bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined sodium-glucose-transporters inhibitors (SGLT2i) and glucagon-like-peptide receptor agonist (GLP1ra) compared with SGLT2i or GLP1ra alone improves survival: a Real-World Registry
Authors: Garcia Vega D , Cinza-Sanjurjo S , Eiras S , Gonzalez-Juanatey J R 
Published: October 2024

Abstract

Background
Prior clinical trials found diabetic patients, after being treated with SGLT2i (sodium-glucose-transporters inhibitors) and/or GLP1ra (glucagon-like-peptide receptor agonist), had lower rates of cardiovascular (CV) complications. But there is poor evidence of the additive benefits of combined therapy in the general population.

Purpose
This study sought to determine if the combined therapy reduced the major CV complications or all-cause of death in comparison with SGLT2i or GLP1ra alone in a health area.

Methods
This is a retrospective observational study of patients who were prescribed with an SGLT2i, GLP1ra or both between January 1st 2018 and 30th June 2022 from one healthcare area that includes primary care centres and hospitals. They were followed up until 31st October 2022. The primary outcomes were the combined incidence of hospitalisation or/and death for heart failure (HF), coronary artery disease (CAD), cerebrovascular accident (CVA) and all-cause mortality. Sex, age, glucose lowering drugs (GLD) (and duration), diabetes (and duration), arterial hypertension (HBP), dyslipidemia (DLP), CAD, HF, atrial fibrillation (AF) and CVA were included on a Cox regression analysis for determining the main predictors for each outcome.

Results
We have included 15.549 patients with/out CVD who were prescribed GLD from 2018. The population was represented by 97% with T2DM, 46% with obesity, 71% with HBP, 59% with DLP, 15% CAD, 10% with HF, 12% with AF and 6% with CVA (Figure 1). The mean follow-up was 33 (19) months. The Kaplan Meier analysis determined that the cumulative risk for CAD and CVA events was similar among the 3 different therapy groups. However, the combined therapy reduced the risk for HF events (HR: 0,771 [95% CI: 0,612-0,970]) or all-cause mortality (HR: 0,255 [95% CI: 0,325-0,414]) (Figure 2a, 2c). The multivariate Cox regression analysis showed that combined therapy, treatment duration and DLP were associated with a significant reduction in HF and all-cause mortality events; while age, sex (male), CAD, HF and AF increased them (Figure 2b, 2d).

Conclusions
Compared with SGLT2i or GLP1ra alone, combined therapy SGLT2i + GLP1ra reduces HF risk and all-cause mortality in a real-world population.Figure 1Figure 2
The potential protective effect of dapagliflozin on the development of cardiotoxicity in cancer patients after one year of observation
Authors: Maragkoudakis S , Marketou M , Sideras M , Stratinaki M , Mavroudeas E S , Emiri F , Lilikaki G K , Tsakonas Dervakos N , Kafkala K 
Published: October 2024

Abstract

Introduction
Despite the widespread use of anthracyclines (ANT) and anti-HER2 agents as trastuzumab (TZB) in chemotherapy schemes, it is known the potential cardiotoxic effects that can limit the intensity and duration of treatments. The clinical trial "DECLARE-TIMI 58" (Dapagliflozin Effect on Cardiovascular Events-Thrombolysis in Myocardial Infarction 58), demonstrated that dapagliflozin, a Sodium glucose cotransporter 2 inhibitor, reduces the composite end point of cardiovascular death/hospitalization for heart failure in a broad population of patients with type 2 diabetes mellitus.

Purpose
We aimed to study if dapagliflozin could exerts cardioprotective effects in anthracycline, carfilzomib and trastuzumab-induced cardiotoxicity through the analysis of ejection fraction (LVEF), global longitudinal strain (GLS) of both left and right ventricle, E/A ratio, E/e’ ratio, left atrium diameter, BNP/NT-pro-BNP and troponin I.

Methods
32 diabetic patients were randomized (16 dapagliflozin;16 placebo). The groups were well-matched for baseline characteristics (age, diabetes duration, HbA1c, renal and heart function as well as chemotherapeutic agents ). Our patients who were diagnosed with cancer at our medical center, receiving potentially cardiotoxic treatment: 52% were treated with only trastuzumab, 34% were treated with only anthracycline and 14% carfilzomib. The primary endpoint was the development of cardiotoxicity after treatment with chemotherapy. Cardiotoxicity was defined as a decrease of LVEF by 5% or more to less than 55% in the presence of symptoms of heart failure or an asymptomatic decrease in LVEF by 10% or more to less than 55%.

