bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of age in the effectiveness of the implementation of a transitional-care heart failure program: a population-based analysis with real-world data in 77,554 patients
Authors: Torres B , Alcober L , Vela E , Cleries M , Corbella M , Jose N , Ramos R , Ras M , Jimenez S , Garay A , Alcoberro L , Pons A , Ruiz M , Enjuanes C , Comin-Colet J 
Published: November 2023

Abstract

Background
Old age has a negative impact in terms of outcomes and medical resource use in patients with heart failure (HF). The efficacy of HF management programs has been widely proved, however the influence of age in the effectiveness of HF programs is still unknown.

Purpose
To analyze the effect of age on health outcomes before and after a pragmatic implementation of an intensive transitional care nurse-based HF management program integrating hospital and primary care and resources for patients with HF at a high risk of events in a health-care area of 209,255 inhabitants.

Methods
For the purposes of this study, we included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January, the 1st, 2015 and December, the 31st of 2019. We considered 3 distinct periods of implementation of the HF program: pre-implementation (2015-2016), transition (2017) and consolidation (2018-2019). To evaluate the efficacy of the program according to age strata, we compared outcomes between HF patients of the implementation area and HF patients of the remaining healthcare areas of Catalonia across implementation periods and stratified according to age strata.

Results
We included 77,554 patients in the study: 3,396 in the implementation area (HUB-Delta area) and 74,158 in the rest of Catalonia. According to age, patients were classified as, 15-74 years age-group (19.624, 25.3%), 75-84 years age-group (28.054, 36.1%) and &gt;84 years age-group (29.876, 38.5%). In the implementation area, all-cause death, clinically related hospitalizations and HF readmissions were significantly improved in the consolidation period compared to the pre-implementation period in all age-groups (Table 1). As shown in Figure 1, left column, the implementation of the program resulted in a significant improvement in all outcomes evaluated for the whole HF population of the HUB-Delta area compared to the rest of Catalonia. The improvement was consistent across all age groups (Figure 1, middle and right columns) in the consolidation period for all outcomes evaluated. However, in patients &gt;84 years old, the size effect of improvement in patients of the HUB-Delta area tended to be attenuated when compared to the benchmark.

Conclusions
The risk of mortality, clinically related hospitalizations and HF hospitalizations in recently discharged patients with HF has an independent association with age. The implementation of an intensive transitional care nurse-based HF management program improves clinical outcomes across age strata. Remarkably these improvements are also seen in very old patients above 84 years old.Figure 1Table 1
A virtual heart failure ward in a rural demography
Authors: Roebuck A , Checkley J , Fawcett B 
Published: November 2023

Abstract

Background
Lincolnshire is a large rural county in the UK with wide economic variation, social deprivation, poor communication infrastructure and no large urban centre of population. As a result of these factors we have a significant incidence of heart failure and a variation in access to services. As part of a county wide initiative to improve the care of patients with heart failure and to reduce acute reduce admissions to hospital we introduced a virtual heart failure ward in January 2022. The ward is overseen by the community cardiology heart failure specialist nurses and led by a cardiology Advanced Clinical Practitioner (ACP) - a multi-professional worker educated to Level 7 with the ability to prescribe and request procedures/ investigations. Governance is from the acute cardiology team via multi-disciplinary meetings. Patients who are decompensating that historically would have required admission can be 'admitted' to the ward and patients who have been admitted to the acute hospital can also be admitted/ stepped down to facilitate discharge. The ward is supported by a 7/7 (expanded from 5/7 to support the project) specialist nursing team, weekly ward rounds, telemedicine (multi-provider app), remote monitoring (oximetry/ weight/ BP), outpatient IV furosemide, specialist heart failure rehabilitation (F2F and remote) and supports a seamless service between primary, community and secondary care.

Results
In the first 13-months N=213 patients were treated via the virtual ward. N=137 (64%) 'step up, N=75 (35%) step down, N=1 (self-referral), see figure one. N=194 patients were discharged. N=25 (12%) were admitted for escalation of care, see figure two. In the first year, we estimate that the virtual ward released 1,147 acute bed days (1,033 admission prevention and 114 early discharge) and delivered a cost reduction of approximately to £1m. An external audit team has identified a 10% reduction in heart failure admissions to the acute hospital. PROMS (patient recorded outcome measures) show high patient satisfaction and staff have found the enhanced 7/7 service beneficial and rewarding.

