bluuebunny/crossref_metadata_2025_split huggingface dataset:
Home blood pressure during COVID-19 related lockdown in patients with hypertension
Authors: Pengo M , Albini F , Guglielmi G , Mollica C , Soranna D , Zambra G , Zambon A , Bilo G , Parati G 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
COVID-19 pandemic has induced governments to promote strict containment measures which inevitably altered patients’ lifestyle with potential effects on blood pressure (BP) control. We aimed to evaluate the changes in home BP (HBP) during the COVID-19 related lockdown in a cohort of hypertensive patients.
Consecutive adult patients with arterial hypertension and stable medical treatment were recruited. HBP values were recorded before and after lockdown in March 2020. An additional set of HBP measurements, recorded one year before the pre-lockdown period, were also considered as reference because of similar environmental temperature.
A total of 126 patients were included: 47% males, mean age 66 [58-72], reference HBP 124.78 (9.90)/76.19 (8.10) mmHg. In the whole group, patients during lockdown exhibited lower systolic and diastolic HBP values compared to the pre-lockdown period [123.23 vs 125.05 mmHg, p = 0.008 and 74.45 vs 75.28 mmHg, p = 0.023, respectively]. Patients with uncontrolled HBP showed the most consistent drop of systolic HBP [136.06 (8.36) and 138.0 (2.08) vs 130 (9.35) p = 0.001 and p &lt; 0.001] and diastolic [81.30 (6.75) and 84.9 (1.85) vs 78.78 (9.25), p = 0.018 and p = 0.002] from pre-lockdown to lockdown and when considering reference values taken one year before, respectively. (Figure 1: Mean values at baseline, pre-lockdown and during lockdown in the 3 groups for systolic (A) and diastolic (B) blood pressure (dotted line = uncontrolled BP group, solid line = unstable BP control, dashed line = controlled BP group). *p&lt;.001 (one year before lockdown vs lockdown SBP), #p = 0.001 (pre-lockdown vs lockdown SBP), $p = 0.002 (one year before lockdown vs lockdown DBP), §p = 0.018 (pre-lockdown vs lockdown DBP). Grey box refers to the lockdown period. SBP = systolic blood pressure, DBP = diastolic blood pressure.)
In conclusion, this study reports for the first time the occurrence of no changes or even a reduction in home BP of treated hypertensive patients during lockdown due to COVID-19. These results may have implications for the management of patients with high blood pressure not only during the current pandemic but also in case of future lockdown conditions.
Abstract Figure 1
Greater cardiorespiratory fitness reduces incidence of atrial fibrillation: a meta-analysis
Authors: Verdicchio C , Elliott A , Mahajan R , Linz D , Lau D , Sanders P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia affecting 1-2% of the global population, with the prevalence of AF increasing dramatically over the past two decades. Although low levels of cardiorespiratory fitness (CRF) and physical activity are predictive of cardiovascular disease onset and mortality, only recently has this emerged as a potential risk factor for AF.

Purpose
The aim of this meta-analysis was therefore to quantify the relationship between CRF, measured by a symptom limited exercise stress test, and incident AF. We hypothesised that there would be an inverse relationship between CRF and the incidence of AF.

Methods
The systematic literature review was conducted using PUBMED, MEDLINE and EMBASE databases, with seven studies meeting the inclusion criteria. A random-effects meta-analysis was then used to compare the multivariate risk estimates of the lowest CRF group from each cohort with the group of the highest CRF.

Results
Data from 206,925 individuals (55.8% males) was used for analysis with a mean age of 55 ± 2.5 years and a mean follow-up period of 10.3 ± 5 years. The total number of AF events across the studies was 19,913. The overall pooled risk of AF in the high-CRF group versus the low-CRF group showed a significant lower risk of incident AF in those with high-CRF (OR: 0.52, 95% CI, 0.44-0.605, p &lt; 0.001). There was evidence of statistical heterogeneity between the studies (I2 = 81%, p &lt; 0.001). AF incidence rates demonstrated an overall decline in rates across the CRF quartiles from low to high. The mean incidence rate for low-CRF was 21 ± 13.4 compared to 6.9 ± 0.7 per 1000 person-years for the high CRF group (p = 0.03).

