bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cangrelor versus no cangrelor during percutaneous coronary intervention in hemodynamically unstable patients: a cohort study on benefits and risks
Authors: Emilsson O L , Mohammad M , Grimfjard P , Persson J , Santos-Pardo I , Erlinge D , Koul S 
Published: October 2024

Abstract

Background
Cangrelor is an intravenous P2Y12 inhibitor which, according to the European guidelines, may be considered for administration in acute coronary syndrome during percutaneous coronary intervention (PCI). Little is known regarding benefits and risks of such administration in hemodynamically unstable patients.

Purpose
To investigate the effects of cangrelor versus no cangrelor during PCI regarding major adverse cardiac events (MACE), in-hospital bleeding, and all-cause mortality in patients with cardiogenic shock and/or cardiac arrest.

Methods
The study population was extracted from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and included patients with cardiogenic shock or cardiac arrest undergoing PCI during the years 2016-2022. Propensity score matching (PSM) was used to create comparable groups. After matching, all variables used for calculating propensity score were balanced (standardized mean difference&lt;0.1). Outcomes were MACE within 30 days, in-hospital bleeding, and all-cause mortality within 30 days. Risk ratios (RR) with 95% confidence intervals (CI) were calculated. When RR deviated from the null, the risk difference (RD) was determined.

Results
In all, 2,100 (66%) out of 3,206 patients with cardiogenic shock and/or cardiac arrest were included in the PSM analyses (median age: 69 years; 76% male; 78% ST-elevation myocardial infarction (STEMI)). Comparing cangrelor versus no cangrelor in this matched set of patients, the RR was 0.93 (95% CI: 0.84; 1.04) for MACE; 1.51 (1.02; 2.25) for in-hospital bleeding, with an RD of 1.9 percentage points (0.10; 3.7); and 0.93 (0.82; 1.04) for all-cause mortality (Table). In the PSM analysis regarding patients with cardiogenic shock, 1,098 (60%) out of 1,815 patients were included (median age: 71 years; 68% male; 82% STEMI). For these patients, RR was 0.85 (95% CI: 0.74; 0.97) for MACE, with an RD of -7.5 percentage points (-1.6; -13); 1.31 (0.82; 2.09) for in-hospital bleeding; and 0.83 (0.72; 0.95) for all-cause mortality, with an RD of -8.0 percentage points (-2.2; -14). In the PSM analysis regarding patients with cardiac arrest, 1,388 (76%) out of 1,827 patients were included (median age: 67 years; 81% male; 75% STEMI). RR was 0.98 (95% CI: 0.86; 1.12) for MACE; 1.53 (0.95; 2.49) for in-hospital bleeding; and 0.98 (0.86; 1.13) for all-cause mortality.

Conclusion
For patients with cardiogenic shock, but not for patients with cardiac arrest, administration of cangrelor versus no cangrelor during PCI was associated with a reduction in both MACE and all-cause mortality, with numbers needed to treat of 14 and 13, respectively. Overall, for patients with cardiogenic shock or cardiac arrest, administration of cangrelor versus no cangrelor during PCI was associated with an increased risk of in-hospital bleeding with a number needed to harm of 53.
Impact of different P2Y12 inhibitors in acute coronary syndrome patients with severe chronic kidney disease: insights from the CORALYS registry
Authors: Giacobbe F , Giannino G , Siliano S , Morena A , De Filippo O , Ghisletti A , Dusi V , Sagazio E , Bruno F , Marchini F , Wanha W , D'ascenzo F , De Ferrari G M 
Published: October 2024

Abstract

Background
The impact of the most potent P2Y12i ticagrelor and prasugrel after acute coronary syndrome in patients with chronic kidney disease (CKD) remains unclear. Most evidence on dual antiplatelet therapy (DAPT) comes from real-world study but is limited to glomerular filtration rate (GFR) under 60 ml/min whereas no data are available regarding patients with severe CKD (stages IV-V)

Methods
Consecutive patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) and severe CKD defined as GFR under 30 ml/min not on dialysis from the CORALYS (Incidence and Predictors of Heart Failure After Acute Coronary Syndrome) registry were included. Incidence of Net Adverse Clinical Events (NACE) defined as major adverse cardiac events (MACE, a composite of cardiovascular death, myocardial infarction and unplanned revascularizations) in addition to major bleedings (classified as BARC scale 3 to 5) was our primary endpoint. Overall MACE and their single components, all bleedings, major bleedings and hospitalizations for heart failure were the secondary ones.

