bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient self-screening stations for atrial fibrillation in general practice waiting rooms: process evaluation
Authors: McKenzie K , Lowres N , Freedman B , Orchard J , Hespe C , Giskes K 
Published: October 2021

Abstract

Background
Our previous work has identified factors relevant to general practitioner (GP)-led screening for atrial fibrillation (AF) in Australian general practices, with GPs indicating significant time constraints. AF SELF SMART (Atrial fibrillation self-screening, management and guideline recommended therapy) allows for opportunistic patient self-screening using purpose-built screening stations located in GP waiting rooms (figure 1). It utilises a single-lead ECG, with results automatically imported into the patient medical record for review during the GP consultation. AF SELF SMART may increase screening rates, but acceptability by practice staff is unknown.

Purpose
Determine staff perspectives on opportunistic self-screening in practice waiting rooms, utilising AF SELF SMART.

Method
14 semi-structured interviews have been conducted with practice staff (GPs, receptionists and practice managers) across 3 practices participating in the AF SELF SMART pilot, with thematic analysis of results.

Results
Several themes were identified.
All staff acknowledged the importance of increasing screening for AF in the practice. GPs in particular placed a high value on AF screening for stroke prevention. GPs valued the increased information and accuracy provided by AF SELF SMART, as previously they checked patients for AF using manual methods, either routinely or as clinically indicated. There were differential impacts on workflow. GPs reported some small increase in workload but these were seen as being acceptable given the benefits of the program. Receptionists and Practice Managers reported significant interruptions to normal workflow associated with assisting patients. Receptionists routinely offered patients help with screening instead of patients screening independently. Staff perceived that patients were either unable to negotiate the self-screening process by themselves, or did not want to try. Given the increase in workload associated with assisting patients, and as screening was not receptionists' main priority, not all patients were offered self-screening during busy periods. Patient refusal was also identified as a factor limiting uptake.

Conclusion
While AF self-screening may increase screening rates, further process improvements are required to reduce impact on reception staff, and enhance the usability of the self-screening station for patients. Such improvements may increase acceptability and ongoing sustainability at a practice level.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Investigator initiated research grant from Bristol-Myers Squibb/Pfizer Alliance Figure 1. Self-screening station
Public awareness of acute myocardial infarction symptoms and emergency response in community residents
Authors: Ma J , Zhang N , Xiao J.-Y , Wang J.-X , Li X.-W , Wang J , Zhang Y , Zheng Q.-X , Zhao S.-Y , Han P , Yang Y.-N , Gao M.-D , Zhang X , Liu Y , Gao J 
Published: October 2021

Abstract

Background
Patient delay in seeking help has been reported to be a major factor that related to delay in care of acute myocardial infarction (AMI). Lack the knowledge of symptoms may translate to behavioral deficiencies which lead up to failing to seek medical assistant at early stage of AMI.

Purpose
The aim of present study is to investigate the awareness of AMI symptoms and the emergency responses among community residents over 35 years old.

Methods
The sample was proportionally distributed by age according to the national census data. The sex ratio was 1:1. The sample size is calculated according to the significance level of 0.05, the allowable error of 0.1, and the estimated Excellent awareness level of 10%. The final sample size is adjusted to 4200, considering non-response rate of 20%. Multi-stage stratified random sampling was used. On the first stage, two districts each in urban and rural regions were randomly selected. On the second stage, 3–10 community health service centers were randomly selected in each district. On the third stage, residents over 35 managed by the community health service center were proportionally sampled to be interviewed. A structured questionnaire was used and the survey was conducted in a face-to-face interview by clinical physicians. Logistic regression was applied to analyze factors related to Good knowledge.

Results
The top three symptom recognized by public is “pain or discomfort in the chest” (71.3%), followed by “difficulty breathing” (65.1%) and “pain or discomfort in the jaw, neck, or back” (60.9%). 85.0% chose to call an ambulance as first response when witness others having an AMI. Those who lives alone (OR=1.408; 95% CI, 1.005–1.972) and whose immediate family had been diagnosed with AMI (OR=1.510; 95% CI, 1.040–2.192) has better knowledge. A significant positive correlation was observed for those with hypertension (OR=1.199; 95% CI, 1.007–1.429), while a negative correlation was observed for those with diabetes (OR=0.788; 95% CI, 0.626–0.992). Public education could improve Good knowledge (OR=1.662; 95% CI, 1.388–1.990), while doctoral advise has been shown negative impact (OR=0.824; 95% CI, 0.691–0.984).