Conclusion
There is an inverse association between a lower CRF and an increased risk of AF, with a higher level of CRF protective against AF. This study highlights that low-CRF may be an additional risk factor for AF along with already other established lifestyle-based risk factors such as obesity and hypertension. Exercise interventions should be promoted as a primary prevention strategy in those at risk of developing AF with known risk factors. Future studies are warranted to identify the mechanism(s) through which improved CRF confers a reduction in AF incidence.
Abstract Figure. AF risk between high and low-CRF
Performance of PRECISE-DAPT Score for predicting upper gastrointestinal bleedings in patients with stable coronary artery disease on long-term antithrombotic therapy
Authors: Khakimova M , Shakhmatova OO , Komarov AL , Korobkova VV , Pidvyshennaya EV , Andreevskaya MV , Yarovaya EB , Shuleshova AG , Panchenko EP 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
PRECISE-DAPT score has become developed for predicting the risk of bleedings in patients treated with coronary stenting and subsequent 1-year dual antiplatelet therapy. The utility of PRECISE-DAPT score in the setting of all-comer CAD population with different regimes of long-term antithrombotic therapy remains unclear. Upper gastrointestinal bleeding (UGIB) is the predominant hemorrhagic complication in CAD patients; however, the PRECISE-DAPT capacity with respect to this type of bleeding has never been evaluated.

Purpose
to evaluate the role of PRECISE-DAPT score in the assessment of upper gastrointestinal bleeding risk in patients with stable coronary artery disease (CAD) receiving long-term antithrombotic therapy.

Methods
Data were obtained from single center prospective Registry of Long-term AnTithrombotic TherApy (REGATTA-1 NCT04347200). The PRECISE-DAPT score was calculated in a total of 434 patients with stable CAD (77,4% males, median age 61 [IQR 55-69] yrs). Most of the patients 93,6 % received DAPT due to recent PCI with a switch to aspirin monotherapy after 6 months. 1,4 % of patients received aspirin only, 22 (5,1%) of patients received oral anticoagulants because of concomitant atrial fibrillation. The primary outcome was any overt UGIB (BARC ≥2).

Results
In a total of 451 person-years of follow-up (median follow-up was 378 days, IQR 365-421), UGIB occurred 40 patients (incidence at 1 year 8.9 per 100 patients). The median time to first occurrence of UGIB was 55 [IQR 8-115] days. Median PRECISE-DAPT score was 12 points [IQR 6; 20]. The cut-off value for PRECISE-DAPT score to predict UGIB was 16 points (AUC = 0.732, p = 0.0001, 95% CI 0.367-0.827) that correspond to at least moderate bleeding risk according to original score discrimination. Kaplan-Meier bleeding rates were separated by score cut-off (Log-Rank p &lt; 0,001) and the risk difference remains consisted in regression model (OR 2.79 [1.07-7.29]; p = 0.0348).
Conclusion(s): PRECISE DAPT score demonstrated good discriminatory capacity (cut-off 16 points) with respect to UGIB in patients with stable CAD receiving long-term antithrombotic therapy.
Homocysteine, a predictor of cardiovascular adverse events in coronary artery disease
Authors: Santos MR , Palma Dos Reis R , Pereira A , Mendonca F , Temtem M , Sousa JA , Monteiro JP , Sousa AC , Freitas S , Henriques E , Ornelas I , Drumond A , Mendonca MI 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
GENEMACOR

Introduction
After the diagnosis of coronary artery disease (CAD), traditional risk factors such as diabetes mellitus, dyslipidemia, hypertension and smoking have been used to assess the risk of major cardiovascular adverse events (MACE). However, despite reduction of these factors, presence of MACE remains high. It is necessary to identify other causal risk factors for MACE in coronary patients and increased plasma Homocysteine (Hcy) level seems to be a likely candidate. However, the influence of Hcy levels in the prognosis of coronary patients presents a limited knowledge.

Objective
To evaluate the influence of high level of Hcy in MACE (defined as a composite endpoint of cardiovascular death, acute myocardial infarction, stroke, admission for heart failure and need to revascularization) of coronary artery patients.

