bluuebunny/crossref_metadata_2025_split huggingface dataset:
Technology assisted physical activity among hospitalised medical patients a cluster randomised clinical trial
Authors: Dall C , Gunnarsson D , Andersen H , Pedersen L , Suetta C , Prescott E , Henriksen M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Bispebjeg University Hospital (public hospital) Danish Physiotherapy Foundation.

Background
To investigate whether patients, with independent basic mobility, admitted to medical wards, by simple feedback on physical activity (the integration of accelerometer measurements and tablet feedback) can be nudged to increase the level of activity during hospitalization.
The aim is to investigate if medical patients with intact basic mobility, can increase the level of physical activity by simple feedback from a new technology solution.

Methods
Design: A cluster randomised clinical trial. Primary outcome: time spend out of bed (min/day). Power calculation: 320 patients.
All included patients had their physical activity level measured. The intervention group received feedback by an app on a tablet. The patients participated for a minimum of 24 hours and up to 7 days. Inclusion of patients from the Department of Carardiology, Geriatric Department and Department of Pulmonary and Infectious disease. Primary efficacy measure: Time out of bed (min).

Results
354 patients were included. Difference between those who received feedback (intervention) and those without feedback (control) was 23.6 min/day more out of bed (95%CI 13.75 – 33.50); P = &lt;.0001.

Conclusion
Patients admitted to medical wards, with independent basic mobility, were on average 23.6 minutes more physically active per day (21%) when they received feedback about their physical activity.

Implication
This technological solution with feedback can be a tool to nudge the patients with independent basic mobility to stay physically active during hospitalization. The solution may also allocate resources for those patients who have a greater need for help and support for mobilization.
Apnea-Hypopnea Index an indicator of increased right cardiac preassures
Authors: Fringu F , Sturz C , Tomoaia R , Zdrenghea D , Horvat D , Caloian B , Comsa H , Rosu R , Cismaru G , Gusetu G , Gurzau D , Ursu M , Simu G , Ivan S , Pop D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Obstructive sleep apnea (OSA) is a disorder frequently associated with clinical conditions and complications such as refractory hypertension, atrial fibrillation, nocturnal angina, dysrhythmias, congestive heart failure and stroke.
Polysomnography is the gold standard test required to diagnose OSA, along with a targeted history and comprehensive examination of the patient. It involves the recording of various physiologic variables during sleep. Sleep related obstructive events may be measured using two indices: the apnea-hypopnea index (AHI) and the respiratory disturbance index, an AHI≥15 being diagnostic for OSA.
The aim of this study was to determine the interaction between sleep apnea and demographic or echocardiographic markers.

Material and methods
This was a prospective study that included 33 patients with sleep apnea. Polysomnography was performed using a VitalNight cardiorespiratory polygraph to determine the apnea hypopnea index (AHI) and echocardiography was performed using a Vivid E95 scanner to determine the left ventricular ejection fraction (LVEF), the peak systolic right ventricular to right atrial pressure gradient (Gmax) and the right ventricular diameter and function (TAPSE and s’).

Results
The mean age of the patients was of 63±8 years and 14 patients (42%) had a Gmax&gt;25mmHg. Regarding cardiovascular risk factors, 31 patients (94%) had arterial hypertension and 26 (79%) were smokers. Out of all patients, 25 (76%) had an appropriate echocardiographic acoustic window. The patients had mean values of AHI of 45±19. Mean values for the LVEF, Gmax, TAPSE and s’ were 53 ± 11%, 25± 14 m/s, 22 ± 4 mm, and 14 ± 3 cm/s, respectively. AHI showed moderate correlations to age (r=0.27), cervical perimeter (r=0.38) and BMI (r=0.30), but also to echocardiographic parameters as LVEF (r=0.29), Gmax (r=0.42), RV diameter (r=0.39), TAPSE (r=0.38) and s’ (r=0.34). ROC curves were determined to calculate the value of AHI to predict a Gmax &gt;25 mmHg. A significant Gmax, as an indicator for increased right cardiac pressures, was predicted with a high sensitivity (86%) and specificity (84%) by a value of AHI &gt; 45 (AUC=0.81, 95%CI = 0.64-0.927, p&lt;0.001).

