bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low cardiac index and high total peripheral resistance are independent predictors of mortality for acutely admitted medical patients
Authors: Hadad R , Haugaard S B , Sajadieh A 
Published: November 2023

Abstract

Introduction
Identification of critically ill and high-risk patients upon hospital admission represents a significant triage task in the emergency department. Rapid identification and treatment of these patients improves survival, reduces complications during admission, decrease hospitalization duration, and lower treatment cost. Hemodynamic variables such as cardiac index (CI) and total peripheral resistance (TPR) hold the potential to improve the diagnosis of critically ill patients by providing better prognostic value.
Using arterial waveform and the model flow method, CI and TPR can be measured non-invasively. These methods are validated against thermodilution, which is the golden standard.

Purpose
The purpose of the study was to examine the association between CI, TPR, and all-cause mortality within 30 and 90-day among patients admitted to acutely the emergency department or cardiac care unit.

Methods
In this observational prospective cohort study, all patients were included from the emergency department and cardiac care unit. Patients of age 18 years or older admitted to the emergency department or cardiac care unit due to acute medical disease, were included. Patients with a life expectance of 3months or less and patients unable to give informed consent were excluded. Within the first 24 hours of admission, patients underwent a 10-minute non-invasive hemodynamic measurement using arterial waveform analysis and the model-flow method. Patients were followed up to 90 days after discharge. The endpoints 30- and 90-day mortality were obtained through electronic patient journals. Cox proportional-hazard models examined the association between CI, TPR, and outcomes. All hazard models were adjusted for age, sex, BMI, heart failure, early warning score, and Charlson comorbidity score.

Results
Between May 2019 and January 2023, we included 920 unselected patients from the department of emergency medicine (n=433) and cardiac care unit (n=487) from a metropolitan hospital. We observed a 3% 30-days mortality while 90-days mortality was 4.9%. The median value of CI was 3.3L, the lowest decile was 2L, and the highest decile was 4.7L. Patients with the lowest CI were older, had higher incidents of heart failure, and had more comorbidities according to Charlson’s comorbidity score (table 1). In Cox proportional hazard models, lowest decile of CI at admission was associated with a significantly higher risk of 30- and 90-days mortality. Total peripheral resistance was significantly associated with 90-day mortality (table 2).

Conclusion
Low CI ≤2.0 liter/min/m2, and high peripheral resistance measured non-invasively were associated with an increased risk of mortality among patients admitted to the emergency department or cardiac care unit. Non-invasive estimation of CI and TPR may assist in identifying high-risk patients.Table 1Table 2
Integrative interpretation of cardiopulmonary exercise tests for cardiovascular risk stratification: a machine learning approach
Authors: Cauwenberghs N , Sente J , Sabovcik F , Ntalianis E , Claes J , Claessen G , Budts W , Goetschalckx K , Cornelissen V , Kuznetsova T 
Published: November 2023

Abstract

Background and objectives
Cardiopulmonary exercise testing (CPET) remains underutilized for cardiovascular (CV) risk assessment. Integrative interpretation of CPET results may improve characterization of cardiorespiratory fitness and assessment of CV risk. Therefore, we explored the clinical value of CPET-based phenomapping for CV risk stratification.

Methods
We retrospectively retrieved clinical data from 2280 patients with diverse CV risk (47.9% female) who underwent maximal CPET by cycle ergometry. We derived 18 key CPET indices as well as data on fatal and non-fatal CV events (median follow-up time: 5.3 years). Next, an unsupervised clustering algorithm (Gaussian Mixture modelling) subdivided the cohort in sex-specific phenogroups solely based on differences in CPET metrics. Clinical characteristics were compared across CPET phenogroups and their multivariable-adjusted association with future CV events was determined.

