bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right heart catherisation – a virtual reality
Authors: Brown M , Krishnananthan N , Paul V 
Published: October 2022

Abstract

Introduction
Right heart catheterisation (RHC) is the gold standard for assessing patients with pulmonary hypertension. Doctors require training in this procedure in a safe and friendly environment with minimal risk to patients. Due to the Covid pandemic, formal RHC teaching workshops were cancelled in our country, so we sought to develop a Virtual Reality Right Heart Catheterisation (VRRHC) training program to fulfil this area of need without the need for face to face contact. The aim was to improve training, competency and confidence in this technique with improved diagnostic skills and reduction of procedural errors.

Method
We approached a health technology company to design a VRRHC training module based on our current RHC simulation workshops. Phase 1 required virtual insertion of RHC via the right internal jugular vein using micro-puncture, double Seldinger technique under ultrasound guidance, followed by insertion of the RHC to the right atrium, right ventricle and pulmonary artery with pulmonary artery occlusion using real time pressure tracings and fluoroscopy. Thermodilution cardiac outputs and chamber saturations were also performed.
The proprietary platform technology was delivered via a laptop and VR headset. Clinicians perform the VRRHC with imaging, monitoring and haptic feedback with the collection of real time performance tracking allowing user data (e.g. failed steps and proficiency scores) to be captured and subsequently visualised in the learning management system.
We collected analytics and data on user engagement, experience and retention, targeted learning outcomes and learning curve, reduction in operating costs, reduction in procedure times due to higher proficiency, early diagnosis of pulmonary hypertension, reduced complications, improved interpretation and diagnosis.

Results
The program was launched in October 2021. Preliminary data shows a learning curve is associated with both using VR (10–15 minutes) and the RHC procedure itself. Initial time to completion of the RHC was 30–40 mins, reducing to 20–30 minutes with experience and 15 minutes in experts. Completion rates increase with experience from 40–50% to 100% and error rates reduce with frequency of completion.

Conclusion
A Virtual Reality Right Heart Catheter training program is safe, feasible and non-invasive. Increased experience results in increased completion rates, reduced procedure time and reduced errors. Using this program will potentially have beneficial effects on doctor training, outcomes, patient safety and health economics with no risk to a real patient.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Janssen Pharmaceuticals
Implementation of a clinical trial recruitment support system based on fast healthcare interoperability resources (FHIR) in a cardiology department
Authors: Scherer C , Endres S , Orban M , Kaeaeb S , Massberg S , Winter A , Loebe M 
Published: October 2022

Abstract

Background
Clinical Trial Recruitment Support Systems can booster patient inclusion of clinical trials by automatically analyzing eligibility criteria based on electronic health records. However, missing interoperability has hindered introduction of those systems on a broader scale.

Purpose
Our aim was to develop a recruitment support system based on FHIR R4 and evaluate its usage and features in a cardiology department.

Methods/Implementation
Clinical conditions, anamnesis, examinations, allergies, medication, laboratory data and echocardiography results were imported as FHIR resources. Trial study nurses and physicians were enabled to add new and edit trial information and input inclusion and exclusion criteria using a web-browser user interface in the hospital intranet. All information were recorded on the server side as the FHIR resources “ResearchStudy” and “Group”. Eligibility criteria linked by the logical operation “OR” were represented by using multiple FHIR Group resources for enrollment. On the client side, eligibility criteria were transformed to a tree-like structure (see Figure 1). Upon user demand, all hospitalized and ambulatory patients in the cardiology department were instantly screened for trial eligibility using the FHIR eligibility criteria on the existing patients' FHIR resources. Furthermore, study personal was able to manually edit trial status (i.e. ineligible, on-study, ...) of patients, which was implemented using the FHIR resource “ResearchSubject”.

Results
This implementation of a CTRSS based on FHIR R4 was evaluated in clinical practice: Beginning from 1st April 2021 the application was used as an additional patient screening tool for the four trials CLOSURE-AF, FAIR-HF2, SPRIRIT-HF and TORCH-PLUS of the German Centre for Cardiovascular Research. As the COVID-19 pandemic is prohibiting any proper comparison of patient inclusion rates, efficacy of the recruitment support system was tested by comparing the numbers of patients identified by the recruitment support system and enrolled in a trial to the actual number of enrolled patients irrespective of the screening method from 1st April 2021 to 23rd November 2021. The system was able to identify 52 of 55 patients included in those four clinical trials.

