bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of psychosocial factors and heart ate variability on blood pressure control in patient with primary hypertension:A path analysis
Authors: Chen T.Y , Kao C.W 
Published: November 2020

Abstract

Background
Hypertension (HTN) is one of the major factors driving the global burden of cardiovascular diseases. About 40% of the adults are affected by elevated blood pressure around the world. The etiology of HTN is multifactorial, including psychological distress, especially symptoms of anxiety and depression. A few meta-analyses and longitudinal studies have reported an association between symptoms of anxiety, depression and HTN. Social support is an important factor in the regulation of emotions in HTN patients. The autonomic nervous system (ANS) plays an important role in the homeostatic control of the cardiovascular system. The measurement of heart rate variability (HRV) is used to evaluate ANS regulation in clinical research.The HRV is also a predictor of cardiovascular-cause events and mortality. Previous studies have identified the association of cardiovascular diseases with social support, anxiety, and depression. Some recent studies have also evaluated the relationship between HRV and cardiovascular diseases. However, very few studies have investigated the association of psychosocial factors, HRV, and blood pressure in patients with HTN.

Purpose
The purpose of this study was to evaluate the effect of psychosocial factors including social support, symptoms of anxiety/depressive, and heart rate variability on mean arterial blood pressures in patients with primary hypertension.

Methods
A cross-sectional descriptive and correlative study was performed. Participants were recruited by convenience sampling from the Cardiovascular Outpatient Clinic at a Medical Center. Data were collected using structured questionnaires, including the Social Support and Hospital Anxiety and Depression Scales. While heart rate variability was measured by a handheld limb lead electrocardiogram recorder device, blood pressure was measured by an automatic sphygmomanometer. Data were analyzed by the structural equation path analysis by the IBM SPSS Amos 21.0 statistical software packages.

Results
This study included 301 patients with primary hypertension. The scores of the Social Support Scale had a significantly direct effect on the scores of Hospital Anxiety and Depression Scale. The Hospital Anxiety and Depression Scale scores had a significantly direct effect on the heart rate variability. The low frequency/ high-frequency ratio of heart rate variability had a significantly direct effect on the mean arterial blood pressures. The path model including all variables explained 45% variance in the mean arterial blood pressures and had good fit indices.

Conclusion
Findings from our research highlight the significance of how psychosocial factors can affect the autonomic nervous system and blood pressure control of patients with primary hypertension. These findings can aid in developing an intervention program for blood pressure management in future.

Funding Acknowledgement
Type of funding source: None
Growing up with a pacemaker
Authors: Poels P , Vermeulen J , Gewillig M , Meyns B , Willems R 
Published: November 2020

Abstract

Indications for pacemakers in young children are rare. In our university hospitals, on average 8 patients/year received a pacemaker in this age group between 2001 and 2015 for a drainage area of 4 million people. In 28% this is for congenital heart block and in 69% for bradycardia after surgical repair of congenital structural heart disease. Despite the extensive range of patient information about pacemakers, we felt a need for targeted material for young patients, who have an indication for a pacemaker, and their family. We wanted to provide this information to this specific group in a creative, accessible and clear way, taking into account their way of thinking. In addition, we also wanted to involve the near and wider environment of the child (family, school, sports club, etc.), and to provide them with tools to better deal with the medical situation.
For the little children we created a stop-motion story in which sinus node disease (SND) and AV block (AVB) are represented by a character: Bob Sparkle (Bob Prikkel in Dutch for SND) and Boris Sparkle (Boris Prikkel for AVB). Bob and Boris get into trouble and are rescued by Pacemaker, the third character in the films. This story is preceded by an informative part for parents and older children in which the normal functioning and conduction system of the heart is explained. Based on the films, we designed customized information brochures for +12 and −12 year-old children. The brochure for +12 includes the same information as the adult version, but in more comprehensible language. The figures Bob and Boris were added throughout this brochure as a sort of common thread. For the −12 group we designed 2 reading books in which the story of Bob / Boris is told. The −12 booklets can be included in a cover along with the +12 brochure, so that the parents can estimate for themselves what is most suitable for their child.
We conducted a survey on how this information was received by patients and their relatives.61 families were contacted by e-mail to fill in a questionnaire using a 5-point Likert Scale. The survey assessed the following three items: graphic design, intelligibility and aid in coping with illness. Currently we have received answers from 12 patients or their relatives.
Overall, there was a positive reception of the different informative tools (agree or strongly agree: booklets: 92.6%; brochure: 77.2%; films: 81.3%).

