bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of achieving the minimum clinically important difference for the Incremental Shuttle Walk Test in a cardiac rehabilitation population
Authors: Alotaibi J , Doherty P , Doherty P 
Published: November 2020

Abstract

The primary aim of this study was to identify the determinants of achieving the minimum clinically important difference (MCID) for the Incremental Shuttle Walk Test (ISWT) in the CR population. The secondary aim was to examine whether achieving MCID in ISWT at the end of the CR programme is associated with the likelihood of patients meeting the physical activity recommendation or whether it is associated with the patients' self-reported physical fitness (Dartmouth COOP tool) at the end of the CR programmme.

Method
Routine clinical data related to patients who undertook ISWT as a pre- and post-CR functional capacity assessment were taken from National Audit of Cardiac Rehabilitation (NACR) during the 2013 to 2016 and retrospectively analysed. A sub-analysis was conducted to address the secondary aim. Logistic regression approaches, taking account of potential confounders were constructed.

Results
For the main study, data from 9,786 patients (mean age of 63.9±10.7), 77.5% of whom were male, were analysed. Sixteen determinants for achieving the MCID for ISWT in CR patients were identified. A sub-analysis was also conducted on 7,950 to address the secondary aim. Patients who achieved the MCID were 30% more likely to meet the physical activity recommendation and 60% more likely to rate themselves positively on the self-reported physical fitness Dartmouth COOP scale.

Funding Acknowledgement
Type of funding source: None
Age, sex and underlying heart rate as determinants of nocturnal heart rate variability among wearable smart ring users
Authors: Kentta T.V , Karsikas M , Rantanen A , Kinnunen H , Koskimaki H 
Published: November 2020

Abstract

Background
Heart rate variability (HRV) is an important marker of overall health and especially cardiovascular health. Decreased HRV has been associated with reduced vagal control of heart rate and with adverse outcome in several studies.

Purpose
The purpose of this study was to investigate the impact of demographic factors (age and sex) and underlying heart rate on nocturnal HRV among wearable smart ring users.

Methods
De-identified data was gathered from 104,431 wearable smart ring users over the course of one week (640,911 nights; 65% men and 35% women; age 42.6±12.1 years). Inclusion criteria included self-reported age of ≥20 years and sleep duration ≥4 hours. The ring estimates heart rate and HRV with photoplethysmographic (PPG) sensors and calculates the root mean square of successive differences (rMSSD) between adjacent inter-beat-intervals (IBI) for 5-minute segments throughout each night. The average HRV in these segments was then taken to represent the cardiac parasympathetic activity among each user. In addition, rate-corrected HRV was calculated by dividing the rMSSD value with mean IBI (crMSSD = 100 * rMSSD/IBI).

Results
Nocturnal HRV was significantly dependent on age and underlying heart rate (Figure). The observed rMSSD values declined with age (P&lt;0.001) in both men and women. Concomitant decrease in rMSSD was observed with increasing heart rate in each age group (P&lt;0.001). Statistically significant sex-related differences were observed in HRV. Men had higher crMSSD during the early decades of life (&lt;40 years) than women. This difference diminished with age and women ≥50 years had higher crMSSD than their male coevals. The average resting heart rate decreased with age and was lower among men throughout the age groups (P&lt;0.001).

Conclusions
Normal aging is associated with reduced cardiac vagal modulation and is reflected as decreased nocturnal HRV values among male and female wearable smart ring users. The underlying heart rate is a significant factor for the degree of HRV throughout life. In this population, the sex-related differences observed during the early decades of life diminish on the verge of midlife and are reversed later in life with women showing higher HRV during and after midlife.
Effects of age and HR on HRV

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Oura Health Ltd
Heart failure patients' adherence to hybrid comprehensive telerehabilitation and its impact on prognosis based on data from TELEREH-HF randomized clinical trial
Authors: Piotrowicz E , Pencina M , Opolski G , Zareba W , Banach M , Kowalik I , Orzechowski P , Szalewska D , Pluta S , Irzmanski R , Glowczynska R , Kalarus Z , Piotrowicz R 
Published: November 2020