Conclusion
Use of FHIR for defining eligibility criteria of clinical trials may facilitate interoperability and allow automatic screening for eligible patients at multiple sites of different healthcare providers in the future. Upcoming changes in FHIR should allow easier description of “OR”-linked eligibility criteria.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft
Wearable device for continuously blood pressure monitoring enable atrial fibrillation risk
Authors: Guo Y , Zhang H 
Published: October 2022

Abstract

Background
The epidemiological data have linked atrial fibrillation (AF) risk with hypertension.
The surging wearable devices allow noninvasive beat-by-beat blood pressure monitoring.

Objective
The present study aimed to investigate dynamic changes on blood pressure with wearable blood pressure monitors and its-related risk for AF occurrence.

Methods
In the mobile Atrial Fibrillation Application (mAFA II) programme, the subjects used the photoplethysmography (PPG)-based smart devices to detect the AF episodes. They simultaneously freely decided whether to take the wearables to monitor their blood pressure.

Results
There were 25388 subjects (mean age ± standard deviation, SD, 48±12 years old, 90.4% male) who received simultaneously blood pressure and cardiac rhythm monitoring with the wearables between Jan 1, 2022 and March 19, 2022. The monitored time (median, interquartile) were 6 (12–18) days and the number of measurements of blood pressure were 16 (3–56).
The 8830 subjects (34.8%, 8830/25388) monitored with average 24-hour BP &gt;130/80 mm Hg and 945 subjects (10%, 945/8830) with pulse differential over 60 mmHg.
The extreme-dippers blood pressure and reverse-dippers blood pressure were in 8563 subjects (33.7%, 8563/25388) and 7018 subjects (27.6%, 7018/25388), respectively.
There were 498 subjects (58±12 years, 89% male) who identified with AF. After adjusting age, gender, diabetes, obstructive sleep apnea, heart failure, coronary artery disease, and hyperthyroidism, the average 24-hour BP &gt;130/80 mm Hg (Odd ratio, OR, 95% confidential interval, CI, 1.38, 1.12–1.69, p=0.002), the reverse-dippers blood pressure (OR, 95% CI, 1.29, 1.07–1.56, p=0.008) and pulse differential over 60 mmHg (OR, 95% CI, 1.76,1.17–2.64, p=0.006) independently predicted the risk of AF.

Conclusion
Wearable devices with beat-by-beat monitoring demonstrated that not only high average 24-hour BP, but also reverse-dippers blood pressure and pulse differential over 60 mmHg increased AF susceptibility, which informing the clinical application of personalized “upstream risk control” of AF.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China
Use of a device-based remote management heart failure care pathway is associated with reduced hospitalization and improved patient outcomes: TriageHF Plus real-world evaluation
Authors: Ahmed F Z , Sammut-Powell C , Martin G P , Callan P , Cunnington C , Kale M , Gerritse B , Lanctin D , Soken N , Campbell N G , Taylor J K 
Published: October 2022

Abstract

Background
Heart failure (HF) is a leading cause of hospital admission. However, prompt identification of worsening HF using implantable device data and proactive intervention may reduce hospitalizations.
The validated TriageHF algorithm in enabled ICD/CRT devices uses sensor data to risk stratify patients for HF hospitalization in the next 30 days. TriageHF Plus is a novel device-based HF care pathway (DHFP) that uses “high” risk status as the trigger for remote intervention (see Figure 1 for pathway overview). Outcomes after DHFP implementation in a clinical setting have not been examined.

Purpose
To evaluate the impact of TriageHF Plus clinical pathway on hospitalisation rates.

Methods
A prospective, multi-center evaluation comparing monthly hospitalization rates for patients enrolled in a DHFP with a concurrent standard of care (SoC) cohort and characterizing staffing resources necessary to implement the DHFP. The DHFP cohort received telephonic assessment and guideline-directed clinical care upon transition to high-risk status. Propensity scores (PS) were applied to DHFP and SoC cohorts to allow unbiased comparison. A negative binomial model was fitted to the monthly number of all-cause hospitalizations with treatment group (DHFP vs. SoC) as a covariate, using PS as weights.

