were found in the myocardium of N=6,072 (75%) patients, with treatment-relevant viral infections detected in N=2,015 (25%) cases. The remaining N=1,705 (21%) patients were diagnosed with other cardiomyopathies, including dilated cardiomyopathy (N=1,252), heart failure with preserved ejection fraction (N=325), hypertrophic cardiomyopathy (N=117) and arrhythmogenic right ventricular cardiomyopathy (N=11).

Conclusions

This retrospective study of over 8,000 patients with heart failure clearly shows that a definitive diagnosis is only possible with a comprehensive EMB diagnosis and leads to specific therapy in 79% of the cases. In the remaining 21% of patients, infectious and inflammatory causes could be excluded in order to initiate standard heart failure therapy. It is important to emphasize here that the quality of the inflammation and therapy-relevant viral infections cannot be detected with imaging techniques, which underlines the clinical-therapeutic importance of endomyocardial biopsy.
Exploring heart failure prevalence and overlooked dimensions: a comprehensive NT Pro-BNP study in high-risk primary care patients
Authors: Celik A , Yesil E , Kilic U , Akcay Ozyurt G , Aytimur S , Demir M , Eker H N , Col A S , Ergen M , Bozkaya S , Okyay I S , Yirtar M , Korkmaz D , Kirdag A , Ozcan I T
Published: October 2024

Background

Heart failure (HF) is a prevalent syndrome linked to significant morbidity and mortality, especially in those with comorbid conditions like diabetes, hypertension, and atherosclerotic cardiovascular disease. Early detection and intervention are crucial. Natriuretic peptides, particularly NT-proBNP, are promising biomarkers for identifying at-risk individuals, but their use in primary care settings is not fully understood.

Methods

This prospective cohort study enrolled 874 participants aged 40 and above with documented risk factors for HF, such as diabetes mellitus, hypertension, metabolic syndrome, obesity, atherosclerotic cardiovascular disease, genetic variants for cardiomyopathy, or exposure to cardiotoxic agents. NT-proBNP levels were measured in blood samples collected at primary care clinics, and participants underwent comprehensive cardiac evaluations at a referral hospital. Clinical characteristics, laboratory findings, electrocardiography, and echocardiography results were recorded.

Results

The study included 874 patients with at least one risk factor for HF, with a mean age of 62.5 ± 9.1 years and 51.9% female. According to the 2022 AHA/ACC/HFSA HF Guideline, 69.1% were Stage A HF, 21.9% Stage B HF, and 9% Stage C HF. Clinical characteristics, laboratory and echocardiographic findings are shown in Picture 1. The majority had hypertension (71.1%), while other prevalent comorbidities included diabetes mellitus (43.4%), dyslipidemia (35.2%), obesity (27.1%), and atherosclerotic cardiovascular disease (26.2%). Laboratory findings showed a significant decrease in HbA1C, eGFR, LDL, triglycerides, and hemoglobin from Stage A to C HF. Median NT-proBNP levels rose from Stage A to C HF (46.4 pg/mL in Stage A, 219 pg/mL in Stage B, and 268.5 pg/mL in stage C), with 84.8% of Stage B HF patients exhibiting elevated levels. NT-proBNP levels were correlated positively with left atrial volume index, left ventricular mass index, age, E/e’, and estimated systolic pulmonary artery pressure levels. Conversely, NT-proBNP levels showed a negative correlation with estimated glomerular filtration rate and left ventricular ejection fraction. Among Stage C patients, 92.4% had HFpEF. The Picture 2 depicted the study's design and outcomes, providing a comprehensive visual representation.

