bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term effectiveness of a nurse-led 7-step transitional intervention programme in heart failure
Authors: Alcoberro L , Vime J , Enjuanes C , Jimenez S , Garay A , Yun S , Moliner P , Guerrero C , Hidalgo C , Calero E , Marin R , Alcober L , Delso C , Comin J 
Published: November 2020

Abstract

Background
Reduction of 30-day readmission in heart failure (HF) patients is a main goal of health-care systems. Programmes to decrease 30-day readmission have successfully reduced it but have failed to neither maintain benefit afterwards nor decrease mortality. Moreover, in many cases the price of reducing 30-day readmission is a mortality increase.

Purpose
Evaluate whether the impact of a fully nurse-led HF programme directed to reduce 30-day readmission and mortality extends to longer periods of time, including 90 days and 180 days after discharge.

Methods
We evaluated all patients discharged from hospital with HF as primary diagnosis between January 2017 and January 2019. We compared outcomes between patients discharged during Period #1 (pre-programme; Jan 2017 - Aug 2017) and those discharged during Period #2 (HF programme; Sept 2017 - Jan 2019).
Primary endpoint was the combined endpoint of all-cause death or all-cause hospitalization 90 days and 180 days after discharge from the index hospitalization.

Results
The study enrolled 440 patients: 123 in Period #1 and 317 in Period #2.
Mean age was 75±9 years. There was a higher proportion of female patients in Period #2 (38.2% vs 26.8%, p=0.025), with no differences in other baseline characteristics.
The combined endpoint of all cause-death and all-cause hospitalization was significantly reduced in patients in the HF programme group, both at 90 days [OR 0.37 (0.22–0.63), p&lt;0.001] and at 180 days [OR 0.27 (CI 0.17–0.43), p&lt;0.001]. Such a decrease was at expense of a reduction in cardiovascular (CV) hospitalization and HF hospitalization.
There were no differences between groups in mortality [OR 0.96 (0.18–5.00), p=0.293].

Conclusions
A fully nurse-led HF programme reduces the combined endpoint of all-cause death and all-cause hospitalization both at 90 days and 180 days after an index discharge for HF.
Such a decrease is driven by a reduction of CV and HF hospitalization, which are maintained over time. There were no differences between groups in mortality.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospital Universitari de Bellvitge
Double check discharge planning to improve the results of a heart failure programme
Authors: Alcoberro L , Vime J , Enjuanes C , Jimenez S , Garay A , Yun S , Moliner P , Guerrero C , Hidalgo E , Calero E , Marin R , Alcober L , Delso C , Comin J 
Published: November 2020

Abstract

Background
Reduction of readmissions in heart failure (HF) patients is a main goal of HF programmes. Establishing a discharge planning for the patient and coordinating it with primary care teams are key aspects for their success.

Purpose
Evaluate whether a double check discharge planning based on adding face-to-face joint weekly sessions with primary care managers to the conventional electronic communication of care plan reduces 6-month readmission and 6-month mortality.

Methods
We evaluated all patients discharged from hospital with HF as primary diagnosis between September 2017 and January 2019. We compared outcomes between patients discharged during Period #1 (single check; September 2017 - April 2018) and those discharged during Period #2 (double check; May 2018 - January 2019).
Primary endpoint was the combined endpoint of all-cause death or all-cause hospitalization 6 months after discharge from the index hospitalization.

Results
The study enrolled 317 patients: 182 in Period #1 and 135 in Period #2.
Mean age was 76±9 years. There was a higher proportion of patients with diabetes and COPD in Period #1, with no differences in other baseline characteristics.
The combined endpoint of all cause-death and all-cause hospitalization at 6 months was significantly reduced in patients in the double check discharge planning group (27% vs. 16%, p 0.021).

Conclusions
In a HF programme, the addition of a double check discharge planning based on having joint weekly sessions with primary care managers on top of the conventional electronic communication of care plan reduces 6-month readmission and 6-month mortality.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospital Universitari de Bellvitge
An improvement in self-care behaviour in heart failure patients lead to better management of hypertension
Authors: Sahlin D.S , Gerward S 
Published: November 2020

Abstract

Background
A common heart failure (HF) aetiology is hypertension (HTN), second only to ischemic heart disease and with a prevalence in the HF community of between 62% and 84%, depending on sex and ejection-fraction. Undertreated HTN leads to worse prognosis and resistant HTN is defined as blood pressure (BP) exceeding 140/90 mmHg, in spite of pharmacological treatment. Since one constituent of self-care behaviour is treatment adherence, we wished to study whether patients exposed to a digital intervention shown to improve self-care behaviour, would also display improved BP control.

