bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital variation in downstream secondary preventive medication uptake: implications for quality and outcomes
Authors: Jug B , Dosenovic Bonca P , Fras Z 
Published: November 2020

Abstract

Background
Adherence to guideline recommended therapy improves outcomes in patients with myocardial infarction. We sought to appraise between-hospital variation in downstream adherence to secondary preventive medication and hypothesised that discharge from high-adherence hospitals was associated with improved long-term outcomes.

Methods
We included 7,624 patients hospitalised because of myocardial infarction in 14 hospitals between 2015 and 2017 in Slovenia (nation-wide sample). Using indirect identifiers, we linked routinely collected data on patients from the i) Hospital Discharge Statistics Database, ii) the National Mortality Registry and iii) the Medication Reimbursement Database. We used random intercept logistic regression modelling for prediction of secondary prevention medication uptake 30 to 90 days after discharge, adjusting for case-mix, hospital size and percutaneous coronary intervention (PCI) availability. We classified hospitals into high- and low adherence (i.e., above and below the national median adjusted odds) and assessed the association between hospital performance, and death or re-infarction with multivariate Cox proportional hazards modelling.

Results
Secondary preventive medication uptake ranged from 30.7% to 87.3% in high- and low-performing hospitals, respectively. Discharge from high-adherence hospitals were associated with significantly lower all-cause mortality and re-infarction rates (hazard ratio 0.82; 95% confidence interval 0.69–0.98) when compared to hospitals with secondary preventive medication uptake below the national median, after adjusting for case-mix and hospital characteristics.

Conclusions
Downstream secondary preventive medication uptake vary across hospitals. Although case-mix and hospital characteristics explain some of the variation, discharge from a hospital with good downstream secondary preventive medication uptake is associated with lower risk of death or re-infarction.
Event rates, low- vs. high-adhererence

Funding Acknowledgement
Type of funding source: None
Achievement of ESC/EAS lipid treatment goals with evolocumab in patients with type 2 diabetes: analyses of the BANTING and BERSON trials
Authors: Lorenzatti A.J , Chen J , Monsalvo M.L , Wang H , Lopez J.A.G , Rosenson R.S 
Published: November 2020

Abstract

Background
BANTING and BERSON showed evolocumab in type 2 diabetes (T2D) effectively lowered low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (ApoB), and non-high-density lipoprotein-cholesterol (Non-HDL-C), all targets in cardiovascular disease (CVD) prevention.

Purpose
To evaluate the achievement of lipid treatment goals with evolocumab vs placebo in T2D.

Methods
We pooled two double-blind, randomised, phase 3 studies. In BANTING, participants received maximally-tolerated statins. In BERSON, participants began atorvastatin 20 mg post-baseline; almost half enrolled in China. LDL-C and non-HDL-C goal achievement were assessed at the mean of weeks 10 and 12; and ApoB at week 12.

Results
Of 1,402 participants analysed, 89.4% were at very high CVD risk. Treatment goals achievement was significantly greater in evolocumab vs placebo. Results were consistent in the Chinese subpopulation.

Conclusion
Evolocumab plus statins enabled most T2D patients at very-high/high CVD risk to achieve their lipid treatment goals

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Amgen Inc.
Excessive salt intake is a significant predictor for future development of metabolic syndrome in the general population
Authors: Takase H , Machii M , Nonaka D , Ohno K , Takayama S , Sugiura T , Ohte N , Dohi Y 
Published: November 2020

Abstract

Background/Introduction
Dietary salt consumption is one of the most important modifiable factors in our lifestyle and restriction of dietary salt results in the reduction of blood pressure in previous studies. Excessive salt intake causes cardiovascular diseases independently of its effects on blood pressure. Since metabolic syndrome also increases a risk of cardiovascular disease, there may be some association between salt intake and metabolic syndrome.

Purpose
The present study was designed to investigate a possible relationship between salt intake and future development of metabolic syndrome in the general population.