Materials and Methods
Study analyses of 1687 patients selected from GENEMACOR study population, with at least one &gt; 75% coronary stenosis by angiography. That population was divided in three terciles according to the Hcy level and the population of the 2nd tercil (Hcy 11.1-13.6mmol/L) was excluded. The end population of 1118 patients was a median age of 53.1 ± 7.9 years and 77.6% were men. We compared patients in the 1st (Hcy &lt; 11.1mmol/L) and 3rd tercil (Hcy &gt; 13.6mmol/L) during a mean follow up of 5.0 ± 4.8 years.

Results
560 (50.1%) patients were included in the 1st tercil group (median age 51.6 ± 3 years, 72.0% men) and 558 (49.9%) patients were in the 3rd tercil group (median age 54.6 ± 3 years, 83.3% men). In our population, high levels of Hcy were associated with MACE (OR 1.43, 95% CI: 1.12-1.83, p 0.004).

Conclusion
In our population a higher level of Hcy was associated with adverse prognosis and increased occurrence of MACE. Knowing that elevated homocysteine levels are associated with increased risk of MACE, in these patients is essential to have a more intensive therapeutic strategy.
Primary care physician services and the frequency of comorbidities in patients with acute myocardial infarction
Authors: King R , Giedrimiene D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The management of patients with multiple comorbidities represents a significant burden on healthcare each year. Despite requiring regular medical care to treat chronic conditions, a large number of these patients may not receive proper care. Significant disparities have been identified in patients with multiple comorbidities and those who experience acute coronary syndrome or acute myocardial infarction (AMI). Only limited data exists to identify the impact of comorbidities and utilization of primary care physician (PCP) services on the development of adverse outcomes, such as AMI.

Purpose
The primary objective was to analyze how PCP services utilization can be associated with comorbidities in patients who experienced an AMI.

Methods
This study was based on retrospective data analysis which included 250 patients admitted to the Hartford Hospital Emergency Department (ED) for an AMI. Out of these, 27 patients were excluded due to missing documentation. Collected data included age, gender, medications and recorded comorbidities, such as hypertension, hyperlipidemia, diabetes mellitus (DM), chronic kidney disease (CKD) and previous arrhythmia. Each patient was assessed regarding utilization of PCP services. Statistical analysis was performed in order to identify differences between patients with documented PCP services and those without by using the Chi-square test.

Results
The records allowed for identification of documented PCP services for 172 out of 223 (77.1%) patients. The most common comorbidities were hypertension and hyperlipidemia: in 165 (74.0%) and 157 (70.4%) cases respectively. The most frequent comorbidity was hypertension: 137 out of 172 (79.7%) in pts with PCP vs 28 out of 51 (54.9%) without PCP, and significantly more often in patients with PCP, p&lt; 0.001. Hyperlipidemia was the second most frequent comorbidity: in 130 out of 172 (75.6%) vs 27 out of 51 (52.9%) accordingly, and also significantly more often (p&lt; 0.002) in patients with PCP services. The number of comorbidities ranged from 0-5, including 32 (14.3%) patients without comorbidities: 16 (9.3%) with a PCP and 16 (31.4%) without PCP services. The majority of patients - 108 (48.5% of 223), had 2-3 documented comorbidities: 89 (51.8%) had two and 19 (34.6%) had three. The remaining 40 (17.9%) patients had 4-5 comorbidities: 37 (21.5%) of them with a PCP and 3 (10.3%) without, with a significant difference (p &lt; 0.001) found for patients with a higher number of comorbidities who utilized PCP services.

Conclusions
Our study shows that the majority of patients who presented with an AMI had one or more comorbidities. Furthermore, patients who did not utilize PCP services had fewer identified comorbidities. This suggests that there may be a significant number of patients who experienced AMI with undiagnosed comorbidities due to not having access to PCP services.
The importance of cardiac rehabilitation programmes in the control of LDL cholesterol after an acute coronary syndrome
Authors: Adeba Garcia A , Vigil-Escalera Diaz M , Alvarez Velasco R , Martin Fernandez M , Barriales Alvarez V , Soroa Ortuno M , Barja Gonzalez N , Santamaria Rubio J , Junco Vicente A , Martinez Leon A , Persia Paulino YR , Fernandez Asensio R , Cuevas Perez J , Florez Llano P , Hevia Nava JS 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction and objectives

Cardiac rehabilitation programmes (CRP) are a fundamental pillar in the education, optimization of treatment and assessment of the functional class in cardiovascular pathology. The aim of this study is to analyse the levels of LDL cholesterol at discharge and after 6 months of follow-up after the CRP carried out in our centre.

