bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations between biomarkers and P-wave indices in patients with heart failure
Authors: Nezami Z , Jujic A , Holm Isholth H , Magnusson M , Platonov P 
Published: October 2024

Abstract

Background
Atrial structural abnormalities linked to the risk of atrial fibrillation (AF), as indicated by P-wave indices on surface ECG, are associated with the fibrotic transformation of the atrial myocardium. To what extent incident AF can be predicted by ECG characteristics in patients with advanced atrial structural remodeling, such as patients with heart failure (HF), is less well studied.

Purpose
To evaluate the association between P-wave indices and biomarkers implicated in cardiac fibrosis, and incident AF in patients with HF.

Methods
Patients with new-onset or worsening of HF were prospectively recruited in a observational study (n=501) and followed-up for 5 years. Blood samples were collected for analysis using proximity extension assay that included a subset of biomarkers that were associated with fibrosis development (TIMP-2, MMP-2, MMP-3, MMP-9, ST-2, GDF-15, Gal-3). All ECGs ever recorded in the hospital catchment area were exported in digital format and processed using Glasgow algorithm for calculation of the P-wave indices (P-wave duration [PWD], P-wave terminal force in V1 [PTFV1] and P-wave axis [Paxis]) and rhythm identification. AF diagnosis was ascertained by manual ECG review. Only patients who did not have AF reported or ECG documented at enrolment were included in the analysis. Of those subjects, 121 patients also had biomarkers of fibrosis analyzed. Cox-regression analyses were used to assess biomarkers’ and p-wave indices’ associations with incident AF.

Results
After exclusion of patients with prevalent AF (n=317), 184 patients comprised the study group (mean age of 71 years, 33.2% women, 121 patients with biomarker data available). During follow-up, incident AF was observed in 39 patients. At enrolment, PWD&gt;120 ms was observed in 38.7%, abnormal PTFV1&gt;40 mm*ms in 24.5% and Paxis&lt;0° in 5.4%. Among the seven biomarkers assessed, five demonstrated significant associations with incident AF in adjusted analyses: TIMP4 (HR 1.78; 95%CI 1.03-3.05; p=0.037); MMP2 (HR 1.97; 95%CI 1.03-3.80; p=0.042), MMP3 (HR 1.39; 95%CI 1.03-1.88; p=0.031); ST2 (HR 1.91; 95%CI 1.29-2.83; p=0.001) and GDF-15 (HR 2.56; 95%CI 1.50-4.35; p=0.001) (Figure 1). However, none of the tested P-wave variables (P-wave duration, P-wave terminal force, and P-wave axis) were associated to incident AF.

Conclusions
In this prospective long-term follow-up study of patients admitted for acute HF, biomarkers with proven associations to fibrosis were strongly associated with incident AF. P-wave indices used for prediction of AF in epidemiological cohorts appear to have limited value in patients with HF who have high prevalence of ECG atrial abnormalities at baseline.
Role of urea to creatinine ratio in the prediction of outcomes in chronic heart failure
Authors: Moreira G , Avila D X , Candia A M , Scaramussa V D , Villacorta H 
Published: October 2024

Abstract

Background
Renal function predicts events in chronic heart failure (HF). Urea to creatinine ratio (UCR) is a simple and cheap biomarker which correlates with neuroendocrine pathways.

Objectives
Evaluate the prognostic role of UCR in patients with chronic HF.

Methodology
86 patients with chronic HF from an academic hospital were included (with reduced, mildly reduced or improved left ventricular ejection fraction). UCR was calculated at baseline, and patients were followed for a median of 360 (interquartile range 180-472) days. We plotted ROC curves for NT-proBNP and UCR and evaluated two scenarios using the Kaplan-Meier curve to determine the event-free survival. We grouped patients into four subgroups: a) UCR and NT-proBNP below the cut-off; b) UCR above and NT-proBNP below; c) UCR below and NT-proBNP above; and d) both above the cut-off. A second scenario was analysed, grouped as follows: a) UCR and NT-proBNP below; b) at least one of them above the cut-off; and c) both above the cutoff. The primary endpoint was cardiovascular death or HF hospitalisation. The level of significance was 5%.