Funding Acknowledgement
Type of funding source: None
The association between anxiety measured with HADS and use of psychotropic medication among cardiac patients
Authors: Cromhout P.F , Christensen A.V.C , Joergensen M.B.J , Ekholm O.E , Juel K.J , Svendsen J.H.S , Rasmussen T.B.R , Borregaard B.B , Mols R.E.M , Thrysoee L.T , Thorup C.B.T , Berg S.K.B 
Published: November 2020

Abstract

Background
Anxiety among cardiac patients is highly prevalent and is associated to poor outcomes. Certain types of psychotropic medication are suspected of causing adverse events in cardiac patients. However, an association between symptoms of anxiety and use of psychotropic medication among cardiac patients has not yet been established.

Purpose
The objective was to explore the association between anxiety (measured by HADS-A) and use of psychotropic medication among cardiac patients.

Methods
All study participant were identified from the DenHeart study and data were a combination of patient-reported survey data and baseline and follow-up data from Danish national registers. Information on redeemed prescriptions of psychotropic medication was obtained from The Danish National Prescription Registry. Anxiety symptoms were defined by a HADS-A score≥8. Patients were defined as users of psychotropic medication if they had redeemed at least one prescription one and three years after discharge. Psychotropic medication was classified by Anatomical Therapeutic Chemical Classification (ATC) codes.
Multiple logistic regression analysis within one year and Cox regression analysis within three year from discharge was conducted to determine the association between symptoms of anxiety and use of psychotropic medication.

Results
Among the 12,913 cardiac patients included, a total of 3231 (28%) redeemed at least one prescription of psychotropic medication within one year and 4726 (37%) within three years after discharge. The most commonly used drugs were benzodiazepines and antidepressants. Among patients using psychotropic medication 1481 (46%) had a HADS-A score ≥8. Cardiac patients with symptoms of anxiety had significantly higher odds of using psychotropic medication within one year from discharge OR 2.47 (95% CI 2.25; 2.72). The increased risk of use of psychotropic medication was confirmed with a almost two-fold risk after three years, HR 1.92 (95% CI 1.80; 2.04), Table 1.

Conclusion
Cardiac patients with symptoms of anxiety measured by HADS were significantly more likely to use psychotropic medication within one and three years after discharge than cardiac patients without symptoms of anxiety.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Novo Nordisk Foundation
Diagnostic performance of 18-leads electrocardiography to distinguish takotsubo syndrome and acute anterior myocardial infarction
Authors: Shimizu M , Cho S , Hara K , Ohmori M , Kaneda T , Tateishi R , Yamakami Y , Shimada H , Manno T , Isshiki A , Kimura S , Fujii H , Suzuki M , Nishizaki M , Sasano T 
Published: November 2020

Abstract

Background
Electrocardiographic (ECG) features on acute phase of Takotsubo syndrome (TTS) is recognized to mimic that of acute anterior myocardial infarction (ant AMI). However, the difference of synthesized 18-leads ECG of both diseases was not elucidated.

Purpose
To elucidate diagnostic performance of 18-leads ECG to distinguish TTS and acute anterior AMI.

Methods
We firstly enrolled consecutive 40 patients of TTS, and among 500 ant AMI patients, one to two matching was done by their age and gender. Finally, 40+80 patients (74.5±11.2 years, 87 females) were enrolled, and ECG at onset of both group was estimated. Because of multicollinearity, all significant differences were compared by machine learning (Random Forest method).

