bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association between adherence to a systematic atrial fibrillation screening program and clinical outcomes: a subanalysis from the STROKESTOP study
Authors: Van Der Velden R , Engdahl J , Crijns H , Friberg L , Kemp-Gudmundsdottir K , Linz D , Svennberg E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Stockholm County Council, the Swedish Heart & Lung Foundation

Introduction
Screening for atrial fibrillation (AF) in older adults and high-risk patients may be beneficial in preventing clinical outcomes such as stroke. Studies on clinical outcomes in screening-detected AF have highlighted difficulties in getting the population at highest risk to participate in screening programs. Whether the risk of clinical outcomes differs among individuals depending on the level of adherence to the screening program instructions, is currently unknown.

Purpose
To explore associations between different levels of adherence consistency of and adherence to systematic screening, consisting of measurements using a handheld ECG device, and clinical outcomes.

Methods
Half of all 75- and 76-year old inhabitants of two Swedish regions were invited to participate in an AF screening program (STROKESTOP I study). Participants in whom AF was not diagnosed previously or during the baseline visit, were asked to perform 30-seconds recordings using a handheld ECG device twice daily for a period of two weeks. The total screening period consisted of 13 days. Adherence was defined as the total number of recordings performed divided by the total number of recordings asked, whereas adherence consistency was defined as the number of screening days on which the asked number of recordings was performed. Based on the thresholds when 90% of AF cases were detected, the participants were divided into low (&lt;73%), moderate (73-99%) and optimal (≥100%) adherence and low (10 days), moderate (11-12 days) and optimal (13 days) adherence consistency groups.

Results
In total, 6436 participants (3585 females (55.7%)) were included in the analysis. Participants with low adherence consistency were at higher risk of ischemic stroke (hazard ratio (HR) 1.7 (95% confidence interval (CI) 1.2-2.3), p=0.001), systemic embolism (HR 1.7 (1.3-2.4), p=&lt;0.001), dementia (HR 1.7 (1.3-2.2), p&lt;0.001), and a composite endpoint of stroke, systemic embolism, bleeding leading to hospitalisation, and all-cause death (HR 1.3 (1.1-1.5), p=0.001), as well as the composite endpoint with the addition of cardiovascular hospitalisation (HR 1.2 (1.1-1.4), p=0.001) compared to patients in the optimal group (Figure 1). In addition, participants with low adherence were at higher risk of the composite endpoint with cardiovascular hospitalisation (HR 1.3 (1.0-1.7), p=0.018), as well as of the individual endpoints dementia (HR 2.5 (1.7-3.6), p&lt;0.001) and cardiovascular death (HR 2.1 (1.3-3.6), p=0.004).

Conclusion
Low adherence and adherence consistency in systematic screening for AF were associated with a higher risk of adverse cardiovascular and cerebral outcomes.
Telemedicine: the future of personalised atrial fibrillation care in a post pandemic world?
Authors: Kotb A , Armstrong S , Koev I , Antoun I , Vali Z , Barker J , Panchal G , Mavilakandy A , Chin S H , Lazdam M , Ibrahim M , Sandilands A , Somani R , Ng G A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): The pilot phase of the Virtual Ward was funded by Leicester, Leicestershire and Rutland Clinical Commissioning Group and supported by a Digital Healthcare Partnership Award from NHS Innovation (now Transformation Directorate).

Background
The current model of care for patients with atrial fibrillation (AF) is born out of legacy physician-centred care models. The development and acceptance of digital technology have enabled the advent of novel telemedicine-based models for patients with fast AF.

Purpose
A virtual AF ward was implemented as a proof-of-concept care model for patients with AF and rapid ventricular response.

Methods
Patients presenting acutely with AF or Atrial flutter (AFL) to the hospital were onboarded to the virtual ward and managed remotely at home, after being given access to a single-lead ECG device (Kardia), a blood pressure monitor and pulse oximeter with instructions to record daily ECGs, blood pressure, oxygen saturations and complete an online AF symptom questionnaire. Data were uploaded to a digital platform (Dignio) for daily review by the clinical team. Primary outcomes included admission avoidance, re-admission avoidance, and patient satisfaction. Patient satisfaction was assessed using the NHS Friends and Family test (FFT) in addition to narrative feedback.

