bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educational intervention to improve self-care behaviours for heart failure patients who develop renal insufficiency
Authors: Al Kalaldeh M 
Published: November 2023

Abstract

Background
Renal insufficiency is common in adults with heart failure. Promoting heart failure self-care behaviours contributes to avoid poor prognosis of acute kidney injury.

Aims
To introduce a nurse-led educational program for patients with heart failure who suffer from acute kidney injury and asses its impact on patients' perception and self-care behaviours.

Methods
In this pretest-posttest interventional study, patients were assessed for their perception and self-care behaviours before and after enrolling in an educational program.

Results
Among fifty patients, ages means were 51.16 years old (SD=5.35). Based on New York Heart Association (NYHA), 62% of patients had class II and IV symptoms, and 76 % had mild to moderate decrease in estimated Glomerular Filtration Rate. In the pre-education assessment, moderate deficits were present in both perception and self-care behaviours. After delivery of self-care education, patients demonstrated an improvement in perception (t: 3.65, df: 49, SE: 0.34, p&lt;0.001, CI: 0.61-2.19), and self-care behaviours (t: 8.66, df: 49, SE: 1.05, p&lt;0.001, CI: 7.02-11.18). In multivariate analysis, the educational program explained 68.1% of the variation in posttest self-care behaviours scores.

Conclusion
Education on self-care behaviour improved the perception and self-care of patients with heart failure who suffer from evolving acute kidney injury.
Health care professionals most relevant phrases used in a digital medical translation tool in 24-7 communication with minority speaking heart surgery patients during hospitalization
Authors: Lie I , Rokeness S , Hasle C H , Johannsen N , Skredsvik K , Nes L S 
Published: November 2023

Abstract

Background/Introduction
Health care professionals’ communications with hospitalized minority speaking heart patients are even in 2023 still frequently limited to non-verbal language, notes from informal caregivers and "google translate" in situations where interpreters are not available. Health care based digital solutions aiding translation may help improve health care professionals’ assessment, information about and treatment of minority speaking patients, and there is an urgent need for innovative research into this area.

Purpose
To describe the most relevant phrases used by health care professionals’ in a digital, medical translation tool for 24-7 communication with minority speaking heart surgery patients during hospitalization.

Methods
A digital medical translation tool was customized using the internationally recognized ABCDE (Airway, Breathing, Circulation, Disability, Exposure) systematic approach to assess and treat, in addition with the pre-operative surgical safety checklist employed as a framework. Health care professionals’ use of phrases in the digital tool when communicating with the minority speaking heart surgery patient’s during their clinical hospital pathway (Figure 1) were then counted, categorized, and finally linked to health care professionals’ actions.

Results
Fifty-five health care professionals (i.e. registered nurses, intensive care nurses, operating room nurses, anaesthesia nurses and physiotherapists) were during 60 shifts with 24-7 follow-up of five minority speaking heart surgery patients using a total of 410 phrases from the digital medical translation tool. The phrases were categorized and counted into the ten most common categories (Figure 2): 1. Pain (e. g. are you in pain?), 2. Nutrition (e. g. are you hungry?), 3. Respiration (e.g. breathe in), 4. Mobilisation (e.g. you have to get up and stand), 5. Psychological support (e.g. the surgery went well), 6. Safe surgery (e.g. do you have any teeth that are loose?), 7. Medications (e.g. pain relievers), 8. Communication (e.g. just answer "yes" or "no"), 9. Examination (e.g. you are going to have an x-ray examination), 10. Circulation (e.g. do you feel dizzy?). Health care professionals’ actions (i.e. assessment, information and reassurance, and instructions) were categorized and related to these phrases.

Conclusions
A health care based digital medical translation tool can aid in communication with minority speaking patients in situations when interpreters are not available. This study shows how health care professionals’ use of such a translation tool when communicating with minority speaking heart surgery patients during hospitalization can employ phrases and categories 24-7 to improve patients’ healthcare.Fig.1 Clinical pathwayFig.2 HCP communication
Novel PVC detection algorithm in an implantable cardiac monitor for longitudinal risk monitoring
Authors: Dukes J , Marmerstein J , Kondama Reddy R , Whittington H 
Published: November 2023

Abstract

Background
Guideline therapy is recommended in patients with frequent premature ventricular contractions (PVCs). Longitudinal monitoring of the PVC burden can effectively guide treatment options, stratify patient risk, and manage HF progression. Implantable cardiac monitors (ICMs) may provide a suitable long-term diagnostic tool to monitor PVC burden and guide clinical therapy.

