bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of peak heart rate on cardiopulmonary exercise testing in patients with chronic heart failure
Authors: Shimono Y , Nakamura K , Nagai T , Ishizaka S , Omote K , Yasui Y , Aoyagi H , Tamaki Y , Mizuguchi Y , Takenaka S , Sato T , Kamiya K , Anzai T 
Published: October 2024

Abstract

Backgrounds
Many factors are known to be related to impaired exercise capacity or worse clinical outcomes in patients with chronic heart failure (CHF). Peak heart rate achievement by cardiopulmonary exercise testing (CPET) can be easily obtained on CPET. However, less data is available regarding the impact of peak heart rate on exercise capacity or long-term clinical outcomes in patients with CHF.

Purpose
We sought to investigate whether lower heart rate during peak exercise displayed poorer exercise capacity and worse clinical outcomes in patients with CHF.

Methods
We examined consecutive 435 patients with CHF referred for CPET in our university hospital between 2013 and 2018. The primary outcome was a composite of all-cause death or hospitalization due to worsening heart failure. Patients were divided into two groups according to the optimal cut-off value of peak heart rate based on receiver operating characteristic curve analysis.

Results
Patients with lower peak heart rate (≤112/min, n=164) were older and, higher brain natriuretic peptide level compared to those with higher peak heart rate (&gt;112/min, n=271). Heart rate during peak exercise was significantly correlated with peak oxygen consumption (peak V̇O2) (Figure 1A), peak workload achievement (Figure 1B), and ventilatory efficiency (V̇E/V̇CO2 slope) (Figure 1C). There were 80 patients with events over a median follow-up period of 3.4 (Interquartile range 0.7–5.6) years. Patients with lower peak heart rate had about 3.0-fold higher risk of events compared to those with high peak heart rate (hazard ratio [HR] 3.17; 95% confidence interval [CI], 2.01–4.98) (Figure 2). In a multivariable Cox regression, 10 bpm-decreased in peak heart rate was associated with 12% increased adverse events (HR 0.88; 95%CI, 0.78–0.98).

Conclusions
Peak heart rate achievement on CPET was associated with reduced exercise capacity and worse clinical outcomes, suggesting that peak heart rate is useful for risk stratification in patients with CHF. Further study is required to identify therapies targeting peak heart rate to improve the exercise capacity or clinical outcomes in patients with CHF.Figure1Figure2
Defining patterns of comorbidity accrual before and after the diagnosis of heart failure
Authors: Macgowan H , Brown O , Walker A , Mcginlay M , Gierula J , Paton M , Straw S , Witte K , Drozd M , Kearney M , Cubbon R 
Published: October 2024

Abstract

Introduction
People with heart failure (HF) usually have multiple comorbidities and these confer adverse prognosis. The chronology of comorbidity development in relation to HF has not been investigated, which hinders development of preventative strategies.

Purpose
We aimed to define the chronology of comorbidity diagnoses in relation to HF diagnosis and hypothesised that HF is preceded by most of its comorbidities.

Methods
We used UK Biobank data to identify 21,127 people with HF diagnosis at any stage before or after recruitment. Comorbidities were defined using primary care records, and were not included if self-reported or their date of diagnosis unknown. Comorbidities were selected based on methods of Conrad et al. (Lancet 2018; 391(10120): 572-580), and defined using CALIBER or UK Biobank criteria. We investigated the time between first diagnosis of HF and first diagnosis of 15 common comorbidities, including after stratification by sex and age at HF diagnosis. Analysis was conducted using RStudio.

Results
For all studied comorbidities, except dementia, at least half of diagnoses predated or developed synchronously with HF. For myocardial infarction, obesity, cancer, atrial fibrillation, hypertension, diabetes and depression, at least three quarters of diagnoses predated or developed synchronously with HF. The median time between comorbidity and HF diagnoses varied substantially between comorbidities, ranging from depression preceding HF by 10.7 years to dementia proceeding HF by 0.7 years. The interquartile range of time between comorbidity and HF diagnoses varied substantially, ranging from 2.4 years for myocardial infarction to 15.2 years for depression, indicating most cases of the former develop in a narrow window (usually prior to HF diagnosis). All comorbidities presented earlier in women, with this being most marked for cancer (median time between cancer and HF -2.6 years for men and -7.1 years for women). As the age of HF diagnosis increased, the time spent with all studied comorbidities also increased. Indeed, in HF diagnosed before the age of 60, a majority of comorbidity diagnoses (except for depression) occurred after HF.

