bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of post-acute myocardial infarction clinic in secondary prevention
Authors: Dev D , Dutta SD , El-Din MO 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background
There is a 5% increased risk of death from cardiovascular causes following acute myocardial infarction[1]. One of the critical factors to improve long-term prognosis is evidence-based medication, but the limiting factors are adherence and optimal up-titration. Studies have shown one of the ways to improve this is early follow up[2]. Post-acute myocardial infarction(AMI) clinics help bridge this gap[3].
Purpose
We realised that the follow-up time for our patients was 257 days. So we created a dedicated post-AMI clinic. We wanted to reduce wait times, improve patient compliance, optimise medication, and manage risk factors.
Methods
We collected retrospective data from our post-AMI clinic between august to december 2020 for 52 patients who had a myocardial infarction.
Results
In 52 patients seen, post-AMI clinic reduced follow up time from 257 to 65 days. In the post-AMI clinic, we picked up the new diagnosis of diabetes in 5.8% of patients. Most medicines required optimisation as depicted in Table 1 and Histogram 1.

Conclusions
Overall, Significant number of patients in post-AMI clinic had early follow up, secondary prevention optimisation. This project demonstrates how Post-AMI clinics are important part of secondary prevention. They should be part of routine post-AMI care in all hospitals.
Table 1 Age 20-40 40-60 60-80 80-100 2 20 24 6 Lesion LAD Cx RCA &gt;1 lesion 23 4 16 9 Meds Optsd B-Blocker ACE-i/ARB Statins DAPt 5(10.8%) 29(55.8%) 8(15.4%) 1(1.9%) Referred to Diabetes Heart failure Need ongoing review 5 2 5 Meds = Medication, Optsd= Optimised, B-Blocker = Beta blocker, ACE-i = Angiotensin converting enzyme inhibitors. ARB= Angiotensin receptor blockers, DAPT = Dual anti-platelet therapy
Abstract Figure. Histogram 1
Evaluation of secondary prevention in Egyptian patients after primary percutaneous coronary intervention
Authors: Thabet NAGWA , Dina LABIB , Samir AHMED , Hosny M , Hassan AHMED , Hekal SOHA , Ibrahim AYMAN , Mansour HOSSAM , Zain-Eldin Hafez M , Farrag AZZA , El-Guindy AHMED 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Effective secondary prevention after acute coronary syndromes is critical to reducing the risk of a subsequent cardiovascular event. Adherence to secondary prevention is disappointingly low worldwide, with no data in Upper Egypt.

Purpose and methods
We sought to determine the prevalence of adherence to secondary preventive among patients who underwent primary percutaneous coronary intervention (PPCI) in a tertiary centre in Upper Egypt from 2014-2016 (n = 468).

Results
Our cohort included 468 patients, mean age at STEMI was 55.7 ± 11.2 years; 79% males. Smoking, diabetes mellitus (DM), dyslipidemia, obesity and hypertension were 62%, 42%, 39%, 38% and 34% respectively. Median follow-up duration (IQR) was 703 (613-830) days. Table 1 shows the prevalence of adherence secondary prevention. Re-myocardial infarction, unstable angina, repeated hospital admission was 4.9%, 5.1%, 14% respectively. Revascularizations were 8.1% and total ischemic complications were 18%. The major adverse cardiac events MACEs were 24%. DM and hypertension were significant predictors of MACEs on univariable and multivariable analysis (multivariable ORs [95% CIs]: 1.685 [1.002 -2.833] and 1.764 [1.033-3.012], respectively).

