bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimizing diuretic management in acute decompensated heart failure: the impact of diuretic algorithm in real-world setting
Authors: Van Der Laan J , Shakoor A , Scholte N , Van Der Boon R , Emans M E 
Published: July 2024

Abstract

Background/Introduction
Achieving euvolaemia is an important prognostic factor in acutely decompensated heart failure (ADHF). The European Society of Cardiology (ESC) guidelines suggest that a stepwise diuretic treatment algorithm based on regular reassessment of urinary output and natriuresis may be superior compared to current standard of care. We studied the implementation and effectiveness of such a pre-specified algorithm in a real-word cohort for realizing euvolaemia.

Methods
In 2020 we implemented the stepped diuretic strategy from the Heart Failure Association position statement, now stated in the 2021 ESC guidelines, in a peripheral hospital. Afterwards we conducted a retrospective cohort study, including patients with ADHF (with hospitalization duration &gt; 3 days for decongestive treatment). Patients admitted between 10-Jan-2021 and 04-Dec-2021, who were treated according to the diuretic algorithm (protocol cohort), were compared to patients who were treated between 04-Jan-2018 and 19-jan-2019 (before implementation of this algorithm). Our primary outcomes were length of hospital stay (days), complications during hospitalization, such as electrolyte disturbance, kidney function, arrhythmias, infections and mortality during hospitalization.

Results
The study comprised 221 patients, with 107 in the pre-protocol cohort and 114 in the protocol cohort. Baseline characteristics were similar between the cohorts, expect for the kidney function and NT-proBNP levels at admission. Mean eGFR was slightly better in the protocol cohort (53 [36-71] vs 43 [29-63] ml/min/1.73m2, p .016), were as NT-proBNP was higher in the pre-protocol cohort (990 vs 480 pmol/l) (Table 1). The mean length of stay was shorter in the protocol cohort (7.0 [5.1-10.3] vs 7.5 [5.9-10.9] days). The incidence of complications, such as electrolyte disturbances and arrhythmias, were comparable. Notably, the mean eGFR on third day of hospitalization was higher in the protocol cohort (50 ± 21 vs. 42 ± 19 ml/min/1.73m2). There was a difference in the median weight lost during the admission between the two cohorts (Figure 1).

Conclusion
Our data suggest that a pre-specified stepwise diuretic treatment algorithm, based on urinary output is feasible and effective in achieving euvolaemia in a real-world cohort. Furthermore, it reduces length of hospital stay without increasing the risk of complications.
Exergaming in patients with heart failure. A pilot study of the HEART-EXERGAME (Heart-eXg) intervention
Authors: Andreassen M , Klompstra L , Lans C , Antoniadou M , Stromberg A , Jaarsma T 
Published: July 2024

Abstract

Background
Physical activity in patients with heart failure (HF) can improve physical function, quality of life, reduce rehospitalization and mortality. A new approach increase physical activity for patients with heart failure (HF) is the use of exergames (games that requires physical activity to play). An international multi-centre RCT study, called the Heart-eXg study (clinicaltrials.gov ID: NCTxxx), is developed to determine the effectiveness of 3-months exergaming for patients with HF to decrease their sedentary time. The mobile exergame is co-designed for this study, entails a farming theme, and personalized on patients exercise capacity. The aim of this pilot study was to test the protocol of the intervention, in terms of recruitment, procedures of the intervention, assessment of outcomes and adherence to exergaming.

Material and methods
In the pilot study, the inclusion of patients was assessed. The randomization was tested but all patients were assigned to the exergame group. To further test the procedures the time was recorded of the installation/instructions to the exergame, the telephone follow-ups (to increase motivation) and outcome assessment.
Outcomes were the 6-minute walk test (exercise capacity), Fried frailty test (frailty), VAS-Score EQ5D, 0-100 (quality of life), Canadian Occupational Performance Measure (occupational performance). Adherence (walking 10 minutes every day with the exergame) was assessed during the 3 months exergaming, as the time exergaming was recorded.

