bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of medical graphic narratives (patient comic) on Patient Reported Outcome Measures (PROMs) in patients undergoing coronary angiography and PCI
Authors: Brand A , Gao L , Dreger H , Hamann A , Crayen C , Brand H , Squier S M , Stangl K , Kendel F , Stangl V 
Published: October 2021

Abstract

Background/Introduction
Increasing evidence suggests that patients scheduled for invasive cardiac procedures such as coronary angiography / PCI feel insufficiently informed about the planned procedure.

Purpose
To improve the Patient Informed Consent (IC) before coronary angiography by using “medical graphic narratives” (patient comic) that illustrate central IC-related aspects in a simple and understandable manner.

Methods
A patient comic illustrating central steps of the procedure, risks, treatment alternatives and behavioural measures was created in collaboration with professional scientific visual communicators. In a randomised, controlled, prospective trial, we included 121 patients undergoing coronary angiography/PCI. Patients were randomised to a group that was informed about the procedure using the usual Patient IC approach (official consent form and conversation with physician; Control group) or a group that additionally obtained a patient comic for reading (graphic illustrations of central IC aspects based on the official consent form; Comic group). Patient Reported Outcome Measures (PROMs), i.e. satisfaction with and perceived quality of the patient IC, were tested in both groups comparing single items of the Client Satisfaction Questionnaire-8 (CSQ-8) and self-designed single items in both IC groups. Differences were compared using the Fisher's exact test. A p-value &lt;0.05 was considered statistically significant.

Results
PROMs showed significant benefits in favour of the Comic group: Quality of the patient IC was perceived to be “very good” in 45.0% of the Comic group compared to 24.9% of patients in the Control group (p=0.023). Only 23.0% of the patients in the Control group, compared to 40.0% in the Comic group, stated that the IC procedure completely met their expectations (p=0.012). 57.4% in the Control group and 76.7% in the Comic group stated that all of their questions were satisfactorily adressed before the procedure (p=0.015). 43.3% in the Comic group, in contrast to 18.0% in the Control group, declared to feel “very satisfied” with the obtained IC procedure (p=0.002). The acceptance of the patient comic was very high: no patient (0%) expressed feelings of not being taken seriously by reading the patient comic.

Conclusions
Our data confirm pronounced limitations of the usual Patient IC practice before coronary angiography. The use of a patient comic that narratively illustrates central steps of the procedure positively impacts on patient-centered endpoints and significantly improves the patient IC procedure.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Friede Springer Herz Stiftung
The experience of cardiovascular professional training across europe: preliminary results from the ESC young cardiovascular professionals survey
Authors: Castelletti S , Kosiuk J , Ladeiras Lopes R , Sohaib A , Bohm A ,   the ESC Board Committee for young cardiovascular professionals
Published: October 2021

Abstract

Background and aim
There are differences in the training programs among European Countries and some sub-specialities are not even recognized in all the training programs. However, discrepancies amongst the Countries and the needs of the trainees are not well known. As such, a survey on the experience of Cardiovascular Professional Training across Europe was created by the ESC Board Committee for Young Cardiovascular professionals to provide a detailed picture of the training programs in the European Countries with deep insights into the needs and expectations of trainees

Methods
Between February and April 2021 a survey with 35 questions on the structure of the training program and on the expectations and needs of the young professionals was launched and advertised through all the official ESC social media and communications channels.

Results
643 under 40-year-old young professionals participated to the survey, 72% cardiologists, 14% other professionals, 3% nurses. The majority of the participants were in practice (59%) and male (57%), mean age was 33 year-old. The current working environment was university hospital (52%), local hospitals (18%), other tertiary locations (13%) and private sector (12%). The majority (54%) of the participants declared not being satisfied with the structure of their training programme and almost all would like a standardised European training programme (94%). The feeling was that more time should be allocated to active participation in interventions (currently 30%, suggested 46%) and that they do not have easy access to all subspecialities (52%). Only 39% of the participants were aware that a 2020 ESC Core curriculum exists and 36% declared that it used in their own Country. Nevertheless, the majority consult the ESC's online education contents (33%, 25% and 17% once per week, per month and per day respectively) and attend Congresses regularly (41% both national and international, 33% only national). Although the majority feel sufficiently recognized for their work by patients, supervisors and society (84%, 65% and 60% respectively), they are unsatisfied from a financial point of view (71%).