Conclusion
In conclusion the study demonstrated that smoking and hypertension are important risk factors in patients with sleep apnea syndrome. There was a significant correlation between AHI and echocardiographic parameters of the right heart. AHI can be used as a predictor of increased right cardiac preassure when the value is above 45.
Obesity in heart failure with preserved ejection fraction with and without diabetes: risk factor or innocent bystander?
Authors: Prausmüller Suriya , Weidenhammer Annika , Heitzinger Gregor , Spinka Georg , Goliasch Georg , Arfsten Henrike , Abdel Mawgoud Ramy , Gabler Cornelia , Strunk Guido , Hengstenberg Christian , Hülsmann Martin , Bartko Philipp E , Pavo Noemi 
Published: May 2023

Abstract

Aims
Heart failure with preserved ejection fraction (HFpEF) is a condition that commonly coexists with type 2 diabetes mellitus (T2DM) and obesity. Whether the obesity-related survival benefit generally observed in HFpEF extends to individuals with concomitant T2DM is unclear. This study sought to examine the prognostic role of overweight and obesity in a large cohort of HFpEF with and without T2DM.

Methods and results
This large-scale cohort study included patients with HFpEF enrolled between 2010 and 2020. The relationship between body mass index (BMI), T2DM, and survival was assessed. A total of 6744 individuals with HFpEF were included, of which 1702 (25%) had T2DM. Patients with T2DM had higher BMI values (29.4 kg/m2 vs. 27.1 kg/m2, P &lt; 0.001), higher N-terminal pro-brain natriuretic peptide values (864 mg/dL vs. 724 mg/dL, P &lt; 0.001), and a higher prevalence of numerous risk factors/comorbidities than those without T2DM. During a median follow-up time of 47 months (Q1–Q3: 20–80), 2014 (30%) patients died. Patients with T2DM had a higher incidence of fatal events compared with those without T2DM, with a mortality rate of 39.2% and 26.7%, respectively (P &lt; 0.001). In the overall cohort, using the BMI category 22.5–24.9 kg/m2 as the reference group, the unadjusted hazard ratio (HR) for all-cause death was increased in patients with BMI &lt;22.5 kg/m2 [HR: 1.27 (confidence interval 1.09–1.48), P = 0.003] and decreased in BMI categories ≥25 kg/m2. After multivariate adjustment, BMI remained significantly inversely associated with survival in non-T2DM, whereas survival was unaltered at a wide range of BMI in patients with T2DM.

Conclusion
Among the various phenotypes of HFpEF, the T2DM phenotype is specifically associated with a greater disease burden. Higher BMI is linked to improved survival in HFpEF overall, while this effect neutralises in patients with concomitant T2DM. Advising BMI–based weight targets and weight loss may be pursued with different intensity in the management of HFpEF, particularly in the presence of T2DM.
Associations of general and abdominal obesity, and genetic risk with atrial fibrillation: longitudinal analyses in the UK biobank study
Authors: Choi S , Yang P S , Kim D , Jang E , Yu H T , Kim T H , Pak H N , Lee M H , Sung J H , Joung B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Observational studies have shown positive associations general and abdominal obesity, and atrial fibrillation (AF). However, little is known about these associations in individuals with elevated genetic susceptibility for this disease.

Methods
The UK Biobank cohort study includes more than 502 421 participants aged 40 to 70 years who were recruited from 22 assessment centers across the United Kingdom from 2006 to 2010. A total of 339 003 unrelated individuals of white British descent with available genotype and matching genetic data and reported sex were included in this study from the UK Biobank population-based sample. Individuals were included in the analyses of AF. Data were analyzed from April 2006 to March 2015. Body mass index (BMI) and waist circumference (WC) were employed for general (BMI: underweight, &lt; 18.5 kg/m²; normal, 18.5 to &lt;25.0 kg/m²; overweight, 25.0 to &lt;30.0 kg/m²; obese, &gt; 30.0 kg/m²) and abdominal obesity (WC: ≥ 94 cm for men and ≥ 80 cm for women). Then we further examined these associations in individuals with different genetic burden by stratifying individuals based on their genetic risk scores for atrial fibrillation. We compared disease risk among individuals in different tertiles of body mass index, and abdominal obesity using lowest tertiles as reference.

Results
Of 343 165 individuals, 185 745 (54.1%) were female, and the mean (SD) age was 57.19 ± 8.01 years. During follow-up, 18 974 of 343 165 (5.5%) developed AF with 8.2% in general obesity (vs. 4.7% control, p&lt;0.001) and 6.6% in abdominal obesity (vs. 3.4% control, p&lt;0.001). Compared to the normal, subjects in the overweight (HR 1.11, 95% CI 1.07–1.15, p&lt;0.001) and obese (HR 1.55, 95% CI 1.20–2.01, p&lt;0.001), and abdominal obesity (HR 1.35, 95% CI 1.31–1.40, p&lt;0.001) had a significantly higher AF risk. Genetic risk and general and abdominal obesity were independent predictors of incident AF, and there were no interactions. Compared with normal in the low genetic risk group, general obesity and abdominal obesity was associated with a hazard ratio of up to 3.98 (95% CI, 3.73–4.24) and 3.44 (95% CI, 3.19–3.70) for AF in the high genetic risk group.