Results Pilot study
In total 13 patients were eligible and 5 included. Mean age was 71 (±10), 2 females, 1 patient in NYHA-class II and 4 patients in NYHA-class III. One patient dropped out directly after baseline (severe disease) and 1 never exergamed (time constraints). Result of exercise capacity, quality of life and occupational performance are presented in the Table. The procedures of the intervention were feasible, the visits to the hospital took between 1 hour and 1.5 hour and the telephone follow up approximately 5-10 minutes. Test of occupational performance took longer time than calculated (30 min instead of 15 min).
Of the 3 patients who exergames, 1 patient played irregularly and stopped after 4 weeks. Two patients were adherent, see Figure.

Conclusion
The protocol of the intervention was feasible to use. In total, 38% of patients accepted to be included in the intervention and 20% of the patients dropped out (1 out of 5) and 50% were completely adherent to the intervention. Time for installation/introduction and telephone follow-ups were appropriate. As the occupational performance assessment took more time than then expected, we decided to test this in 100 out of the 600 patients planned to be included in the RCT study.TableFigure
Impact of reduced ejection fraction on affect, cognition and self-care behaviors in adults with heart failure
Authors: Jedrzejczyk M , Lee C S , Denfeld Q E , Szczepanowski R , Nowak B , Czapla M , Vellone E , Uchmanowicz I 
Published: July 2024

Abstract

Introduction
In response to the escalating complexity of clinical care for individuals with heart failure, there is a growing need for in-depth investigations. This study investigated the influence of ejection fraction (EF) on affective symptoms (i.e. anxiety and depression), cognitive function, and self-care behaviors in adults with heart failure.

Aim
The primary aim of this study was to compare affective symptoms, cognitive function and self-care behaviors between adults who had heart failure with reduced EF (HFrEF: EF≤40%) and adults who had heart failure with preserved EF (HFpEF: EF&gt;40%). The secondary aim was to explore differences in the relationship between cognitive function and self-care behaviors.

Material and Methods
Participants in this cross-sectional study were recruited from heart failure clinics in Wroclaw, Poland between 2022 and 2023. Comprehensive clinical characteristics, including EF, were extracted from the medical record. Participants completed a survey that included reliable and valid measures of affective symptoms (Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9)), cognitive function (i.e. the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE)), and self-care behaviors (self-care of heart failure index).

Results
The study included a total of 250 participants with heart failure: 145 (58%) had HFrEF and 105 (42%) had HFpEF. Patients with HFrEF were younger (71.1±6.2 years) than those with HFpEF (73.0±7.0 years; p=0.011). There were fewer women with HFrEF (n=16 (15.2%)) than HFpEF (n=61 (42.1%); p&lt;0.001). There were no statistically significant differences in affective symptoms, cognitive function or self-care behaviors comparing adults with HFrEF vs. HFpEF (all p&gt;0.05). Overall, worse cognitive function was associated with worse self-care based on the MMSE (r=-0.20, p=0.001) but not the MoCA (r=-0.12, p=0.056).

Conclusion
Although there were no affective, cognitive, or self-care behavioral differences between adults with HFrEF and HFpEF, age and gender differences between these groups must be considered in clinical care. Additionally, cognitive dysfunction, especially as measured by the MMSE, must serve as a red flag for poor self-care in heart failure irrespective of EF.
A study to determine if the fluid heart tracker app supports patient decision-making at the onset of worsening heart failure
Authors: Caples N , O'brien F , Mooney M 
Published: July 2024

