bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of SLGT2 inhibitors treatment initiation on the reduction of atrial and ventricular arrhythmias in patients with implanted cardiac defibrillator
Authors: Minguito Carazo C , Rodriguez Manero M , Garcia Seara J , Martinez Sande J L , Fernandez Lopez X A , Garcia Rodeja F , Sanchez Munoz E , Rodriguez Santamarta M , Tundidor Sanz E , Fernandez Vazquez F , Gonzalez Juanatey J R 
Published: October 2024

Abstract

Introduction
Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) have been associated with improved prognosis in patients with heart failure; however, their impact on atrial arrhythmic (AA) and ventricular arrhythmic (VA) events is not fully understood.

Methods
Retrospective multicentric study of heart failure patients with implantable cardiac defibrillator device (ICD) from 2015 to 2020 with or without cardiac resynchronization therapy (CRT) receiving SGLT2 inhibitors. Device-registered arrhythmic events were analyzed and compared in two time periods for each patient: one year before and one year after starting SGLT2i. Relevant VA were defined as the occurrence of any sustained VT (SVT) (&gt;30 seconds), ventricular fibrillation (VF), or appropriate therapy (antitachycardia pacing or shock). All VA included all the relevant VA and the occurrence of non-sustained ventricular tachycardia (NSVT). AA included atrial fibrillation (AF) burden, and episodes of more than 24 hour of AF.

Results
A total of 195 patients (66.8 [61.3-73.1] years, 18.5% women) were included. A reduction was observed in the percentage of patients with any VA (pre: 52.3% vs post: 30.3%; P &lt; 0.001) and clinically relevant VA (excluding NSVT) (pre: 21.5% vs post 8.7%; P &lt; 0.001) in the post-SGLT2i period. There was also a reduction in the number of episodes per patient/year of NSVT (pre: 2 (1-5) vs post: 1 (0-2); P &lt; .001), and SVT (pre: 1 (1-3) vs post: 0 (0-2); p = 0.046). This protective effect was also observed after controlling confusion factors (Any VA: OR 0.35 (0,24-0,50); p&lt;0.001 and relevant VA: OR 0.30 (0,17-0,52); p&lt;0.001). However, no differences were observed in the prevalence of AA (24.7% vs 18.8%; P = 0.117) or the burden of atrial fibrillation (pre: 0% (0-0.1) vs post 0% (0-0); p = 0.097).

Conclusions
Following the initiation of SGLT2i treatment, a reduction in the percentage of patients with relevant VA was observed. However, this effect was not observed for AA.Figure 1Figure 2
Effect of participant baseline characteristics on adherence to self-monitoring of diet, physical activity and weight in a 12-month weight loss mHealth trial
Authors: Burke L O R A E , Bizhanova Z B , Cheng J , Conroy M B , Beatrice B , Kariuki J K , Sereika S M 
Published: October 2024

Abstract

Background
Self-monitoring (SM) of lifestyle behaviors is the centerpiece of standard behavioral treatment (SBT) for weight loss as SM increases one’s awareness of their behaviors. Extensive evidence demonstrates a significant relationship between adherence to SM and successful weight loss outcomes.

Purpose
Examine baseline characteristics of participants that are associated with higher adherence to SM of diet, physical activity (PA), and weight in a 12-month mHealth weight loss trial.

Methods
SMARTER was a single-site, 2-arm randomized controlled trial. We randomized 502 adults with a body mass index (BMI) 27-43 kg/m2 to diet, weight, and PA SM plus tailored feedback messages (SM+FB, n=251) or SM alone (n=251). We provided the SM+FB group feedback messages via the SMARTER app on diet daily, PA every other day and weight weekly. The study provided a wearable PA tracker and smart scale for weight and utilized a smartphone app for dietary SM. Adherence of dietary SM was defined as the % of days with ≥50% of calorie goal recorded and PA SM was % of days with ≥500 steps. Weight SM was the % of days with weight based on the scale record. Linear mixed modeling was applied to assess the monthly percent adherence to SM of diet, PA, and weight over a 12-month period. Our analysis incorporated time effects in months and polynomials of time, treatment group assignment (SM+FB vs. SM), baseline variables of interest (e.g., BMI, age, sex, race, education years, income), and the interactions between treatment and time effects with other variables. For parsimony, non-significant effects were removed.