Abstract

Background
Adherence to treatment guidelines in heart failure (HF) patients (pts) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Introducing hybrid comprehensive telerehabilitation (HCTR) consisting of telecare, telerehabilitation and remote monitoring of implantable devices might be an option to improve adherence to recommendation and can affect the prognosis. Purpose to investigate the association of adherence to HCTR with mortality and hospitalization. Methods The present analysis formed part of TELEREH-HF multicenter, randomized trial that enrolled 850 HF pts (NYHA I-III,LVEF≤40%). Patients were randomized 1:1 to HCTR plus usual care or usual care only and followed up for 14 to 26 months. During the first 9 weeks, pts underwent either an HCTR (1 week in hospital and 8 weeks at home) or usual care. This analysis focuses on pts randomized to HCTR. Adherent pts were those who adhered both to the number of training sessions prescribed and to the duration of the prescribed cycle by at least80%; non-adherent pts, were those who adhered&lt;20% to the prescribed number of training sessions and their duration. The remaining pts were classified as partially adherent.

Results
There were 350 (88.4%) adherent pts, 39 (9.8%) partially adherent pts and 7 (1.8%) non-adherent pts. There were 54 deaths during follow-up in the HCTR arm. Non-adherence or partial adherence was associated with statistically significantly higher risk of cardiovascular (CV) mortality (hazard ratio (HR) = 2.62, p=0.021); all-cause mortality or HF hospitalization (HR=1.71, p=0.038); CV mortality or HF hospitalization (HR=1.89, p=0.014).

Conclusion
The adherence to HCTR was very high. Adherence to HCTR was associated with improved prognosis for CV mortality.
Kaplan-Meier Probability of CV Mortality

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Centre for Research and Development, Warsaw, Poland
Artificial intelligence-based analysis of payment system data can predict one-year mortality of hospitalized patients with heart failure
Authors: Tohyama T , Funakoshi K , Kaku H , Enzan N , Ikeda M , Matsushima S , Ide T , Todaka K , Tsutsui H 
Published: November 2020

Abstract

Background
Individual risk stratification is fundamental in the care of heart failure (HF) patients. However, the prediction performance of risk scores, such as MAGGIC and SHFM, is not adequate and, more importantly, they need additional predictors including various biomarkers, imaging data, and environmental factors. Data from a case-mix payment system including diagnosis and procedures with outcomes can be used to develop the risk prediction models, allowing the use of big data for a more accurate prediction of mortality.

Purpose
This study aimed to develop artificial intelligence (AI) models for predicting 1-year mortality in patients hospitalized due to HF.

Methods
We analyzed the data from 10175 patients enrolled in the Japanese Registry Of Acute Decompensated Heart Failure (JROADHF). Candidate variables included the data obtained from a payment system introduced by the Japanese government, the Diagnosis Procedure Combination (DPC), which included each patient profile (age, sex, height, weight), principal diagnosis for hospitalization, comorbidities, procedures, length of hospital stay, and discharge status. They did not include clinical data available from patients such as vital status, laboratory data including bio-makers, electrocardiographic and echocardiographic data. The collected data were divided into the training set and the validation set (80%: 20%). With the training set, 5 AI models (logistic regression, random forest, support vector machine, neural network, and ensemble classifier) learned the one-year mortality results. AI models were evaluated by using the validation set with ROC analysis. The training and validation steps were repeated 10 times with different seed values to calculate the C-statistic of each model. We also identified the predictors for one-year prognosis acquired from the AI models.

Results
At 1-year of follow-up, a total of 1727 patients had died (17%). Among the machine learning models, the ensemble classifier showed the highest C-statistic of 0.76 (95% confidence interval: 0.75 to 0.77) for predicting mortality. Top predictors acquired from the random forest classifier was ADL (Barthel Index) at discharge, age, body mass index, and length of hospital stay.