Conclusions
Our data provide first population-based estimates of public awareness in our country. Further promotional strategies to increase overall awareness in general public are seriously needed.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Major Science and Technology Projects of Tianjin Science and Technology Commission Multivariable logistic regression
Cost-minimisation analysis of acute myocardial infarction rule-out in low-risk patients: primary care emergency setting versus hospital setting
Authors: Johannessen T R , Halvorsen S , Atar D , Wisloff T , Munkhaugen J , Nore A K , Vallersnes O M 
Published: October 2021

Abstract

Background
Hospital management of low-risk chest pain contributes to extensive use of healthcare resources and emergency department crowding. High efficacy rule-out, with subsequent reduction in costs and length of stay, has been demonstrated for the ESC 0/1-hour algorithm using high-sensitivity cardiac troponins (hs-cTn) in hospital cohorts.

Purpose
To estimate potential differences in healthcare costs by assessing patients with low risk for acute coronary syndromes (ACS) in a primary care emergency setting using the ESC 0/1-hour algorithm compared to routine management in a hospital setting.

Methods
This cost-minimisation analysis compared direct costs of applying the 0/1-hour algorithm in a low-risk primary care cohort to a low-risk chest pain cohort at a large general hospital in Norway. Data from the prospective OUT-ACS study (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome,[1] inclusion period 2016–2018) were used to calculate costs per patient at a primary care emergency clinic. For the hospital setting estimates, anonymous data were extracted for all low-risk chest pain patients treated at a large general hospital in 2018. Cost items include complete hospital costs per different diagnosis-related groups as defined in national assessments, as well as resource items required to use the algorithm in primary care, including personnel time and test- and treatment costs. Primary outcome was the difference in healthcare costs when assessing the low-risk cohort in a primary care setting compared to a hospital setting. The secondary outcome was the difference in length of stay.

Results
The costs of assessing the low-risk cohort at the primary care emergency clinic and the general hospital were estimated at €178 and €1480, respectively (Table 1). Thus, the estimated reduction in health care costs among patients assessable by the 0/1-hour algorithm outside of hospital was €1302 per patient, with a mean decrease in length of stay of 18.9 hours. Additional diagnostic procedures (e.g. stress ECG and echocardiogram) were performed in 31.9% (n=181/567) of the low-risk hospital cohort, which was part of the cost-driving estimate.

Conclusion
Assessment of patients considered as low-risk for ACS with the ESC 0/1-hour algorithm in a primary care emergency setting seems to decrease healthcare costs significantly, in addition to a reduction in both length of stay and potentially unnecessary hospitalisations.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Norwegian Research Fund for General PracticeThe Norwegian Committee on Research in General Practice
Association between social deprivation status, age of presentation, and survival following ST-segment elevation myocardial infarction
Authors: Laffan J , Hogg M , Devlin P , Mailey J , Montgomery J , Johnston N , Spence M , Walsh S 
Published: October 2021

Abstract

Introduction
Many factors influence age of presentation with and survival following ST-segment myocardial infarction (STEMI). These include age, mode of, and time-delay to emergency treatment, diabetes and smoking. We sought to assess whether overall social deprivation status is associated with age of presentation and mortality following STEMI patients treated with primary PCI.

Methods
All patients treated emergently for STEMI in a large Northern Irish tertiary hospital from 2013 – 2017 were reviewed. Social deprivation is determined as a composite score relating to income, crime etc, and assigned to small geographical regions by the Northern Ireland Statistics and Research Agency. Deprivation score was assigned to patients based on their postcode. The database was ranked by social deprivation score and divided in to quintiles. The most (Grp 1) and least (Grp 5) deprived quintiles were compared. Mortality was determined from a national electronic health record.