Conclusion

NT-proBNP screening in primary care settings identified a substantial proportion of individuals with undiagnosed HF, particularly those in Stage B and Stage C. The high prevalence of HFpEF underscores the need for comprehensive evaluation and management strategies targeting this population. Early detection facilitated by NT-proBNP screening may lead to timely interventions and improved outcomes in individuals at risk for HF.
Serum transferrin concentration: a new prognostic biomarker in heart failure with reduced ejection fraction
Authors: Zinoune L , Bouchlarhem A , Bazid Z , Ismaili N , El Ouafi N
Published: October 2024

Introduction

Iron deficiency (ID) is a common comorbidity in patients with reduced heart failure (HFrEF), and is associated with poor clinical status and outcomes, but there is not enough data investigating serum transferrin concentration (STC) as a biomarker HFrEF to predict prognosis and mortality.

Purpose

We investigated relationship between STC at admission and all-cause mortality during follow-up in HFrEF.

Methods

We reviewed the medical data of 420 patients hospitalised in our institution for HFrEF over a period of 18 months. Laboratory tests were performed on the first 24 hours of admission. Patients were divided into two groups according to STC, using the value of 199 μg/dl as the cut-off. This value was determined from the ROC analysis to be the value with the highest sensitivity and specificity. Then we analysed relationship between STC at admission and all-cause mortality during follow-up between the two groups, after adjustment of the various variables described in the literature.

Results

Of 420 patients with HFrEF, 18.6% had STC ≤ 199 μg/dl (group 1) and 81.4% had STC > 199 μg/dl (group 2) with no difference in age and sex distribution (p = 0.873 ; p = 0.304). Patients with low STC were more likely to be diabetic (70.5% vs 46.5% ; p < 0.001), have dyslipidemia (52.6% vs 33%; p = 0.002), and history of chronic renal failure (6.4% vs 2.0% ; p = 0.045). There was no relation between STC and NYHA class (p = 0.776), hospital stay (p = 0.491) nor EF (p = 0.146). Biologically, lower STC was significantly associated with higher serum ferritin (292.77 vs 198.17 ; p < 0.001), TSAT (68.30 vs 22.21 ; p = 0.020) and C-reactive protein (CRP) (124.91 vs 39.98 ; p = < 0.001), lower plasma B-type natriuretic peptide (BNP) (5798.32 vs 6449.97 ; p = 0.002), with no difference in haemoglobin level (p = 0.272) and estimated glomerular filtration rate (eGFR) (p = 0.260). The prevalence of iron deficiency by the ESC criteria was lower in those with low STC; ferritin < 100 μg/l (15.4% vs 29.2% ; p = 0.015) or TSAT < 20% (33.3% vs 51,8% ; p = 0.004). There was no difference between the two groups in term of NYHA class and EF at three months (p = 0.87, p = 0.108). However, all-cause mortality during follow-up was significantly associated with low STC (37.2% vs 17.0% ; p <0.001). (Figure 1)

In multivariable analysis, all-cause mortality was independently associated with STC ≤ 199 μg/dl (HR 1.71; 95% CI : 1.08 ; 2.7 ; p = 0.02). This is the same finding for the ischaemic origin of HFrEF (HR 2.1 ; p = 0.001), therapeutic inertia during follow-up (HR 5.53 ; p <0.001) and EF < 36% (HR 1.03 ; p = 0.047) (Figure 2).

Conclusion

More data are required before the routine use of STC as a biomarker of prognosis in HFrEF, but it may represent a reliable and cost-effective option to predict mortality.FIGURE 1FIGURE 2
Circulating secretoneurin concentrations predict cardiovascular death in ambulatory patients with heart failure
Authors: Sze S , Squire I B , Omland T , Rosjo H
Published: October 2024

Background

Secretoneurin (SN) is a novel biomarker, which predicts cardiovascular (CV)-related mortality in patients with acute dyspnea and sepsis. Higher SN concentrations have also been found associated with all-cause death in outpatients with heart failure (HF), but whether SN primarily reflects cardiovascular (CV)-related mortality in HF outpatients is not known.

Objectives

To evaluate the relation between SN concentrations and CV- & non-CV death in ambulatory patients with HF.

