bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frailty evaluation a key to tailored cardiovascular rehabilitation in elderly patients
Authors: German-Sallo M , Preg Z , Balint Szentendrey D , Pal T , Nagy Z , Tatar M C 
Published: June 2024

Abstract

Introduction
Aging most frequently is associated with increasing number of comorbidities and disability leading to frailty, which decreases functional independence. Cardiovascular rehabilitation can be challenging in these situations.

Purpose
Our aim was to assess frailty syndrome in elderly patients, as part of a comprehensive cardiovascular rehabilitation program and to identify the main components contributing to loss of self –care.

Methods
A total number of 92 patients (53,3% female) , aged 60 years or older (mean age 72,4 ±7,44 ) admitted to a cardiovascular rehabilitation clinic were included in a cross- sectional study. History, physical examination and guideline recommended investigations were performed. 2 different instruments were used to evaluate frailty: Clinical Frailty Scale (CFS) and Frail Scale (FS). Based on the obtained points, patients with a mean CFS score of 5 or higher or a mean FS score 3 or higher were classified into the frail group. We compared the clinical and laboratory parameters of the frail patients with data of the non-frail group. In addition we looked for occurence of frailty in individuals below 70 years compared to those above 70 years. Data were processed using Microsoft Excel 2019 , t- test and chi-square test, p&lt;0.05 was considered statistically significant.

Results
30 patients (32,6%) were identified with frailty according to CFS and also based on FS. Mean age of frailty patients was higher (76,89 ±6,7 years vs. 70,37 ±6,7 years , p &lt; 0,001). Prevalence was significantly higher in subjects older than 70 years (28% vs 11%, p&lt;0,001) according to CFS, but not to FS. In the frailty group the following parameters were significantly lower : serum albumin (3.92 g/dl vs. 4.15 g/dl, p=0.02), hemoglobin (12.01 g/dl vs. 13.13 g/dl; p =0.01) and eGFR (66.65 ml/min/1.73 m2 vs. 82.86 ml/min/1.73 m2, p=0.02). Based on CFS the following comorbidities were more prevalent in the affected group: atrial fibrillation (57,1% vs 30,6%, p=0,01), chronic kidney disease (42,85% vs 18%, p &lt; 0,001) and osteoarticular diseases (39% vs 19%, p=0,04). FS score based evaluation showed that previous stroke (26% vs 8%, p=0,01) , CKD (50%vs 15%, p=0,01) and osteoarticular diseases (39% vs 19%, p=0,04) were more frequent in frail patients.

Conclusions
Assessment of frailty can be integrated in older cardiovascular patient's evaluation. Revealing and addressing specific frailty related aspects could overcome the barrier to restoration of their functional independence.
Lipid-lowering treatment pattern in chronic coronary syndrome - lower proportion of treatment observed among women during 3 years of follow-up
Authors: Johnston N , Schubert J , Svensson M K , Taufer Cederlof E , Cars T , Gustafsson S , Schalin L , Hagstrom E 
Published: June 2024

Abstract

Background
Lipid-lowering treatment (LLT) is one of the cornerstones in secondary prevention in patients with chronic coronary syndrome (CCS). Despite having the same recommendations for target levels of low-density lipoprotein cholesterol (LDL-C), studies have shown that women have worse control of LDL-C than men. Older age has been suggested as a significant explanatory factor.

Purpose
To describe and compare the treatment pattern and target achievement of LDL-C levels in men and women managed for CCS in a primary care setting. Furthermore, to elucidate factors contributing to sex differences by examining the frequency of LDL-C assessment and LLT intensity by age.

Methods
A retrospective observational study of patients with CCS was performed in a region of Sweden comprising 390 000 inhabitants. The study population included men and women with a CCS first-time diagnosed between 2012 and 2020 and without previous myocardial infarction. The CCS diagnosis was based on the combination of an international classification diagnosis code (ICD-10) of angina and coronary artery disease confirmed by either a non-invasive or an invasive investigation. Data on clinical measurements after inclusion were collected from the electronic health records. Target levels were LDL-C &lt;1.8 mmol/L (2012-2015) and LDL-C &lt;1.4 mmol/L (2015-2020) and systolic blood pressure (SBP) &lt;140 mmHg. Data were stratified by sex and age categories (&lt;60, 60-&lt;70, 70-&lt;80, ≥80 years). Measurement of blood pressure (BP) was used as a proxy for a healthcare visit.