Results
In the first year of observation patients treated with dapagliflozin didn’t show any deterioration of LV GLS (¬19.8±2.8 vs ¬19.3±4.1%, p=0.403) There was no change in LVEF (57.8±4.9% vs 59±6.8%) and GLS of right ventricle (20.3±2.8% vs 20.0±3.6%). Conversely, patients treated with placebo, presented a significant impairment of LV GLS (¬20.8±2.1% vs ¬18.5±2.2%, p=0,001) while a borderline deterioration of EF was noticed after treatment with placebo(60±5.4 vs 56.7±6.7%, p=0,045).

Conclusions
At the best of our knowledge, our study is the first to investigate the prophylactic use of dapagiflozin in the development of non-ischemic cardiomyopathy in diabetic patients receiving anthracycline or trastuzumab,carflilzomib therapies. Treatment with dapagliflozin prevented deterioration of myocardial function and preserved ejection fraction
P2Y12 inhibitor monotherapy after short DAPT in acute coronary syndrome: a systematic review and meta-analysis
Authors: Galli M , Laudani C , Occhipinti G , Spagnolo M , Gragnano F , D'amario D , Navarese E P , Mehran R , Valgimigli M , Capodanno D , Angiolillo D J 
Published: October 2024

Abstract

Background
P2Y12 inhibitor monotherapy after a short course of dual antiplatelet therapy (DAPT) has been proposed as an alternative to standard 12-month DAPT for balancing ischemic and bleeding risks in patients with acute coronary syndrome (ACS). However, it remains uncertain how different P2Y12 inhibitors used as monotherapy affect outcomes.

Purpose
To explore the clinical impact of different P2Y12 inhibitors as monotherapy versus standard 12-month DAPT.

Methods
Randomized controlled trials (RCTs) comparing P2Y12 inhibitor monotherapy after a short course of DAPT (≤3 months) versus standard 12-month DAPT in ACS were included. The primary endpoint was major adverse cardiovascular events (MACE). Secondary endpoints included single components of MACE, net adverse clinical events (NACE), any bleeding, and major bleeding. All analyses were run according to the pre-specified subgroup based on the P2Y12 inhibitor used as monotherapy.

Results
Six RCTs including a total of 23,884 ACS patients were included. Mean DAPT duration in the monotherapy arm was 59 days. Compared with standard 12-month DAPT, P2Y12 inhibitor monotherapy after a short course of DAPT was associated with a significant reduction in any bleeding (odds ratio, OR, 0.55; 95% CI 0.44–0.70) and major bleeding (OR 0.48 95% CI 0.36–0.62) without significant interaction for subgroup differences according to the P2Y12 inhibitor used. There were no differences in MACE (OR 0.92; 95% CI 0.74–1.15) or individual ischemic or mortality endpoints between P2Y12 inhibitor monotherapy and standard DAPT. However, there was a significant subgroup difference (pint=0.013) in MACE according to the agent used, with a reduced risk with ticagrelor (OR 0.82; 95% CI 0.69–0.97) but not with clopidogrel (OR 1.32; 95% CI: 0.94–1.84). Significant subgroup differences between ticagrelor and clopidogrel monotherapy were also found in all-cause death (pint=0.038), NACE (pint=0.030), and myocardial infarction (pint=0.015). Trial sequential analysis showed conclusive evidence of improved NACE with ticagrelor monotherapy, but not with clopidogrel monotherapy, compared with standard DAPT.

Conclusions
In patients with ACS, P2Y12 inhibitor monotherapy with either ticagrelor or clopidogrel after a short course of DAPT nearly halves bleeding compared with standard DAPT. Ticagrelor, but not clopidogrel monotherapy, reduced ischemic events and NACE compared with standard DAPT, supporting its use after aspirin discontinuation in ACS patients.
Vitamin C intake, psychological distress and health outcomes in patients with heart failure
Authors: Wu J , Kang J H , Lennie T A , Moser D K 
Published: October 2024

Abstract

Background
Patients with heart failure (HF) have lower dietary vitamin C intake than healthy adults, which may increase oxidative stress and worsen important patient-reported health outcomes (functional status and quality of life [QOL]). Patients with HF are more likely to have higher levels of psychological distress (anxiety and depressive symptoms). However, it is not known whether psychological distress is a link in the association of dietary vitamin C with health outcomes.