Results
8 of the 18 CPET metrics were excluded from clustering due to high collinearity (i.e. an absolute Pearson correlation coefficient &gt;0.8). Based on the remaining 10 CPET variables, the clustering algorithm subdivided the cohort in four male and four female CPET phenogroups. In both males and females, the phenogroups differed significantly in age, BMI, spirometric and CPET measurements and prevalence of hypertension, intake of antihypertensive and lipid-lowering drugs, CV disease and CV surgery (P&lt;0.05 for trends). During follow-up, 278 males and 109 females experienced a CV event (43.9 and 16.2 events per 1000 years of follow-up, respectively). Compared to male phenogroup 1, male phenogroups 3 and 4 presented higher risk for incident CV events (multivariable-adjusted hazard ratio: 1.97 and 1.62; P≤0.027). Significant differences in risk for future CV events between the female phenogroups disappeared after adjustment for confounders.

Conclusion
Integrative CPET-based phenogrouping adequately stratified patients according to their risk for future CV events. Such phenomapping may facilitate comprehensive evaluation of CPET results and steer future CV risk management.Study flow and findings
The association of oral hypofunction/adiposity and increased arterial stiffness
Authors: Matsumoto C , Tomiyama H , Nakai T , Matsuura M , Nakano H , Shiina K , Yamashina A , Chikazu D 
Published: November 2023

Abstract

Background
Sarcopenia and adiposity are risk factors for cardiovascular diseases (CVD). Recently, oral hypofunction, a disease in which oral function is complexly reduced not only by aging but also by a variety of factors, has been regarded as a major risk factor for sarcopenia. However, no studies have evaluated the association between oral hypofunction/adiposity and arterial stiffness, which is a CVD marker.

Purpose
This study aimed to evaluate the association between oral hypofunction/adiposity and arterial stiffness.

Methods
Japanese Subjects aged &gt; 50 years who underwent annual health check-ups were enrolled in this cross-sectional study. Subjects with a history of CVD or dementia were excluded from the study. Arterial stiffness was evaluated using the brachial-ankle pulse wave velocity (baPWV). Adiposity was defined as visceral fat &gt; 100 cm2, as evaluated using abdominal computed tomography. Oral hypofunction was evaluated according to the guidelines of the Japanese Association for Dental Science. Seven oral factors were assessed: oral hygiene, oral moisture, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function. Oral hypofunction was　diagnosed if more than 3 factors deteriorated. We categorized the participants into four groups according to the existence of oral hypofunction and adiposity. The associations between oral hypofunction/adiposity and baPWV were assessed by multivariable linear regression analysis adjusted for conventional CVD risk factors.

Results
We categorized 146 subjects (mean age:59±7 years) into four groups: subjects with both oral hypofunction and adiposity (N=16), only adiposity (N=46), only oral hypofunction (N=17), and none of them (N=67). The baPWV values of the groups were 1673±354, 1481±262, 1412±206, and 1372±254 cm/s, respectively. BaPWV in subjects with both oral hypofunction and adiposity was the highest compared to that in the other three groups (P&lt;0.01). Multivariable linear regression analysis revealed that the combination or oral hypofunction and adiposity was significantly associated with increased arterial stiffness independent of CVD risk factors including lipid and glucose metabolism. (β=232±77, P&lt;0.01). Also, the combination or oral hypofunction and adiposity, only adiposity, only oral hypofunction, were gradually associated with increased arterial stiffness (β=54±22, P=0.01).

Conclusion
The combination of oral hypofunction and adiposity was associated with increased arterial stiffness independent of conventional CVD risk factors. Further research on oral hypofunction/adiposity and CVD is warranted.
Validation of ARIC heart failure risk score in the Asian population: The CORE-Thailand cohort study
Authors: Phrommintikul A , Osataphan N , Chichareon P , Suwannasom P , Leemasawat K , Prasertwittayakij N , Gunaparn S , Wongcharoen W 
Published: November 2023

Abstract

Background
The Atherosclerotic Risk in Communities (ARIC) heart failure (HF) score was developed from population in the United States to predict HF. However, it has not been validated in Asian population.

Purpose
To validate the ARIC HF score and develop the new ARIC-CORE score to predict HF in Asian population in the Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand).