Results
Median age was 68 (interquartile range [IQR], 62-74) and 70 (IQR, 63-76) years in men (N=1037) and women (N=415), respectively. Compared with men, women were less often treated with LLT and less likely to receive combination with a statin and ezetimibe (Figure 1). A larger proportion of women was not treated with any LLT. In all age subgroups, a decline in LLT use in women compared to men was observed over time. Assessment of LDL-C decreased markedly after the first year of follow-up irrespective of sex (assessment of LDL-C was 67.7% and 50.9% at year one and three, respectively). In both men and women, target achievement of LDL-C was low and decreased during follow-up (Figure 2). Regardless of sex, measurements and target achievement of BP were monitored more frequently than those of LDL-C levels.

Conclusion
Women were less often and less aggressively treated with LLT than men, on average. Although most patients with CCS are in contact with healthcare professionals for BP monitoring, little or no actions seem to be taken to improve lipid management.
Incidence and short term outcome of patients manifesting delirium in a university hospital cardiac intensive care unit
Authors: Pavli E , Sulku E , Dado E , Gjana A , Kristo E , Dibra L , Katana E , Seiti J , Xhafaj M , Tafaj E , Kastrati A , Dibra A 
Published: June 2024

Abstract

Introduction
Among patients admitted in Intensive Care Unit, delirium is increasingly a common manifestation, especially on those who need mechanical ventilation. Due to its potential unfavorable effect on outcomes, early detection and adequate treatment may have an important preventive value.

Purpose
To evaluate in-hospital and 30 days’ outcome of patients experiencing delirium in a Tertiary Center Cardiac Intensive Care Unit.

Methods
We prospectively collected in hospital and 30-day follow-up data of 113 consecutive patients admitted at our cardiac intensive care unit from May to December 2022, who manifested delirium. Primary endpoint was in-hospital and 30-day all-cause death. Secondary endpoints included major in-hospital adverse events (composite of new onset or decompensated heart failure, bleeding, malignant ventricular arrhythmia, and acute renal failure), and composite of re-hospitalization and reappearance of cognitive dysfunction at 30-day follow-up.

Results
Out of 1952 patients admitted at our intensive care unit, 133 (5.79%) manifested delirium, with a rate of in-hospital all-cause mortality of 14.78% compared to 4.6% of total cohort. 30 days’ all-cause mortality for the studied population was 30.97%. New onset or worsening of heart failure occurred in 27.4% of patients, acute kidney injury in 27.4% of patients, malignant ventricular arrhythmias in 12.4% and major bleeding (BARC3, 5) in 5.3% of patients. During 30 days’ follow-up, the rate of re-hospitalization for cardiac causes was 9.4% and 33.3% of patients re-manifested cognitive dysfunction. Independent predictive factor for an in-hospital adverse event resulted the use of inotropic and vasopressor drugs and for occurrence of an adverse event at 30 days’ follow-up was history of atrial fibrillation and use of inotropic and vasopressor drugs.

Conclusions
Delirium among patients hospitalized in cardiac ICU is related with worse short term outcomes including higher rates of death from any cause. Early detection and appropriate treatment has a crucial importance in preventing major adverse events.
Prevalence of modifiable risk factors among patients hospitalized for acute coronary syndrome in Brazil: a call to action for Brazilian healthcare
Authors: Mota D , Almeida K M N D , Ferreira I M , Sobreira V , Baccaro B M , Bicalho V , Ramadan H R , Sequetin P A U , Franchini K 
Published: June 2024

Abstract

Background
Acute Coronary Syndrome (ACS) represents a substantial public health challenge in Brazil. Modifiable risk factors are pivotal in its incidence, yet large-scale data is sparse for crafting effective interventions to mitigate the leading cause of mortality.

Purpose
To elucidate the prevalence of classic modifiable risk factors in ACS hospitalizations at a premier Brazilian public cardiology institution.

Methods
This investigation harnessed the ACS registry data from a prominent high-complexity cardiology reference center in Brazil. The study spanned from July 2018 to October 2022, encompassing patient demographics, clinical characteristics, and outcomes. The focus was on the prevalence of modifiable risk factors (hypertension, diabetes, dyslipidemia, overweight/obesity) in patients with verified ACS diagnoses, ascertained via self-reporting or at admission.

