bluuebunny/crossref_metadata_2025_split huggingface dataset:
3154The incidence of atrial fibrillation continues to increase across all socioeconomic subgroups: 30-year time trends from a Nationwide cohort
Authors: Yaqub Z M , Sehested T S G , Bonde A N , Olesen J B , Torp-Pedersen C , Gislason G , Staerk L 
Published: October 2019

Abstract

Introduction
The incidence rate of atrial fibrillation (AF) has increased substantially throughout the last decades. Socioeconomic factors such as income and education are well known to be associated with the development of cardiovascular disease, however, the impact on long-term trends of AF incidence rates is yet to be described.

Purpose
This nationwide cohort study examined the temporal trends of AF incidence rates over a span of 30 years (from 1987 to 2016) in Denmark. Furthermore, the impact of income and education was outlined.

Method
Patients were identified through linkage across Danish national registries from 1987 to 2016. We extracted data on the total number of inhabitants in Denmark aged ≥18 years, and used their age, sex, civil status, income and educational level for each calendar year. Data on socio economics were available from 1994. Income was defined by the average income over the prior 5 years and grouped into low (&lt;q1),&gt;Q3). Educational level was divided into primary school, high school, bachelor's degree, or master's degree. We defined incident AF as all first-time in- and outpatient diagnoses of AF. The incidence rates of AF were age-standardized per 1000 person-years for each calendar year and calculated for men and women separately.

Results
A total of 6,968,997 Danish inhabitants aged ≥18 years contributed to the study population from 1987 to 2016, and 393,183 (6%) developed AF over the study period. The age-standardized incidence rates of AF per 1000 person-years increased from 1.23 (CI 1.15:1.30) to 4.05 (CI 3.93:4.17) for men and from 1.13 (CI 1.06:1.30) to 3.56 (CI 3.44:3.68) for women from 1987 to 2016. Income status and educational level influenced the age-standardized incidence rates more significantly in women than men. The incidence rate from 1994 to 2016 for women with low income increased by a factor of 2.1 from 2.0 (CI 1.89:2.21) to 4.36 (CI 4.03:4.73). However, the high income group increased by a factor of 1.6 (from 1.74 (CI 1.10:3.32) to 2.83 (CI 2.29:3.55) per 1000 person-years). Moreover, the incidence rate for women with low educational level increased from 1.60 (CI 0.95:5.97) to 4.01 (CI 3.80:4.23) per 1000 person-years. The high educational group increased only by 1.2 (from 2.55 (CI 0.77:10.38) to 3.1 (CI 3.32:4.11) per 1000 person-years).

Conclusion
In a nationwide population, the incidence rate of AF continued to increase during a 30-year period. All socioeconomic subgroups experienced an increase in AF incidence, but the impact of low socioeconomic status was more significant among women than among men. The progressive growth in AF incidence has significant public health implications.

Acknowledgement/Funding
Danish Heart Foundation
3268Impact of heart failure on prognosis compared to other complications in patients with diabetes mellitus type 2
Authors: Zareini B , Blanche P B , D'Souza Diederichsen M D D , Elmegaard Malik M E M , Lund Kristsensen S L K , Selmer C S , Koeber L K , Gislason G G , Torp-Pedersen C T P , Schou M S , Lamberts M L 
Published: October 2019

Abstract

Background
Recent studies have highlighted a high incidence of heart failure (HF) in type 2 diabetes mellitus (T2D), but it remains unclear how the development of HF affects prognosis compared to other T2D complications.

Purpose
To estimate the risk of death associated with the development of HF compared to ischemic heart disease (IHD), chronic kidney disease (CKD), stroke, and peripheral artery disease (PAD).

Methods
Incident T2D patients were identified in the period between 1998–2015, as all patients redeeming a first-time prescription of non-insulin glucose-lowering medication through Danish nationwide registers. Patients with a history of T2D complications and patients <18 years were excluded. Incident T2D complications were defined as HF, IHD, CKD, stroke, and PAD. We estimated the 5-year risk of death after the development of T2D complications according to the time since the onset of T2D by yearly landmark analyses. We estimated the survival probability and risk ratios (with T2D patients free of complications as reference) at each landmark year among patients who survived their T2D complication.

