bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness and safety of oral anticoagulants in the treatment of acute venous thromboembolism: a comparative cohort study in France
Authors: Bertoletti L , Gusto G , Khachatryan A , Quignot N , Chaves J , Moniot A , Mokgokong R 
Published: October 2021

Abstract

Background
RCT evidence has shown that direct oral anti-coagulants (DOACs) are at least as effective and safer in terms of bleeding, compared to vitamin K antagonists (VKAs) in the treatment of acute venous thromboembolism (VTE).

Purpose
To compare the risks of recurrent VTE and of bleeding leading to hospitalisation, in patients treated with DOACs (each compared with VKAs) for acute VTE in a real-world setting.

Methods
A retrospective cohort study of treatment-naïve adult patients with VTE (patients with active cancer were excluded) treated with a DOAC (apixaban or rivaroxaban) or VKA, from 2013 to 2018. The French national health data system (SNDS) was used. After propensity score (PS) matching for each DOAC-VKA comparison, risks of bleeding (defined as principal diagnoses of hospital stays), recurrent VTE, and all-cause mortality were compared at 6 months. Cox proportional-hazards regression was used to estimate adjusted hazard ratios of the endpoints.

Results
58137 treatment-naïve patients were included: 10775 (18.53%) VKAs, 10440 (17.96%) apixaban, and 36922 (63.51%) rivaroxaban. Patients initiating VKAs were older than those initiating apixaban or rivaroxaban (mean age in years: VKAs, 71; apixaban, 65; rivaroxaban, 60) and had a higher comorbidity burden (mean CCI score: VKAs, 1.55; apixaban, 0.91; rivaroxaban, 0.69). PS matched cohort sizes were: apixaban (n=7503) and rivaroxaban (n=9179). Crude risks of recurrent VTE per 100 patient-year (95% CI) were 4.99 (4.36; 5.70), 3.36 (2.88; 3.92) and 4.33 (4.03; 4.66) for VKAs, apixaban, and rivaroxaban respectively. For bleeding, the respective crude risks were 5.21 (4.57; 5.94), 1.84 (1.49; 2.28), and 2.64 (2.41; 2.90). For all-cause mortality, the respective crude risks were 12.23 (11.26; 13.27), 4.69 (4.11; 5.34), and 2.73 (2.49; 2.99). Adjusted hazard ratios for the endpoints are presented in the table.

Conclusions
Apixaban was associated with a lower risk of recurrent VTE and bleedings requiring hospitalisation compared with VKAs. Similar trends in risk reduction for these outcomes were observed for rivaroxaban compared with VKAs but without reaching statistical significance. Both DOACs were associated with lower risk of all-cause mortality compared with VKAs.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): BMS/Pfizer alliance
Early experience utilizing bivalirudin as anticoagulation in extracorporeal membrane oxygen in coronavirus disease 2019
Authors: Jones C X J , Chen K C , Tejera C T , Reddy R R , Faber C F , Mirza S M , Ghumman W G , Rarendran V N , Chait R C 
Published: October 2021

Abstract

Background
Extracorporeal membrane oxygenation (ECMO) is utilized as rescue therapy in patients diagnosed with coronavirus disease 2019 (COVID-19) with refractory respiratory or cardiogenic failure. Systemic anticoagulation with heparin remains the initial choice for thromboembolism prophylaxis in ECMO-treated patients. However, heparin carries the risk of severe complications, such as heparin-induced thrombocytopenia (HIT), and acquired antithrombin deficiency. Bivalirudin has been suggested as an alternative anticoagulant since it neither requires anti-thrombin III monitoring nor triggers HIT.

Purpose
There is very limited data on the utilization of bivalirudin in patients with COVID-19 treated with ECMO. We report the clinical safety and efficacy of using bivalirudin at our institution.

Methods
We retrospectively reviewed 17 patients diagnosed with COVID-19, who were treated with ECMO from 7/31/2020 to 12/20/2020. All patients received bivalirudin for thromboprophylaxis while on ECMO support.