Methods
Consecutive 12,256 subjects without metabolic syndrome (male=7,053, 52.1±12.3 year-old) who visited our hospital for an annual physical check-up from April 2010 to March 2018 were enrolled. After baseline examination, subjects were followed up until March 2019 (median 1,582 days) with the endpoint being the development of metabolic syndrome. Metabolic syndrome was diagnosed according to the Japanese criteria (2005). Individual salt intake was estimated using a spot urine by a previously reported method.

Results
Salt intake was 11.9±3.0 g/day in male and 8.2±2.1 g/day in female subjects at baseline. During the follow-up period, 1,669 subjects developed metabolic syndrome (29.9 per 1,000 person-year) with the incidence being more frequent in male than female subjects (41.8 vs. 14.2 per 1,000 person-year). Non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of salt intake for the development of metabolic syndrome was 1.157 (1.142–1.173). In analysis where subjects were divided into gender-specific quartiles according to the baseline salt intake, Kaplan-Meyer curve analysis revealed that the incidence of metabolic syndrome were increased across the quartiles (20.6, 25.0, 32.4, and 42.7 per 1,000 person-years; logrank p&lt;0.001). Multivariate Cox proportional hazard analysis adjusted for age, gender, body mass index, systolic blood pressure, heart rate, serum creatinine, uric acid, fasting plasma glucose, low-density lipoprotein cholesterol, triglyceride, hemoglobin and current smoking habit at baseline revealed that salt intake predicted the new onset of metabolic syndrome (HR: 1.036, 95% CI: 1.019–1.054).

Conclusions
Excessive salt intake is significantly associated with the new development of metabolic syndrome in the general population. The results suggest that salt restriction prevents metabolic syndrome as well as hypertension leading to cardiovascular diseases.

Funding Acknowledgement
Type of funding source: None
Social status and long-term events among acute myocardial infarction patients
Authors: Kim M , Lee K.M , Moon H.Y , Jo Y.S , Jin X , Yuan S.L , Kim R.B , Hwang J.Y , Lee J.H 
Published: November 2020

Abstract

Background
Mood disorders, depression, and loneliness are known risk factors for thrombotic occlusions. Social relationships in general, and marital status in particular may play a role in predicting cardiovascular outcomes and survival after ST-segment elevation myocardial infarction (STEMI), but the evidence is inconclusive, especially in Asians. We sought to analyze clinical outcomes following AMI according to insurance type and living type.

Methods
From July 2016 to Sept 2018, the Korean Registry of Regional Cardiocerebrovascular Center for Acute Myocardial Infarction database collected patients over 18 years old who suffered AMI. 3 months and 1-year all-cause death, CVA and re-MI (composite endpoint) were collected by telephone interview.

Results
Overall, the total of 463 all-cause death and 113 re-MI occurred. At 3-months, each group did not any differences in all-cause death and re-MI. At 1-year, however, the single & medical aid patients exhibited significantly higher all-cause death (6.8% vs 18.3%; p=0.000) and composite endpoint (12.5% vs 20.6%; p=0.000) compared to the live together & health insurance.

Conclusion
Social and economic status may be linked to 1-year all-cause death in Korean patients with ST-segment elevation myocardial infarction.
All-cause death and Composite outcomes

Funding Acknowledgement
Type of funding source: None
Cardiovascular rehabilitation after valvular heart surgery: predictive factors of major complications
Authors: Maranta F , Pellegrino S , Bonaccorso A , Rizza V , Castiglioni A , De Bonis M , Alfieri O , Cianflone D 
Published: November 2020

Abstract

Background
The population of patients affected by valvular heart disease is growing and for many of them valvular surgery is still considered the gold standard treatment. Cardiovascular Rehabilitation (CR) following intervention is fundamental for the post-surgical functional recovery and for the monitoring and management of complications that may occur after surgery.

Aim of the study
We aimed at identifying predictors of major complications in patients who underwent valvular surgery and subsequently were involved in an in-patient CR program. Major complications were defined as those requiring an in-patient management: severe anemia needing transfusions, infection of the sternal surgical wound requiring an antibiotic treatment, a positive hemoculture in the presence of systemic signs of infection and pericardial effusion requiring surgical drainage.