Results
A total of 153,403 patients with incident T2D (median age 64 years [interquartile range (IQR):55; 72] and 54% males) were included and followed for a median of 7.4 years (IQR: 4.3; 11.5). During follow-up, 48,087 (31%) patients died. Among the patients who survived, the following number of T2D complications were present at landmark year one vs. ten: HF: 1030 (0.7%) vs. 1082 (2.2%), IHD: 3622 (2.4%) vs. 6354 (12.6%), CKD: 905 (0.6%) vs. 2084 (4.1%), stroke: 1446 (1.0%) vs. 2387 (4.7%) and PAD: 1122 (0.8%) vs. 1517 (3.0%). HF posed the most unfavorable prognosis compared to other T2D complications (see figure). The 5-year risk of death associated with HF development one, five and ten years after T2D diagnosis was: 46.9 (95% confidence interval [CI]: 43.5; 50.3), 47.6 (95% CI: 44.8; 50.3) and 41.8 (95% CI: 38.0; 45.7) respectively. The 5-year risk ratios of death associated with HF development during one, five and ten years after T2D diagnosis compared with T2D patients free of complications was: 3.2 (95% CI, 3.2; 3.3), 3.0 (95% CI 2.9; 3.1) and 2.2 (95% CI, 2.1; 2.2), respectively.

Conclusion
While IHD was the most common complication at each landmark year, developing HF was associated with the highest risk of death compared to the other T2D complications.
3297Real-world outcome of applying the ESC 0/1-hour algorithm in clinical routine
Authors: Twerenbold R , Costabel J P , Nestelberger T , Campos R , Arbucci R , Boeddinghaus J , Puelacher C , Du Fay De Lavallaz J , Rubini Gimenez M , Koechlin L , Lambardi F , Resi S , Alves De Lima A , Trivi M , Mueller C 
Published: October 2019

Abstract

Background
The European Society of Cardiology (ESC) recommends the use of a 0/1h-algorithm for rapid triage of patients with suspected non-ST-elevation myocardial infarction (NSTEMI). To date, its impact on patient management and ultimately also safety when routinely applied in emergency departments (ED) is unknown. We therefore aimed to determine these important real-world outcome data.

Methods
In a prospective international multicenter study enrolling unselected patients presenting with suspected NSTEMI to the ED, we assessed the real-world feasibility, adherence, efficacy, effectiveness, and safety of the ESC 0/1h-algorithm using high-sensitivity cardiac troponin T embedded in routine clinical care. Patients with ST-segment elevation myocardial infarctions were excluded. Safety was quantified by the 30-day incidence of major adverse cardiac events (MACE, defined as the composite of cardiovascular death and myocardial infarction including the index event) in the rule-out group and in outpatients.

Results
Among 2296 patients, NSTEMI prevalence was 9.8% (224/2296). Feasibility was very high with a median time to the “1h-draw” of 65 minutes [q1 61, q3 72]. Adherence was very high with 94% (95% confidence interval [CI], 93–95) of patients managed without protocol violations. Effectiveness was very high: 98% (95% CI, 97–98) of patients triaged towards rule-out by the ESC 0/1h-algorithm did not require additional cardiac investigations including hs-cTnT measurements at later time points (e.g. 3–12h) or coronary CT-angiography in the ED. Median time to discharge from the ED was 150 [q1134, q3235] minutes in the overall population. The ESC 0/1h-algorithm triaged 62% (95% CI, 60–64) of patients towards rule-out and 13% (95% CI, 12–14) towards rule-in of NSTEMI. Overall, 71% (95% CI, 69–72) of patients underwent outpatient management (Figure 1). Safety of rule-out and outpatient management were very high with a 30-day MACE incidence of 0.2% (95% CI, 0–0.5) and 0.1% (95% CI, 0–0.2), respectively. These findings were consistent in several predefined subgroups.
Figure 1

Conclusions
These real-world data document the excellent feasibility, adherence, effectiveness, efficacy and safety of the ESC 0/1h-algorithm for the rapid management of patients presenting with suspected NSTEMI to the ED when applied in routine clinical practice.
333018F-Fluorodeoxyglucose Positron Emission Tomography Computed Tomography (PET/CT) for the diagnosis of prosthetic valve infective endocarditis (PVIE): a prospective multicenter study
Authors: Philip M , Tessonnier L , Mancini J , Mainardi J L , Lussato D , Cammillieri S , Weinmann P , Hagege A , Gouriet F , Camoin L , Casalta J P , Riberi A , Drancourt M , Lepidi H , Habib G 
Published: October 2019

Abstract

Background and objectives
18F-FDG PET/CT has recently been added as a major criterion in the ESC 2015 infective endocarditis (IE) guidelines, but the value of this new diagnostic algorithm has never been prospectively assessed.