Conclusions
The majority of the young cardiovascular professionals feel that their training programme is not satisfactory and a standardised European programme should be implemented. However the ESC Core Curriculum is not well known among the young and not widely used in European Countries. These findings suggest more efforts will be needed to implement a standardized training programme by the ESC and national cardiac societies.

Funding Acknowledgement
Type of funding sources: None. Interventional training needsRecognition feelings of the participants
Impact of adverse events on quality of life and hospital costs in secondary cardiovascular disease prevention
Authors: Lui N M J , Williams C , Keng M J , Hopewell J , Bowman L , Landray M , Gray A , Mihaylova B ,   HPS3/TIMI55-REVEAL Collaborative Group
Published: October 2021

Abstract

Background and purpose
People with atherosclerotic vascular disease remain at high risk of cardiovascular (CVD) events despite effective risk factor management 1. There is little research on impacts of adverse events on quality of life (QoL) and hospital cost to inform evaluations of novel interventions in this population. We estimate QoL and annual hospital costs associated with a range of adverse events of interests using the individual participant data from the Randomized Evaluation of the Effects of Anacetrapib through Lipid Modification (REVEAL) trial.

Methods
Data from the 30,449 participants with atherosclerotic vascular disease receiving effective statin therapy in REVEAL, were used to estimate regression models for participants' hospital costs and QoL using participants' characteristics at entry (socio-demographic, clinical, prior diseases and treatments) and time-updated adverse events. We estimate costs and QoL in the year of an event, and in subsequent years, using stepwise covariate selection (p-value &lt;0.01). Standard errors were adjusted for clustering of participant annual costs.
Hospital episodes were costed (2019 UK£) using the UK Healthcare Resource Groups reference costs 2. One- and two-part generalized linear regression models (GLMs) for annual hospital costs (part 1: logistic model for estimating probability of incurring cost, part 2: GLM with Gaussian, Poisson or Gamma distributions with identity or log links for estimating costs, conditional on incurring any) were compared.
EQ-5D-5L questionnaires, completed by study participants at entry and final follow-up visits in the study, were mapped into QoL utility scores 3. QoL utility at final follow-up was used to estimate QoL decrements of adverse events using GLM linear model and adjusting for QoL at entry in addition to other participants characteristics.

Results
The two-part model with gamma distribution and identity link, indicated by specification tests and model fit statistics, was selected for modelling annual hospital costs (Figure 1). Non-haemorrhagic stroke, non-coronary revascularization, coronary revascularization and incident cancer were associated with highest hospital costs. The QoL model (Figure 2) indicated large QoL decrements associated with non-fatal non-haemorrhagic stroke, heart failure hospitalization, incident cancer and non-coronary revascularization, and comparatively small QoL decrement associated with experiencing non-fatal myocardial infarction.

Conclusion
These cost and QoL models in a well-managed contemporary high CVD risk patient population would assist in assessments of long-term net effects and cost-effectiveness of novel interventions to reduce cardiovascular risk.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Merck Sharp & Dohme and UK Medical Research Council Figure 1Figure 2
Trends in infective endocarditis mortality in the United Kingdom and EU 15+ countries between 1990–2019: an analysis of the Global Burden of Diseases database
Authors: Hammond-Haley M , Hartley A , Delago A J , Goodall R , Marshall D , Salciccioli J D , Shalhoub J 
Published: October 2021

Abstract

Background
Infective Endocarditis (IE) is a relatively uncommon but lethal condition, with no convincing evidence to date of improving mortality trends (1). The epidemiology of IE is complex, driven by a wide range of constantly evolving factors. While marked international variation has been recently reported (2), temporal trends in mortality over recent decades remain unclear.