Methods

We studied 184 consecutive patients who attended our HF clinic for routine follow up and had stored blood samples available for SN analysis. SN concentrations were measured with a CE-marked SN ELISA assay. We assessed the associations between SN concentrations and CV & non-CV death. Mortality was ascertained using medical records, autopsy reports and death certificates, and CV deaths included sudden cardiac deaths or mortality due to myocardial infarction, HF or stroke. We assessed association with CV & non-CV death by Kaplan-Meier curves and by Cox proportional hazard regression analysis.

Results

Median age was 76 years (range: 38-94 years) and two thirds were male. Sixty-three percent had HF with reduced ejection fraction, 22% had NYHA III/IV symptoms and median NT-proBNP was 1079 (interquartile range: 462-2347) ng/L. Median SN level was 60 (range: 21-134) pmol/L.

In multivariable linear regression analysis, impaired renal function and lower body-mass index were significantly associated with increasing (log)SN concentration.

During median follow up of 540 days, there were 18 CV deaths, including 15 HF deaths, and 7 non-CV deaths. A higher SN concentration was associated with higher risk of CV death, while we did not find statistically significant association between SN concentrations and non-CV deaths (Figure). Patients with SN concentration in the top tertile had 15-fold increased risk of CV death compared to patients with SN concentration in the lowest tertile. In multivariable Cox regression analysis that adjusted for age, NYHA functional class, frailty status, increasing SN concentrations were independently associated with CV death: hazard ratio per logSN (95% CI): 3.01 (1.02-8.90), p=0.04.

Conclusion

In ambulatory patients with HF, circulating SN concentrations were predictive of CV death. Higher SN concentrations in ambulatory HF patients seemed to be linked to impaired renal function and lower body-mass index.

Figure: Kaplan Meier curves illustrating the relation between SN tertiles and (A) CV mortality (B) Non-CV mortality.
Association of soluble ST2 with heart failure and other comorbidities in patients with severe coronary heart disease
Authors: Pec J , Tafelmeier M , Schmid C H , Maier L , Arzt M , Wagner S
Published: October 2024

Background

Circulating levels of soluble suppression of tumorigenicity-2 (sST2) reflect vascular congestion, inflammation, and fibrosis. sST2 has been proposed as a useful biomarker to predict the mortality and hospitalization due to heart failure. However, there is limited evidence regarding the relationship between sST2 and heart failure, as well as other comorbidities, in severe coronary heart disease (CAD).

Purpose

This study aims to measure the circulating levels of soluble ST2 (sST2) in a large population of patients with severe CAD to determine its association with heart failure, cardiac function, inflammation, and other important comorbidities.

Methods

This subanalysis is part of the ongoing perspective observational study. Available serum samples from 520 patients undergoing elective coronary artery bypass grafting (CABG) were analysed for sST2 levels. The inclusion criteria were written informed consent and age between 18-85 years. Exclusion criteria for this analysis were severe valvular disease, severe chronic obstructive pulmonary disease, oxygen therapy, nocturnal positive airway pressure support or mechanical ventilation, and the need for catecholamines or circulatory assist devices.

The circulating levels of human sST2 were measured from frozen serum (-80°C) using commercially available ELISA kits. The plasma was diluted 100 times to detect sST2 levels (assay range of 31.2 - 2,000 pg/mL). Two measurements were taken to account as means for intra-assay variabilities. Logarithmic transformation was used to convert non-normal distributed data. Student t' test and linear regression were applied to categorical or continuous variables as appropriate.

Results

sST2 levels (median 20.4 ng/ml, [IQR 15.5 – 28.8]) significantly predict worse left ventricular ejection fraction (β = -0.164, p = 0.006), and significantly correlate with levels of NT-proBNP (β = 3.263, p < 0.001), hs-Troponin T (β = 3.391, p < 0.001), high-sensitivity C-reactive protein (β = 2.472, p = 0.014) and heart failure (p= 0.002). Interestingly, common comorbidities such as chronic kidney disease (estimated glomerular filtration rate < 60 mL/min/1.73 m2, p = 0.004), diabetes mellitus (p = 0.001) and higher levels of glycated haemoglobin (HbA1c, β = 3.615, p < 0.001) showed also a significant association with sST2 levels. No significant association of sST2 was observed with arterial hypertension (p = 0.190), atrial fibrillation (p = 0.289), obesity (BMI ≥ 30 kg/m2, p = 0.302), sleep apnoea (apnoea-hypopnoea index ≥ 15/h, p = 0.068), peripheral artery disease (p = 0.823), or previous stroke (p = 0.861).