Results
The mean age of our study cohort was forty-five years. Thirteen patients (76.4%) were of either Hispanic or African American descent. Of the seventeen patients, six (35.3%) patients developed deep venous thrombosis and one (5.9%) patient developed pulmonary embolism. Two (11.8%) patients developed a clotted circuit that required exchange. Fifteen (88.2%) patients had hemorrhage requiring transfusion with the gastrointestinal tract as the most common bleeding site. Nine (52.9%) patients developed thrombocytopenia. Six (35.3%) patients were discharged home or to a long-term acute care center; eleven (64.7%) patients died. The average length of stay was thirty-seven days.

Conclusion
In our small case series, the rates of complications and mortality remained high while using bivalirudin as anticoagulation of choice in patients diagnosed with COVID-19 and treated with ECMO. Further studies are needed to investigate the optimal anticoagulant in this population.

Funding Acknowledgement
Type of funding sources: None.
Increased Let-7e expression is associated with long-term all-cause mortality and antiplatelet treatment in patients with type 2 diabetes mellitus
Authors: Eyileten C , Pordzik J , Jakubik D , Czajka P , Wolska M , Jarosz-Popek J , Fitas A , Nowak A , De Rosa S , Gasecka A , Cieslicka-Kaplon A , Siller-Matula J , Postula M ,   I-COMET
Published: October 2021

Abstract

Background
In the light of growing prevalence of type 2 diabetes mellitus (T2DM), efforts are made to discover novel biomarkers. MicroRNAs (miRNAs-miR) are non-coding RNAs used in various processes involved in regulating gene expression which play a role in platelet function.

Purpose
To analyze the ability of platelet-derived miRNAs in prediction of mortality and response to antiplatelet treatment among T2DM-patients.

Methods
252 diabetic subjects were enrolled and were receiving either acetylsalicylic acid (ASA) 75mg (65%) or 150 mg (15%) or clopidogrel (19%). Plasma miR-126, miR-223, miR-125a-3p and Let-7e expressions were assessed by qRT-PCR and compared between the patients who survived and those who died. Median observation time was 5.9 years. Adjusted Cox-regression analysis was used for prediction of mortality. Differential miRNAs expression due to different antiplatelet treatment was analyzed.

Results
ROC curve analysis revealed increasing concentrations of miR-126, Let-7e and miR-125a-3p levels had a diagnostic ability for prediction of long-term all-cause mortality (c-index=0.75, p&lt;0.001; 0.72, p&lt;0.001; 0.72, p=0.001, respectively). Multivariate Cox regression model revealed high miR-126 and Let-7e expressions which were strong and independent predictors of all-cause long-term mortality (HR=5.08, 95% CI: 1.92–13.43; p=0.001; HR=5.94, 95% CI: 1.98–17.79; p=0.001,respectively). After including all miRNAs into one multivariate Cox regression model, only Let-7e was predictive of future occurrence of long-term all-cause death (HR=7.83, 95% CI: 1.2–51.1; p=0.032). MiR-126, Let-7e and miR-223 expressions in the clopidogrel group were significantly higher than in the ASA group (p=0.014; p=0.013; p=0.028, respectively).

Conclusions
Let-7e expression is a strong and independent predictor of long-term all-cause mortality among patients with T2DM. MiR-223, miR-126 and Let-7e present significant interactions with antiplatelet treatment and clinical outcomes.

Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
Machine-learning fusion approach for the prediction of atrial fibrillation onset using photoplethysmographic-based smart device
Authors: Guo Y T , Cui Y , Zhao C , Liu L , Li L , Chen M ,   mAFA investigators
Published: October 2021

Abstract

Background
The mobile and wearable technology and artificial technology are rapidly developing for atrial fibrillation (AF) detection. Nonetheless, how these smart technologies combine to improve AF prediction, rather than detection, remains unclear.

Objective
To investigate a machine-learning fusion approach beyond photoplethysmographic (PPG)-based AF detection for predicting AF onset.