Conclusion
By using AI-based analysis of a national case-mix payment system data, the present risk stratification model could predict the one-year mortality of hospitalized HF patients without any quantitative laboratory and physiological data. Furthermore, the present results could emphasize the advantage of this approach using the claim-based data that are routinely collected in a usual daily practice with no need to collect any additional information.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development
HartWacht telemonitoring effectively reduces blood pressure in a real-life setting
Authors: Abeln B.G.S , Blok S , Van Den Born B.J , Somsen G.A , Tulevski I.I , Winter M.M 
Published: November 2020

Abstract

Introduction
Telemedicine platforms have the potential to reduce costs and improve outcomes in blood pressure reduction. Although results in the literature are promising, evidence remains limited and few home monitoring programs have successfully been integrated into daily clinical practice. The HartWacht home monitoring program is set-up for remote monitoring and treatment of patients with therapy resistant hypertension (systolic blood pressure&gt;140 mmHg and &gt;1 antihypertensive drugs). HartWacht is fully integrated into clinical care and is reimbursed by the majority of Dutch healthcare insurers.

Purpose
The purpose of this study is to evaluate the effectiveness of the HartWacht program in blood pressure treatment in a real-life setting, and evaluate the number of interventions necessary to reach normotension.

Methods
In this single center retrospective cohort study, we included all patients with therapy resistant hypertension that were included in the HartWacht program by their treating physician. At baseline, all patients measure blood pressure twice a day for the duration of one week, after which blood pressure measurements were performed once a week. Two pre-set alarms informed a team of designate nurses if blood pressures exceeded 140/90 mmHg (orange alarm) or 180/110 mmHg (red alarm). After one red or two successive orange alarms, the patient was contacted by telephone for guideline driven lifestyle advice or medication adjustment in consultation with a cardiologist. After every intervention, a blanking period of four weeks was set in which no orange alarms were visible.

Results
The cohort consisted of 161 patients (mean age 63±9.8 years; 54% male). The median follow up time was 318 days. At baseline, the mean blood pressure was 155/91 mmHg. During follow-up mean blood pressure decreased significantly to 134/83 mmHg (p&lt;0.001 for both systolic and diastolic blood pressure). At follow up, 102 (62%) patients were normotensive. During follow up participants received a mean of 0.46 lifestyle advices and 0.74 medication changes in 1.07 consultations.

Conclusion
Home monitoring and treatment of patients therapy resistant hypertension with HartWacht resulted in a significant overall reduction of blood pressure, with &gt;60% of patients being normotensive at last follow-up.
Normotension in HartWacht patients

Funding Acknowledgement
Type of funding source: None
Accurate detection of atrial fibrillation using a smartphone remains uncertain: a systematic review and meta-analysis
Authors: Gill S , Sartini C , Uh H.W , Ghoreishi N , Cardoso V , Bunting K.V , Gkoutos G , Suzart-Woischnik K , Asselbergs F.W , Eijkemans M.J.C , Kotecha D 
Published: November 2020

Abstract

Introduction
Early diagnosis of atrial fibrillation (AF) is essential to reduce complications such as stroke, and improve patient quality of life. Novel screening techniques using smartphone camera photoplethysmography (PPG) can be used for AF detection, but their clinical applicability remains unclear.

Purpose
To assess the diagnostic accuracy of smartphone PPG compared to conventional ECG for AF detection.

Methods
We performed a systematic review of MEDLINE, EMBASE, Cochrane library, and other databases (1980-October 2019), including any study or abstract where smartphone finger-tip PPG was compared with a reference ECG (1, 3 or 12-lead). Outcomes were sensitivity (SE), specificity (SP), positive and negative predictive value (PPV; NPV) and overall accuracy. Bivariate hierarchical random effects meta-analysis was performed for studies with confidence intervals for SE and SP, and funnel plots were used to identify publication bias. Study quality was assessed using the established QUADAS-2 tool by two independent graders.

