bluuebunny/crossref_metadata_2025_split huggingface dataset:
Xanthine oxidase inhibitors withdrawal syndrome
Authors: Kuwabara M , Nakai M , Sumida Y , Kodama T 
Published: November 2023

Abstract

Background
In humans, uric acid is the final metabolite of adenosine triphosphate, an energy source. Xanthine oxidase (XO) contributes to urate metabolism, and XO inhibitors (XOI) suppress the production of uric acid and could store ATP. However, recent studies showed that discontinuation of XOI may lead to ATP depletion and increased death as a withdrawal syndrome. We examined whether the XOI withdrawal syndrome actually occurs.

Methods
This study retrospectively analyzed the Japanese Registry Of All cardiac and vascular Diseases (JROAD) database, which included 8,927,858 patients out of 9,825,635 data from April 2014 to March 2020, excluding 330,847 patients younger than 20 years and 566,930 patients older than 90 years. Of these, 356,405 were hospitalized patients with cardiovascular disease who were receiving uric acid-lowering drugs, and 315,388 were on XOI (41,017 were on other uric acid-lowering medications)(Fig). The XOI adherents were divided into the following four groups, and the number of deaths and mortality rates for each were identified as follows.

Results
(1) Those who were on the drug at admission and continued the drug at discharge: 219,020 cases, of which 59 deaths (0.03%). (2) 89,035 patients were discharged from the hospital on the medication they were on at the time of admission, of which 17,663 died (19.84%). (3) 7,241 patients who were not on any medication at admission (medication was given during hospitalization) and continued on medication at discharge, including 11 deaths (0.15%). (4) No medication at admission (medication was given during hospitalization) and stopped at discharge: 92 cases, of which 11 deaths (11.96%).
Continuous medication group: 226,261 cases, including (1) and (3), of which 70 deaths, (0.03%). Withdrawal group: 89,127 cases, including (2) and (4), of which 17,674 deaths (19.8%). The number of deaths in the withdrawal group was 620 times higher than that in the continuation group (p&lt;0.001).

Conclusion
XOI withdrawal syndrome is detected in our study. However, some of the deaths in the XOI discontinuation group were due to the fact that other medications were also discontinued, which indicate impossible to determine a direct causal relationship between XOI withdrawal and death. Further studies are needed to check the relationship between XOI withdrawal and death in other algorithms.Fig. Flow-chart of the study
Sex differences in incidence of self-reported adverse drug reactions after percutaneous coronary intervention
Authors: Pettersen T , Schjott J , Allore H , Bendz B , Borregaard B , Fridlund B , Hadjistavropoulos H D , Larsen A I , Nordrehaug J E , Rasmussen T B , Rotevatn S , Valaker I , Wentzel-Larsen T , Norekval T M 
Published: November 2023

Abstract

Background
Despite experiencing adverse drug reactions (ADRs) more often than men, the proportion of women participating in clinical drug trials is low. Thus, evidence for sex differences in the incidence of ADRs is limited.

Aim
To determine sex differences in incidence of self-reported ADRs after percutaneous coronary intervention (PCI). Further, to determine whether receiving information about ADRs is associated with sex.

Methods
CONCARDPCI is a prospective multicentre cohort study (N=3417) conducted at seven referral PCI centres in two Nordic countries. Clinical data were collected from patients’ medical records. Socio-demographic characteristics were obtained by self-report after PCI. Two questions from the Heart Continuity of Care Questionnaire (HCCQ) were used to determine if information about potential ADRs was received before hospital discharge. De novo created questions were used to determine if patients reported ADRs from prescribed therapy. Questionnaires were distributed two- (T1), six- (T2), and twelve months (T3) after hospital discharge to assess the incidence of self-reported ADRs in a longitudinal perspective. Logistic regression was utilised to scrutinize the aims, reported as odds ratios (ORs) with 95% confidence intervals (CIs).

