bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of secondary prevention in centre-based cardiac rehabilitation: predictors and between-center variation
Authors: Novakovic M , Trsan J , Tasic J , Krevel B , Krunic B , Pusnik Vrckovnik M , Pagliaruzzi M , Cencic V , Ravnikar T , Lainscak M , Farkas Lainscak J , Fras Z , Jug B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency Ministry of Health, Republic of Slovenia.

Background
Cardiac rehabilitation (CR) is a complex intervention, providing supervised exercise training, risk factor control, and secondary prevention. Centre-based outpatient CR provides the necessary structure to accomodate the delivery of several preventive interventions, but the quality of secondary prevention may vary. The present study sought to assess the impact of CR on the improvement and between-center variation of the quality of secondary prevention.

Methods
Data were extracted from the Slovenian National CR Registry for patients who completed CR between 2017 and 2020. A composite quality score (CQS) was calculated adjudicating one point for each of the following: non-smoking status, body mass index &lt;25 kg/m2, systolic blood pressure &lt;130 mmHg, low-density lipoprotein (LDL) cholesterol &lt;1.4 mmol/L, antiplatelet therapy, and high-potency statin/combined lipid-lowering therapy. Predictors of CQS improvement were assessed using mixed-effects ordinal logistic regression model acknowledging the hierarchical nesting of patients within centres.

Results
A total of 1,952 patients from 5 centres were included (mean age 59.4±10.8 years; 22% women). Mean CQS improved from 3.16±1.11 to 3.53±1.21 (p&lt;0.001), with CR associated with an OR 1.72 (95% confidence interval [CI] 1.49-2.00) for CQS improvement (Figure). Improvement of CQS was also positively associated with increasing number of sessions &gt;12 (e.g., OR 6.06 [3.29-11.14] for 12-24 sessions) and total number of co-morbidities (OR 1.40 [95%CI 1.33-1.48]), and negatively associated with male sex (OR 0.78 [95%CI 0.65-0.92]), high cardiac risk (OR 0.83 [95%CI 0.68-0.99]), age &gt;60 years (e.g., OR 0.62 [95% CI 0.41-0,94] for age group 60-69 years), and referral diagnosis other than STEMI (e.g., OR 0,56 [95%CI 0.39-0,72] for non-infarction coronary artery disease). Random-effects partitioning attributed 68.8% of variance to patient-level factors and 19.8% to between-center variability.

Conclusions
Centre-based CR is associated with improved quality of secondary prevention; factors affecting quality improvement range from patient-level (e.g., age and sex) to mode of provision (e.g., number of sessions). Up to one fifth of the variation, however, can be attributed to between-center variationm.
NT-ProBNP value to monitor the treatment with intropics of acute heart failure associated with acute coronary syndrome
Authors: Carias M , Almeida A , Paralta M , Claudio F , Rocha R , Bento A , Trinca M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
NT-proBNP is a cardiac biomarker with diagnostic and prognostic value. Assessment of NT-proBNP enables to determine, or exclude, cardiac cause of dyspnea, and variations in its levels are significantly related with prognosis, as higher values in heart failure have a significantly worse prognosis than those with reduction of its value.
Acute heart failure might be associated with acute coronary syndromes (ACS) and may require inotropic therapy to improve hemodynamic status and optimize cardiac output. Inotropes help improve cardiac contractility, therefore, increase stroke volume, cardiac output, and meliorating heart failure congestive or low perfusion symptoms and NT-proBNP value.

Purpose
This study aims to evaluate the effect of the use of Inotropes on the NT-proBNP value, comparing Levosimendan with Dobutamine, in patients hospitalized for acute heart failure associated with ACS.

Methods
We analyzed a retrospective, multicenter, observational cohort of 150 patients, admitted for ACS, with Killip 3 or 4 at presentation, requiring inotropic therapy. The population was divided into two groups: a group that used Levosimendan and a second group that used Dobutamine. The mean value of NT-proBNP, during hospitalization, was compared between both groups and compared with placebo.