Results
The sample (N=502) was 82% white (n=414), 79% female (n=399), and had a mean age of 45.0±14.4 years and BMI of 33.7±4.0 kg/m2. Over 12 months, percent adherence to SM of diet, PA, and weight declined non-linearly. Treatment groups did not demonstrate significant differences. The impact of treatment on the monthly decline in adherence to diet SM was curvilinear and varied significantly over 12 months. Older age was associated with greater adherence to the SM of diet (b=0.72, 95% CI: 0.55-0.88, P &lt; .0001), PA (b=0.50, 95% CI: 0.35-0.66, P &lt; .0001), and weight (b=0.71, 95% CI: 0.57-0.85, P &lt; .0001). Conversely, higher baseline BMI was associated with lower adherence to SM of diet (b=-1.14, 95% CI: -1.73 to -0.55, P &lt; .0001) and PA (b=-0.79, 95% CI: -1.35 to -0.22, P= .006). Other baseline variables were not significantly related to adherence.

Conclusion
The findings suggest that individuals with a higher BMI at baseline may need additional enhancement strategies to improve their engagement with the digital tools for SM lifestyle which could lead to improved weight outcomes.
N-acetyl-beta-D-glucosaminidase and kidney injury molecule 1: detection of potential tubular injury in atrial fibrillation
Authors: Lang F , Schlossbauer M , Staudner S , Leininger S , Vogel M , Lehn P , Burckhard R , Zimmermann C , Hupf J , Hubauer U , Maier L , Jungbauer C 
Published: October 2024

Abstract

Introduction
Acute heart disorders are often associated with an already present atrial fibrillation and cardiorenal syndrome in the emergency department (ED). This study focused on evaluating the potential cardiorenal biomarkers N-acetyl-β-D-glucosaminidase (NAG) and kidney injury molecule 1 (KIM) in a real-world chest pain cohort according to sinus rhythm (SR) and atrial fibrillation (AFib).

Methods
The urinary concentrations of the tubular markers NAG and KIM were measured in 601 samples (mean age = 61.1 y, SD = 16.9 y) of patients presenting with acute chest pain in the ED of a university hospital. 533 patients presented with SR in the initial ECG upon hospital admission contrary to 68 patients presenting with AFib.
The participants were divided into 4 groups based on their diagnosis for hospitalization, Acute coronary syndrome (ACS), acute decompensated heart failure (ADHF), non-ischemic chest pain without congestion (NICP) and chest-wall-syndrome (CWS). The CWS group only included healthy patients presenting with SR.

Results
Significantly increased NAG and KIM concentrations were identified among the patients presenting with AFib compared to those presenting with SR (each p &lt; 0.001, AUCNAG = 0.730, AUCKIM = 0.634). Furthermore, ACS patients showed significantly increased tubular biomarker concentrations when presenting with AFib compared to SR (each p &lt; 0.05). Similarly, for NICP patients significantly elevated NAG-concentrations were measured (p &lt; 0.001), opposite to KIM (p = n. s.). Regarding ADHF, the concentration of NAG did not significantly differ between AFib and SR. However, KIM concentrations were significantly reduced in AFib. Both, NAG and KIM showed significantly higher concentrations in ACS or ADHF compared to CWS patients (p &lt; 0.001).
Regarding multivariate linear binary regression, NAG was an independent predictor of AFib (p &lt; 0.001), contrary to KIM, blood NT-proBNP and high-sensitivity troponin T, blood creatinine (each p = n. s.).

Conclusion
Both, NAG and to a lesser extent KIM correlate with AFib. This finding implies significantly higher tubular injury in acute heart diseases among individuals beating in AFib compared to those in SR. Hence, AFib may have a high impact on renal function and the cardiorenal syndrome in ACS-patients.ROC-Curve comparing AFib and SR overallNAG in AFib and SR according to disease
Implementation of digital patient decision support tools for Atrial Fibrillation treatment: systematic review
Authors: Laranjo L , Zeng A , O'hagan E , Chow C 
Published: October 2024

Abstract

Background/ Introduction
Treating atrial fibrillation (AF) involves complex decisions. Digital patient decision-support tools can facilitate shared decision making by significantly reducing decisional conflict and improving patient knowledge [1,2]. Yet, implementation in clinical practice is lagging [3].

