bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ferric derisomaltose versus usual care in patients with heart failure, reduced ejection fraction, and iron deficiency: a short-term UK cost-utility analysis based on the IRONMAN RCT
Authors: Pollock R , Kalra P R , Mcmurray J J V , Graham F J , Pellicori P , Cleland J G F , Ford I 
Published: October 2024

Abstract

Background
In the IRONMAN trial, patients with heart failure (HF), a reduced ejection fraction and iron deficiency who were randomly assigned to ferric derisomaltose (FDI), rather than usual care, had a lower rate of the composite of hospitalization for heart failure (HHF) and cardiovascular (CV) death (rate ratio, RR, 0.82; 95% CI 0.66 to 1.02; p=0.07). A COVID-19 sensitivity analysis, censoring data at 1 year of follow-up showed a greater magnitude of treatment effect (RR 0.66; 95% CI 0.48 to 0.91; p=0.011).

Purpose
Patient-level data from IRONMAN were used to evaluate the effectiveness and cost-utility of FDI compared to usual care for patients with a current or recent HHF, or raised plasma natriuretic peptide concentrations, from a UK National Health Service (NHS) perspective.

Methods
A cost-utility analysis (CUA) was conducted covering the first year after randomization. Numbers-needed-to-treat (NNTs) were calculated for the primary endpoint censored at 1 year. In the CUA model, patient survival and rates of (re)hospitalization due to HF, other CV events, infections, respiratory conditions, and other non-CV events were modeled based directly on data from the IRONMAN RCT. UK-specific costs were obtained from the national schedule of NHS costs. Quality of life was estimated based on EQ-5D-5L data collected from patients included in the IRONMAN RCT. Results were undiscounted and reported as absolute and incremental costs in 2023 pounds sterling, and quality-adjusted life expectancy in quality-adjusted life years (QALYs). A willingness-to-pay threshold of £20,000 per QALY was adopted to allow calculation of a net monetary benefit (NMB), a summary measure of the overall value of FDI in monetary terms, capturing changes in both cost and QALY outcomes.

Results
The NNT analysis showed that 9 patients would need to be treated with FDI to avoid one composite primary endpoint event (CV death and HHF) over 1 year. Relative to usual care, FDI was associated with an improvement of 0.01 QALYs per patient over 1 year (0.58 versus 0.57 QALYs). Total average costs per-patient were £1,672 for FDI, versus £1,975 for usual care, leading to a saving of £302 per patient with FDI. The cost of iron procurement was more than offset by reductions in costs of (re)hospitalizations (Figure). FDI was therefore dominant over usual care, yielding an NMB of £483 over 1 year.

Conclusions
This short-term, within-trial CUA suggests that FDI both improves QALYs and reduces healthcare expenditure versus usual care when administered to patients with HF and iron deficiency in the UK. Iron repletion with FDI may be a prudent allocation of healthcare resources in this patient population.Breakdown of costs
O2 consumption overshoot in patients with heart failure: crossing the line
Authors: Carvalho R , Gomes D , Pohle C , Lima M R , Amador R , Bello A R , Santos R , Paiva M S , Rocha B , Brizido C , Moreno L , Durazzo A , Mendes M , Adragao P , Cunha G 
Published: October 2024

Abstract

Background
Cardiopulmonary exercise testing (CPET) is among the most valuable clinical tools for evaluating disease severity and physical activity limitations in heart failure (HF) patients. Peak oxygen uptake (pVO2) reflects maximal cardiac output during exercise, and it is considered a major parameter in selecting candidates for cardiac transplantation. VO2 overshoot, a transient increase in VO2 during recovery from maximal exercise, has been frequently observed in HF patients and is attributed to the transient increase in cardiac output caused by the mismatch between cardiac contractility and afterload reduction. However, the prognostic significance of this phenomenon remains to be fully established.

Purpose
This study aimed to characterize the prognostic significance of VO2 overshoot following peak exercise in individuals with HF.

Methods
This retrospective single-center study included consecutive adult patients with chronic (&gt;3 months) and stable HF, with left ventricular ejection fraction (LVEF) &lt;50%, who underwent CPET between 2015 and 2020. Following maximal exercise, patients recovered over a 3-minute period (walking 2km/h for 1 minute and sitting passively for 2 minutes). VO2 overshoot kinetics during recovery were measured and described as the time until post-exercise VO2 fell below pVO2 for at least 15 seconds. Please refer to Figure 1A for an example of normal and prolonged VO2 overshoot. The study endpoint was time to cardiovascular (CV) death, urgent cardiac transplant, or left ventricular assist device (LVAD) over 1-year follow-up.