Discussion
Our experience of implementing a virtual heart failure ward in a rural demography has been exceedingly positive. We have observed significant reductions in admissions, facilitated early discharged from hospital with high patient and staff satisfaction. this intervention has also delivered a substantial cost saving to the wider health economy.Step Up/ Step DownDischarge Destinations
Association of cardiovascular health with incident heart failure in community population without cardiovascular disease: results of the China PEACE million persons project
Authors: Cai A P , Chen C L , Ou Y Q , Wang J B , Feng Y Q , Nie Z Q 
Published: November 2023

Abstract

Aim
To evaluate the association of cardiovascular health (CVH) with incident heart failure (HF).

Methods
The China PEACE million persons project is a nationwide, government-funded and population-based cardiovascular disease (CVD) screening study. This was a sub-cohort study of the project that included community-dwelling adults free of CVD. Components of CVH, including diet, physical activity, smoking status, sleep status, body mass index (BMI), non-HDL, blood glucose and blood pressure, were collected using self-report questionnaires. Each component and CVH were categorized as poor, intermediate and ideal status based on the AHA Life’s Essential 8 criteria. HF cases were identified by linking hospital records.

Results
Among the cohort (n=38571, median age 54 years and women 60.5%), proportion of individuals with poor, intermediate and ideal CVH was 30.7%, 56.9% and 12.4% respectively. After a median follow-up of 3.6 years, the incidence of HF in individuals with poor, intermediate and ideal CVH was 2.5%, 1.1% and 0.5% (P&lt;0.001). Compared to poor CVH, intermediate (adjusted HR: 0.52 [95% CI: 0.43-0.61]) and ideal CVH (adjusted HR: 0.38 [95% CI: 0.26-0.57]) were associated with a lower risk of incident HF. A gradient of association between CVH and risk of incident HF was observed (P-trend &lt; 0.001). Ideal physical activity, ideal smoking status, and intermediate and ideal status of BMI, blood glucose and blood pressure were independently associated with a lower risk of incident HF.

Conclusion
Poor CVH was independently associated with an increased risk of incident HF and promotion of CVH may have important implications for HF prevention.Graphical abstract
Biventricular dysfunction and lung congestion in post-COVID patients: a speckle tracking and stress lung echocardiography analysis
Authors: D'andrea A , Pandang S , Tagliamonte E , Boshchenko A , Colonna P , Wierzbowska-Drabik K , Zagatina A , Djordievic-Dikic A , Rigo F , Cocchia R , Ciampi Q 
Published: November 2023

Abstract

Background
Cardiovascular abnormalities have been observed in half of all COVID-19 patients in the acute phase of the infection. Additionally, 10-35% of these patients have various long-term symptoms diagnosed with post-acute sequelae of COVID-19 (PASC). Aim of this study was to evaluate the role of exercise stress echocardiography (ESE) with an integrated approach, inclusive of Speckle-Tracking Echocardiography (STE) with Myocardial Work (MW) analysis in the evaluation of patients after COVID infection.

Methods
We prospectively recruited a population of 370 post-COVID 19 patients (Group 1) (225 males; 55.8 ±8.3 years), and of 250 age- and sex-comparable healthy controls (Group 2). In Standard Doppler echocardiography, STE and MW analyses and lung ultrasound at rest and at peak supine-bicycle ESE were performed.