Purpose
To systematically review trials of digital patient decision-support tools for AF treatment decisions, focusing on factors influencing their implementation in clinical practice.

Methods
We conducted a systematic review following Cochrane methods. EMBASE, MEDLINE and Scopus were searched from 2005 to 2023. Eligible randomised controlled trials and quasi-experimental trials that evaluated digital patient decision-support tools for AF treatment decisions were included. Two independent reviewers screened title and abstract, extracted data and assessed risk of bias. The implementation outcomes included a description of when and how the tool was used, as well as its characteristics and user satisfaction.

Results
Thirteen articles reporting on eleven studies (5 RCTs and 6 quasi-experimental trials) met the inclusion criteria (2,714 participants; mean age 71±4.2 years; 26% women; 92% with non-valvular AF, remaining not reported). Risk of bias was low for 2 studies, moderate for one and high for seven studies. All tools (n=11) focused on anticoagulation choice (1: warfarin vs no warfarin; 1: aspirin vs warfarin; 7: Direct Oral Anticoagulants (DOAC) vs antiplatelet or warfarin; 2: unspecified choice). The tools were used either pre-visit (at home or in the waiting room) or during the consultation (n=5). Tools were delivered using a mobile application (n=4), web-based application (n=5), or a desktop (n=2). Of the eleven tools, 2 could automatically calculate individualized stroke risk using data from electronic health records. Most articles reported favourable user feedback regarding use of the digital patient decision-support tools, such as high perceived usefulness, user-friendliness, and overall satisfaction. No significant difference was found in encounter times between intervention and control arms (2 RCTs). Four tools were publicly available and 3 were implemented in healthcare delivery beyond research.

Conclusion
Despite demonstrated efficacy in reducing decisional conflict and improving patient knowledge, as well as positive clinician and patient experience, only 3 tools were implemented in clinical practice beyond their trial. Future tools could better leverage digital capabilities to integrate with Electronic Health Records, automate stroke and bleeding risk calculations, and personalise content based on patient values and preferences. Additional robust trials and implementation studies are warranted to understand barriers and enablers to the use of these tools.
Differences in treatment and outcome of patients with ST- Elevation Myocardial Infarction (STEMI) and Non-STEMI in Germany
Authors: Lange S A , Engelbertz C M , Feld J , Makowski L , Karanatsios G , Fischer A J , Guenster C , Droege P , Ruhnke T , Gerss J , Reinecke H , Koeppe J 
Published: October 2024

Abstract

Background
ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) are the main diagnoses of acute coronary syndrome (ACS). Although both types of infarction are classed as ACS, the treatment and overall survival rate are different.

Methods
Health claims data (≈26 million members) were screened for patients with STEMI and NSTEMI from 01/2010 to 12/2018. Patient demographics, hospitalization details, adherence to guideline-directed drug therapy, and survival were assessed.

Results
The total cohort of acute myocardial infarctions comprised 544,529 patients (mean age 74 (IQR 62 - 82), one third of whom were hospitalized with a STEMI. Patients with STEMI were more likely to be in a life-threatening situation and had higher in-hospital, 30- and 60-day mortality, but better long-term survival. Major adverse cardiac and cerebrovascular events (MACCE), infarct recurrence, chronic kidney disease, peripheral arterial disease, heart failure and cerebrovascular disease were more common in patients with NSTEMI. STEMI-patients received coronary angiography and percutaneous coronary intervention more frequently. Although there was a clear correlation between guideline-compliant therapy and overall survival, adherence to guideline-compliant therapy decreased over time, especially in NSTEMI patients.