Results
A total of 254 patients were included (mean age 59 ± 12 years; 83% males; mean LVEF 34 ± 9%; 70% with ischemic HF; 77% in NYHA class II-III; mean pVO2 18 ± 6 mL/kg/min; mean predicted pVO2% 52 ± 16%; mean VE/VCO2 slope 41 ± 13). The VO2 overshoot had a normal distribution (Figure 1B) and lasted on average for 45 ± 33 seconds. There were no differences between patients that had an overshoot higher and below average. Overall, during follow-up, 25 patients met the composite endpoint (12 CV deaths, 9 urgent heart transplants, and 4 LVAD). Univariate analysis showed a significant relationship between VO2 overshoot and the outcome of interest (HR 1.01, 95% CI 1.00 – 1.02, p=0.027). In multivariate analysis, this association remained significant, even after adjusting for pVO2 and VE/VCO2 slope (HR 1.01, CI 95% 1.00– 1.02, p=0.026).

Conclusion
This study delves into the intriguing phenomenon of VO2 overshoot in patients with heart failure, shedding light on its potential prognostic significance. The independent association between VO2 overshoot and the composite endpoint suggests that this transient increase in oxygen consumption may carry prognostic value. Further studies should confirm these findings.
Exercise stress testing recovery kinetics: the forgotten phase
Authors: Carvalho R , Amador R , Domingues M S , Pereira J C , Bello A R , Gomes D , Santos R , Paiva M S , Rocha B , Brizido C , Moreno L , Durazzo A , Mendes M , Adragao P , Cunha G 
Published: October 2024

Abstract

Background
Impaired exercise capacity is a cardinal feature of heart failure (HF). Peak oxygen uptake (pVO2) and ventilatory efficiency (VE/VCO2 slope) during exercise are well-consolidated prognostic markers in patients with HF. A previous study suggested that abnormally prolonged VO2 recovery, specifically the failure to decrease VO2 from peak exercise by 10.5 mL/kg/min at 180 seconds of the recovery phase, predicts adverse outcomes in HF. However, it is unknown to what extent the recovery of VEqCO2, a marker of ventilation/perfusion mismatch, adds prognostic value to the already existing parameters.

Purpose
The aim of this study was to characterize the functional and prognostic significance of VEqCO2 kinetics following peak exercise in individuals with HF.

Methods
This retrospective single-center study included consecutive adult patients with chronic (&gt;3 months) and stable HF with left ventricular ejection fraction (LVEF) &lt;50% who underwent cardiopulmonary exercise testing (CPET) between 2015 and 2020. Following maximal exercise, patients recovered over a 3-minute period (walking 2km/h for 1 minute and sittng passively for 2 minutes). VO2 and VEqCO2 kinetics during recovery, described as the absolute difference to peak VO2 (difVO2) and VEqCO2 (difVEqCO2), were measured at 30, 60, 120, and 180 seconds. Outcomes were assessed as a composite of cardiovascular (CV) death, urgent cardiac transplant, or left ventricular assist device (LVAD) implantation at 1 year.

Results
A total of 238 patients were included (mean age 58 ± 12 years; 82% males; mean LVEF 34 ± 10%; 68% with ischemic HF; 75% in NYHA class II-III; mean pVO2 18 ± 6 mL/kg/min; mean VE/VCO2 slope 41 ± 12). During the 1-year follow-up, 19 patients met the endpoint (8 CV deaths, 8 urgent heart transplants, and 3 LVAD). ROC curve analysis showed that the best correlation between difVEqCO2 and outcomes was apparent at difVEqCO2 of 180 seconds (AUC 0.83) with a cut-off value of 1 (sensitivity 93%, specificity 58%). These patients, who had a decrease in VEqCO2 (difVEqCO2 &gt;1) at 180 seconds, were significantly older (p=0.02), had a lower LVEF (p&lt;0.001), and higher NYHA (p&lt;0.001). They were at an increased risk of cardiovascular events compared to those with an increase in VEqCO2 (difVEqCO2 &lt;1) at 180 seconds (event-free survival at 1 year 86% vs. 98%, log-rank p&lt;0.001). In multivariate analysis, the statistical association between difVEqCO2 and outcomes remained significant, even after adjusting for difVO2 at 180 seconds (HR 4.315, CI95% (1.349-13.804), p=0.014).