Material and methods

Analysis of a prospective cohort of 268 patients, included in the CRP between November 2015 and October 2018 after an acute coronary event and with a minimum follow-up of 6 months. The CRP consists of a medical and nursing consultation both for inclusion and prior to discharge. It lasts 1 month and includes 3 weekly sessions of individualised and monitored exercise which are carried out together with talks on cardiovascular risk factors, diet, treatments... In the pre-discharge consultation, an analysis is carried out to adjust the treatment, and a new control is performed after 6 months.

Results

Average age 56.2 years (SD: 8.9), 90% men, 46% hypertense, 24% diabetics, 68% dyslipemics, 70% smokers/ex-smokers and 57% sedentary. 60% of the patients had presented a STEMI, with 80% being revascularized percutaneously. 48% had 1-vessel disease. LVEF was conserved in 74% of the patients.
The mean LDL cholesterol after the event is 105.3 mg/dl (SD: 37.7) and at the discharge of the program, 61 mg/dl (SD: 21.3) being the difference statistically significant (p &lt; 0.005). The mean LDL at 6 months was 62 mg/dl (SD: 19.9) with no statistically significant difference with respect to the previous one (p = 0.53) (table 1). At the beginning of the CRP 91% of the patients presented an LDL &gt;55 mg/dl, after the same 55 % and at 6 months 57% (graph 1). After 6 months, 4% maintained levels &gt;100 mg/dl. 98% of patients were receiving high-potency statins and 12% ezetimibe. At discharge, treatment with ezetimibe was started in 28 patients (13%). No treatment with iPCSK9 was initiated. This study was carried out while the 2016 European guidelines were still in effect, with an LDL target in secondary prevention of less than 70 mg/dl.

Conclusions

CRPs are effective in improving control of LDL cholesterol, due to a closer monitoring and a better health education that allows greater therapeutic adherence. However, after the programme it is necessary to continue with regular monitoring to maintain and, in some cases, reach the target figures. In our case there is a small percentage of patients who could still benefit from starting treatment with iPSCK9.
Abstract Figure. Graph 1
Impact of obesity on the clinical outcomes of patients undergoing pacemaker insertion during hospitalization: An analysis of the United States National Inpatient Sample
Authors: Almani M , Usman M , Qudrat Ullah M , Fatima N , Yousuf M , Edigin E 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
1. Introduction
Obesity causes significant cardiovascular morbidity. Nonetheless, there is also evidence supporting obesity paradox particularly in heart failure patients. The impact of obesity on the outcomes of patients undergoing pacemaker insertion is not well studied.
2. Purpose
The purpose of this study is to determine if obesity paradox exists for the patients who undergo pacemaker insertion.
3. Methods
Data were extracted from the National Inpatient Sample (NIS) 2016 - 2018 Database. The NIS was searched for patients who underwent pacemaker insertion while hospitalized. The patients were divided into two groups based on presence or absence of obesity as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used to for analysis.
4. Results
Of 408,040 patients who underwent pacemaker insertion, 64185 (15.7%) were obese. The adjusted odds ratio for inpatient mortality for obese patient undergoing pacemaker insertion compared to non-obese patients was 0.65 (95% CI 0.516 – 0.821, p &lt; 0.001). Secondary outcomes are listed in table 1.
5. Conclusion
Obese patients who underwent pacemaker insertion had lower inpatient mortality compared to non-obese patients. Also, obese patients undergoing pacemaker insertion were less likely to have cardiac arrest but they were more likely to develop decompensated heart failure and acute renal failure compared to non-obese patients.
Outcome Without Obesity, % With Obesity, % aOR (95% CI) p-value* Primary outcome In hospital mortality 10.8 7.0 0.65 (0.516 - 0.821) &lt;0.001* Secondary outcomes Length of stay (days), mean 5.7 6.3 0.031 (-0.105 - 0.168) # 0.654 Total hospital charges (US$), mean 121250 134757 720 (-2307 - 3747) # 0.641 Decompensated heart failure 13.3 19.2 1.53 (1.451 - 1.629) &lt;0.001* Cardiogenic shock 2.3 2.7 1.00 (0.883 - 1.141) 0.954 IABP placement 0.5 0.6 0.98 (0.746 - 1.294) 0.898 Cardiac arrest 4.27 4.30 0.83 (0.753 - 0.920) &lt;0.001* Acute renal failure 20.7 25.4 1.17 (1.112 - 1.231) &lt;0.001* Abbreviations: *; statistically significant, #; adjusted mean difference, aOR: adjusted odds ratio, CI: confidence interval, IABP: Intra-aortic balloon pump.Adjusting factors: Age, race, Charlson comorbidity index, primary insurance, median household income for patient’s zip code, location and teaching status of the admitting hospital, dyslipidemia, chronic obstructive pulmonary disease, hypertension, peripheral vascular disease, diabetes mellitus, chronic kidney disease, liver disease and smoking status. Table 1: Clinical outcomes of hospitalizations for pacemaker insertion based on presence or absence of obesity, analysis of United States National Inpatient Sample from 2016 through 2018.
Subclinical impact of diabetes and hypertention on left ventricular function
Authors: Maaroufi A , Abouradi S , Zahidi H , Choukrani H , Habbal R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Assessment of longitudinal left ventricular (LV) function has a major clinical significance for the early detection of contractile LV dysfonction. The measurement of the MAPSE (Mitral annular plane systolic excursion) and the systolic peak velocity of the edge of the mitral ring (Sm) allow an accurate assessment of longitudinal systolic performance

