bluuebunny/crossref_metadata_2025_split huggingface dataset:
Indications for prescription and deprescription in multimorbid independently living elderly outpatients
Authors: Popov A , Izmozherova N V , Gavrilova E I , Kuryndina A A , Shambatov M A , Bakhtin V M 
Published: October 2021

Abstract

Introduction
Global trend to population ageing is associated with inevitable increase of polypharmacy in multimorbid elderly population.

Purpose
To estimate the level and structure of comorbidity and pharmacotherapy in independently living patients of different age groups with high and extreme cardiovascular risk, when observed in outpatient clinics

Methods
282 consecutive patients of high cardiovascular risk have been enrolled. Inclusion criteria were: SCORE ≥5%, documented history of acute myocardial infarction (AMI), acute or transient cerebrovascular accident (CVD), coronary artery intervention, acute coronary syndrome (ACS), stable angina, intermittent claudication, type 2 diabetes mellitus (DM2) or type 1 DM with diabetic nephropathy, angiogram or ultrasound proved atherosclerotic plaques, total serum cholesterol level ≥8 mmol/L, blood pressure ≥180/110 mmHg and signed voluntary informed consent form. Current clinical conditions, pharmacologic treatment and indications for prescription and deprescription were studied.
STOPP criteria for prescribing potentially non-recommended drugs in people over 65 years of age, START criteria for not prescribing necessary drugs in people over 65 years of age, non-recommended in elderly people over 65 drug list were used to assess polypharmacy.
According to the WHO age classification, there were three groups: Group 1 (aged 45 to 59), Group 2 (aged 60 to 74) and Group 3 (aged 75 +).

Results
There were no differences in the frequency of statins administration (p=0.72) and antiplatelet agents (p=0.49) between 3 groups. Polypragmasia (administration of more than 5 drugs) was registered in 150 patients (53%) and was significantly more common in Group 3 (p=0.001). 48 cases of inadequate prescribing were registered in 46 (28%) elderly patients. 24 cases of prescribing potentially unacceptable medications for the elderly were reported.

Conclusion
Unavoidable polypragmasia was found in 53% multimorbid elderly patients.
Irrational drug treatment was detected in 28% elderly patients
STOPP criteria were met in 32.1% and START criteria were met in 30.4% cases.
Polypragmasia being inevitable in elderly multimorbid patients, administration of any new medication should be performed after a thorough risk-benefits balance assessment.

Funding Acknowledgement
Type of funding sources: None.
Efficacy of mindfulness-based cognitive therapy on symptoms of depression and anxiety in patients with coronary artery disease: insights from a prospective registry
Authors: Pascual-Madorran T , Zocca G , Ploumen E H , Szabo - Te Fruchte K , Buikema L , Kok M M , Van Buiten D G , Kuijpers P M J C , Von Birgelen C , De Man F 
Published: October 2021

Abstract

Introduction
Patients with coronary artery disease (CAD) report psychological distress and poor physical functioning after cardiovascular events. In cardiac rehabilitation, an exercise program is often used as A primary strategy; however, this is often not sufficient to address stress and psychosocial well-being.

Purpose
To investigate the effectiveness of a mindfulness-based cognitive therapy (MBCT) program on feelings of anxiety and depression in patients with CAD.

Methods
In this single-center prospective observational study, eligible cardiac rehabilitation patients with symptoms of anxiety or depression were recruited after referral for psychological consultation. During eight consecutive weeks, patients participated in group meetings. The program included psycho- education, cognitive behavioral therapy, meditation and slow abdominal breathing. Standard measures of depression, anxiety and blood pressure were obtained at baseline and after completion of the program. The Hospital Anxiety and Depression Scale (HADS) questionnaire was used as an instrument for detecting states of anxiety and depression.

Results
A total of 135 patients (mean age 56±9 years; 24% female) were enrolled. The mean HADS-Anxiety score improved from 11.0±3.7 at baseline to 6.6±3.4 after MBCT (p&lt;0.001). The mean HADS-Depression score improved from 8.8±3.6 to 4.7±3.2 (p&lt;0.001). In addition, during the MBCT program a significant decrease in blood pressure was noted: systolic from 140±18 to 130±17 mmHg and diastolic from 84±12 to 77±10 mmHg (p&lt;0.001 for both).