Conclusion
Abnormal VEqCO2 kinetics in the recovery period of CPET is an easily recognizable non-invasively derived measurement that predicts outcomes in HF. VEqCO2 may complement the evaluation of VO2 and other parameters during recovery to further improve prognostic risk stratification in HF.
Artificial intelligence assessment of heart failure and mortality after acute stroke
Authors: Oh M Y , Lee M S , Kang S R , Kwon J M 
Published: October 2024

Abstract

Background/Introduction
The adverse cardiovascular outcomes following a stroke have shown significant associations with post-stroke mortality. However, studies focusing on predicting heart failure and its impact on long-term mortality are scarce.

Purpose
To address this gap, we employed an commercially approved artificial intelligence/machine learning enabled software as a medical device (AiTiALVSD version 1.00.00) which uses only 12 lead electrocardiogram data, resulting probability score for predicting left ventricular systolic dysfunction. We derived the AiTiALVSD probability score from initial ECGs at stroke admission, and assess its implications for prediction of heart failure and long-term mortality.

Methods
We collected data from 335 ischemic stroke patients admitted to a cardiovascular center during acute periods between 2013 and 2019. The AiTiALVSD score was employed to predict heart failure with reduced ejection fraction and heart failure with mild reduced ejection fraction, analyzed through logistic regression. Subsequently, we used the Cox Hazard proportional model, incorporating the AiTiALVSD score and clinical factors, to predict long-term mortality.

Results
The model incorporating the AiTiALVSD score with clinical variables demonstrated a higher AUC for predicting heart failure (0.905 [95% CI, 0.827-0.927] vs. 0.828 [95% CI, 0.749-0.907], p&lt;0.004) than clinical variables alone. Moreover, for long-term mortality prediction, this model outperformed the conventional mortality score (AUC, 0.884 [95% CI, 0.836-0.933] vs. 0.755 [95% CI, 0.690-0.820], p&lt;0.001).

Conclusion
Multivariable models which combine the AiTiALVSD score with clinical factors, effectively predicts heart failure and long-term mortality. This model could enhance therapeutic strategy tailoring by providing acute phase prognostic predictions for individual stroke patients.Prediction performance for heart failurePrediction performance for mortality
Healthcare utilization following acute myocardial infarction findings from RECORD MI registry
Authors: Talha K , Hammonds K , Afzal A , Alhamdow A , Bennett M , Bomar J , Ettlinger J , Gottlieb R L , Martinez Traba M , Priest E , Schmedt N , Shaver C , Widmer R , Zeballos C , Butler J 
Published: October 2024

Abstract

Background
As therapeutic options and epidemiology have evolved rapidly, the contemporary healthcare utilization following acute myocardial infarction (MI) is not well known.

Methods
All patients admitted with MI between 01/2015 and 12/2021 in the Baylor Scott & White health system were studied. Patient characteristics and outcomes including hospital readmissions, cardiovascular (CV)-related hospital readmissions, emergency department (ED) encounters, and outpatient visits were studied.

Results
Of 6804 patients, 6556 were discharged alive. Median age was 69 years, 60% were male, and 77% had non-ST elevation MI (NSTEMI); 1172 (22%) had an LVEF &lt;40%, 493 (7.5%) were revascularized within 3 months of discharge, and 1090 (17%) had multivessel disease. The number of unique patients with first hospital readmission within 30-days, 3-months, and 12-months were 844 (13%), 1372 (21%) and 2306 (35%), respectively, with a higher risk in patients with NSTEMI, prior heart failure (HF), new HF, and LVEF &lt;40%. ED visits at 12 months for any cause were 2401 (37%) and for CV cause were 1321 (20%), with a higher risk in patients with prior HF. Patients with at least 1 primary care visit within 12 months of discharge were captured for 4102 (63%), CV specialty visits for 5009 (76%), and non-CV visits for 3860 patients (59%), with similar distribution across subgroups (Table).

Conclusions
Post-MI patients had a high risk of readmissions, and ED and outpatient visits, especially amongst those with a prior or new HF diagnosis.
Is the incidence of cerebral embolic events underestimated in Takotsubo cardiomyopathy?
Authors: Lepage S , Ilinca M , Vignola A , Trudel-Deschenes C , Daneault-Peloquin I , Malick M 
Published: October 2024

Abstract

Introduction
Although initially considered a benign cause of transient left ventricular dysfunction, Takotsubo cardiomyopathy (TCM or stress cardiomyopathy) has become an increasingly recognized cause of cerebral embolic events. Prior case series have suggested a 0.9% to 3% risk of ischemic stroke following the diagnosis of TCM. With the growing number of cases of stress cardiomyopathy reported since the COVID pandemic, we want to evaluate if the risk of stroke in the literature has been underestimated.

Purpose
In our study, we want to evaluate the risk of ischemic stroke one year following the diagnosis of Takotsubo cardiomyopathy in our university health centre. We also want to evaluate the time interval between the incidence of stroke and the initial diagnosis of TCM.

