bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multichannel electrocardiograms obtained by a smartwatch for the diagnosis of acute coronary syndromes: the SMARTAMI TRIAL
Authors: Spaccarotella C.S , Polimeni A.P , Principe E.P , Curcio A.C , Migliarino S.M , Mongiardo A.M , De Rosa S.D , Indolfi C 
Published: November 2020

Abstract

Background
Smartwatches are increasingly popular and used for digital health information. A new smart watch introduced an integrated ECG tool, which allows recording a single-lead ECG that has been used for atrial fibrillation detection. The aim of the present study was to prospectively investigate the feasibility and the accuracy of the Apple Watch in patients admitted in the CCU with the diagnosis of Acute Coronary Syndrome compared with a standard 12-lead ECG.

Methods
A commercially available smart watch series 4 was used and the posterior sensor of the watch was positioned in different standardized body positions to obtain nine bipolar ECGs (corresponding to Einthoven leads I, II and III and Precordial leads V1-V6) that were compared with a simultaneous standard 12-lead ECG.
One hundred subjects were included in the study. Fifty-five patients had a STEMI, twenty-seven patients had an NSTEMI all treated with percutaneous coronary revascularization. Eighteen age-matched subjects were included as controls.

Results
A very good agreement was found between Smartwatch ECG and Standard ECG for the identification of normal ECG, ST segment elevation and NSTE alterations (Cohen's kappa 0.90 [95% CI 0.78 to 1], 0.88 [95% CI 0.78 to 0,97], 0.85 [95% CI 0.74 to 0.96]), respectively.
The sensitivity and specificity of Smartwatch ECG for the diagnosis of normal ECG were 84% (95% CI 60 to 97) and 100% (95% CI 95 to 100), STE deviation were 93% (95% CI 82 to 99) and 95% (95% CI 85 to 99), NSTE ECG alterations were 94% (95% CI 81 to 99) and 92% (95% CI 83 to 97), respectively.
No significant differences between Smartwatch ECG and Standard ECG for the amplitude of ST changes were reported for each lead (see Figure).

Conclusions
The Smart Ami Trial demonstrated a very good agreement between the Smartwatch ECG and Standard ECG for the identification of ST-segment elevation and ST depression in patients with acute coronary syndromes opening the possibility of using this tool when a standard ECG is not available.
Figure 1

Funding Acknowledgement
Type of funding source: None
P wave dispersion – fading light of a popular parameter
Authors: Zawadzki J , Mercik J , Marecka A , Zawadzki G , Adamowicz J , Zysko D , Slawuta A , Gajek J 
Published: November 2020

Abstract

Background
The P wave dispersion concept was created to describe the non-uniform atrial conduction as a separate AF factor. However the major assumptions of the theory are inconsistent with the main principle of electrocardiography, which assumes that 12 leads of ECG, recorded simultaneously, register the same events at the same time. The presence of dispersion suggests the presence of a P wave in one lead, while in the other one it has ended and no longer exists. This observation per se could be considered as a methodological artifact.

Objective
The major objective is to present that the P wave dispersion descends from imprecise measurements in various ECG leads. We intend to demonstrate that more accurate measurements make this parameter disappear.

Methods
Our study included 150 patients (89F, 61M) assessed using the electrophysiological system, which allowed to assess the sinus P waves. The P wave duration was measured by 3 independent researchers in all leads twice: 1. paper speed=50 mm/s, enhancement 16x (basic measurement) 2. paper speed=200 mm/s, enhancement 128–256x, simultaneously measuring the P wave dispersion. All measurements were repeated 3 times.

Results
The results are presented in Table 1

Conclusion
1. The P wave dispersion is the artifact of measurement. It is clear that after using much more accurate tools, the parameter disappears. 2. The P-wave dispersion is connected with Pmax, therefore may be apparently clinically useful but as a matter of fact, doesn't carry any meaning itself. 3.The significant P wave duration parameter should be a total atrial activation time, from the beginning of the earliest recorded P wave, till the end of the last Pwave recorded in any lead.