Conclusion(s)

Circulating levels of sST2 significantly correlate with heart failure, NT-proBNP, hs-TnT, and hs-CRP in patients with severe CAD. Additionally, sST2 levels were found to be elevated in patients with diabetes mellitus and chronic kidney disease.
Albuminuria is associated with progression of diastolic dysfunction in patients at risk for cardiovascular disease
Authors: Min K D , Matsumoto Y , Asakura M , Ishihara M
Published: October 2024

Background

The number of the patients with heart failure with preserved ejection fraction (HFpEF) is increasing as society ages, which indicates that the number of pre-HFpEF patients is increasing even more. To combat this sociomedical burden, it is critical to establish cost-effective and simple biomarkers to identify the high-risk population at early phase of the disease. Recent studies demonstrated the association between albuminuria and incident heart failure, but the prognostic impact of albuminuria on diastolic dysfunction, an early phenotype of HFpEF, has not been elucidated.

Purpose

To examine the impact of albuminuria on the diastolic function over time in the patients with cardiovascular risks.

Methods

One hundred and fifty-eight patients with at least one cardiovascular risk factor without history of heart failure were followed up for 5 years. Echocardiogram was conducted at baseline, year 3, and year 5. Diastolic dysfunction was defined as E/e’ >14. Albuminuria was defined as urine albumin-to-creatinine ratio (UACR) 30 ≧mg/gCre. The patients with ejection fraction <40% and those had diastolic dysfunction at baseline were excluded from the study. The relationship between albuminuria at baseline and diastolic function at year 3 and 5 were investigated.

Results

Among 158 subjects, 27 showed albuminuria at baseline and the prevalence of hypertension, dyslipidemia, and diabetes was not significantly different between patients with and without albuminuria. The baseline E/e’ tended to be higher in patients with albuminuria, although the difference was not statistically significant (Fig1: E/e’ = 10.0±2.4 vs. 9.4±2.2, p = 0.08) . However, the patients with albuminuria showed a steeper increase in E/e’ than those without albuminuria, and the significant difference was observed at year 3, that was even greater at year 5 (Fig1: E/e’ = 11.1±2.8 vs 10.0±2.6, p = 0.04 in year 3, E/e’ = 12.5±4.1 vs 10.3±2.9, p = 0.002 in year 5, respectively). Furthermore, log UACR at baseline showed significant correlation with E/e’ at year 5 (p = 0.02, r = 0.21) and normo-, micro-, and macroalbuminuria (UACR<30, 30-300, and >300mg/gCre, respectively) at baseline showed elevated E/e’ at year 5 in this order ( p = 0.01 for UACR<30 vs. 30-300mg/gCre, and p = 0.04 for UACR<30 vs. >300mg/gCre, reapectively ). The prevalence of incident diastolic dysfunction increased greater in patients with albuminuria throughout the follow-up period and the difference reached statistical significance at year 5 (Fig2: 18.5% vs. 9.2%, p = 0.28 for year 3, and 25.9% vs. 8.4%, p = 0.009 for year 5, respectively).