Conclusion
This study provides evidence that a MBCT program has the potential to improve feelings of anxiety and depression in patients with CAD. Therefore, adding MBCT to cardiac rehabilitation in selected patients may be of great value.

Funding Acknowledgement
Type of funding sources: None.
Temporal trends in the inclusion of patient-reported outcomes in heart failure randomized trials published in high-impact medical journals: a systematic bibliometric review
Authors: Eliya Y , Averbuch T , Le N , Xie F , Thabane L , Mamas M , Van Spall H 
Published: October 2021

Abstract

Background
Patient reported outcomes (PROs) are important measures of health, particularly in symptomatic conditions such as heart failure (HF), and regulatory agencies have encouraged their collection in randomized controlled trials (RCTs).

Purpose
To assess temporal trends in the inclusion of patient-reported outcomes (PROs) in heart failure (HF) randomized controlled trials (RCTs) published in high-impact medical journals, explore trial characteristics associated with inclusion of PROs, and describe the quality of PRO reporting in HF RCTs.

Methods
We searched MEDLINE, EMBASE and CINAHL for studies published between January 1, 2000 and July 17, 2020. We included RCTs published in journals with impact factor ≥10. We assessed temporal trends using the Jonckheere-Terpstra test and conducted multivariable logistic regression analysis to explore trial characteristics independently associated with inclusion of PROs. We assessed the quality of PRO reporting using the Consolidated Standards for Trial Reporting PRO extension statement.

Results
We identified 12,342 articles, of which 417 RCTs met inclusion criteria. PROs were included in 224 RCTs (53.7%, 95% confidence interval [CI]: 48.8%-58.6%), of which 44 (19.6%) reported PRO as primary or co-primary endpoint. The proportion of RCTs with PROs increased significantly between 2000–2003 (37.4%) and 2016–2020 (65.1%) (p&lt;0.001). PROs had higher odds of inclusion in RCTs that were multicenter (odds ratio [OR]: 1.95; 95% CI: 1.05–3.64; p=0.036); medium-sized (n=51–250) (OR: 2.29; 95% CI: 1.24–4.23; p=0.008); coordinated in in Central and South America (OR: 6.79; 95% CI: 1.34–34.36; p=0.021); and assessed health services (OR: 4.21; 1.97–8.98; p&lt;0.001), device / surgical (OR: 6.24; 95% CI 3.05–12.80; p&lt;0.001), or exercise and rehabilitation interventions (OR: 3.98; 95% CI 1.59–9.97; p=0.003). A majority (54.9%) of the 224 RCTs reported four or less of the eleven CONSORT-PRO items. The median number of CONSORT-PRO items reported was 4 (interquartile range [IQR] 3–6 items per trial), with improved reporting in trials with PRO as primary or co-primary endpoint.

Conclusions
PROs are included in in just over half of HF RCTs, with an increased reporting of PROs between 2000 and 2020. Large, pharmacotherapy trials conducted in North America and Europe were less likely to include PROs. The quality of PRO reporting in HF RCTs was modest, with trials most often reporting four of eleven CONSORT-PRO items.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research
A genetic risk score predicts recurrent events after myocardial infarction in young patients with a low level of traditional risk factors
Authors: Mendonca F , Mendonca M I , Temtem M , Santos M , Sousa J A , Sousa A C , Henriques E , Freitas S , Rodrigues M , Borges S , Guerra G , Drumond A , Palma Dos Reis R ,   GENEMACOR study
Published: October 2021

Abstract

Introduction
Coronary Heart Disease (CAD) is a multifactorial disease, including environmental and genetic risk factors. Current smoking, dyslipidemia and diabetes have a significant impact in long- term mortality and morbidity. However, several genetic variants associated with CAD but not with traditional risk factors (TRFs) has been reported to improve prediction of events and extended mortality, in younger CAD people.