Objective
Quantify the performance of a novel QRS morphology and timing-based PVC detection algorithm as implemented for an ICM.

Methods
The algorithm utilizes self-adapting timing-based ectopy detection and dynamic measures of QRS morphology to identify unifocal and multifocal PVCs. The training dataset consisted of 200 sECG episodes recorded in implanted BIOMONITOR (BM) devices, collected from 48 patients. The algorithm was then evaluated on 227 sixty-second duration sECG episodes from 79 BM patients in the CERTITUDE registry. Each beat was adjudicated as normal, PVC, or PAC by at least two clinical experts. In a total of 22,433 beats, 756 true PVCs were assessed (3.4% PVC prevalence). Overall, patient averaged, and generalized estimating equation (GEE) estimates for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated, as well as patient-specific PVC burden (PVCs/Total Beats).

Results
Patient-averaged PVC detection sensitivity was 73.8%, with a PPV of 89.2%, specificity of 99.6%, and NPV of 99.1%. Using a GEE model to adjust for multiple episodes per patient, the algorithm achieved detection sensitivity of 66.6±9.8% (95% CI) and PPV of 86.6±6.5%, with specificity of 99.5±0.4% and NPV of 99.0±0.5%. The main reasons for missed PVC detections were morphological similarities to normal beats, insufficient prematurity, or lack of a compensatory pause. Additionally, the algorithm faithfully represented the PVC burden, with a median difference of -0.24% between the PVC burden calculated by the detection algorithm and the adjudicated burden. Algorithm burden was highly correlated with the true PVC burden for each patient, with a Pearson correlation coefficient of 0.80 (p &lt; 0.0001).

Conclusions
The PVC detection algorithm was highly specific, achieving a specificity of 99.6% and a sensitivity of 73.8%, and accurately representing the overall PVC burden for each patient. This PVC detection algorithm would provide a valuable clinical diagnostic marker to monitor PVC burden trends to guide therapy as well as assess the longitudinal risk of HF. Measurement of PVC burden combined with the 5.5-year longevity of the BIOMONITOR ICM could provide an innovative approach to optimize clinical management of patients.Example PVCs detected by the algorithm
Examining the real-world up-titration of heart failure therapy and treatment related factors limiting optimisation in Irish nurse-led heart failure clinics
Authors: Lehane M , Farrell C , Burke E , Nugent C , Molloy A , Aherne J , Corrigan R , Howley C , Mcnally C , Murphy C , Fall S , Maher S , Thorpe R , Mcgovern N , Caples N 
Published: November 2023

Abstract

Introduction
The potential of guideline-directed heart failure therapy to reduce mortality and morbidity in HF patients is tremendous however real-world data indicates sub-optimal up-titration to target doses. Challenges to optimisation include patient-related factors, treatment related factors and service-related factors. The observational QUALIFY Study reported a prescription rate of 87.8% for ACEI's/ARB's, 86.9% for Beta-blockers and 70.3% for MRA's.

Purpose
To examine the real-world pattern of up-titration and maximisation of four pillars of HF therapy to maximum doses in Irish Nurse-led HF Clinics in comparison to recent observational/registry studies and to highlight the main treatment related factors limiting optimisation.

Methods
A cross sectional prospective audit over a 3-month period was carried out in 18 HF centres in Ireland. Ethical approval was sought and granted in all centres. Patients included in the audit were those with HFrEF that achieved optimal tolerated dose of betablocker, ARNI/ACE-I, MRA and SGLT2I during the period of the audit.

Results
The audit included 648 participants, 499 (77%) male and 147 (23%) female (2 unknown). Average age of male was 68.5 years old and female was 68.7 years old.
The rate of prescription for ARNI and ACEi/ARB was 93.8% (n=608), 65% (n=420) of patients were prescribed ARNI, ACEi were prescribed for 147 (22.6%) and ARB’s for 41 (6.3%) patients respectively. Hypotension was a limiting factor in 22.4% (n=146) of cases.
Over 608 (93.6%) patients received a beta-blocker to maximum tolerated dose and 6% (n=40) did not receive a beta-blocker. Hypotension was a limiting factor for 77 (11.8%) patients, followed by fatigue in 15 (2.3%) of patients.
84% of patients received an MRA and 97 (14.9%) patients did not received an MRA. Hyperkalaemia was a limiting factor in 51 cases (7.8%), followed by chronic kidney disease in 32 cases (4.9%) and hyponatraemia in 6 cases (0.9%).
Only 13.2% (n=86) of patients did not receive an SGLT2 and 86.8% were prescribed an SGLT2. Urinary tract infection was reported in 13 cases (2%), CKD preluded prescription in 7 patients (1%) and fungal infection occurred in 3 cases (0.4%).