Conclusion

In the patients with cardiovascular risk factors, albuminuria was associated with development and progression of diastolic dysfunction over subsequent 5 years. Future prospective study is warranted to investigate the effectiveness of albuminuria-directed care to prevent development of HFpEF.
Exploring vocal biomarkers as non-invasive fine-tuning assays of cardiovascular health: heart failure model
Authors: Yilmaz M B , Durmus M , Yilmaz R E , Polat Z P , Colakoglu S
Published: October 2024

Background

Mobile health (mHealth) technologies offer a promising avenue for non-invasive heart failure monitoring through vocal biomarkers. The relationship between feature changes in anonymous and standardized voice recordings of heart failure patients and the NYHA scores of the same patients is assessed, aiming to identify vocal biomarkers as delicate indicators of chronic noncommunicable disease progression and/ or fluctuation.

Methods

In a cardiology outpatient setting, 55 chronic heart failure patients provided voice recordings via a mobile app, performing specific vocal tasks prospectively. We analyzed waveforms visually via Mel spectrograms and extracting features by audio processing, focusing on chroma centroids and tonnetz measurements across 147 clinical and laboratory parameters (Mean NYHA: 2.62, SD: 0.56). Applying Ordinary Least Squares (OLS) test, we assessed the relevance of spectral bandwidth mean (0.04), spectral bandwidth std (0.00), spectral roll-off std (0.011) between NYHA scores, given each p-score < 0.05.

Results

147 voice recordings taken from 55 patients were analyzed to examine whether there were any correlations between changes in the voice recordings and NYHA scores. OLS test underscored the significance of spectral bandwidth mean (0.04), spectral bandwidth std (0.00), spectral roll-off std (0.011) between NYHA scores with p-value < 0.05. These findings show the potential role of multiple vocal features in reflecting heart failure progression and/or fluctuation. Analysis based on the clinical status progression from NYHA 2 to NYHA 3 over time showed notable changes in chroma centroids (mean = 0.006, std = 0.174, skew = 0.179, kurtosis = 0.205) and tonnetz (mean = 0.023, std = 0.131, skew = 0.023, kurtosis = 4.247).

Conclusion

This investigation highlights vocal biomarkers' potential in heart failure management, offering insights into non-invasive monitoring techniques and shows the importance of standardised recording procedures and patient engagement for data integrity. Future directions include quantifying vocal changes' correlation with clinical status and integrating additional parameters (e.g., edema, weight) to enhance predictive models for personalised care.Vocal features according to NYHA scores
Tackling Health Inequalities in Times of Crisis
Authors:   Organised by: EuroHealthNet
Published: October 2024

Across Europe, people are grappling with a multitude of challenges, spanning from the cost of living to housing, food insecurity, climate change, conflicts, and social unrest. These adversities significantly impact individuals’ health and wellbeing, and create the conditions for persisting health inequalities. At the root of these crises are unjust economic systems, in which the privileged few benefit while the majority face difficulties on a daily basis.

Societies across Europe are witnessing rising polarisation and discrimination. Competitiveness and security are emerging as key priorities in the new European political landscape, with health and wellbeing pushed to the sidelines.

Tackling health inequalities in times of crisis requires urgent, targeted action across societal sectors and levels. Education emerges as a crucial equaliser, alongside income and social safety nets. Moreover, effective climate strategies must prioritise the needs of the most vulnerable population groups.

This plenary session lays the groundwork for understanding our contemporary, rapidly evolving landscape and its implications for addressing health inequalities. What lessons can we draw from new approaches across sectors that meet social and health needs, and how can we navigate these challenges – and sail those waves of innovation – to ensure equitable health and social justice for all?

Moderators

Caroline Costongs

Director EuroHealthNet

Cristina Abreu Santos

Vice-President Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Portugal

Keynote speakers

Fran Baum

The Stretton Institute, The University of Adelaide, Australia (by video message)

Katarina Ivanković Knežević

Director for Social Rights and Inclusion, Directorate-General Employment, Social Affairs and Inclusion, European Commission

Panellists

Didier Jourdan

UNESCO Chair and WHO Collaborating Centre ‘Global Health and Education’, University of Clermont-Auvergne, France