Results
The mean age was 66.1±12.1y, and 60.5% were male. There were 28 events in the follow-up (32.5%). The ROC curve for UCR had an AUC of 0.75 (CI 0.64-0.86; p=0.0002) for a cut-off of 43.8 (sensitivity of 75% and specificity of 70.7%). The AUC for NT-proBNP was 0.64 (0.51-0.77; p=0.043) for a cut-off of 2010 pg/mL (sensitivity of 64.3% and specificity of 65.5%). In the Cox regression model, the UCR was the only independent predictor with HR of 1.06 per 1 unit increase (1.03-1.10; p=0.0002). UCR above cut-off (as a categorical variable) was the only independent predictor, with HR 5.34 (2.26-12.6; p=0.0001). Kaplan-Meier curves in Figures 1 and 2 show the UCR performance associated with NT-proBNP.

Conclusions
UCR is a simple and cheap biomarker that has been shown to have predictive power, probably due to persistent neuroendocrine activation in patients with low volume. In this population, elevated UCR added risk even in patients with low levels of NT-proBNP.
Blood urea monitoring in heart failure patients - an important predictor of mortality
Authors: Oswald A S , Hussain M S , Win M L , Liew Y J , Dihoun A , Nicholls J , Newey R , Baird E , Smith G , Garland C , Pigazzani F , Khan F , Choy A M , Mordi I R , Lang C C 
Published: October 2024

Abstract

Background
Recent ESC position statement regarding worsening renal failure recommends the use of blood urea monitoring of patients with heart failure with reduced ejection fraction (HFrEF). Although both serum creatinine and blood urea nitrogen are markers for renal dysfunction, blood urea nitrogen levels are also affected by reabsorption in the renal tubules, a process modulated by renin-angiotensin-aldosterone activity, sympathetic nervous activity and arginine-vasopressin activity. Thus, neurohormonal activity is reflected in the BUN/creatinine ratio (bUCR) which effectively ‘normalizes’ BUN for the degree of renal dysfunction, as measured by the creatinine level. Previous studies have demonstrated increased mortality at bUCR &gt;100mmol/l. however, most of the prognostic data has come from patients admitted with acute heart failure. The use of bUCR in patients with chronic HFrHF receiving intensive titration of guideline directed medical therapy (GDMT) has not been studied.

Purpose
To identify the extent of blood urea monitoring in primary care in HFrEF and whether bUCR remains a significant prognostic indicator despite intensive GDMT.

Methods
We analysed the electronic health records of all patients referred to the Heart Failure Nurse Service (HFNS) in an NHS population approx. 400,000 in 2022. Inclusion criteria consists of patients with symptomatic heart failure NYHA II-IV with echocardiogram demonstrating HFrEF. Patients were segregated into two cohorts, with a urea/creatinine ratio greater or less than 100mmol/l and analysed.

Results
Data from 338 patients [mean age 72.3 ± 15.6 years; 218 (64.5%) males; 143 (42.3%) ischaemic cardiomyopathy; 141 (41.7%) AF; 49 (14.5%)] were analysed. Of these, 112 (33.1%) had chronic kidney disease (CKD) with eGFR &lt;60 ml/min/1.73m2 at the time of HF diagnosis and 181 (53.6%) had CKD on discharge from the HFNS. During follow-up, 132 (39%) had further admission with HF and 76 (22.5%) died. Sixty-eight (20.1%) patients did not have blood urea checked despite the availability of serum creatinine. While an eGFR &lt; 60 ml/min/1.73m2 at discharge was associated with a twofold increased risk of death (OR 2.4, 95% CI 1.1-5.3, p=0.029), a bUCR &gt; 100mmol/l at discharge was associated with a four-times greater risk of death (OR 4.2, 95% CI 2.2-7.9, p &lt;0.001).