Methods
There are 2,120,210 individuals who used PPG-based smart devices (Huawei Technologies Co., Ltd., Shenzhen, China) to monitor their pulse rhythm from pre-mAFA study (Huawei heart study) for AF screening across China between October 26, 2018 and March 26, 2021. Two machine-learning (ML) models, short-term model and long-term mode, have been developed based on PPG continuing monitoring signals to predict AF episode at 4h or 8h before AF onset respectively, with supervised ML (XGBoost and LightGBM) techniques, and further optimized with feature extension and hyperparameter optimization, respectively. The probabilities of AF onset calculated by both short-term and long-term models with timely PPG monitoring signals would be further input into Warning Decision Module, combined with prior predicting risk of AF onset, then the real risk ratio of predicting AF onset in advance would be output by the fusion module (Figure). The predictive ability of ML models, classified by time to last AF onset, has been validated among individuals involving in AF screening from pre-mAFA study between March 19 to March 26, compared to identified AF by PPG monitoring.

Results
There were 6294 (mean age ± standard deviation, 51.6±16.0 years old, 5439 male) individuals with identified AF, with total 142,518 identified AF episodes by PPG. The 107,864 identified AF were utilized to validate ML fusion approach for the prediction of AF, given effective PPG monitoring signals before identified AF episodes for ML models. There were 443,630 PPG monitoring signals before identified AF episodes and 563,309 non-AF PPG monitoring signals of ML models.
The sensitivity of ML fusion approach for the prediction of AF onset was 94.04%, the specificity of 96.35%, and the recall of 94.04%, respectively (Table). When time to last AF onset over 24 hours, the sensitivity of ML fusion approach for AF onset at 8h in advance was 85.73%, specificity of 96.62%, and recall of 85.73%, respectively (Table).

Conclusion
The ML fusion approach based on PPG-smart devices provided the effective early 'alters' of AF onset in advance in this large cohort, which may help the early 'upstream' management of AF.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National HealthCare of China (20BJZ26)
A machine-learning-based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease
Authors: Raparelli V , Proietti M , Romiti G F , Seccia R , Di Teodoro G , Tanzilli G , Marrapodi R , Flego D , Corica B , Cangemi R , Palagi L , Basili S , Stefanini L ,   EVA Group
Published: October 2021

Abstract

Background
Although cardiovascular disease is the leading cause of mortality in both females and males, women are more likely to have non-obstructive ischemic heart disease (IHD) than men. However, the underlying sex- and gender-specific mechanisms and differences in IHD manifestations are still not fully understood.

Aim
To develop an interpretable machine learning (ML) model to gain insight on the clinical, functional, biological and psychosocial features playing a major role in the supervised prediction of non-obstructive versus obstructive CAD.

Methods
From the EVA study, we analyzed a consecutive unselected cohort of adults hospitalized for IHD undergoing coronary angiography. Non-obstructive CAD was defined by a coronary stenosis at the angiogram &lt;50%. Baseline clinical and psycho-socio-cultural characteristics were used for computing a frailty index based on Rockwood and Mitnitsky model, and gender score according to GENESIS-PRAXY methodology. The serum concentration of inflammatory cytokines was measured with a multiplex flow cytometric assay. An XGBoost classifier combined to an explainable artificial intelligence tool (SHAP) was employed to identify the most influential features in discriminating obstructive versus non-obstructive CAD.

Results
Among the overall EVA cohort (n=509), 311 individuals (mean age 67±11 years, 38% females; 67% obstructive CAD) with complete data were analyzed. The ML-based model (83% accuracy and 87% precision) revealed that while obstructive CAD associated with higher frailty index (i.e., lower physiological reserve), older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was more likely associated with higher gender score (i.e., social characteristics traditionally ascribed to women, regardless of biological sex) and with a cytokine signature characterized by IL-18, IL-8, IL-23.

Conclusions
Integrating clinical, biological and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of the observed associations.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Italian Ministry of Education, Research and University, Scientific Independence of young Researcher (SIR)
Case-ascertainment of acute myocardial infarction hospitalisations across two national data sources for an English cardio-oncology cohort
Authors: Coles B , Teece L , Adlam D , Sweeting M J ,   the VICORI collaborative
Published: October 2021

Abstract

Background
Cardio-oncology is an emerging field aimed at minimising cardiovascular morbidity and mortality in survivors of cancer. Though cardio-oncology patients make up a significant proportion of hospital admissions, they are typically excluded from clinical trials. Electronic health record-based research is a good alternative to understand the risk of cardiovascular disease in these patients. However, completeness and validity of cardiovascular outcome ascertainment may vary by data source.