Conclusion
A strong commitment to optimising heart failure therapy is evident in Irish nurse-led clinics. Prescription rates for patients optimised were 93.8% for ARNI/ACE/ARB, 93.6% for BB, 84% for MRA and 86.8% for SGLT2. This has surpassed target doses seen in observation studies. Future audits will examine the impact of nurse prescribing on the achievement of optimal target doses.
Allied health professional-physician collaboration to enhance guideline-directed medical therapy of heart failure: expanding therapeutic opportunities
Authors: Khaykin Y , Pirbaglou M , Yang J , Gao-Kang J , Giuria J , Pandher M , Garber D , Dell E , Shamiss Y 
Published: November 2023

Abstract

Background
Guideline-directed medical therapy (GDMT) is the cornerstone of treatment for heart failure patients with reduced ejection fraction (HFrEF). Optimization of GDMT at a targeted allied professional medication titration clinic represents a key opportunity to provide greater access to care and further refine patient care models, leading to improvements in clinical outcomes.

Purpose
To evaluate the effectiveness of an allied health practitioner optimization clinic model in HFrEF as indicated by changes in rates of triple and quadruple GDMT therapy (see associated table).

Methods
Qualified patients were either: proactively screened from clinic lists, having demonstrated a diagnosis of heart failure, reduced ejection fraction, and not receiving triple or quadruple therapy, or were physician-referred after initial optimization during 2021-2022. Participants subsequently underwent medication review and optimization by an allied health professional, involving introduction, up-titration, down-titration, or withdrawal of medications across relevant medication classes as tolerated.

Results
52 (78.8% male) patients with a mean age of 70.3 (11.4) years and mean ejection fraction of 30.1 (6.7) percent underwent medication optimization. Along with HFrEF, all patients exhibited cardio-metabolic multi-morbidity (2-3 cardio-metabolic diagnoses), including hypertension (59.6%), dyslipidemia (71.2%), coronary artery disease (61.5%), atrial fibrillation (42.3%), and type 2 diabetes (21.2%). Pre-optimization prescription rates ranged from: 53.8% for ACEi/ARB, 30.8% for ARNI, 80.8% for beta-blockers, 59.6% for MRA, 40.4% for diuretics, and 13.5% for SGLT2i. Medication review and optimization spanned an average of 2.8 (1-7) meetings, and lead to an average of 1.9 (range 0-4) medication changes. Among 49 patients considered for ARNI optimization, there were 43 (87.7%) successful introductions and progressive dose adjustments, including 12 (27.9%) dose adjustments among those already prescribed. Additional changes involved optimizations in: beta-blockers (5 introductions, 5 dose-changes), MRA (8 introductions, 4 dose-changes, 2 withdrawals), diuretics (1 introduction, 7 dose-changes, 2 withdrawals), and SGLT2i (17 introductions). Collaboration between allied health professionals and physicians in optimization demonstrated significant improvements in rates of triple (42.3% vs 63.5%, P= 0.003) and quadruple (5.8% vs 26.9%, P= 0.001) therapy post-optimization.

Discussion
A Collaborative approach to medication optimization increased the use of GDMT in ambulatory patients with HFrEF. Collaboration presents both clinicians and health systems with greater opportunities to improve healthcare access, therapeutic inertia, and disease management.Pre-post Changes in GDMT Rates
Improving frequency and appropriateness of direct oral anticoagulant (DOAC) prescribing for af through integrated pharmacy-led care
Authors: Turner E , Stirling K , Donley M 
Published: November 2023

Abstract

Background
Anticoagulants for stroke-risk reduction in atrial fibrillation (AF) are underutilised and international literature shows 10-25% of patients on a direct oral anticoagulant (DOAC) for AF are prescribed an inappropriate dose, increasing the risk of stroke and bleeding. NHS England targets are for 90% high-risk AF patients to be prescribed anticoagulation by 2029.