Methods
SMART-HF was a randomized controlled trial, recruiting patients from seven centres in Region Skåne in southern Sweden, where patients in the intervention group (IG) were equipped with a digital home-based tool, designed to enhance self-care behaviour for HF-patients and the control group (CG) were subject to standard care. BP data was registered at baseline and after eight months of intervention and self-care behaviour was measured using the European Heart Failure Self-care Behaviour Scale (EHFScB). We used a Chi-square test to analyse whether there was an inter-group difference of prevalence of resistant HTN or a mean arterial pressure (MAP) outside the recommended range of 60 mmHg &lt; MAP &lt;100 mmHg.

Results
Out of the 118 patients included in the original analysis, 92 (78%) had complete BP measurements. At baseline there was no difference in self-care behaviour between the groups, with CG: 25 [17.5; 32] and IG: 24.5 [18; 30], p=0.61, and 28% of the CG patients and 24% of the IG population displayed resistant HTN, p=0.73. After eight months of intervention the IG had 21% (or 4.5 points) better self-care behaviour compared to the CG, p=0.014, and the fraction of patients with resistant HTN was 30% for the CG and 11% for the IG, p=0.027. There was also a significant effect on the fraction of patients having a MAP &gt;100 mmHg, with 22% in the CG versus 16% in the IG having MAP &gt;100 mmHg at baseline (p=0.39) and 19% in the CG versus 0% in the IG at follow-up (p=0.002).

Conclusions
There was a significant improvement in self-care behaviour and also a significant reduction in the number of patients with resistant hypertension and elevated mean arterial pressure after eight months of intervention.

Funding Acknowledgement
Type of funding source: None
92 aetiologic factors for heart failure: prevalence, co-occurrence, prognosis and potential for prevention in 170,885 incident HF cases
Authors: Banerjee A , Pasea L , Chung S.C , Direk K , Asselbergs F.W , Denaxas S , Hemingway H 
Published: November 2020

Abstract

Background
ESC and AHA guidelines identify 92 putative aetiological factors for heart failure, but primary prevention strategies for heart failure (HF) have had limited success. There are no previous studies systematically evaluating the potential for prevention among such a wide range of clinically manifest aetiologic factors.

Objective
To estimate for 92 (putative) aetiologic factors their prevalence, co-occurrence, preventability and impact on HF prognosis in incident HF.

Methods
We identified 170885 individuals aged ≥30 years with incident HF from 1997–2017 using linked primary and secondary care electronic health records (EHR) in the UK (CALIBER). For each of the 92 factors we developed EHR phenotypes using ICD-10 diagnosis, Read, procedure and medication codes (total = 5961 codes). We conducted a literature review of trials of primary HF prevention across 92 factors.

Results
35.6% of individuals with HF had ≥4 aetiologic factors recorded in the preceding 5 years. Of all new HF cases 71.5% had ≥1 of the 7 aetiologic factors with trial evidence of effective preventive therapy for HF; 12.9% had ≥1 aetiologic factor with effective preventive therapy for CVD and 15.6% had either no aetiological factor, or an aetiological factor with no evidence of preventive potential. 88/91 factors were represented. The commonest factors in the 5 years prior to HF diagnosis were hypertension (48.7%), smoking (46.6%), reduced physical activity (39.6%), stable angina (35.6%), obesity (29.4%), atrial arrhythmias (17.3%), unstable angina (16.9%), cancer (16.6%), myocardial infarction (15.9%), diabetes (15.2%), alcohol (14.9%) and severe anaemia (14.3%). Mortality at 1 year varied across all 91 factors (lowest: pregnancy-related hormonal disorder – 4.2%; highest: phaeochromocytoma – 73.7%).

Conclusion
We provide a systematic map of primary preventive opportunities for heart failure, demonstrate the high burden of co-occurring aetiologic factors and highlight need for trials tackling multiple aetiological factors.
Aetiologic factors of heart failure

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Innovative Medicines Initiative-2 Joint Undertaking
A novel SGLT-2 score to identify HFpEF patients who may benefit from SGLT-2 inhibitors
Authors: Binder C , Poglitsch M , Rettl R.R , Dachs T , Seirer B , Capelle C , Dusik F , Duca F , Dalos D , Schrutka L , Badr-Eslam R , Bonderman D 
Published: November 2020

Abstract

Background
Established heart failure (HF) treatments have shown no effects in HF and preserved ejection fraction (HFpEF). Subgroup analyses of the HFpEF populations suggest that certain patients benefit from HF treatments. This underlines the importance of individualized therapy regimens in HFpEF. Sodium-glucose transporter 2 (SGLT-2) inhibitors are emerging as a promising treatment of HF. The mechanisms leading to improved outcomes include 1) treatment of diabetes, 2) osmodiuresis preventing volume overload, 3) enhancement of the cardio protective Angiotensin (Ang) 1–7 pathway, instead of Ang II. We aimed to characterize patients by factors which are modified by SGLT-2 inhibitors to identify individuals who may benefit from these drugs.