Results
Left ventricular (LV) wall thickness, diameters and mass index were comparable between the two groups. Both LV ejection fraction (EF) and right ventricular (RV) functional indexes (TAPSE and Tissue Doppler S’ wave) at rest did not show differences between the two groups. Conversely, baseline LV GLS (-16.2±2.8 vs. –20.4±3.3 %; p&lt;0.01), MW efficiency (88.8±3.2 vs. 93.2±3.3 %; p&lt;0.001), and RV strain (-16.4±2.8 vs. –20.4±4.3 %; p&lt;0.01), were significantly reduced in Group 1. Also pulmonary artery systolic pressures (PASP) (33.5±3.8 vs. 24.6±3.1 mmHg; p&lt;0.001), and LV E/e’ ratio were significantly increased in COVID group, while B-lines ( ≥ 2) at rest were found in 25.3% of Group 1 and 5.1% of Group 2 (p &lt; 0.001). During effort, COVID patients showed reduced exercise time and exercise capacity (&lt;0.001). Values of LVEF, RV strain and LV GLS (all with p value &lt;0.01) and MWE (p&lt;0001) were much lower in COVID patients when compared to Group 2. Additionally, COVID patients showed at peak effort an increased LV E/e’ ratio, pulmonary pressures and B-lines by lung ultrasound (all p &lt;0.001). Multivariable analysis detected independent associations of baseline GLS and MWE with maximal workload (watts reached), LV E/e’ ratio and B-lines during effort (p&lt;0.001), stronger than the association of LVEF with the same functional parameters (p&lt;0.01). What’s more, RV strain (p&lt;0.001) was significantly associated with PASP levels at peak effort.

Conclusions
In post-COVID patients, biventricular involvement with impairment of LV and RV systolic function is frequent, missed by conventional indices such as EF or TAPSE, and detected by more sensitive STE indices such as LV-GLS, ME, and RV-strain. These alterations are functionally significant and associated with shorter exercise -time, more pulmonary hypertension, and greater pulmonary congestion during stress.
Improved heart failure screening and prevention in type 2 diabetes mellitus by cardiologist in rural areas
Authors: Klabnik A , Murin J 
Published: November 2023

Abstract

Purpose
Guidelines recommend screening in type 2 diabetes mellitus (T2DM) for unrecognised asymptomatic left ventricular systolic dysfunction (LVSD), reduced (HFrEF), mid-range (HFmrEF) or preserved (HFpEF) heart failure (HF) with periodic evaluation of natriuretic peptides (NTproBNP) or echocardiography (echo). Tissue doppler and speckle-tracking echo may be needed to facilitate HF diagnosis at earlier, more treatable stage.

Methods
2185 consecutive asymptomatic T2DM (age 62 ±4 years, 62% women) patients (pts) were referred from January 2015 by rural diabetologists (dia) to echolab with elevated NTproBNP (&gt;125 pg/mL) or 5-year HF risk score WATCH-DM ≥14 points.
After exclusion of abnormal electrocardiogram or chest x-ray and significant valvular heart disease was compared continued usual care by diabetologist with randomly assigned prospective follow-up by regional cardiologist.

Results
At referral in both groups were similar baseline characteristics, 20% pts were treated with ACE-inhibitor (ACEi), 2% beta-blockers (BB). After cardiologist consultation ACEi and BB use increased significantly to 96% and 84% in both groups (all p &lt;0.001).
Global LVSD (EF≤50%) was detected in 8% at baseline and 29% pts after 5 years in diabetologist group, respectively 9% at baseline and 13% after 5 years in cardiologist group (p &lt;0.001).
Systolic dysfunction (S’≤6.0 cm/s) occured in 20% at baseline and 41% pts after 5 years in dia group, respectively 19% at baseline and 24% after 5 years in cardiologist group (p &lt;0.001).
Reduced global longitudinal (GLS&lt;16%) observed in 26% at baseline and 59% pts after 5 years in dia group, respectively 26% at baseline and 36% after 5 years in cardiologist group (p &lt;0.001).
At baseline we found 1% pts with new-onset HF in both groups (only HFmrEF). After mean follow-up of 54 ±7 months in cardiologist group developed new HF in 4% pts (2% HFmrEF, 2% HFpEF) compared with 25% pts (3% HFrEF, 7% HFmrEF, 15% HFpEF) in diabetologist group (p &lt;0.001).
Significant (p &lt;0.001) predictors of incident HFmrEF were systolic dysfunction (S’≤6.0 cm/s), hazard ratio (HR) 3.6, 95% CI 2.96-4.2) and reduced GLS (HR 4.6, 95% CI 3.8-5.2), all p &lt;0.01.
The strongest (p &lt;0.001) predictors of incident HFpEF were new-onset atrial fibrillation (HR 2.5, 95% CI 1.2-3.7) and echo-detected left ventricular hypertrophy (septal and posterior wall thickness ≥13 mm, HR 1.7, 95% CI 1.2-2.1), all p &lt;0.01.