Aim
To evaluate the clinical utility of a GRS composed by variants from GWAS associated to CAD but not with TRF to predict life-long residual risk in patients under 55 years old and a low level of TRFs.

Methods
We conducted a prospective study with 573 consecutive patients aged &lt;55 years presenting with AMI and a low level of TRFs (without diabetes and with LDL cholesterol &gt;150 mg/ml). We analysed several biochemical markers and performed a GRS with variants not associated with TRFs (TCF21 rs12190287, CDKN2B-AS1 rs1333049, CDKN2B rs4977574, PHACTR1 rs1332844, MIA3 rs17465637, ADAMTS7 rs3825807, ZC3HC1 rs11556924, SMAD3 rs17228212 and GJA4 rs618675). We studied the GRS association with a primary composite endpoint of all-cause vascular morbidity and mortality including recurrent acute coronary syndrome (myocardial infarct and unstable angina), coronary revascularization (coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), re-hospitalization for heart failure, ischemic stroke and cardiovascular dead.

Results
A total of 573 patients were studied and followed up for a mean of 4.7±4.0 years. There were 169 recurrent cardiovascular events. The GRS was sub-divided into terciles, verifying that patients in the third tercile (high risk) had a higher number of risk alleles. Compared with the low-risk GRS tercile, the multivariate-adjusted HR for recurrences was 1.520 (95% CI 1.011–2.286); p=0.044 for the intermediate-risk group and was 2.051 (95% CI 1.382–3.044); p&lt;0.0001 for the high-risk group. Inclusion of the GRS in the model with TRFs alone (low risk) improved the C-statistic analysis (C-statistic = 0.030; p=0.004), cNRI (continuous net reclassification improvement) (30.8%), and the IDI (integrated discrimination improvement index) (0.022).

Conclusions
A multilocus GRS may identify young coronary disease patients with a low level of TRFs but at significant risk of long-term events recurrence. The genetic information may improve prediction discrimination, and reclassification over the conventional risk factors alone, providing better cost-effective therapeutic strategies.

Funding Acknowledgement
Type of funding sources: None. Figure 1
CD69 expression in regulatory T cells protects from the immune-mediated damage after myocardial infarction
Authors: Blanco-Dominguez R , De La Fuente H , Garcia-Guimaraes M M , Rodriguez C , Rodriguez-Arabaolaza I , Jimenez-Alejandre R , Sanchez-Diaz R , Alfonso F , Sanchez-Madrid F , Martinez-Gonzalez J , Martin P 
Published: October 2021

Abstract

CD69 depletion from the lymphoid compartment promotes a Th17/Treg imbalance and exacerbates the development of atherosclerosis. As atherosclerosis is the trigger of myocardial infarction, we have analyzed the role of CD69 in Treg cells after a) permanent occlusion of the left-anterior-descending coronary artery (LAD-ligation) in mice, and b) coronary angiography in two cohorts of acute myocardial infarction (MI) patients.
Our data show that CD69 expression in Treg cells is critical to maintain immune homeostasis after myocardial infarction and increases overall survival in mice after LAD-ligation. Cd69−/− mice develop IL17A+ gdT cell responses early after ischemia that increment myocardial inflammation and, consequently, worsen cardiac function. Furthermore, we found that CD69+ Treg cells induce apoptosis and diminish IL-17A production in gdT cells by a mechanism dependent on membrane CD39 ectonucleotidase activity. The adoptive transfer of CD69+ Treg cells to Cd69−/− mice after LAD-ligation reduces IL17A+ gdT cell recruitment, resulting in increased survival and improved outcome.
In accordance, data from two independent cohorts of patients indicate that increased levels of CD69+ Treg cells in the blood of patients early after MI is associated with lower risk of developing chronic heart failure. Our data support the role of CD69+ Treg cells to prevent excess of inflammation and damage after MI, whose value remains associated with improved heart function in the medium term.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fondo de Investigaciones Sanitarias. Instituto de Salud Carlos III. Ministerio de Ciencia Innovaciόn y Universidades (Spanish Government). Summary immage
Vascular repair and regeneration in cardiometabolic diseases
Authors: Hess David A , Verma Subodh , Bhatt Deepak , Bakbak Ehab , Terenzi Daniella C , Puar Pankaj , Cosentino Francesco 
Published: October 2021

