bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between life's essential 8 score and 5-year all-cause and cardiovascular mortality in people with prediabetes: based on a cohort study
Authors: Li X , Chen Y , Liu B , Liu B , Lu L , Guo R 
Published: October 2024

Abstract

Background
The Life's Essential 8 (LE8) score, which evaluates cardiovascular health (CVH) status, is linked to premature mortality in individuals with diabetes. However, the relationship between LE8 score and the risk of all-cause and cardiovascular mortality in individuals with prediabetes remains unclearly.

Purpose
This study aims to investigate the association between LE8 score and both all-cause and cardiovascular mortality among prediabetic patients within the United States population.

Methods
Our retrospective cohort study was based on the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2016. We selected prediabetic patients with blood glucose levels between normal and type 2 diabetes range from this database. The CVH status of these patients was categorized into low group (0-49), medium group (50-79), and high group (80-100) based on the LE8 score, which was assessed on a scale of 0 to 100. We constructed a multivariable Cox proportional hazards model to explore the relationship between LE8 score and mortality, and used restricted cubic spline curves to assess their non-linear correlation. Additionally, we conducted stratified analyses by age, gender, BMI, comorbid hypertension, and ASCVD in different populations to investigate the association between LE8 score and mortality.

Results
This study enrolled a total of 4,912 individuals with prediabetes (577 with low LE8 scores, 3,549 with medium LE8 scores, and 786 with high LE8 scores). Compared to the other groups, prediabetic patients with high LE8 scores exhibited younger age, lower BMI levels, a smaller proportion of Non-Hispanic Black individuals, higher education levels, and fewer clinical comorbidities. After adjusting for covariates using Cox proportional regression risk models, we observed that a low LE8 score was significantly associated with an increased rate of cardiovascular mortality (HR 4.13; 95% CI = 1.16-14.72) and all-cause mortality (HR 3.42; 95% CI = 1.73-6.74) in prediabetic patients. Restricted cubic splines demonstrated a linear trend between high LE8 scores and decreased risks of all-cause and cardiovascular mortality (P&gt;0.05). Stratified analysis indicated that compared to the group with high LE8 scores, the group with low LE8 scores had a significantly higher risk of death within subgroups defined by age (≥65), gender, BMI&lt;30, presence of hypertension, and absence of ASCVD.

Conclusions
In the American population, as the LE8 score increases, the risk of all-cause and cardiovascular mortality decreases for individuals with prediabetes over a 5-year period. Maintaining an ideal LE8 score will provide long-term benefits for individuals with prediabetes.Cox proportional regression modelRestricted cubic spline curves
Type 2 diabetes rather than the presence of significant coronary stenoses is associated with quality of life in angiographied coronary patients
Authors: Ratz M , Vogel J , Elsner P , Plattner T , Vonbank A , Mader A , Larcher B , Leiherer A , Muendlein A , Frick M , Drexel H , Saely C H 
Published: October 2024

Abstract
Chronic medical conditions such as type 2 diabetes (T2DM) or coronary artery disease (CAD) and their treatment have a crucial impact on patients’ daily life. The EQ-5D-5L questionnaire is a validated and widely used tool to measure the health-related quality of life (HRQL). We investigated and compared the HRQL in patients with or without T2DM and CAD.
We included 481 consecutive patients undergoing coronary angiography for the evaluation of established or suspected stable CAD in a tertiary care setting in Central Europe. Patients’ HRQL was measured using the EQ-5D-5L, comprising the EQ index calculated from the domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.
A response rate of 88.1% was achieved. From our patients, 166 (34.5%) had T2DM according to ADA criteria, and 254 (52.8%) had significant CAD with stenoses ≥50% at angiography. Patients with T2DM showed significantly lower EQ index values than patients without T2DM (0.891 [IQR=0.783-0.970]) vs. 0.943, [IQR=0.861-1.0], p=0.002)). Regarding the different dimensions of the questionnaire, patients with T2DM reported to have significantly more problems with anxiety and depression (p=0.002) and mobility (p&lt;0.001) than non-diabetic patients. EQ index values in contrast did not differ significantly between patients with vs. those without significant CAD. Accordingly, in analysis of covariance T2DM (F=7.38, p=0.007) but not significant CAD (F=1.74, p=0.183) predicted EQ index values after adjustment for age, sex and body-mass-index.
We conclude that T2DM rather than the presence of significant CAD is associated with quality of life in angiographied coronary patients.
How can the detection of AF be improved? Insights from patient journeys and primary care clinicians
Authors: Apenteng P , Nanton V , Lobban T , Lilford R 
Published: October 2024

Abstract

Background
Atrial fibrillation (AF) is underdiagnosed and it is estimated that a third of people with AF remain undiagnosed. AF is complex to detect because it can be intermittent and some patients are asymptomatic. When symptoms are present they can be non-specific. In the absence of a screening programme to detect AF it is important to identify ways to improve its detection of AF in order to reduce the risk of AF-related stroke.