Results
Of 143,352 patients evaluated in the emergency department, 19,752 required admission, with 5,580 confirmed ACS cases (28.2%). ACS presentations were unstable angina (56.0%), NSTEMI (34.8%), and STEMI (9.2%). The mean age was 63 years, with females constituting 35.9%. A staggering 99.3% displayed sedentary lifestyles, 80.4% had hypertension, 72.5% were overweight/obese, 56.6% had diabetes, 53.5% had dyslipidemia, and 20.6% were smokers.

Conclusion
The study underscores a critical prevalence of modifiable risk factors in ACS admissions. These findings underscore the critical need for aggressive public health strategies and lifestyle interventions to tackle the modifiable risks associated with ACS in Brazil.
Prognostic significance of non-ischemic computational pressure-flow dynamics derived fractional flow reserve in stable coronary artery disease patients in LAD versus non-LAD artery lesions
Authors: Sze H , Leung K L C , Yiu K H 
Published: June 2024

Abstract
Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is an angiographic-derived index to determine the fractional flow reserve (FFR) without the need of invasive pressure wire and hyperaemic stimulus. Although the safety of FFR-guided deferral of revascularization in non-ischemic lesions is well-established, physicians are not always comfortable deferring treatment of a stenosis in the left anterior descending (LAD) artery because the LAD often supplies a large territory of myocardium. It has been suggested that because of the relatively large area of myocardium at risk, only hyperaemia-based indexes can be trusted for decision-making in the LAD. However, whether caFFR guided deferral of LAD lesions is safe compared to non-LAD lesions is unclear. The aim of the study is to investigate the prognostic implications of caFFR for non-ischemic deferred LAD compared to non-LAD lesions in stable coronary artery disease (CAD) patients.
Among the 1552 stable CAD patients who were recruited from 2014-2017, 650 of the stable CAD patients (mean age=63.3±12.2, 65.2% male) had non-ischemic lesions defined by caFFR≥0.80 and did not undergo PCI for said lesions. The primary endpoint was the vessel-oriented composite endpoint (VOCE), defined as vessel-related cardiovascular mortality, vessel-related myocardial infarction (MI) and any unplanned revascularisation at median follow-up time of 4.4 years. Survival curves were constructed using Kaplan-Meier estimates and differences between groups were tested using the log-rank test. Cox proportional hazards model was also used to evaluate the association between an LAD artery and the risk of VOCE, with parameters with P&lt;0.1 upon univariate analysis entered into multivariable Cox model.
A total of 430 (23.1%) LAD and 1434 non-LAD (76.9%) non-ischemic lesions that had not undergone PCI were studied. Mean caFFR was 0.90±0.04 amongst LAD lesions and 0.92±0.04 for non-LAD lesions (P&lt;0.001). LAD lesions had significantly higher incidence rates than non-LAD lesions in terms of VOCE (6.0% vs 3.0%; P=0.003), MI (2.1% vs 0.6%; P=0.007), and unplanned revascularisation (4.9% vs 2.4%; P=0.009). After multivariate adjustment, LAD lesions had a significantly higher risk than non-LAD lesions in terms of VOCE (HR 1.80; 95%CI 1.10-2.95; P=0.019), vessel-related MI (HR 3.54; 95%CI 1.36-9.20; P=0.010), and unplanned revascularisation (HR 1.82; 95%CI 1.06-3.14; P=0.031).
In stable CAD patients, caFFR-based deferral has superior prognostic durability in non-LAD lesions compared to LAD lesions during long-term follow up. This novel index could enhance risk stratification of non-ischemic vessels in stable CAD patients for LAD and non-LAD lesions. Kaplan-Meier curves for VOCE
Feasibility and preliminary effectiveness of a population health management approach to improve cardiovascular risk management in primary care: a mixed-method implementation study
Authors: Rakers M , Van Hattem N E , Hiddink E , Van Peet P G , Vos R C , Chavannes N H , Atsma D E , Bonten T N , Van Os H J A 
Published: June 2024

Abstract

Background
Cardiovascular disease (CVD) is a leading cause of death and results in a significant burden on the healthcare system. Population-level prevention strategies in primary care, especially combined with technology such as remote patient management (RPM), are promising for managing risk factors effectively. To overcome implementation barriers in cardiovascular risk management using RPM, population health management has been proposed as a systematic approach for proactively assigning appropriate interventions tailored to specific subgroups of patients.

Purpose
This study evaluated the feasibility, acceptability and preliminary effectiveness of Connect@Heart, a proactive population health management RPM program which includes a blood pressure monitor, scale, or activity tracker. These devices were connected to a data exchange platform, enabling real-time cardiovascular risk management.