Methods
The CORE-Thailand registry was a prospective study that enrolled Thai patients with high atherosclerotic risk. Patients were followed for the occurrence of cardiovascular events including HF. The ARIC HF score comprised nine variables (age, race, heart rate, systolic blood pressure, BP-lowering medication use, diabetes, coronary heart disease, smoking status, and body mass index) to predict the occurrence of HF. Original coefficients of the full ARIC HF model were used to calculate the original ARIC HF score. The new ARIC-CORE score was developed by re-estimating the coefficients of all ARIC score variables in the study population using ridge regression analysis. The polynomial function was applied to the continuous variables with non-linear association with HF, which included heart rate, systolic blood pressure, and body mass index. Discrimination of the models was determined using C-index and calibration was assessed by plotting the observed outcomes versus the predicted probabilities of the outcomes. Net reclassification index (NRI) was used to compare the prediction performance between the ARIC HF and the ARIC-CORE risk score. Clinical utility of the scores were assessed with decision curve analysis.

Results
From a total of 8919 patients who had no history of HF, 199 (2.23%) developed HF. The ARIC HF score provided a good discrimination at C-statistics of 0.71 (95% confidence interval (CI) 0.67-0.75) with good calibration. (Figure 1 A). The ARIC-CORE risk score had a C-statistics of 0.75 (95%CI;0.71-0.76) with good calibration. (Figure 1B) Using the ARIC-CORE was associated with an improved classification of HF risk (NRI 0.32, 95%CI:0.18-0.44) compared to the ARIC HF score. The net benefit of using the ARIC-CORE score was higher than the original ARIC HF score in the decision curve analysis (Figure 2).

Conclusion
The ARIC HF score had acceptable discrimination and calibration in the CORE cohort. Interestingly, the ARIC-CORE score performed better in classifying HF risk and could be a suitable model to be used in Asian populations.Calibration plotDecision curve analysis
Development and validation of risk score for patients in primary care setting in Poland
Authors: Banach M , Osadnik T , Lejawa M , Golawski M , Gierlotka M , Jozwiak J 
Published: November 2023

Abstract

Background
Suitable, optimal risk prediction in primary care is still a large challenge. Current tools enable the creation of risk scales based on data for specific populations, which can be a large support to recognized risk scales used in primary and secondary prevention.

Purpose
Therefore, we decided to suggest a new risk score generated with the machine-learning tools based on the data from consecutive patients in the family physicians’ practices within the LIPIDOGRAM cohort study 2015.

Methods
The LIPIDOGRAM 2015 study was carried out in 2015 and 2016 in the primary care setting all 16 administrative regions of Poland. 438 physicians participating in the study were proportionally distributed to the number of inhabitants in each administrative region. Each patient was asked to fill the detailed questionnaire on chronic diseases, treatment, and lifestyle. The primary outcome, based on the data from the National Health Fund, was all-cause mortality. A machine learning-based framework AutoScore was used to generate risk score basing on the variables obtained from questionnaires. Dataset was divided into training, validation, and test cohort in the proportion of 0.6, 0.1 and 0.3 respectively. Performance of the risk score was evaluated using ROC analysis in the test set Kaplan-Meier analysis of survival according to quartiles of the score was carried out.

Results
13 611 patients were finally recruited. 5 years follow-up data was available for 13 419 patients (98.6%). A score based on age, sex, body mass index (BMI), alcohol consumption, smoking, presence of comorbidities - hypertension, diabetes mellitus, atrial fibrillation, chronic kidney disease, hypertension, history of myocardial infarction, self-declared physical activity, place of residence and education level that is presented in detail in Table 1, achieved an AUC of 0.825 (95% CI - 0.794-0.856) (Figure 1).