Methods
HFpEF patients were included in a single center registry. Baseline evaluation included assessment of HbA1c, fluid status measured by body composition monitor and plasma angiotensin concentration. A “SGLT-2 score” with a maximum of 3 points was calculated using the following parameters: 1) HbA1c &gt;6.5%, 2) overhydration, defined as a fluid overload of &gt;1,5L and 3) plasma renin activity (PRA) levels above the median as a parameter of over-all RAS activity. Primary outcome was defined as all-cause death or HF hospitalization. All parameters used in the “SGLT-2 score” were independently predictive for the chosen endpoint. Kaplan Meier analyses was used to show the association between the score and outcomes.

Results
90 patients were included in this registry. Median HbA1c was 6.0%, median fluid status was 1.2L and the median Ang II levels in the “high PRA-group” were 5.35.1 pmol/L. After a mean follow up time of 44.0±38.7 months, 60 patients (66.6%) reached the endpoint. Kaplan Meier analysis showed an association between SGLT-2 score and outcome (p=0.003).

Conclusion
Patients with HbA1c &gt;6.5%, overhydration and high RAS activity have poor outcomes. We propose the future use of this score to identify a subgroup of HFpEF patients who may benefit from SGLT-2 inhibitors.
Kaplan Meier analysis

Funding Acknowledgement
Type of funding source: None
Sleep apnea in heart failure: in search of a better prognosis predictor
Authors: Maltes S.F.C , Rocha B.L , Cunha G.L , Duarte J , Gomes R.V , Silverio R , Maravilha C , Presume J.P , Campos L , Henriques C , Rodrigues C.A.P.F , Araujo I , Fonseca M.C 
Published: November 2020

Abstract

Background
Sleep apnea (SA) is a burdensome and often underdiagnosed condition in heart failure (HF). Portable devices, such as ApneaLinkTM, are currently validated as a screening tool for SA. The apnea-hypopnea index (AHI) as been long considered the gold-standard measurement for the diagnosis of SA, also having a prognosis impact. Recently, however, other respiratory variables have been proposed as better prognosis predictors in patients with HF. The main goal of this study was to assess the prognostic value of other respiratory measurements evaluated by ApneaLinkTM at discharge in a population admitted for HF.

Methods
This was a single-center retrospective study enrolling consecutive patients admitted in a HF Clinic for acute HF from 2013 and 2018. All stable patients without previously known sleep-disordered breathing underwent ApneaLinkTM screening the night before discharge in the euvolemic state. Those with a total respiratory evaluation time &lt;180 minutes or in need of supplemental oxygen were excluded. A primary endpoint of long-term HF hospitalizations was evaluated.

Results
Overall, 231 patients (mean age 74.5±10.6 years; 47% male; 83% hypertension; 41% chronic kidney disease; 44% anemia; 18% with a NYHA&gt;2 at discharge; 43% ischaemic HF; 41% with a left ventricle ejection fraction lower than 50%) were assessed. One-hundred and sixty-nine patients (59.1%) had an AIH &gt;15, with a median of 19 (IQR 7–42); the median number of obstructive apneas and central apneas was 13 (IQR 2–68), and 2 (IQR 0–10), respectively. Two-hundred patients (69.9%) had nocturnal periods of an oxygen saturation below 85% (T85), with a median time under that value of 8 (IQR 0–47) minutes. Over a median follow-up of 34.1 (IQR 18.40–54.37) months, 105 (45.7%) patients died and 128 (55.7%) were readmitted for AHF. After adjustment for cofounders (namely, the presence of anemia) a T85 above the 75th percentile was significantly correlated with a higher risk of HF readmission in a multivariate analysis (adjusted HR: 1.58, 95% CI: 1.08–2.30, p=0.017) (figure 1). These results were independent of the apnea-hypopnea index.