Methods
We conducted a mixed methods feasibility study to assess the improvement of blood pressure control through a six-month pre-post intervention in four general practices in the Leiden region in the Netherlands. Patients with a moderate to high risk of CVD or established CVD were proactively identified by an algorithm embedded in the electronic health record. Assessments were performed between baseline and six-month follow-up using paired-sample t-tests and linear mixed effects models. Feasibility criteria included &gt;80% enrollment and completion rates. Acceptability was measured using the System Usability Scale (score &gt; 68), Client Satisfaction Questionnaire-8 (score &gt; 20), and interviews with healthcare professionals. Preliminary effectiveness was determined by changes in blood pressure and weight.

Results
94% (189/200) of eligible patients were enrolled, of which 81% (153/189) completed the assessments after 6 months. In total, 121 technical queries sent to the technical portal of which 71% could be solved immediately. Patients rated the program as acceptable (SUS = 65.86 and CSQ-8 = 24.58). Interviews with healthcare professionals confirmed this. At 6-month follow-up, patients showed significant reductions in systolic blood pressure (baseline mean 140 mmHg, SD 18 mmHg; follow-up mean 131 mmHg, SD 14 mmHg; p &lt; 0.001) and diastolic blood pressure (baseline mean 86 mmHg, SD 10 mmHg; follow-up mean 81 mmHg, SD 9 mmHg; p &lt; 0.001). A 49% relative risk reduction in uncontrolled systolic blood pressure (&gt;135 mmHg) was found at 6-months.

Conclusion
The Connect@Heart program is an acceptable and feasible approach for healthcare professionals and patients, tailored for individuals at risk of cardiovascular disease or with established CVD, and may substantially reduce blood pressure levels. The Connect@Heart program
Mixed messages? Information about cardiovascular health and alcohol use: a cross-sectional study of patients in cardiology care
Authors: Wallhed Finn S , Welfordsson P , Bjorck C , Grzymala-Lubanski B , Hambraeus K , Lidin M , Haugen Lofman I , Braunschweig F , Danielsson A K 
Published: June 2024

Abstract

Background
Hazardous alcohol use is a leading risk factor for disability and death, yet observational studies have also reported reduced cardiovascular disease mortality among regular, low-level drinkers. Such findings are refuted by more recent research, yet have received significant media coverage. There has been little research on how adults with cardiovascular disease access information and how they perceive risks of alcohol consumption. Studies to date are restricted to the United States, limiting generalizability to other contexts.

Purpose
To explore: 1) how patients with cardiovascular diseases access health information about moderate drinking and cardiovascular health; 2) the perceived messages these sources convey, and 3) associations with own level of alcohol use.

Method
We conducted a cross-sectional survey of patients in cardiology services at three hospitals in three different regions in Sweden. The study outcome was hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test-C questionnaire and defined as ≥3 in women and ≥4 in men. The exposure was accessing information sources suggesting that moderate alcohol consumption can be good for the heart, as opposed to accessing information that alcohol is bad for the heart. Health information sources were described using descriptive statistics. Gender, age and education were adjusted for in multiple logistic regression analyses.

Results
From 1230 eligible patients, 83% responded to relevant survey questions. Of these, 48.6% had heard that drinking moderately can affect the heart (mean age 70.5 years, 65% males). A total of 330 (62.3%) patients who had heard that drinking moderately can affect the heart described being exposed to reports that moderate alcohol use can be good for the heart, and 108 (21.7%) met criteria for hazardous alcohol use. Health information sources included newspapers (32.9%), television (29.2%), healthcare staff (13.4%), friends/family (11.8%), social media (8.9%) and websites (3.7%). Participants indicated that most reports (77.9%) conveyed mixed messages about the cardiovascular effects of moderate drinking. Exposure to reports of healthy heart effects was associated with increased odds of hazardous alcohol use (odds ratio=1.67, 95% confidence interval=1.02–2.74).

Conclusions
This study suggests that many patients in cardiology care access health information about alcohol from media sources, which convey mixed messages about the cardiovascular effects of alcohol. Exposure to reports suggesting that moderate drinking has protective cardiovascular effects was associated with increased odds of hazardous alcohol use. Findings highlight a need for clear and consistent messages about the health effects of alcohol. Table Health information sources
The chronic heart failure evolutions: different fates and routes
Authors: Chiesa M , Salvioni E , Emdin M , Piepoli M , Sinagra G , Mapelli M , Senni M , Bonomi A , Metra M , Limongelli G , Parati G , Agostoni P 
Published: June 2024

Abstract

Background
Individual prognostic assessment and disease evolution pathways in chronic heart failure (HF) are unmet needs. The application of unsupervised learning methodologies could help at: a) identification of HF patient phenotypes; b) identification of the evolution states and progression in each phenotype and c) assessment of risk of adverse event.