Objective
To examine the inter-relationships among dietary vitamin C intake, psychological distress (anxiety and depressive symptoms), and health outcomes (functional status and QOL) in patients with HF.

Method
We performed a secondary analysis of baseline data from 206 adults with HF (female: 33%, age: 61±12, NYHA class III/IV: 44%) with complete data on dietary vitamin C intake, anxiety, depressive symptoms, functional status, and QOL. Dietary vitamin C intake was assessed using a 4-day food diary and analyzed using the Nutrition Data System for Research software program. Low dietary vitamin C intake was defined as averaged daily intake below the estimated average requirement (EAR) from the Institute of Medicine of 75 mg/day for men and 60 mg/day for women. Anxiety was assessed using the Brief Symptom Inventory Anxiety subscale. Depressive symptoms were assessed using the Beck Depression Inventory II. Functional status was measured using the Duke Activity Status Index. Quality of life was measured using the Minnesota Living with Heart Failure Questionnaire. Linear regression was conducted using the PROCESS macro in SPSS.

Results
Eighty-four patients (41%) had low dietary vitamin C intake based on the EAR standard. In bivariate analyses, patients with low dietary vitamin C intake had higher levels of anxiety, depressive symptoms, poorer functional status, and worse QOL (all p &lt;.005). In the mediation regression model, low dietary vitamin C intake was directly associated with higher levels of anxiety, but not with depressive symptoms. Depressive symptoms were directly associated with functional status and QOL. Dietary vitamin C intake was not directly associated with functional status or QOL. Low dietary vitamin C intake was indirectly associated with poor functional status through higher levels of anxiety and depressive symptoms (Figure 1). Similarly, low dietary vitamin C intake was indirectly associated with worse QOL (Figure 2).

Conclusion
Anxiety and depressive symptoms link the relationship between dietary vitamin C intake and functional status and between dietary vitamin C intake and QOL. Our findings highlight the importance of including interventions to enhance diet quality and psychological well-being as part of HF treatment to improve health outcomes.Vitamin C and functional statusVitamin C and quality of life
Trends and predictors of cardiac rehabilitation referrals and participation in patients undergoing elective percutaneous coronary intervention
Authors: Chen Y , Marshall A , Wu C J , Hattingh L , Howes L , Jayasinghe R , Poulter R , Rahman A , Starmer G , Singbal Y , Yadav R , Smith I 
Published: October 2024

Abstract

Background
Research evidence shows that greater cardiac rehabilitation (CR) referrals and participation can reduce cardiovascular mortality and morbidity, which leads to social and economic benefits (1). It remains unknown, however, what the CR referrals and participation are for patients following elective percutaneous coronary intervention (PCI).

Aim
Our aim was to identify the prevalence, trends, and predictors of CR referrals and participation in patients undergoing elective PCI between July 2017 and December 2021 among six public hospitals in one of the Australian states.

Methods
A retrospective observational study was conducted. Data were extracted from a state-wide Cardiac Outcomes Registry for patients who underwent elective PCI. Patients were identified if they were referred to CR following hospital discharge. CR participation has two assessments. The initial assessment focuses on a comprehensive cardiovascular risk factor review that occurs before attending a CR program, whereas the final assessment represents CR completion. We conducted descriptive and inferential statistical analyses.

Results
Out of 3081 patients who underwent elective PCI, 1845 (59.9%) had CR referrals. Of the 1845 patients who had CR referred, 1022 (55.4%) completed an initial assessment, and 400 (21.7%) completed both an initial and final assessment. The rate of CR referrals increased from 12.0% in 2017 to 23.5% in 2018 before decreasing slightly in 2019 and 2020 (21.0% and 22.8%, respectively). There was a decline in the proportion of patients who had an initial assessment from 44.0% in 2017 to 29.0% in 2021. The rate of the final assessment showed a slight increase from 32% in 2017 to 41% in 2021. Multivariate logistic regression showed that of those patients undergoing PCI, patients who stayed overnight were 9.9 times more likely to receive a CR referral than those with same-day discharge. However, for those who had CR referrals, overnight stay was not a predictor in completing the initial assessment. Similarly, of those who completed an initial assessment, overnight stay was also not a predictor in completing the final assessment; rather, those with a positive family history were more likely to complete the final assessment.