Conclusions
Risk scales created based on data representative of primary care patients can be easily created thanks to modern statistical tools. Such scores may include variables that better describe local communities, such as education level, place of residence, physical activity, or alcohol consumption, and in the consequence may better predict and monitor (in case of intervention) the risk of all-cause and cause-specific mortality.Developed predictive model.Test set results. 5-year prognosis.
The RAPID-10 score: a new risk score from the retrospective analysis of maximal workload predictors of survival in ischemic heart disease at 10 years
Authors: Braganca B , Campos I G , Cruz I , Lopes R G , Oliveira I , Monteiro J P , Queiros C , Pinto P , Andrade A 
Published: November 2023

Abstract

Background
Cardiac stress testing (CST) is valuable in the management of ischemic heart disease (IHD). The FIT Treadmill Score from the largest study of physical fitness - the Henry Ford Exercise Testing Project– is among the most accurate model in predicting survival. Recent data from our group showed that workload-indexed blood pressure (WPBR) is a strong and independent predictor of survival in IHD, a variable not included in the FIT score.

Purpose
Therefore, our purpose was to create a new score that includes WBPR and other maximal exercise variables and compare with the FIT score.

Methods
The study comprised 713 patients with IHD that performed CST on treadmill between 2009-2010. The follow-up period was 10±2 years. WBPR (systolic blood pressure / (metabolic equivalent of task(met)-1)) and the FIT score were calculated at baseline as previously described 1,2. Continuous variables were fitted using linear and nonlinear regressions. Time-to-event (death and major adverse cardiovascular events (MACE)) were correlated with baseline variables through logistic regression models. The new score was built using a backward stepwise regression of clinical and CST variables. Score accuracy was assessed with receiver operating characteristic (ROC) curves. Event-free survival analyses used Cox regression models. Data are: mean ± standard deviation; 95% confidence interval (CI) for hazard ratios (HR); significance level p&lt;0.05.

Results
Relevant baseline characteristics were: age 59±10 years, 87% male, 74% dyslipidemia, 65% hypertension,body mass index 29±4 kg/m2, 31% diabetes, 16% chronic kidney disease, 45% smokers, 5% stroke, 76% myocardial infarction. During follow-up, 109 patients died (16%), 342 (49%) had MACE, 183 (26%) de novo heart failure (HF) and 100 (14%) myocardial infarction (MI). The final score (RAPID-10) combines four predictive variables of survival: binary WBPR (1 if ≥ 5.15 mmHg/met) and sex (1 if female); continuous maximal predicted heart rate (MPHR) and age-squared. The adjusted final model is: 4WPBR + 0.008age^2 + 20MPHR + 6sex. The median score was 11 points, ranging from -13 to 40 points. After adjusting for comorbidities and medication, each 10-point increase in RAPID-10 was associated with mortality (HR 1.85, CI 1.42-2.42, p&lt;0.0001), MACE (HR 1.26, CI 1.42-2.42, p&lt;0.0001), and HF (HR 1.4, CI 1.19-1.56, p&lt;0.0001) but not MI (HR 0.91, CI 0.77-1.01, p=0.239). Discriminative power of RAPID-10 was good in ROC curves (AUC = 0.75), and slightly higher than FIT score (AUC = 0.73).

Conclusions
The RAPID-10 score is a robust tool, with good discriminative power to predict 10-year survival in IHD patients. Further studies are needed to validate the model in other populations.
Utility of a polygenic risk score for incident CHD: interplay with lifestyle in a multi-ethnic cohort of more than 60,000 individuals
Authors: Iribarren C , Lu M , Elosua R , Rana J S 
Published: November 2023

Abstract

Background
The degree to which benefits of healthy eating, physical activity and not smoking are protective for coronary heart disease (CHD) based on levels of polygenic risk remains an important question. We set out to investigate whether and to what degree a favorable lifestyle could reduce the effect of high genetic risk.