Purpose
A new pharmacy-led integrated care model was developed to improve the frequency and quality of prescribing and monitoring of DOACs for AF in line with national guidance. This abstract describes the results when this model of care was rolled out across a large UK city.

Methods
The integrated model of care was designed to provide a multi-pronged approach and empower primary care pharmacy teams to prescribe and manage DOACs for AF. The model includes an education and training programme, a weekly specialist-run virtual clinical discussion service, a 48-hour turn around advice and guidance service and a clinical tool that identifies and makes recommendations for patients on an unlicensed dose of a DOAC.

Results
16,594 patients are included on the city’s AF register. From April-November 2022, an additional 1,339 (8%) patients were anticoagulated. An increase from 76.3% to 84.3% of patients on the AF register. Dosing as per manufacturers Summary of Product Characteristics (SmPC) improved for all DOACs. In April 2022 an incorrect dose was prescribed for 10%, 15% and 12% of patients respectively on apixaban, edoxaban and rivaroxaban. In November 2022 incorrect dosing reduced across the board to 7%, 8% and 7% of patients respectively. 914 patients prescribed an inappropriate dose had their dose adjusted to meet SmPC recommendations based on relevant characteristics (renal function, age, weight, serum creatinine, interacting medicines). Monitoring according to local guidelines also increased. Experience of staff was overwhelmingly positive and demonstrated growth in knowledge, skills, and activity amongst primary care pharmacy teams. Rapid access to specialist support allowed patients to be managed close to home.

Conclusions
This integrated care model improves frequency and appropriateness of DOAC prescribing for patients with AF. The model results in incorrect dosing lower than any described in international literature. The service model is sustainable and scalable, grows cross-sector clinical leadership and develops relationships between primary and secondary care. The next steps are to roll this model out across a large region.
Improving omnipolar electrogram reconstruction: an animal model study
Authors: Ruiperez-Campillo S , Castells F , Casado-Arroyo R , Merino J L , Millet J 
Published: November 2023

Abstract

Background
Cardiac arrhythmias are a significant cause of morbidity and mortality worldwide. The characterization of cardiac tissue's electrophysiological substrate is crucial for the diagnosis and treatment of these conditions. High-density (HD) electrode arrays, such as the Advisor™ HD Grid Mapping Catheter and Sensor Enabled™ (SE), are commonly used to examine cardiac tissue locally and create activation maps. However, the current method for reconstructing omnipolar EGMs, a novel technique claimed to be orientation-independent, has limitations. The enhancement of this reconstruction methodology has the potential to improve the accuracy and reliability of electrophysiological mapping. This, in turn, can have a positive impact on patients suffering from cardiac arrhythmias, ultimately leading to better clinical outcomes.

Purpose
We propose a novel reconstruction method to estimate omnipolar EGM that overcomes the angle dependence weakness of the current method to enhance the reconstruction of electrophysiological signals.

Methodology
Prior experiments were conducted on isolated rabbit hearts using a 128-electrode array with electrodes spaced 1mm apart over the ventricular epicardium. Four-electrode cliques were designed from these experiments, with different inter-electrode distances as depicted in Figure 1A, to reconstruct the current and novel omnipolar configurations. Metrics were designed to assess the quality of the electrogram signals, including the bipolar loop area and the ratio of the bipolar components of the omnipole (see fig. 2). The bipoles were calculated from unipolar electrograms, and the signal was corrected with a 45º offset in the cross. The propagation angle was then detected, and the local activation time (LAT) was estimated.

Results
In the bipole plots, it was observed that the morphology of the bipolar loop becomes distorted with an increase in the inter-electrode distance, becoming thinner for distances less than 2mm. There is a direct relation between the areas in the bipolar loop and the inter-electrode distance (see Figure 2A). Furthermore, the values of the area in the cross are always comparable to the best-performing triangular clique. For the ratio of bipoles, the relation is inversely related to distance (see Figure 2B). Similarly, the performance of the cross is comparable to the best-performing triangular omnipole.