Results
Patients were predominantly male (78%), with a mean age of 65 years (SD 11). Female patients were older (68, SD 10). Acute coronary syndrome was the most frequent cause of admission for PCI (62%). At T1, 2656 of the included patients responded to the questions from the HCCQ. Of these, 1019 patients (39%) reported being informed of potential ADRs from prescribed therapy, 1075 patients (42%) reported not having been informed, 511 patients (20%) reported ‘Hard to decide’, and 51 (2%) reported ‘Not applicable’. Patients reporting ‘Hard to decide’ or ‘Not applicable’ were excluded from further analysis. Women were less likely to receive information than men (OR 0.58, CI 0.45 – 0.75, p&lt;0.001). For the total study population, 42%, 49% and 40% reported ADRs at T1-T3 respectively. After adjusting for sociodemographic and clinical variables, the incidence of self-reported ADRs were significantly higher in women compared to men at T1 (OR 1.71, CI 1.36 – 2.15, p&lt;0.001), T2 (OR 1.89, CI 1.49 – 2.38, p&lt;0.001), and T3 (OR 1.79, CI 1.40 – 2.28, p&lt;0.001).

Conclusion
Women report significantly more ADRs from prescribed therapy than men after PCI. However, they are less likely to receive information about potential ADRs compared to men. Efforts to improve communication on ADRs and gender equity should be a priority.
Nurse-driven protocol for the management and follow-up of subclinical atrial fibrillation episodes in pacemaker patients
Authors: Iglesias J A , Benezet Mazuecos J , Lozano A , Crosa J , Miracle A , Esteban I , Elosegui C , Illescas C 
Published: November 2023

Abstract

Background
Atrial high-rate episodes (AHREs) compatible with atrial fibrillation (AF) detected in pacemakers are associated with an increased risk of stroke. Nurses trained in pacemaker (PM) follow-up can detect theses AHREs during patient’ scheduled visits and provide the best care option to the patients.

Purpose
To evaluate a nurse protocol applied in these patients focused on a) identifying those with AHREs and taking into account the timing of these events and their duration, and b) provide the best care and follow-up then after.

Methods and Results
To create our protocol, we evaluated PM patients without a previous history of AF and classified the incidence of AHREs into 3 groups: &gt;5 minutes to 24 hours; &gt;24 hours and patients who are in clinical AF (documented on ECG) at the time of the visit. We also evaluate the time elapsed since PM implantation (£ 3 months vs &gt; 3 months) and the type of atrial electrode fixation (active vs passive). In a prior study we analyzed 110 patients with AHREs &gt;5 minutes and &lt;24 hours (56% male, age 75 ± 9 years, mean CHA2DS2VACS scores of 3.5 ± 1.5). After 24 ± 9 months, 40 patients (36.4%) presented AHREs, and CT images showed ischemic brain lesions in 26 of them (23.6%). The presence of AHREs at 3 months was more frequent in patients with a recent MP implantation (17% vs 4.5%) and with a significant relationship with the type of active fixation of the electrode. The presence of ischemic lesions on CT was related to the detection of AHREs during follow-up, but not with AHREs in the first 3 months. Therefore, we designed a dedicated protocol for follow-up in these patients (AHREs &gt;5 minutes and &lt;24 hours) after PM implantation with repetitive follow-up visits assessing the evolution of AHREs. In cases of &gt;24 hours and those with ECG documented AF, Guidelines recommendations were followed.

Conclusions
In PM patients, the presence of AHREs might be related to serious clinical complications. On the other hand, AHREs occur regularly during the first 3 months after PM implantation, maybe related to the procedure itself and the use of active fixation for the atrial lead. AHREs in this period may not be related to major complications and individual risk should be carefully assessed before starting anticoagulation. A dedicated protocol for closer follow-up visits in these patients might help to identify those at risk and prevent clinical events.
Co-production of a structured integrated post pulmonary embolism care model (Attend-PE)
Authors: Hojen A A , Lindegaard S F , Larsen T B , Johnsen S P , Rolving N 
Published: November 2023

Abstract

Background
More than half of patients with pulmonary embolism (PE) develop persistent functional limitation and experience lower quality of life (1). To mitigate long-term complications, the European Society of Cardiology clinical guidelines on PE management recommends an integrated model for patient care after PE. However, there is currently no consensus on what such an optimal follow-up strategy should include, and high-quality evidence to provide guidance is lacking (1,2).