Results
Of 14699 patients in the CORALYS registry, 257 presented with severe CKD not on dialysis and had available data on antiplatelet regimen at discharge. Patients were divided into two groups according to the type of P2Y12i prescribed at discharge: 193 (75.1%) were given clopidogrel while 64 (24.9%) with ticagrelor or prasugrel. Our populaiton was predominantly male (153, 59.5%) with an average age 75.8 ± 10.9 years old. Average GFR was 21.8 ± 6.3 ml/min.
Over a median follow-up of 459 days, Ticagrelor and Prasugrel were associated to lower rates of NACE compared to Clopidogrel (39.9% vs 25.0%, p=0.036). This was mainly driven by an excess of both CV mortality (31.1% vs 6.3%) and myocardial infarction (20.7% vs 9.4%) reported in the clopidogrel group. No difference was reported regarding overall bleeding events (5.7% vs 4.6% with clopidogrel and new P2Y12i respectively, p=0.81) and major bleedings (1.7% vs 4.6% with clopidogrel and new P2Y12i respectively, p=0.15). At multivariate Cox regression analysis DAPT with Ticagrelor/Prasugrel resulted independently associated with a lower risk of NACE (Adj Hr 0.41, 95%CI 0.23-0.74, p=0.003) whereas left main involvement or multivessel coronary disease led to higher risk of NACE (Adj HR 1.96 95%CI 1.21-3.18, p=0.006)

Conclusions
In ACS patients treated with PCI with severe CKD ticagrelor and prasugrel were associated to lower risk of NACE, MACE, CV death and myocardial infarction compared to clopidogrel. No significative difference was reported in overall and major bleedings despite a relative increase of major bleedings in the group treated with Ticagrelor or Prasugrel.
Evolving atrial fibrillation (AF) care in New Zealand (NZ): a nurse specialist-led clinic aiming to improve standardisation, equity, cost-effectiveness, and lifestyle modification in AF management
Authors: Hosking A , Jameson M , Stiles M , Ryan H , Sugden L , Joyson P , Tan C 
Published: October 2024

Abstract

Background
Management of atrial fibrillation (AF) in NZ is challenging and variable between regions. NZ has a diverse population with Māori and Pacific ethnic groups, in particular, facing significant difficulties with access to care and inequity in treatment. The integration of nurse specialists into the care of patients with AF is increasingly recognised and discussed in AF management, including the European Society of Cardiology (ESC) guidelines. This approach also allows emphasis on managing lifestyle factors, pivotal contributing factors in disease burden

Objective
This study assesses the efficacy of a nurse specialist-led AF clinic in a large regional centre in New Zealand. We look specifically at the standardisation of care, lifestyle management, the impact on health equity in managing AF, and the cost-effectiveness of these strategies.

Methods
A retrospective analysis of the first year of the clinic’s establishment was conducted reviewing the outcomes, attendance, and adherence to management guidelines. The clinic is running three days per week to follow up those presenting to the Emergency Department with a primary diagnosis of AF. After discharge, appointments are available within 48-72 hours of presentation. The clinics efficacy and ability to serve wider NZ populations will also be presented alongside a recently-published, similar initiative in Christchurch, NZ.

Results
Over the first year, 247 appointments were made (Median age 66, interquartile range 58-76, 48% male, 75% NZ European). 168 patients were established on a rhythm control strategy, with 20 directly referred for ablation, 26 receiving cardioversions, and the remainder established on anti-arrhythmic medication strategies. Lifestyle modifications were addressed with majority of these patients. Demographic data also highlighted once more, a need to focus on equity with only 17.4% of appointments attended by Māori and Pacific patients, lower than would be expected given population data and relative disease burden.

