bluuebunny/crossref_metadata_2025_split huggingface dataset:
Haemorrhagic risk in elderly patients with atrial fibrillation that develop low platelet count during direct oral anticoagulant treatment: insights from the ATHERO-AF study
Authors: Menichelli D , Crisanti L , Brogi T , Lip G , Pignatelli P , Pastori D 
Published: October 2024

Abstract

Background
Bleeding risk in atrial fibrillation (AF) patients is complex and dynamic. Among others, thrombocytopenia has been suggested as a bleeding risk factors. No data on thrombocytopenia occurring during direct oral anticoagulants (DOACs) therapy are available.

Purpose
We investigated the incidence rate of thrombocytopenia and major bleeding (MB) in AF patients on DOACs. We also investigated whether the addition of incident thrombocytopenia to the HAS-BLED score might increase its predictive value compared to baseline HAS-BLED calculation.

Methods
955 AF patients from the prospective ongoing ATHERO-AF study followed for a mean of 38.4±26.6 months. All patients were on DOACs. Thrombocytopenia was defined by a platelet count &lt;150 x109/L registered during follow-up visits. MB events were defined according to ISTH definition and were recorded at each follow-up visit. Patients with thrombocytopenia at baseline were excluded. Multivariable Cox proportional hazards regression analysis was used to calculate the hazard ratio (HR) with 95% Confidence interval (95%CI) for each factor in relation to bleeding risk.

Results
Mean age was 77.3±9.0 years and 40.1% were women. During a follow-up, 139 patients developed thrombocytopenia with an incidence rate of 0.8% per year. We recorded no difference between thrombin and factor Xa inhibitors. During follow-up, 179 bleedings occurred, of which 80 were major. Patients experiencing bleedings were more likely to suffer from arterial hypertension, heart failure, anaemia and had higher CHA2DS2-VASc and HAS-BLED scores. At multivariable Cox proportional hazards regression analysis, factors associated with MB were incident thrombocytopenia (HR 1.995, 95%CI 1.211-3.288), antiplatelet use (HR 2.716 95%CI 1.269-5.816) and age (HR 1.033, 95%CI 1.003-1.064). The addition of incident thrombocytopenia to the HAS-BLED score increased the predictive value of baseline HAS-BLED in patients without thrombocytopenia for MB events (AUC from 0.54 to 0.61, p=0.016).

Conclusion
Incident thrombocytopenia is associated with an increased risk of MB. The addition of incident thrombocytopenia to the baseline HAS-BLED score increased its predictive value, suggesting that continuous bleeding risk evaluation of AF patients may provide additional prognostic information compared to the baseline only.
Unfractionated heparin or low molecular weight heparin in patients with acute pulmonary embolism: a meta-analysis of randomized controlled trials
Authors: Maqsood M , Zhang R , Bangalore S 
Published: October 2024

Abstract

Introduction
There is limited data on the use of unfractionated heparin (UFH) and low molecular weight heparin (LMWH) in patients admitted for acute pulmonary embolism (PE). Current ESC guidelines preferred LMWH over UFH based on extrapolated data. We aimed to compare UFH and LMWH in patients with acute PE using randomized controlled trials (RCTs).

Methods
A comprehensive literature search was performed from inception to 02/01/2024 of the PubMed database. Studies of adult patients comparing UFH to LMWH were evaluated for short-term (7-to-12 days) mortality, long-term mortality (90-days to 180-days), short-term (7-to-12 days) and long-term major bleeding (90-days to 180-days). Odds ratio (OR) with 95% confidence intervals (CI) were calculated using DerSimonian-Laird method.

Results
Of a total 2400 studies, nine RCTs with 1,996 subjects (1025 UFH and 971 LMWH) were included with mean age of 62.9 years and 48.5% males. There was no difference in short-term (OR= 0.89 [95% CI 0.44-1.82]; p=0.75; I2=0%; 6 trials) and long-term mortality (OR= 0.77 [95% CI 0.50-1.21]; p=0.26; I2=0%; 6 trials) with use of LMWH or UFH (Figure Panel A and B). Similarly, there was no difference in short-term (OR= 0.70 [95% CI 0.38-1.32]; p=0.27; I2=0%; 9 trials) and long-term major bleeding (OR= 0.92 [95% CI 0.53-1.60]; p=0.77; I2=0%; 6 trials) with use of LMWH or UFH (Figure Panel C and D). Overall, there was no evidence of publication bias using either funnel plot or eggers test (p &gt; 0.05).