Purpose
To describe trends in IE mortality in high income countries over the last 30 years.

Methods
Age-standardised mortality rates (ASMR) for IE, stratified by sex, were extracted from the Global Burden of Disease (GBD) database (3) between 1990 and 2019. The United Kingdom and selected countries with comparable health expenditure (EU15+ countries) were included. Relative changes in ASMR over the observation period were determined and trends were analysed using Joinpoint regression analysis.

Results
Between 1990–2019 ASMR from IE increased for both sexes in all included countries except Finland (−20.1% in males, −15.1% in females) and Austria (−8.98% in males, −22.6% in females). The largest increase in ASMR in males was observed in Greece (+197%), while the largest increase in females was observed in Italy (246%). Joinpoint regression analysis identified multiple significant trends within this observation period (Figure 1; clear squares indicate males, filled circles indicate females and lines represent modelled trends based on joinpoint data). At the end of the observation period the Netherlands had the highest ASMR in both males and females (2.28/100,000 in males and 2.37/100,000 in females), while Finland had the lowest ASMR in both males and females (0.45/100,000 and 0.23/100,000 respectively).

Conclusions
Significant international variation in IE mortality rates were observed. While mortality from IE has generally increased over the last 30 years, recent data suggest this trend may now be plateauing or even reversing in certain countries.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Trial leadership by women is associated with racial diversity among heart failure clinical trial participants: a systematic bibliometric review 2000–2020
Authors: Wei S , Le N , Zhu J W , Breathett K , Greene S J , Mamas M A , Zannad F , Van Spall H G C 
Published: October 2021

Abstract

Background
For the results of randomized controlled trials (RCTs) to be generalizable, they should report on and include the broad range of patients who have the disease.

Purpose
We assessed temporal trends and trial factors associated with 1) the reporting of race or ethnicity data and 2) the enrolment of Black, Indigenous, and people of colour (BIPOC) in Heart Failure (HF) RCTs.

Methods
We searched MEDLINE, EMBASE, and CINAHL for RCTs that recruited adults with HF and were published in journals with an impact factor ≥10 between January 1, 2000 and June 17, 2020. We extracted data in duplicate and used the Cochran-Armitage and Jonchkeere-Terpstra tests to examine temporal trends. We used multivariable regression to assess the independent association between trial factors and the outcomes of interest.

Results
A total of 414 RCTs met inclusion criteria, of which a vast majority (90.6%; 95% CI 87.4–93.2%) were coordinated in either Europe or North America. Only 157 of the 414 RCTs (37.9%; 95% CI 33.2–42.8%) reported race/ethnicity data; among the 158,200 participants in these trials, only 29,512 (18.7%; 95% CI 18.5–18.9%) were BIPOC. There was a significant increase in the reporting of race or ethnicity data (from 26.9% in 2000–2001 to 54.2% in 2019–2020, p&lt;0.001) and in enrollment of BIPOC (from 16.5% in 2000–2001 to 23.9% in 2019–2020, p=0.038) between 2000–2020. Trial leadership by a woman was associated with twice the adjusted odds of reporting of race or ethnicity data (OR 2.0; 95% CI 1.1–3.8; p=0.028) and an 8.4% (95% CI 1.9–15.0%; p=0.012) adjusted increase in enrollment of BIPOC. The race/ethnicity of trial leaders was not available for analysis.