Methods and statistical analysis
1600 patients who have been hospitalized in our CR Unit after valvular surgery were enrolled (median age 64 years; 60% males). We examined the demographic data, the cardiovascular risk factors, the main comorbidities, the type of heart surgery (type of valvular surgery and the presence of concomitant other cardiac intervention), the complications developed in Cardiac Surgery Unit and in the CR Unit, the in-hospital length of stay, the 6 minutes-walking tests and principal blood tests.

Results
At multivariate analysis we found that chronic renal dysfunction [OR 1,902 (CI 1,103–3,280), p=0,021], complex cardiac intervention [OR 1,554 (CI 1,030–2,344), p=0,036], sternal re-synthesis [OR 4,671 (CI 1,659–13,152), p=0,004], early post-surgical transfusions [OR 1,670 (CI 1,083–2,573), p=0,020] are independent risk factors for major complications, while a higher hemoglobin value at CR admission [OR 0,677 (CI 0,566–0,810), p&lt;0,001] resulted an independent protective factor.

Conclusions
We identified predictors of major complications during CR after valvular surgery. These factors may help in defining the patients at major risk tailoring the patient management, adopting an individualized clinical and instrumental monitoring. A tailored CR period gives the possibility to optimize the use of hospital economic resources and to achieve a better final outcome.

Funding Acknowledgement
Type of funding source: None
Efficacy of neuromuscular electro stimulation on muscle strength in elderly patients with diabetes mellitus underwent cardiovascular surgery – a multicenter randomized controlled trial
Authors: Takino K , Kameshima M , Asai C , Kawamura I , Tomita S , Hirakawa A , Yamada S 
Published: November 2020

Abstract

Introduction
Cardiovascular surgery causes muscle weakness probably due to a postoperative increase in inflammatory cytokine production, and diabetes mellitus (DM) may promote the postoperative muscle weakness because of increased insulin resistance.

Purpose
A multicenter randomized controlled trial was conducted to examine the effects of postoperative neuromuscular electrical stimulation (NMES) on muscle strength for elderly patients with DM after cardiovascular surgery (UMIN000029940).

Methods
Patients underwent cardiovascular surgery were consecutive screened for eligibility (With DM and age ≥65 years) as study subjects. If eligible, patients were randomly assigned either to the NMES or the sham group. Both of group underwent NMES or sham stimulation (60 minutes / 5 times) and usual postoperative early mobilization program until postoperative day (POD) 7. The primary outcome was the percent change in knee extensor isometric muscle strength (%ΔKEIS) between preoperative to POD 7. Secondary outcomes were the percent change in usual (%ΔUsual walking speed) and maximum walking speed (%ΔMaximum walking speed) and grip strength (%ΔGS). Assessors for physical function were blinded to the outcomes. The statistician who was blinded to the allocation analyzed the data using preoperative value adjusted ANCOVA.

Results
Of 1151 consecutive patients screened for eligibility from February 2018 to January 2020, 158 participants (NMES group, n=79; sham group, n=79) were enrolled. NMES group demonstrated significantly lower %ΔKEIS compared with those in the sham group (Table). Among secondary outcomes, NMES group showed significantly lower %ΔMaximum walking speed and tendency of lower %ΔUsual walking speed and %ΔGS (Table).

Conclusion
NMES prevented postoperative muscle weakness in the elderly patients with DM, indicating that NMES along with early mobilization could be implicated as specific intervention to those populations.

Funding Acknowledgement
Type of funding source: None
Residential cardiac rehabilitation (rCR) derived survival predictors in patients after transcatheter aortic valve replacement (TAVR): a retrospective multicenter study
Authors: Tarro Genta F , Dalla Vecchia L , Scalvini S , Sarzi Braga S , Iannuzzi G.L , Bussotti M , Ceresa M , Rizzo C , Riboni G , Marcassa C , Giordano A , Pedretti R.F.E 
Published: November 2020

Abstract

Purpose
To evaluate exercise-based rCR derived outcome predictors in patients referred after TAVR.