Conclusion
In ACS patients, there are clear differences between STEMI and NSTEMI patients in terms of short- and long-term survival. Guideline-based therapy improved long-term survival in both, but more significantly in STEMI patients.
Advanced waveform analysis of the electrocardiogram signals using complementary signal processing techniques to investigate the response to a QTc prolonging drug vs control
Authors: Rickard J , Nandi M , Djumanov D , Mejia E , Sadsad T J , Taubel J , Lorch U , Serna Pascual M 
Published: October 2024

Abstract

Background
Thorough QTc (TQT) studies using Electrocardiogram (ECG) data, are a well-established method for testing the pro-arrhythmic propensity of drugs performed during safety studies as part of drug development. ECG analysis is currently reduced to simplified biomarkers, such as rate, intervals and amplitudes. However, ECG waveforms are complex and generally sampled with high fidelity (125-1000 Hz). Our novel mathematical method, Symmetric Projection Attractor Reconstruction (SPAR) analyses the morphology and variability of such waveforms, using every data point to generate a new, faithful 2D waveform representation termed an ‘attractor’.
Moxifloxacin is a reversible blocker of the rapid component of the delayed rectifier, potassium current of the cardiac IKr potassium channel and has been shown to cause a mean increase of the QTc interval of 10–14 ms after an oral single dose of 400 mg. Separately, studies have shown that meals can alter QT interval as well as altering the pharmacokinetic profile of moxifloxacin itself with gender and ethnicity impacting individual responses. In-depth knowledge of these physiological factors could support safer medicines development and clinical use.

Purpose
This project investigated the feasibility of SPAR analysis of ECG signals to detect drug induced changes which a higher degree of sensitivity, to support safety evaluation during medicines development.

Methods
High resolution triplicate 12 lead ECG time-series data from a Phase one study of healthy human volunteers cross over of placebo, moxifloxacin or moxifloxacin + food was retrospectively analysed using SPAR. Using a bespoke software tool was used to perform SPAR analyses to transform ECG time-series into corresponding attractors. Corresponding single point measurements were previously obtained as part of the original Phase one study.

Results
Initial evaluation of attractors revealed high inter-individual variation, consistent with previous SPAR ECG analysis. Nevertheless, we identified changes in subjects receiving Moxifloxacin (six hour time point) when compared to those receiving placebo control. These changes were not as evident in previously obtained QT intervals.

Conclusion
This pilot study illustrates that SPAR is highlighting changes on the ECG that are less obvious from QT data alone. Further evaluation of the whole dataset to identify generalisable SPAR features, and their comparison with existing markers is now necessary. The individualised nature of ECGs and corresponding attractors indicates the method may have highest utility in personalised medicine, evaluating each individual’s change and hence individual risk to drug induced arrhythmia.Visualisations of SPAR analysis of ECGs
Substantial morbidity and mortality due to cardiovascular diseases in hospitalized vaccinated and un-vaccinated patients with COVID-19 from 16 countries: the WHF COVID-19 Long-term study
Authors: Sliwa Hahnle K , Raspail L , Singh K , Nikhare K , Akter S , Talukder S H , Kato T , Bertagnolio S , Rylance J , Banerjee A , Narula J , Pineiro D , Perel P , Prabhakaran D 
Published: October 2024

Abstract

Background
Long-term adverse consequences of the COVID-19 affect many organ systems, and this requires the identification and appropriate care of diverse symptoms.

Purpose
The World Heart Federation (WHF) international study describes the burden of clinical sequelae of COVID-19 up to 1 year after hospitalization, including patients from low- middle-and high-income countries.

Methods
We prospectively recruited patients hospitalized due to COVID-19 from 16 countries between January 2022 and June 2023. Patients were followed up at 1, 3, 6, and 9-12 months after hospital discharge. A standardized questionnaire administered by telephone collected data on long COVID symptoms, quality of life using the EuroQol 5 Dimension scale (EQ-5D), and disease outcomes including new onset diabetes and hypertension, major adverse cardiovascular events (MACE), and mortality. We report a descriptive analysis including demographic characteristics and outcomes up to one year after initial hospitalization.