Conclusion
HF most often develops late in the process of comorbidity accrual, although this pattern is reversed in people developing HF at younger ages. Sex differences are also notable, with women developing comorbidities earlier in relation to their HF diagnosis. Understanding the chronology of comorbidity development may help to guide strategies to prevent multimorbidity, which are likely to require a personalised approach. For people with established HF, our data also emphasise the importance of holistic care that accounts for complex multimorbidity.Figure 1
Undetected heart failure in tertiary care: prevalence, predictors and outcomes
Authors: Rumora K , Puelacher C , Pargger M , Wussler D , Schaefer I , Lopez Ayala P , Durandi V , Walter J E , Hure G , Strebel I , Glarner N , Zellweger M J , Gualandro D , Pfister O , Mueller C 
Published: October 2024

Abstract

Background
Undetected heart failure (HF) seems to be unexpectedly common in primary care. We hypothesized that undetected HF may also be common in tertiary care, even in care pathways including cardiologists.

Methods
We assessed prevalence, predictors, and outcome of undetected HF in a large prospective cohort study enrolling patients referred for myocardial perfusion single photon emission tomography (MPI-SPECT) with central adjudication of HF according to guidelines. Findings were validated in two independent prospective cohorts (outpatient cardiac rehabilitation program, major noncardiac surgery). Prevalence of undetected HF, ratio of undetected HF to known HF and number needed to screen (NNS) were the primary endpoints.

Results
Among 3623 patients, median age 68 years, 31% women. 100 patients (3%) had known HF and 928 patients (25.6%) were adjudicated to have undetected HF, resulting in a ratio of undetected to known HF of 9.3-to-1 and a NNS of 2.8. Older age, atrial fibrillation, and previous pacemaker implantation were strong independent predictors of undetected HF. Patients with undetected HF were at significantly higher risk of cardiovascular death or HF hospitalization (adjusted HR 1.47 [95%CI, 1.17-1.85] versus no HF). These findings were confirmed in both validation cohorts: among 970 and 1563 patients the prevalence of undetected HF was 21.5% and 19%, ratio of undetected HF to known HF 0.7-to-1 and 2.8-to-1, NNS 2.2 and 3.7, respectively.

Conclusion
The prevalence of undetected HF is high also in tertiary care, even higher with older age, atrial fibrillation, and previous pacemaker implantation, and associated with increased risk of cardiovascular death or HF hospitalization.Prevalence of undetected HFKaplan-Meier cumulative incidence curves
The association between endogenous erythropoietin levels and the risk of heart failure in a Chinese community-based population
Authors: Xie H , Gong Y J , Fan F F , Jia J , Zhang Y 
Published: October 2024

Abstract

Background
Patients with heart failure (HF) often have elevated endogenous erythropoietin (EPO) levels, which are associated with disease severity and prognosis. Previous studies have indicated that in the special population elevated endogenous EPO levels are associated with HF and cardiovascular death. However, whether endogenous EPO levels are associated with the risk of HF in the general population remains to be elucidated.

Purpose
Our study aims to investigate the association between endogenous EPO levels and the risk of HF admission in the general population.

Methods
We conducted a prospective cohort study on subjects from a Beijing community in China who had no history of stroke or myocardial infarction. Endogenous EPO levels were measured at baseline for all participants. The endpoint of interest was admission with HF. Cox proportional hazard regression models were used to analyze the relationship between endogenous EPO levels and the occurrence of the endpoint.