Methods
Data of 434 patients (aged 81±6 years) admitted to an average 3-week rCR program after TAVR (walking, up to 30 minutes of cycling or treadmill session twice daily, respiratory and calistenic training) from January 2009 to December 2017 and home discharged, were retrospectively collected at 10 Italian rCR Division of Istituti Clinici Maugeri SpA. Comorbidity (cumulative illness rated state-comorbidity index) (CIRS-CI) score, echocardiography on admission, Disability (Barthel Index) (BI) score, Morse Fall Scale score (MFS), six minutes walking test distance (6MWT) on admission and discharge and maximal training session intensity (MTSI expressed in METs per minutes) were collected. The mortality was assessed up to 3 years after rCR discharge.

Results
During a 3-years follow up there were 120 (28%) deaths. At t-test analysis non survivors compared to survivors had significantly higher CIRS CI (p=0.000), MFS score on admission (p=0.008) and discharge (p=0.017), serum creatinine level on admission (p=0.000) and discharge (p=0.000); moreover they had significantly lower BI score on admission (p=0.000) and discharge (P=0.000), left ventricle ejection fraction (p=0.008),6MWT on admission (p=0.001) and discharge (p=0.000) and MTSI (p=0.022) in comparison to survivors.
At multivariate logistic stepwise analysis, BI score on admission and serum creatinine level at discharge were the only independent predictors of mortality (Table 1); the AUC of the final logistic model was 0.72.

Conclusions
Patients attending rCR after TAVR seem to be very old; overall mortality at 3 years follow up in patients discharged home after rCR is substantial. Disability profile on admission (measured by Barthel Index) and impaired renal function on discharge (measured by creatinine levels) are independently correlated to death at long term follow up.

Funding Acknowledgement
Type of funding source: None
Left atrial performance during exercise in endurance athletes: the impact of gender
Authors: Simard F , Sanz-De La Garza M , Vaquer-Segui A , Blanco I , Prat-Gonzalez S , Bijnens B , Sitges M 
Published: November 2020

Abstract

Background
High-intensity endurance training is associated with an increased risk of atrial fibrillation (AF) in male athletes while it seems to have a protective effect for the development of atrial arrhythmias in female athletes. Mechanisms underlying this fact are unknown but a differential atrial adaptation to exercise may be involved.

Aim
To evaluate left atrial (LA) performance during exercise in endurance athletes (EAs) of both sexes.

Methods
Highly-trained (&gt;10 hours training/week) EAs performed a maximal cardiopulmonary exercise test. LA evaluation was performed at rest and immediately after exercise. LA analysis consisted of standard and speckle-tracking assessment: atrial contractile, reservoir and conduction strain.

Results
80 EAs (55% women, 34.8±5.8 years) were enrolled. Baseline LA size and functional parameters were similar in both sexes (Table 1). Compared to men, women achieved a higher predicted VO2max (Δchange+11.9%, p&lt;0.01) but a similar increase of systolic blood pressure (Δ+63 vs +66%, p=0.58). Exercise induced a mild decrease in LA size but of similar amplitude for both sexes. LA strain parameters of EAs improved with exercise, but a significantly greater improvement in LA reservoir and conduit function was noted in women compared to men. In EAs with marked atrial remodelling (LA ≥35ml/m2), the same trend of greater improvement of LA reservoir and conduit function in women persisted.

Conclusion
In highly-trained EAs, premenopausal women have better LA function profile during exercise compared to men, even when the LA is significantly dilated. This discriminatory LA adaptation in female EAs could at least partly explain the dichotomous relationship between AF and exercise regarding sexes and warrants further studies to clarify the underlying mechanism.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Government of Spain - Plan Nacional I+D, Ministerio de Economia y Competitividad
You've got to be in it to win it: the importance of including female athletes in screening ECG cohorts
Authors: Janssens K , Paratz E , Brosnan M , Lindqvist A , Mitchell A , Afridi A , Orchard J , Prior D , La Gerche A 
Published: November 2020

Abstract

Background
ECG screening is widely employed in athletic populations with the aim of identifying cardiac conditions associated with sudden death. Recommendations for athlete ECG interpretation are disproportionately reliant on data from male athletes and sex-specific differences have not been adequately elucidated.