Conclusion
Adherence to secondary prevention after PPCI is sub-optimal in Upper Egypt. We need to raise the standard of preventive cardiology care through more effective primary and secondary prevention programs, to reduce morbidity and mortality.
Risk factor Target level Number (%) Diabetes HbA1c &lt;7% 280(62) Blood pressure &lt;140/90 295(63) Smoking cessation in smokers Complete cessation 122 (43) Smoking status No smoking 301(65) Physical activity Walking at least 30 minutes 5 days/week 301(60) Body mass index &lt;25 kg/m2 101(22) Waist circumference &lt;102 cm in males, &lt;88 cm in females 164(36) Diet Low salt and fat, adequate fruits and vegetables 268 (57) Lipids LDL &lt; 70 gm/dL 93(26)
Subacute postoperative atrial fibrillation after heart surgery: incidence and predictive factors in cardiac rehabilitation
Authors: Rizza V , Maranta F , Cianfanelli L , Grippo R , Meloni C , Avitabile M , Castiglioni A , De Bonis M , Alfieri O , Cianflone D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Postoperative atrial fibrillation (POAF) is the most common arrhythmic complication following cardiac surgery. It may occur between the second and fourth postoperative days as acute POAF, or within 30 days as subacute POAF (sPOAF). The incidence varies from 15% to 60%, with the highest rates observed in patients undergoing valvular surgery. POAF is associated with longer hospital stay and higher thromboembolic risk, which consistently increase patients’ morbidity and mortality. Identification of high-risk categories may allow optimization of in-hospital prevention and treatment, possibly improving clinical outcomes.
Aim of the study. The aim of this study was to assess the incidence of sPOAF and to identify possible predictors in patients performing Cardiovascular Rehabilitation (CR) after Cardiac Surgery (CS).
Methods. A single-centre retrospective study was performed on 383 post-cardiac surgery patients hospitalised in our CR Unit for inpatient rehabilitation. The entire population was on sinus rhythm at the admission in CR and continuous monitoring with 12-lead ECG telemetry was performed during the hospital stay. We calculated the incidence of sPOAF and then evaluated the predictive value of the following variables: anamnestic data, type of cardiac intervention, clinical course in both CS and CR Unit, laboratory parameters including baseline neutrophil-to-lymphocyte ratio (NLR).
Results. Median age was 65 years (63% male). sPOAF was documented in 122 cases (31.9%). Patients developing sPOAF were older [median age 69 (63-76) vs. 61 (51-70); p &lt; 0.001)], more frequently underwent complex surgical procedures (50% vs. 36%; p = 0.009) and were known for previous episodes of atrial fibrillation (27.9% vs. 11.2%; p &lt; 0.001). On the first day after surgery (T1), sPOAF group showed higher values of glycemia [median 155 (126.5–186.8) vs. 129 (106.5–164); p &lt; 0.001] and troponin T [median 721.5 (470.1–1084.3) vs. 488 (301.6-776.2); p &lt; 0.001]. The multivariate analysis identified advanced age (OR 1.04, 95% CI 1.01-1.08; p = 0.023), acute POAF in the Cardiac Surgery Unit (OR 3.51, 95% CI 1.62-7.59; p = 0.001), baseline NLR (OR 1.46, 95% CI 1.10-1.93; p = 0.008) and T1-troponin &gt; 552 ng/L (OR 4.16 95% CI 1.50-11.53; p = 0.006) as independent risk predictors of sPOAF during the CR period.
Conclusions. sPOAF is common after cardiac surgery occurring in 31.9% of patients during CR. Age, acute POAF, baseline NLR and elevated troponin T on the first postoperative day were shown predictors of increased sPOAF risk. Recognition of new predictors of POAF could be helpful to better stratify patients, improving management strategies and outcomes.
Impact of an online cardiac rehabilitation program after an acute coronary syndrome during SARS-CoV-2 pandemic
Authors: Severo Sanchez A , Rivero Santana B , Arbas Redondo E , Juarez Olmos VM , Poveda Pinedo D , Tebar Marquez D , Dalmau Gonzalez-Galarza R , Castro Conde A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario La Paz

Introduction
The SARS-CoV-2 pandemic has overloaded health care systems at several fields. Spanish COVID-19 first wave led to the interruption of most cardiac rehabilitation (CRH) programs in our country. Resume activity without compromising patient"s safety has been a challenge. At our centre (a third-level hospital), we modified our routine clinical practice from face-to-face interviews to a complete online CRH program since July 1st 2020.