Results
1,192 patients were included in the analysis. Mean follow up was 52.5 months (SD 15.6), minimum follow up was 35.6 months. There was no difference in gender: 70.1% male in Grp 1 vs 75.2% male in Grp 5 (p=0.68); no difference in ECG to balloon time: mean 89.9mins (95% CI 84.9–94.9) Grp 1 vs 90.5mins (95% CI 86.2–94.9) Grp 5 (p=0.86). The more deprived group was younger: mean age 60.6 (95% CI 59.5–61.6) vs 65.2 (95% CI 64.2–66.3) (p&lt;0.000). Crude survival measured by Log-rank test was the same between the groups (p=0.52). Following Cox-regression adjustment for age, survival was longer in the least deprived group (p=0.042).

Conclusion
Social deprivation is associated with both a younger age of presentation with, and a higher mortality following STEMI. This is important variable is often overlooked in medical literature and should be further studied.

Funding Acknowledgement
Type of funding sources: None.
The transcriptional landscape of the clustered protocadherins in the cardiovascular system
Authors: Zhu W , Chhibbar P , Lo C 
Published: October 2021

Abstract

Background
The alpha, beta and gamma clustered protocadherins (cPcdhs) genes encode homotypic cell adhesion molecules that are highly expressed in the brain. They are well described to be expressed in a combinatorial fashion to specify neuronal identity for coding synaptic connectivity. Unexpectedly, we recently uncovered evidence from studies in mice and human showing PCHDA variants can cause congenital heart defects. As all the genes of the alpha or gamma PCDH cluster share a common 3' end and are highly homologous, the expression of these gene clusters has been underestimated or overlooked due to multimapping issues. This is especially problematic in single cell RNAseq (scRNA) data generated using 3' based amplification protocols.

Methods and results
We constructed a modified bioinformatic pipeline for analyzing the cPcdhs transcripts (Fig. 1a). Raw data of Publicly available scRNA datasets were downloaded and re-processed and analyzed for expression of the cPCDH transcripts using our custom pipeline. Integrating 10 scRNA datasets of mouse heart tissues from embryonic 7.75 (E7.75) to postnatal 30 months (PM30) were performed by Harmony and Seurat. This showed Pcdhg had the highest expression among the three Pcdh gene clusters, with next being Pcdhb and then Pcdha (Fig. 1b). Pcdhb and Pcdhg were enriched in endocardial cells and fibroblasts (Fig. 1b). Unlike gene expression in neurons, expression of the cPcdhs in cardiac cell types did not shown the stochastic, sparse, combinatorial expression patterns seen in neurons (Fig. 1b). Despite the relatively low level of Pcdha expression in all cardiac cell types, it is intriguing that independent scRNA datasets showed Pcdha is expressed most highly in the atrium in the early embryo, possibly due to known atrial dominance in the early embryo (Fig. 1c). Pcdhb is highly expressed in the OFT and atrioventricular canal of both human and mouse heart, suggesting its perturbation may contribute to outflow tract or AV valve abnormalities (Fig. 1c-d). Consistent with our previous finding of an important role for the Pcdha gene cluster in left ventricular outflow obstructive (LVOTO) lesions, we observed expression of Pcdhg was broadly upregulated in the Adamts19 homozygous knockout mice exhibiting aortic valve dysfunction, a CHD phenotype in the LVOTO spectrum (Fig. 1e).

Conclusions
Using a new bioinformatics pipeline, we systematically mapped the transcriptional landscapes of cPcdhs during heart development using scRNA data. This revealed cell type-specific and anatomical characteristics in the expression of the different cPcdhs. These findings show the cPcdhs are transcriptionally regulated very differently in the cardiovascular system from regulation observed in the brain. The single cell transcriptional profile for the cPcdhs in the cardiovascular system can serve as the foundation for future investigations into the broader role of the cPcdhs in cardiovascular development and disease.

Funding Acknowledgement
Type of funding sources: None.
Pericardial adipose tissue-derived leptin promotes myocardial apoptosis in high fat diet-induced obese rats through JAK2/ROS/NKA signaling pathway
Authors: Wang P , Luo C H , Song Y , Cao L F , Luan H , Zheng S P , Zhu D J , Tian G 
Published: October 2021

Abstract

Background
Pathophysiologic mechanisms underlying cardiac structural and functional changes in obesity are complex and linked to adipocytokines released from pericardial adipose tissue (PAT) and cardiomyocyte apoptosis. Although leptin is involved in various pathological conditions, its role in paracrine action of pericardial adipose tissue on myocardial apoptosis remains unknown.