Objective
The aim of this study was to compare the impact of isolated type 2 diabetes and the coexistence of hypertension and diabetes on LV longitudinal systolic performance.

Patients and Methods
The study included 170 diabetic patients, of whom 85 had both hypertension and diabetes, and 50 controls. The systolic mitral annulus (Sm) velocity by tissue Doppler and the Mitral annular plane systolic excursion (MAPSE) by M mode were measured in all subjects.

Results
The mean age was 52.8 ± 15 years with a sex ratio M / F 0.23 in diabetic patients, and a mean age 60.8 ± 8 years with a sex ratio M / F 0.45 in control subjects. The mean MAPSE value was reduced in diabetics (11.5 ± 2.6 mm) and even more in hypertensive diabetics (10.5 ± 3.0 mm) compared to controls (16.1 ± 2.4 mm ) (p = 0.02). Similar results were found for Sm (controls, 12.4 ± 2.5 cm / s; diabetics, 9.0 ± "3.3 cm / s; diabetic hypertensive, 7.3 ± 2.0 cm) (p = 0.04).

Conclusions
diabetics present a depression of the LV longitudinal systolic indices compared to healthy controls; the coexistence of diabetes and hypertension results in further impairment of LV longitudinal systolic function in an additive manner.
Usefulness of cardiometabolic index for the estimation of diabetes risk among general population in rural China: a community-based study
Authors: Wang HY , Shi WR , Sun YX 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiometabolic index (CMI) defines adiposity based on triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) ratio and waist-to-height ratio (WHtR). This newly proposed metric has been used to detect multiple cardiovascular risk factors, but data relative to diabetes in the general population are lacking. This study aims to validate CMI’s utility of discriminating diabetes and compares it with other indexes among general Chinese population.

Methods
Analyses were based on a cross-sectional study of 11,478 participants that underwent assessment of metabolic and anthropometric parameters in rural areas of northeastern China in 2013. CMI was calculated by TG/HDL-C × WHtR. Multivariate logistic regressions were performed to clarify CMI’s association with diabetes, ROC analyses were engaged to investigate CMI’s discriminating ability for diabetes.

Results
The prevalence of diabetes was 9.93% in males while 10.76% in females, and increased with CMI’s increment. After full adjustment, each SD increment of CMI had odds ratios (ORs) for diabetes of 1.471 (1.367–1.584) and 1.422 (1.315–1.539) in females and males, respectively. Compared with bottom categories of CMI, the top quartiles had ORs of 3.736 (2.783–5.015) in females and 3.697 (2.757–4.958) in males. The ROC results showed an excellent discriminating power of CMI (AUC: 0.702 for females, 0.664 for males).

Conclusions
An increasing CMI was correlated with higher odds of diabetes, supporting CMI as a useful and economic measure to screen and quantify diabetes in general Chinese population. Monitoring and promoting achievement of dyslipidemia and abdominal obesity based on CMI may improve subclinical and cardiovascular outcomes.
Abstract Figure.