Results
Prevalence of Q wave had no difference. Conversely, ST depression in TTS and ST elevation in ant AMI were significant differences in V7–9 leads. T-wave polarity of V3R-V9 leads were significantly different (flat T-wave in TTS and positive in ant AMI). Machine learning revealed T wave polarity in V7 lead had the highest feature importance.

Conclusion
18-leads ECG at onset had powerful diagnostic performance to distinguish the two diseases.

Funding Acknowledgement
Type of funding source: None
A single-center validation of the effectiveness in Obstructive Sleep Apnea screening with a photoplethysmography-based smart device
Authors: Chen Y , Wang W , Guo Y , Zhang H , Chen Y , Xie L 
Published: November 2020

Abstract

Background
Obstructive sleep apnea (OSA), the most common upper-airway disease, is closely associated with cardiovascular risk. However, the early detection of OSA is challenging, relying on polysomnography (PSG) or portable monitor (PM) in hospitals. A novel technology, photoplethysmography (PPG), has been developed for OSA screening. But there has been limited validation of PPG-based smart devices compared to PSG or PM.

Objective
This study aimed to investigate the feasibility and verify the validity of PPG-based smart devices in the detection of OSA in real-world settings.

Methods
A total of 119 consecutive outpatients, were recruited from the Chinese PLA General Hospital from Sep 29 to Nov 10, 2019. Participants were simultaneously tested with a smart watch, and PSG or PM for a whole night sleep.

Results
In all, 102 patients (48.5±13.7 years old, female 23.5%) were into the final analysis after excluding 17 patients with poor quality of PPG signals. Among them, 83 patients (81.3%) were diagnosed with OSA. Compared to PM, the corresponding accuracy, sensitivity and specificity of PPG-based smart device in predicting moderate to severe OSA patients ( Apnea Hypopnea Index, AHI ≥15) were 87.9% (95% Confidential Interval, CI: 78.8%–94.1%), 89.7% (95% CI: 75.8%–97.1%) and 86.0% (95% CI: 72.1%–94.7%), respectively. Compared to PSG, the accuracy, sensitivity and specificity in predicting all the sleep apnea patients (AHI ≥5) were 81.1% (95% CI: 72.1%–88.2%), 76.5% (95% CI: 50.1%–93.2%) and 100% (95% CI: 29.2%–100%), respectively. Moreover, for moderate to severe OSA patients (AHI ≥15), the predictive ability of PPG-based smart device in OSA was of no significant difference compared to PM (P=0.75) or PSG (P=0.52).

Conclusions
The PPG-based smart device demonstrated good performance in detecting OSA. Nevertheless, it requires further validation in a large-scale population on screening OSA.

Funding Acknowledgement
Type of funding source: None
Anti-cancer drugs associated with sudden death and ventricular arrhythmias: a cardio-oncology pharmacovigilance analysis
Authors: Mirabel M , Karapetiantz P , Marijon E , Le Beller C , Reda Al-Sayed Z , Boutouyrie P , Jouven X , Lillo-Lelouet A , Hulot J.S 
Published: November 2020

Abstract

Background
Experimental data have shown that some anticancer drugs can affect cardiac repolarization and induce life-threatening cardiac arrhythmias.

Objective
To identify anti-cancer drugs associated with the occurrence of sudden death (SD) and ventricular arrhythmias using the World Health Organization individual case safety report (ICSR) database, Vigibase.

Methods
The system organ class MEDRA was used to identify cases as ICSR with the terms sudden death, sudden cardiac death, cardiac arrest, ventricular fibrillation, ventricular tachycardia, ventricular arrhythmia and torsades de pointes (named as SD events) from Nov 1967 to Nov 2019. We used the ATC code L01 which regroups 219 antineoplastic agents. A disproportionality analysis was performed to estimate of relative Odds Ratio (ROR). Signals were considered significant when the lower boundary of the 99.97% confidence interval (ROR0.25) was ≥1.