Results
There were 50 admissions to the virtual ward between January and August 2022. Twenty-four initial hospital admissions were avoided with patients instead directly enrolled from the outpatient setting and a further 25 re-admissions were appropriately prevented during virtual surveillance, avoiding a total of 49 admissions to hospital beds. Most admissions were in AF 78% (n=39) or AFL 18% (n=9), with two admissions frequently alternating between sinus rhythm and AF 4% (n=2). Mean HR at the time of admission and discharge was 122 ± 26 and 82 ± 27 bpm, respectively. FFT response rate was 90% (n=45), with 100% positive responses. Only one patient declined using the service due to technology related anxiety. None of the patients demanded to unilaterally terminate the monitoring, or stopped using the online platform before being discharged from the virtual ward.

Conclusion
This is a first real-world experience of an AF virtual ward that demonstrates a potential for reducing the healthcare burden imposed by AF admissions, while providing the holistic and personalised care that AF needs. Work is ongoing to further confirm safety and cost-effectiveness upon progress in a larger patient cohort.
Adherence to a mobile health-based atrial fibrillation screening program: a subanalysis from STROKESTOP I and II
Authors: Van Der Velden R , Engdahl J , Crijns H , Friberg L , Kemp-Gudmundsdottir K , Linz D , Svennberg E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Stockholm County Council, the Swedish Heart & Lung Foundation

Introduction
Atrial fibrillation (AF) is associated with an increased risk of stroke, which may be reduced through timely and adequate treatment initiation. Consequently, early detection of AF is important. In a recent European Heart Rhythm Association practical guide on the use of digital devices, systematic screening for AF of those ≥75 years is recommended.

Purpose
To 1) evaluate adherence and adherence consistency to a handheld electrocardiography (ECG)-based device for AF screening and 2) evaluate factors associated with optimal adherence and adherence consistency.

Methods
In STROKESTOP I and II, half of the 75- and 76-year old population in up to two regions in Sweden were invited to an AF screening program. Participants without previously known AF and without AF during baseline visit, were asked to perform 30-seconds recordings using a handheld ECG-based device for a period of two weeks twice daily in STROKESTOP I and four times a day in STROKESTOP II. Adherence was defined as the number of recordings performed per number of recordings that were asked from the participant over the entire screening period. Adherence consistency was defined as full screening days, i.e. the number of screening days on which the asked number of recordings was performed. Since baseline date was excluded from analysis, the total screening period consisted of 13 days.

Results
In total, 6436 participants from STROKESTOP I (3585 females (55.7%)) and 3712 participants from STROKESTOP II (2218 females (59.8%)) were included in the current analysis. Median adherence was 100% [92-100%] and 90% [75-98%] in STROKESTOP I and II, respectively. The median number of full screening days was 12 [11-13] in STROKESTOP I and 8 [3-11] in STROKESTOP II. In STROKESTOP I, female sex, region of inclusion, income in 1st to 3rd quartile and no university or college education were factors independently associated with both optimal adherence and adherence consistency (Figure 1). In addition, no previous stroke or transient ischemic attack and the use of beta blockers were associated with optimal adherence, whereas no diabetes and low alcohol index were associated with optimal adherence consistency. In STROKESTOP II, socioeconomic factors were not available at the time of the current analysis. Other associations (female sex, absence of diabetes) were comparable to STROKESTOP I.

