bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can the use of a structured management approach using ABCDEF mnemonic to manage multi-morbdiity in HFpEF improve clinical outcomes?
Authors: Murphy N , Duvva D , Kelly A M , Nyjo S , Bower C , Jackson C , Oguguo C , Sankaranarayanan R 
Published: July 2024

Abstract

Introduction
Patients with heart failure with preserved ejection fraction (HFpEF) also have other co-morbidities which independently influence clinical outcomes as well as response to treatment. ESC guidelines recommend management of multimorbidity to improve clinical outcomes. The aim of this feasibility study was to test the use of a structured approach by HF specialist nurse using the prompt of an ABCDEF mnemonic to guide management of multimorbidity in HFpEF clinics and compare this with standard care (without prompt by a mnemonic).

Methods
This was a retrospective analysis of a prospective cohort study of 75 patients with recent decompensated HFpEF within 30 days, who were reviewed in a clinic by a HF specialist nurse. (38 patients in the "mnemonic" cohort and 37 patients in the standard care cohort). ABCDEF mnemonic was used to prompt the HF specialist nurse to address co-morbidities in the "mnemonic cohort" (A-Anaemia/Atrial fibrillation/sleep Apnoea, B- Blood pressure control, Body Mass Index, C- Chronic Kidney Disease and Chronic Obstructive Pulmonary disease, D- Diabetes control, E- Exercise rehab, F- Frailty assessment and need for advance care planning) whereas the HF nurse who assessed patients in standard care cohort followed standard national and international HFpEF guidelines for multimorbidity management (without the aid/prompt of a mnemonic). We also compared all-cause readmissions at 30 days and 3 months between the 2 cohorts. Statistical analysis was performed using Chi-squared test or Student’s T test as appropriate.

Results
The mean age was comparable between the 2 cohorts (mnemonic cohort -77.5±13.6, standard care 76.9±10.2 p=0.8) as was the proportion of female patients (mnemonic cohort 54% vs. standard care 46%; p=0.45). There was also no significant difference in terms of co-morbidities (mnemonic cohort 3.7±1.2 vs. std. care 3.6±1.1; p=0.7), frailty (mnemonic cohort 4.3±1.3; std. care 4.5±1.1; p=0.42), NTproBNP (Mnemonic cohort 1590 ng/L (368-11657(; std. care 1926 ng/L IQR- 389-10593; p=0.51). Investigations or interventions were performed to address co-morbidities in lower proportion of HFpEF patients in the standard care cohort (43%) compared to mnemonic cohort (100%; p&lt;0.001). 30-day all-cause re-admissions showed a trend towards being lower in the mnemonic cohort (30 readmissions mnemonic 10% vs. std. care 22%; p=0.1); 3 month (mnemonic cohort 16%, std. care 35% p=0.05).

Conclusions
Use of a structured mnemonic approach to manage multimorbidity appears to be an easy tool to apply in HFpEF clinics, reflected by the high adherence rate and shows a trend towards lower 3-month all-cause readmissions. The results will need to be validated in a a larger randomised controlled trial with longer follow-up.
Quality of life up to one year after revascularisation with percutaneous coronary intervention in patients with previous coronary artery bypass surgery
Authors: Madsen D , Pettersen T R , Hjertvikrem N , Haaverstad R , Rotevatn S , Norekvaal T M 
Published: July 2024

Abstract

Background
Approximately 1 out of 11 patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI) have a history of coronary artery bypass (CABG) surgery. Most studies investigating patients treated with PCI with prior CABG have focused on harder outcomes such as morbidity, mortality and complications. However, quality of life (QoL) is increasingly recognized as an important outcome measure after PCI.

Purpose
To determine QoL after revascularisation with PCI in patients with and without a history of CABG.

Methods
CONCARDPCI, a prospective multicenter cohort study including 3417 consecutive patients revascularised with PCI, was conducted at seven high-volume referral PCI centres in Norway and Denmark. Of these, 312 had a history with CABG. Baseline clinical data were collected from patient´s medical records and national registers. Sociodemographic characteristics were self-reported. Patient-reported outcomes measures were collected at baseline, 2-, 6- and 12-months after discharge. QoL and health status were measured with the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), RAND-12-Item Short Form Health Survey (RAND-12) and the Seattle Angina Questionnaire 7 (SAQ-7).