Conclusion
Blood urea/creatinine ratio is an important predictor of outcome and can be utilised to help identify at-risk patients with HFrEF despite intensive GDMT.Survival from diagnosis bUCR
SNORD3A: a new possible circulating biomarker of human heart failure
Authors: Polese P , Paolillo R , Schiattarella G G , D'apice S , Cattaneo F , Lee Holley C , Prevete N , Della Corte A , Bancone C , Ioele D , Carotenuto M , Watson M , Esposito G , Rockman H , Perrino C 
Published: October 2024

Abstract

Background
Heart failure (HF) is a complex clinical syndrome and the leading cause of mortality, morbidity and hospitalization in industrialized countries. Human cardiac biopsies are invaluable resources for identifying cardiac signaling pathways, however blood fractions and peripheral blood mononuclear cells (PBMCs) could be used as a source of surrogate biomarkers of signaling pathway activation in human heart failure.

Purpose
In the present study we aimed to identify novel circulating biomarkers mirroring human myocardial signaling in HF and to study the role played by SNORD3A in cardiomyocyte survival and death.

Methods
Cardiac left ventricle samples and PBLs from 8 HF patients undergoing heart transplantation and 2 control patients (CTRL) were analyzed by RNA sequencing (RNASeq) to identify transcripts that were regulated in both hearts and PBLs. Five identified transcripts, KCNQOT1, MIAT, SCRN1, MALAT1 and SNORD3A, were then validated by quantitative real-time PCR in PBMCs and in LVs. Next, we analyzed the expression of the Small Nucleolar RNA (snoRNA) SNORD3A in LVs and PBMCs from 8-week-old wild type C57BL/6 mice with pressure overload-induced HF by transverse aortic constriction (TAC). Sham-operated mice (sham) were used as controls. To further investigate the role of SNORD3A in cardiomyocyte function and survival, SNORD3A antisense oligonucleotides (SNOaso) and scramble control sequences (GFPaso) were synthesized and tested in cardiomyoblasts H9C2 cells under normoxic or hypoxic conditions to evaluate SNORD3A transcription levels, cell death and protein synthesis.

Results
SNORD3A expression was significantly increased in both LVs and PBMCs from HF patients compared to control subjects. Consistent with these results, SNORD3A levels were increased both in PBMCs and LVs from TAC mice compared to sham. In vitro hypoxia significantly increased SNORD3A expression levels in H9C2 cells, compared to normoxia. After SNOaso transfection, SNORD3A transcripts were downregulated, and they were further reduced following 3-hour-hypoxia. Depletion of SNORD3A levels increased cardiomyocyte death and reduced protein synthesis in H9C2 cells.

Conclusions
Our data suggest that SNORD3A might be involved in the regulation of cardiomyocyte survival in HF and could be useful for diagnostic and prognostic applications in HF.
Innovations in abortion care in France, Germany and the UK following the COVID-19 pandemic
Authors: Miani C , Niemann J 
Published: October 2024

Abstract

Background
Through an international comparison of health systems and policies, we aim at assessing the contextual and circumstantial characteristics of abortion care innovation in three European countries following the upheaval of the COVID-19 pandemic. The three contrasting care models pre-pandemic constitute an interesting baseline for observing different systems’ reaction to health crises.

Methods
We conducted a review of the recent (2020 onward) peer-reviewed and grey literature, including national policy documents and guidelines. We then carried a comparative analysis of innovations implemented during the pandemic and their sustainability post-crisis.

Results
In France and the UK, where abortion care was more accessible before the pandemic than in Germany, a series of innovations were officially introduced to facilitate access during the pandemic. They included teleconsultations and the mailing of abortion medication. Most changes have been sustained since then, contributing to addressing historic and systemic health inequities in terms of access (e.g. due to geography and the existence of “medical deserts”). In Germany, innovations during the pandemic have been crafted by the civil society through NGOs offering for the first time teleabortion services (e.g. Balance Berlin and Doctors for Choice). The legitimation of those practices by professional bodies is still in the making, highlighting the limitations of the catalyst role of crises in the face of cultural barriers and resistance of health systems to innovation.

Conclusions
The COVID-19 pandemic provoked or accelerated innovation in terms of abortion care in France, Germany and the UK. Yet, its sustainability, as well as its scaling up, remains fragile, especially in Germany, where the disruptive approach of civil society organisations has not yet found its way into mainstream health care services.