Conclusions
In this screening program for AF, median adherence was optimal in case of twice daily measurements, and nearly optimal in case of measurements four times a day. Several demographic and socioeconomic factors, as well as low alcohol index and the absence of diabetes and previous stroke were associated with optimal adherence and/or adherence consistency.
The economic impact of remote control in patients with implantable cardioverter defibrillators or cardiac resynchronization therapy defibrillators: single center experience
Authors: Marini M , Videsott L , Dalle Fratte C F , Francesconi A , Bonvicin E , Quintarelli S , Martin M , Guarracini F , Coser A , Benetollo P , Bonmassari R , Boriani G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Remote monitoring (RM) technologies have the potential to improve patient care by increasing compliance, providing early indications of heart failure (HF) decompensation, and potentially allowing for optimization of therapy to prevent HF admissions. The aim of this observational, retrospective study was to assess the clinical and economic consequences of RM vs standard monitoring (SM) through in-office cardiology visits, in patients carrying an implantable cardioverter defibrillator (ICD) or a cardiac resynchronization therapy defibrillator (CRTD).

Methods
Clinical and resource consumption data of this retrospective analysis were extracted from the Electrophysiology Registry of our Cardiology Unit, which has been systemically collecting patient information from January 2011 to February 2022. From a clinical standpoint, survival analysis was conducted, and incidence of CV-related hospitalizations was measured. From an economic standpoint, direct costs of RM and SM patients were collected to compare the cost per treated patient over a 2-year time horizon. Propensity score matching (PSM) was used to reduce the effect of confounding biases and the unbalance of patient characteristics at baseline.

Results
In the enrollment period, N=402 patients carrying ICD/CRTD met the inclusion criteria and were included in the analysis (N=189 patients -47.0%- followed through SM; N=213 patients -53.0%- followed through RM). After PSM, comparison was limited to N=191 patients in each arm (Figure 1). After a follow-up of 2 years since ICD/CRTD implantation, mortality rate for any cause was 1.6% in the RM group and 19.9% in the SM group (log-rank test, p&lt;0.0001). Also, a lower proportion of patients in the RM group (25.1%) were hospitalized for CV-related reasons, compared to the SM group (51.3%; p&lt;0.0001, two-sample test for proportions). Overall, the implementation of the RM program in our territory was cost-saving in both payer and hospital perspectives. The investment required to fund RM (a fee for service in the payer perspective, and staffing costs for hospitals), was more than offset by the lower rate of hospitalizations for CV-related disease. RM adoption generated savings of -€4,771 and -€6,752 per patient in 2 years, in the payer and hospital perspective, respectively (Figure 2).

Conclusion
RM of patients carrying ICD/CRTD improves short-term (2-year) morbidity and mortality risks, compared to SM (based on the traditional in-office visit approach) and finally reduces direct management costs for both hospitals and healthcare services
The relationship between high dominant frequency and low voltage areas in patients with atrial fibrillation: digital twin study
Authors: Lim B , Kwon O S , Jin Z , Yang S , Kim D , Park J W , Yu H T , Kim T H , Uhm J S , Joung B , Lee M H , Hwang C , Pak H N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): a grant [2022R1I1A1A0106342211] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF) which is funded by the Ministry of Science, ICT & Future Planning (MSIP)

Background
It has been suggested that the high dominant frequency (DF) site plays an atrial fibrillation (AF) driver, but its relationship with the atrial substrate voltage map (Vm) in the entire chamber AF map has yet to be studied. We explored the relationship between the DF site during AF and Vm in the entire chamber maps by applying the human left atrial (LA) electroanatomical map (EAM) to the digital twin AF map.

Methods
We acquired LA substrate Vm (at sinus rhythm, &gt;800 points bipolar electrograms) of 110 patients with persistent AF (male 72.7%, 58.7±9.8 years old) who underwent AF catheter ablation. We applied EAM to digital twins (0.4 million nodes), reflecting anatomy, histology, and electrophysiology. We evaluated the highest 10% DF areas for 6 sec after inducing virtual AF. The correlation between the highest 10% DF and the low Vm areas (&lt;0.2mV) was evaluated in the LA region of 10 segments.

Results
The mean voltage of the entire LA area was 1.96±0.85 mV (2.19±0.82 mV extra-PV area, 1.33±0.93 mV PV area) in 110 patients. The correlation between low Vm and high DF areas was not significant in the entire LA (r=0.106, p&lt;0.001), extra-PV (r=0.157, p&lt;0.001), and PV (r=0.079, p=0.097) areas. In the LA 10 segment regional analysis, 72 patients (65.5%) showed the co-localization of the highest DF in the region with the lowest Vm, and 14 patients (12.7%) had the lowest Vm segment in the region with the highest DF. The mean voltage where high DF appeared was 0.69±1.35 mV, and the mean voltage of the region where high DF did not appear was 0.59±1.15 mV (p=0.171).