Results
Levosimendan sample included 75 patients, of which 35,0% (n=26) were women, with a mean age of 82 ± 14.5 years old, while Dobutamine sample had 75 elements, of which 38% (n=28) were women with a mean age of 81.8 ± 12.9 years old. There was no statistically significant difference between both samples on age and sex distribution.
Levosimendan group had a mean NT-proBNP value of 8870±100 pg/mL, while Dobutamine group had a mean mean NT-proBNP value of 12454±984 pg/mL. There was no statically difference on mean NT-proBNP value comparing both inotropic therapy samples (p&gt;0,05), however, there was a statistically significant difference, with a higher decrease in mean NT-proBNP value, in patients using Levosimendan, comparing with not using inotropes (1382 pg/mL vs 12329 pg/mL, p&lt;0,01), not verified, with a not statistically significant difference comparing Dobutamine and no inotropic therapy.

Conclusion
Levosimendan is associated with a higher decrease in NT-proBNP value. As heart failure might complicate ACS episode, and might require inotropic therapy, we should be aware that the choice of using Levosimendan in these situations may confer a greater analytic benefit, associated with the higher decrease in NT-proBNP value, which might be associated with a better prognostic value. However, treatment guided by value of NT-proBNP is yet to be validaded.
Risk modification role of opportunistic screening of lipoprotein(a) at first acute coronary syndrome admission in patients under 65 years old
Authors: Fernandez Ruz L , Mora Robles J , Ceballos Gomez C , Sanchez Sanchez C , Urbano Carrillo C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
There is a strong association between lipoprotein(a) (Lp(a)) and atherosclerotic cardiovascular disease (ASCVD). Recent guidelines recommend its measure once in each adults’ lifetime, but the moment remains undefined. Moreover, little is known about Lp(a) in the acute setting.

Purpose
To describe Lp(a) levels in young patients (under 65) affected by its first acute coronary syndrome (ACS) as part of the standard evaluation during hospitalization and how it can affect lipid residual risk stratification.

Methods
We conducted a descriptive and retrospective study involving 51 patients under 65 years old admitted to hospital between July 2022 and October 2022, for ACS, irrespective of the onset of symptoms (unstable angina, myocardial infarction with or without ST-segment elevation (STEMI, NSTEMI). We tested Lp(a), apolipoprotein B (ApoB), low and high-density lipoprotein cholesterol (LDLc, HDLc), triglycerides (TG) and glycated haemoglobin (HbA1c), in those patients.

Results
We included 51 patients in our study. 76,5% were male. Mean age was 56,1 years (± 7,34). The distribution of risk factors was: smoking 68,6%, hypertension 52,9%, diabetes 31,4%, dyslipidaemia 43,1%. 30 patients had STEMI (58,8%), 17 NSTEMI (33,3%); 4 unstable angina. Immediate percutaneous coronary intervention was made in 33 patients (64,7%). Mean LVEF was 55,19% (± 9,4). Mean high-sensivity troponin I (hsTnI) peak was 47648,14 ng/L (± 71365).
13 patients had Lp(a) &gt;50 mg/dL (25,5%), including 2 patients with Lp(a) levels above 180 mg/dL. The rest of the lipid profile is shown in Table 1.

Conclusion
In our sample of young ACS patients, one of each four patients has Lp(a) levels above 50 mg/dL, which confers a higher risk for ASCVD. We consider screening for Lp(a) in ACS as an opportunity to redefine cardiovascular risk and intensify lipid lowering therapies during follow-up.
Did nocturia, in hypertension, correlate with dipping status?
Authors: Croce A , Parazzoli C , Pengo M , Rosa D , Bilo G , Chiodini I , Parati G F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The association between nocturia and hypertension has been widely reported yet remains poorly characterized, precluding a more refined understanding of blood pressure as it relates to the cardiovascular setting. Nocturia is associated with significant morbidity and mortality (1,2,3) which is thought to be mediated in large part by the fact that nocturia is a potential manifestation of systemic disease (4). Previous studies have reported that heart failure and uncontrolled hypertension were responsible for clinically significant nocturia (5,6). However, it remains unclear the relationship with any hypertension mechanism and the effect on circadian blood pressure rhythm.