Methods
In this retrospective single-centre observational study, we collected data from 267 consecutive patients hospitalized for a diagnosis of Takotsubo cardiomyopathy (confirmed by echocardiography and cardiac catheterization) between May 2008 and December 2017 at our medical centre in Sherbrooke. All patients were followed for a minimum of one year. We excluded 14 patients with a prior history of stroke or a diagnosis of atrial fibrillation in the year following the diagnosis of TCM. We used a descriptive statistical analysis to evaluate the rate and time to event up to 1 year after the diagnosis.

Results
253 patients were included in the study. The cohort was composed of 220 females (88% of the population), and the mean age was 69 years (SD: 11.8 years). Among this population, we identified 15 patients presenting with a stroke within a year after the diagnosis of stress cardiomyopathy, with a crude incidence of 5.9%. The median time interval between the incidence of stroke and the initial diagnosis of TCM was 17 days (2 to 298 days; an inter-quartile range of 3 to 105 days). The proportion of patients that reached the primary endpoint in the first 30 days was 67%.

Conclusion
According to our study, the risk of stroke in the year following the diagnosis of TCM is significantly higher than what is currently described in the literature. The fact that 10 of the 15 events occurred in the first 30 days may suggest a therappy design to lower the risk during that critical period could be explored. However, further studies are needed to address this issue.
Independent risk factors of ejection fraction deterioration post discharge in hospitalized heart failure patients with mildly reduced ejection fraction
Authors: Wu M X , Peng X , Zhu Y L , Liu Z C , Huang H B , Zhang L L , Liao M , Zhao W J , He W F , Tan D , Zeng J P 
Published: October 2024

Abstract

Background
The identification of independent risk factors for left ventricular ejection fraction (LVEF) deterioration is of clinical importance in patients diagnosed heart failure with mildly reduced ejection fraction (HFmrEF). This study aimed to determine the independent risk factors of LVEF deterioration post discharge among hospitalized HFmrEF patients.

Methods
This retrospective study analyzed data from 807 HFmrEF patients admitted to our hospital between January 2015 and August 2020. LVEF values were assessed by echocardiography between 6 months and 1 year after discharge. Patients were followed up to a mean of 33 months. The primary endpoint was disease progression expressed as heart failure with reduced ejection fraction (HFrEF) between 6 months and 1 year post discharge. The secondary endpoint was all-cause death. Multivariate logistic regression analysis was conducted to identify independent risk factors associated with LVEF deterioration.

Results
There were 225 patients progressed to HFrEF between 6 months and 1 year post discharge. All-cause death was significantly higher in HFrEF patients (43%) compared to patients with stable LVEF (unchanged or improved, 24%, P&lt;0.001). Multivariate logistic regression analysis showed that the independent risk factors associated with worsening LVEF in patients with HFmrEF were: female (OR=1.71, 95% CI 1.14 to 2.57, P=0.009), higher NT-proBNP (≥2312 pg/ml, OR=1.71, 95% CI 1.14 to 2.57, P=0.010), higher uric acid (≥318 µmol/L, OR=11.63, 95% CI 7.89 to 17.15, P&lt;0.001), and larger end-diastolic left ventricular dimension (OR=1.05, 95% CI 1.02 to 1.08, P&lt;0.001).

Conclusion
Results of this study might help risk stratification to identify hospitalized HFmrEF patients with increased risk of progression to HFrEF post discharge. Patients with above clinical features should undergo more intensively monitoring and enhance care adherence to HF guideline medications. Future studies are needed to validate if tailored guideline adherence management strategies for post-discharged HFmrEF patients based on personalized risk stratification could mitigate LVEF progression and improve survival of these patients.
The impact of ethnicity on clinical outcomes in patients with heart failure and atrial fibrillation
Authors: Fox S , Champsi A , Hardy E , Bunting K , Kotecha D 
Published: October 2024

Abstract

Introduction
Heart failure (HF) and atrial fibrillation (AF) are increasingly prevalent and associated with substantial morbidity (1,2). When HF and AF co-exist, the outcome profile is significantly worse than for either condition in isolation (3). Ethnic background is known to influence disease outcomes and treatment efficacy (4), but there is limited knowledge about how HF, AF and ethnicity interact on mortality and hospital admission.

Purpose
This study aims to address the null hypothesis of no difference in death and cardiovascular events comparing non-white and white patients with HF and concomitant AF, and assess the differential impact of ethnicity in patients with these conditions.