Purpose
We conducted a qualitative study in primary care to explore the patient path to diagnosis of AF and identify ways to improve detection

Methods
We recruited patients with a recent diagnosis of AF (&lt; 6 months) and interviewed them to understand their path to diagnosis. We interviewed GPs and practice nurses to explore their experience of detecting AF in primary care. The interviews were audio-recorded and transcribed, and the data were analysed using framework analysis.

Results
Thirty patients and ten primary care clinicians were interviewed. The presence and nature of symptoms experienced by patients and how they interpreted these were significant in the pathways to diagnosis. Patients with acute symptoms presented to A &E and had a quick diagnosis while asymptomatic patients were diagnosed incidentally. Patients with non-specific symptoms generally did not perceive the symptoms as serious, and many delayed seeing a healthcare professional. Their experiences in primary care aligned with findings from interviews with primary care clinicians, who acknowledged AF may not necessarily be the initial suspicion when a patient presents with certain non-specific symptoms. Primary care clinicians described narratives of good practice in the form of opportunistic pulse palpation, as well as challenges of detecting AF in primary care. These included lack of access to 24-hour ambulatory ECG in primary care and limited opportunities to detect AF due to healthcare assistants taking on more responsibilities.

Conclusions
A number of opportunities to improve the detection of AF can be drawn from these findings. Public education about AF, its signs and symptoms would increase patient knowledge and presentation to healthcare professionals. Standardizing good practice of opportunistic pulse palpation in primary care and training healthcare assistants to perform this is also indicated. Access to 24-hour ambulatory ECG in primary care will reduce delays in diagnosis. Further research on which patients are likely to have undiagnosed AF will facilitate detection in primary care.
Prevecardio: a single-visit population screening model for detection and prevention of 10-year cardiovascular risk
Authors: Flores Soler J , Vila Costa I , Bengoa Terrero C , Fernandez Perez C , Garcia Gonzalez F , Bas Villalobos M , Perez-Villacastin Dominguez J , Villares J 
Published: October 2024

Abstract

Introduction
Cardiovascular diseases (CVDs) are a major contributor to global mortality. The early detection of cardiovascular risk factors, coupled with timely intervention strategies, is essential for CVD prevention. PreveCardio was developed as an innovative, single-visit population screening model designed to facilitate the early identification and management of cardiovascular risk factors within a population of 1 million in a European capital city region totaling 6 million inhabitants.

Purpose
This study aimed to ascertain the prevalence of cardiovascular risk factors within the general population and to evaluate the effectiveness of the PreveCardio model in estimating 10-year cardiovascular risks and promoting preventive interventions.

Methods
In this cross-sectional prevalence study, individuals aged 50 to 75 from a health network were randomly selected and invited to participate in a comprehensive health check. The 30-minute screening consisted of lifestyle evaluations, anthropometric measurements, and blood tests for lipid profiles and glycated haemoglobin. The methodology was designed to provide participants with immediate feedback on their results, cardiovascular health and practical guidance for risk management.

Results
From the 8,492 individuals solicited, 3,546 took part in the screening: 56,83% were female, mean age 61,17 ± 7,33 y.o. Picture 1 shows the population's percentages with various modifiable cardiovascular risk factors, including 20% with active smoking, 30% with sedentarism, 16% with risky alcohol consumption, 49% with non-adherence to the Mediterranean diet, 40% with overweight, and 30% with obesity. The screening revealed new diagnoses of LDL-hypercholesterolemia in 47% participants, high levels of blood pressure in hypertension range in 49%, prediabetes in 30% and diabetes in 2% (Picture 2). After use SCORE2 and SCORE-OP risk prediction algorithms, PreveCardio is estimated to potentially prevent between 39 to 202 fatal and non-fatal cardiovascular events over 10 years. Predictive modelling based on PreveCardio data projected that expanding the screening across the capital region could prevent at least 26,260 cardiovascular events over 10 years.

Conclusion(s)
PreveCardio has established itself as a viable and effective model for the early detection of cardiovascular risk factors in a general population. It holds significant promise for public health impact by potentially reducing the incidence of CVD through comprehensive screening and proactive intervention.
Practicing what you preach. Do cardiology trainees in the United Kingdom follow the lifestyle advice that they would give to patients?
Authors: Jenner W , Brown O I , Camm C F 
Published: October 2024

Abstract

Background
The role of lifestyle factors in determining the risk of cardiovascular disease is well established. As a result, lifestyle modification is recommended as part of numerous European Society of Cardiology guidelines. However, it remains uncertain how closely cardiologists adhere to guidelines in their personal life. Poor lifestyle among clinicians can contribute to poor health and may increase absenteeism and potentially reduce the quality of patient care.