Purpose
1) Determine ascertainment of acute myocardial infarction (AMI) hospitalisations across two national data sources for English cancer patients, and 2) understand factors that affect ascertainment in this population.

Methods
English cancer patients were obtained from the National Cancer Registration and Analysis Service. AMI hospital admissions occurring during 2010–2017 were identified from two sources: the Myocardial Ischaemia National Audit Project (MINAP) registry and Hospital Episode Statistics (HES). Admissions were ascertainable from both MINAP and HES, or “matched”, if dated within 30 days.

Results
112,502 hospital admissions for 95,509 patients were identified of which 57,265 (50.9%) admissions were captured in MINAP and HES, 26,104 (23.2%) in MINAP only, and 29,133 (25.9%) in HES only. Case-ascertainment percentages were similar across cancer site, stage and grade of disease. Cases ascertained from MINAP only were younger, had fewer comorbidities, and were more likely to have ST-elevated MI and better survival than those ascertained from HES only. The percentage of admissions that could be ascertained from both MINAP and HES has improved from over time.

Conclusions
MINAP and HES define different populations of cancer patients with AMI. Only half of AMI hospital admissions were captured in both MINAP and hospital records. Therefore, these results support the use of multiple linked data sources for observational cardio-oncological research into AMI.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation and Cancer Research UK
Adopting digital health interventions for secondary prevention of cardiovascular disease: clinician perspectives
Authors: Gao Y , Diab A , Sharma A , Khoury S , Huynh P , Spaulding E , Martin S , Marvel F 
Published: October 2021

Abstract

Background
Cardiovascular disease (CVD) remains the leading cause of death globally, taking an estimated 18 million lives each year. Digital health interventions (DHI), such as wearables and smartphone applications, have shown promise in CVD detection, prevention, and management. However, there are scarce data regarding clinician perspectives on the utility of DHI and identification of key elements to support adoption in clinical practice.

Method
In this cross-sectional study, a web-based survey was administered to 107 clinicians directly involved in the care of cardiac inpatients across multiple academic health care systems in the United States, between January 2020 and March 2021. Participants (1) reported their perceptions of DHI impact on their ability to care for patients with CVD, (2) rated the importance of factors related to DHI adoption, and (3) shared perspectives on using DHI for secondary CVD prevention to support guideline-directed medical therapy in patients after acute myocardial infarction. Descriptive statistics were analyzed and summarized as frequencies with percentages.

Results
Among survey respondents, 41% were women; 22% specialized in cardiovascular medicine; and 31% were practicing attendings (Table). Overall, 92% (86/94) of respondents believed that DHI would be important in offering advantages in cardiovascular patient care (Figure). Increasing patient adherence was reported as the most important benefit of DHI adoption by 39% of clinicians, followed by improvement in the patient-clinician relationship (29%), enabling remote care (18%), and improving patient experience (14%). Clinicians under age 40 years old, cardiologists, and internists were the groups more likely to consider DHI important in remote patient care, disease monitoring, and tele-visits, as compared to clinicians over age 40 years old or in other clinical specialties.

Conclusion
Our results highlight clinician perspectives on the advantages of DHI and the potential for its adoption for secondary prevention of CVD.

Funding Acknowledgement
Type of funding sources: None. Table 1. Characteristics of RespondentsFigure 1. Clinician Survey
Process evaluation of the TeleClinical Care pilot study
Authors: Indraratna P , Biswas U , Liu H , Lovell N H , Ooi S 
Published: October 2021

Abstract

Background
A novel smartphone app-based model of care (TeleClinical Care – TCC) for patients with acute coronary syndrome (ACS) and heart failure (HF) was evaluated in a two-site, pilot randomised control trial of 164 participants in Australia. The trial demonstrated improvements in readmission rates, cardiac rehabilitation completion and medication compliance for participants in the intervention arm.