Conclusions
Among HF RCTs published between 2000–2020, &lt;38% reported data on race or ethnicity, although this increased over time. Among trials reporting such data, &lt;19% of participants were BIPOC, with modest increases in enrollment over time. Trials led by women had greater adjusted odds of reporting race/ethnicity data and enrollment of BIPOC.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): CIHR
Single-cell RNA sequencing of human fetal epicardium reveals novel markers and regulators of EMT
Authors: Streef T J , Van Herwaarden T , Goumans M J , Smits A M 
Published: October 2021

Abstract

Background
The heart is covered by the epicardium, consisting of epithelial cells and a mesenchymal layer. The epicardium has been shown to be essential during cardiac development by contributing cells through epithelial-to-mesenchymal transition (EMT) and the secretion of paracrine factors. In the adult, the epicardium conveys a cardioprotective response after myocardial infarction, albeit suboptimal compared to the epicardial contribution to heart development. Although the developing epicardium has been characterised in mice and zebrafish, knowledge on the human fetal epicardium derives mostly from cell culture models. Therefore, direct analysis of the human fetal epicardium is vital as it provides new insights into the cellular and biochemical interactions within the developing heart, which can potentially contribute to enhancing the post-injury response.

Aim
To study the human fetal epicardium using single-cell RNA sequencing (scRNA seq) in order to determine its cellular composition. The data are further explored to e.g. identify regulators of epicardial EMT.

Methods
Epicardial layers were isolated from four fetal human hearts (14–15 weeks gestation, obtained under informed consent and according to local ethical approval). Tissue was digested, and single live cells were sorted into 384-wells plates and sequenced. Data analysis was performed using R-packages RaceID3 and StemID2. Findings were validated using qPCR and immunohistochemistry.

Results
Analysis of 2073 cells reveals a clear clustering of the epicardial epithelium and the mesenchymal population. Importantly, we found that “classical” markers, such as Wilms' Tumor 1 and T-box transcription factor 18, are not specific enough to reliably identify the epicardium, but our analysis has provided markers that do allow for robust identification of the epicardium. Additionally, we were able to identify epicardial subpopulations based on their expression profile and validated these using immunohistochemistry in human fetal and adult heart tissue sections. To establish the regulation of epicardial activation we are focussing on the process of EMT within our dataset using RaceID2. From our analysis, several regulators of epicardial EMT are proposed that will be followed up on in vitro.

Conclusions
We identify various novel markers of the fetal epithelial epicardium, as well as characterizing markers of the mesenchymal layer. We also identified novel factors involved in epicardial EMT, and these are currently being validated in our cell-culture model. These data can provide new insights into the post-injury response in the adult heart.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation
Positronium life-time as a new approach for cardiac masses imaging
Authors: Stepien E , Kubicz E , Grudzien G , Dulski K , Leszczynski B , Moskal P 
Published: October 2021

Abstract

Background/Introduction
Positron Emission Tomography (PET), also a standard in cardiovascular imaging, enables semi-quantitative myocardial perfusion evaluation and assessment of atherosclerosis. PET is based on positron-electro annihilation inside a patient's body and in about 40% events it proceeds via formation of positronium. Positronium is an exotic atom created from an electron and a positron in a patient during standard PET imaging. Positronium is not stable and its life-time depends on molecular environment. Recently, it was shown that with the new generation of high sensitivity long-axial field of view PET systems is possible to perform simultaneous imaging of the metabolism rate of administered pharmaceutical and imaging of positronium life-time. Positronium life-time informs about tissue nanostructure and allows distinguishing pathology.

Purpose
Purpose of the presented study is the evaluation of positronium life-time as a biomarker for cardiac masses, namely cardiac myxoma (CM) and normal tissues, obtained from symptomatic patients.

Methods
CM and adipose tissue samples were obtained during a surgery from six symptomatic patients with ECHO confirmed cardiac masses in a left atrium. Immediately after sampling, sample were analyzed with the dedicated positronium-life time measurement system. Samples were irradiated with positrons emitted from the 22Na radionuclide. The system enabled to measure the time-difference spectrum between the formation and annihilation of positronium atom within the studied samples. The life-time spectrum was used for the extraction of a mean positronium life-time. The sample underwent histopathological and micro-computer-tomography (micro-CT) examinations, which confirmed a diagnosis and revealed microstructure of a cardiac mass.