Results
A total of 4870 participants were included. Among all participants, the mean (±SD) age was 56.72 ± 8.78 years, with 1802 (37.0%) being men. The median (interquartile range, IQR) EPO level was 13.19 (9.47-18.20) IU/L. During a mean 9.57-year follow-up, a total of 176 (3.6%) subjects experienced heart failure. Subjects were grouped in quintiles according to baseline endogenous EPO levels. Higher and lower endogenous EPO levels were both associated with increased risk of HF (Figure 1A). The Kaplan–Meier curves showed significant differences in cumulative hazards of heart failure among EPO quintiles (log-rank test: P＜0.05) (Figure 1B). After adjusting for covariates, including demographics, traditional risk factors for cardiovascular disease, renal function, and hemoglobin levels, and using the middle quintile (Q3) (11.72-14.94IU/L) of EPO levels as a reference, we found that the highest quintile (Q5) (&gt;19.86 IU/L) was associated with a 159% increased risk of HF admission (HR 2.59, 95% CI 1.57-4.28, P = 0.0002). Similarly, the lowest quintile (Q1) (&lt;8.66 IU/L) was associated with a 94% increased risk (HR 1.94, 95% CI 1.11-3.41, P = 0.0210) (Table 1).

Conclusion
There exists a "U-shaped" relationship between endogenous EPO levels and HF admission in the general population. Both higher and lower endogenous EPO levels were associated with an increased risk of HF admission in the community population. These findings differ from previous studies, so further research may be needed to explore the underlying pathophysiological mechanisms of endogenous EPO and HF.
Hyponatremia and risk of new-onset heart failure in patients with type 2 diabetes - a real-world study of 70,000 patients
Authors: Malik M E , Koeber L , Garred C H , Zahir D , Jensen J , Jensen M H , Holt A , Andersson C , Fosboel E , Mohamed A A , Binding C , Mcgettigan P , Schou M 
Published: October 2024

Abstract

Background
Hyponatremia is common in patients with heart failure and in patients with type 2 diabetes (T2D), and is a risk marker for increased morbidity and mortality. However, it is unclear whether hyponatremia in patients with T2D is associated with an increased risk of new-onset heart failure.

Purpose
To investigate whether hyponatremia is associated with an increased risk of new-onset heart failure in patients with T2D.

Methods
From Danish nationwide registers, all patients with T2D with no history of heart failure were identified from 2013-2021. Patients with at least two samples of plasma sodium measured (at least one month apart), during the first six months following their T2D diagnosis, were included with follow-up start six months after T2D diagnosis as well. Patients were categorized in two groups according to the mean plasma sodium concentration at baseline: 1) sodium &gt;137 mmol/L; and 2) sodium &lt;137mmol/L. Cumulative incidence curves and Cox proportional hazards models (crude and adjusted for age, sex, comorbidities, and potential hyponatremia-inducing medications including diuretics, anticonvulsants, and antidepressants) were used to investigate the association of sodium concentration with the incidence of heart failure during follow-up. Incidence rates of heart failure per 1000 person-years were calculated across the spectrum of the measured sodium levels.

Results
We included 69,750 patients where 57% were male and the median age was 63 (interquartile range: 54-71). At index, 57,723 (83%) patients had a mean sodium concentration of &gt;137 mmol/L and 12,027 (17%) patients had a mean sodium concentration &lt;137 mmol/L (hyponatremia). Patients with a sodium level &lt;137 mmol/L were associated with a significantly higher hazard rate of heart failure compared to patients with sodium concentrations &gt;137 mmol: adjusted hazard ratio (HR) 1.27 (95% confidence interval 1.15-1.41, p-value &lt;0.001). In analyses where sodium concentration was considered a continuous variable, increasing concentration of 1 mmol/L was associated with a decreasing hazard rate of heart failure: adjusted HR 0.96 (0.94-0.97, p-value &lt;0.001).

Conclusions
Hyponatremia was common and associated with a significantly higher risk of new-onset heart failure in patients newly diagnosed with T2D. Whether hyponatremia could be a new treatment target to prevent heart failure in T2D remains to be determined.Cumulative incidence of heart failureIncident heart failure
Machine learning methods for diagnostic disease prediction and treatment decisions in parvovirus B19 positive viral cardiomyopathy
Authors: Baumeier C , Starlinger J , Aleshcheva G , Escher F , Schultheiss H P 
Published: October 2024

Abstract

Background
Parvovirus B19 (B19V) is the most common type of virus found in endomyocardial biopsies (EMB) from patients with inflammatory heart disease. However, the detection of genomic B19V-DNA appears to have little clinical significance and is often considered an incidental finding. Recent analyses of a large cohort of B19V-positive patients revealed that the detection of RNA transcripts rather than DNA is of clinical importance, as B19V-RNA-positive patients have a significantly worse cardiovascular outcome. Here, we applied machine learning (ML) methods to assess the impact of B19V transcriptional activity on cardiac inflammation and patient clinical outcome.

