bluuebunny/crossref_metadata_2025_split huggingface dataset:
An italian real-world analysis of obstructive hypertrophic cardiomyopathy through a large administrative healthcare database
Authors: Maggioni A P , Ronconi G , Dondi L , Dondi L , Calabria S , Dell Anno I , Piccinni C , Pedrini A , Esposito I , Addesi A , Martini N 
Published: November 2023

Abstract

Background
The obstructive hypertrophic cardiomyopathy (HCM) is still not curable. Pharmacological treatments and removal of excess cardiac tissue are recommended to manage symptoms.

Purpose
The study aimed to identify and describe patients with obstructive HCM, from the perspective of the Italian National Health Service (INHS).

Methods
From the Fondazione ReS (Ricerca e Salute) database (∼5 million inhabitants/year), adults with ≥1 in-hospital main/secondary diagnosis of obstructive HCM (ICD9-CM code: 425.1) and surgical resection between 01/01/2013 and 12/31/2018 (accrual period), were identified. They are characterized by age, sex, comorbidities and implantation of cardiac devices/revascularization performance, at the baseline. Within 2 years from 01/01/2019 (index date), mortality and related causes, pharmacological therapy (obstructive HCM-related drugs, other cardiovascular "CV" and non-CV drugs), overnight hospitalizations due to CV causes of interest (i.e., obstructive HCM/heart failure/coronary artery disease/hypertension/cerebrovascular disease), other CV, and non-CV diagnoses, local outpatient specialist care, and healthcare integrated costs charged to the INHS, were assessed.

Results
Out of 640 adults (incidence 16.2x100,000 inhabitants; 55% males; mean age 70±14) with obstructive HCM, 60 (9.4%) underwent resection. The most common comorbidities were hypertension (95%), arrhythmia (53%), and dyslipidaemia (50%). A mean of 2 implantations of cardiac devices/revascularizations are performed in 36% (229/640) patients with obstructive HCM. Within 2 years, 65/640 (10.2%) patients died. Among in-hospital deaths (40/65): 2.5% are due to obstructive HCM, 27.5% to CV and 70% to non-CV causes. During follow-up: ∼90% of patients received ≥1 obstructive HCM-related drug (∼80% β-blockers), 88% ≥1 other CV drug and ∼92% ≥1 non-CV medication. Within the 1st and 2nd follow-up years, respectively, 28% and 22% are hospitalized at least once: 14% and 10% for CV causes of interest, ∼2% for other CV events, and 17% and 13% for non-CV causes; on average, ∼10 days of in-hospital stay. From 85% to 80% of patients received ≥1 local outpatient specialist service, during 1st and 2nd years, respectively. On average, the 1st and 2nd year, respectively, the INHS spent per patient €4362 and €3791: pharmaceuticals accounted for 35% and 40% (mostly concomitant drugs), hospitalizations for 57% and 52%, specialist care for 9% and 8% of the total cost.

Conclusion
Despite the low prevalence of obstructive HCM, this study shows its high overall burden on the INHS, particularly due to concomitant pharmacological treatments and overnight hospitalizations.
Opportunistic identification of atrial fibrillation during unscheduled contact with emergency ambulance services in England: a qualitative exploration
Authors: Wilkinson C , Moloney S , Mcclelland G , Todd A , Doran T , Price C 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is an important risk factor for stroke which commonly affects people attended by Emergency Medical Services (EMS). There may be an opportunity for. EMS clinicians to find new incidental cases of AF suitable for oral anticoagulation (OAC) amongst the population who do not require conveyance to hospital following urgent ambulance review.

Purpose
This study explored whether it was acceptable to propose a formal pathway for identification and subsequent referral of non-conveyed EMS patients with incidental AF to their general practitioner (GP) for consideration of OAC prescription. The perspectives of patients, paramedics, and field experts were included.

Methods
This qualitative study included four online focus groups involving 18 members of the public and one-to-one online interviews in England with 11 health care and service providers (6 paramedics, 5 field experts providing multiple expertise in cardiology, general practice, public health, academic research, healthcare policy, and primary care commissioning) between June and September 2022. A semi-structured topic guide was used, with purposive sampling to maximise the diversity of perspective and experience in all participant groups. Data were audio-recorded, transcribed anonymously and analysed thematically.