Conclusion
This study highlights the importance of accurate reconstruction of omnipolar EGMs for the diagnosis and treatment of cardiac arrhythmias. To achieve precise reconstruction, inter-electrode distances smaller than 2mm are recommended. The proposed reconstruction method based on the cross configuration is more accurate and robust to wavefront propagation, provided that the recommended distance criterion is met. This study opens up new possibilities for the design of new devices and practices in the clinic.Figure 1Figure 2
Comparison of vest-recorded electrocardiogram versus conventional electrocardiogram concerning ST-deviation in acute coronary syndrome
Authors: Parale G , Parale C , Parale H , Kolhapure S , Gandhi V 
Published: November 2023

Abstract

Background and Aim
With the 12 lead ECG being the cornerstone in the diagnosis of ACS Development of a home-based, user-friendly recording of a 12 lead ECG will be a breakthrough in combating delay in diagnosing Acute Coronary Syndrome (ACS). This study evaluates the potential of a wearable vest 12-lead ECG (V-ECG) compared with the gold standard, conventional 12-lead ECGs (C-ECG) in diagnosing ACS.

Methodology
A prospective single-centre observational study conducted in a tertiary care centre. C-ECG and wearable V-ECG were recorded in hemodynamically stable adult patients and patients with normal ECG. The location of the electrodes in the vest included ten specific torso positions. Two independent physicians interpreted all the ECGs in a blinded fashion.

Results
Out of 241 patients, the vest fitted 236 patients (97.9%). Among 234 patients (72.5% males, 27.5% females; mean age 57.5 years), 154 had ACS. Three patients had an additional set of ECGs recorded, given their dynamic ECG changes during hospitalisation. The sensitivity and specificity of V-ECG, compared with the gold standard C-ECG for the diagnosis of ACS, were 98.7% ( CI 95.36-99.77) and 96.5% (CI 90.2-99.1), respectively. Among patients with STEMI, the sensitivity of V-ECG went up to 100% (CI 95.9-100). V-ECG has correctly identified anterior and inferior STEMI patients with 100% accuracy.

Conclusion
12 lead ECG recording by a wearable garment using novel torso positions is feasible in the vast majority, including both genders, and reasonably accurate for diagnosing ACS.

Highlights
Commercial availability of this vest might enable an otherwise lay person to record an ECG in an out-of-hospital setting (even at home), thus leading to an expedited diagnosis of ACS and saving precious time and lives.
Duration of left and right atrial activation wavefront assessed non-invasively is significantly higher in patients with atrial fibrillation than in controls
Authors: Parreira L , Carmo P , Nunes S , Zubarev S , Chmelevsky M , Marinheiro R , Mesquita D , Amador P , Ferreira A , Farinha J , Adragao P 
Published: November 2023

Abstract

Introduction
Ablation strategies in atrial fibrillation (AF) are currently a "one-size- fits- all" type of approach. Pulmonary vein isolation as the standard of care is not perfect, especially in the persistent forms, but none of the alternatives has shown better results. The dichotomic paroxysmal versus persistent AF classification in no longer acceptable. Characterization of the atrial substrate before ablation is needed. Electrocardiographic imaging (ECGI) is capable of non-invasively assess atrial activation in a single beat and in a panoramic fashion. The aim of this study was to evaluate the feasibility and accuracy of ECGI to assess the activation speed and identify possible targets for ablation.

Methods
We studied 18 consecutive patients, 9 referred for ablation of paroxysmal AF and 9 without AF, referred for ablation of premature ventricular contractions (PVCs), that had an ECGI performed before ablation. No patient had structural heart disease and all patients had normal electrocardiographic evaluation in sinus rhythm (SR). The ECGI was performed in SR with the AMYCARD 01 system, based on body surface electrocardiograms of a maximum of 224 electrodes and computed tomography imaging data. Total duration of atrial activation, left atrial (LA), and right atrial (RA) activation duration, and presence of lines of conduction block (LOB) defined as the presence of a jump in the local activation time of 50 ms or more between contiguous points, were assessed. The results were compared in patients with and without AF.

Results
The results are depicted in the Table. Patients with AF were older. Total atrial activation duration, LA, and RA activation duration were longer in patients with AF and there was a trend towards a higher prevalence of LOB in the LA in patients with AF (Figure).

Discussion & Conclusion
Total atrial activation duration as well as LA and RA activation duration assessed with the ECGI were significantly prolonged in patients with AF. Presence of LOB in the LA showed a trend towards a higher prevalence in AF patients. These pilot study has proved that this technology is accurate in identifying a pathological substrate in AF patients. We intend to use ECGI in a subsequent study that will include patients with AF both in paroxysmal and persistent forms, in order to identify markers of disease as well as possible targets to perform a customized AF ablation.Comparison between AF and control groupsECGI showing local activation times