Results
Of 2504 patients, the majority were Asian (78%), and male (56%). Mean age was 59.2 years (SD 19.9). Low- and lower-middle-income country participants constituted 65% of the cohort, with upper middle-income and high-income representing 20% and 15%, respectively. Follow-up rate was complete for 86%. 55% had received at least two doses of COVID-19 vaccination. At 1 month, 63% reported at least one persistent symptom, which decreased to 28% at 9-12 months. Fatigue was reported by 45% at 1-month and 17% at final follow-up. Anxiety occurred in 20% and 9% at these respective timepoints, and breathlessness in 12% and 6%. At 9-12 months, moderate to severe impairment of usual activities as measured by EQ-5D occurred in 19%, anxiety/depression in 10%, and mobility problems in 10%.
The most frequent post-discharge new-onset illnesses were pulmonary embolism (7%), kidney problems (4%), and hypertension (3%). In-hospital mortality was 4% (n=102), and a further 12% (265 patients) died by one-year. The most common cause was sudden cardiac death (59%), respiratory disease including pulmonary embolism (13%), and stroke (6%).

Conclusions
We observed a significant burden of post-COVID-19 complications with one fifth of patients with persistent difficulties in usual activities at one year. This underscores the urgent need to understand the underlying mechanisms for organ damage and death, and for targeted preventive strategies and proactive management approaches to reduce them.
Effects of deferment of clinic visit on cardiovascular outcomes during COVID-19 outbreak: a prospective cohort study
Authors: Lai A , Hui K H , Yan B , Tan G M 
Published: October 2024

Abstract

Background
Current guidelines recommend 3-6 months interval outpatient follow-up for patients with cardiovascular (CV) diseases and risk factors such as hypertension, diabetes mellitus (DM) and dyslipidemia. The impact of longer follow-up intervals is unclear. From 2020 to 2022, due to the infection control measures for COVID-19 pandemic, many patients voluntarily deferred their scheduled clinic visits. This provided us with an opportunity to study the impact of prolonged visit intervals on management CV risk factors.

Purpose
We aimed to investigate the impact of prolonged clinic visit intervals on CV outcomes and CV risk factor management among patients with CV diseases.

Methods
Patients with at least 1 CV risk factor (DM, hypertension, dyslipidemia, or a history of CV disease) were recruited from cardiology outpatient clinics from a tertiary teaching hospital from 2020-2022. Patients who opted to defer their appointment (Deferred group) were compared to those who attended their scheduled appointment (Normal group). The primary outcomes were composite major adverse cardiovascular events (MACE) of myocardial infarction, stroke, or CV-related death. The secondary outcomes were any unscheduled hospitalizations, suboptimal DM control (haemoglobin A1C &gt;7%) or hyperlipidemia (LDL &gt; 1.4 mmol/L).

Results
Out of the 455 patients recruited from outpatient clinics, 162 patients (35.6%) opted to defer their scheduled clinic visit (mean age 64.7 ± 12, 37.7% female), and 293 patients (mean age 64.5 ± 10, 36.2% female) continued to attend their appointments. The mean appointment interval was 226 days for the normal group and 582 days for the deferred group (p&lt; 0.001). There was no significant difference in the primary outcome of MACE between the ‘Normal’ group and the ‘Deferred’ group (2.5% vs 0.6%, p=NS). The number of patients with suboptimal DM control (11.4% vs 21.9%, p = 0.029) was higher in the deferred group, whereas suboptimal hyperlipidemia (73.1% vs 77.1%, p=NS) was not statistically different. There were a total of 27 of unscheduled hospitalizations, among which the majority was for CV-related events (63.0%). Patients in the ‘Deferred’ group had higher rates of unscheduled hospitalization (12.3% vs 2.4%, p &lt; 0.001) and higher rate of CV-related hospitalization compared to the ‘Normal’ group (6.2% vs 2.4%, p=0.041).

Conclusion
Our prospective data demonstrates that a prolonged clinic visit interval of more than 365 days was not associated with significant increase in adverse CV event or worsening of lipid control. However, prolonged clinic visit interval was associated with worse DM control and more frequent unscheduled hospitalization. More frequent medical contact might allow timely management of medical emergency at the outpatient setting and contribute to the lower rate of hospitalization in the routine follow-up group.