Abstract
Chronic cardiometabolic assaults during type 2 diabetes (T2D) and obesity induce a progenitor cell imbalance in the circulation characterized by overproduction and release of pro-inflammatory monocytes and granulocytes from the bone marrow alongside aberrant differentiation and mobilization of pro-vascular progenitor cells that generate downstream progeny for the coordination of blood vessel repair. This imbalance can be detected in the peripheral blood of individuals with established T2D and severe obesity using multiparametric flow cytometry analyses to discern pro-inflammatory vs. pro-angiogenic progenitor cell subsets identified by high aldehyde dehydrogenase activity, a conserved progenitor cell protective function, combined with lineage-restricted cell surface marker analyses. Recent evidence suggests that progenitor cell imbalance can be reversed by treatment with pharmacological agents or surgical interventions that reduce hyperglycaemia or excess adiposity. In this state-of-the-art review, we present current strategies to assess the progression of pro-vascular regenerative cell depletion in peripheral blood samples of individuals with T2D and obesity and we summarize novel clinical data that intervention using sodium-glucose co-transporter 2 inhibition or gastric bypass surgery can efficiently restore cell-mediated vascular repair mechanisms associated with profound cardiovascular benefits in recent outcome trials. Collectively, this thesis generates a compelling argument for early intervention using current pharmacological agents to prevent or restore imbalanced circulating progenitor content and maintain vascular regenerative cell trafficking to sites of ischaemic damage. This conceptual advancement may lead to the design of novel therapeutic approaches to prevent or reverse the devastating cardiovascular comorbidities currently associated with T2D and obesity.
Planetary health research: insights from The Lancet Planetary Health original articles
Authors: Cadeddu C , Pezzullo AM , Sapienza M , Castagna C , Regazzi L , Carini E , Messina R , Silenzi A , Villani L , Damiani G , Ricciardi W 
Published: October 2021

Abstract

Background
In 2017, the Lancet group launched The Lancet Planetary Health to promote the dissemination of research conducted in this field. Planetary health was also extensively discussed during the World Congress on Public Health 2020, which underlines the strategic importance recognized to this topic by experts and researchers active in public health at an international level. The aim was to investigate the role of public health university departments in the field of planetary health.

Methods
The Lancet Planetary Health database was queried from the inception to February 2021, to retrieve original articles or reviews whose first and/or last author was affiliated to a University Department of Public Health worldwide. We used the twenty-six EUPHA operational sections to define the research areas of the identified articles. The following data were extracted: study design, EUPHA area, research question, topic, identified gaps in the literature, and key concepts.

Results
Out of 543 entries, 44 original articles and reviews were included. Thirty-two percent studies were conducted in Asia, 20% in America, 13% in Europe, 8% in Oceania, 4% in Africa while 23% in a multicentric global context. The area investigated was mainly environmental and health (68%) followed by infectious disease control (14%). Collaboration across different disciplines is highly present in the authorships. Regarding the study design, 30% of the included articles were cohort studies.

Conclusions
From 2017 till February 2021, the number of studies performed by public health researchers published on The Lancet Planetary Health is gradually increasing.
Since published articles take advantage of the typical research methods and topics of public health and environmental health research, public health university departments can contribute to planetary health science if they seek transdisciplinary collaboration and adopt a planetary health vision.
Is COVID 19 introducing a new model of internal medicine ward?
Authors: Rosiello F , Pietrantonio F , Berardino A Di , Delli Castelli M , Ciamei A , Piccione A , Rainone M , Alessi E , Vinci A , Ruggeri M 
Published: October 2021

Abstract

Background
Covid 19 has recently been defined as a syndemia, because it combines the epidemic emergency of Sars Cov 2 with that of non-communicable diseases. This aspect is particularly known in internal medicine wards (IM), which have had to split up to support these new criticalities.

