bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing dual antiplatelet therapy strategies post-acute coronary syndrome: network meta-analysis
Authors: Turgeon R , Hong C , Wang E H Z , Wong G C , Ellis U 
Published: October 2022

Abstract

Background
Various approaches to dual antiplatelet therapy (DAPT) management exist to balance thrombotic and bleeding risks following acute coronary syndrome (ACS).

Purpose
The aim of this study was to compare and rank different DAPT management strategies in patients with ACS with or without percutaneous coronary interventions.

Methods
We conducted a systematic review with network meta-analysis of randomized controlled trials comparing DAPT strategies in patients with ACS using MEDLINE, Embase, and CENTRAL (2007-July 2021). The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included all-cause death and major bleeding. We performed Bayesian network meta-analyses to compare all interventions simultaneously using the Markov-chain Monte Carlo method, conducted under the assumption of transitivity. We generated odds ratios (ORs) with 95% credible intervals (CrI) from the medians and 2.5th and 97.5th percentiles of the posterior distributions using a hierarchical Bayesian framework, using a random-effects model with informative priors for between-study heterogeneity based on pharmacological interventions with semi-objective outcomes (MACE or bleeding) or death. To rank interventions for each outcome, we calculated the mean surface under the cumulative ranking (SUCRA) curve.

Results
From 5941 articles, we included 24 trials (89,620 patients). Both clopidogrel- and ticagrelor-based DAPT increased MACE compared with pharmacogenomics-guided P2Y12 inhibitor selection (odds ratio [OR] 1.37, 95% credible interval [CrI] 1.08–1.74 and 1.35, 1.05–1.79, respectively) and empiric P2Y12 inhibitor de-escalation (OR 1.53, 95%CrI 1.00–2.30 and 1.51, 1.00–2.27, respectively). Compared with short-duration DAPT, standard DAPT duration with all P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) and pharmacogenomics-guided P2Y12 inhibitor selection increased major bleeding. Ticagrelor-based DAPT increased major bleeding compared with platelet function testing-guided DAPT (OR 1.60, 95%CrI 1.00–2.55). Empiric P2Y12 inhibitor de-escalation ranked best for MACE (SUCRA 0.89), whereas short-duration DAPT ranked best for death (SUCRA 0.89) and major bleeding (SUCRA 0.93).

Conclusions
In patients with ACS, empiric P2Y12 inhibitor de-escalation was most efficacious whereas short-duration DAPT was the safest compared to other DAPT strategies.

Funding Acknowledgement
Type of funding sources: None.
Dual antiplatelet therapy for 1 versus 3 months in high bleeding risk patients with or without oral anticoagulant therapy after coronary stenting
Authors: Cao D , Mehran R , Sartori S , Spirito A , Snyder C , Valgimigli M 
Published: October 2022

Abstract

Background
A short DAPT duration after coronary stenting has been associated with similar ischemic outcomes and fewer bleeding complications in patients at high bleeding risk (HBR). Whether these effects are preserved irrespective of concomitant oral anticoagulant (OAC) therapy remains unclear.

Purpose
To evaluate the safety and efficacy of 1-month versus 3-month DAPT among HBR patients with or without indication to OAC therapy who undergo cobalt-chromium everolimus-eluting stent implantation.

Methods
The XIENCE Short DAPT Program comprises three prospective, international, single-arm studies evaluating 1-month (XIENCE 28 USA and Global) or 3-month (XIENCE 90) DAPT in HBR patients who had undergone successful everolimus-eluting XIENCE stent implantation. OAC therapy at discharge was a study inclusion criterion. Subjects were eligible to discontinue DAPT at 1 or 3 months if free from ischemic events and adherent to DAPT. The primary endpoint was the composite of all-cause death or any myocardial infarction (MI). The major secondary endpoint was Bleeding Academic Research Consortium (BARC) type 2–5 bleeding. In this exploratory analysis, HBR patients on 1-month DAPT were compared with those on 3-month DAPT according to the presence of background OAC therapy. Ischemic and bleeding outcomes were assessed between 1 and 12 months after index PCI using propensity-score (PS) adjustment.