Conclusions
For preventing HF progression is required additional research focused on cooperative care between diabetologists and specialised HF outpatient clinic.
Circulating beta-hydroxybutyrate levels in advanced HFrEF: the determinants and prognostic impact
Authors: Melenovsky V , Benes J , Monzo L , Kotrc M , Reichenbach A , Jurcova I , Kovar J , Jarolim P , Kautzner J 
Published: November 2023

Abstract

Background
Beta-hydroxybutyrate (BOHB) is the main ketone body and is generated mainly in the liver during states of exessive fatty acid (FA) utilisation, such as starvation or diabetic ketosis. BOHB serves as a metabolic substrate to heart. Mild ketosis or enahancement of BOHB utilisation may favorably affect cardiac function in preclinical HF models. Patients with HF have increased BOHB levels, but regulation of ketosis in HF is poorly understood.

Purpose
To investigate the determinants and prognostic implact of circulating BOHB levels in patients with advanced HFrEF.

Methods
We examined 847 pts with symptomatic HFrEF (age 57±11y, 50% CAD, 82% males, NYHA 2.7±0.6, LVEF 22±5%, BNP 802±850 pg/ml), referred to IKEM for TX or device (ICD/CRT/LVAD) implant. Patients underwent clinical and echocardiographic examination, MLHFQ questionnaire, circulating metabolite assessment, body composition (DEXA, n=150) and right heart catheterisation (n=383). BOHB in peripheral vein was measured in all subjects after overnight fasting by an enzymatic metod (Autokit 3-HB, Wako). Patients were followed for occurrence of an event (death/urgent Tx/LVAD).

Results
Median BOHB level was 64 (IQR: 33-161) mmol/l. BOHB was higher in DM patients (111 vs 163, &lt;0.001) and inreased with age. Body composition, congestion status, insulin resistance (HOMA-IR), liver function tests, weight loss history, HF symptoms (NYHA, MLHFQ), gender, HF etiology or HF therapy (BB, ACE/ARB) were unrelated to BOHB levels. BOHB strongly correlated with markers of lipolysis (free FA, BNP) and GDF15, less strongly with pulmonary hypertension (PA systolic pressure, pulmonary vascular resistance-PVR), inflammation (CRP level, leukocytes%) and humoral regulators of ketogenesis in the liver (insulin/glucagon ratio). After median follow-up of 1126 days (IQR: 410; 1781), 60% patients experienced an event. In Cox analysis, Increased BOHB levels predicted worse survival (RR: 1.001, 95%CI: 1.0005-1.001, p&lt;0.0001), particularly in the upper BOHB tercile. Impaired survival was also associated with elevated free FA (RR: 1.78 (1.23-2.51, p= 0.002). In bivariate Cox analysis of free FA and BOHB levels, only free FA, but not BOHB, remained significantly asccociated with adverse outcome.

Conclusion
Increased BOHB levels in HFrEF correlate with free FA levels, likely due to sympatetic activation-driven and BNP-driven lipolysis. The association of increased BOHB with adverse outcome dissapears after adjustment to free FA level. Other notable associations of BOHB were diabetic status, GDF15 level, systemic inflammation and pulmonary hypertension.
The prognostic value of right ventricular longitudinal strain in predicting incident atrial fibrillation and ischemic stroke in the general population
Authors: Saed Alhakak A , Hauser R , Skaarup K G , Lassen M C H , Johansen N D , Jensen G B , Schnohr P , Mogelvang R , Biering-Sorensen T 
Published: November 2023

Abstract

Background
Right ventricular (RV) longitudinal strain (RVLS) is a predictor of many cardiovascular outcomes including ventricular arrhythmias. However, the prognostic value of RVLS in predicting incident atrial fibrillation (AF) in participants from the general population is currently unknown.

Purpose
The aim of this study was to investigate if RVLS can be used to predict AF and ischemic stroke in the general population.

Methods
A total of 2794 participants (mean age 54±17 years, 42% male) from the general population underwent a health examination including two-dimensional speckle tracking echocardiography. RVLS was measured in the apical four-chamber projection optimized for a view of the RV. The RV free wall was divided into three segments, and the strain values of the three segments were averaged to obtain RVLS.
The primary endpoint was incident AF at follow-up. All participants with known AF and prior stroke at baseline were excluded (n=175). The secondary endpoint consisted of the composite of AF and ischemic stroke.