Purpose
To describe the co-production of a structured model for PE follow-up.

Methods
This study is part of the project - A structured Integrated post PE care model (Attend-PE) aimed at developing and testing the effectiveness of a structured, integrated and patient-centred follow-up care model for patients with PE in Denmark.
The co-production of the Attend-PE model was conducted from October 2021 till June 2022, featuring user-centred and participatory design techniques. This methodology was combined with a structural stepwise approach based on Intervention Mapping, to ensure the developed model was founded on evidence and theory (3).

Results
In accordance with the Intervention Mapping protocol, a national panel of stakeholders was formed, and a needs assessment was conducted. The needs assessment comprised a mapping of PE follow-up at all main sites treating PE in Denmark (18 hospitals), based on a co-design process with patients and health care professionals inspired by the patient journey method. To supplement this, a literature search was conducted to identify further knowledge concerning the follow-up care needs and preferences of patients with PE, as well as the optimal clinical management of PE follow-up. Based on this, the overall goal and performance objectives of a structured follow-up care model were formulated, laying the foundation for co-production workshops. In two full-day workshops, patient representatives and healthcare professionals, as well as experts in the field of PE, developed the components, scope, and sequence of the Attend-PE model. Subsequently, the structure and organization of the follow-up model were refined during online workshops, and a working group produced patient education material.
The Attend-PE model (Figure 1), outlines a systematic strategy for post-PE in-hospital follow-up, involving patient education, the content and frequency of individual follow-up consultations, and the application of patient reported outcome measures to actively assess physical and psychological well-being. This model supports an individualized post-hospitalization follow-up care plan tailored to the patient's specific needs.

Conclusion(s)
The co-production process was successful in developing a structured follow-up model for patients with PE which was based on patients’ needs and preferences, as well as the clinical experience and perspectives of healthcare providers, and was in line with current clinical guidelines.Attend-PE model
The effectiveness of high-intensity interval training compared to moderate-intensity continuous training in patients with heart failure: a systematic review and meta-analysis
Authors: Okamura M , Shimizu M , Yamamoto S , Nishie K , Konishi M 
Published: November 2023

Abstract

Background/Introduction
Cardiac rehabilitation including exercise therapy is beneficial for improving exercise tolerance, physical function, quality of life (QOL), and life expectancy in patients with heart failure. High-intensity interval training (HIIT) has attracted attention as a new training modality in heart failure, whereas moderate-intensity continuous aerobic training (MCT) is recommended as the main training modality to improve exercise tolerance. However, the effects of HIIT in patients with heart failure remain controversial.

Purpose
This systematic review and meta-analysis aimed to examine the effectiveness of HIIT compared to MCT on exercise tolerance in patients with heart failure.

Methods
We searched for studies published up to 4 March 2022 in EMBASE, MEDLINE via Ovid SP, PubMed, and the Cochrane Library via Wiley Online Library with no limitations on data, language, or publication status. We included randomised controlled trials comparing the effectiveness of HIIT and MCT on peak oxygen uptake (VO2), as a measure of exercise tolerance, aerobic threshold (AT) VO2, ventilatory equivalent of carbon dioxide (VE/VCO2), and QOL. We pooled the data on peak VO2, compared HIIT to MCT, and conducted a sub-analysis if there was heterogeneity in the result.

Results
We identified 15 randomised controlled trials with 557 patients from a total of 23,272 records. Our meta-analysis showed that participants who underwent HIIT achieved a significantly higher peak VO2 than those who underwent MCT (mean difference 1.46 ml/kg/min, 95% confidence interval 0.39 to 2.53; I2 = 65.7%; very low-quality evidence) (Figure 1). Participants who underwent HIIT had no statistically significant difference in AT VO2, VE/VCO2, and QOL compared to those who underwent MCT. The meta-regression analysis, conducted as a sub-analysis to explore possible causes of heterogeneity, revealed that the effect size of HIIT compared to MCT was inversely associated with body mass index (r = -0.508, p = 0.028, 95% confidence interval -0.95 to -0.07) (Figure 2).