Purpose
The aim of this study is to analyse the impact of an online CRH program after hospital discharge for an acute coronary syndrome in health goals and adherence to secondary prevention measures at the end of the program.

Methods
This is a retrospective study made up of patients who, after suffering an acute myocardial infarction, followed an online CRH program from June to November 2020. A first online assessment is made by a cardiology consultant. Then, it is followed by ten online group interviews of up to three patients and a health care proffesional: either a nurse or a physiotherapist. These interviews last around ninety minutes. Four weeks after, an online follow-up interview is made by a cardiology consultant. These interviews focus either on physical exercise instructions (aerobical exercise and endurance exercise) or educational interviews (ischemic cardiomyopathy, Mediterranean diet, pharmacological treatment, sexual dysfunction, stress management techniques and solution of questions).

Results
Up to eighty-four patients were included in our CRH program (this means 83% of patients discharged from our hospital after an acute coronary event). Median of time from discharge to first online interview was 8"79 days and from this last one to program beginning, 3"67 days. Four weeks after the beginning of the program, 82% of the patients presented with a LDL-cholesterol level below aim level (&lt; 55 mg/dL). Workout, Mediterranean diet and tobacco abstinence observance rates were over 90%. There were just three patients who gave up or did not complete the program.

Conclusion
Despite the fact that SARS-CoV-2 pandemic has arisen a huge challenge for ongoing CRH programs in Spain, the benefit that has been showed by them on cardiovascular health, makes it necessary to develop new tools to allow them going on. New technologies are an opportunity for us to keep on following these patients, moreover showing good results as for adherence, availability and patient and operator assesssment.
Effectiveness of cardiac telerehabilitation with relapse prevention compared to centre-based cardiac rehabilitation: results from the SmartCare-CAD randomised controlled trial
Authors: Brouwers R , Kraal JJ , Regis M , Spee RF , Kemps HMC 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was part of the SmartCare project, which was partially funded under the ICT Policy Support Programme (ICT PSP), grant agreement number 325158.

Background
Most studies failed to show superiority of cardiac telerehabilitation (CTR) over traditional, centre-based cardiac rehabilitation (CR).

Purpose
To evaluate the effectiveness of a novel CTR intervention on the adherence to a physically active lifestyle in patients with coronary artery disease (CAD).

Methods
We randomised patients with CAD entering phase II outpatient CR to either CTR with relapse prevention by on-demand coaching (intervention group), or centre-based CR with supervised exercise training (control group). The primary outcome measure was objectively assessed physical activity level (PAL), secondary outcome measures included physical fitness and quality of life (QoL).

Results
A total of 300 patients (89% male, mean age 60.7 ± 9.5 years) participated in the trial. Both groups significantly improved their PAL at 12 months follow-up (p &lt; 0.01), but without a significant between-group difference in the response over time (p = 0.73). Similarly, we observed sustained increases in physical fitness and QoL, but without significant between-group differences in responses over time.