Conclusions
In this meta-analysis of 9 RCTs, there was similar efficacy and safety of UFH and LMWH in patients admitted for acute PE. However, future large-scale trials are needs to confirm these findings.
Sex-related outcomes in patients receiving shortened or longer dual antiplatelet treatment after percutaneous coronary intervention: a systematic review and meta-analysis
Authors: Apostolos A , Nastouli K M , Bozika M , Papafaklis M , Karanasos A , Kramvis A , Trigka A , Toutouzas K , Davlouros P , Tsigkas G 
Published: October 2024

Abstract

Background
There are known gender disparities in the pathophysiology, clinical presentation, and prognosis of coronary artery disease between male and female patients. Although antiplatelet therapy cessation is more frequent among women, female gender is an independent factor for major bleeding after percutaneous coronary interventions. Considering that the ischemic and bleeding risk of women undergoing PCI differ from men, it follows that the safety and efficacy of shortened, one or 3 months, DAPT (S-DAPT) compared to longer DAPT (L-DAPT) after PCI might differ between the sexes.

Purpose
Our systematic review and meta-analysis aims to explore the safety and efficacy of S-DAPT versus L-DAPT in men and women having undergone PCI.

Methods
Three major databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Scopus) were screened for eligible randomized – controlled trials, or subgroup or post – hoc analyses of them. The studies should compare S-DAPT with L-DAPT in male and female patients undergoing PCI, providing separate data. The endpoints were Net Adverse Clinical Events (NACE), Major Adverse Cardiac Events (MACE), all-cause mortality, myocardial infarction and major bleeding. All endpoints were used as per trial defined and should be evaluated in 12-months. The effect of different DAPT regimens was assessed by calculating the risk ratio (RR) with 95% confidence intervals (CIs), using a random-effects model (Mantel-Haenzel).

Results
A total of eight studies and 46,476 patients were included; women were underrepresented being only the 26% (N=12,063) of the total participants. MACE did not differ significantly in the two arms in the total sample (RR: 0.94, 95%CI: 0.86-1.04); however, they were significantly reduced in women treated with S-DAPT (RR: 0.82, 95%CI: 0.70-0.97) (p-interaction: 0.049). (Figure 1) S-DAPT was associated with a significant reduction in both NACE (RR: 0.91, 95% CI: 0.85-0.99) (Figure 2A) and major bleeding (RR: 0.73, 95% CI: 0.57-0.95) (Figure 2C) in the total sample, without significant differences between male and female patients (p-interaction: 0.14 and 0.053, respectively). All-cause mortality (RR: 0.86, 95%CI: 0.73-1.01) (Figure 2B) and myocardial infarction rates (RR: 1.03, 95%CI: 0.86-1.24) (Figure 2D) were similar in both S-DAPT and L-DAPT in the total sample, without any significant subgroup differences (p-interaction: 0.13 and 0.051, respectively).

Conclusions
Shortened duration of DAPT significantly decreased MACE in women, in contrast with male patients, showing that women may benefit from abbreviated duration of DAPT. Further studies specifically investigating the optimal duration of DAPT in women are warranted and a sex-based approach could be considered in the management of antiplatelet treatment after PCI.A. NACE B. Mortality C. Bleedings D. MI
Shortened versus standard duration of dual antiplatelet treatment after percutaneous coronary intervention in patients with and without chronic kidney disease: a systematic review and meta-analysis
Authors: Apostolos A , Bozika M , Nastouli K M , Papafaklis M , Karanasos A , Koros R , Theofilatos A , Toutouzas K , Davlouros P , Tsigkas G 
Published: October 2024

Abstract

Background
Impaired renal function is an established risk factor for recurrent cardiac events. The severity of chronic kidney disease (CKD) is related with an increased risk for both ischemic and bleeding complications. As a result, the clinical implications of antithrombotic therapies may be different in patients with CKD as compared to those without. Recently, shortened duration of DAPT, namely one to three months, after percutaneous coronary intervention (PCI) has been proven as a safe and feasible strategy in various different clinical scenarios, like in high-bleeding risk patients, in acute coronary syndromes and complex PCI. However, it remains debatable whether DAPT should be shortened in patients with high ischemic and bleeding risk, such as those with CKD.

Purpose
The aim of our systematic review and meta-analysis is to explore the safety and efficacy of shortened therapy (1-3 months; S–DAPT) in patients without and without CKD undergoing PCI.