Conclusions
The Nurse Specialist-led AF clinic shows promising outcomes and is a positive step forward in AF management in this region of NZ. Incorporating ESC guidelines with emphasis on lifestyle factors and including rhythm control strategies to good effect. This clinic brings international standards to a local stage and throws a focus on our unique healthcare needs and an emphasis on equitable delivery of care. This clinic is scalable, effective, and an inclusive approach to AF care.
Sources of stress and outcomes in carepartners of persons with chronic heart failure
Authors: Dunbar S , Butts B , Ferranti E , Higgins M 
Published: October 2024

Abstract

Background
Serving as a carepartner (CP) for someone with chronic heart failure (HF) can be challenging and difficult and may yield adverse psychological outcomes. Sources of HF CP burden and strain may come from physical, informational, and tangential demands. Yet additional life events and sources of stress may be present and compound experiences of HF CPs. Greater understanding of the factors associated with stress sources is needed to direct CP assessment and interventions.

Purposes
To explore the contributions of CP perceptions of HF care burden and strain, other sources of stress from occupational type and working status, and financial concerns to CP psychological outcomes and to examine the influence of social support in mitigating these outcomes.

Methods
CPs of persons with chronic HF, defined as providing care for the person with HF at least 4 hours a week, were enrolled. Baseline variables and measures were demographics (age, marital status, education), sources of stress (CP perceived strain and burden [Oberst, STRAIN], caring for others, occupation type, working status, and financial concerns. Psychological outcomes were overall perceived stress (PSS) and depression (CES-D) with social support measured by the Enriched Social Support Inventory (ESSI). Relationships among stress sources and outcomes were assessed using best model subsets regression analysis (Akaike information criterion) comparing the models with and without adjusting for social support. For each model, age, caring for others, CG strain (mental and physical), CG burden (time and difficulty), financial worry, occupation type and status were considered for the model.

Results
CPs of persons with HF (n=127; 92% women; 58% Black; primarily spouses and adult children) were included. For stress, the best model included age, caring for others, mental strain, occupation and CP burden of difficulty and time (adjusted r2=0.381). After adjusting for social support, occupation type was not significant, and adjusted r2 increased to 0.462. For depression, caring for others and CP burden (difficulty) were included in the best model subset (adjusted r2=0.208). After adjusting for social support, caring for others was not significant, and the adjusted r2 increased to 0.286.

Conclusion
Sources of stress from higher perceived CP burden of the person with HF, occupation type, and having other caregiving roles contributed to overall stress with social support mitigating the effects of occupation type and caring for others. These findings support further study of comprehensive assessments of sources of stress and their contributions to adverse psychological outcomes for CPs within the context of social support to tailor CP interventions to the CP’s specific needs. The consistent role of social support in attenuating psychological stress warrants study of ways to clinically incorporate social support into interventions to improve outcomes for CPs.
Using the VES-13 score for risk stratification in outpatient heart failure management to predict mortality
Authors: Roig T , Lupon J , Domingo M , Santiago-Vacas E , Codina P , Borrellas A , Gonzalez B , Pulido A , Crespo E , Velayos P , Lopez Y , Diaz V , Diez-Quevedo C , Miralles R , Bayes-Genis A 
Published: October 2024

Abstract

Background
We have previously demonstrated the efficacy of the Vulnerable Elders Survey-13 (VES-13) as a valuable tool for identifying frailty and predicting outcomes, such as mortality and hospitalisations, in heart failure (HF) outpatients when frailty is detected using a cut-off value of ≥3.

Purpose
This study aims to assess whether scores obtained from the VES-13, beyond its initial use with a frailty diagnosis threshold, enable a more precise categorization of mortality risk among heart failure outpatients.

Methods
Nurses administered the VES-13 during patients' initial consultations. We examined a sample of 331 patients, analyzing their main characteristics and individual VES-13 scores. VES-13 scores were categorized into quintiles for risk assessment.