Results
1350 publications were screened, of which 17 studies were included in the systematic review (7 full text publications and 10 abstracts), providing 21 comparisons of accuracy for AF detection. Most studies were based in secondary care and small (range n=33 to 1095), with a total of 5469 participants including 1384 with AF. Only 4 studies were multicentre. Smartphone applications used were Cardiio Rhythm, Fibricheck, Preventicus and Heartbeats, with 7 studies not specifying the tool used. Overall SE and SP for AF detection were high, ranging from 76 to 100%, and 85 to 100% respectively. PPV ranged from 54 to 100% and NPV from 77 to 100%, with overall accuracy between 61 and 99%. The meta-analysis included 12 comparisons from 10 studies (n=2714; 936 with AF). The pooled SE was 93% (95% CI 90–96%) and SP 97% (95% CI 95–99%); Figure 1A. QUADAS-2 assessment demonstrated poor quality of studies overall, with a high or unclear risk of bias in at least one domain for all studies. There was clear evidence of publication bias; Figure 1B.

Conclusions
PPG offers the potential for large scale, non-invasive, patient-led screening of AF. However, current evidence is limited to biased, low quality studies often with unrealistic results for AF detection. These are insufficient to advise clinicians on the true value of current smartphone PPG technology.
Figure 1. Meta-analysis & publication bias

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): BigData@Heart EU/EFPIA IMI 116074.
The features and trends of out-of-hospital cardiac arrests in Japanese working generation: long-term aspects of a prospective, nationwide, population-based registry
Authors: Yamagishi Y , Oginosawa Y , Miyamoto T , Tukahara K , Ohe H , Kohno R , Otsuji Y , Abe H 
Published: November 2020

Abstract

Background
Despite sudden cardiac death (SCD) in working generation is a crucial issue in terms of public health, social and economic significance, the long-term SCD condition in working generation is unclear.

Purpose
This study aimed to clarify the features and long-term trends of SCD in working generation from 2005 through 2016 in Japan, using a prospective, nationwide, population based out-of-hospital cardiac arrest (OHCA) registry.

Methods
We performed data analysis of the nation-wide registry in Japan who experienced OHCA during the 12 years. Working generation was defined as 20 to 69 years and we analyzed only definitive cardiogenic OHCA as an approximation of SCD.

Results
The number of definitive cardiogenic OHCA of working generation during the period was 66,214 and 31% of the events in whole population was working generation. Definitive cardiogenic OHCA in working generation in terms of both number and percentage of the population had been decreased from 6522 (0.07‰) in 2005 to 4910 (0.06‰) in 2016, bystander cardiopulmonary resuscitation (CPR) and usage of automated external defibrillator (AED) ratio increased from 32.7% in 2005 to 49.6% in 2016, and 0.3% in 2005 to 14.7% in 2016 respectively, and the survival rate after one-month improved year by year, from 12.8% in 2005 to 34.0% in 2016 (picture below). Among non-medical bystanders, CPR was most often performed by colleagues in this generation, while AED use rate by colleague was smaller, and the time from witness to initial defibrillation was significantly longer than by passerby. Good prognosis was observed in terms of one-month survival ratio and neurological outcome for those undergoing CPR by colleague and passerby compared with other bystanders. For 12 years, although the degree varies, all non-medical bystander had same tendency; bystander CPR and usage of AED ratio increased, and the survival rate after one-month and neurological outcome improved year by year.

Conclusions
Not only the number but the incidence of cardiogenic OHCA in working generation has been decreased in Japan. The positive prognosis of this generation may be related to CPR by colleagues.
Figure 1. OHCA number & 1-month survival rate

Funding Acknowledgement
Type of funding source: None
Management of conflicts of interests of ESC guideline authors
Authors: Seggewiss H , Schurig N , Lempert T 
Published: November 2020

Abstract

Introduction
According to WHO definition medical guidelines are systematically developed statements to support the decisions of clinicians and patients about appropriate health care for specific clinical situations. Guidelines should be based on on results of randomized trials and independence from economic interests. Therefore, not only detailed declaration but also active management of conflicts of interests (COI) of guideline committee members should be declared. The public database LeitlinienWatch (GuidelineWatch) analyzes German and European guidelines with respect to COI declaration and management.