Purpose
To investigate characteristics of hypertensive patients in who complain for nocturia.

Methods
We prospectively recruit 49 patients among outpatients attending the Hypertension Centre of Hospital San Luca, Istituto Auxologico Italiano. Physical examination, standard routine blood tests, urine analysis for microalbuminuria, 24-hour sodium excretion, 24-hour urinary cortisol levels, 24-hour urinary metanephrine/normetanephrine and a standard 24h ABPM has been performed. We asses in every patients the presence of nocturia (≥2 nightly voids) then we compare sub mentioned features between patients with nocturia or not.

Results
The population recruited demonstrate a mean age of 62 years old, it is made by a majority of men (M 61%, F 39%). We found nocturia in 13 patients on the 49 recruited. Demographic, anthropometrical and hematochemical features of the population recruited is described in Table 1. We compare patients who complain nocturia with patients with a normal number of nocturnal voids. Only height and hemoglobin demonstrate significative difference in the population. In a second analysis we compare ABPM results of patients with nocturia with patients who don’t have this symptom. The results are described in Table 2. Differently to what we expect no difference is demonstrated between the two group in dipping status, we found a significative difference in overall heart rate, this difference is evident only the day period but not in the night period.

Conclusion
These preliminary data suggest that patients with nocturia than patient with normal number of nocturnal voids i) have lower height and hemoglobin level, this in support to nocturia is a potential manifestation of systemic disease (4);) have both a lower overall and diurnal cardiac frequency. No dipping correlation have been found in our study, more study are needed to clarify a potential relationship with sleep disorder.
Hematological effects of Levosimendan therapy in patients with heart failure
Authors: Rocha De Almeida A , Carias De Sousa M , Congo K , Trinca M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Levosimendan is an inotropic drug, acting as calcium sensitizer, used in the management of acute heart failure. Despite its hemodynamic benefits, Levosimendan is associated with several adverse reactions, including hematological effects, with a hemoglobin value decrease, causing anemia.
Acute coronary syndromes (ACS) might be a precipitant of acute heart failure, in a substantial proportion of cases. These situations may require the use of inotropic drugs, such as Levosimendan. Antithrombotic therapy is the cornerstone therapy for management of acute coronary syndromes, and the decision of which strategy is determined by the balance of ischemic and hemorrhagic risks.
Therefore, in the management of acute heart failure, associated with ACS, the use of Levosimendan might be associated with the increase of hemorrhagic risk, due to hemoglobin decrease, influencing the antithrombotic therapy strategy choice.

Purpose
This study aims to evaluate the effect of the use of Levosimendan on the hemoglobin value, comparing with Dobutamine, in patients hospitalized for ACS.

Methods
We analyzed a retrospective, multicenter, observational cohort of 317 patients, admitted for ACS, requiring inotropic therapy. The population was divided into two groups: a group that used Levosimendan and a group that used Dobutamine. The mean decrease in hemoglobin value, and the minimum hemoglobin value, during hospitalization, was compared between both groups.

Results
Levosimendan sample included 39 patients, of which 40,1% (n=15) were women, with a mean age of 83±12,1 year old, while Dobutamine sample had 278 elements, of which 38% (n=105) were women with a mean age of 82±12,1. There was no statistically significant difference between both samples on age and sex distribution.
Levosimendan group had a mean minimum hemoglobin value of 10,7±2,2 g/dL and a mean decrease in hemoglobin value, during hospitalization, of 2,7±1,9 g/dL, while Dobutamine group had a mean minimum hemoglobin value of 10,7±2,2 g/dL and a decrease in hemoglobin value, during hospitalization, 2,1±1,9g/dL. There was no statically significant difference on mean minimum hemoglobin value on both samples (p&gt;0,05), however, there was a statistically significant difference, with a higher decrease in mean hemoglobin value, during hospitalization in patients using Levosimendan, comparing with patients using Dobutamine (2,7±1,9g/dL vs 2,1±1,9g/dL, p=0,04).