Abstract

Background
Delay in seeking early intervention for worsening heart failure (HF) can result in poorer patient outcomes, hospital admission and increased risk of mortality (Andersen 2017, Matsue et al. 2017, Mikami et al. 2021). Despite the availability of health-related mobile apps for HF self-care, no study has focused on whether apps designed for HF weight monitoring make a meaningful contribution to the decision-making process of HF self-care.
The Fluid Heart Tracker App was developed as a simple app to support the patient in the identification of significant weight gain as a result of worsening HF. An Advanced Nurse Practitioner in HF proposed the concept of the app, and it was developed by an Open-Source Volunteer team. It has one feature which is weight monitoring. It does not require interpretation of symptoms. The app has CE approval. It does not have a backend. The Irish Heart Foundation (IHF) has championed the app and the National Heart Programme listed it as a patient resource in the National Model of Care for Heart Failure in Ireland. The app is free to download from play store and the app-store in Ireland and the UK.

Pilot study
An evaluative, cross-sectional pilot study was initially carried out in potential users from three acute general hospitals. to determine the acceptability and usefulness of the Fluid Heart Tracker-App for patients with HF. This to garner feedback to use to develop, alter or refine the app.

Methods
Participants downloaded the app and used it to monitor their daily weight for two weeks. A short bespoke questionnaire was developed for the survey. It comprised five valid questions with dichotomous answers and an option at the end for participants to add any additional six comments.

Results
31 participations- 13 female. The average age was 72. All participants (N=31, 100%) used the app, found it useful and found it easy to use and all participants would recommend the app to other patients with heart failure. 30 participants used the app daily, while one used it on alternate days. Participants stated that it was easy or very easy to use. Based on these positive results a before and after, quasi-experimental study is currently being undertaken.

Aim of current study
The aim of this current study is to determine the impact, use and the effect of the Fluid Heart Tracker App on patient decision making in HF.

Primary Outcomes
1) Compare if using the app improved previous engagement patterns for weight monitoring.
2) Determine which factors influence engagement with the app.
3) Determine the impact of an app alert to the patient on seeking medical attention for worsening heart failure.

Progress to date
179 participants were recruited from 12 HF sites in Ireland. Data collection was completed November 2nd, 2023. Currently the data set is being cleaned prior to statistical analysis. This investigation has been undertaken as part of a PhD study.
Sex differences in acute myocardial infarction - Preliminary results from an umbrella review
Authors: Torres C , Ann Kristin Bjornnes A K B , Milada Hagen M H , Sigrun Halvorsen S H , Tomas Jernberg T J , Irene Lie I L 
Published: July 2024

Abstract

Background
Cardiovascular disease (CVD) is the leading cause of premature death among women, and the negative impact on public health is profound. Women have higher rates of comorbidities, complications such as stroke, in addition to higher mortality compared to men (1-6) and targeting sex-related differences regarding the treatment of CVD in women is of great importance to prevent the number of CVD events. The purpose of this study was to get an overview of the systematic reviews and meta-analyses investigating sex differences in patients with acute myocardial infarction (AMI) the past 10 years.

Methods
A systematic search was carried out in Epistemonikos, the largest database of systematic reviews that screens PubMed, Cochrane, Embase, CINAHL, PsycInfo and others (i.e., currently nine databases) (7, 8). The search was conducted 12 January 2024, with the general search strings: (1) sex differences OR gender differences AND myocardial infarction, (2) sex differences OR gender differences OR women OR female AND myocardial infarction. The search was restricted to systematic reviews conducted the last 10 years.