Purposes
1. Primary objective: to assess the value of the new ESC criteria including 18F-FDG PET/CT in prosthetic valve infective endocarditis (PVIE).
2. Secondary objectives: to determine the reproducibility of 18F-FDG PET/CT; to assess its ability to predict embolic events.

Methods
Between 2014 and 2017, 175 patients with suspected PVIE were prospectively included in 3 French centers. After exclusion of patients with uninterpretable or not feasible PET/CT,115 patients were finally included in the analysis, including 91 definite IE and 24 rejected IE, as defined by an expert Consensus of Endocarditis Team after 3-month follow-up as Gold Standard
Nuclear data were blindly analyzed by two independent nuclear medicine physicians.
Patients follow-up was scheduled at one and three months after hospitalization

Results
Significant cardiac uptake by PET/CT (major criterion) was observed in 67 among 91 patients with definite PVIE and 6 patients with rejected IE (sensitivity 73.6%, specificity 75%, positive predictive value 91%, negative predictive value 42%). Considering cardiac uptake as a major criterion, the ESC 2015 classification increased the sensitivity of Duke criteria from 57 to 84% (p<0.001) but decreased its specificity from 84 to 70% (p<0.001).
Intraobserver reproducibility of cardiac uptake evaluation was good (kappa = 0.84) but inter observer reproductibility was less satisfactory (kappa = 0.63).
Embolic events occurred in 31 patients (27%) and were correlated with vegetation size by ECHO (p<0.001), Staphylococcus infection (p=0.003), and PET/CT cardiac uptake (p=0.02).

Conclusion
1. the value of PET CT and ESC criteria is confirmed and may allow earlier diagnosis of PVIE
2. PET CT is associated with an increased risk of false positive results probably related to the technical improvements
3. Reproducibility of nuclear measurements seems unsatisfactory, justifying efforts to standardize PET studies interpretation
4. Our study describes for the first time a positive correlation between a positive PET/Ct and occurrence of embolic events, warranting additional studies.
3333Contemporary mortality rates in myocardial infarction patients in Sweden: a tale of two registries
Authors: Siverskog J , Janzon M , Levin L.-Å , Alfredsson J , Henriksson M 
Published: October 2019

Abstract

Background
Sweden has contributed to the understanding of the long-term prognosis after myocardial infarction (MI) utilising the quality registry SWEDEHEART, including patients admitted to heart intensive care, and the National Patient Registry (PAR), based on administrative records for Swedish hospitals. As registration procedures differ between the registries, and not all MI patients are admitted to heart intensive care, MI patients identified in SWEDEHEART and PAR, respectively, will yield different cohorts of patients. This may result in different epidemiological research findings regarding prognosis after MI.

Purpose
To study MI populations identified in SWEDEHEART and PAR, respectively, and investigate potential differences in mortality outcome.

Methods
Patients hospitalised with an MI primary diagnosis (ICD-10 I21) between 2002 and 2015 were identified using SWEDEHEART and PAR. The analysis time started at the date of hospital admission and survivors were followed for 365 days. Kaplan-Meier analysis was used to estimate survival by cohort category controlling for age and gender.

Results
Excluding cases with invalid data (n=1,905), 225,612 and 282,118 SWEDEHEART and PAR patients, respectively, were identified. We found 213,367 patients in both SWEDEHEART and PAR, whereas 12,245 and 68,751 patients were unique to SWEDEHEART and PAR, respectively. The one-year survival probability after MI in the SWEDEHEART population was 0.841, compared to 0.788 in PAR (Figure). This discrepancy can be explained by high mortality among patients not covered by SWEDEHEART and persists after controlling for age and gender (Table). To what extent differences in registration procedures and other patient characteristics can explain the mortality difference is an area for further research.
One-year survival by age and gender Age ± 1 year Male Female PAR S.H. Diff. PAR S.H. Diff. 65 0.922 0.936 0.015 0.919 0.936 0.017 70 0.893 0.909 0.016 0.889 0.908 0.019 75 0.829 0.858 0.029 0.834 0.860 0.026 80 0.743 0.783 0.040 0.768 0.800 0.033 85 0.625 0.677 0.052 0.662 0.705 0.042
One-year survival after MI

Conclusion
Estimated one-year survival for MI patients differs by up to 5 percentage points depending on the registry used. Although further research is needed to fully understand these differences, epidemiological findings regarding MI prognosis should be interpreted in light of registry type used and population represented.