Results
A total of 331 outpatients were prospectively included in the study. Patient characteristics were as follows: mean age of 69.85±11.96 years, 68% males, 67.6% in NYHA class II, and 25.7% in class III; ischemic aetiology was the most common (42%), and the mean left ventricular ejection fraction (LVEF) was 38.79±13.58. The VES-13 mean’s score was 2.67±2.81. Quintile 1 corresponded to a VES-13 score of 0, quintile 2 to score of 1, quintile 3 to score of 2, quintile 4 to scores of 3 or 4, and quintile 5 to a VES-13 score of 5 points or higher. During a follow-up period of 17.6±6.6 months (up to 24 months), 41 patients died (12.4%). After adjusting for sex, LVEF and ischemic aetiology stratifying VES-13 scores into quintiles allowed us to observe an accurate stratification of the risk of death with a statistically significant relationship between higher VES-13 quintiles and higher mortality (p=0.001) (Figure 1). Indeed, quintiles 4 and 5 were showed a very high hazard of risk of death compared to quintile 1 group (HR 6.97 [1.53, 31.65], p=0.012 for quintile 4; and HR 12.17 [2.77, 53.54], p=0.001 for quintile 5).

Conclusions
The VES-13, a standard screening tool in our heart failure clinic for identifying frailty, demonstrated the ability, when divided in quintile groups, of accurately stratify the risk of death over a follow-up period of up to two years.
The trajectory of self-care over a 12-month period in patients with heart failure, comparing those with consistently good and poor self-care
Authors: Klompstra L , Stromberg A , Jaarsma T 
Published: October 2024

Abstract

Background
Self-care behaviour plays a pivotal role in enhancing the quality of life for patients with heart failure (HF) and reducing mortality and morbidity rates, but many patients struggle with suboptimal self-care behaviours. It is crucial to understand the factors influencing long-term self-care management.

Purpose
To assess the trajectory of self-care over a 12-month period and assess differences between patients who have constantly good self-care over a 12-month period compared to constantly poor self-care.

Method
This study use data from a randomised controlled intervention study, called the HF-Wii study. We included patients who had complete data on self-care during on baseline, 3, 6 and 12 months. Self-care was measured with the European Heart Failure Self-care Behaviour scale (EHFSBs). A threshold score of equal or higher than 70 was used to define self-care behaviour as good and a score lower than 70 as poor self-care.
Based on literature, the following characteristics (collected from questionnaires and medical records at baseline) were considered in the analysis: age, sex, marital status, education, history of myocardial infarction, duration of HF, New York Heart Association (NYHA) functional class, LVEF, comorbidity. Other factors assessed were Health-related Quality of Life (HrQoL, Minnesota living with HF questionnaire), depressive symptoms (Hospital Anxiety and Depression scale), cognition (Montreal Cognitive Assessment), sleep (Minimal Insomnia Symptom Scale) and level of HF knowledge (Dutch HF knowledge scale).
Logistic regression was performed with backwards elimination of the factors considered associated with the differences between patients who have constantly good self-care at baseline, 3, 6 and 12 months compared to constantly poor self-care.

Results
In total, 407 patients were included in this study. At baseline, the mean self-care was 65±21, with 41% of the patients (n=245) performing good self-care. In total, 126 patients had a constantly good self-care over 12 month (31%), 120 patients had a constantly bad self-care over 12 months (30%) and 161 (39%) fluctuated in their self-care (Figure).
In the multivariate analysis, patients that had continuously good self-care over 12-months were of older age (68±10 vs. 64±12, odds ratio (OR) 1.061, P-value&lt;0.001), had higher HF knowledge (score 13±2 vs. 12±2, OR 1.439, P-value&lt;0.001) and had higher HrQoL (score 28±20 vs 36±22, OR 0.984, P-value=0.022). compared to patients with consistently poor self-care. The variance was explained by 20%.