Methods and results
A total of 305 patients with a known clinical course and a positive endomyocardial B19V-DNA test were included in this study. Follow-up measurements of the B19V-specific transcripts VP1/2 and NS1 revealed significantly worse clinical courses than in patients without B19V-RNA detection (P=0.019, hazard ratio (95% CI)=1.62 (1.10-2.57)). LVEF at follow-up was significantly lower in patients with detected B19V-RNA (P=0.007), and adverse events such as worsening LV function (P=0.003) or stable systolic dysfunction (P=0.013) were more frequent in this group. Importantly, analysis of inflammatory markers in EMB showed no difference in patients with and without RNA detection (P=0.432), suggesting that the deterioration in clinical outcome was related to B19V transcriptional activity rather than an increase in inflammation. The analysis of area under the receiver operating characteristic curve (AUROC) of B19V-RNA-negative patients revealed that the macrophage marker MAC-1 (AUROC=0.66, P=0.002) was the single most prognostically relevant parameter, while the T cell marker CD3 (AUROC=0.73, P&lt;0.001) was identified as the most prognostically relevant marker in B19V-RNA-positive patients. The linear combination of several inflammatory markers increased the AUROC value to 0.67 in B19V-RNA-negative patients and to 0.74 in B19V-RNA-positive patients. To further increase prognostic accuracy, we trained ML models on features derived from EMB inflammatory markers. For the prediction of major adverse cardiac events within 60 months, the best ML-models achieved an AUROC of 0.87 in B19V-RNA-positive and of 0.86 in B19V-RNA-negative patients, while models that neglect the differentiation of patients with regard to the presence of B19V RNA transcripts only achieved an AUROC of up to 0.76.

Conclusions
These results show that B19V transcriptional activity is an independent risk marker for adverse cardiac events in patients with viral cardiomyopathy and thus confirm the clinical-therapeutic importance of myocardial biopsy. Furthermore, we present an ML-based algorithm that accurately indicates disease progression in B19V-positive cardiomyopathy patients and is thus helpful for appropriate therapy recommendation.
Racism in health care: systemic changes and institutional policies to advance health equity
Authors: Khan-Gökkaya S 
Published: October 2024

Abstract
Globally, the COVID-19 pandemic has amplified inequalities in health care. Racism is one cause of such inequalities that disadvantage Black, Indigenous, and people of color around the world, but particularly in Germany, European countries, and the United States. To advance health equity and ensure an equitable health care system for marginalized groups, it is necessary to implement systemic change, but international studies indicate there is little evidence of antiracist interventions in organizations and through policies, as well as limited data on their effectiveness. This presentation will present novel research that identifies antiracist interventions on a systemic level, meaning interventions within organizations will be analyzed. The results from this research will be used to derive recommendations and inspire policymakers and providers toward equity-oriented health care. The overarching goal of the proposed research is to contribute to a paradigm shift in Germany and Europe more broadly and enrich a previously deficit-oriented perspective on the topic with important approaches and solutions. It will also increase the geopolitical relevance of the interventions in the US and enable cross-border exchange and partnerships.
Exploring racial inequalities in maternal mental health outcomes
Authors: Wilson C 
Published: October 2024

Abstract
Perinatal mental illness affects around 1 in 5 birthing people globally and is associated with adverse outcomes for those affected and their families. Such adverse outcomes are not inevitable and there is now good evidence for a range of both preventive and treatment interventions. There are well-documented inequalities in mental health outcomes across a range of social determinants, including race; such inequalities are also apparent during the perinatal period. There are also racial disparities in mental health care delivery during the perinatal period. Racial inequalities in perinatal mental health are now being recognized as key policy priorities in both the United States and the United Kingdom. This presentation will present routinely collected epidemiological data, investigating the drivers of these racial inequalities in access to perinatal mental health services and associated maternal and child outcomes. It also will present qualitative approaches to exploring current initiatives to reduce inequalities. Findings have the potential to inform the development of culturally sensitive interventions to promote equity in this area for underserved populations in the U.K., U.S., and elsewhere.
How ambient NO2 impacts the mortality burden of ischemic heart disease in Portugal (2011-2021)?
Authors: Clemente M , Corda M , Martins C 
Published: October 2024