Jill Litt

Professor of Environmental Health in the Environmental Studies Programme, University of Colorado, USA and Senior researcher, Barcelona Institute of Global Health (ISGlobal), Spain
Reducing obesity and overweight: Subregional Policy Dialogues in the WHO European Region
Authors: Williams J , Spiroski I , Heinen M , Whiting S , Rakovac I , Wickramasinghe K
Published: October 2024

In the WHO European Region, obesity and overweight stand as leading causes of disability and premature mortality. They contribute significantly to the burden of noncommunicable diseases, hindering efforts to achieve sustainable development goals related to health, including SDG goal 3.4, aiming to reduce premature mortality from NCDs by one-third by 2030. Despite some policy successes such as sugary drinks taxes, restrictions on marketing unhealthy products to children, and physical activity promotion campaigns, no country has managed to halt the rising levels of obesity. Addressing obesity requires a comprehensive approach, and WHO endeavors to support countries in implementing a wide range of policy actions across various settings. The WHO Special Initiative for NCDs and Innovation has recently adopted a subregional approach to promote evidence-based, data-informed policy action. In June 2022, it organized a series of obesity dialogues, including sessions for the Western Balkans. This session will outline the methods and outcomes of these dialogues, including stakeholder engagement, presentation of the latest obesity data, evidence-based policy recommendations, and the process of prioritizing policy options with decision-makers. It will consider the lessons learned from this process, offering insights not only for the health agenda but also for addressing other complex public health, environmental, or social challenges, which require multisectoral collaboration and comprehensive, policy actions on many levels.
Diet Impact Assessment model: an interactive tool for analysing the health, environmental and affordability implications of diets
Authors: Springmann M
Published: October 2024

Global diets, environmental factors, and health require a holistic approach in public health discourse that takes into account the well-being of both humans and planetary health. Modeling tools have demonstrated being useful to estimate priorities and differences between countries and gain insight into future paths that depend on predetermined priorities. Modeling efforts that include environmental goals indicate the possibility of reducing environmental impacts while both improving food quality and overall health outcomes, especially in high-income settings. The aforementioned forecasts highlight the effectiveness of giving priority to dietary recommendations that lead to better, balanced patterns as the most effective approach to reducing mortality risks and environmental implications. The presentation will introduce the Diet Impact Assessment (DIA) model - a new interactive modelling tool for analysing the health, environmental and affordability implications of diets and dietary change. The tool enables countries to analyse user-specific scenarios of dietary change, and to estimate the health, environmental and cost burden of each scenario in terms of diet costs, avoidable deaths, changes in resource use and compatibility with global environmental targets, including those associated with food-related greenhouse gas emissions, land use, water use and fertilizer application. The tool was commissioned by the WHO Regional Office for Europe and is based on analytical frameworks developed by Marco Springmann and colleagues.
Maternal near-miss and mortality associated with being referred: a case control study in Luanda
Authors: Castelo M , Campos P , Magalhães P , Teixeira C
Published: October 2024

Background

Understanding of determinants of severe maternal morbidity is crucial for reducing Maternal Near Misses (MNM) and Maternal Deaths (MD). We aimed to assess whether being referred from lower level to tertiary-level hospitals is a determinant of MNM and MD in Luanda, capital of Angola.

Methods

A facility-based case control study was conducted (June-September 2022) at 2 referral hospitals in Luanda. Consecutive sampling for the cases (women admitted with life-threatening conditions) and systematic sampling for the controls (women admitted for vaginal delivery) was used. Cases were classified by the outcome at discharge: MD or MNM. Multivariate multinomial regression was conducted to assess whether being referred is associated with MNM and MD (controls as reference). Sociodemographic, clinical and obstetric factors and circumstances at admission related with MNM or MM (p-value <0.05) were included in the models. Reduced models (forward technic) were fitted for obtaining adjusted odds ratio (AOR) and respective 95% confidence interval (95%CI).