Results
Between 09/11/2019 and 06/24/2021, 758 patients were included in the study (443 DHFP, 315 SoC). Proportion CRT 76%/ 89% and LVEF &lt;50% 78%/ 66% for DHFP/ SoC, respectively.
196 high risk transmissions prompted telephone assessment, with successful contact in 182; of which, 79 (43%) identified an explanatory acute medical issue. A secondary intervention was undertaken in 44/79 (56%). High risk transmissions took on average 19 minutes per clinical assessment (initial telephone triage and 30 day follow up). The rate of hospitalizations was 58% lower in the DHFP group, compared with SoC, after PS adjustment (IRR 0.42, 95% CI: 0.23, 0.76, p=0.004), see Figure 2. Sensitivity analyses showed Covid-19 had little effect on results.

Conclusions
This is the first prospective, real-world evaluation of a device-based HF care pathway to report a reduction in hospitalizations and does so with minimal staffing time. Integrated into existing HF services, device-based remote monitoring of HF patients can improve outcomes.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic
Endothelial dysfunction in the post-COVID-19 period: a meta-analysis
Authors: Theofilis P , Oikonomou E , Lampsas S , Siasos G , Tsioufis K , Tousoulis D 
Published: October 2022

Abstract

Background
Coronavirus disease (COVID)-19 is an entity characterized by a cytokine storm and profound endotheliitis. Although several reports have pointed to the presence of endothelial dysfunction in the acute phase, data is accumulating regarding a possible prolonged adverse effect of COVID-19 on endothelial function.

Purpose
This systematic review and meta-analysis aims to evaluate the degree of endothelial impairment, assessed by flow-mediated dilation (FMD) of the brachial artery, in individuals recovering from COVID-19.

Methods
We conducted a systematic literature search for studies assessing FMD between in patients post-COVID-19 and controls. Exclusion criteria consisted of the absence of a control group, measurement of FMD only during the acute phase of the disease, and not reporting FMD in % change. Effect sizes were pooled via random-effect model and the results are expressed as uncorrected standardized mean difference (SMD), using the Cohen's d as the effect size metric, with 95% confidence intervals (CI). Between-study heterogeneity was assessed through the calculation of I2. Subgroup analysis according to follow-up duration and the presence of cardiovascular risk factor-matched controls was also carried out.

Results
Database search identified 51 studies. Following the application of the exclusion criteria, 7 studies were included in the meta-analysis (post-COVID-19: 342 subjects, Control: 273 subjects). Compared to controls, patients post-COVID-19 had significantly lower FMD% values (SMD: −1.06, 95% CI: −1.74 to −0.38, p&lt;0.01, I2: 86%) (Figure 1). Results remained unaffected after exclusion of any single study using the leave-one-out method. Subgroup analysis revealed no significant differences in FMD between post-COVID-19 patients and controls according to follow-up duration or the presence of cardiovascular risk factor-matched control group.

Conclusion
Flow-mediated dilation of the brachial artery, indicative of endothelial dysfunction, was significantly reduced in post-COVID-19 subjects compared to non-infected controls. This finding may be an alarming sign towards a higher risk of incident cardiovascular events.

Funding Acknowledgement
Type of funding sources: None.
Incidence in atrial fibrillation in Denmark in relation to country of origin: a nationwide register-based study
Authors: Frydenlund J , Valentin J , Norredam M , Riahi S , Kragholm K , Boggild H , Johnsen S 
Published: October 2022

Abstract

Background
Immigrants' healthcare needs can be a considerable challenge, as their risk profile can differ from the native population, and they may experience barriers to accessing health services in recipient countries. Immigration is projected to increase further due to conflicts and climate changes, and awareness on immigrants' health status is therefore warranted. Atrial fibrillation (AF) is the most common sustained arrhythmia with an estimated prevalence of approximately 2%. However, there is a paucity of data on AF epidemiology among immigrants.

Purpose
The aim of this study is to examine incidence of AF hospital diagnoses according to country of origin and to study if there is a difference in risk between immigrants and Danish born individuals.