Methods
Three major databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Scopus) were screened for eligible randomized – controlled trials, or subgroup or post – hoc analyses of them. The studies should compare shortened (S–DAPT) with longer (&gt;3 months) DAPT (L–DAPT) in patients undergoing PCI, and include data on CKD presence. The endpoints were Net Adverse Clinical Events (NACE) and Major Adverse Cardiac Events (MACE) and should be evaluated at 12 months. NACE and MACE were used as per trial defined. The effect of different DAPT regimens was assessed by calculating the risk ratio (RR) with 95% confidence interval (CI) using random-effects model (Mantel-Haenzel).

Results
A total of eight studies and 56,660 patients were included in our analysis; a notable proportion of patients (9.7%, N=5,466) suffered from CKD. Our analysis showed an overall benefit of S-DAPT in NACE (RR: 0.88, 95%CI: 0.81 – 0.95), which was consistent in patients with and without CKD (p-interaction=0.58). (Figure 1) No significant difference regarding MACE was observed between S-DAPT and L-DAPT (RR: 0.98, 95%CI: 0.90 – 1.06) in both patients with and without CKD (p-interaction=0.19). (Figure 2)

Conclusions
Our analysis showed an overall benefit of S-DAPT in NACE without any difference in MACE, with similar findings among patients with and without CKD. Thus, DAPT shortening could be a feasible and safe approach when it is required, even in patients with impaired renal function. Further randomized controlled trials focusing on patients with CKD are required for validating the previous results and exploring further benefits of abbreviated duration of DAPT.Net adverse clinical eventsMajor adverse cardiac events
Prediction of QT interval in ECGs through baseline wander removal and deep learning technique
Authors: Kim Y R , Lee S , Park J , Yang H J 
Published: October 2024

Abstract

Background
In electrocardiograms (ECGs), the QT interval, calculated from the onset of the Q-wave to the end of the T-wave, reflects the repolarization status of the heart. Currently, the QT interval automatically measured in 12-lead electrocardiograms is inaccurately derived as the median value, rather than utilizing the more precise mean value of QT intervals from all leads. This approach fails to provide information on heterogeneous QT prolongation crucial for predicting arrhythmias, as it does not accurately represent the values of QT intervals in each lead.

Purpose
Traditional analysis of ECGs based on QT intervals necessitates direct interpretation by cardiologists, leading to potential errors in diagnosis. In response to this challenge, we present a model that integrates low-pass filtering and continuous wavelet transformation to eliminate baseline wander noise occurring during ECG measurements. Moreover, to account for temporal features, we incorporate Convolutional Neural Networks (CNN) and Bidirectional Long Short-Term Memory (Bi-LSTM) to estimate QT intervals.

Methods
The dataset used in this study was the QT Database, comprising ECG data for 105 patients recorded at a sampling rate of 250Hz over a duration of 15 minutes. Each ECG was associated with annotations for two leads and information regarding the P, QRS, and T waves. We structured the dataset into a ratio of approximately 8:1:1, resulting in 51 patients for training (15,490 samples), 6 patients for validation (1,564 samples), and 7 patients for testing (1,682 samples).

Results
For the evaluation of deep learning, we selected Accuracy and F1-Score as metrics. We experimented with two configurations: the proposed model with two Bi-LSTM layers and an alternative with a single Bi-LSTM layer of 100 units. We also tested a similar recurrent neural network, GRU, with the same unit configuration. The results indicated that the method with two Bi-LSTM layers outperformed others in both Accuracy and F1-Score.

Conclusion
By incorporating CNN and Bi-LSTM, we conducted QT interval estimation, leveraging temporal features. This methodology facilitated the elimination of diverse noise types during ECG measurements, resulting in enhanced accuracy for QT interval estimation through the consideration of temporal ECG characteristics. In our future research endeavors, we plan to deploy this model for predicting arrhythmias, specifically targeting conditions like long QT syndrome and drug-induced QT prolongation.Methods and result
Health literacy in adult cardiac surgery patients; a multi-site Australian study
Authors: Wynne R , Mctier L , Rowe C , Abbs M , Kerr D 
Published: October 2024

Abstract

Background
Almost 60% of Australians report low levels of health literacy (HL). International evidence indicates limited comprehension of the risks and benefits of cardiac surgery, in addition to understanding the basic elements of informed consent.

Purpose
The aim of this study was to explore HL in adult cardiac surgical candidates.

Methods
We recruited consecutive English speaking adult patients from a major public (Site 1), major private (Site 2) and regional hospital (Site 3) in Victoria, Australia. Prior to discharge, a Registered Nurse conducted a semi-structured interview using the Health Literacy Questionnaire (HLQ). The HLQ is a multidimensional validated instrument comprised of 9 independent scales. Data were analysed using descriptive statistics, t-tests and ANOVA.