Conclusion
High DF site, a parameter representing a localized focal source, had statistically significant but very poor correlations with LA extra-PV voltage substrate in patients with persistent AF.
Clinical factors that influence the onset of atrial fibrillation or worsen its course after infection with Covid - 19
Authors: Stasyshena O V , Sychov O S , Romanova O M , Talaeva T V , Sribna O V , Deyak S I , Mikhalieva T V , Ilchyshyna O I A , Getman T V 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): In. of cardiology

Introduction
It is known that atrial fibrillation (AF) is not only one of the most common arrhythmias, but also a frequent rhythm disturbance in patients who have undergone SARS-CoV-2 infection. This arrhythmia often develops in the post-covid period.

Purpose
to determine clinical factors associated with the onset or worsening of the course of atrial fibrillation in patients with coronavirus disease (COVID-19).

Materials and methods
The study included 187 patients aged 62.5±0.9 years (47% men, 53% women). The vast majority of patients (89%) had arterial hypertension (II stage – 80%, III stage – 9%). Chronic forms of coronary heart disease were diagnosed in 53% of patients. The first three groups formed 116 patients who had AF and underwent coronavirus infection (CI). The first group (G1) consisted of 36 patients who did not have AF before CI. The second group (G2) was represented by 25 patients in whom the transition of the paroxysmal form of AF into persistent, or persistent AF into its permanent form occurred. The third group (G3) consisted of 55 patients in whom the form of AF did not change, but in 35 of them the frequency or duration of AF paroxysms increased (subgroup 3a), and in 20 people the frequency or duration of AF paroxysms did not change (subgroup 3b). Two control groups were also formed: K1 - 49 patients with AF who did not have a history of HF, and K2 - 22 patients with extrasystole who experienced HF, but who did not develop AF.
The results. G1 patients were older than those in K2 (63.6±0.64 years vs. 50.7±1.1 years, respectively; p&lt;0.001). At the same time, G2 patients at the time of inclusion in the study were older than those in G3 (66.5±1.04 years vs. 62.9±1.12 years, respectively; p&lt;0.05). Women more often occurred in G1 than in K1 (51.7% vs. 30.6%, respectively; p&lt;0.001), as well as in the combined group of G2-G3 compared to K1 (53.7% vs. 30.6% ,respectively; p&lt;0.001). Concomitant hypertension was associated with an increase in the frequency and duration of AF paroxysms after COVID-19. Thus, group 2, compared to group 3, was characterized by more frequent detection of both stage II hypertension (72% vs. 65.5%; p&lt;0.05) and its stage III (12% vs. 3.6%, p&lt;0 ,05). Similarly, patients with chronic forms of CAD were more frequent in group 2, in contrast to group 3 (72.0% vs. 50%, p&lt;0.001). In addition, the frequency of detection of patients with chronic forms of coronary heart disease was higher in subgroup 3a, compared to subgroup 3b (54.3% vs. 45.0%; p&lt;0.005).

Conclusion
Older age, female sex, hypertension, and coronary heart disease were clinical factors associated with the occurrence of AF or worsening of previously diagnosed AF in patients with COVID-19.
PITX2c impairment electrical remodeling increases susceptibility to atrial fibrillation
Authors: Mun D S , Kang J Y , Chun Y M , Park D S , Kim H E , Yun N R , Joung B Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the National Research Foundation of Korea (NRF) grants funded by the Korea government (MSIT), the Korean Fund for Regenerative Medicine (KFRM) grant funded by the Korea government

Background
Functional mutations in the PITX2 (Paired-like homeodomain transcription factor 2) gene cause genetically inherited atrial fibrillation (AF). PITX2 is known to plays a pivotal role in regulating the expression of distinct ion channels, beta-adrenergic stimulation, cell-cell coupling and resulting in AF due to abnormal calcium abnormalities and electrical remodeling. However, the pathophysiological mechanisms linking impaired PITX2 with AF are still to be explored. This study was performed to generate PITX2c knockout human iPSC atrial cardiomyocytes (hiPSC-atrial CM), which are useful tools for arrhythmia modeling, and evaluate the mechanism of PITX2 deficiency leading to AF.