Methods
The study period included 1st of January 1998 to 31st of December 2017 and the population consisted of all Danish citizens aged 45 or older. We included individuals as they turned 45 during the study period. Individuals who had been diagnosed with AF were excluded. Data was obtained from the Danish National Patient Registry and the Civil Registration System. Country of origin was based on the ten most represented counties in the population. Immigrants were defined as people born outside Denmark with none of the parents being both Danish citizens and born in Denmark. AF was defined as a hospital diagnosis according to international Classification of Diseases (ICD) version 8 and 10. Poisson regression were used to compute relative risk (RR) and associated 95% confidence intervals (CI). RRs were adjusted for sex, age, socioeconomic status, visits to general practitioner and comorbidity.

Results
The study population consist of 3,596,234 Danish-Born and 215,401 immigrants. A total of 334,636 had an incident AF diagnosis during the study period. Compared to Danish-born individuals, migrants from the Nordic countries had a higher adjusted RR of being diagnosed with AF: Norway 1.21 [95% CI: 1.05; 1.40], Sweden 1.16 [95% CI: 0.99; 1.35] and Germany 1.17 [95% CI: 1.06; 1.28]. In contrast, lower adjusted RRs were observed for individuals from Poland (0.82 [95% CI: 0.67; 1.01]), UK (0.89 [95% CI: 0.73; 1.08]), and the US (0.95 [95% CI: 0.72; 1.25]), respectively, and in particular for individuals from the non-Western countries: Turkey (0.49 [95% CI: 0.40; 0.59], Iran (0.48 [95% CI: 0.36; 0.65]), Iraq (0.32 [95% CI: 0.22; 0.45] and Bosnia-Herzegovina (0.63 [95% CI: 0.49; 0.79]).

Conclusion
Substantial variation in the incidence rate of incident AF hospital diagnoses according to country of origin. Further studies are warranted in order to clarify to what extent these differences reflets true differences in AF incidence or ethnic inequalities in the detection of AF in the health care system.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Karen Elise Jensen Foundation
Cost-effectiveness of clopidogrel versus ticagrelor in patients of 70 years or older with non-ST-elevation acute coronary syndrome
Authors: Van Den Broek W W A , Van Paassen J G , Gimbel M E , Deneer V H M , Ten Berg J M , Vreman R A 
Published: October 2022

Abstract

Background/Introduction
In older patients with non-ST-elevation acute coronary syndrome (NSTEMI) the POPular AGE trial clopidogrel showed superiority to ticagrelor in reducing bleeding risk and non-inferiority in net clinical benefit (all-cause death, myocardial infarction, stroke, and PLATelet inhibition and patient Outcomes; major or minor bleeding).

Purpose
The aim of this analysis was to estimate the long-term cost-effectiveness of clopidogrel compared to ticagrelor in these older patients with NSTEMI and to address the impact on quality of life by both treatment strategies.

Methods
A 1-year decision tree based on the POPular AGE trial in combination with a lifelong Markov model was developed to compare clopidogrel with ticagrelor in terms of clinical outcomes, costs and quality-adjusted life years (QALYs) in elderly patients (above 70 year) with NSTEMI. Cost-effectiveness was assessed from a Dutch healthcare system perspective. Events rates and utility data observed in the POPular AGE trial were combined with lifetime projections to evaluate cost and effects for a fictional cohort of 1000 patients. Deterministic, probabilistic sensitivity analyses and several scenario analyses were performed. The several scenario's included different time horizons, identical prices for P2Y12-inhibitors, different health utilities in the clopidogrel and ticagrelor arm and a prolonged duration of bleeding disutility.

Results
Treatment with clopidogrel instead of ticagrelor led to a cost saving of €1,482,775 (€1,483 per patient) and a decrease of 10,96 quality-adjusted life years (QALY's) (0.011 QALY per patient) in the fictional cohort. In an alternative base case with equal distribution over health states in the first year based on the non-inferiority of the POPular AGE trial, treatment with clopidogrel was the dominant strategy both cost saving and increasing QALY's. In all scenario analyses, treatment with clopidogrel was cost saving. In the scenario with different health utilities in the clopidogrel and ticagrelor arm, the distinct average reported health utilities in both treatment arms were used. In this scenario clopidogrel was the dominant strategy.