Results
A total of 3,364 patients, 1,392 on 1-month DAPT and 1,972 on 3-month DAPT, were eligible for the analyses. Patients on OAC therapy (n=1424, 42.3%) were younger, more often male and of white race, and with a lower prevalence of other HBR criteria such as chronic kidney disease and anemia. The incidence of death or MI at 12 months was similar between the two groups (8.0% vs 7.9%) while BARC 2–5 bleeding was higher in OAC patients (12.2% vs 7.2%). After PS adjustment, 1-month DAPT, compared with 3-month DAPT, did not increase the 1-year risk of death or MI in both OAC (adjHR 0.71, 95% CI 0.47–1.08) and non-OAC patients (adjHR 1.24, 95% CI 0.88–1.75; p-interaction = 0.11). The risk of BARC 2–5 bleeding was consistently reduced in both OAC (adjHR 0.71, 95% CI 0.51–1.00) and non-OAC patients (adjHR 0.77, 95% CI 0.53–1.11; p-interaction = 0.69).

Conclusions
Among HBR patients undergoing everolimus-eluting stent implantation, 1-month DAPT compared with 3-month DAPT was associated with similar ischemic outcomes and reduced bleeding, regardless of concomitant OAC therapy.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott
Incidence of drug-drug interactions of QT-prolonging drugs in an onco-hematological outpatient
Authors: Fort E , Otero S , Moliner P , Bleda C , Prats J , Nadal E , Palmero R , Jimenez L , Piulats J M , Rey M , Fontanals S 
Published: October 2022

Abstract

Background
Oral anticancer therapy is increasingly integrated into the care of patients (pts) with cancer. Recognition and management of pharmacodynamic drug-drug interactions is critical to provide efficacious and safe anticancer treatment.

Purpose
We aimed to gain insight into the real-world prevalence of potentially significant drug-drug interactions of QT-prolonging with oral antineoplastic agents used in an Oncohematological Hospital

Methods
We performed a prospective observational study in an oncohematological hospital between October 2020 and June 2021. Consecutive pts diagnosed with an oncohematological neoplasia and who were evaluated before start treatment with an oral anticancer drug or suport treatment (antibiotics, antivirals) were included. Cancer treatment data were obtained from our prescription software System. Demographic data and concomitant medication were obtained from our electronic medical record software. Micromedex was used to find potencial QT-prolonging interactions between anticancer drugs and chronic medication, and were classified as major or moderate.

Results
Oncohematological treatment was started in 1.217 pts during the study period. A total of 266 potential drug-drug interactions were detected in 171 patients (14.5%). A total of 46 drug-drug interactions of QT-prolonging (17.3%) were detected in 37 pts (21.6%), 22 men and 15 women, with a median age of 66.6 (range 40.9–87.3). Twenty-one (45.7%) and 25 (56.3%) drug interactions of QT-prolonging were classified as major and moderate, respectively, with a median interaction per pts 1.24 (1–3). The 3 most common cancers were: Renal carcinoma in 12 pts (32.4%), non-small cell lung carcinoma in 9 pts (24.7%) and prostate carcinoma in 4 pts (10.8%). The most commonly detected interacting drugs were sunitinib 12 pts (26.1%), osimertinib 10 pts (21.7%), and cabozantinib 5 pts (10.9%) among oncohematological drugs, and citalopram 8 (17.4%), quetiapine 6 (13%) and tramadol 5 (10.8%) among concomitant drugs.

Conclusion
Drug-drug interactions can play a significant role in drugs' cardiac safety in oncohematological pts, specially in renal, lung and prostate cancers, with more than one potential interacting drug or at least one major interaction. Cardiac monitorizacion should be considered when potential drug drug interaction is detected.

Funding Acknowledgement
Type of funding sources: None.
Sustained effect on diet quality of a self-care intervention to reduce cardiovascular disease risk among informal rural caregivers of people with chronic illnesses: does health literacy matter?
Authors: Kang J H , Katsumata Y K , Lennie T A L , Chung M L C , Biddle M J B , Miller J M , Moser D K M 
Published: October 2022

Abstract

Background/Introduction
Rural caregivers of those with chronic illnesses have higher cardiovascular disease (CVD) risk than urban caregivers. Diet is a major lifestyle factor that contributes to CVD risk. However, interventions are often not constructed with health literacy in mind. We previously found a moderation effect of health literacy on short-term (4-month) diet quality from a self-care intervention to reduce cardiovascular disease risk (RICHH) among rural caregivers. The RICHH intervention was designed to be equally effective in caregivers with marginal or adequate health literacy.