Results
We recruited 164 (29.5%) eligible participants from; Site 1 (63, 32.1%), Site 2 (49, 19.3%) and Site 3 (52, 49.5%) respectively. Average age was 64.6 (SD 11.8), most participants were male (n = 134, 81.7%), few lived alone (n = 28, 17.1%), 122 (74.4%) identified as being Australian 5 (4.1%) of whom were indigenous and 9 (5.5%) spoke a language other than English at home. The majority of participants highest level of education was aligned with a trade certificate (n = 48, 29.3%) or not completing high school (44, 26.8%) and most were retired (n = 68, 41.5%), working full time (n = 51, 31.1%) or part time (n = 24, 14.6%). Less than half had private insurance (n = 72, 43.9%), more than half had presented to emergency (n = 87, 53.0%) in the previous 12 months and a history of cardiac complaints (n = 137, 83.5%) was as expected. In this study participants felt understood and supported by healthcare providers (Scale 1 M 3.32, SD 0.26), had sufficient information to manage their health (Scale 2 M 3.13, SD 0.35), proactively managed their health (Scale 3 M 2.98, SD 0.39), had strong social supports (Scale 4 M 3.31, SD 0.36), could appraise health information (Scale 5 M 2.88, SD 0.49) and were proactively engaged (Scale 6 M 4.00, SD 0.50). More challenging was their ability to advocate on their own behalf (Scale 7 M 3.80, SD 0.60), to explore information (Scale 8 M 3.70, SD 0.60) and to understand all written information (Scale 9 M 3.90, SD 0.60). Site 2 participants were highly educated, less likely to live alone, more likely to have private insurance, had fewer emergency presentations and higher scores on scales 6 to 9 (p &lt; 0.05) that measure health care interactions, than those from Site 1 or 3.

Conclusions
There was a high level of HL in this cohort and findings indicate patient strengths in relation to HL differed according to site. In measuring individual skills and experience of participants interacting with services, systems and the health care environment this study provides valuable insight into HL levels in cardiac surgery candidates.
Risk factors for delirium in patients aged 60 years and over with recent myocardial infarction
Authors: Niemiec M , Burchacka A , Baranski K , Bednarek A , Banka P , Mecka K , Mizia-Stec K 
Published: October 2024

Abstract

Introduction
Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem. Modifiable and unmodifiable risk factors may influence delirium appearance.

Purpose
The study aimed to assess the prevalence and characteristic of delirium risk factors in patients ≥ 60 years of age hospitalized due to acute myocardial infarction (AMI).

Methods
The study included 405 consecutive patients (mean age: 73.1[8.5], males: 248/61.2 %) hospitalized due to AMI divided and characterized according to the in-hospital delirium presence. The following sets of data were analysed: demographic data, length of hospitalization, type of AMI, coronary intervention, multimorbidity, accompanying symptoms, psychiatric conditions, and pharmacotherapy used.

Results
Of 405 patients, 57 (14%, mean age: 80.9[7.3] years, males: 33/58%) experienced delirium. Patients with delirium were older (80.9[7.3] vs 71.82[8.1] years), all of them presented multimorbidity, they more frequently used polypharmacy (96.5 vs 30.2%) and their hospitalization was longer (8.0[1.4] vs 4.6[1.0] days) as compared to the patients without delirium. Patients with delirium more frequently experience in-hospital reversible problems: periprocedural complications (limited number of radial access, prolonged compression and pain after the procedure, pseudoaneurysm of femoral artery, as well as the following accompanying symptoms: fever (40.4% vs 0.9%), infections (78.9% vs 3.7%), pulmonary oedema (73.7% vs 0.6%), hypoxemia (91.1% vs 98.3%), urinary catheter (96.5% vs 17.2%), dehydration (89.5% vs 6.6%), and insomnia (71.9% vs 0.3%) compared to patients without delirium (Table 1). Delirium was also associated with mild (49.1% vs 0.3%, p&lt;0.0001) and moderate (47.4% vs 9.2%) dementia and symptoms of mild depression (59.6% vs 2.3%) (P&lt;0.0001 for all).
Valvular heart disease (OR=4.78; 95%CI: 1.10-2.70; p&lt;0.0001, pulmonary oedema (OR=66.79; 95%CI: 12.04-370.34, p&lt;0.001), and dehydration (OR=37.26; 95%CI: 10.50-132.27, p&lt;0.001) were risk factors for delirium occurrence. Analysis of all factors related to delirium revealed that the coexistence of ≥ 11 concerned 44% of the delirium population (Table 1).