Conclusion
This analysis shows that clopidogrel is a cost-saving alternative to ticagrelor in elderly patients after NSTEMI, with a very small negative effect on QALY's. It supports the conclusion of the POPular AGE trial to regard clopidogrel as a favourable alternative to ticagrelor in the elderly patient after a NSTEMI.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMw
Impact of COVID-19 on cardiac procedure activity in England and associated 30-day mortality
Authors: Mohamed M , Banerjee A , Clarke S , De Belder M , Goodwin A , Gale C , Curzen N , Mamas M 
Published: October 2022

Abstract

Background
The COVID-19 pandemic had a significant impact on the quality of healthcare provision across all specialities and disciplines. However, there are limited data on the scale of its disruption to cardiac procedure activity from a national perspective and whether procedural outcomes different before and during the COVID-19 pandemic.

Methods
Major cardiac procedures (n=374,899) performed between 1st January and 31st May for the years 2018, 2019 and 2020 were analysed, stratified by procedure type and time-period (pre-COVID: January-May 2018 and 2019 and January-February 2020 and COVID: March-May 2020). Multivariable logistic regression modelling was undertaken to examine the odds ratio (OR) of 30-day mortality for procedures performed in the COVID period (vs. pre-COVID).

Results
There was a deficit of 45,501 procedures during the COVID period compared to the monthly averages (March-May) in 2018–2019. Cardiac catheterisation and cardiac electronic device implantations were the most affected in terms of numbers (n=19,637 and n=10,453) while surgical procedures including mitral valve replacement, other valve replacement/repair, atrial and ventricular septal defect repair, and CABG were the most affected as a relative percentage difference (D) to previous years' averages. TAVR was the least affected (D-10.6%). No difference in 30-day mortality was observed between pre-COVID and COVID time-periods for all cardiac procedures except cardiac catheterisation (OR 1.25 95% confidence interval (CI) 1.07–1.47, p=0.006) and cardiac device implantation (OR 1.35 95% CI 1.15–1.58, p&lt;0.001).

Conclusion
There was a significant decline in national cardiac procedural activity in England during the COVID-19 pandemic, with a deficit in excess of 45000 procedures over the study period. However, there was no increase in risk of mortality for most cardiac procedures performed during the pandemic. While health service pressures are gradually easing given the increased roll out of vaccination and decline in infection rates, there is a need for major restructuring of cardiac services deal with this significant backlog of procedures, which would inevitably impact longer-term morbidity and mortality.

Funding Acknowledgement
Type of funding sources: None.
Association of late gadolinium enhancement in cardiac magnetic resonance with heart failure outcomes in patients with non-ischemic cardiomyopathy
Authors: Tao M , Al-Sadawi M , Aslam F , Mann N , Goldschmidt M , Tam E 
Published: October 2022

Abstract

Background
Late-gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) has been found to be associated with increased mortality in patients with non-ischemic cardiomyopathy (NICM). The correlation between LGE and heart failure (HF) hospitalization, referral for heart transplant, and ejection fraction (EF) improvement have not been well established.

Purpose
This meta-analysis assessed the relationship between LGE in CMR with HF hospitalization, referral for heart transplant and EF improvement in patients with NICM.

Methods
We searched the databases for studies reporting the association between LGE in CMR for NICM and HF outcomes including Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar for all studies. The search was not restricted to time or publication status. The minimal follow up duration is one year.

Results
A total of 216 studies resulted from the literature search. A total of 25 studies and 3,039 patients (1,265 with LGE vs 1,774 without LGE) were included; mean follow up is around 33 months (ranging between 13 to 71 months). Our analysis demonstrated that LGE in NICM was associated with increased risk of HF hospitalization (odds ratio 3.38, 95% confidence interval 2.27–5.04; P&lt;0.01), referral for transplant (odds ratio 5.08, 95% confidence interval 2.49–10.35; P&lt;0.01), and lower chance for EF improvement (odds ratio 0.16, 95% confidence interval 0.03–0.85; P 0.03). Heterogeneity is moderate: χ2=49.5, df=21 (P=0.001), I2=57%. (Figures 1 and 2)

Conclusions
Our results suggest that LGE is associated with increased risk of HF hospitalization and referral for heart transplant and lower chance for EF improvement in long-term follow up.

Funding Acknowledgement
Type of funding sources: None.