Purpose
To establish whether cardiology trainees in the UK follow appropriate guideline-directed lifestyle advice in their personal life.

Methods
All cardiology trainees within the UK were eligible to participate in the 2023 British Junior Cardiologists' Association (BJCA) training survey and the survey was advertised through national and local campaigns. The survey contained questions on smoking status, alcohol intake, healthy diet, partaking in regular exercise, frequency of adequate quality of sleep, and demographic questions. Responders were eligible for inclusion if they consented to participate in health and wellbeing survey questions, and if they had completed four demographic questions.

Results
Of the 398 responders to the 2023 BJCA survey, 212 consented to answer health and wellbeing questions (66% male, age 34±4 years, 42% had dependents) and were included. Responders included trainees representing all four UK nations. Very few cardiology trainees were current smokers either of cigarettes/cigars (n=2, 1%), or e-cigarettes (n=2, 1%), with 12 (6%) being ex-smokers. Few trainees (n=13, 6%) consumed alcohol above the UK recommended maximum of 14 units per week (Fig 1A). However, only 14% (n=29) regularly achieved 30 minutes of moderate or 15 minutes of intense exercise on at least 5 days each week (Fig 1B). Most trainees (n=167, 80%) only obtained adequate sleep on four or fewer nights each week (Fig 1C). Only 37% (n=78) of trainees agreed or strongly agreed that they were able to maintain a healthy diet most days (Fig 1D).

Conclusions
Most UK cardiology trainees followed guidance related to smoking and alcohol intake. However, far fewer trainees followed healthy lifestyle guidance relating to exercise, sleep, and diet. Whether these findings are similar across other ESC nations should be investigated. Further work is required to establish the impact of healthy living on clinician working activity and subsequent quality of patient care. Training bodies should consider how occupational factors may contribute to a trainee’s adverse healthy living.
Association between wearable activity trackers usage and levels of physical activity among Athens Medical Society members
Authors: Lampsas S , Marinos G , Lamprinos D , Sarantos S , Gounaridi M I , Goliopoulou A , Pantelidis P , Theofilis P , Anastasiou A , Gialamas I , Kalogera S , Pililis S , Katsarou O , Siasos G , Oikonomou E 
Published: October 2024

Abstract

Introduction
Wearable Activity Trackers (WAT) provide real-time feedback on activity levels and play a pivotal role in fostering an active lifestyle. Moreover, WAT can encourage doctors’ awareness to be more conscious of their daily physical activity whose exercise habits range between different medical specialties.

Purpose
The aim of this study is to evaluate the influence of WAT usage on physicians’ exercise habits according to the recommendations of ESC Guidelines.

Methods
This cross-sectional study comprised 742 physicians of the Athens Medical Society (AMS), Greece. The study instrument was a self-administered questionnaire mailed in October 2023 to evaluate physicians’ usage of WAT, baseline characteristics of population, specialty, and physical exercise habits. European Society of Cardiology (ESC) Guidelines recommend at least 150 min/week of moderate-intensity exercise in all healthy adults. Subjects were divided in two groups according to their usage of WAT or not in their everyday life: 1. Daily usage of WAT (Group A); 2. No regular or even on usage of WAT (Group B).

Results
A considerably high proportion of the total population use WAT daily (38%). Between Group A and Group B there was no difference in age (49±12 years vs. 51±13 years, p=0.07), male sex prevalence (55% vs. 49%, p=0.08) and BMI (25.7± 4.6 kg/m2 vs. 25.2± 4.1 kg/m2, p=0.11). Interestingly, there was statistically significant difference in mean exercise endurance training time between Group A and Group B (301±304 min. vs. 209±268 min., p&lt;0.001) (Figure 1) and in the proportion of the doctors who follow the ESC Recommendations (63.5% vs. 47.2%, p&lt;0.001). Furthermore, most of the physicians who use WAT have awareness for ESC Guidelines (59% vs. 47%, p&lt;0.001), and most of them apply diet to lose weight (36% vs. 29%, p=0.04). Finally, WAT were mostly used by 4 main specialties: Cardiology (47%), Endocrinology (44%), Surgery (35%) and Internal Medicine (25%), with cardiologists reporting the higher use (p=0.045).