Results
All participant groups supported formalising the opportunistic detection of AF during EMS review, but each had concerns and caveats. Of paramount concern to all groups was that any change in practice must not create delays in the emergency response system since incidental AF is non-urgent and other community pathways are in place for detection and management.
Public participants were also concerned about how the diagnosis would be communicated to the patient, and opinion was split between whether this should be ‘on the scene’ or in a subsequent GP appointment. Paramedics reported that they frequently identify incidental AF, but that there is variation in practice regarding whether (and how) this is communicated to the GP. There was a concern that the finding of AF was not easily visible within the existing EMS report and may be missed. Paramedics also focussed on safety-netting of patients not being conveyed to hospital and of a need for an ‘active’ reporting process to ensure that the finding of AF was acted upon. In general, field experts felt that a formal pathway would be useful but relatively low impact, and favoured a simple intervention that did not overly complicate existing AF pathways.

Conclusions
There is support amongst the public and professionals for the development of a formal pathway to ensure ongoing follow-up and care for people with AF incidentally detected in the community by EMS. This novel case finding opportunity has the potential to improve AF detection, oral anticoagulation rates, and reduce the risk of stroke.
The role of seasonal influenza immunisation in cardiovascular care: a survey of cardiologists
Authors: Monagle S R , Spear E , Thakur U , Pol D , Tan S , Bellamy K , Hickman J , Jackson B , Chan J , Nicholls S J , Nelson A J 
Published: November 2023

Abstract

Background
Seasonal influenza immunisation reduces cardiovascular events by 30% in those with atherosclerotic cardiovascular disease (ASCVD) and up to 50% in those with recent acute coronary syndrome. However, uptake in high-risk patients remains poor. Clinician recommendation has been shown to increase adoption of influenza immunisation in the general population; thus, cardiologists are well-placed to promote uptake in patients with cardiovascular disease.

Purpose
To describe the attitudes and behaviours of Australian cardiologists regarding seasonal influenza immunisation.

Methods
We used an exploratory sequential mixed methods design. Semi-structured interviews of 10 cardiologists were performed to identify themes for quantitative evaluation in an online survey. Multiple choice and Likert scale questions explored (a) attitudes and behaviours regarding influenza immunisation, (b) engagement with colleagues and professional bodies and (c) preventative care in cardiology. The survey was administered to 63 cardiologists between November 2020 and January 2021 and respondents received an honorarium for their time.

Results
The majority of respondents were general cardiologists (50/63) – compared with subspecialist cardiologists, and had spent an average of 21 years in practice. Less than half of the cardiologists surveyed asked patients about their vaccination status always or most of the time (46%, 29/63). Only one quarter (25.4%, 16/63) of cardiologists recommended influenza immunisation to all of their patients while higher proportions recommended it among patients with ASCVD (49.2%, 31/63), heart failure (69.8%, 44/63) and those over the age of 65 years (68.3%, 44/63). Just over half of the cardiologists (57.1%, 36/63) agreed that influenza immunisation was important/very important for prevention of cardiac events, however this was of lower priority compared with other components of preventive care including smoking cessation (100% agreed important, 63/63), anti-hypertensives (96.8%, 61/63), statins (94.3%, 60/63), exercise (80.9%, 51/63), anticoagulants (74.6%, 47/63), SGLT2 inhibitors (69.8%, 44/63) and diet (68.2%, 43/63). Three quarters of cardiologists (76.2%, 48/63) believed that the clinician predominantly responsible for ensuring that patients received the immunisation was the general practitioner, with only a minority (12.7%, 8/63) reporting that it was the role of the cardiologist.

Conclusions
Despite a relative risk reduction exceeding that of statins and antihypertensives for patients with CVD, influenza immunisation is not prioritized or recommended by many cardiologists. Efforts at increasing awareness and advocacy among cardiologists may assist in broadening uptake among high-risk patients with cardiovascular disease.
Prospective associations of non-HDL cholesterol with premature structural and functional cardiac damage progression in British youth: the ALSPAC study
Authors: Agbaje A O 
Published: November 2023

Abstract

Background
Non high-density lipoprotein (non-HDL) cholesterol from childhood has been associated with signs of cardiac damage and subclinical atherosclerosis in middle age adults. Cumulative non-HDL cholesterol has been associated with subclinical atherosclerosis during growth from mid-adolescence through young adulthood. Due to the scarcity of repeated measures of cardiac structure and function, there is limited knowledge regarding the independent associations of non-HDL cholesterol with premature cardiac damage in youth.

Purpose
To investigate the longitudinal association of changes in non-HDL cholesterol with structural and functional cardiac damage progression during growth from adolescence through young adulthood.