Results
Forty-nine (search 1: 19, search 2: 30) systematic reviews and meta-analyses were identified, and five studies investigating sex differences in relation to AMI were included. Two systematic reviews, Babioakis (2021) and Meer (2015), reported of longer door-to-balloon (D2B) time and/or symptom-to-balloon (S2B) time in female patients presenting with STEMI and referred for PCI, compared to male patients (9). Chaudhary (2022) investigated adverse event of MINOCA (more commonly in women/ younger age (51-59 years) and reported higher risk of MACE among women than men (10.1% vs. 9.1%, OR 1.15, 1.04-1.23), in addition to higher incidence of stroke (3.5% vs. 2.2%, OR 1.3, 1.01-1.68), however no significantly differences were observed for all-cause mortality, non-fatal AMI, and cardiovascular readmissions between the groups (10).
Three systematic reviews reported of higher risk of mortality after STEMI among women, compared to men (11-13). Xi (2022) reported of higher risk of short-term mortality (RR, 1.73; 95% CI 1.53 to 1.96)) (adjusted RR, 1.24; 95% CI 1.11 to 1.38) (13), Pancholy (2014) reported of higher risk of in-hospital mortality (RR, 1.93; 95% CI, 1.75-2.14) (adjusted RR, 1.48; 95% CI, 1.07-2.05) (11), and van der Meer (2015) reported of higher crude short- and long-term mortality in women, in addition to less use of GP IIb/IIIa inhibitors in women, compared to men (women 51%, men 57%) (12).

Conclusions
Our umbrella review revealed that women had longer timeline for treatment in AMI, had less use of medication and higher risk of mortality and MACE compared to men. Clinical practice needs further improvements in management in female patients.
Out-of-hospital cardiac arrest - does location affect ROSC?
Authors: Mickiewicz A , Czapla M , Lewandowski L , Kubielas G , Kedzierski K , Wroblewski P , Smereka J 
Published: July 2024

Abstract

Introduction
Out-of-hospital cardiac arrest (OHCA) is a significant public health problem, with hundreds of thousands of cases occurring annually in the UE and the USA. While overall survival rates remain low, studies indicate that the location of OHCA plays a critical role in survival outcomes. The discrepancy in survival rates between public and non-public locations can be stark, with public OHCA showing a notably higher chance of the return of spontaneous circulation (ROSC). This exploratory study aims to investigate the effect of OHCA location (public vs non-public) on ROSC in Poland.

Methods
The study was a retrospective analysis of patient records, focusing on cases handled by the Polish EMS from January 2021 to June 2022. This research utilized data from the National Emergency Medical Services. From a total of 4,925,214 EMS calls, 54,190 patients diagnosed with cardiac arrest (CA, ICD 10-I46), where paramedics initiated CPR on-site, were initially selected from the database. The study excluded patients whose CAs were due to suicide attempts, criminal acts, trauma and cases that lacked initial rhythm data of CA. Ultimately, data from 33,636 patients were analyzed. Data preprocessing was performed with Python 3.10.6 and STATISTICA 13.3. The α value used for statistical inference was 0.05.

Results
A higher frequency of CAs was in public places among younger individuals (p &lt; 0.001). In public locations, we have also observed a lower prevalence of diabetes and higher incidences of myocardial infarction and return of spontaneous circulation (ROSC) in cases of CA (31.53 vs 35.79%). The odds of ROSC were modulated by age depending on the CA location – each subsequent increase in age by one year decreased the odds by 1.62% in at-home cases (p &lt; 0.001) or by 0.40% upon public incidence (p ≈ 0.009). (Table 1). In multi-factor-adjusted logistic regression models, it is evident that the initial rhythm of VF/pVT significantly increases the likelihood of ROSC by more than 3.7 times compared to the Asystole/PEA rhythm, regardless of location. Obesity notably decreases ROSC chances in home incidents, unlike public cases. In public location CAs, conditions like stroke or myocardial infarction significantly increased ROSC odds. Additionally, the impact of age on ROSC probability varies with the location of the cardiac arrest, showing different rates of decrease with each additional year of age in home versus public incidents.

Conclusion
Patients with OHCA were statistically more likely to achieve ROSC if the CA occurred in a public location. In addition, if the initial rhythm was VF/pVT, the odds of ROSC were almost four times higher for both public and non-public locations. The odds of ROSC decreased with each additional year of age, regardless of the location of the CA. In addition, the presence of myocardial infarction increased the odds of ROSC in public locations. In non-public locations, obesity was associated with decreased odds of ROSC.
The course of COVID-19 infection in patients with cardiovascular diseases
Authors: Smoktunowicz M , Zbroch E 
Published: July 2024

Abstract

Background
Certainly, the COVID-19 pandemic has changed the paths of modern medicine. Elevated morbidity and mortality that was observed especially during first and second year focused health care providers on highlighting the high risk group of patients. Many results have showed the influence of comorbidities on the course of COVID-19.