Conclusions
General and abdominal obesity demonstrated positive associations with incident AF in the general population, as well as in individuals with elevated genetic risk for these diseases.
Myeloperoxidase causes both arrhythmogenic structural and electrical remodelling in neonatal rat ventricular myocyte monolayers
Authors: Al-Shama R F M , Ernault A C C , Meulendijks E R , Fabrizi B , Van Amersfoorth S C M , Boender A R , Coronel R , Boukens B J D , De Groot J R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported by Netherlands Organization for Health Research and Development

Background
Myeloperoxidase (MPO), an enzyme most abundantly expressed by neutrophils, is increased in the atrial tissue of AF patients and is associated with treatment failure. Moreover, MPO increases fibrosis and AF susceptibility in mouse atria. However, how MPO promotes AF has yet to be fully established.

Purpose
To investigate the role of MPO in electrophysiological and structural remodelling.

Methods
We incubated cultured neonatal rat ventricular myocyte (NRVM) monolayers with 1 μg/mL MPO or vehicle for 24 hours. We then performed electrophysiological mapping using an 8x8 multielectrode array (MEA) setup with 100 μm-sized electrodes and 700 μm inter-electrode distance (n=8 MPO, n=7 control) and recorded action potentials (AP) using a microelectrode during pacing. Additionally, we quantified the number of fibroblasts using vimentin staining (n=5/group) and the expression of extracellular matrix (ECM) genes (COL1A1, COL8A2, FN1, CTGF, TNC, THBS2, MMP2, MMP12) using qPCR (n=4/group). Multielectrode data were analyzed with custom-made software in MATLAB. Statistical analysis was performed in R. Data presented as median [interquartile range].

Results
NRVM monolayers incubated with MPO were unresponsive to pacing (5/8 vs 0/7 control) or had a higher pacing threshold (1300 [1000-2500] vs 500 [400-600] μA) (p=0.02). The percent of excitable tissue was lower in the MPO than in the control group, and the propagation of spontaneous activations was slower and more heterogeneous (index: 5 [3.6-9.5] vs 2 [1.5-3], p=0.004). More fractionated electrograms were present in MPO than in the control (29 [25-40] vs 11 [4-23] electrodes per grid, p=0.02). Re-entry was observed in 3/8 MPO-incubated monolayers vs 0/7 controls. Intracellular recordings revealed a less negative resting membrane potential (-50 [-24- -52] vs -69 [-56- -79] mV, p=0.04) and lower AP upstroke velocity (4 [2.5-14] vs 26 [22-28] V/s, p=0.01) in MPO-incubated cardiomyocytes than in the control. Moreover, relative to the control, MPO significantly increased the number of fibroblasts (126 [120-128] vs 87 [70-106] cells/0.26 mm^2, p=0.02) and the expression of MMP12 (1.17 (fold-change), p=0.04), whereas a trend toward increase was observed for other ECM genes, such as COL8A2 (1.5 (fold change), p=0.1).

Conclusion
Incubation of NVRM with MPO results in depolarization of cardiomyocytes and an increase in the number of fibroblasts and ECM gene expression. Thereby, MPO increases conduction heterogeneity and susceptibility to re-entry.
Mechanisms for increased healthcare expenditures among patients with device detected atrial fibrillation
Authors: Peigh G , Zhou J , Roberts A I , Rosemas S C , Longacre C , Schwab G , Soderlund D , Passman R S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
There are limited data on the mechanisms of increased healthcare costs among patients with atrial fibrillation (AF). Differences in healthcare expenditures at various sites of service may provide mechanistic insight into the cost differentials between patients with and without AF.

Objective
To assess for associations between sites of service and healthcare costs among patients with and without device detected AF (ddAF).

Methods
Using the de-identified Optum® Clinformatics® U.S. claims database (2015 to 2020) linked with the Medtronic CareLink® database, we identified CIED patients that transmitted data ≥6 months post-implant (baseline period). Annualized per-patient costs during follow-up, subdivided by site of service, were compared between patients with and without ddAF and adjusted to 2020 US Dollars. Analyses were adjusted for geographical region, insurance type, CHA2DS2-VASc Score, and implant year. The ten most common hospitalization diagnosis-related groups (DRG) were analyzed in patients with and without ddAF.