Results
Patients with prior CABG were older (mean age 71 vs 65, p&lt;0.001), more often men (84% vs 78%), and had more comorbidities. They were less likely to be current smokers (6% vs 18%, p=0.033) and less likely to be working full time (15% vs 33%). Patients with prior CABG reported a lower QoL on all questionnaires at all measuring time points compared with the no CABG group. Both groups had a significant improvement in the physical and mental component scores from baseline to two months on RAND-12 (p&lt;0.001). In addition, an improvement was found on physical limitation from baseline to two months on SAQ-7 (p&lt;0.001). For both groups QoL was best at baseline using WHOQOL-BREF.

Conclusion
QoL improved in patients with and without a history of CABG throughout the 12-month follow-up period. However, patients with prior CABG scored worse. These findings are important for future clinical decision-making regarding rehabilitation programs after PCI.SAQ-7 mean domain scores over time
Radiation exposure of patients undergoing transcatheter aortic valve implantation and factors contributing to it
Authors: Farrugia M , Foulkes D J 
Published: July 2024

Abstract

Background/ Introduction
Aortic stenosis (AS) is a calcific disease which affects the aortic valve leaflets and is commonly prevalent in people who are 65 years and older. The global burden of AS is expected to keep on increasing due to the longer life expectancy as well as the morbidity and mortality associated with the disease. Transcatheter aortic valve implantation is utilised for the management of AS. Currently, TAVI is recommended as a first-line treatment for patients who are 75 years and older and those who are at an intermediate to high surgical risk, with the aim of becoming the first treatment option for patients who are 65 years and older. However, one of the concerns of TAVI is the need of ionising radiation during valve placement. The study of exposure to ionising radiation in the TAVI population is becoming progressively more important to consider due to the broader population being considered and the long-term effects related to radiation.

Purpose
Locally there was no data available covering this topic, thus the aim of the study was to quantify the radiation dose that patients receive during TAVI procedures and to determine any procedural and patient factors that contribute to this radiation dose.

Methods
Retrospective data analysis was performed for procedures effected between January 2019 and December 2022. All the patients that underwent a transfemoral (TF) TAVI and fit within the inclusion criteria were included in the study. The data was collected from medical databases and underwent a process of data cleaning before information relating to patient and procedural characteristics was extracted. Data about percutaneous coronary interventions (PCI) that were performed during the same time period by the same operators was collected for comparison purposes.

Results
In total the data of 241 TAVI patients was analysed. Dose Area Product (DAP) was the main radiation metric utilised to quantify the radiation dose. Non-parametric statistical tests were performed due to right-skewedness. The median (IQR) DAP for these procedures was 9000 cGym2 (5975-13150) and the median (IQR) fluoroscopy time was 18.25 minutes (15, 23.5). The years 2019 and 2020 had the lowest median DAP. The DAP obtained in this study is lower than the European DRLs of 13000 cGym2.
The median (IQR) DAP (5320cGym2 (2385-9860)), and fluoroscopy time (13.75 mins (8.25-21.62)) for PCIs were lower than for TAVI and this difference is statistically significant (P = &lt;0.001).
DAP was not significantly related only to age category and the operator’s combination. Generalised linear models (GLM) showed that prosthetic valve size, body surface area (BSA) and aortic valve gradient are statistically significant predictors of DAP.

Conclusion
This study shows that the local TAVI patients receive a radiation dose which is within acceptable European limits and that valve size and patient’s BSA are the variables that impacted the radiation dose.
Frailty response in patients with aortic stenosis undergoing transcatheter aortic valve implantation: protocol for a pilot, cluster randomised controlled trial (FRAIL-AS Response Trial)
Authors: Straiton N , Muller D , Macdonald P , Arriagada A , Roy D , Mills N , Middleton S 
Published: July 2024

Abstract

Background
Three in ten severe aortic stenosis patients undergoing transcatheter aortic valve implantation (TAVI) are frail. Frailty correlates with adverse post-procedure patient outcomes, such as higher 1-year mortality, increased adverse events, prolonged hospital stays, and diminished quality of life. Despite the urgency for evidence-based frailty management in this population, research in this area is limited.