Purpose
To compare the impact of RICHH intervention on 12-month diet quality in rural caregivers with marginal versus adequate health literacy.

Methods
A total of 296 rural caregivers (54.5±13.7 years old, 76% female) of individuals with chronic illnesses participated. The newest vital sign (NVS) and Healthy Eating Index-2015 (HEI-2015) were used to determine health literacy and diet quality, respectively. The NVS was dichotomized using a cutoff score of 4. The HEI-2015 was computed based on food frequency questionnaires at baseline, 4-month, and 12-month. The RICHH intervention was delivered using video conferencing technology by nurse interventionists once a week for 12 weeks followed by bi-weekly and monthly booster sessions. A piecewise linear mixed-effect model, controlling for age, education, smoking status, and perceived stress, was used to evaluate the impact of the intervention on diet quality between the two health literacy groups.

Results
There was a significant difference in improvement in the HEI-2015 total scores at 4 months between control and intervention in the marginal health literacy group (beta estimate = 1.56, SE=0.74, P=0.039) but not in the adequate health literacy group (beta estimate = 0.27, SE=0.38, P=0.475). The improvement in the marginal health literacy group was sustained at 12-months (beta estimate = 8.12, SE=3.57, P=0.022).

Conclusions
The results of our study indicate that an intervention designed to address health literacy is effective in producing a sustained improvement in diet quality to reduce CVD risk in rural caregivers with marginal health literacy.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health National Institute of Nursing Research
Changes in health-related quality of life following percutaneous coronary intervention – a nationwide prospective cohort study
Authors: Olsen S , Bonaa K H , Hanssen T A 
Published: October 2022

Abstract

Background
In addition to mortality and morbidity, improved health-related quality of life (HRQOL) is a goal of treatment in patients suffering of cardiovascular heart disease. There is a limited knowledge of changes in HRQOL following percutaneous coronary intervention (PCI).

Aims
The aims of this study were to determine total and gender specific changes in HRQOL at baseline and four-years following PCI.

Methods
This study use data from the Norwegian Coronary Stent Trial which included 9013 patients undergoing first time percutaneous coronary intervention in Norway during September 2008–February 2011. HRQOL was assessed using the Short-Form-12 (SF-12) at baseline and at four years of follow up in a representative subgroup (n=775).

Results
The mean age was 64 years (SD 9.2) and 75% were male. Eighty percent were living with a partner and 67% had a higher level of education. The majority of the patients had stable angina as indication for PCI (40%). There was a significant improvement in all domains of SF-12 from baseline to four years of follow up (p&lt;0.001). The highest changes were in Role Physical (43.6 vs. 48.2), Bodily Pain (44.8 vs. 50.1) and Vitality (44.1 vs. 49.3). Analysing gender differences at four years follow-up, men had a higher improvement in the physical component summary score than women (4.8 vs 2.8, p=0.04), but not in the mental component summary score (2.8 vs 4.4, p=0.11).

Conclusion
In patients undergoing first time PCI, HRQOL improved significant from baseline to four years of follow up. Both at baseline and at five years of follow up males report a higher HRQOL compared to females.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Northern Norway Regional Health Authority
Short- and long-term quality of life after electrical cardioversion of atrial fibrillation
Authors: Morken I , Ponitz V , Brugger-Andersen T , Aareskjold O , Aadnanes L , Melberg T , Bru E , Nordrehaug J E 
Published: October 2022

Abstract

Background
Electrical cardioversion (ECV) of atrial fibrillation (AF) is known to be effective in restoring sinus rhythm. However, limited and contradictory data exist on the impact of ECV on short- and long-term quality of life outcomes.

Purpose
To examine the impact of ECV on short- and long-term quality of life in patients with AF.

Methods
This was a prospective cohort study of consecutive patients with AF referred for outpatient electrical cardioversion at a university hospital in Norway. Recruitment started March 2017, and ended December 2019. Baseline demographics, clinical characteristics, and procedure details were obtained from medical records. Quality of life was measured with the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire before electrical cardioversion (baseline), and at three and 12 months after ECV.