Conclusions
In patients with CAD who had low residual cardiovascular risk, CTR with relapse prevention resulted in a sustained increase in PAL, physical fitness and QoL, but without differences in responses over time as compared to centre-based CR. For this reason, future CTR interventions should be directed specifically to patients who are at risk for relapse into unhealthy lifestyle behaviour.
Main outcome measures Control (centre-based CR) Intervention (CTR) Baseline 3 months 12 months Within groups p-value 0-3 months Within groups p-value 0-12 months Baseline 3 months 12 months Within groups p-value 0-3 months Within groups p-value 0-12 months PAL † 1.40 (0.45) 1.53 (0.48) 1.55 (0.46) &lt;0.001 0.001 1.44 (0.50) 1.67 (0.50) 1.61 (0.46) &lt;0.001 &lt;0.001 Workload (% of expected) * 92.1 ± 19.3 103.6 ± 19.5 104.8 ± 21.0 &lt;0.001 &lt;0.001 91.3 ± 18.6 101.2 ± 18.8 102.5 ± 19.6 &lt;0.001 &lt;0.001 KVL-H total † 5.3 (1.4) 6.1 (1.0) 6.3 (0.9) &lt;0.001 &lt;0.001 5.4 (1.8) 6.0 (1.0) 6.2 (1.0) &lt;0.001 &lt;0.001 CR cardiac rehabilitation; CTR: cardiac telerehabilitation; KVL-H: Kwaliteit van Leven bij Hartpatiënten (quality of life in cardiac patients); PAL: physical activity level. †Values reported as median (interquartile range). Within-groups differences assessed by Wilcoxon signed-rank test. *Values reported as mean ± standard deviation. Within-groups differences assessed by paired samples T-test.
Natural history of right ventricle: longitudinal study in veteran athletes
Authors: Ferrara R , Serdoz A , Egisto G , Zuccaro M , Di Giacinto B , Maestrini V , Cavarretta E , Spataro A , Pelliccia A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
INTRODUCTION
Right ventricular (RV) enlargement is a physiologic adaptation to long lasting athletic training. Its clinical implications for veteran athletes are poorly understood. In recent years, controversial data suggest an association between ultra-endurance exercise and a RV cardiomyopathy similar to arrhythmogenic cardiomyopathy (ACM). In this context, the effects of exercise detraining have not been extensively studied yet.
PURPOSE
The aim of this study was to assess the morphological and functional RV changes in veteran athletes and to evaluate the effect of a long period of detraining.
METHODS
This is a longitudinal study including 22 veteran rowers with at least 10 years of competitive career. We evaluated them with an echocardiographic assessment at baseline and after a minimum of 3 years of detraining (age: 23.2 ± 4.4 and 43 ± 7.4 years), by reducing the weekly training volume from 26 ± 0.7 to 3 ± 2 hours. In this second evaluation we also performed an RV strain analysis and a cardiac magnetic resonance (CMR) study.
RESULTS
RV end diastolic (ED) areas significantly reduced after detraining (31.48 ± 5.8 versus 28.59 ± 6.8; p = 0.001), although remaining larger than normal. RV enlargement was balanced: the ratio between inflow (IT) and outflow tract (OT) (RVIT/RVOT = 1.4 ± 0.1) and the ratio between RV and left ventricle (LV) (RV/LV = 0.81 ± 0.1) were within normal limits. The fractional area change (FAC%) was normal at baseline and increased significantly (41.5 ± 6% versus 45.8 ± 7%; p = 0.011). After detraining, RV longitudinal strain was normal (-19.7 ± 2.7%). CMR assessment showed enlarged RVED volumes (97.9 ± 14 ml/m2) but normal RV ejection fraction (55.5 ± 4.1%).
CONCLUSIONS
RV enlargement in endurance athletes persists after a long period of detraining. However, detraining results in a significant reduction of RV dimensions. Furthermore, the absence of RV dysfunction or disproportionate RV geometry are reassuring findings that suggest a physiological remodeling of the RV.
Significant echo findings. RV ECHO PARAMETERS BASELINE DETRAINING MEAN DIFF. (C.I. 95%) p VALUE RVOT plax (mm) 34.8 ± 4 33.7 ± 14 1.1 (0.18; 2.1) p = 0.011 RVOT psax (mm) 34.9 ± 3.3 33.09 ± 3.5 1.8 (0.9; 2.7) p &lt; 0.001 RV basal diameter (mm) 47.31 ± 5.3 45.86 ± 6.4 1.4 (0.04; 2.8) p = 0.022 RV end-diastolic area (cm&sup2;) 31.48 ± 5.8 28.59 ± 6.8 2.8 (1.1; 4.6) p = 0.001 FAC% 41.5 ± 6 45.8 ± 7 0.04 (-0.07; -0.007) p = 0.011 RV inflow/outflow ratio 1.36 ± 0.1 1.36 ± 0.2 -0.003 (-0.06; 0.06) p = 0.454 RV/LV ratio 0.82 ± 0.07 0.81 ±0.1 0.01 (-0.01; 0.04) p = 0.219
Abstract Figure. Comparison in the same veteran athlete.
Sudden cardiac death related to physical exercise and sports in the young: a nationwide cohort study of Australia
Authors: Ha F , So J , Han HC , La Gerche A , Teh A , Sanders P , Farouque O , Lim H 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sudden cardiac death (SCD) during physical exercise is uncommon but devastating.