Methods
We generated a PITX2 knock-out iPSC line using a CRISPR/Cas9-based genome editing system. hiPSCs were electroporated with Cas9/sgRNA ribonucleoprotein (RNP) complexes. PITX2c knock-out hiPSC-CMs differentiated into atrial cardiomyocytes based on the manipulation of retinoic acid signaling. For the three-dimensional (3D) culture model, cells were plated in the spherical plate 5D. Electrophysiological properties and oxidative stress were assessed in PITX2c-deficient cardiomyocytes. Proarrhythmic effects of the PITX2c knock-out were quantified with AP morphology, AP duration (APD) restitution, wavelength (WL) and conduction velocity (CV) restitution using microelectrode arrays (MEA).

Results
We demonstrated that atrial-specific differentiated hiPSC-CMs expressed atrial-specific genes and the properties of action potentials were like those of human atrial cardiomyocytes. In addition, both 2D and 3D PITX2c knock-out atrial hiPSC-CMs showed signs of APD shortening and reduced wavelength (WL) and increased conduction velocity (CV) restitution (P&lt;0.05). Next, a functional assessment of calcium homeostasis has shown that PITX2c causes atrial arrhythmias by impairing calcium handling genes (SERCA2a, RyR2, PLN). We then demonstrated that miR-374a-5p and miR-374b-5p could be involved in pathophysiological functions as therapeutic candidates when affinity for PITX2 was based on the upper context score percentile (&gt; 99).

Conclusions
This study provides an understanding of electrical remodeling by PITX2c loss-of-function mutations and suggests the potential therapeutic candidates by miR-374a-5p and miR-374b-5p, thus helping to understand the mechanism of PITX2 deficiency leading to atrial fibrillation.
Soluble ST2 in predicting an adverse outcome of revascularization and the development of heart failure in patients with acute myocardial infarction with ST segment elevation
Authors: Kutya I , Rodionova I , Korytsya M , Hilova Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objective
to study the relationship between the sST2 level and the degree of epicardial blood flow recovery and with the heart failure (HF) development or exacerbation in 6 month follow-up in patients with STEMI after PCI.

Materials and methods
The study involved 61 patients with STEMI — 51 (83.6%) males and 10 (16.4%) females, with average age of 59.85 ± 10.01 years. Standard clinical and biochemical parameters were determined, as well as sST2 level was measured by enzyme immunoassay using a reagent kit «Presage ST2 analysis, Critical Diagnosis» (USA) in all patients, on the first day of the disease. Patients were divided into two groups depending on the degree of blood flow recovery in a culprit artery (TIMI) The first group (n = 12) included patients with TIMI 0, I, II, the second group (n = 49) with TIMI III.

Results
The sST2 level was significantly higher in the first hours of the disease in the group with unrepaired or decreased epicardial blood flow (TIMI 0-II) after PCI (p = 0.003). ROC analysis showed that sST2 levels above 34.2 ng / ml, detected in the first hours of the disease, is an independent predictor of adverse revascularization (TIMI 0-II) in patients with STEMI with a sensitivity of 92.3% and a specificity of 62.5%; the area under curve (the AUC) is 0.8 (95% CI = 0.651 - 0.873; p = 0.001). When conducting a univariate (χ2 = 17.741; p = 0.04) and multivariate (χ2= 9.293; p = 0.004) logistic analyzes, sST2 was a significant predictor of the unfavorable outcome of epicardial vascular revascularization (TIMI 0-ІІ).

Conclusions
sST2 is highly associated with the degree of epicardial blood flow recovery in patients with STEMI and is of great clinical importance as prognostic marker.