Conclusion
Levosimendan is associated with a higher decrease in hemoglobin value. As heart failure might complicate ACS episode, and might require inotropic therapy, we should be aware that the choice of using Levosimendan in these situations may confer a greater risk of bleeding, associated with the higher decrease in hemoglobin value, in patients who need intense antithrombotic therapy.
Digital health nudging to increase physical activity and quality of life in pediatric patients with congenital heart disease: a randomized controlled trial
Authors: Willinger L , Oberhoffer-Fritz R , Ewert P , Mueller J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): This research was funded by an unrestricted grant from the “Stiftung KinderHerz Deutschland gGmbH.”

Background
Digital health nudging has been shown to be a compelling, age-appropriate, and modern e-health intervention to increase physical activity (PA) in healthy adolescents. However, such studies are lacking in adolescents with congenital heart disease (CHD), although activity promotion is particularly important in this vulnerable population.

Purpose
This randomized-controlled trail examines if digital health nudging via daily smartphone messages increases PA and health-related quality of life (HrQoL) in adolescents with CHD.

Methods
From May 2021 to April 2022, 97 patients (15.1 ± 2.0 years, 50% girls) with moderate or severe CHD were randomly allocated 1:1 to an intervention group (IG) or control group (CG). Daily PA was objectively assessed in minutes of moderate-to-vigorous PA (MVPA) by the wrist worn wearable "Garmin Vivofit jr." over the entire study period. HrQoL was assessed with the KINDL-questionnaire at baseline and after the intervention. The IG received daily, short and informative smartphone messages based on Bandura’s social cognitive theory on the subject of MVPA, thus nudging them to be more active in their everyday lives over a period of three month. Intention-to-treat analysis was performed based on multiple imputed data. To analyze the change of MVPA, the first two weeks of the intervention were compared to the last two weeks of the intervention with Mann-Whitney-U test. Results are expressed as median [25 quartile; 75 quartile].

Results
MVPA decreased from 78.1 [62.5; 86.5] to 71.4 [56.6; 75.2] min/day in the IC and from 80.2 [64.7; 102.9] to 76.0 [68.0; 94.0] min/day in the CG over the study period of three month. There was no significant change in MVPA when comparing the IG with the CG group (IG: Δ -6.4 [-18.6; 3.0] min/day vs. CG: -2.5 [-12.8; 8.5] min/day, p=0.199). Physical well-being significantly increased over the study period (IG: Δ1.60 [-0.24; 6.25] vs. CG: Δ0.00 [-12.5; 6.35], p=0.043), but not the total HrQoL score (p=0.518).

Conclusion
Three month of digital health nudging did not increase PA, but improved feelings of physical well-being in adolescents with CHD. Our results might indicate that although wearables and digital health nudging initially have a positive influence on physical activity, activity declines over time in both groups and digital health nudging apparently does not have the potential to stop or slow down this phenomenon.
Self-efficacy and barriers to exercise across the different stages of heart failure with a preserved ejection fraction
Authors: De Wilde C , Claes J , Bekhuis Y , Claessen G , Decorte E , Gevaert A , Falter M , Gojevic T , Hansen D , Kuznetsova T , Michielsen M , Van Craenenbroeck E , Cornelissen V 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FWO - Research Foundation – Flanders.

Background
Exercise is a key therapy for patients across all the stages of heart failure with preserved ejection fraction (HFpEF). Despite being a class I recommendation, the EUROASPIRE registry showed that only a third of patients is sufficiently active, with numbers being even lower among patients with symptomatic HFpEF (stage C). Knowledge of barriers and confidence to exercise is needed to increase the uptake of exercise and a physically active lifestyle.

Objective
To assess barriers to exercise and self-efficacy in patients along the continuum of HFpEF and to detect possible differences between patients in different HFpEF stages.