Funding Acknowledgement
Type of funding source: None
Micro-simulation model to predict effects of low-dose aspirin on colorectal cancer, cardiovascular disease and safety outcomes among low-dose aspirin users
Authors: Bollaerts K , Biccler J , Pareen V , Sole E , Garcia Rodriguez L.A , Lanas A , Langley R , Holl K , Verstraeten T , Soriano-Gabarro M 
Published: November 2020

Abstract

Background
Regular use of low-dose aspirin (LDA) has been shown to reduce the risk of cardiovascular disease (CVD). Recent evidence indicates that regular LDA use also reduces the risk of colorectal cancer (CRC). Use of LDA has also been associated with an increased risk of gastrointestinal (GI) bleeding, peptic ulcers and intracranial hemorrhage (ICH).

Purpose
We aim to evaluate the population-level benefits and risks of daily and/or regular LDA among individuals taking LDA for primary or secondary CVD prevention in the United Kingdom (UK) accounting for the evidence on the reduced CRC risk.

Methods
Individual-level state transition modelling was used to predict the impact of LDA on CRC, CVD, safety events (GI bleeding, ICH and symptomatic peptic ulcers) and related deaths in a UK population. Individual event histories were simulated for hypothetical cohorts of 1 million adults aged 50–59 years and aged 60–69 years indicated to take LDA for primary or secondary CVD prevention. The QRISK CVD prediction score was used to simulate adults indicated to use LDA for CVD prevention. Model parameters were informed based on published scientific literature on CVD, CRC and safety outcomes mimicking the UK epidemiology and prevention guidelines. Monte Carlo simulation was used to account for parameter uncertainty.

Results
In the cohort of subjects for which low-dose aspirin use was initiated between 50–59 years, the decrease in incidence rates (IRs) (per 100,000person years) of non-fatal CVD was smaller when low-dose aspirin use was initiated for primary prevention compared to initiation for secondary prevention (−203 [95% UI, −277 to −115] versus −794 [95% UI, −997 to −536]). Similar results were obtained for fatal CVD (−97 [95% UI, −136 to −60] versus −381 [95% UI, −502 to −257]). Whether low-dose aspirin treatment was initiated for primary or secondary CVD prevention did not greatly influence the changes in the IR of the non-CVD outcomes. The changes in IR for fatal CRC were −46 [−69, −31] and −44 [−67, −26] for primary and secondary CVD prevention while the changes in IR for fatal bleeding were 5 [1, 9] and 5 [1, 10]. Similar results were obtained when low-dose aspirin use was initiated between 60–69 years.

Conclusions
In all simulation settings considered, low-dose aspirin related reductions in non-fatal and fatal CVD outcomes were larger in case of secondary CVD prevention compared to primary CVD prevention. These reductions were larger than the increases in fatal safety events. This favorable benefit-risk profile is more pronounced in the case of secondary CVD prevention. The results from the simulation model can be used to inform discussions with patients about the potential benefits and risk of LDA initiation.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Bayer AG
M-health and telemedicine: are people ready for the future? A real-world survey
Authors: Dossi F , Marini A , Sanna G.D , Saba P.S , Parodi G 
Published: November 2020

Abstract

Background
Many scientific societies highlight the importance of using e-Health and Telemedicine in everyday life. Are patients truly ready for this changing scenario in the cardiovascular field? Considering the current limited evidence on this topic we conducted a real-world data analysis in a rural area.

Purpose
The aim of the present study was to assess the attitude of a rural area population towards the use of m-Health and Telemedicine for the improvement of cardiovascular healthcare-organization and prevention.

Methods
An observational cross-sectional study, surveying 200 adult-subjects, with a multiple-choice questionnaire, was carried out by the authors during local health-fair events. We gathered self-reported demographics, digital skills, attitude towards telemedicine, and data regarding primordial, primary and secondary cardiac prevention, along with the strengths and the weaknesses of m-Health use.