Conclusion
Nocturnal hypoxemia (T85) was an independent predictor of rehospitalization in patients with HF. These results further validate the utility and prognosis impact of other respiratory measurements (other than AHI) evaluated by ApneaLinkTM screening at discharge in a population of patients admitted for HF.
Figure 1

Funding Acknowledgement
Type of funding source: None
Does cardiac transplant protect against broken hearts?
Authors: Isath A , Perembeti S , Correa A , Rao S , Chahal A , Padmanabhan D , Contreras J , Garg V 
Published: November 2020

Abstract

Background
Takotsubo cardiomyopathy (TC) is a reversible stress-induced myocardial dysfunction with increased sympathetic activity caused by excessive release of catecholamines playing a central role in its pathophysiology. The occurrence of TC in transplanted hearts is rare given the complete denervation done during transplantation. However, it has been demonstrated that 40% of transplant recipients undergo sympathetic re-innervation. There have only been case reports describing TC in post-transplant recipients.

Purpose
To evaluate the incidence, baseline characteristics and outcomes of TC occurring in heart transplant recipients using Healthcare Cost and Utilization Project (HCUP) National (nationwide) Inpatient Sample (NIS) in United States from 2009 to 2014.

Methods
Using NIS data, we identified patients who underwent cardiac transplantation using ICD9 procedure codes 37.5 and 33.6. Among these patients, we identified those admitted to the hospital with diagnosis of TC based on ICD-9-CM code 429.83. We presented categorical data as percentages and continuous data as mean or median as appropriate.

Results
We identified 257 hospitalizations for TC in heart transplant recipient patients. There was an approximately 9-fold increase in admissions from 11 in 2009 to 95 in 2014. Among patients with TC, the mean age was 65.3±1.8 years and majority were female (76.6%). A majority of patients were Caucasians (63%) followed by smaller proportion of African-Americans (13.2%).
In-patient mortality in patients admitted with TC following heart transplant was 11.3% (n=29). During the hospitalization, 4.8% of patients had cardiogenic shock and 2.8% required mechanical circulatory support. The average length of stay for patients with TC was 16.6±3.3 days. The mean cost of hospitalization for these patients when adjusted for inflation were 237248±55709 dollars.

Conclusion
TC can still occur in substantially in heart transplant recipients and should be considered one of the differential diagnosis in transplant patients presenting to the hospital.

Funding Acknowledgement
Type of funding source: None
Incomplete recovery of takotsubo cardiomyopathy is a major determinant of cardiovascular mortality
Authors: Matsushita K , Lachmet-Thebaud L , Marchandot B , Sato C , Dagrenat C , Greciano S , De Poli F , Leddet P , Trimaille A , Heger J , Reydel A , Trinh A , Ohlmann P , Jesel L , Morel O 
Published: November 2020

Abstract

Introduction
Although there is an apparent rapid and spontaneous recovery of left ventricular ejection fraction (LVEF) in patients with takotsubo cardiomyopathy, recent studies have demonstrated the long-lasting functional impairment in those patients.

Purpose
We sought to evaluate the predictors of incomplete recovery in chronic phase and its impact on cardiovascular mortality after takotsubo cardiomyopathy.

Methods
Patients with takotsubo cardiomyopathy between 2008 and 2018 were retrospectively enrolled in three different institutions. Takotsubo cardiomyopathy was diagnosed according to the European Society of Cardiology Heart Failure Association criteria. After exclusion of in-hospital deaths, 407 patients were split into 2 subgroups according whether their LVEF were &gt;50% (recovery group; n=333), or ≤50% (incomplete recovery group; n=74) at follow-up. The primary endpoint was the impact of incomplete recovery on cardiovascular mortality.

Results
Patients with incomplete recovery were more likely to be male, to have dementia, pacemaker, and supraventricular arrhythmia. C-reactive protein (CRP) levels on admission, at peak, and at discharge were significantly higher in patients with incomplete recovery. By multivariate logistic regression analysis, lower EF at discharge (odds ratio [OR]: 0.91; 95% confidence interval [CI]: 0.88 to 0.95; p&lt;0.001) and higher CRP levels (OR: 5.56; 95% CI: 1.86 to 16.61; p&lt;0.001) were independent predictors of incomplete recovery at follow-up. The cumulative event-free survival rate according to cardiovascular death was significantly lower in the incomplete recovery group (p&lt;0.001; log-rank test).

Conclusions
We demonstrate that incomplete recovery after takotsubo cardiomyopathy is characterized by a residual systemic inflammation and an increased cardiac mortality at follow-up. Altogether, our findings underline patients with persistent inflammation as a high-risk subgroup, to target in future clinical trials with specific therapies to attenuate inflammation.