Abstract

Background
Air pollution is a major environmental risk to human health, contributing to premature death and disease. Nitrogen dioxide (NO2) is a pollutant of significant public health concern, associated with increased risks of all-cause mortality, particularly in cardiovascular and respiratory deaths. In 2021, NO2 exposure exceeding the World Health Organization Air Quality Guidelines resulted in 69,000 deaths in the European Union. This study aims to estimate the impact of ambient NO2 exposure on ischemic heart disease (IHD) in Portugal, from 2011 to 2021, estimated in years of life lost (YLL).

Methods
Data on ambient NO2 levels were obtained from the Portuguese Environment Agency’s online database QualAr. Only monitoring stations that reported valid data for at least 75% of the time in a year were considered. The number of IHD mortality cases from 2011 to 2021 was sourced from Statistics Portugal. The burden of IHD attributed to NO2 exposure was estimated in YLL for the Portuguese population aged 25 years and older, categorized by five-years age groups, regions of mainland Portugal and sex, using the population attributable fraction (PAF).

Results
Between 2011 and 2021, mainland Portugal experienced a declining trend in NO2 mean levels, with occasional fluctuations. Regarding IHD YLL attributed to NO2 exposure, the same trend was followed with an overall decline over the study period. In total, 94,843.75 (95% CI 53,408.35-134,766.17) IHD YLL were attributed to NO2 exposure, with an estimated number of IHD YLLs higher for males than for females.

Conclusions
These findings underscore the significant impact of air pollution on human health. Despite an overall reduction in YLL across mainland Portugal, persistent health effects emphasize the need to reduce NO2 concentrations, with informed decision-making being crucial to mitigate these impacts and protect public health.

Key messages
• Ambient NO2 exposure significantly impacts ischemic heart disease mortality in Portugal.
• These estimates underscore the necessity of well-informed decision-making to safeguard public health.
Exploring the relationship between energy poverty and mental wellbeing: a qualitative study
Authors: Stevens M M , Ambrosio-Albala P , van Ooij C , Searle B A , Garcia N , Rocher E , Middlemiss L , van Grieken A 
Published: October 2024

Abstract

Background
Rising rates of energy poverty in Europe, affecting 11% of households, are a serious public health concern. The inability to meet energy needs impacts mental wellbeing, preventing people from productively engaging in society. Our objective was to explore this relationship within the context of three European cities, each characterized by distinct climatic conditions, cultural and societal characteristics and governance arrangements. This work is part of the European funded research project WELLBASED, grant no. 945097.

Methods
Semi-structured interviews (n = 34) were conducted with people experiencing energy poverty in the United Kingdom, the Netherlands and Spain. Purposive sampling ensured the representation of a diverse range of family and household types, gender and experiences with energy poverty. Thematic analysis was conducted using MaxQDA software.

Preliminary results
The analysis resulted in six themes: (1) worries and fear (2) stress (3) value of the home and neighborhood, (4) caring for others, (5) engaging with daily life and (6) autonomy in managing the situation and seeking for and receiving support. Participants were worried and stressed about the rising energy bills, the thermal discomfort, and health impacts of their poor housing conditions. In relation to caring responsibilities, participants were especially concerned about the impact on their children and prioritized children’s needs. Participants also expressed a strong will for independence and having control over their lives, but at the same time valued being seen and supported.

Conclusions
The persistent worries, fear and stress highlight implications of failure to meet energy needs for mental wellbeing. Caring responsibilities, engaging with daily life and autonomy proved important for mental wellbeing among people living in energy poverty. Our findings call for addressing energy poverty challenges in public health programs to improve mental wellbeing of vulnerable citizens.

Key messages
• People experiencing energy poverty in the United Kingdom, Spain and the Netherlands recognize the impact of their energy poverty situation on their mental wellbeing.
• The public health community needs to be informed and engaged about the impact of energy poverty on mental wellbeing in order to take action.