Conclusions
Our systematic review showed that HIIT achieved a higher peak VO2 than MCT in patients with heart failure. In addition, HIIT may be more effective in improving exercise tolerance in patients with low body mass index.
Individual tailored physical training in patients with postural orthostatic tachycardia syndrome after COVID-19 - a feasibility study
Authors: Svensson A , Svensson-Raskh A , Stahlberg M , Bruchfeld J , Holmstroem L , Fedorowski A , Nygren-Bonnier M 
Published: November 2023

Abstract

Background
A significant proportion of patients with COVID-19 have developed persistent symptoms, described as post-acute COVID-19 syndrome (PACS ). A specific PACS variant is the postural orthostatic tachycardia syndrome (POTS). POTS is a cardiovascular autonomic dysfunction characterized by an excessive increase in heart rate in standing, deconditioning and low quality of life. Studies that have evaluated the effect and feasibility of individual tailored physical training in POTS associated with COVID-19 are sparse.

Purpose
To evaluate the effects and feasibility of individualized exercise on physical and psychological function in patients with POTS after COVID-19.

Method
Patients with POTS + PACS were enrolled between Dec 2021 and Dec 2022. The intervention consisted of individually tailored training, including endurance and muscle-strengthening exercises with a gradual progression of time, dose and position. The training was based on the study subject's heart rate and/or self-estimated exertion using BORG RPE. The intervention lasted 12 weeks. Progression of the exercise was halted if the study subject described increased symptoms &gt;24h after the last exercise session. Measurements were carried out at baseline and after intervention: 6-minute walking test (6MWT), Active Standing Test (AST) and self-assessment of symptoms through forms; Malmö POTS scale (MaPS), Vanderbilt Orthostaic Symptom Score (VOSS), Fatigue Severity Scale (FSS) health-related quality of life (EQ-5D-5L), anxiety (GAD) and depression (PHQ-9). Physical activity and time in different positions (lying, sitting, standing and walking) were measured using accelerometers (ActivPAL). Recruitment rate, compliance and adverse events was registered as feasibility.

Results
A total of 24 patients were enrolled and 23 patients completed the intervention (19 women; mean age, 40.9 years (SD 10.7). No severe adverse events occurred however some of the patients described symptoms as post exertion malaise (PEM). After the intervention, patients demonstrated improvement in physical (6MWT, p&lt;0.005) and psychological functions (PHQ-9, p&lt;0.001), less symptoms related to POTS (MaPS p&lt;0.01, VOSS p&lt;0.02, FSS p&lt;0.045) and improved HrQoL (EQ-5D p&lt;0.001) (Table 1). The primary outcome, time spent in upright position increased by 1.5h/day i.e. by 49% (Figure 1).

Conclusion
In patients with COVID-19-related POTS, an individually tailored training seem to contribute to increased time in upright position, reduction of POTS-specific symptoms and improved functions. The intervention seems to be feasible in terms of recruitment, compliance and safety. Further studies are needed to verify these results and compare disease progression with and without intervention.Table 1Figure 1
Quantification of heart failure decompensation through mixed digital methodology
Authors: Romano L , Curcio A , Scalzi G , Malizia B , Festa M , Indolfi C 
Published: November 2023

Abstract

Background
While natriuretic peptides (NPs) quantification and echocardiographic assessments are recommended for diagnosis of heart failure (HF), yet electrocardiographic determinants of cardiac rhythm alterations predisposing to sudden cardiac death (SCD) are lacking. Premature ventricular contractions (PVCs) are common in HF. In some patients, PVCs are triggered by the same mechanism that gives rise to ventricular tachycardia (VT). Appropriate clinical evaluation is important in these patients. Currently, smartwatches are becoming particularly popular to enhance health monitoring.