Purpose
We aimed to determine risk factors, causes and circumstances of sports and exercise-related SCD in the young in Australia.

Methods
We retrospectively reviewed the National Coronial Information System (NCIS) registry for deaths in Australia relating to cardiovascular disease (CVD) in cases aged 10 to 35 years between 2000-2016. Included cases had been undertaking sports or physical exercise at time of event. We collected baseline demographics and circumstances of death including location, type of physical exercise, whether the event was witnessed, and engagement of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use prior to ambulance arrival.

Results
Over a 17-year period, 1,925 SCD cases were identified of which 110 cases (6%) related to sports/physical exercise were included in final analysis. Median age was 27 years (interquartile range [IQR] 21-32 years) with most being male (92%). Median BMI was 27 kg/m2 (IQR, 23-30) with 13 cases (12%) occurring in active athletes. Most common causes were coronary artery disease (CAD; 37%) and sudden arrhythmic death syndrome (SADS; 20%). Australian Rules Football (24%), running/jogging (14%) and soccer (14%) were the most frequently practiced at time of event. Prior symptoms were present in 39% (chest pain 37%, presyncope/syncope 26%). Most were witnessed (87%) with bystander CPR in 70%. AED use prior to ambulance arrival was 8%.

Conclusions
This study demonstrates the high occurrence of CAD and SADS in exercise-related SCD in the young. Although events were commonly witnessed, an AED was seldom used prior to ambulance arrival highlighting an important opportunity to improve outcomes in the post-arrest chain of survival.
Clinical and genetic factors associated with mismanagement of dyslipidemia. Multiple cross-sectional analysis
Authors: Chekanova V , Marques-Vidal P , Abolhassani N 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aims
Identify the clinical and genetic factors associated with poor control of high cholesterol in the Swiss population.

Methods
Data from three waves [baseline, N = 617; first, N = 844 and second, N = 798 follow-ups] of a population-based, prospective study conducted in Lausanne, Switzerland. Inadequate management of dyslipidemia was assessed according to the most common Swiss guideline. Genetic scores for lipid levels were computed based on the existing literature.

Results
Prevalence of inadequately managed dyslipidemia was 30%, 31.5% and 17.4% in the baseline, first and second follow-up. On multivariable analysis, participants at high risk of CVD had a lower likelihood of being adequately managed: odds ratio (OR) and (95% confidence interval) for high-risk relative to low-risk: 0.10 (0.06-0.18), 0.11 (0.07-0.17) and 0.15 (0.09-0.27) for the baseline, first and second follow-up (p for trend &lt; 0.001). Use of more potent statins increased the likelihood of adequate management, OR and (95% CI) for third vs. first level: 2.89 (1.76-4.74) and 5.17 (2.51-10.6) in the first and second follow-up (p for trend &lt; 0.001). No differences in total cholesterol, LDL and HDL genetic scores were found between adequately and inadequately managed participants: for the total cholesterol, -3.7 ± 9.6 vs. -2.7 ± 9.4; -3.5 ± 8.9 vs. -3.7 ± 9.5 and -3.8 ± 8.9 vs. -3.3 ± 9.4 in the baseline, first and second follow-up, p = NS. Those findings were replicated when the thresholds for adequate control were relaxed.