Purpose
A process evaluation was designed with the aims of identifying contextual factors and mechanisms that influenced the results of the trial, as well as identifying methods of improving site and participant recruitment and the delivery of the intervention, for a planned larger effectiveness trial of over 1000 patients across the state of New South Wales (TCC-Cardiac).

Methods
Multiple data sources were used in this mixed-methods process evaluation including interviews with four TCC team members, three general practitioners and three cardiologists. Cardiac rehabilitation completion (CR) rates, heart failure outreach service (HFOS) referrals and cardiologist follow-up appointments were audited. A patient questionnaire was also analysed for evidence of improved self-care as a mechanism of benefit of the TCC app.

Results
Several factors were identified that influenced the success of the trial. Rates of HFOS referral and cardiologist follow-up were high in both arms, and were not significantly different. Team members were largely positive towards their introduction into the trial, but highlighted several factors that could be optimised for the TCC-Cardiac trial, namely streamlining of the enrolment process and improving the reach of the trial, by maximising the screening of potential participants. In their interviews, the GPs and cardiologists viewed the intervention favourably in regard to potential benefit of closely monitoring, and responding to abnormalities in their patients. Several factors were suggested to be optimised prior to the commencement of TCC-Cardiac, such as additional workload and delineation of which party was responsible for alert management. Several patients commented on improved self-management as a result of TCC participation.

Discussion
The TCC trial was successful with the results likely influenced by high rates of follow-up from HFOS and cardiologists. Improved self-care likely drove several benefits including higher engagement with cardiac rehabilitation. The conduct and delivery TCC-Cardiac will be improved by extending recruitment to patients in non-cardiac wards, ensuring team members have adequate time (&gt;15 hours per week) to optimise recruitment, establishing the responsibilities of GPs and cardiologists as part of the model and provision of summary data to them.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Prince of Wales Hospital
Impact of telehealth in the outpatient management of atrial fibrillation during the COVID-19 pandemic
Authors: Shatla I , Sammour Y , Kennedy K , Wimmer A P 
Published: October 2021

Abstract

Background
The COVID-19 pandemic accelerated adoption of a telehealth model to replace outpatient visits. We studied quality indicators and clinical outcomes associated with virtual visits in comparison to in-person ambulatory visits for patients with atrial fibrillation (AF) seen by electrophysiology providers.

Methods
Quality indicators and outcomes for patients with primary diagnosis of AF seen by electrophysiology providers (6 physicians and 4 nurse practitioners) for the 12 week period of March 22–June 13, 2020 were compared with those from the 12 week period of March 24–June 15, 2019.

Result
We identified 2340 clinic visits for AF (1081 in 2019 and 1259 in 2020). Telehealth was not used in 2019, and was used in 90.5% of the 2020 visits. On multivariate analysis during 120 days following each encounter, there was no difference in hospital admissions between 2019 and 2020 (OR 0.89; 95% CI 0.69–1.14; p=0.3624), and there was trend towards lower emergency department visits in 2020 compared with 2019 (OR 0.77; 95% CI 0.6–1; p=0.0509). There were 36 deaths at 120 days, mortality was similar in 2020 as compared with 2019 (OR 1.5; 95% CI 0.74–3.03; p=0.2601). There was no difference in completed procedures including permanent pacemakers, cardiac resynchronization therapy devices, implantable cardioverter-defibrillators and catheter ablations. There was a significant difference in anticoagulant (OR 0.71; 95% CI 0.52–0.99; p=0.0412) and antiarrhythmic (OR 0.78; 95% CI 0.61–0.99; p=0.0384) dose adjustment or new prescriptions in 2019 compared with 2020.

Conclusion
Telehealth was associated with similar intermediate-term clinical outcomes when compared to traditional ambulatory encounters. However, adjusting or providing new prescriptions for anticoagulant or anti-arrhythmic medications was more common with in-person than with virtual visits.

Funding Acknowledgement
Type of funding sources: None.