Methods
We utilized data from the Genetic Epidemiology Resource in Adult Health and Aging (GERA) Multi-Ethnic cohort of 60,682 (mean ± SD age = 59 ± 9 years; 67% female; 18% non-European ancestry) Kaiser Permanente of Northern California (KPNC) members. We characterized the cohort at baseline in 2003-2007 by smoking status (never, former or current smoker), Mediterranean-pattern diet (MedDiet) and meeting current AHA physical activity recommendations (PAR) of at least 150 min of moderate activity or 75 min of vigorous activity per week. We stratified the cohort into three groups of CHD genetic risk (low: quintile 1, intermediate: quintiles 2, 3 and 4 combined, and high: quintile 5) using a validated 12-SNP Polygenic Risk Score (PRS) for CHD (CARDIO inCode-Score, GENinCode Plc). Incident CHD consisted of primary in-patient codes for angina pectoris, myocardial infarction, revascularization procedures or CHD death (n=2,220) through 12/31/2014; mean follow-up was 9.5 years.

Results
Age-adjusted CHD rates per 10,000 person-years were estimated using Poisson regression (accounting for death and health plan disenrollment) by number of favorable lifestyle factors (LF) and, within each level, by genetic risk groups (see Figure below). Genetic background provided further CHD risk stratification within each lifestyle group. The most favorable lifestyle (never smoking, MedDiet, meeting PAR) reduced the effect of high genetic risk by 59% (age-adjusted rates per 10,000 person-years 40 vs. 99) and similar reductions were observed at intermediate or low genetic risk.

Conclusions
Our results are consistent with an additive model of genetic risk and lifestyle as determinants of CHD. These results underscore the importance of favorable lifestyle and the need to prioritize those individuals with the highest CHD risk (most unfavorable lifestyle and high genetic risk), who will benefit the most from lifestyle advice.
External Validation of HASBLED and ORBIT bleeding risk scores in Wales-AF population
Authors: Torabi F A T E M E , Harris D , Lacey A , Akbari A , Gravenor M , Halcox J 
Published: November 2023

Abstract

Background
Anticoagulant therapy (AC) is recommended for Atrial Fibrillation (AF) patients when formal assessment of thromboembolic and bleeding risk suggests a net benefit of AC treatment. Recent UK National Institute of Health and Care Excellence guidelines consider that the ORBIT bleeding risk score(1) provides a more accurate assessment of bleeding risk with AC than the HASBLED score(2) and is recommended for routine clinical use in the UK.

Purpose
To compare the performance of HASBLED and ORBIT scores to predict hospitalisations for bleeding (HB) in a large population of UK patients with AF receiving AC.

Methods
We conducted a retrospective longitudinal analysis using linked primary and secondary care health records in the All-Wales SAIL databank. Patients with a diagnosis of AF treated with AC were identified between 2012 and 2018. Both HASBLED and ORBIT scores were calculated for each patient annually based on identified comorbidities, demographics and prescription data. All HB were evaluated. Logistic regression models were used to compare sensitivity and specificity of each score for HB prediction. The Area Under Curve for the Receiver operating Characteristic plot (AUC) was generated for each score to illustrate the risk discrimination ability of each prediction schemes.

Results
A total of 107,137 (45% female, mean age=74) AF patients were evaluated over the study period. The number of anticoagulated AF patients increased from 27,959 in 2012 (49.3% of cohort) to 48,595 in 2018 (66.8%), providing a total of 265,410 patient years of AC therapy for analysis. There were 710 HB (2.5% of AC patients) in 2012 increasing to 1,146 (2.4%) in 2018. The predictive power of HASBLED and ORBIT increased slightly over the period of study: with observed HASBLED AUC of 60.8 and ORBIT AUC of 64.8 in 2018 (Figure 1). Over the period of study, the observed HB rates for AC AF patients with HAS BLED scores of 0-3 and ORBIT scores of 0-5 were similar to those observed in the original studies, but observed HB for patients with higher HASBLED and ORBIT scores were less consistent (Fig. 2)

Conclusion
Our findings demonstrated that HASBLED and ORBIT were relatively limited in their predictive performance for HB in a large, real-world AC AF population, with ORBIT providing more accurate prediction across the overall risk range. This highlights the need to develop and validate new bleeding risk scores from the wide range of clinical and demographic factors in AF patients to improve effectiveness of risk communication and AC prescribing in AF.Figure 1Figure 2