Conclusion
Younger patients with HF tend to struggle with consistent self-care over a year, underscoring the necessity for tailored interventions for this group. Conversely, patients with greater HF knowledge and higher HrQoL maintained good self-care habits.
Novel 3D-ECG algorithms for reliable screening of cardiac amyloidosis
Authors: Mahabadi A A , Kobeloch J , Wakili R , Michel L , Dykun I R Y N A , Fach C , Rassaf T 
Published: October 2024

Abstract

Background
Cardiac amyloidosis is associated with high morbidity and mortality. Early detection is crucial to allow for specific therapy and improvement of patient’s prognosis. However, there is no established screening tool for cardiac amyloidosis, leading to a delay in diagnosis in the majority of patients.

Aims
We aimed to develop and validate a screening tool for cardiac amyloidosis based on structured evaluation of 3-dimensional electrocardiograms (ECGs).

Methods
We included patients from a vascular center with confirmed cardiac AL- or ATTR-amyloidosis as well as controls of patients with other cardiovascular diseases but without amyloidosis into two independent cohorts, a derivation and validation cohort. All patients received 3-dimensional ECGs and vector loops were categorized based on pre-defined patterns by two independent cardiologists. Consecutively, an AI algorithm was trained in the derivation cohort (n=66 amyloidosis cases, n=89 controls). This algorithm was then applied to the validation cohort (n=33 amyloidosis cases, n=67 controls). Overall accuracy of the algorithm for detection of amyloidosis was evaluated in both cohorts.

Results
Overall, 99 patients with amyloidosis and 156 controls were included (mean age: 75±24 years, 82% male). In the derivation cohort, the AI algorithm reached a sensitivity of 85%, a specificity of 89%, a positive predictive value of 91%, and a negative predictive value of 87%. Applying the algorithm on the independent validation cohort, a sensitivity of 79%, specificity of 82%, a positive predictive value of 61%, and a negative predictive value of 92% was reached. The overall accuracy of the algorithm for detection of cardiac amyloidosis was 85%.

Conclusion
We here describe a novel screening tool, which allows for reliable detection of cardiac amyloidosis.
Comparison of machine learning and traditional methods for prediction of adverse clinical events after percutaneous coronary intervention
Authors: Zaka A , Gorcilov J , Mutahar D , Gupta A , Kovoor J , Stretton B , Mridha N , Sivagangabalan G , Thiagalingam A , Chow C , Zaman S , Kovoor P , Bacchi S 
Published: October 2024

Abstract

Background
Accurate prediction of clinical outcomes following percutaneous coronary intervention (PCI) is essential for mitigating risk and periprocedural planning. Traditional risk models have demonstrated modest predictive value. Machine learning (ML) models offer an alternative risk stratification that may provide improved predictive accuracy. We performed a systematic review and meta-analysis comparing ML models and traditional risk scores for prediction of clinical outcomes after PCI.

Methods
This study was reported according to PRISMA guidelines. PubMed, EMBASE, Web of Science and Cochrane databases were searched until 1st November, 2023 for studies comparing ML models with traditional statistical methods for event prediction after PCI. The primary outcome was comparative discrimination measured by C-statistics with 95% confidence intervals between ML models and traditional methods in estimating the risk of all-cause mortality, major bleeding and the composite outcome major adverse cardiovascular events (MACE).

Results
Thirty-four models were included across 13 observational studies (4105916 patients). The summary C-statistic all ML models across all clinical endpoints was 0.81 (95% CI, 0.78-0.85), compared to traditional methods 0.79 (95% CI, 0.74-0.85). The difference in C-statistic was 0.02 (95% CI, 0.002-0.04, p=0.56). Of included studies, only 1 model was externally validated and 10 models were calibrated.

Conclusion
ML models did not outperform traditional risk scores in the discrimination of all-cause mortality, major bleeding or MACE following PCI. While integration of ML algorithms into electronic healthcare systems may improve periprocedural risk stratification, immediate implementation in the clinical setting remains uncertain. Further research is required to overcome methodological and validation limitations.