Methods
Individual patient data were obtained from 12 randomized controlled trials (RCTs) in patients with HF. RCT data were harmonised and meta-analysed to investigate the interaction of baseline heart rhythm (sinus rhythm versus atrial fibrillation) and ethnicity (non-white versus white). The primary outcome of all-cause mortality and secondary outcome of cardiovascular (CV)-related mortality were analysed using adjusted Cox regression models and propensity-score matching.

Results
16,713 HF patients were included of which 1,899 (11%) were non-white, median age 66 (interquartile range [IQR] 57-73) and 4,703 (28%) women. During median follow-up of 1.4 years (IQR 0.8-2.3), death occurred in 394 (21%) non-white patients and 2,142 (15%) white patients; adjusted hazard ratio (HR) 1.36, 95% CI 1.20-1.54; p&lt;0.001. The impact of ethnicity was greater in patients with coexisting HF and AF (non-white versus white HR 2.05; 95% CI 1.55-2.70; p&lt;0.001), than in those with HF in sinus rhythm (non-white versus white HR 1.24; 95% CI 1.08-1.41; p=0.002). A significant interaction was evident between ethnicity and rhythm status for all-cause mortality (p=0.003), with similar findings using propensity-score matching (Figure 1). An exploratory analysis of beta-blockers versus placebo demonstrated divergent efficacy with respect to mortality for non-white (HR 1.00, 95% CI 0.79-1.27; p=0.99) and white patients (HR 0.70, 95% CI 0.63-0.78; p&lt;0.001); p-interaction=0.008 (Figure 2). For cardiovascular hospitalisation, the non-white cohort also had higher rates, with greatest disparity in patients with combined HF and AF (non-white versus white HR 1.80, 95% CI 1.63-2.37; p&lt;0.001) compared to HF in sinus rhythm (non-white versus white HR 1.23, 95% CI 1.11-1.36; p&lt;0.001); p-interaction=0.012 in propensity-matching.

Conclusion
Non-white patients with HF suffer from substantially higher rates of death and hospitalisation than corresponding white patients, with the presence of comorbid AF significantly worsening this ethnicity-related disparity. In those with HF in sinus rhythm, beta blockers were found to be significantly less effective at reducing mortality in non-white patients.Figure 1 Figure 2
Sex-specific association of NT-proBNP with clinically inapparent structural heart disease in the general population: results from the STAAB study
Authors: Morbach C , Gelbrich G , Schmidbauer L , Sahiti F , Chen M , Cejka V , Frantz S , Heuschmann P U , Stoerk S 
Published: October 2024

Abstract

Background
Guidelines recommend echocardiography in subjects beyond defined levels of natriuretic peptides. The ACC/AHA guidelines on heart failure (HF) state echocardiographic signs of structural heart disease (SHD) that define the precursor stage B of heart failure.

Purpose
To study the age- and sex-specific association between echocardiographically assessed structural heart disease (echoSHD) and NT-proBNP levels in the general population.

Methods
The STAAB study investigates precursor stages of HF in the general population of a medium-sized city in Germany (source population 124,297 inhabitants as of 2011 census). Study participants were recruited between 12/2013 and 10/2017 from the source population without preceding HF diagnosis, stratified for sex and age (30-79 years). For this analysis, we excluded participants with previously diagnosed coronary artery disease. EchoSHD was accepted if one of the following criteria, diagnosed according to current echo guidelines, was detectable at echocardiography: left ventricular (LV) hypertrophy, LV dilation, reduced LV ejection fraction, moderate-to-severe LV valve disease, and LV diastolic dysfunction.

Results
Of 4,649 subjects analysed (93.6% of STAAB participants, age 30-79 years, 53.5% women), 863 (18.6%) had echoSHD. NT-proBNP depended strongly on age and sex (figure). Frequencies of echoSHD varied between women (23.0%) and men (13.5%; P&lt;0.001). EchoSHD was associated with increased NT-proBNP levels in both women (geometric mean ratio 1.18, 95%CI 1.09–1.27, P&lt;0.001; figure) and men (ratio 1.62, 1.46–1.79, P&lt;0.001); P&lt;0.001 for different ratios in both sexes. Of note, age did not influence these ratios as well as their difference (P=0.34 and P=0.95, resp.).

Conclusion
Clinically inapparent echoSHD was associated with higher levels of NT-proBNP, of a magnitude that was relevant in men. The sex difference in the strength of this relationship might be due to different pathophysiological processes leading to SHD and ultimately HF in women and men. It might also indicate the need for adopted definitions of echoSHD in women. Our results further point towards the need of age- and sex-specific NT-proBNP thresholds.NTproBNP according to sex, age, and SHD