Results
Of the 200 surveyed subjects, only 179 [90%] completed the poll. Overall, 40% [n=71] appeared to be aware of telemedicine and 86% [n=154] stated to be interested in its use for everyday health-organization and cardiovascular prevention. No significative difference emerged regarding basic and advanced technological skills after subject stratification based on the education level, residence or age, except for the oldest subjects (i.e. over 80 years of age) which resulted less technologically skilled [p&lt;0.05]. According to the respondents, Personal Computer, smartphone and wearable devices were considered useful tools to improve treatment adherence [median value: 4 out of 5 - IQR 4–5], save time [median value: 4 out of 5 - IQR 4–5] and develop a tailored treatment approach [median value: 4 out of 5 - IQR 1–5]. Nonetheless, m-Health was unknown to half of the respondents; in fact, only 48% [n=86] of the interviewed subjects were aware of its existence and 35% [n=63] affirmed to use apps for a preventive purpose on a daily basis. Otherwise, the large majority of subjects reported to be interested in its use [75%, n=135]. Privacy issues emerged as a major concern for app users in the setting of primary and secondary prevention; while, only 19.4% of those using apps for primordial prevention showed the same degree of concern [p&lt;0.05]. No other significative difference appeared among tested queries.

Conclusions
Our unselected population showed good technological skills and looked with favour at the advantages of telemedicine in everyday health-management because it provides reliable and feasible tools to improve cardiovascular healthcare in rural areas. However, awareness of its existence remains limited, underlining the need for more effective advertising policies. Although privacy and reliability issues currently make m-Health less feasible for primary and secondary prevention, m-Health has proved to be an excellent tool for primordial prevention.

Funding Acknowledgement
Type of funding source: None
Detection of new-onset atrial fibrillation in heart failure patients using daily non-invasive ECG monitoring in the TIM-HF2 telemedicine trial
Authors: Stegmann T , Koehler K , Schulze M , Laufs U , Wachter R , Koehler F 
Published: November 2020

Abstract

Background
Heart failure (HF) and atrial fibrillation (AF) impair the prognosis when they occur concomitantly. Recent telemedical studies suggest that HF patients with AF may derive a greater benefit from telemedicine care but the results are inconsistent. The rate of newly detected AF in HF patients by daily non-invasive electrocardiogram (ECG) monitoring is unknown and a possible influence on the outcome of remote patient management (RPM) remains unclear.

Purpose
We aimed to investigate the detection of new atrial fibrillation in patients assigned to RPM in comparison to patients assigned to usual care (UC) in the
TIM-HF2 trial.

Methods
The prospective, multicentre and controlled TIM-HF2 trial randomised 1538 patients (765 RPM, 773 UC). All patients had a 12-channel ECG at baseline and after one year at the final study visit. Patients who were assigned to RPM additionally transmitted a daily ECG to the telemedical centre (TMC). We excluded all patients with pacemaker including implantable cardioverter defibrillator (ICD) or cardiac resynchronisation therapy (CRT) in the baseline ECG, leaving 879 patients for analysis (RPM: 442 and UC: 437). The patients were stratified into patients with SR and patients with AF according to the rhythm documented at baseline. The primary endpoint of this analysis was newly documented AF within one year after randomisation. We analysed the daily to the telemedical centre transmitted ECGs of patients assigned to RPM with the documented rhythm status of the ECGs performed at the final study visit of patients assigned to UC.

Results
569 patients had SR and 310 patients had AF at baseline. The proportion of patients with AF was nearly the same in the RPM (159, 36.0%) and the UC (151, 34.6%) group. 68 patients (24.0%) were detected with new atrial fibrillation in the RPM group compared to 22 patients (7.8%) in the UC trial arm during the one-year follow-up (p&lt;0.001, number needed to screen 6).

Conclusion
In patients with heart failure and daily ECG transmission, atrial fibrillation was detected three times more frequently in comparison to usual care within one year.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The TIM-HF2 study was supported by a research grant of the German Federal Ministry of Education and Research (grant numbers 13KQ0904A, 13KQ0904B, 13KQ1104A). The TIM-HF2 study was a part of the research and development project “Gesundheitsregion der Zukunft Nordbrandenburg – Fontane” (Fontane). The Fontane system was developed in private–public partnership (PPP) supported by research and development grants from the German Federal Ministry of Education and Research, the European Regional Development, and the Federal State Brandenburg.
Reliable detection of atrial fibrillation with a medical wearable under inpatient conditions (CoMMoD-A-fib)
Authors: Jacobsen M , Dembek T.A , Ziakos A.P , Kobbe G , Kollmann M , Heinemann L , Sause A , Deubner N , Isenmann S , Seyfarth M 
Published: November 2020

Abstract

Background
Atrial fibrillation (A-fib) is the most common arrhythmia; however, detection of A-fib is a challenge due to irregular occurrence.