Results
Among the 2,170,203 adverse events associated with anticancer drugs, 11,979 (0.55%) concerned SD events. A total of 49 molecules were significantly associated with SD events, among which 4 were withdrawn from market. These molecules were mainly anti-metabolites (20.0%), chemicals such as arsenic (17.8%,), anthracyclins (8.9%) and alkaloids (8.9%). When agents were grouped according to their mode of actions, the highest risks were observed for platinum-based drugs (n=1628 cases, ROR0.25=1.2) and anthracyclins (n=1323 cases, ROR0.25=1.3). While the risk for SD or severe arrhythmias was reported in the drug label for 29 agents (64.4%), we found that this risk was not identified or mentioned for 16 agents (35.5%).

Conclusions
We identified 49 anticancer drugs that are significantly associated with SD events overreporting. Appropriate monitoring and preventive measures should be considered for patients receiving these drugs.

Funding Acknowledgement
Type of funding source: None
Impact of environmental pollution and climate changes on the incidence of ST-elevation myocardial infarction
Authors: Biondi-Zoccai G , Frati G , Gaspardone A , Mariano E , Di Giosa A , Bolignano A , Dei Giudici A , Calcagno S , Scappaticci M , Sciarretta S , Valenti V , Peruzzi M , Federici M , Romeo F , Versaci F 
Published: November 2020

Abstract

Background/Introduction
Several reports have highlighted the detrimental impact of environmental pollution and climate changes on cardiovascular disease. However, detailed analyses aiming at disentangling the differential impact of pollution versus climate are lacking. Most importantly, limited research has focused on ST-elevation myocardial infarction (STEMI), the most severe yet distinctive form of acute coronary syndrome.

Purpose/Methods
We aimed at appraising the impact of environmental pollution and climate changes on the incidence of STEMI, analyzing the bivariate and multivariate association between several environmental and atmospheric parameters and the daily incidence of STEMI in two large Italian urban areas. Specifically, we appraised: carbon monoxide (CO), nitrogen dioxide (NO2), nitric oxide (NOX), ozone, particulate matter smaller than 10 μm (PM10) and than 2.5 μm (PM2.5), temperature, atmospheric pressure, humidity, and rainfall. On top of same day association, we appraised STEMI risk 1, 2, and 3 days later. Computations were performed using a multilevel mixed-effects generalized linear model with Poisson likelihood and log link, yielding incidence ratios (95% confidence intervals) and corresponding p values.

Results
A total of 4458 days at risk were appraised, 3473 cases of STEMI. Specifically, no STEMI occurred in 1920 (44.8%) days, whereas one or more occurred in the remaining 2365 (55.2%) days. Multilevel modeling identified several pollution and climate predictors of STEMI, either occurring on the same day, or on the following ones. In particular, concentrations of CO (p=0.024), NOX (p=0.039), O3 (p=0.003), PM10 (p=0.033), and PM2.5 (p=0.042) predicted STEMI as early as three day before the event, as well subsequently, and NO predicted STEMI one day before (p=0.010), as well as on the same day. A similar predictive role was evident for temperature and atmospheric pressure (all p&lt;0.05). Notably, strong correlations were evident between same-day temperature, pollutants and climate.

Conclusions
The risk of STEMI in the current primary percuntaneous coronary intervention area is strongly associated with pollution and climate features. Most notably, environmental and climate changes can be exploited to predict STEMI risk in the following days.