Acknowledgement/Funding
Region Östergötland
3335First-line coronary computed tomography predicts long-term clinical outcome in patients with Non-ST-segment elevation acute coronary syndrome - The VERDICT trial
Authors: Kofoed K F , Engstroem T , Sigvardsen P , Torp-Pedersen C , Linde J , Riis Hansen P , Holmvang L , Hofsten D , Elming H , Gislason G , Kelbaek H , Kober L 
Published: October 2019

Abstract

Background
In patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) coronary pathology may range from structurally normal vessels to severe coronary artery disease. Current guidelines recommend early invasive coronary angiography (ICA) for risk assessment and choice of treatment strategy.

Purpose
We tested the hypothesis that 1) a first-line coronary computed tomography angiography (CCTA) predicts long term clinical outcome in patients with NSTE-ACS and 2) adding ICA to CCTA does not improve prediction of cardiovascular events.

Methods
We included patients with NSTE-ACS confirmed by ischaemic ECG changes and/or elevated biomarkers of myocardial ischaemia, in whom both CCTA and ICA were feasible within 12 hours. According to the VERDICT study protocol (ClinicalTrials.gov number NCT02061891) patients were randomised 1:1 to evaluation within 12 hours (Very Early) or 48–72 hours (Standard). CCTA was conducted prior to ICA and patients with an event between tests were excluded. Based on CCTA and ICA, patients were categorized according to European Society of Cardiology (ESC) guidelines as having prognostic indication for coronary revascularization ESCprog (left main stenosis, proximal left anterior descending artery stenosis or multivessel disease) or no prognostic indication – ESCnon-prog. The primary endpoint was a combined endpoint of all-cause mortality, non-fatal recurrent myocardial infarction, hospital admission for refractory myocardial ischemia or hospital admission for left sided heart failure. Discrimination of 1.5-year outcomes was assessed by time-dependent area under the receiver operating characteristic curve (AUC).

Results
CCTA and ICA was conducted in 979 patients. During a median follow-up time of 4.2 (IQR 2.7–5.5) years the primary endpoint occurred in 209 (21.3%) patients. Patients with ESCprog as defined by CCTA had a hazard ratio of 1.53 (95% CI 1.16–2.03) for occurrence of the primary endpoint. AUC for the prediction of the primary endpoint by CCTA was 68.6 (95% CI: 62.7–74.5) as compared to 68.6 (95% CI: 62.8–74.5), when adding ICA to the model. Similar findings were noted in patients randomized to either Very Early or Standard treatment strategy.

Conclusions
Long-term risk assessment in patients with NSTE-ACS may be conducted using a first-line CCTA strategy and may thus potentially guide patient management. Adding invasive coronary angiography to CCTA does not improve risk assessment.

Acknowledgement/Funding
This study was funded by the Danish Agency for Science, Technology, and Innovation and the Danish Council for Strategic Research (grant no. 09–066994)
4034Distance from hospital as an early marker of outcomes in out of hospital cardiac arrest acute myocardial infarction survivors treated with endovascular mild therapeutic hypothermia
Authors: Hetclova D , Hutyra M , Precek J , Moravec O , Skala T , Sanak D , Adam T , Taborsky T 
Published: October 2019

Abstract

Background
The prediction of outcome in comatose patients after out of hospital cardiac arrest (OHCA) has major ethical and socioeconomic implications. At present, there is a lack of data comparing the predictive value from cardiac arrest localization to hospital distance in OHCA survivors treated with endovascular therapeutic hypothermia.