Conclusion
Our findings reveal a low CR referral rate in patients undergoing elective PCI, and overnight stay is a strong predictor for CR referrals. As a referral is a gateway to CR participation (2), more work is needed to explore the options to increase CR referrals, particularly for patients discharged on the same day as their procedure. Following referrals, overnight stay did not predict completion of initial and final assessments, indicating that other strategies are required to promote CR participation.
Healthcare professionals' experiences of the usefulness and ease of using a digital medical translation tool in communicating with minority language-speaking hospitalized heart surgery patients
Authors: Lie I , Rokeness S , Skredsvig K , Johannsen N , Lindsjorn K E , Hasle C H , Nes L S 
Published: October 2024

Abstract

Background/Introduction
Healthcare professionals are required to deliver high-quality care while adhering to the human right to equity for all patients. Language barriers often result in miscommunication between healthcare professionals and patients, leading to decreased patient satisfaction, compromised patient safety (such as increased adverse events), and diminished healthcare quality. Studies focusing on implementing digital medical translation tools and measuring their usefulness during patients’ hospitalization are highly warranted.

Purpose
To survey and explore healthcare professionals' experiences of the usefulness and ease of using a digital medical translation tool in communicating with minority language-speaking heart surgery patients during hospitalization.

Methods
Participants completed an internationally published six-item, study-specific questionnaire on health care professionals' experiences regarding perceived usefulness and ease of use from October 2022 to February 2023. The first three items, namely: (1) 'The digital tool was easy to use,' (2) 'The languages were easy to understand,' and (3) 'The digital tool was useful,' were measured on a 5-point Likert scale ranging from 1 ('totally agree') to 5 ('totally disagree'). The last three items were open-ended: (4) 'What they liked best,' (5) 'What they liked the least,' and (6) 'Suggestions for improvement'.

Results
Health care professionals (i.e., registered nurses, intensive care nurses, operating room nurses, anaesthesia nurses and physiotherapists) (n=53) aged, mean 35 (SD, min-max 9.7, 25-58). They reported the digital medical translation tool was easy to use ("totally agree/agree" 15/33, 91%), easy to understand ("totally agree/agree" 30/22, 97%), and useful ("totally agree/agree" 24/25, 92%) as illustrated in figure 1. Illustrative citations from the open responses: What health care professionals liked best: "Enabling communication with minority language-speaking patients feels safe in terms of patient safety" and "The opportunity to form a clinical picture of the patient at the beginning of the shift gives me confidence. The possibility to meet the patient's psychosocial needs and the opportunity to more easily clarify situations and pains and discomforts." They liked the least that it "Took some time to find my way around between questions at the beginning of using the tool" and suggestions for improvement were cited as "Split up the phrases in the tool in several categories (icons) e.g., intubation phase" and "Add more phrases specific for our heart surgery patients".

Conclusions
Healthcare professionals found a digital medical translation tool to be useful and easy to use in meeting the needs of patients and improving patient safety during communication with minority-speaking heart surgery patients.
NICE guidance in the rapid access chest pain clinic: does it work?
Authors: Pottle A , Harrison S 
Published: October 2024

Abstract

Background
Rapid Access Chest Pain Clinics (RACPC) were developed following the publication of the National Service Framework for Coronary Heart Disease in 2000(1). The National Institute for Health and Care Excellence (NICE) produces guidelines for the management of patients with recent onset chest pain of suspected cardiac origin(2). In 2016 the guidance was updated and recommended the use of CT coronary angiography (CTCA) as the initial investigation for patients with chest pain which was typical or atypical of angina. Adherence to the guideline may be dependent upon factors such as local availability of CT scanners and clinician preference. The RACPC in this tertiary centre is nurse-run with no medical involvement. There is good engagement with the CT department and in July 2017 the NICE guidance was adopted in the clinic.

Purpose
To evaluate the use of CTCA as the first line investigation for patients with typical or atypical chest pain.

Methods
Data from all patients reviewed in the clinic between 01/07/2017 and 31/12/2023 were prospectively collected, entered into a database, and then retrospectively analysed. The data were organised into 3 groups: patients with typical chest pain; atypical pain and those with non-cardiac sounding chest pain. The number of patients in each group who underwent a CTCA, and the outcome of the scan were evaluated. The CT scans were categorised as showing significant coronary artery disease (CAD), non-obstructive CAD, no CAD, or as inconclusive. The outcome of patients who had a positive CTCA was also recorded.