Purpose
The aim of this study is to identify any different patterns in female athletic training response on ECG screening.

Methods
444 elite athletes (156 male rowers, 135 female rowers, 117 male cricketers, 36 female cricketers) underwent electrocardiogram (ECG) screening. Standard definitions were used to characterize abnormalities identified on ECG. Comparisons were made according to sex and endurance (rowing) vs skill-based (cricket) athletes (EA and SBA respectively).

Results
“Potentially pathological” T-wave inversion extending to V3 was more prevalent in female athletes (9.9% vs. 2.9%, P=0.002), especially amongst endurance athletes (11.9% female EA vs. 2.8% female SBA, P=0.004) (Figure 1). As compared with males, the QTc interval was longer in female athletes (418 vs. 402ms), the QRS duration was shorter (90 vs. 100 ms) and left ventricular hypertrophy on voltage criteria were less prevalent (9.9% vs. 33.3%, P&lt;0.001 for all). First-degree heart block and incomplete right bundle branch block were more prevalent amongst male athletes.

Conclusion
Female athletes exhibit different training-related cardiac remodelling responses to exercise compared to males. A greater proportion of ostensibly healthy female athletes, especially female endurance athletes, have ECG changes that would be deemed “potentially pathological” according to current sex-agnostic guidelines.
Figure 1

Funding Acknowledgement
Type of funding source: None
Serum uric acid possibly associated with abnormal left ventricular diastolic function in healthy individuals
Authors: Liu C.W , Tu C.M 
Published: November 2020

Abstract

Background
Elevated serum uric acid (SUA) is reportedly associated with the traditional left ventricular diastolic dysfunction (LVDD).

Purpose
We aimed to investigate the association between SUA and the contemporarily defined LV diastolic function (LVDF).

Methods
We prospectively enrolled healthy individuals who underwent echocardiography to evaluate electrocardiographic abnormalities at the health exam between 1st Jan 2018 and 31th Dec 2019. The evaluation for LVDF includes four criteria: (1) septal E' velocity &lt;7 cm/s or lateral E' &lt;10 cm/s. (2) average E/e' ≥14, (3) left atrial volume index (LAVI) &gt;34 ml/m2, (4) tricuspid regurgitation (TR) velocity &gt;2.8 m/s. The study interest were the presence of the LVDF criteria for each or combined.

Results
The study consisted of 275 healthy individuals (89% male) with the mean age of 32.9±7.6 years and SUA of 6.1±1.3 mg/dl. The hyperuricemic (N=77) vs. normouricemic (N=198) groups had greater ratio of septal e' &lt;7 (18.2% vs. 5.6%, P=0.002), lateral e' &lt;10 (26% vs. 10.8%, P=0.003), the composite of septal e' &lt;7 or lateral e' &lt;10 (31.6% vs. 13.3%, P=0.001), and average E/e' &gt;14 (3.9% vs. 0%, P=0.021). SUA remained significantly associated with septal e' &lt;7 cm/s (adjusted HR: 1.704, 95% CI: 1.093–2.655, P=0.019) and the presence of any LVDF criteria (adjusted HR: 1.342, 95% CI: 1.044–1.724, P=0.022); Trends toward significant association were found between SUA and average E/e' &gt;14 (adjusted HR: 1.330, 95% CI: 0.981–1.804, P=0.066) and between SUA and lateral e' &lt;10cm/s (adjusted HR: 1.342, 95% CI: 0.970–1.857, P=0.076).

Conclusions
Elevated SUA was associated with abnormal LVDF in the healthy individuals with normal kidney function. Maintaining SUA level within a normal limit may prevent from the development of abnormal LVDF and LVH.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Tri-service General Hospital, Songshan branch