Methods
Delphi method has been used to make the Ishikawa's diagram to analyze the reasons of the death in COVID ward. Each item was attributed a score according to a pros/cons and opportunities/threats system, derived from evidence in the literature. Scores were presented in a Cartesian graph showing the positioning according to the potential value and the perceived risk associated with the items. In the end, the performances of MC (Covid ward, split in I wave, II wave and overall) and MCF (internal medicine Covid-free ward) have been compared through the Barber's nomogram.

Results
MCF hospitalized 790 patients (-23,90% compared to 2019), Overall-MC patients: 50% of the 2019 MCF. Main cause of mortality-risk: patients originating from local facilities (+7%) and comorbidities (58% Chronic renal failure, 41% cancer, 90% age, 70% COVID 19 WHO stage 3. &gt;3 comorbidities: 100%, ≥5: 24,7%). Length of stay: 8-60 days (mean value, MV: 17) for MC, 2-12 (MV 8) for MCF. Turnover Index: 10 day for MC II, 8 MC I, 1 for MCF. 25% of patients in MC have been treated with Non Invasive Ventilation (NIV), with high cost hospitalization-related.

Conclusions
Internal-Medicine ward model is a ward strictly tied to the community both before and after hospitalization. COVID 19 proposes a new model of IM, nearly subintensive ward, with NIV and continuous monitoring of vital signs, long length of stay and low turnover index. Is this the internal medicine ward for the future?

Key messages
COVID 19 proposes a new model of Internal Medicine ward, nearly subintensive ward, with Non Invasive Ventilation and continuous monitoring of vital signs, long length of stay and low turnover index. Covid 19 mortality is strictly connected with the origin from territorial health-assisted residences.
Evaluation of a targeted COVID-19 vaccination strategy for Austria–a decision-analytic modeling study
Authors: Jahn B , Sroczynski G , Bicher M , Rippinger C , Mühlberger N , Santamaria J , Urach C , Ostermann H , Popper N , Siebert U 
Published: October 2021

Abstract

Background
The supply of COVID-19 vaccine was limited when introduced. We aimed to inform decision makers at an early stage about targeted COVID vaccination strategies, accounting for limited capacities and adherence to support vaccination prioritization in Austria.

Methods
We applied a dynamic agent-based population model to compare different vaccination prioritization strategies targeting the elderly (65 ≥ years), middle aged (45-64 years), younger (15-44 years), vulnerable (risk of severe disease due to comorbidities), and healthcare workers (HCW), to minimize COVID-19-related hospitalizations and deaths. First, outcomes were optimized for an initially available vaccine batch for 200,000 individuals. Second, stepwise optimization was performed, deriving a prioritization sequence for 2.5 million people. We considered sterilizing and non-sterilizing immunity, with different assumptions of effectiveness, over a 6-month period. The project team was advised by a Standing Policy and Expert Panel, consisting of Austrian decision makers, clinical and ethical experts as well as international modeling specialists.

Results
Maximum reduction of hospitalizations and deaths was achieved by starting vaccinations with the elderly and vulnerable, followed by middle-aged, HCW, and younger individuals. Optimizations for vaccinating 2.5 million individuals yielded the same prioritization and avoided about one third of deaths and hospitalizations. Starting vaccination with HCWs leads to slightly smaller reductions. The negative effects of COVID-19-related HCW absenteeism were not yet considered in our model.

Conclusions
Our decision-analytic study shows that the elderly and vulnerable should be prioritized for vaccination until further vaccines are available to minimize COVID-19-related hospitalizations and deaths. An important ethical aspect complementing our modeling results is the protection of HCW, maximizing their occupational safety and ensuring risk-compensatory justice.

Key messages
To minimize COVID-19-related hospitalizations and death the elderly and vulnerable should be prioritized for vaccination until further vaccines are available. Prioritizing health care workers for COVID-19 vaccination is slightly less effective in the simulation but they may be considered for occupational safety and to ensure risk-compensatory justice.