Purpose
Evaluating feasibility and performance of a non-invasive medical wearable for detection of A-fib.

Methods
In the CoMMoD-A-fib trial admitted patients with a high risk for A-fib carried the wearable and an ECG Holter (control) in parallel over a period of 24 hours under not physically restricted conditions. The wearable with a tight-fit upper arm band employs a photoplethysmography (PPG) technology enabling a high sampling rate. Different algorithms (including a deep neural network) were applied to 5 min PPG datasets for detection of A-fib. Proportion of monitoring time automatically interpretable by algorithms (= interpretable time) was analyzed for influencing factors.

Results
In 102 inpatients (age 71.0±11.9 years; 52% male) 2306 hours of parallel recording time could be obtained; 1781 hours (77.2%) of these were automatically interpretable by an algorithm analyzing PPG derived intervals. Detection of A-Fib was possible with a sensitivity of 92.7% and specificity of 92.4% (AUC 0.96). Also during physical activity, detection of A-fib was sufficiently possible (sensitivity 90.1% and specificity 91.2%). Usage of the deep neural network improved detection of A-fib further (sensitivity 95.4% and specificity 96.2%). A higher prevalence of heart failure with reduced ejection fraction was observed in patients with a low interpretable time (p=0.080).

Conclusion
Detection of A-fib by means of an upper arm non-invasive medical wearable with a high resolution is reliably possible under inpatient conditions.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Internal grant program (PhD and Dr. rer. nat. Program Biomedicine) of the Faculty of Health at Witten/Herdecke University, Germany. HELIOS Kliniken GmbH (Grant-ID 047476), Germany
Process mining tools: where should we build another PCI centre to reduce STEMI mortality?
Authors: Borges-Rosa J , Oliveira-Santos M , Simoes M , Teixeira C , Ibanez-Sanchez G , Fernandez-Llatas C , Monteiro S , Carvalho P , Goncalves L 
Published: November 2020

Abstract

Introduction
The expected delay of transport between patient location and percutaneous coronary intervention (PCI) centre is paramount for choosing the adequate reperfusion therapy in ST-segment elevation myocardial infarction (STEMI). The central region of Portugal has heterogeneity in PCI assess due to geographical reasons. However, this data is usually presented numerically without providing a visual distribution of patients.

Purpose
We aimed to analyse the impact of distance to PCI centres on mortality in patients with STEMI through visual maps of patients' flow by using an experimental process mining tool, integrated in EIT Health's project PATHWAYS.

Methods
Using the Portuguese Registry of Acute Coronary Syndromes (ProACS), we retrospectively assessed patients with an established diagnosis of STEMI, geographical presentation specified, reperfusion option identified (PCI, fibrinolysis or no reperfusion), short-term outcomes defined as discharge or in-hospital death. With the 2 317 patients that fulfilled the criteria, we used a process mining tool to build national and regional models that represent the flow of patients in a healthcare system, enhancing differences between groups.

Results
Colour gradient in nodes and arrows changes from green to red, with green representing a lower number of patients as opposed to red. In the national model, most patients from all regions had PCI. Mortality was similar between PCI and fibrinolysis groups (4%) but higher in those without reperfusion (9%). In the central region model, one third of the patients were more than 120 minutes away from a PCI centre. Despite that, almost one third of these patients had PCI instead of fibrinolysis. In this model, fibrinolytic therapy had higher in-hospital survival rate than PCI (98% vs. 94%). Overall mortality was higher in the central model compared with the national model (6.92% vs. 5%). Central region had less PCI (53% vs. 73%), more fibrinolysis (15% vs. 7%) and more patients with no reperfusion (32% vs. 20%).

Conclusion
In the ProACS registry, mortality was higher in the central region compared with national data. Even though global interpretation of these findings is limited by underrepresentation from certain central areas, process mining offers an easily understandable view of patients flow. With its statistical upgrade and continuous development, this tool will facilitate the analysis of big data and comparison between groups.