Results

Data from 331 cases (245 MNM and 86 MD) and 662 controls were analyzed and bivariate analysis revealed large differences between groups in regards to the sociodemographic, clinical and obstetric characteristics and circumstances of admission. The proportion of being transferred from another facility was 7.9%, 51.0% and 65.1% among controls, MNM and MD, respectively. After adjusting for pre-existing diseases during pregnancy, previous cesarean section and delay in seeking care, being referred from another facility increased the odds of MNM (AOR=10.97; 95%CI: 7.19-16.75) and MD (AOR=18.89; 95%CI: 10.50-33.89).

Conclusions

According to our findings, being referred from lower level facilities is a strong determinant of MNM and MD. Strategies for improving lower level of healthcare services and the referral system for pregnant women could have a positive impact on prevention of MNM and MD in our setting.

Key messages

• Awareness should be given to the conditions of maternal transfer from lower level to tertiary level hospitals in Angola.

• Public health strategies should address the quality of maternal care at primary and secondary level hospitals, before maternal transfer, as well as, the maternal referral system in this setting.
Home and leisure accidents among children and young people up to 19 years old as an event observed in the EU-IDB surveillance system: 2012-2021 data
Authors: Alves T , Giustini M , Papadakaki M , Nijmans S , Valkenberg H , Silva S , Braz P , Matias-Dias C
Published: October 2024

Paediatric injuries are widely acknowledged as a major public health issue among different medical disciplines. In the context of injuries and accidents, the surrounding environment of children and young people remains a major health concern. The present study was developed to extend current knowledge on the characteristics and magnitude of home and leisure accidents in this population. A descriptive, observational, cross-sectional study was developed under the EU-IDB (European Injury Database) collaborative network comprising up to 25 European countries and ten years of data collection (2012 to 2021). The methodology of the EU-IDB is a well consolidated standard for collecting injury data in Emergency departments, in compliance with the Eurostat methodological requirements for European health statistics. During the ten years of data collection in emergency departments, through EU-IDB surveillance 3 603 975 episodes of home and leisure accidents (HLA) were recorded at European level, involving people aged 0-19 years, constituting 34.5 % of hospital ED attendances due to HLA. Children and young people between 10 and 14 years old represented the major age group proportion of HLA(33.0%), the proportion of HLA increased across age groups until fourteen years old, being these differences statistically significant(p < 0,001). Falls were the most common cause of injuries among all age-groups, in the youngest group up to 4-years(54.4%), the 5-9years old (52.2%), the 10-14years old (46.1%) and in the oldest group between 15-19 years(37.5%), representing 47.2% of the total HLA mechanism. As regards to the treatment/follow-up, the vast majority of the HLA episodes were not admitted to hospital (92.9%). Hospital ED Injury data represent very useful information on the health burden of non-fatal injuries in this population of interest. These data could be used for the design of injury prevention policies and regulations for accidents that occur at home, school and outdoor spaces.
2.B. Scientific session: Learning from intercountry comparisons in digital healthcare transition monitoring
Authors:   Organised by: NIVEL, Università Cattolica del Sacro Cuore (Italy), University of Copenhagen (Denmark),   Chair persons: Gemma Williams (UK)
Published: October 2024

In many countries, healthcare is facing several challenges, including increasing healthcare demand, healthcare workforce shortages, rising healthcare costs, and keeping healthcare accessible. It is thought that the use of digital health might help to tackle these challenges. However, digital health programs and interventions are often not (systematically) monitored or evaluated. Monitoring of the digital healthcare transition in countries over time helps policymakers and healthcare professionals to investigate which digital services work well, and which do not, to (partly) solve the experienced challenges. In Europe, several countries monitor the digital healthcare transition within the primary and secondary care in their country. Comparing and sharing the monitoring methodologies between countries and describing the current state of the digital healthcare transition in primary and secondary care, will help to learn from other countries about how digital health could help to tackle the frequently experienced healthcare challenges. During this workshop, three countries throughout Europe (the Netherlands, Italy and Denmark) will briefly share their methodologies used for monitoring the digital healthcare transition in their country and will provide an up-to-date overview of the current state of the digital healthcare transition in primary and secondary care in their country. Challenges, achievements and future plans for the monitoring of this transition will also be shortly discussed in 10-minute presentations. Further, there will be 25 minutes for audience interaction which will be moderated by the chairperson. During this discussion, there is time to hear experiences from other countries and explore best practices in monitoring the digital healthcare transition.