Methods
We retrospectively analyzed the MECKI registry including 7948 HF patients. After preliminary preprocessing, we selected 4876 patients with a minimum 2-year follow-up. We implemented a Topological Data Analysis (TDA), based on 43 variables derived from clinical, biochemical, cardiac ultrasound and exercise evaluations, to identify several patients’ clusters. Thereafter, we used the trajectory analysis to describe the evolution of HF states, which is able to identify bifurcation points, characterized by different follow-up paths, as well as stopping points, i.e. specific end-stages conditions of the disease. Finally, we conducted a survival analysis to generate 5-year time-to-event curves using as study endpoint the composite of cardiovascular death, LVAD or urgent heart transplant. Findings were validated on internal (n=527) and external (n=777) populations.
Figure 1 shows the main methodological steps (upper and middle panel).

Results
Nineteen patient clusters were identified by TDA. Table 1 shows the main collected variables according to events occurrence at 2 and 5 years follow up. Trajectory analysis revealed a path characterized by 3 bifurcation points with 2 different follow-up path each and 4 stopping points (Figure 1, lower panel). Clusters survival rate varied from 44% to 100% at 2 years and from 20% to 100% at 5 years, respectively. Finally, we compared the event frequency at a 5-year follow-up for each study cohort cluster with those in the validation cohorts (R = 0.94 and R = 0.84, p &lt; 0.001, for internal and external cohort, respectively).

Conclusions
Each HF phenotype has a specific disease progression and prognosis. The bifurcation points need attention since are followed by different disease routes with 4 different disease end-stages which are characterized by different prognosis. These findings allow to individualize HF patient evolutions and to tailor assessment.
Impact of iron deficit in exercise capacity in heart failure patients: the role of VE/VCO2 slope and VO2peak
Authors: Campodonico J , Salvioni E , Mapelli M , Vignati C , Pezzuto B , Acquistapace A , Lorenzon B , Agostoni P 
Published: June 2024

Abstract

Aims
Iron Deficit (ID) is frequently observed in HF patients even in the absence of anemia. In Heart Failure (HF) patients ID is associated to a reduced exercise performance regardless of anemia, related to abnormality in O2 delivery and utilization (evaluated by VO2 peak) and/or to inefficiency in ventilation during exercise (evaluated by VE/VCO2 slope), respectively. Of note, both peak VO2 and VE/VCO2 are independent predictors of HF severity being in ID HF patients reduced and increased, respectively. The aim of this study is evaluating whether it is possible to indicate as the leading cause of exercise limitation in HF patients with ID, but not anemia oxygen delivery abnormalities or reflex induced hyperventilation or whether both are concomitant.

Methods and Results
We analysed data of 1043 patients hospitalized for HF. 413 patients have ID (transferrin saturation, TSAT &lt;20%) and 630 have TSAT≥20%. Patients with TSAT&lt;20% showed a significantly lower VO2 anerobic threshold (AT) and VO2 peak and a higher VE/VCO2 slope, also when parameters were adjusted for hemoglobin (Hb), left ventricular ejection fraction (LVEF), age, gender and serum creatinine. In particular, in patients with TSAT&lt; 20% VO2AT= 688 ± 290 ml/min, VO2 peak= 967 ± 377 ml/min, VO2 peak/Kg= 15 ± 3 ml/min, and VE/VCO2= 38 ± 9 while in patients with TSAT≥20% VO2AT= 881 ± 357 ml/min; VO2 peak= 1269 ± 529 ml/min, VO2peak/Kg= 16 ± 6 ml/min, and VE/VCO2= 33 ± 8 (Table 1).
Finally, adjusting also for VO2 peak difference between TSAT&lt; and ≥ 20% for VE/VCO2 persists as after adjusting for VE/VCO2 VO2 peak differences did (Fig 1a and 1b).

Conclusion
In HF patients ID is associated with exercise performance impairment independently from anaemia, age, left ventricle ejection fraction and serum creatinine. Both peakVO2 and VE/VCO2 relationship slope are pivotal and independent causes of exercise limitation in these patients. Fig 1 Table 1