Results
Two hundred and ninety-five patients underwent ECV and completed follow-up questionnaires at three months (n-259) and at 12 months (n=258). The median age was 68 years (range 37–86 years) and 79% were men. The mean left ventricular ejection fraction obtained by echocardiography was 51% (±9.2). The mean body mass index score was 28±4.8. Immediate success of electric cardioversion was 91%. Recurrence of AF after successful ECV was 36% within three months. Twenty-two percent of the patient underwent new ECV before three months, and 25% of the patients had persistent AF at three months. The overall mean AFEQT score at baseline was 62.9±21.4, and the domain-specific scores were as follows: symptoms, 72.3±23.1; daily activities, 52±26.6; treatment concerns, 71.1±22.4; and treatment satisfaction, 59.9±25.2. There were significant improvements in the overall mean AFEQT score at three months, 70.8±20.8, (p&lt;0.01) and at 12 months, 72.3±20.8 (p&lt;0.01) compared with baseline values. There were also significant improvement (p&lt;0.01) in all AFQET subscales at three and 12 months. Daily activity scores and treatment satisfactions scores demonstrated highest improvement in mean score with a 10% increase from baseline to three months and 13% increase from baseline to 12 months. Sub-analyses revealed that patients with persistent AF within three months were significantly dissatisfied with treatment (p&lt;0.01) and reported lower activity level (p&lt;0.01) compared with the rest of the sample.

Conclusions
Results indicate both significant improvement in short- and long-term quality of life for patients after electrical cardioversion, in particular when sinus-rythm was maintained.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Stavanger University Hospital
Costs of an exergame intervention for patients with heart failure
Authors: Klompstra L , Mourad G , Jaarsma T , Stromberg A , Alwin J 
Published: October 2022

Abstract

Background
Exergaming is promising for patients with heart failure who are less inclined to start or maintain exercise programmes involving traditional modes of physical activity. It is important to gain insights into aspects related to costs to in order to compare with other costs for rehabilitation and make priorities.

Purpose
To gain insights into aspects related to the costs of an exergame intervention for patients with heart failure and their willingness to pay for such an intervention.

Method
In a randomised controlled trial, the HF-Wii study, the intervention group (n=305) received an introduction to the exergame, the exergame was installed at home and technical and practical support was available when needed for three months. Patients received telephone follow-ups after the installation. The control group (n=300) received activity advice and telephone follow-ups. We collected data on hospital use and costs, costs of the exergame intervention, patient time-related costs and conducted interviews to establish willingness to pay in a subset of patients.

Results
No significant differences were found between the exergame group (n=300) vs. the control group (n=305) in hospital use or costs (one-year number of hospitalisations p=0.60, costs p=0.73). The cost of the intervention was 190 Euros, and the patient time-related costs were 98 Euros (see Table 1). Of the total estimated costs for the intervention, 288 Euros, patients were willing to pay, on average, 58%. Satisfaction level regarding the exergame intervention was significantly correlated with patients' willingness to pay (rs=0.47, p=0.01).

Conclusion
Although the costs of developing a exergame can be high, this study shows that the cost for the implementation of exergaming in an individual for practice was only 288 Euro per patient. Patients were willing to pay more than half of the exergame intervention and patients with higher satisfaction levels were willing to pay more than those with lower satisfaction levels.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish National Science Council
OUES from submaximal cardiopulmonary exercise
Authors: Rudd A , Khan H , Gamble D , Stephen P , Horgan G , Dawson A , Frenneaux M P , Dawson D K 
Published: October 2022

Abstract

Introduction
Cardiopulmonary exercise testing (CPEX) provides valuable diagnostic and prognostic cardiopulmonary function data. However, in clinical setting a maximal test is not always achievable. The Oxygen Efficiency Uptake Slope (OUES) has been proposed as a possible submaximal measure of cardiopulmonary function as it remains relatively stable during the final quartile of the exercise test. This study explored the validity of OUES as a surrogate marker for cardiopulmonary function in the event of a submaximal test.

Methods
Four groups of subjects [128 healthy controls (73 M), 44 asymptomatic hypertensive (HT) patients (26 M), 67 adult cardiac congenital heart disease (ACHD) patients (44 M) and 35 Heart Failure with preserved Ejection Fraction (HFpEF) (10M) patients] were recruited after informed consent. All subjects underwent clinical assessment, resting ECG, blood pressure and spirometry prior to a treadmill CPEX to volitional exhaustion and a respiratory exchange ratio (RER) of at least 1.1 using the same testing protocol. Peak VO2 (ml/min) was recorded from the last 5s of the maximal test (RER=1.1) and OUES was calculated from complete (RER=1.1) and truncated (RER=0.9) gas exchange data. The linear relationships between absolute peak VO2 and OUES from complete and truncated gas exchange data were assessed using Pearson's correlation coefficient. Subsequently, the two correlations obtained in each patient group were compared. Statistical significance was set at p&lt;0.01.