Conclusion
This study underscores the widespread adoption of WAT among physicians, highlighting their potential to positively influence exercise habits and adherence to ESC Guidelines. Physicians using WAT demonstrated increased exercise endurance training time, greater awareness of ESC Guidelines, and a higher propensity to implement weight loss diets compared to non-users. Additionally, variations in WAT usage and awareness of ESC Guidelines across medical specialties emphasize the need for targeted interventions to promote physical activity and enhance overall health among healthcare professionals.
Economic evaluation of fractional flow reserve-guided versus intravascular ultrasound-guided percutaneous coronary intervention
Authors: Wang J , Hu X , Zhao T , Zhang J , Fu Z 
Published: October 2024

Abstract

Background
The randomized, controlled FLAVOUR trial demonstrated that the clinical outcomes of the fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) strategy were non-inferior to the intracoronary ultrasound (IVUS)-guided PCI strategy.

Purpose
This study aimed to compare the difference in economic implications and health-related quality of life between the two strategies.

Methods
A total of 890 patients with intermediate stenosis in 9 sites in China from the FLAVOUR trial were included. Direct medical costs were calculated using a combination of resource-based and event-based methods. Health utility was defined as quality-adjusted life years and assessed based on the 19-item Seattle Angina Questionnaire. The primary analysis was a cost-utility analysis. Probabilistic sensitivity, one-way sensitivity, and subgroup analyses were performed.

Results
At two years, the average total cost per patient was Chinese yuan (CNY) 36,287±19,531 in the IVUS-guided group and CNY 29,237±19,239 in the FFR-guided group (ΔIVUS-FFR=CNY 7,050, p&lt;0.001). The difference was driven primarily by the cost of initial admission (ΔIVUS-FFR=CNY 6,284, p&lt;0.001). Quality-adjusted life years gained showed no significant differences between the two groups (FFR vs. IVUS: 1.639±0.086 years vs. 1.638±0.128 years, p=0.872). The probabilistic sensitivity and one-way sensitivity analyses revealed robust results. The subgroup analysis found that the cost reductions attributed to FFR guidance decreased in several subgroups, including patients with diabetes and those with high anatomical complexity.

Conclusions
In patients with intermediate stenosis, FFR-guided PCI is associated with significant cost savings compared with IVUS-guided PCI at two years and shows no differences in health-related quality of life outcomes.Central Illustration
Implementing dynamic atrioventricular delay optimization for cardiac resynchronization therapy: an economic analysis in the EU5 countries
Authors: Kellmann T , Bozzari I , Furneri G , Vincenzi L , Gennaro D , Ihara Z 
Published: October 2024

Abstract

Background
Heart failure (HF) poses an escalating public health challenge, contributing significantly to patient morbidity, mortality and healthcare expenditures [1,2]. Cardiac resynchronization therapy (CRT) is a well-established intervention that improves functional capacity and enhances quality of life while mitigating symptoms, hospitalizations, and mortality in HF patients [3]. Nevertheless, the reaction to CRT varies among individuals; some experience positive responses and others show resistance to the therapy, with unfavourable outcomes and increased healthcare costs [4]. The introduction of the dynamic atrioventricular (AV) optimization algorithm aims to enhance CRT response by enabling dynamic optimization of the AV delay [4].

Purpose
Despite the strong clinical evidence supporting the effectiveness of dynamic AV optimization algorithm, a comprehensive assessment of its economic implications is still lacking. This study aims to evaluate the economic impact of activating dynamic AV optimization algorithm in patients undergoing CRT treatment across the Big 5 European countries (EU5; France, Germany, Spain, Italy, and the UK).

Methods
The study examines two scenarios over a 3-year timeframe: a) current scenario, where dynamic AV optimization algorithm activation is limited to a small segment of the population, and b) future scenario, where dynamic AV optimization algorithm activation is progressively expanded per year from 15% to 50%. Treatment efficacy data, measured in terms of HF hospitalization and mortality rates, were sourced from Varma et al. studies [1,4]. Hospitalization and mortality costs were extracted from national DRG tariffs and relevant literature [5–14]. It is important to note that there is no additional cost for algorithm activation if the device is already equipped with it.

Results
In this hypothetical analysis of 1,000 patients, around 30% undergo CRT implantation compatible with dynamic AV optimization algorithm activation. The treatment cost of patients with the algorithm ON is reduced by -15% compared to patients with the algorithm OFF, considering a weighted average across the EU5 countries (France: -11%, Germany: -16%, Italy: -14%, Spain -17%, UK: -16%), as shown in Table 1. The steady increase in algorithm activation led to an annual expenditure reduction equal to €21,109, calculated on the weighted average across the EU5 countries (France: €15,549, Germany: €33,753, Italy: €13,844, Spain: €20,385, UK: £13,423). When compared to the current scenario, the future scenario saved €36,468 on average across the EU5 countries. Further country-specific cost savings are shown in Table 2.

Conclusion
The conducted economic analysis gives confidence in dynamic AV optimization algorithm, positioning it as a valuable and economically sustainable asset for enhancing CRT treatment outcomes in patients with HF.