Purpose
This study was designed to investigate the role of PAT-derived leptin on myocardial apoptosis in high fat diet-induced obese rats.

Methods and results
Hearts were isolated from lean or high fat diet-induced obese Wistar rats for myocardial remodeling studies. Obese rats had abnormal myocardial structure, diastolic dysfunction, greatly elevated cardiac apoptosis and increased oxidative stress level. Enzyme-linked immunosorbent assay (ELISA) detected significantly higher than circulating leptin level in PAT of obese, but not lean rats. Western blot and immunohistochemical analyses demonstrated increased leptin receptor density in obese heart. H9c2 rat cardiomyoblasts after exposed to PAT-conditioned medium of obese rats exhibited pronounced reactive oxygen species (ROS)-mediated apoptosis, which was partially reversed by leptin antagonist. Moreover, leptin derived from PAT of obese rats inhibited Na+/K+-ATPase activity of H9c2 cells through stimulating ROS, thereby activating calcium-dependent apoptosis. Pretreatment with specific inhibitors revealed that JAK2/STAT3 and PI3K/Akt signaling pathways was involved in the leptin-induced myocardial apoptosis.

Conclusion
PAT-derived leptin induces myocardial apoptosis in high fat diet-induced obese rats via activating JAK2/STAT3/ROS signaling pathway and inhibiting its downstream Na+/K+-ATPase activity.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Nature Science Foundation of ChinaKey Projects of Shaanxi Science and Technology Research and Development Plan
Overexpression of genes involved in lymphocyte activation and regulation are associated with reduced CRM-derived cardiac remodelling after STEMI
Authors: De Dios E , Rios-Navarro C , Perez-Sole N , Gavara J , Marcos-Garces V , Forteza M F , Oltra R , Vila J M , Chorro F J , Bodi V 
Published: October 2021

Abstract

Aims
Lymphopenia after ST-segment elevation myocardial infarction (STEMI) correlates with deleterious cardiac consequences and worse prognosis. An in-depth examination of genes implicated in lymphocyte proliferation, activation and regulation and their association with short- and long-term cardiac structure and function is therefore of great interest.

Methods
Peripheral blood mononuclear cells were isolated from 10 control subjects and 64 patients with a first STEMI treated with primary percutaneous coronary intervention and submitted to cardiac magnetic resonance after 1 week and 6 months. mRNA expression of genes implicated in lymphocyte activation (CD25 and CD69) and regulation [programmed death (PD)-1 and cytotoxic T-lymphocyte antigen (CTLA)-4] were determined by qRT-PCR.

Results
In comparison to controls, STEMI patients showed heightened mRNA expression of CD25 and lower PD-1 and CTLA-4 96h after coronary reperfusion. Patients with extensive infarctions (&gt;30% of left ventricular mass) at 1 week displayed a notable reduction in CD25, CD69, PD-1, and CTLA-4 expression (p&lt;0.05). However, CD25 was the only predictor of 1-week extensive infarct size in multivariate logistic regression analysis (odds ratio 0.019; 95% confidence interval [0.001–0.505]; p=0.018). Regarding long-term ventricular function, mRNA expression of CD25 under the mean value was associated with worse ventricular function and more adverse remodelling.

Conclusions
Following STEMI, heightened expression of genes expressed in regulatory T cells (CD25 and CD69) and immune checkpoints (PD-1 and CTLA-4) correlates with a better short- and long-term cardiac structure and function. Advancing understanding of the pathophysiology of lymphopenia and evaluating novel immunomodulatory therapies will help translate these results into future clinical trials.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER”
Meta-analysis assessing cardiovascular outcomes with febuxostat versus allopurinol for patients with gout
Authors: Patoulias D , Boulmpou A , Tranidou A , Nikolaidis A , Papadopoulos C E , Vassilikos V , Bakatselos S , Damianidis G , Doumas M 
Published: October 2021

Abstract

Background
Gout, the most common inflammatory arthritis in the USA, represents an established risk factor for cardiovascular disease and coronary artery disease mortality. In addition, patients with gout experience an increased risk for non-fatal myocardial infarction, while they might also feature increased risk for stroke. Recent real-world data also highlight the association between gout and atrial fibrillation, which inevitably augments cardiovascular burden. Allopurinol, a xanthine oxidase inhibitor, remains the uric acid-lowering treatment option of first choice, while febuxostat is prescribed, when allopurinol is contraindicated or not tolerated. Unfortunately, medication adherence among gout patients is poor, associated with age and related co-morbidities.