Methods
From the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort, 1595 adolescents aged 17 years who had fasting plasma non-HDL cholesterol computed from the difference between total cholesterol and HDL cholesterol at 17- and 24-year clinic visits were included. Repeated echocardiography measured LVM indexed for height2.7 (LVMI2.7), relative wall thickness (RWT), LV diastolic function from mitral E/A ratio (LVDF), and LV filling pressure from E/e´ ratio (LVFP) were available at baseline and follow-up. LVMI2.7 ≥51g/m2.7, RWT ≥0.44, LVDF &lt;1.5, and LVFP ≥8 were categorised as LV hypertrophy, high RWT, LVD dysfunction, and high LVFP, respectively. Multivariable adjusted associations were examined using generalized linear mixed-effect models and generalized logit mixed-effect models and adjusted for sex, and time-varying covariates measured at both baseline and follow-up such as age, insulin, high-sensitivity C-reactive protein, heart rate, systolic blood pressure, glucose, fat mass, lean mass, smoking status, family history of hypertension/diabetes/high cholesterol/vascular disease, socioeconomic status, sedentary time, light physical activity, and moderate to vigorous physical activity.

Results
Among 1595 adolescents (mean [SD] age at baseline, 17.74 [0.38] years; 955 [59.8%] females]) mean non-HDL cholesterol values increased in males from 2.34mmol/L to 2.82mmol/L and in females from 2.60mmol/L to 2.77mmol/L, over 7 years. The prevalence of LV hypertrophy increased in males from 3.6% to 11.9% and in females from 1.6% to 4% over 7 years. The prevalence of LVD dysfunction increased in males from 7.8% to 16.6% and in females from 10.3% to 15.4%. In a fully adjusted model, 1 mmol increase in non-HDL cholesterol was significantly associated with higher odds of LV hypertrophy progression (odds ratio 1.21; [95% CI, 1.11 – 1.33], p&lt;0.0001), high RWT (1.16; [1.07 – 1.29], p=0.005), and high LVFP (1.15; [1.06 – 1.25], p=0.001) but not LVD dysfunction (1.05 [0.95 – 1.18], p=0.342), over 7 years.

Conclusion
Increased non-HDL cholesterol during growth from adolescence through young adulthood was prospectively associated with worsening structural and functional cardiac damage in asymptomatic youth.
Reduction in acute coronary events without excess out of hospital cardiac arrest during the COVID-19 lockdown of 2020 in new South Wales, Australia
Authors: Fathieh S , Madronio C , Faddy S , Negishi K 
Published: November 2023

Abstract

Background
The COVID-19 pandemic has seen a significant reduction in reported ACS cases, raising concerns of avoidance behaviour contributing to increased OHCA incidence; exploring this phenomenon can help identify potential mediating factors for these changes and better understand its impact on cardiovascular health.

Purpose
Australia's successful COVID-19 lockdown provides a unique opportunity to study whether it affected the incidence of ACS and OHCAs, shedding light on the impact of pandemic-related behavioural modifications on cardiovascular health.

Method
Using data from the NSW Government database for ACS and NSW Ambulance dispatch data for OHCA, along with climate, traffic, and air quality data, we estimated the excess number of cases using an interrupted time-series analysis that adjusted for seasonal variations, day of the week and temperature. As a sensitivity analysis, we also conducted a two-stage time series analysis for the excess OHCA.

Results
During COVID-19’s first lockdown period (15th March to 1st July 2020), there were reductions in both ACS (-1259 [95% CI -1530, -989]) and OHCA (-69[-235, -92]) (Fig1). In this period there was a clear changes in anthropogenic activities with reductions in traffic (5670±1380 in 2020 versus 9150±1220 in 2018 and 8640±2370 in 2019) and flights (207±169 versus 884±152 and 902±103).These reductions were accompanied with improvement in PM2.5 (5.1±2.1μg/m3 versus 9.0±3.2 in 2018 and 8.2±3.2 in 2019), PM10 (13.3±5.4μg/m3 versus 20.9±8.6 and 17.7±6.0), and NO2 (7.4±2.7 ppb versus 8.4±3.3 and 9.0±2.8) (Fig2).

Conclusion
During the first COVID-19 lockdown in NSW, there was a significant reduction in the number of ACS cases without any associated excess in OHCA. This may be caused, at least partly, by the improved air quality from the behavioural changes.Excess ACS (STEMI & NSTEMI) and OHCAChanges in Traffic and Flights Activitie
Mortality after cardiovascular surgery and percutaneous coronary intervention prior to versus during the COVID-19 pandemic
Authors: Chu A , Wang X , Paterson J M , Hillmer M , Malikov K , Lee D S 
Published: November 2023

Abstract

Background
The COVID-19 pandemic disrupted the usual delivery of health care services globally. However, little is known about its specific impact on cardiovascular procedure rates and outcomes.