Results
Mean and 95% confidence intervals of the peak VO2 for males and females in each decile of life examined in the 4 subject groups are shown in the Figure. Peak VO2 values achieved in each of the patient groups were significantly lower when matched for age and sex compared to healthy participants (HT p=0.006, ACHD patients p&lt;0.001 and HFpEF patients p&lt;0.001).
In all 4 groups there was a good correlation between absolute peak VO2 and the OUES at RER 1.1 (healthy volunteers r=0.910, p&lt;0.001, HT r=0.899, p&lt;0.001, ACHD r=0.816, p&lt;0.001 and HFpEF r=0.846, p&lt;0.001). Correlations were inferior for absolute peak VO2 and OUES at RER 0.9 (healthy volunteers r=0.74, p&lt;0.001, HT r=0.780, p&lt;0.001, ACHD r=0.651, p&lt;0.001 and HFpEF r=0.817, p&lt;0.001). Correlations between absolute peak VO2 vs OUES at RER of 1.1 and 0.9 were significantly different only for healthy controls (p=0.001, Z-score = −4.649), but not for HT (p=0.05, Z-score = −1.909), ACHD (p=0.04, Z-score = −2.080) or HFpEF (p=0.7, Z-score = −0.377) patients.

Conclusion
Our data support the use of submaximal OUES at an RER of 0.9 as a surrogate marker for absolute peak VO2 obtained at an RER of 1.1, especially in patients, in whom it can often be difficult to achieve maximal exercise.

Funding Acknowledgement
Type of funding sources: None.
Clinical validation of an artificial intelligence algorithm offering cross-platform detection of atrial fibrillation using smart device electrocardiograms
Authors: Mannhart D , Lefebvre B , Gardella C , Henry C , Serban T , Knecht S , Kuehne M , Sticherling C , Badertscher P 
Published: October 2022

Abstract

Introduction
Multiple smart devices capable of “screening” for atrial fibrillation (AF) based on single-lead electrocardiogram (SL ECG) are presently available. Manufacturers' algorithm capabilities and accuracy for the automated detection of AF vary. Reliable artificial intelligence (AI) algorithms would be valuable to assist physicians with managing the large amount of data. We aimed to assess the clinical value of applying a smart device agnostic AI-based algorithm for the detection of AF from five different smart devices (four smartwatches, one handheld device) and compared the results to the cardiologist-interpreted 12-lead ECG in a real world cohort of patients.

Methods
This is a prospective, observational study enrolling patients presenting to a cardiology service at a tertiary referral center. Patients were prescribed a 12-lead ECG, followed by five consecutive smart device recordings from five different manufacturers. SL ECGs were exported as PDF files from the devices and analyzed by a deep neural network (DNN) based platform which allows automated AI assisted cardiac rhythm interpretation.

Results
We prospectively enrolled 157 patients (32% female, median age 66 years). AF was present in 48 patients (31%) at time of recording, as documented by the 12-lead ECG. Accuracy for the detection of AF by the DNN-based algorithm was 96.6% for the Apple Watch 6, 95.2% for the AliveCor Kardia Mobile, 96.0% for the Fitbit Sense, 95.7% for the Samsung Galaxy Watch 3 and 93.8% for the Withings Scanwatch, respectively (Figure 1, left). While diagnostic accuracy of the DNN-based algorithm was similar compared to each manufacturer's individual algorithm, the proportion of SL ECGs with a conclusive diagnosis was significantly higher for all smart devices when using the DNN-based algorithm, p&lt;0.001 (Figure 1, right). As complementary analysis, we assessed sensitivity and specificity detection capabilities in both algorithms (Figure 2).

Conclusion
In this clinical validation, a DNN-based algorithm reported significantly more conclusive diagnoses for each smart device compared to the manufacturers' algorithms, whilst showing similarly high accuracy in the detection of AF compared to the cardiologist-interpreted standard 12-lead ECG. Given further validation, SL ECG assisted rhythm interpretation through a cross-platform AI-algorithm presents a promising clinical value for AF detection and offers a possible solution for managing the data surge for smart device-acquired ECGs.

Funding Acknowledgement
Type of funding sources: None.