Funding Acknowledgement
Type of funding source: None
Maximum artificial intelligence and complete reconstruct of population-based AMI care
Authors: Mehta S , Gibson M , Niklitschek S , Fernandez F , Villagran C , Escobar E , Vera F , Frauenfelder A , Vieira D , Vijayan Y , Quintero S , Vallenilla I , Pinto G , Cardenas J , Merchant S 
Published: November 2020

Abstract

Background
After creating a behemoth hub and spoke AMI network that encompasses more than 100 million patients in 5 countries, we have begun to incorporate Artificial Intelligence (AI) algorithms into our telemedicine strategy with the goal of creating comprehensive, very early AMI diagnosis and physician-free triage. In doing so, we have replaced door-to-balloon times (d2b) with symptom-to-balloon times (s2b) as an immutable objective.

Purpose
To incorporate AI attributes for very early AMI detection, triage, and management.

Methods
We expanded our effective telemedicine strategy (100 million population; 877,178 telemedicine encounters; 55% overall mortality reduction; $291 million cost savings) with a logistic reset to impact s2b. To do this, we incorporated our Single Lead 1.0 (lead I) and Single Lead 2.0 (lead V2) technology for self-administered AMI detection with our physician-free STEMI diagnosis and triage AI algorithms. Single Lead algorithms and physician-free protocols were generated by utilizing Machine Learning from our mammoth annotated EKG repository.

Results
In addition to three logistic markers of efficiency Time-to-Telemedicine Diagnosis (TTD), Door-In-Door-Out (DIDO) and Transfer Times (TT); we are monitoring s2b. A gradual release of the algorithms and single lead is occurring at the telemedicine spokes. Detailed results will be available at the time of presentation.

Conclusions
Impacting s2b, the Achilles Heel of Primary PCI, may be achieved with the use of patient-administered AMI detection tools. Incorporation of these technologies into AI algorithms will add to telemedicine efficiencies for population-based AMI care.

Funding Acknowledgement
Type of funding source: None
The first disease centred network in Spain: a bottom-up cardiovascular hospital and primary care network focused on reducing variability, improving population health and efficiency
Authors: Bengoa Terrero C , Bas Villalobos M , Macaya Miguel C , Maroto Castellanos L.C , Fernandez Rozas I , Garcia Lledo A , Perez Villacastin J 
Published: November 2020

Abstract

Introduction
In an autonomous region in Spain, the heads of cardiovascular disease from four hospitals, forty-three primary care centres and the ambulance provider, have come together to collectively reduce variability, improve outcomes and patient experience, increase efficiency and focus on population health through prevention. As a result, a cardiovascular network was founded to address the needs of the population through eight projects, each with a group of professionals dedicated to its completion. This region has Beveridge-type universal healthcare and the clinical network must operate under a choice model in which patients can choose where they wish to be treated. This approach has never been carried forward in Spain previously nor, as far as we are aware, in Europe from the bottom-up with clinical leaders achieving buy-in from the political level.

Purpose
With the well-known demographic challenge putting the system under strain, our hypothesis is that this innovative collaborative approach where by hospitals pool resources and implement collective improvements from the bottom-up will results in better health for its population of over one million people.

Methods
The Institute for Healthcare Improvement's Assessment Scale for Collaboratives is used to track project progress through the valuation of project leads assigned to each project and the senior project manager. This scale divides progress from: forming team, activity but no changes, modest improvement, significant improvement, and outstanding sustainable results; some are further subdivided as shown in the image. Projects each have their set of indicators to ensure project objectives are achieved.

Results
The network has 8 working projects which include different specialists, professional groups and organizations including primary care and the main ambulance provider. The four hospitals have pulled together their resources to recruit two project managers. Progress measured with the Assessment Scale for Collaboratives indicates that projects have moved forward 18% in a three month period, reaching an average progress of 35%.

Conclusion
The closer collaboration across four hospital sites has put this network at the forefront of Spanish health policy by focusing work on diseases rather than by geographical areas. This allows clinical leaders to decide and focus on objectives that most suit the needs of its population whilst building a culture of continuous improvement across multiple care sites and professional groups.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Fundaciόn Interhospitalaria para la Investigaciόn Cardiovascular - Fundaciόn FIC