Purpose
To compare rates of isolated coronary artery bypass graft (CABG) surgery, isolated open valve surgery (iValve) and percutaneous coronary intervention (PCI), and 30-day all-cause mortality among patients undergoing these procedures before versus during the COVID-19 pandemic.

Methods
We undertook a retrospective cohort study of patients aged 18 years and older in Ontario, Canada, comparing procedure and outcome event rates between April 1, 2018 and March 31, 2020 (pre-pandemic) with those between April 1, 2020 and March 31, 2022 (pandemic). Procedures were identified from hospital records, available for all patients hospitalized in the province, and were calculated per 100,000 population. Deaths were identified from the Ontario Health Insurance Plan Registered Persons Database. Multivariable logistic regression models were used to compute mortality rates adjusted for relevant sociodemographic and clinical characteristics. Additionally, we estimated the number of procedures needed to result in one excess death as the difference between the two periods divided by the pre-pandemic rate.

Results
During the study period, 24,823, 7,768 and 86,549 patients underwent CABG, iValve and PCI respectively. Between the pre-pandemic and pandemic periods, CABG, iValve and PCI rates declined 18.8%, 19.3% and 14.7%, respectively (Figure). Overall, the 30-day mortality rates were 1.9%, 2.4% and 2.6% following CABG, iValve and PCI, respectively. Adjusted 30-day mortality after CABG increased from 1.92 per 100 procedures (95% CI 1.69-2.15) pre-pandemic to 2.25 (2.01-2.49) during the pandemic (p=0.043). Adjusted 30-day mortality also increased among patients receiving iValve [from 2.25 (1.78, 2.71) to 3.29 (2.76, 3.82); p=0.016] and PCI [from 2.41 (2.28, 2.54) to 2.74 (2.60, 2.88); p&lt;0.001]. These differences translate to an estimated excess of one death per 303 CABG surgeries, 96 iValve surgeries and 303 PCIs during the pandemic period.

Conclusions
In Ontario, Canada, CABG, iValve and PCI rates decreased during the COVID-19 pandemic and had not fully returned to pre-pandemic levels by two years following its initiation. While 30-day mortality rates following cardiovascular procedures significantly increased during the pandemic, the incremental number of additional deaths was small.
How reliable are single day electrocardiogram measurements to detect excessive supraventricular ectopic activity?
Authors: Maneheim A , Persson A P , Slusarczyk M , Healey J , Engstrom G , Johnson L 
Published: November 2023

Abstract

Background
Excessive Supraventricular Activity (ESVEA) is widely recognized as a significant risk marker for incident atrial fibrillation, but the diagnostic reliability of ESVEA measured by 24-hour electrocardiogram (ECG) is unknown.

Objectives
To study the variability of ESVEA over 14 days using mobile cardiac telemetry (MCT).

Methods
We included US patients aged 17-100 years with ≥14 full days of ambulatory full-disclosure ECG using an MCT device during 2017, without atrial fibrillation during any of the recording days. ESVEA was defined as the presence of ≥720 premature atrial complexes and/or a ≥20 beat long supraventricular tachycardia, and calculated for each recording day.

Results
The study population consisted of 9,899 patients (median age 70 (interquartile range 59-77) years, 57% female). ESVEA was very common: 45% (n= 4,453) had ESVEA on at least one day. Of the patients with ESVEA, it occurred on one day only in 28% and on all registered days in 18%. The median number of ESVEA positive days was 4 (IQR 1-12). On the first monitoring day, 20% were ESVEA positive, resulting in a sensitivity of 44.64% and a negative predictive value of 68.84% of a single day measurement of ESVEA.

Conclusions
ESVEA occurs in almost half of an MCT population, but less than half of the patients with any occurrence of ESVEA are detected on the first monitored day. Reliable diagnosis of supraventricular ectopy requires longer monitoring durations.
Global burden of myocarditis from 1990 to 2019 and projections until 2030
Authors: Chen A , Chen Z W , Xia Y , Lu D B , Yang Z , Che X Y , Qian J Y , Ge J B 
Published: November 2023

Abstract

Background
Myocarditis remains a major public health challenge worldwide, which might be increasing with the pandemic of coronavirus disease 2019.

Purpose
This study aimed to examine the myocarditis burden at the global level, and predict the future trend until 2030.

Methods
Incident cases, deaths, disability-adjusted life years (DALYs), and their corresponding age-standardized rates, as metrics of myocarditis burden, were obtained from the Global Burden of Disease Study 2019. The estimated annual percentage changes (EAPCs) were calculated to reveal temporal trends from 1990 to 2019. Bayesian age-period-cohort model was used to make projections.