Purpose
The aim of the study was to demonstrate whether cardiovascular diseases correlate to severity of coronavirus disease 2019 infection.

Methods
The study group contained 70 patients admitted to the hospital from the 1st of January 2021 to the 10th of November 2022 due to symptoms indicating respiratory infection. The survey's inclusion criteria was U07.1 COVID-19, virus identified (code from Chapter XXII: Codes for special purposes of The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) – WHO, Version 2019: COVID expanded). The used research method was the analysis of patients' medical records. Subsequently the data were subjected to quantitative and statistical analysis.

Results
There were 16 different cardiovascular diseases diagnosed in the study group. The most common were: I10 Essential (primary) hypertension (46/70 patients; 65,71%), I50.9 Heart failure, unspecified (16/70 patients; 22,86%), I48 Atrial fibrillation and flutter (16/70 patients; 22,86%). The data of concerning hospitalizations of groups of patients with the most commonly observed cardiovascular diseases, along with a comparison to the entire study group, are presented in Table 1. Furthermore, there was statistically significant correlation between at least one cardiovascular comorbidity and the need to transfer the patient to continue the treatment of COVID-19 in the intensive care unit (p&lt;0,001).

Conclusions
The results of this study showed that patients with most common cardiovascular diseases stayed hospitalized for longer time, were older and more often needed antibiotic and anticoagulant therapy compared to the entire study group. That provide a basis to conclude that patients with cardiovascular diseases are at higher risk of severe COVID-19 and the special management to this group should be applied into common medical practice.
The relationship between gender, body mass index, and length of hospital stay in patients with hypertension
Authors: Lokiec K , Kwasny A , Uchmanowicz B , Kubielas G , Smereka J , Juarez-Vela R , Czapla M 
Published: July 2024

Abstract

Introduction
Globally, hypertension impacts approximately 40-45% of the adult demographic. This condition serves as a changeable risk factor for cardiovascular diseases (CVD), and its escalation demonstrates a direct correlation with heightened mortality rates and the onset of additional medical issues, including myocardial infarction, heart failure, and cerebrovascular accidents. The financial burden of CVD management is substantial, marking it as a significant issue in public health worldwide. Influencing factors that contribute to the duration of a patient's hospital stay (LOS) encompass both suboptimal nutritional status and the coexistence of other health conditions.

Purpose
The aim of this study was to assess whether there are sex differences in the prognostic impact of BMI, as calculated on admission to the cardiology department, on the length of hospital stay in patients with hypertension (HT).

Methods
We performed a retrospective analysis of 486 medical records of patients who had been admitted to an University Hospital between January 2017 and June 2021. Linear regression was used to analyse the impact of selected variables on continuous outcomes. Regression parameters with 95% confidence intervals were shown. The significance level for all statistical tests was set to 0.05. R 4.3.0. was used for computations.

Results
Women accounted for 53% of the study group and were significantly older than men (64.7±12.8 vs. 60.5±11.8, p=0.466). The mean BMI in women was 28.49±5.39 and in men 29.14±4.88. In an unadjusted linear regression mode, underweight, overweight and obesity by BMI were not independent predictors of longer hospitalization in either sex. The same result was noted after adjusting the model for patient age. After adjusting the model for comorbidities for women, a significant independent predictor of prolonged hospitalization was a prior MI, which prolonged hospitalization by an average of 1,727 days (B=1,727, p=0.034). For men, none of the analyzed features was a statistically significant predictor of length of hospitalization.

Conclusions
The result of body mass index score assessed at the time of a patient's admission to the cardiology department is not a predictor of length of hospitalization in both men and women with hypertension.