Purpose
We sought to determine the comparative efficacy of febuxostat versus allopurinol across surrogate cardiovascular outcomes of interest, by pooling data from the 2 dedicated cardiovascular outcome trials available so far. The motive for this analysis was the U.S. Food and Drug Administration (FDA) warning raised after the publication of the CARES trial, regarding the increased risk for cardiovascular and all-cause death with febuxostat compared to allopurinol.

Methods
We pooled data from the 2 dedicated cardiovascular outcome trials (CARES and FAST) and we assessed the following cardiovascular outcomes of interest: cardiovascular death, all-cause death, non-fatal myocardial infarction (MI), non-fatal stroke, fatal MI, fatal stroke, transient ischemic attack, hospitalization for heart failure, coronary revascularization, cerebrovascular revascularization and atrial fibrillation. Risk of bias was low across the included studies.

Results
Our analysis in a total of 12,318 patients with gout showed that febuxostat compared to allopurinol treatment does not confer significant risk reduction for any of the assessed, prespecified surrogate outcomes in a study population with significant cardiovascular co-morbidities (Figure 1). One third of patients enrolled in the FAST trial and 40% of the patients enrolled in the CARES trial had pre-existing cardiovascular disease, as depicted in Figure 2. Heterogeneity was low for the vast majority of the assessed outcomes, except for cardiovascular and all-cause death and fatal MI.

Conclusions
There is no significant difference across surrogate cardiovascular outcomes of interest between febuxostat and allopurinol in patients with gout and cardiovascular co-morbidities. Febuxostat seems to be a safe treatment alternative to allopurinol, despite initial concerns in terms of its cardiovascular safety.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Inequalities in non-communicable diseases across the European Union: current state and trends from 2000 to 2019
Authors: Peñalvo JL , Mertens E , Devleeschauwer B , Grad DA , Hrzic R , Bikbov B , Abbafati C , Balaj M , Cuschieri S , Eikemo TA , Fischer F , Ghith N , Haagsma JA , Ngwa CH , Noguer-Zambrano I , O’Caoimh R , Paalanen L , Padron-Monedero A , Pallari E , Sarmiento Suárez R , Sulo G , Tecirli G , Vasco Santos J 
Published: October 2021

Abstract

Background
Non-communicable diseases (NCDs) remain the leading cause of disease burden in the European Union (EU). However, this burden varies across Member States, driven by the socioeconomic and demographic structure of the populations, as well as health care and social support systems in each country. This geographical gradient in the burden of NCDs represents health inequalities that may have expanded as a result of population ageing, migration, and economic crisis, and historic backgrounds.

Methods
Using data from the GBD 2019 study, we quantify the inequality gap between EU countries, characterize the geographical gradient of total and individual NCDs, and analyze the trends over the last 20 years.

Results
A considerable gap exists in the rates of NCD-related DALYs between the country with the lowest burden (Slovenia in 2019) and the highest (Bulgaria in 2019), with a constant (p-trend &gt; 0.05) ratio of 1.6 (95%CI, 1.57; 1.64) since the year 2000. The largest inequality was observed for the burden of stroke between the lowest (France in 2019) and the highest (Bulgaria in 2019) with a ratio of 7.47 (6.78; 8.24) Increasing steadily (p-trend &lt; 0.001) since 2000. Using the relative index of inequality to characterize the gradient of inequalities across the EU, a decreasing trend (p &lt; 0.001) can be observed for NCD-related DALYs rates from 1.56 (1.44; 1.7) in 2000 to in 1.42 (1.33; 1.52) 2019.

Conclusions
Despite overall improvements in health, spatial disparities related to NCDs in the EU persist. Our estimates provide a baseline to inform future equitable health policies.