Results
Increases were noted in incident cases (62.19%) and deaths (65.4%) of myocarditis, with a slight decrease of DALYs (-0.42%). Age-standardized death rate (ASDR) showed a stable trend over time [EAPC: -0.09, 95% confidence interval (CI): -0.38 to 0.2], decreases were noted in age-standardized incidence rate (ASIR) (EAPC: -0.23, 95% CI: -0.26 to -0.21) and age-standardized DALY rate (EAPC: -1.19, 95% CI: -1.33 to -1.04). Males bore more myocarditis burden than females. Almost a third (29.94%) of myocarditis patients resided in countries with a middle sociodemographic index (SDI). Higher ASIRs were observed in regions with higher SDI levels. People aged less than 20 years in low and low-middle SDI quintiles developed myocarditis and died from it earlier than those in other quintiles. Global ASIR and ASDR were predicted to continuously decrease until 2030.

Conclusion
These findings suggested considerable heterogeneity in the epidemiologic patterns of myocarditis, guiding the policymakers to formulate optimal strategies and resource allocation for myocarditis.Abstract Picture 1
Impact of referral diagnosis on diagnostic yield in 1-day vs 7-day and 14-day extended wear holter
Authors: Parikh P , Grigoriadis C J , Dunn A , Norlock V , Gillstrom G , Wadhwa M 
Published: November 2023

Abstract

Background
Use of Extended Wear Holter (EWH) with monitoring durations up to 14 days has become common in clinical practice. When ordering a monitor, a referral diagnosis (RefDx) is provided to indicate the reason for the study. We previously presented data showing EWH monitors, irrespective of RefDx, provided a 2x diagnostic yield (DY) at 7d and 2.5x DY at 14d when compared to 1d Holter.

Purpose
To determine the impact of RefDx on DY for clinically significant arrythmias (CSA) using ePatch EWH monitoring for 1d, 7d, and 14d.

Methods
From October - December 2021, retrospective data was analyzed for RefDx (ICD-10 diagnosis code) and DY of CSA for ePatch with 1d, 7d, and 14d of analyzable data. RefDx were categorized as Common and Uncommon. Common RefDx included ICD-10 codes which represented at least 1.5% of total referrals on 1d monitors, while all RefDx with &lt;1.5% were grouped together as Uncommon. CSA was defined as Bradycardia &lt; 40 bpm, Pause ≥ 3 seconds, ≥ 2nd Degree AV Block, AF &gt; 30 sec, SVT &gt; 160 bpm for ≥ 3 beats, and VT &gt; 100 bpm for ≥ 3 beats. DY was calculated as the percentage of patients with at least one CSA over the monitoring duration. Patients with Chronic AF were excluded from this analysis.

Results
RefDx for patients who wore ePatch for 1d (n=21,505), 7d (n=9,252), and 14d (n=11,269) are shown in the Table. Irrespective of monitoring duration, the most frequent RefDx was Palpitations (&gt;35%).
For each RefDx, the DY for any CSA at 1d vs 7d, 1d vs 14d, and 7d vs 14d was statistically significant (see Figure). Across all RefDx, DY increased 1.7x - 2.8x when comparing 1d to 7d, 1.9x - 4.2x when comparing 1d to 14d, and 1.1x – 1.5x when comparing 7d to 14d. For 1d, the lowest DY was for RefDx Chest Pain (13%) while the highest was for RefDx Bradycardia (43%). The DY benefit of extending monitoring from 1d to 7d was normally distributed across RefDX, while the DY benefit of extending monitoring from 7d to 14d was greatest (1.5x) for Chest Pain, and the DY benefit of extending from 1d to 14d was greatest (≥3.4x) for Chest Pain, Tachy Unspecified, Palpitations, Syncope/Collapse, and Dizziness/Giddiness. Notably, the most common RefDx of Palpitations demonstrated a DY of only 17% at 1d that increased 2.5x at 7d and 3.4x at 14d.

Conclusion
The impact of extending monitoring duration from 1d to either 7d or 14d was that a disparity in additive DY was observed when analyzing by RefDx. The 5 RefDx with the lowest DY for 1d of monitoring showed increases of ≥2.5x DY at 7d and ≥3.4x Dy at 14d of monitoring. Conversely, the 3 RefDx with the highest DY for 1d of monitoring showed &lt;2X DY at 7d and &lt;2.2x DY at 14d. Our data suggests that the RefDx can potentially be used to guide an optimal duration of telemetry monitoring.