Results
During a median follow-up of 5 years (interquartile range, 4.5-6.2 years), 110 participants (4%) were diagnosed with incident AF and 59 (2%) experienced an ischemic stroke, resulting in 169 (6%) experiencing the composite outcome. The risk of AF increased incrementally with decreasing tertile of RVLS, being approximately 3-fold higher in the 1st tertile as compared to the 3rd tertile (HR 2.71; 95% CI (1.64-4.46), p&lt;0.001; figure).
RVLS was a univariable predictor of AF with 9% increased risk per 1% decrease in RVLS (per 1% decrease: HR 1.09; 95% CI (1.06-1.13), p&lt;0.001). The association remained significant even after multivariable adjustment for clinical and echocardiographic parameters (per 1% decrease: HR 1.06; 95% CI (1.01-1.11), p=0.015).
RVLS was also a univariable predictor of the composite outcome of AF and ischemic stroke (per 1% decrease: HR 1.08; 95% CI (1.05-1.12), p&lt;0.001). After multivariable adjustment for the same clinical and echocardiographic parameters, RVLS remained an independent predictor of the composite outcome (per 1% decrease: HR 1.04; 95% CI (1.00-1.09), p=0.032)
Additionally, RVLS provided incremental prognostic information with regard to predicting AF as assessed by a significant increase in the net reclassification improvement (NRI) index beyond the CHARGE-AF score (continuous NRI, 0.232; 95% CI, 0.011-0.570).

Conclusion
In a low-risk general population, RVLS provides novel prognostic information on the long-term risk of AF and ischemic stroke. In addition, RVLS provides incremental prognostic information beyond the CHARGE-AF score in predicting AF in the general population.
Exosomal preconditioning of human iPSC-derived cardiomyocytes beneficially alter cardiac electrophysiology during hypoxia
Authors: Rosand O , Scrimgeour N , Marwarha G , Hoydal M 
Published: November 2023

Abstract

Introduction and purpose
Cardiac-Exosomes (EXO) are nano-sized extracellular vesicles, continuously secreted by the myocardium. Despite previous misconceptions, cardiac-EXO are not just a way for the cell to dispatch waste, but functions as carriers of signaling molecules. Furthermore, the effects of cardiac-EXO signaling during hypoxic stress is not well understood. The present study aimed to determine the biological effects of EXO released from hypoxic cardiomyocytes, focusing on whether the EXO-cargo can benefit recipient cells during hypoxic stress. We hypothesize that cardiomyocytes exposed to hypoxic stress would display advantageous electrophysiological properties after preconditional treatment with isolated cardiac-EXO secreted from cardiomyocytes exposed to hypoxic stress.

Methods
For preconditional treatment we isolated EXO from human iPSC-derived cardiomyocytes (CM) exposed to hypoxia (1% O2) for 16 h (H-EXO). H-EXO was thereafter administrated as preconditional treatment to a secondary population of CM 24 h before subjection to 16 h of hypoxia. Electrophysiological effects of H-EXO precondition treatment were assessed with a multiwell microelectrode array (MEA) system. Using the MEA-system; field potential, beat period, spike slope, spike amplitude, excitation-contraction (EC) coupling, and cardiac action potentials were recorded and analyzed.

Results
We found that CM exposed to hypoxic stress conditions (16 hours) displayed significant increase in beat period when preconditioned with H-EXO compared to non-treated CM (+15.7%, p&lt;0.05). Furthermore, precondition with H-EXO resulted in faster EC coupling compared with non-treated CM after 16 h of hypoxia (-25.3%, p&lt;0.05). More efficient EC coupling indicates that the H-EXO recipient cells are less affected by the hypoxic stress. There were no significant changes in field potential, spike slope, spike amplitude and cardiac action potential between the two groups after 16 h of hypoxia.

Conclusion
The present study report that EXO secreted by CM under hypoxia alter electrophysiological properties in recipient cells exposed to 16 h hypoxic stress. The alterations indicate more efficient cardiomyocyte EC coupling and longer beat period.