Funding Acknowledgement
Type of funding source: None
Systematic review and meta-analysis of placebo-controlled invasive interventions for the management of chronic stable angina
Authors: Rivera M , Brown D.L 
Published: November 2020

Abstract

Background
The benefits of invasive therapies for chronic stable angina are in large part supported by open label studies comparing invasive procedures to medical therapy alone. Placebo effects are frequently unaccounted for as control arms rarely receive placebo (sham) interventions.
This review pools studies comparing invasive therapies for chronic stable angina to placebo interventions and aims to measure the true effects of different invasive interventions.

Methods
We performed a systematic review and meta-analysis of double blinded randomized placebo-controlled trials of invasive therapies for the management of chronic stable angina. The outcomes of interest were change in exercise tolerance time, change in Canadian cardiovascular society angina grade and rate of post-procedural complications including myocardial infarction and all-cause mortality.

Results
Six randomized placebo-controlled trials were included, with a total of 742 participants. Median follow-up ranged from 6 weeks to 16 months. Contrary to data reported in individual studies, pooled analysis favored invasive therapies over placebo procedures: exercise tolerance time was higher (standard mean difference (SMD) 35.2 seconds [4.4- 66.0]), angina scores were more likely to improve by ≥1 class (Odds Ratio (OR) 2.16 [1.05- 4.46]) and by ≥2 classes (OR 1.76 [1.13- 2.74]). There was no difference in post-procedural myocardial infarction (incidence rate ratio (IRR) 2.91 [0.61–13.93]) and all-cause mortality (IRR 0.39 [0.35–4.27]).

Conclusions
This meta-analysis of placebo-controlled trials for chronic stable angina found a beneficial effect from invasive therapies. This favorable effect has not been seen in individual studies. Our findings suggest that sample sizes should be adjusted upwards in placebo-controlled studies to detect true treatment effects independent of the placebo effect.

Funding Acknowledgement
Type of funding source: None
Time-dependent improvement in coronary flow reserve in collateral donor artery following successful recanalization of the Coronary Chronic Total Occlusion
Authors: Dobric M , Beleslin B , Tesic M , Djordjevic Dikic A , Stojkovic S , Giga V , Tomasevic M , Jovanovic I , Petrovic O , Rakocevic J , Boskovic N , Stankovic G , Vukcevic V , Nedeljkovic M.A , Ostojic M 
Published: November 2020

Abstract

Background
Coronary chronic total occlusion (CTO) is characterized by the presence of collateral blood vessels which can provide additional blood supply to CTO-artery dependent myocardium. Successful CTO recanalization is followed by significant decrease in collateral donor artery blood flow and collateral derecruitment.

Purpose
Study aim was to assess time-dependent changes in coronary flow reserve (CFR) in collateral donor artery after CTO recanalization and identify factors that influence these changes.

Methods
Our study enrolled 31 patients with CTO scheduled for percutaneous coronary intervention (PCI). Non-invasive CFR was measured before PCI in collateral donor artery, and 24h and 6 months post-PCI in CTO and collateral donor artery. Gated SPECT MIBI was performed before PCI, while quality of life was assessed by Seattle angina questionnaire (SAQ) pre-PCI, and 6 months after PCI.

Results
Collateral donor artery showed significant increase in CFR 24h after CTO recanalization compared to pre-PCI values (2.30±0.49 vs. 2.71±0.45, p=0.005), which remained unchanged after 6 months (2.68±0.24). Maximum baseline blood flow velocity of the collateral donor artery showed significant decrease measured 24h post-PCI compared to pre-PCI values (0.28±0.06 vs. 0.24±0.04m/s), and remained similar after 6-months. There was no significant difference in maximum hyperemic blood flow velocity pre-PCI, 24h and 6 months post-PCI. CFR change of the collateral donor artery 24h post-PCI compared to pre-PCI values showed inverse correlation with left ventricle ejection fraction (LVEF) measured on SPECT. CFR changes showed no correlation with the changes in quality of life assessed by SAQ post-PCI compared to pre-PCI.

Conclusions
Significant increase in CFR of the collateral donor artery was observed within 24h after successful recanalization of CTO artery, which maintained constant after the 6 months follow-up. This increase was largely driven by the significant reduction in the maximum baseline blood flow velocity within 24h after CTO recanalization compared to pre-PCI values. Our results suggest that possible benefit of CTO recanalization could be the improvement in physiology of the collateral donor artery.

Funding Acknowledgement
Type of funding source: None