Results
Of the 21,391 patients (72.9±10.9 yrs; 56.3% male) analyzed, 7,798 (36.5%) had ddAF. Compared to patients without ddAF, those with ddAF had higher annualized total healthcare costs (adjusted cost ratio (CR) 1.21 (1.16-1.25); p&lt;0.001). There were no differences in clinic health expenditures between patients with and without ddAF (adjusted CR 1.01 (0.98-1.04); p=0.63). Patients with ddAF had higher inpatient hospitalization (adjusted CR 1.29 (1.21-1.37); p&lt;0.001), outpatient hospitalization (adjusted CR 1.20 (1.15-1.24); p&lt;0.001), long-term care facility (adjusted CR 1.39 (1.24-1.55); p&lt;0.001), and total pharmacy (adjusted CR 1.14 (1.10-1.19); p&lt;0.001) costs than patients without ddAF (fig). Heart failure hospitalizations accounted for the highest percentage of analyzed DRGs. Patients with and without ddAF had similar percentages of DRGs for heart failure hospitalization (ddAF: 41.9%; no ddAF: 41.3%). Of the hospitalization DRGs analyzed, 9.7% were for arrhythmia-related hospitalizations in the ddAF cohort.

Conclusion
Increased hospitalization, long term care facility, and pharmacy costs are largely responsible for the healthcare cost differential between patients with and without ddAF. It is likely that arrhythmia-related hospitalizations account for a significant portion of the increased cost associated with ddAF. Further research into specific interventions that occur at various sites of service, which produce increased cost among patients with ddAF, is needed.
Outcomes associated with sodium glucose co-transporter 2 inhibitors in anticoagulated atrial fibrillation patients
Authors: Fawzy A M , Bisson A , Fauchier L , Lip G Y H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sodium glucose co-transporter 2 inhibitors (SGLT2i) have been associated with favourable outcomes in patients with heart failure. Studies also indicate a reduced risk of atrial fibrillation (AF).

Purpose
We performed an exploratory analysis to evaluate the impact of SGLT2 inhibitors in anticoagulated patients with AF.

Method
All anticoagulated patients with AF and type 2 diabetes between January 2014 and December 2018 were identified from a federated electronic medical record database (TriNetX), and followed up for 3 years. A 1:1 propensity score matched (PSM) analysis was performed to balance the SGLT-2i and non-SGLT-2i cohorts. The primary outcome was ischaemic stroke/ transient ischaemic attack (TIA), bleeding events, hospitalisation for AF and composite of cardioversion and ablations. Secondary outcomes included all-cause mortality, haemorrhagic stroke, ventricular arrhythmias, cardiac arrest, incident heart failure and composite of arterial and venous thrombotic events.

Results
A total of 236,493 and 20,841 were identified from the non-SGLT2 and SGLT2 inhibitor groups respectively. After PSM, each group had 17,968 patients. In anticoagulated AF patients, SGLT2 inhibitor use was associated with a significantly lower risk of ischaemic stroke/ TIA, hazard ratio (HR) 0.759 (95% CI 0.719-0.802), bleeding HR 0.657 (95% CI 0.619-0.697), hospitalisation for AF HR 0.875 (95% CI 0.855-0.897), and composite of cardioversion/ablations HR 0.705 (95% CI 0.655-0.759). A lower risk of all-cause mortality HR 0.481 (95% CI 0.453-0.510), haemorrhagic stroke HR 0.54 (95% CI 0.454-0.642), ventricular arrhythmias HR 0.766 (95% CI 0.719-0.816), cardiac arrests HR 0.539 (95% CI 0.476-0.611), incident heart failure HR 0.709 (95% CI 0.661-0.760) and composite of arterial and venous thrombotic events HR 0.737 (95% CI 0.712-0.763) were also observed with SGLT2 inhibitor use.

Conclusion
Our findings suggest that SGLT2i use is associated with a lower risk of AF-related complications such as ischaemic stroke/ TIA, bleeding, ventricular arrhythmias and reduced need for procedures such as cardioversion and ablations. Further studies are required to confirm this association.
Atrial fibrillation and in-hospital mortality in Covid-19 patients
Authors: Kotadia I , Dias M , Roney C , Parker R A , O'dowling R , O'hare D , Solis-Lemus J A , Sim I , Birns J , Sommerville P , Bhalla A , Newby D , Niederer S , O'neill M , Williams S E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Wellcome/EPSRC Centre for Medical Engineering

Background
Although primarily considered a respiratory virus, cardiovascular manifestations have been reported in patients with Covid-19 infection. Atrial fibrillation has been observed as the most common arrhythmia with the prevalence rate reportedly as high as 16.5%(1).