Purpose
The aims of this study were: to evaluate the feasibility and reliability of the clinical use of a smartwatch, to detect main features of QRS-complex (width, voltage), and to correlate PVCs with VT originating in different aetiologies of HF.

Methods
From November ‘22 to February ’23, 53 patients admitted to the Division of Cardiology of our academic hospital underwent standard ECG and smartwatch-based lead I acquisitions. Concordance between the two technologies was assessed by Cohen κ coefficient. Bland-Altman method for analysis of measurement agreement was used for comparison.

Results
Clinical characteristics of the subjects included in this study are described in the Table. All patients had diagnosis of acute or chronic HF and had PVCs (N= 47) and/or VT (N=3). Sustained and non-sustained VT were more common in patients with HF and reduced ejection fraction. In 7 cases we detected PVCs with the same standard ECG’s morphology and axis during recording ECG with the smartwatch. The Cohen κ coefficients for the measurement of the voltage and width of QRS complex were 0.833 (95% CI, 0.725-0.936) and 0.869 (95% CI, 0.747- 0.956), respectively; voltage and width of PVCs were 0.860 (95% CI, 0.579-1.00) and 0.822 (95% CI, 0.429-1.00), respectively. Concordance was found between the smartwatch ECG and standard ECG for QRS width (bias, −0.05; SD, 0.395; lower limit, −0.821; and upper limit, 0.727), for QRS voltage (bias, −0.004; SD, 0.034; lower limit, −0.073; and upper limit, 0.062), for PVC width (bias, −0.7; SD, 2.167; lower limit, −4.372; and upper limit, 4.12), PVC voltage (bias, −0.02; SD, 0.07; lower limit, -0.112; and upper limit, 0.162) using the Bland-Altman analysis.

Conclusions
Smartwatch can accurately measure QRS width and voltage and reproducibly detect PVCs compared with standard ECG. Valid correlation indices and good concordance between the two methods were observed using digitally-assessed lead I. These data could be of great interest due to the widespread diffusion of wearable devices; the smartwatch could be helpful especially when frequent monitoring of VT becomes necessary. Currently available smartwatches display, in this regard, an implementation for PVCs detection.
Artificial intelligence-based identification of left ventricular systolic dysfunction from 12-lead electrocardiograms: External validation and advanced application of an existing model
Authors: Koenig S , Hohenstein S , Nitsche A , Pellissier V , Leiner J , Stellmacher L , Hindricks G , Bollmann A 
Published: November 2023

Abstract

Background
The diagnostic application of artificial intelligence (AI)-based models to detect cardiovascular diseases from electrocardiograms (ECG) evolves and some promising results were reported. However, most published algorithms lack external validation.

Purpose
Aim of this study was to validate an existing, open-source algorithm for the detection of left ventricular systolic dysfunction (LVSD) from 12-lead ECGs.

Methods
Patients with digitalized data pairs of 12-lead ECGs and echocardiography (at intervals of ≤7 days) were retrospectively selected from the Heart Center Leipzig ECG and electronic medical records databases. A previously developed AI-based model was applied to ECGs and calculated probabilities for LVSD. Area under the receiver operating characteristic curve (AUROC) was computed overall and in cohorts stratified for baseline and ECG characteristics. Repeated echocardiography studies recorded ≥3 months after index diagnostics were used for follow-up (FU) analysis.

Results
At baseline, 42,291 ECG-echocardiography pairs were analyzed and AUROC for LVSD detection was 0.88. Corresponding sensitivity and specificity were 82% and 77% for the optimal LVSD-probability cutoff based on Youden’s J. AUROCs were lower in ECG-subgroups with tachycardia, atrial fibrillation and wide QRS complex. In patients without LVSD at baseline and available FU, model-generated high probability for LVSD was associated with a 4-fold increased risk of developing LVSD during FU.

Conclusion
We provide the external validation of an existing AI-based ECG-analyzing model for the detection of LVSD with excellent and robust performance metrics. The association of false positive LVSD screenings at baseline with a deterioration of ventricular function during FU is hypothesis-generating and deserves further research.