Methods
A pilot, cluster randomised controlled trial to assess the feasibility of implementing a Frailty Response Program intervention in 10 hospital TAVI programs for frail patients with aortic stenosis undergoing valve replacement. The intervention includes an implementation strategy and a Frailty Response Clinical Protocol, focused on malnutrition identification, patient education, general practitioner notification, comprehensive geriatric assessment, and cardiac rehabilitation. Eligible hospitals will be randomised (1:1) to either the intervention or control (standard care). Primary outcome: proportion of patients receiving nutritional assessment upon frailty identification. Secondary outcomes include mortality and hospital admissions, frailty improvement, quality of life, and evidence-based frailty management. Implementation outcomes will be evaluated through a process assessment.

Discussion
The trial aims to bridge the gap between the recognition of frailty in patients with aortic stenosis undergoing TAVI and the implementation of evidence-based frailty management practices to improve patient outcomes and care quality.
Involving patients and families in prioritising research in cardiomyopathies
Authors: Bueser T , Jarman E , Field E , Newbury-Ecob R , Cook L 
Published: July 2024

Abstract

Background/Introduction
Cardiomyopathy affects 1 in 300 of the population and can have profound physical and psychological impacts on patients and families. There remains uncertainty around many aspects of disease management and patient needs. Research can address these uncertainties by identifying definitive treatments, optimal management strategies, and holistic support requirements. To ensure that cardiomyopathy research reflects the shared interests of patients, carers and clinicians, a leading cardiomyopathy patient charity sponsored a Research Priority Setting Partnership (PSP).

Methods
The Cardiomyopathy PSP was run according to the James Lind Alliance (JLA) method(1, Figure 1).

Results
A steering group (SG) comprised eight people with lived experience of cardiomyopathies and nine healthcare professionals (HCPs), representing the multidisciplinary team, decided on the scope and breadth of the PSP to cover cardiomyopathies and for a United Kingdom-wide survey.
The initial survey was open to the cardiomyopathy community from June-August 2023 (six weeks). They were invited to submit questions that they would like answered by research. The survey was online and hard copies were also sent to peer support groups where group leaders encouraged members to complete the form during their in-person meeting. There were 1020 respondents generating just over 2000 questions. The majority of respondents (78%) were people with lived experience.
The SG and an information specialist grouped submitted questions into topic headings, consolidated similar questions, removed those that were out of scope and agreed on the final list of 60 questions for the shortlisting survey. This second survey consisted of 2 steps: 1. Respondents selected from the full list of questions identified by the first survey and 2.They were then asked to choose 10 questions from their selection which were most important to them. A total of 660 responses were collected and selected questions were organised into 2 groups according to the type of respondent (those with lived experience or HCPs). Questions were weighted according to the number of times they were selected within each group and then merged into a single shortlist of 26.
The final workshop was conducted on February 2, 2024 where the Top 10 Research Questions from the shortlist were agreed by a mixed group of lived experience and HCP participants (Figure 2).

Conclusion
A Research PSP using the JLA method facilitates the generation and prioritisation of research questions/uncertainties that address the mismatch between what researchers want to research and the practical solutions/information needed day-to-day by HCPs to give holistic care that is relevant to patients, families and carers.Fig 1James Lind Alliance MethodFig 2Top Ten Research Questions
Association between iron intake with diet and diabetes and impaired fasting glucose among PURE Poland study participants
Authors: Rozanska D , Szuba A , Zatonska K , Regulska-Ilow B 
Published: July 2024

Abstract

Introduction
Different studies results show that higher iron intake and increased iron stores in the body are significantly associated with a higher risk of diabetes mellitus (DM), a risk factor for cardiovascular diseases. Iron metabolism in the body is associated with the production of free oxygen radicals, which, combined with the stressful effect of glycation end products in pre-diabetes, increases the risk of diabetes and cardiovascular events.
The purpose of the study was to assess the relationship between iron intake with diet and diabetes and impaired fasting glucose among PURE Poland study participants.