Methods
Between 2015 and 2019 nine German National Standard of Care guidelines (NVL), 10 German Cancer Society (DKG) guidelines, and 10 ESC guidelines were compared according to five criteria. Each criterion was scored 0–3 points (Table). Furthermore, up to 3 extra points could be awarded for methodological quality.

Results
Overall, guidelines of NVL (11.3±3.5) and DKG (9.8±3.3) achieved more points than ESC guidelines (2.8±0.4; p&lt;0.00001). ESC-guidelines scored points only by documentation of COI and sometimes an extra bonuspoint for an internal review process. In all ESC guidelines &gt;50% of the authors had COI. These conflicts did not lead to an exclusion of lead authors or abstentions from voting. A public accessible review was standard practice in NVL-guidelines and more often performed in DKG-guidelines but was lacking in ESC guideline process. Overall, NVL- and DKG-guidelines showed better handling of COI (Table).

Conclusion
Declaration and management of COI are quality criteria for medical guidelines. Current ESC guidelines do not meet international standards for COI management. Therefore, the rules for the ESC guideline process need to be revised.

Funding Acknowledgement
Type of funding source: None
Free dental care for patients at high risk of developing infective endocarditis – a cost-effectiveness study
Authors: Barradas Pires A , Boyalla V , Meras-Colunga P , Dimopoulos K 
Published: November 2020

Abstract

Background
Good dental hygiene is strongly recommended for reducing the risk of developing infective endocarditis (IE). This is particularly important for patients with predisposing cardiac conditions (PCC), such as prosthetic valves, in whom the life-long risk of developing IE is much higher than in the general population. Despite this, the United Kingdom (UK) National Health System (NHS) only provides free dental care until the age of 18 years. Thereafter, adult patients enter a co-payment model, resulting in a large proportion not being able to access adequate dental care.

Purpose
To study the cost-effectiveness of providing free dental care to IE-high-risk patients in the UK.

Methods
A decision analytical cost-effectiveness model was designed as a combination of a Decision Tree (for a short-term model) and a Markov Model (for cost-benefit estimation in a long-term horizon). The costs and benefits (measured as quality-adjusted life-years or QALYs) of free dental care from the age of 18 years, or 50 years, in a high-risk population were assessed using NHS data. The cost of dental care reimbursement varies across the UK, from £18 to £162 per Unit of Dental Activity (UDA), depending on the Dental Practices contracts with the NHS. The cost of dental care used in the model was £26 per UDA, an average of the UK prices. In a co-payment scenario this translates into the NHS paying £4 and the rest of the cost being passed out to the patient. In a free dental care scenario, the NHS would pay the full £26.

Results
In a short-term horizon of 1 year, the model estimated that if 1 million high-risk patients were given access to free dental care, 638 cases IE (53 cases a month) and 95 deaths could be avoided each year. The cost of 1 death averted would be £142,926 (€162,208). The long-term model shows free dental care would translate into an extra cost of £66,687/QALY (€74,844) for the NHS if started at 18 years of age, or £96,287/QALY (€120,864) if started at 50 years of age.

Conclusions
Free dental care in patients at high-risk of IE is not cost-effective within the current willingness-to-pay (WTP) NICE guidelines (£20–30,000/QALY). This is significantly influenced by the elevated cost of dental care in the UK. If the UDAs were reimbursed as £18 homogeneously across the UK, the model results would be closer to the WTP threshold. Further studies are needed to explore alternative scenarios where this policy would be cost-effective.
Transition state probabilities

Funding Acknowledgement
Type of funding source: None