Results
2986 patients were reviewed in the RACPC in the above period. 14.2% of patients presented with typical pain, 47.4% with atypical pain, and 30.6% had non-cardiac pain. The remaining patients presented with other symptoms such as breathlessness. CTCA was used as the first investigation in the majority of patients with typical or atypical pain, unless alternative investigations or management were deemed to be more clinically appropriate. In 59.5% of typical and 78.5% of atypical presentations, the CT scan showed no CAD, or non-significant CAD. There was a low incidence of positive scans in both groups, however patients with typical pain were more likely to have significant CAD (Table).
All patients who had a CTCA indicating significant CAD, were referred for invasive angiography. 88.0% of typical presentations, and 64.0% of those with atypical pain, underwent revascularisation. No patient who underwent invasive angiography was found to have normal coronary arteries.

Conclusion
Atypical pain is the most frequent presentation in the RACPC, however the majority of these patients, and most of those with typical pain, do not have significant CAD. Careful assessment and the use of CTCA as the initial investigation, enable the identification of those patients who need invasive angiography. This is a cost-effective strategy which also reduces risk and radiation exposure for patients.
A nurse-led intervention improves quality of life and reduces arrhythmic recurrences in patients undergoing atrial fibrillation ablation. Results of the NURSECAT-AF randomized clinical trial
Authors: Cano Valls A , Mont L L , Carro E , Venturas M , Lajara M A , Martinez-Monblan M A , Guasch E 
Published: October 2024

Abstract

Background/Introduction
Atrial fibrillation (AF) is a prevalent condition that can lead to a decrease in quality of life and frequent re-hospitalizations. Some data suggest that integrated care nurse-led may blunt these consequences in unselected patients with AF, but not all studies support this. While AF ablation is becoming a cornerstone treatment for symptomatic patients with AF, it is unclear what impact a nurse-led intervention would have on these, quite likely, more receptive patients.

Purpose
To assess the impact of nurse-led intervention on quality of life among AF patients undergoing ablation.

Methods
We conducted a single-centre prospective randomised clinical trial to test the effect of an expert nurse-based intervention consisting of an educational programme on AF, support for the patient undergoing cardiac ablation to ensure its success, and management of risk factors associated with this arrhythmia. The control group underwent standard medical follow-up. Patient selection was based on chronological order. Only patients who underwent their first ablation and did not have heart failure were included. The primary endpoint was quality of life at 12 months post-ablation using the Arrhythmia-Specific Scale in Tachycardia and Arrhythmia (ASTA) questionnaire (higher values denote impaired quality of life). Secondary endpoints were AF knowledge and satisfaction at 15 days post-ablation using validated instruments, symptoms using the ASTA questionnaire as well, and readmissions rates, emergency room visits, and AF recurrence rates over a one-year period.

Results
116 patients were screened (50 were excluded mostly because were re do). A total of 66 patients were eventually included and randomized (33 per arm; mean age [mean±SD] 63±10 years; 44 men [67%]). At 12 months, quality of life was significantly better in the intervention group than in the control group (4.5 ± 6.1 vs 0.57 ± 2.3, respectively, p=0.001)(Figure). Furthermore, satisfaction levels (17 ± 4.1 vs 12.7 ± 5.4, p&gt;0.001) and disease knowledge (20.5 ± 5.1 vs 15.9 ± 4.5, p&lt;0.001) were higher in the intervention group. Patients in the control group experienced a higher symptom burden during the first year (0.6 ± 1.5 vs 3.8 ± 4.5, p&lt;0.001. Relevant clinical endpoints such as readmissions (3% vs 18.2%, p=0.046), emergency room visits (21.2% vs 57.5%, p=0.021), and arrhythmia recurrences (15.2% vs 45.5%, p=0.02) were all significantly lower in the intervention group.

Conclusion(s)
Nurse-led integrated care for patients undergoing AF ablation yields substantial improvements in quality of life and symptomatic relief at one year post-procedure. Additionally, it enhances patient knowledge of AF and satisfaction levels, and reduces readmissions, emergency room visits, and arrhythmia recurrences.