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): EIT Health
Evaluation of new-onset atrial fibrillation using continuous patch monitor in patients undergoing transcatheter aortic valve replacement
Authors: Miki T , Senoo K , Okura T , Sato Y , Shiraishi H , Shirayama T , Matoba S 
Published: November 2020

Abstract

Background
Transcatheter aortic valve replacement (TAVR) has emerged as an important therapeutic option among intermediate- and high-risk patients with symptomatic severe aortic stenosis. Heart rhythm disorders frequently complicate TAVR, particularly atrial fibrillation (AF), which can affect &gt;40% patients undergoing the procedure. There is wide variation in rates of new-onset AF (NOAF) following TAVR across the initial pivotal randomized trials and observational studies, but burden of AF in each patient is not well known. The aim of this study is to evaluate AF burden detected by continuous patch ECG monitor (WR-100; Fukuda-Denshi, Tokyo,Japan) in patients after TAVR.

Method
Among KPUM-TAVR cohort, 58 consecutive patients (mean age:85.5±5.5, 44 females) kept recording continuous patch ECG monitor for 14 days after the procedure of TAVR. We excluded 11 patients with ECG indicating AF before procedure (paroxysmal AF 5, persistent AF 6). Finally, 47 eligible patients were selected according to the study criteria. AF was defined as a presence of AF more than 30sec on ECG monitor. The incidence and burden of NOAF was assessed.

Results
We identified 9 of 47 patients (19.1%) who developed NOAF (94% of transfemoral access patients, 6% of non- transfemoral access patients). Patients developing NOAF and had higher Society of Thoracic Surgeons risk scores (5.9±3.8 vs 9.9±6.3 p=0.0187). AF was first observed from day1 to day13. Despite having a median CHA2DS2-VASc score of 5 (25th and 75th percentile: 5 to 6), only 33% of patients with NOAF were given oral anticoagulation during the follow-up.

Conclusion
By using continuous patch ECG monitor, NOAF can be identified in 19.1% of patients after TAVR, with wide variety of first onset of AF. Given the clinical significance of post-TAVR AF, additional studies are necessary to describe the optimal management strategy in this high-risk population.
Figure 1

Funding Acknowledgement
Type of funding source: None
Relationship between previous HbA1c value and subsequent severe hypoglycaemia in patients with coronary artery disease and type 2 diabetes. Data from the DMP in North Rhine, Germany
Authors: Hagen B , Groos S , Kretschmann J , Macare C , Weber A 
Published: November 2020

Abstract

Background and purpose
Based on the documentation data of DMP type 2 diabetes in North Rhine from 2018, it was examined to what extent the HbA1c value from 2012 influenced the emergence of severe hypoglycaemia from 2013 in patients with coronary artery disease (CAD).

Methods
The predictors were determined in separate logistic regression models. The database was the last follow-up documentation of 2018. For all patients it was determined which HbA1c value was available in 2012 and whether severe hypoglycaemia has been documented for the first time since 2013.

Results
Within a group of a total of 98,950 patients, 2,520 new cases of severe hypoglycaemia have been documented since 2013. Treatment with insulin (odds ratio OR 7.00; 95-%-CI 5.80–8.44), HbA1c over 8.5% in 2012 (OR 1.66; 1.43–1.93), and the presence of diabetic complications (OR 1.37; 1.23–1.52) were the greatest risk factors, adjusted for age, gender, duration of DMP care and blood pressure. When the up to 70-year-old patients were analyzed separately, the two main predictors turned out to be somewhat weaker (insulin OR 5.40; 3.76–7.76; HbA1c &gt;8.5% OR 1.61; 1.23–2, 11), on the other hand, they were somewhat more pronounced for patients over 70 years of age (insulin OR 7.58; 6.09–9.44; HbA1c &gt;8.5% OR 1.72; 1.42–2.07). The influence of comorbidity was comparably high in both subgroups (≤70 years, OR 1.45; 1.16–1.79; &gt;70 years OR 1.34; 1.19–1.51).

Conclusion
In patients with CAD and type 2 diabetes, the insulin prescription, a previously high HbA1c value and comorbidity are significant predictors for the later recurrence of severe hypoglycaemia; these influences are somewhat weaker in younger patients and somewhat more pronounced in older patients. A association between low HbA1c values and an increased risk of new onset of severe hypoglycaemia could not be demonstrated even in older patients with CAD and T2D.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Joint Establishment Disease Management Programs North Rhine