Results
It was established that positronium life-time in CM tissues is significantly (at the level of 10 standard deviations) smaller than in adipose tissue. At the same time, the determined positronium life-time in CM samples from different patients was the same within two standard deviations. Micro-CT imaging showed that CM samples had different calcification spots, but did not revealed existing microvasculature.

Conclusion
Obtained results confirm that positronium life-time differentiates between cardiac pathologies (CM) and normal tissues. And may be used as a biomarker in cardiac masses assessment available during PET examination.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Foundation for Polish Science through the TEAM POIR.04.04.00-00-4204/17 Programme, the National Science Centre.
Birth weight and young adult body mass index for predicting the risk of developing adult heart failure in men
Authors: Bygdell Maria , Ohlsson Claes , Lilja Lina , Celind Jimmy , Martikainen Jari , Rosengren Annika , Kindblom Jenny M 
Published: October 2021

Abstract

Aims
Hospitalizations for heart failure among young adults and middle-aged individuals have increased. The aims of the present study were to evaluate the association between birth weight and risk of adult heart failure and the importance of change from low birth weight to overweight/obesity at young adulthood.

Methods and results
We used the population-based body mass index (BMI) Epidemiology Study cohort Gothenburg (n = 35 659) with birth weight and young adult BMI (20 years) available from child healthcare records, school health records, and military conscription register for men born 1945–1961. The cohort includes all children who finished school, which was mandatory, in Gothenburg, Sweden. Information on heart failure diagnosis was retrieved from the National Patient Register and the Cause of Death Register (n = 415). In cox regression analyses, there was an inverse association between birth weight and risk of heart failure [hazard ratio (HR) 0.83 per standard deviation (SD), 95% confidence interval (CI) 0.76–0.90], and a direct association for young adult BMI (HR 1.48 per SD, 95% CI 1.36–1.61). Of note, individuals with birth weight in the lowest tertile, who were overweight/obese in young adulthood had a five-fold risk of heart failure (HR 4.95, 95% CI 3.36–7.31) compared with individuals in the middle birth weight tertile who were normal weight at 20 years.

Conclusions
Birth weight was inversely associated with the risk of hospitalization due to heart failure. The combination of low birth weight and overweight/obesity in young adulthood results in excess risk of heart failure beyond that of low birth weight or young adult overweight/obesity separately. These findings indicate the need of a life course perspective in heart failure prevention and risk assessment.
The role of socioeconomic and educational determinants in the context of COVID-19
Authors: Costa Giuseppe 
Published: October 2021

Abstract
The Ministry of Health has committed a health inequalities impact assessment of the pandemic and policy response to the pandemic in Italy. The document reviewed the knowledge available to estimate the effect of the main mechanisms for generating health that primarily deserve mitigation. The results recommend to give priority to interventions of proportionate universalism that avoid in short term the social discrimination related to a) the recovery of non-COVID-19 treatments that have been displaced due in the lockdown, b) the access to prevention, immunization and territorial care for people most susceptible to unfavourable outcomes of COVID-19 due to comorbidity and most vulnerable to social disadvantage due to lockdown; c) the loss of social support for fragile and disabled people. In the medium to long term priorities are to protect those with low income and precarious work from social exclusion and the effects on mental and physical health; enable children from families at risk of poverty to benefit from suitable development opportunities; promote resilient and inclusive local communities to reduce isolation and generate help resources; also valuing the beneficial aspects of the pandemic: trust assets to health and adherence to health promotion, more physical exercise, etc. The report has also identified priorities for research including mechanisms that are more difficult to investigate, such as studying the interaction between environmental risks and the risk of COVID-19 infection and progression and the unequal mental health effects of the pandemic and confinement.