Methods
Study group consisted of 1889 individuals (1185 women and 704 men, aged 35-70 years, from urban and rural area), who were participants of the Polish arm of the Prospective Urban Rural Epidemiology (PURE) study. The study was approved by the Ethics Committee. The data were collected between 2007-2009, in the first stage of the PURE Poland study. Diabetes was diagnosed when fasting glucose level was ≥ 126 mg/dl or there was a declaration about DM occurrence in the medical interview. Diagnosis of impaired fasting glucose (IFG) was made when fasting glucose level was between 100-125 mg/dl with no statement about DM in the interview. Analysis were conducted for DM+IFG in three models: 1. crude data, 2. adjusted for energy intake, 3. adjusted for energy intake, age, body mass index and smoking. Food Frequency Questionnaire (FFQ) was used to assess food intake. FFQ was developed and validated for this population within the PURE study. Iron intake with diet was calculated based on the data from FFQ. For further analysis the study group was divided into tertiles based on the daily iron intake with diet, separately for men and women.

Results
The prevalence of DM+IFG in each tertile (T) of iron intake with diet was: 27.6% (T1), 37.0% (T2) and 38.7% (T3) among women, and 30.3% (T1), 40.9% (T2) and 37.9% (T3) among men. Taking into account crude data the OR (95% CI) for DM+IFG among women was 1.54 (1.14-2.08) in T2 and 1.66 (1.23-2.24) in T3 when comparing with T1. In model 2 the OR (95% CI) for DM+IFG among women was 1.63 (1.16-2.28) in T2 and 1.88 (1.21-2.94) in T3 when comparing with T1. In model 3 in the group of women the OR (95% CI) for DM+IFG was 1.52 (1.07-2.16) and 1.62 (1.02-2.56) when comparing T2 vs T1 and T3 vs T1, respectively. In the group of men in model 1 the OR (95% CI) for DM+IFG prevalence was 1.59 (1.08-2.32) in T2 vs T1 and 1.40 (0.95-2.05, p&gt;0.05) in T3 vs T1. In the group of men in model 2 and 3 the results were not statistically significant, both in T2 vs T1 and T3 vs T1. Taking into account the whole study group the risk of DM+IFG was significantly higher in T2 vs T1 (model 1, 2 and 3) and in T3 vs T1 (model 1 and 2).

Conclusions
Higher iron intake with diet was associated with a higher risk of diabetes and impaired fasting glucose in the study group, especially among women.
Determinants of anxiety and depression disorders among patients with pulmonary arterial hypertension
Authors: Sarzynska K , Beata Jankowska-Polanska B J P 
Published: July 2024

Abstract

Introduction
Pulmonary arterial hypertension (PAH) is a rare chronic disease that, as it progresses, contributes to decreased ability to perform daily activities, deterioration of physical and mental well-being and social functioning. Patients with PAH experience anxiety and depression-like disorders that directly affect their quality of life. In view of the above, it is necessary to determine the determinants that affect the deterioration of mental functioning in this group of patients.

Purpose
The aim of the study was to determine the prevalence of anxiety and depression and their determinants.

Material and methods
The study included 89 patients , pulmonary arterial hypertension (PAH), who participated in the Therapeutic Treatment of Pulmonary Arterial Hypertension program by the National Health Service. Patients were asked to complete a standardized questionnaire (HADS) to assess Anxiety and Depression and a self-report questionnaire assessing sociodemographic factors and severity of symptoms. Medical data were taken from the hospital registry.

Results
In the study group, the mean anxiety score (HADS-A) was M=5.33 (SD=3.31), and the mean depression score (HADS-D) was M=4.4 (SD=3.78), indicating their low level of severity. Significant levels of the studied mood disorders are observed in one in five patients covered by the NHF drug program. Factors significantly (p&lt;0.05) correlating with the severity of anxiety symptoms were chest pain (r=0.343), weakness (r=0.256), fatigue (r=0.327), MWT score 6 (r= -0.266), and arrhythmias (r=0.42). In addition to the above-mentioned factors, significant correlations (p&lt;0.05) were obtained with the severity of depressive symptoms, for such factors as WHO FC Class (r=0.427), eldery age (r=0.263), NT-pro BNP (r=0.239).