Purpose
The aim of the study was to establish the incidence of atrial fibrillation in patients hospitalised with Covid-19 and evaluate the relationship between patient characteristics and disease severity with new-onset atrial fibrillation in patients with Covid-19.

Methods
A single centre, retrospective study of 1241 patients with a confirmed PCR diagnosis of Covid-19 admitted during the 1st wave of the pandemic (1st March to 31st September 2020). Patient demographic data, medical history and clinical outcome data were manually collected.

Results
The study population comprised of 1241 patients hospitalised with Covid-19. Of these, 94 (7.6%) patients were known to have pre-existing atrial fibrillation. In an unadjusted analysis, in-hospital mortality was twice as likely in patients with pre-existing atrial fibrillation compared to patients with no history of atrial fibrillation (odds ratio (OR): 2.18; 95% CI 1.29-3.59, p=0.002). However, after multi-variable matching for age, sex and CHA2DS2VASc score there was no significant difference between groups (OR: 1.13, 95% CI 0.57-2.21, p=0.732).
During their admission, 42 (3.4%) patients developed new-onset atrial fibrillation. New-onset atrial fibrillation was associated with an increased risk of mechanical­­­ ventilation (OR: 4.59, 95% CI 2.34-9.06, p&lt;0.005), intensive care admission (OR: 7.19, 95% CI 3.52-15.61, p&lt;0.005) and in-hospital mortality (OR: 3.58; 95% CI 1.78-7.06, p&lt;0.005). Statistical significance remained after matched analysis (mechanical ventilation OR: 14.00, 95% CI 1.84-106.5, p=0.01; intensive care admission OR: 18, 95% CI 2.40-134.83, p&lt;0.005, in-hospital mortality OR: 2.80, 95% CI 1.01-7.77, p=0.048).
New-onset atrial fibrillation was associated with older age (p&lt;0.005), higher CHA2DS2VASc score (p&lt;0.005), elevated white cell count (p=0.046), neutrophil count (p=0.010), C-reactive protein ( p&lt;0.005), ferritin (p=0.020), lower albumin (p&lt;0.005) and eGFR (p=0.013) at the time of hospital admission. No association was found with gender (p=0.683) or race (p=0.080).

Conclusion
New-onset atrial fibrillation during admission with Covid-19 is associated with both co-morbidity status and markers of disease severity at the time of hospital admission. New-onset atrial fibrillation is associated with elevated in-hospital mortality compared with patients with either pre-existing or no history of atrial fibrillation.
How often atrial flutter and atrial fibrillation coexist? Results from a large nationwide ECG-based study
Authors: Aro A , Eyob-Fesseha H , Haukka J , Halminen O , Putaala J , Linna M , Mustonen P , Hartikainen J , Airaksinen J , Lehto M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Sigrid Juselius foundation
Finnish Foundation for Cardiovascular Research

Background
Atrial flutter (AFL) is often encountered in atrial fibrillation (AF) patients. There are many similarities in the etiology and treatment of these arrhythmias, including the need for anticoagulation for the majority, but there are also significant differences in their management. In many population-based studies AFL and AF are combined; thus, data are lacking on their individual prevalence in the general population.

Purpose
To investigate how common are isolated AF and AFL in the population and how often these two arrhythmias coexist in a patient.

Methods
All adult patients with an ICD-10 code I48 (including AF and AFL) in Finland 2004-2017 were identified from comprehensive national registries including primary and specialist care, reimbursement registries and hospitalization records. A subset of the cohort living in a region using an electronical ECG storage system had their ECG reports produced by the ECG analysis program retrieved for the analysis. ECGs with poor quality and paced or unspecified rhythm were excluded.

Results
Altogether, 1,248,851 ECGs from 85,690 patients (14.6 ECGs per patient) with the ICD-10 code I48 were included. Mean age was 70.7 ± 13.1 and 53.4% were men. ECGs documenting AF/AFL were available for 67,529 patients (78.8% of the entire ECG-cohort). 51,105 of them had ECG documentation of AF only (AF-only; 53.7% male), and 13,195 (20.5%) of patients with AF had also AFL documented in the ECG (AF+AFL; 47.6% male). 3,229 (4.8% of those with AF/AFL) presented with isolated AFL (AFL-only, 63.1% male). Of the total of 16,424 patients with documented AFL, 80.3% also had AF. The rest of the subjects did not have a 12-lead ECG in the retrieved electronic records documenting atrial arrhythmia.

Conclusions
One-fifth of the AF patients had also atrial flutter documented with a 12-lead ECG. Moreover, 80% of the atrial flutter patients experiences atrial fibrillation as well. These findings may have implications for the treatment and follow-up of these patients.