Methods
The first 60 patients (n = 20 HFpEF stage A, 20 HFpEF stage B, 20 HFpEF stage C) from the PRIORITY randomized controlled trial (PeRsonalIzed remOtely guided preventive exeRcIse therapy for a healThY heart) were included. Barriers to exercise and self-efficacy were evaluated using the Exercise Barrier Questionnaire and the Exercise Self-Efficacy Scale.

Results
Patients with HFpEF stage C were older (72 ± 9.41 years), more likely to be female (70%) and were less physically fit (peak VO2 14.09 ± 2.58 ml/min/kg) compared to patients with HFpEF stage A (63.5 ± 9.10 years, 40% women and peak VO2 21.43 ± 4.94 ml/min/kg) and stage B (70.5 ± 5.25 years, 40% women and peak VO2 17.84 ± 5.15 ml/min/kg). As shown in Figure 1, patients with HFpEF stage C reported more barriers to exercise compared to patients with HFpEF stage A or HFpEF stage B. In particular, 50% of HFpEF stage C reported that they would not exercise when they perceived the exercise as boring (vs A:21%, B:22%), not fun (vs A: 21%, B:21%), if supervised by a bad instructor (vs A:32%, B:33%) or during holidays (vs A:26%, B:17%). Almost 40% of patients with HFpEF stage C reported that having to exercise alone would be a barrier for them (vs A:11%, B:22%). As shown in Figure 2, patients with HFpEF stage C were less confident that they 1) could overcome barriers to exercise by finding appropriate exercise resources (A:0%, B:6%, C:11%), 2) would exercise when feeling tired (A:5%, B:24%, C:28%), 3) would exercise without family support (A:5%, B:6%, C: 17%) or 4) without professional support (A:11%, B:18%, C:17%).

Conclusion
Barriers to exercise and self-efficacy were rated differently by the 3 stages of HFpEF. Patients with more advanced stages of HFpEF experienced more challenges to be physically active.
Burden of cardiometabolic diseases and life expectancy with and without atrial fibrillation among men and women
Authors: Lu Z , Aribas E , Tilly M , Geurts S , De Groot N , Kavousi M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation is the most common cardiac arrhythmia worldwide, with significant sex differences in its epidemiology. Cardiometabolic diseases commonly coexist with atrial fibrillation and associate with a larger mortality risk. However, how increasing burden of cardiometabolic diseases affect life expectancy lived with atrial fibrillation remains largely unknown.

Purpose
To determine the impact of burden of cardiometabolic diseases on life expectancy lived with and without atrial fibrillation.

Methods
From the population-based Rotterdam Study, 4045 men and 5526 women (mean age 62 years) were included. Participants with cardiometabolic diseases, including diabetes, coronary heart disease, stroke, and heart failure, were divided into three groups according to the number of prevalent disorders (0, 1, and ≥2). A multistate life table was developed to calculate the life expectancy lived with and without atrial fibrillation according to the burden of cardiometabolic disease.

Results
Men aged 55 with no cardiometabolic disease had a life expectancy of 22.0 years and lived 5.9 years longer than men aged 55 with ≥2 cardiometabolic diseases (life expectancy 16.1 years). Of the total life expectancy at age 55, men with no cardiometabolic disease spent 29.1% (6.4 years) of their remaining years with atrial fibrillation, whereas men with ≥2 cardiometabolic diseases spent 36.0% (5.8 years) of their remaining years with atrial fibrillation. Women aged 55 with no cardiometabolic disease had a total life expectancy of 25.2 years, which was 8.1 years longer than women aged 55 with ≥2 cardiometabolic diseases (life expectancy 17.1 years). Of the total life expectancy at age 55, women with no cardiometabolic disease spent 25.4% (6.4 years) of their remaining years with atrial fibrillation, and those with ≥2 cardiometabolic diseases spent 29.8% (5.1 years) of their remaining years with AF.

Conclusions
The larger burden of cardiometabolic diseases was associated with a lower life expectancy among men and women, and a larger proportion of remaining years spent in atrial fibrillation. Findings suggest that larger proportion of time spent in AF translates to a lower quality of life and larger health care costs at population level.