Conclusion
Management of dyslipidemia is suboptimal in Switzerland. Use of newer, more potent statins in high-risk patients could improve this status. The use of genetic scores appears to be of little interest.
Multivariate Analysis First FUOR (95% CI) p-value Second FUOR (95% CI) p-value CVD risk Intermediate 0.18 (0.10 - 0.32) &lt;0.001 0.22 (0.09 - 0.55) 0.001 High 0.07 (0.04 - 0.12) &lt;0.001 0.09 (0.04 - 0.2) &lt;0.001 p-value for trend &lt;0.001 &lt;0.001 Swiss vs Non-Swiss 1.34 (0.87 - 2.05) 0.181 0.79 (0.43 - 1.43) 0.428 FH dyslipidemia (yes/no) 1.02 (0.63 - 1.63) 0.948 0.55 (0.29 - 1.03) 0.060 Statins potency First 1 (ref.) 1 (ref.) Second 2.00 (1.22 - 3.27) 0.006 2.59 (1.23 - 5.44) 0.012 Third 2.89 (1.76 - 4.74) &lt;0.001 5.17 (2.51 - 10.6) &lt;0.001 p-value for trend &lt;0.001 &lt;0.001
Conventional cardiac risk factors associated with Trastuzumab induced cardio-toxicity in breast cancer: a meta-analysis
Authors: Koulaouzidis G , Charisopoulou D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Trastuzumab has had a major impact on the treatment of human epidermal growth factor receptor 2(HER-2) positive breast cancer patients. However, it is associated with cardiotoxicity, expressed as an asymptomatic decrease in LVEF and less often as clinical HF. Published studies have tried to identify risk factors predisposing to cardiotoxicity but the results are not uniform.
The aim of this meta-analysis is to identify the association of the conventional cardiovascular risk factors:age, smoking, hypertension, hyperlipidaemia, obesity, diabetes mellitus, family history of cardiac disease and the previous history of coronary artery disease (CAD), with the development of Trastuzumab induced cardiotoxicity (TIC).

Methods
A literature search of PubMed was conducted to identify studies examining the association between cardiovascular risk factors and TIC. The primary outcome of interest was the development of cardiotoxicity manifested as heart failure or deterioration in LVEF based on the criteria presented within each study. We included prospective and retrospective studies of patients with HER2 positive breast cancer who were treated with Trastuzumab. Data were extracted and pooled odds ratios (ORs) with 95% confidence intervals (Cis) were calculated examining the odds of developing TIC for each of the risk factors.

Results
A total of 35 studies were included in the analysis. Age &gt; 60 years old (OR: 0.7; 95% CI: 0.318-1.09; p = 0.0004), hypertension (OR: 0.69; 95% CI: 0.26-1.12; p = 0.001), smoking (OR: 0.35; 95% CI: 0.01- 0.69; p = 0.038), diabetes mellitus (OR: 0.44; 95% CI: 0.24- 0.68; p = 0.0001) and family history of CAD (OR: 5.51, 95%CI 1.76-17.25; p&lt; 0.00001) were significantly associated with the development of cardiotoxicity. Known history of CAD (OR: 3.72; 95%CI 2.11-6.57; p = 0.0005) was also associated with the development of TIC. On the other hand, obesity (OR: 2.47; 95% CI: 0.93- 6.55; p= 0.07) and hyperlipidaemia (OR: 1.32, 95% CI: 0.71- 2.46; p = 0.38) did not meet statistical significance for association with TIC.

Conclusion
Identifying women at risk for TIC have several important potential applications. Clinicians may decide to assess LVEF more frequently in patients at highest risk for TIC in order to detect LV systolic dysfunction earlier. Identifying high risk patients may play a role for recognition which individuals would obtain the most benefit from prophylactic therapy for preventing TIC.
this could help identify patients who would benefit most from prophylactic therapy for preventing TIC. Finally, these factors could in the future form the basis of a risk model for TIC.