Methods
86 patients (64±14 years, 69 men) were evaluated after OHCA due to ventricular fibrillation (VF) during an acute myocardial infarction (MI). All patients (NSTEMI 28%, STEMI 72%) were indicated for urgent coronary angiography, echocardiography for left ventricular ejection fraction (LVEF) estimation using Simpson biplane formula and treated with mild therapeutic hypothermia (MTH) using intravascular temperature management to maintain target temperature (33 °C) for 24 hours. The Cerebral Performance Categories scale (CPC) was used as the outcome measure and was assessed 3 months post admission; a CPC of 3–5 was regarded as a poor outcome (n=45), and a CPC of 1–2 (n=41) as a good outcome.

Results
Distance to hospital was significantly higher (p=0.0473) in patients with poor outcomes (CPC 3–5) after OHCA (37.5±4.5 km) compared with CPC 1–2 patients (27.1±4.4 km). No significant differences in return of spontaneous circulation time (21; 10.5–47.5 95th percentile vs. 23; 10.0–50.0, p=0.738), lactate (7.8; 4.5–12.4 vs. 8.4; 5.4–13.5, p=0.54), LVEF (40; 22–50 vs. 40; 21–62%, p=0.208), peak cardiac troponin T (1.5; 0.08–10.00 vs. 0.64; 0.04–5.28 μg/L, p=0.078), NSE (29.2; 15.7–54.9 vs. 25.8; 13.6–52.3 μg/L, p=0.26) and S100-B (0.17; 0.09–1.69 vs. 0.19; 0.04–1.14 μg/L, p=0.734) were found in CPC 3–5 and CPC 1–2 groups comparison. Using an optimal cut-off value ≥33 km calculated from the receiver operating characteristic curve (area under curve = 0.62; p=0.004), the sensitivity of predicting survival with poor neurological outcome was 61% and the specificity was 62%.

Conclusions
In patients after OHCA for VF during MI, distance from cardiac arrest localization to hospital gives reliable and on return of spontaneous circulation time independent prognostic information concerning outcome after cardiopulmonary resuscitation.

Acknowledgement/Funding
Grant support FNOL RIV 87-85
4037Nurse counseling of patients with atrial fibrillation to improve compliance to oral anticoagulation
Authors: Chilian-Hof R , Schnupp S , Mahnkopf C , Brachmann J , Kleinecke C 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is the most frequent arrhythmia with a prevalence of 1%–2% in the general population. Oral anticoagulation (OAC) is state-of-the art for preventions of thromboembolic events, in particular ischemic stroke, in patients with atrial fibrillation. Despite its proven benefit, numerous studies have documented under use of OAC for a variety of reasons.

Purpose
To establish a program of nurse counseling in patient with atrial fibrillation and treatment with oral anticoagulation. The program is designed to improve patients satisfaction, compliance to OAC, prevention of medication errors, ischemic and bleeding events.

Methods
Patients with atrial fibrillation and treatment with oral anticoagulation were prospectively identified at the department of cardiology of our clinic. They received a 30 minutes nurse counseling about oral anticoagulation during the hospital stay and another 30 minutes telephone counseling 3 months after inclusion. Furthermore, they received a brochure to inform about atrial fibrillation, oral anticoagulation and methods to improve medication compliance. Demographic characteristics with stroke and bleeding risk (CHA2DS2-VASc and HAS-BLED scores), as well as procedural data were systematically assessed in a predefined standardized way and captured in a dedicated database.

Results
Between June 2017 and January 2018, a total of 617 patients (female gender: 43.1%) with atrial fibrillation and oral anticoagulation received nurse counseling. Demographic and follow-up data of 204 patients (female gender: 85/204 (41.7%); mean age 69.7±17.3, CHA2DS2-VASc score 4.2±1.7, HAS-BLED score 2.8±0.37) were assessed in a dedicated database. Indication for OAC was paroxysmal and persistent/permanent AF in 110/204 (53.9%), 93/204 (45.6%) and others 17 (8.3%), respectively. 33/2014 (16.2%) were treated with vitamin K antagonists, and 172/204 (84.3%) with non-vitamin K antagonists. After a follow-up of 0.46±2.9 years and 187 patients-years the rates of cardiovascular death, major bleeding events and all-cause stroke and TIA were 1.07%, 2.14% and 1.61% per 100 patient-years.

Conclusion
Nurse counseling in patients with atrial fibrillation and treatment with oral anticoagulation has been established at the REGIOMED clinics, Germany. Its effectiveness in terms of quality of live, medication complications and cardiovascular events has to be proven in a randomised trial.

Acknowledgement/Funding
Daichi-Sankyo