Key messages
• International comparison of health systems’ reaction to the COVID-19 pandemic in terms of abortion care shows different paths to innovation.
• The sustainability of innovation beyond the first pandemic years pertains to the wider debate on equity in access to abortion care.
Bridging the gap: mapping co-creation methods for public health impact and innovation
Authors: Agnello D M , Balaskas G , Steiner A , Chastin S 
Published: October 2024

Abstract

Background
Co-creation offers a promising approach to public health innovation, particularly for tackling complex issues. However, the lack of a standardized methodology limits its reliability and reproducibility, especially across diverse contexts. This study explores co-creation methods used by researchers and practitioners, aiming to shed light on their implications for public health. Understanding this methodological landscape can enhance the effective implementation of co-creation processes to address complex challenges.

Methods
Utilizing the Systematic Methods Overview approach, we examined co-creation methods. Data were gathered from the Health CASCADE Co-Creation Database and grey literature using an artificial intelligence-assisted recursive search strategy and a two-step screening process. We conducted textual, comparative, and bibliometric analyses to evaluate methodological underpinnings and relationships between methods.

Results
Analysis of 2,627 academic articles and grey literature sources identified over 900 co-creation methods. While surveys, focus groups, and group discussions were prevalent, participatory methods were underutilized. Notably, 91.3% of methods co-occurred, with a predominant combination of qualitative approaches. Furthermore, a significant discrepancy between research and practice was evident, with only 10.2% convergence.

Conclusions
This study revealed a critical gap between co-creation in research and practice, emphasizing the need to bridge this methodological divide for advancing co-creation as a reliable approach in public health. The over-reliance on qualitative methods raises concerns about tokenistic engagement and undermines meaningful public participation in co-creation. Addressing this trend is vital to preserve the essence of true co-creation and maximize its potential for addressing complex public health challenges.

Key messages
• Mapping the diverse methods of co-creation in public health reveals both richness and disparities in approach, from surveys to participatory methods.
• Addressing the discrepancy between co-creation in research and practice is vital for establishing a reliable and effective approach to tackling public health challenges.
Validation of the NEED assessment framework: an EU level Delphi study
Authors: Claerman R , De Pauw R , Cleemput I , Kohn L , Levy M , Schönborn C , Maertens de Noordhout C 
Published: October 2024

Abstract

The NEED (Needs Examination, Evaluation and Dissemination) assessment framework was developed to identify and measure health-related patient and societal unmet needs across different health conditions, supporting the creation of needs-driven healthcare policy and innovation. It includes 25 criteria of needs and 46 related indicators allowing to estimate if the needs are met. The current study aims to validate this framework on the EU level using a modified Delphi approach. The selection of national and European institutes invited to participate in the Delphi process was based on their respective roles; specifically, public health, health technology assessment (HTA), medicine authorisation, pricing and reimbursement (P&R), and patient advocacy. Through a modified Delphi approach, the experts were able to express their opinion on the framework structure (dimensions and domains), health-related needs criteria and indicators. Two Delphi rounds were performed using online questionnaires. Consensus was reached when 85% of the respondents agree or totally agree with a proposal and less than 5% of the respondents totally disagree. A panel of 27 experts participated in the first round of the study. The majority of the experts worked in HTA agencies (39%) and P&R agencies (24%), followed by national medicine authorities (9%) and umbrella patient organisations (9%). Seventeen EU Member States were represented, with a higher representation of experts from Austria, Belgium, France, Germany, The Netherlands, Spain and Sweden. Consensus was reached for 22 out of the 25 criteria and 41 out of the 46 indicators after the first round. The modified Delphi technique was an adequate approach to aid the validation of the NEED framework at the EU level. This represents an important first step in achieving consensus on how to define and identify unmet health-related needs and move towards a more needs-driven healthcare policy and innovation landscape.