Conclusions
Drug and depressive disorders in the study group of PAH patients are not common and may affect one in five patients (study participants on PAH treatment). The occurrence of anxiety disorders correlates with many PAH symptoms, sociodemographic and clinical factors. Learning about the factors associated with the occurrence of mental disorders can help to better identify them and prevent their occurrence.
Determinants of sleep disturbances in patients with pulmonary arterial hypertension
Authors: Sarzynska K , Beata Jankowska-Polanska B J P 
Published: July 2024

Abstract

Introduction
Pulmonary arterial hypertension (PAH) is a rare, chronic disease that leads to the development of a range of cardiopulmonary and cardiovascular symptoms. Studies indicate that sleep problems may contribute to the deterioration of function in patients with PAH. Identifying factors that are related to the occurrence of sleep disorders can help identify them, and will also allow you to take steps to minimize the risk of insomnia.

Purpose
The aim of this study was to determine the determinants affecting the incidence of sleep disorders among patients with pulmonary arterial hypertension.

Material and methods
The study included 89 patients with a diagnosis of pulmonary arterial hypertension (PAH) who are chronically treated and participate in the state program for Therapeutic Treatment of Pulmonary Arterial Hypertension by the National Health Service. The study used standardized tools: a self-administered survey questionnaire, as well as the Pittsburgh Sleep Quality Index (PSQI) questionnaire.

Results
Patients had a mean PSQI score of M=8.7 (SD=4.64), indicating low sleep quality. Factors that had a significant impact on sleep disturbance were: old age (r=0.373), chest pain (r=0.307), weakness (r=0.296), fatigue (r=0.316), shortness of breath (r=0.242), MWT score 6 (r= -0.237), NT-proBNP (r=0, 517), social support (r=0.237), staying in a relationship (r= -0.21), arrhythmia (r=0.211), number of hospitalizations (r=0.33), male gender (r=0.257), WHO FC class (r=0.503).

Conclusions
In the study group of patients with PAH, sleep disorders are present in the majority. The progression of clinical symptoms and selected sociodemographic data significantly correlate with the occurrence of insomnia.
Factors influencing high cardiovascular risk in subpopulation of young adults
Authors: Banaszak-Zak B , Mizia-Stec K , Mizia-Szubryt M , Mlynarska A 
Published: July 2024

Abstract

Introduction
The cardiovascular risk factors determine the development of early atheriosclerotic lesions, and the susceptibility to their proartheriosclerotic action is programmed by external factors and also those present during fetal development. The occurrence of atherosclerotic risk factors depends on an age. In population of children and young adults it seems reasonable to assess the classical risk factors for atherosclerosis in the connection with such additional given as family history being an indirect surrogate of genetic factors, and a low birth weight.
Aim of the study was to categorize the study group into two groups - those who exhibit a low-risk and those who exhibit a high-risk of cardiovascular disease, and to determine the factors characteristic for each risk group.

Materials and Methods
The study was done on 512 volunteers, students in the following Faculties: Health Care Faculty: Nursing Course (178 / 34,7%), Physiotherapy Course (109 / 21,3%), Obstetrics Course (49 / 9,5%), Faculty of Medicine (176 / 34,3%). The questionnaire on cardiovascular risk factors was constructed. According to the results of its assessment the following groups were divided: the group of high risk (10% of investigated with the highest awarding of points) and the group of low risk (10% of investigated with the lowest awarding of points).

Results
Significant quantitative and qualitative differences were found between the low-risk and high-risk groups. Groups of the high and low risk did not differ in respect of sexes investigated and in respect of the direction of studies. One ascertained essential differences in variable qualitative and quantitative between the group of the low and high risk. Family history of diabetes, arterial hypertension, cardiovascular diseases, lipid disturbances, stroke were indeed greater in the group of high risk. The low birth weight was significantly lower in the group of high risk (p=0,02). The current and chronic stress status grading according to the punctual scale (0-10) was significantly higher in the group of high risk as compared to the low risk group (p=0,01, p=0,03, respectively). The systolic pressure was significantly higher in the high risk group in comparison to the low risk subjects (p=0,01).

Conclusions
High cardiovascular risk in subgroup of young adults results from high smoking status, low physical activity, diet and family history of cardiovascular disorders. The numerous cardiovascular risk factors that occur in some students are associated with low birth weight and a positive family medical history. The above observations show the influence of genetic and fetal factors on the development of atherosclerosis. Young adults with high cardiovascular risk are characterized by higher subjective stress level.
Quantitative differences in high risk Medical family history