Key messages

• The digital healthcare transition can be monitored in different ways. Experiences from three European countries may inspire others to organize national monitoring programs.

• The speed and nature of the digital healthcare transition differs between European countries. Experiences from three European countries provide insight into state of the art of national transitions.
Monitoring the digital healthcare transition in Denmark: Challenges, achievements and future
Authors: Vrangbaek K
Published: October 2024

Denmark is often mentioned as one of the countries that have introduced digital solutions early and extensively within the health care sector, including the launch of health portal sundhed.dk in 2003, the introduction of the e-record system ‘e-Journalen’ in 2007, and the establishment of a national infrastructure for telemedicine in 2012. Denmark is well advanced in digital health measurement, providing opportunities for researching the digital transition and its effects for healthcare organizations and Danish citizens. Most digital health data is collected through national population-based databases and registries. Additionally, annual surveys of health professionals and biennial surveys of citizens’ use of health IT are conducted. Recent data show that all general practitioners use electronic health records, mainly for receiving laboratory test results from hospitals, ordering prescriptions at pharmacies, exchanging records, and sending referrals to hospitals. This workshop provides an overview of developments in Denmark and a discussion of challenges, achievements, and prospects. Particular attention will be paid to the monitoring of digitalization progress and effects, and the use of digital solutions in primary and secondary care. Issues about implementation and evaluation of digital infrastructure will be discussed with examples from Danish health care. A key question is whether digital solutions can fulfill their promise of supporting integrated and home based health care in an era of changing demographics.
Did social inequalities in child development change during the COVID-19 pandemic in Germany?
Authors: Hoffmann S , Tschorn M , Spallek J
Published: October 2024

Background

Early childhood development (aged <6 years) is dependent on the social conditions in which children live and strongly affect their life course trajectory. This study describes changes in social inequalities in language development during the COVID-19 pandemic based on data from the legally prescribed school entry examination in the German federal state of Brandenburg. The aim is to inform public health interventions for individuals at risk of long-term health inequalities.

Methods

Secondary data from three cohorts of 5-7-year-olds were used [n = 19,2992018|19; n = 19,9162019|20; n = 19,6982020|21]. Language development was assessed as delayed compared to peers [LD yes/no], measured by public health services using validated instruments. Descriptive bivariate and multivariate analyses [OR, 95%CI] examined language delay [%] with social inequalities defined by (1) an index composed of parents’ reported education and occupation [SEP low|high], (2) ‘German native language’ [yes|no] and (3) ‘years of kindergarten attendance’ [<4|≥4].

Results

Overall, the proportion of LD decreased over the years (21.1%2018|19; 19.2%2019|20; 18.8%2020|21), both among children from families with high SEP (14.3%2018|19; 13.0%2020|21) and from German-speaking families (20.2%2018|19; 17.8%2020|21). LD rates among children increased with low SEP (42.4%2018|19; 43.4%2020|21) and remained constant with a non-German native language (36.0%2018|19; 35.5%2020|21). The probability for LD differed only for SEP (2018|19: ORlow|high=4.4, 3.93-4.94; 2020|21: ORlow|high=5.12, 4.54-5.77) and for native language (2018|19: ORnon-German|German=2.22, 1.86-2.66; 2020|21: ORnon-German|German=2.54, 2.19-2.95).

Conclusions

Social inequalities in language development based on SEP and native language increased slightly during the pandemic compared to the pre-pandemic period. Research should examine the effects of the pandemic on early development as well as protective and risk factors on a longitudinal basis.

Key messages

• Social inequality in early development increased in Germany during the COVID-19 pandemic.

• To reduce health inequality in the life course, longitudinal research should assess the impact of the pandemic on child development.