Key messages
• Consensus on the definition and identification of unmet health-related needs is crucial to transform public health innovation.
• Expert consultation by means of the Delphi technique assumed a pivotal role to reach consensus on the NEED framework.
The cost of not getting care: income disparities in the affordability of health services across high-income countries
Authors: Gunja M , Gumas E , Williams R , Doty M , Shah A , Fields K 
Published: October 2024

Abstract
This presentation will present findings from the Commonwealth Fund 2023 International Health Policy Survey of the General Population, focusing on financial barriers in accessing healthcare among adults across 10 countries. It highlights significant income-related disparities in healthcare affordability, particularly in the United States, where nearly a quarter of the population lacks affordable access to care. While disparities exist in other countries, Germany and the Netherlands demonstrate lower rates of affordability issues and income disparities, possibly due to their universal health coverage models and cost-sharing caps based on income levels. These countries also prioritize mental health and dental care within their public health plans. The analysis emphasizes the critical need for affordable and comprehensive healthcare coverage to ensure equitable health outcomes. It suggests that policies such as cost-sharing caps and income-based subsidies could mitigate financial barriers to care, drawing insights from successful models in Germany and the Netherlands. Ultimately, addressing affordability is vital for achieving health equity and improving overall population health.
Inequities faced by those with substance use disorder (SUD)
Authors: Finbråten A 
Published: October 2024

Abstract
This presentation delves into the inequities faced by individuals with substance use disorder (SUD), with a particular focus on people who use drugs (PWUD) and people who inject drugs (PWID). Individuals contending with SUD encounter multifaceted barriers that hinder access to appropriate care and support. This presentation will highlight the discourse surrounding biases that exacerbate health disparities among PWUD and PWID. Structural stigma and discriminatory practices not only impede access to healthcare services but also perpetuate social exclusion, amplifying the challenges faced in seeking help and support. PWUD and PWID often require tailored interventions that address not only their substance use but also co-occurring physical and mental health conditions. However, the fragmented nature of healthcare delivery and the lack of integration between substance use treatment and mainstream healthcare services pose significant obstacles to holistic care provision. Drawing on empirical evidence and lived experiences, this presentation explores strategies to dismantle the barriers faced by individuals with SUD in Norway. Ultimately, this presentation aims to foster dialogue that addresses the inequities entrenched in healthcare systems around the world. By advocating for a compassionate and inclusive approach to SUD care, we can strive towards a society where all individuals, regardless of their substance use history, can access the support and resources they need to lead healthy and fulfilling lives.
Better together: a program to increase the public health corps in the southeast United States
Authors: Kershner S , George T , Hucks J 
Published: October 2024

Abstract

Background
This undergraduate public health program implemented in the southeastern United States addresses the need for an expanded public health corps to fill health service gaps underscored by the Covid-19 pandemic, including a shortage of personnel with the skill to function on emergency frontlines; workforce development resources; and socially just healthcare programs to support under-resourced areas.

Objectives
To enhance student knowledge of public health and increase volunteers available for emergency and public health response within local, state, and global communities. After program participation, how confident did participants feel that they could know what to do in the case of an emergency? After program participation, how knowledgeable did participants feel that they would know what to do to protect others in the case of an emergency? After program participation, how aware were participants about the issue of public health response and preparedness?

Results
216 students were recruited at a university in the southeastern United States, and 75% completed 30 hours of modules, immersion activities and skill-based trainings. Almost all (91%) were pre-nursing/nursing or public health majors. The majority of participants (90%) indicated a level of agreement with the statement, “I am confident that I know what to do in the case of an emergency” and 93% indicated a level of agreement with the statement, “I would know what to do to protect others in the case of an emergency”. Almost all participants (96%) indicated a level of agreement with the statement, “My awareness of public health response and preparedness has increased due to participation in the project”. Qualitative results mirrored a similar strong level of support for the program.

Conclusions
Students who complete appropriate training play an essential role in pandemic management and the broad training the medical workforce receives can also be applied to diverse disaster scenarios.

Key messages
• The goal of the project was to enhance undergraduate student knowledge of public health.
• The secondary goal of the project was to increase the number of students available to volunteer for emergency and public health response in local, state, and global communities.