Conclusions
The in-hospital course of AMI is complicated by delirium occurrence in 14% of patients ≥ 60 years old. Multimorbidity and polypharmacy regard most of the subjects with delirium. The potent reversible complications of the in-hospital course of AMI associated with delirium should be recognized and limited to prevent this problem.Table1.Number of delirium risk factors.
Does perceived usability of a multi-component mobile device intervention improve health-related quality of life?
Authors: Candelaria D , Serafica R , Reyes A T , Cacciata M , Sta Maria A , Lee J A , Stromberg A , Evangelista L S 
Published: October 2024

Abstract

Background
Good health-related quality of life (HRQL) is essential to healthy aging. Prior studies have demonstrated that mobile device technologies can promote HRQL in older adults. However, evidence of technology acceptance in older adults is often inconsistent and poorly understood.

Purpose
This study aims to 1) describe technology acceptance using efficiency, learnability, user experience (i.e., acceptability), and perceived control from the USABILITY survey of a multi-component mobile device intervention consisting of a wearable activity tracker (Fitbit Versa), access to Lose It app, and text messages (for experimental group only) in older adults at risk for cardiovascular disease, and 2) examine the correlation between technology acceptance and changes in HRQL before and after using each component of the digital intervention.

Methods
Data were collected using a purpose-built technology usability survey, and HRQL was assessed using the 12-Item Short Form Survey (SF-12), which measured perceived physical and mental health. Correlations were used to identify associations between technology acceptance and HRQL.

Results
The mean age of participants (n=54) was 65.4 ± 6.0 years; a majority were females (60%), married (53%), Hispanic (66%), and had a high school education or higher (76%). Table 1 shows that the experimental group had considerably higher HRQL at three months, but no differences in technology acceptance were noted. Fitbit technology adoption was found to be correlated with physical HRQL (r=304, p=0.027). The Lose It app showed no correlation with HRQL. Despite receiving higher usability ratings, SMS messages were not correlated with physical or mental HRQL.

Conclusion
Our findings demonstrate that older persons at risk for cardiovascular disease find mobile device intervention components acceptable. However, each component affected physical and mental health differently. These findings inform more complete technology acceptance models for older individuals' technology design, education, and deployment. Older persons prefer personalized communication, such as customized text messages, as the most favored aspect of the multi-component mobile device intervention. It warrants a larger clinical trial to determine its efficacy on HRQL.
Nurse led assessment of congestion in outpatient heart failure patients: remote dielectric sensing versus lung ultrasound comparison
Authors: Abbo A , Elad B , Moshe E I , Sabra O , Abboud A , Gepstein L , Caspi O 
Published: October 2024

Abstract

Introduction
Congestion stands as a primary driver behind exacerbating heart failure (HF), leading to hospitalizations and increased mortality rates. Despite the evident significance of congestion as a prognostic indicator, there exists a pressing need for a straightforward, trustworthy assessment method that caters to various healthcare providers' needs.

Aims
To assess the feasibility and compare the accuracy of nurse-led congestion assessment using radar based dielectric sensing (ReDS) to a "gold-standard" point of care assessment using lung ultrasound (LUS).

Methods
A retrospective analysis of consecutive patient visits at the ambulatory advanced HF clinic was used in which both exams (ReDS and LUS) were conducted. Study population included heart failure patients (Stage C, NYHA II-IV). ReDS, an objective non-invasive, transcutaneous measurement of lung fluid status, was assessed by HF nurse and LUS, evaluated using 6 measurement zones, was performed by HF cardiologist.

Results
During 17-month period and 174 clinic visits (103 patients), ReDS and LUS were recorded simultaneously. Mean ReDS reading was 33%±6% vs. mean LUS of 2.3±3.2 B-lines. Pearson correlation coefficient between the readings was moderate r= 0.41 (p&lt;0.05). For LUS cutoff of 3 B-lines, ReDS sensitivity was 55.5% and specificity was 70% (p&lt;0.01). ReDS negative predictive value (NPV) was 88% with positive predictive value (PPV) of 27%. ReDS overall accuracy was 68%.

Conclusion
Despite its low sensitivity, nurse-led ReDS assessment is feasible and possess a relatively high NPV allowing to rule out congestion at point-of-care. The simplicity of use empowers more health providers to assess congestion.