bluuebunny/crossref_metadata_2025_split huggingface dataset:
Protective effect of proton pump inhibitor against gastrointestinal bleeding in patients receiving oral anticoagulants: a systematic review and meta-analysis
Authors: Ahn H J , Lee S R , Choi E K , Rhee T M , Kwon S , Oh S , Gregory L I P 
Published: October 2022

Abstract

Background
The concurrent use of proton pump inhibitor (PPI) in oral anticoagulant (OAC) treated patients may be associated with a lower risk of gastrointestinal bleeding (GIB), but evidence is still conflicting according to individual OACs.

Purpose
We conducted a meta-analysis to estimate the risk of GIB in patients with OAC and PPI co-therapy.

Methods
A systematic search of PubMed, EMBASE, and Cochrane was performed for studies reporting GIB risk in OAC and PPI co-therapy. Primary outcomes were total GIB and major GIB events. We calculated pooled estimates of GIB risk by a random-effect meta-analysis and reported as odds ratios (OR) and 95% CI. Stratified analyses according to the origin of GIB, ethnic groups, individual OACs, and the presence of underlying GIB risk factors were performed.

Results
A total of 10 studies (1 randomized controlled study and 9 observational studies) and 1,970,931 patients who received OAC were included. OAC and PPI co-therapy were associated with a lower risk of total GIB, and major GIB; OR (95% CI) was 0.67 (0.62–0.74) for total GIB and 0.68 (0.63–0.75) for major GIB, respectively. Among total GIB, only the risk of upper GIB was lower with OAC and PPI co-therapy (OR 0.67, 95% CI 0.64–0.70). No difference in the lower risk of primary GIB outcomes of PPI co-therapy was observed between Asians and non-Asians (p-for-difference, total GIB=0.695, major GIB=0.748, respectively) and among individual OACs except for edoxaban. The protective effect of PPI on total GIB was more significant in high-risk patients, defined as those with concurrent medication of antiplatelets or non-steroidal anti-inflammatory drugs (OR 0.62, 95% CI 0.52–0.73) and presence of high bleeding risk factors such as previous GIB history, HAS-BLED score ≥3, or underlying gastrointestinal diseases. (OR 0.65, 95% CI 0.61–0.70).

Conclusion
In patients who receive OAC, the use of PPI co-therapy was associated with a lower risk of total GIB and major GIB irrespective of ethnic group and OAC type except for edoxaban. PPI co-therapy can be considered particularly in patients on concomitant NSAID and antiplatelet use or patients with high GIB risk factors.

Funding Acknowledgement
Type of funding sources: None.
Factors determining the use of NOACs vs. Warfarin in a Kenyan cohort of patients requiring anticoagulation
Authors: Mucyo W , Jeilan M , Varwani M H , Ngunga M 
Published: October 2022

Abstract

Background
Non-Vitamin K oral anticoagulants (NOACs) are widely used for stroke prevention in atrial fibrillation (AF) and prevention and treatment of venous thromboembolism (VTE). Apart from conditions in which warfarin is still the anticoagulant of choice, other factors may influence the choice between NOACs and warfarin.

Purpose
This study aims to determine factors associated with the use of NOACs as compared to warfarin in Kenya.

Methods
The Heart Registry Kenya is a prospective record of patients from two public hospitals and one private hospital in Kenya, with acute coronary syndrome, heart failure, AF, and VTE from 2020 to date. Data of patients with AF and VTE was analyzed to determine if demographic, clinical, or other non-clinical factors influence the choice of anticoagulants. The Chi-Square test was used to identify statistically significant associations between independent variables and dependent variables (NOACs or warfarin), with a 95% confidence interval.

Results
Data was collected on 452 patients (165 with AF and 288 with VTE) from 3 centers; the mean age was 51 years, and 61.7% were female. The proportions of patients on NOACs among AF and VTE patients were 60.5% and 57.5%, respectively (χ2: 0.122, p: 0.727). Proportions of patients on NOACs at public hospital number 1, public hospital number 2, and private hospital, were 37%, 50%, and 87.7%, respectively (χ2: 45.2, p: &lt;0.001). The use of NOACs in low, mid-low, mid-high, and high income groups was 50.4%, 31.3%, 75%, and 88.2%, respectively (χ2: 23.4, p: &lt;0.0001). There was no statistically significant association between the choice of anticoagulant and age, gender, race, renal function, indication for anticoagulation, use of antiplatelets, or extended anticoagulation therapy.

Conclusion
Patients with high socioeconomic status, as determined by monthly income and treatment facility, were more likely to be discharged on NOACs than warfarin. This may signal socioeconomic disparities affecting the treatment of AF and VTE in Kenya.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research Fund - The Government of Kenya
Aspirin therapy on prophylactic anticoagulation for hospitalized patients with COVID-19: a propensity score-matched cohort analysis of the HOPE-COVID-19 registry
Authors: Santoro F , Nunez Gil I , Vitale E , Perez-Villacastin J , Fernandez-Ortiz A , Brunetti N D 
Published: October 2022

Abstract

Background
COVID-19 is an infectious illness, featured by an increased risk of thromboembolism. However, no standard antithrombotic therapy is currently recommended for COVID-19 hospitalized patients. Aim of this study was to evaluate safety and efficacy of additional therapy with aspirin over prophylactic anticoagulation (PAC) in COVID-19 hospitalized patients and its impact on survival.

Methods
8168 patients hospitalized with COVID-19 were enrolled in a multicenter-international prospective registry (HOPE COVID-19). Clinical data and in-hospital complications, including mortality, were recorded. 344 patients with incomplete data were excluded. Study population included patients treated with PAC or with PAC and aspirin. A comparison of clinical outcomes between patients treated with PAC and PAC and aspirin was performed using an adjusted analysis with propensity score matching.

Results
Of 7824 patients, 360 (4.6%) received PAC and aspirin and 2949 (37.6%) PAC. Propensity-score matching yielded 298 patients from each group. Mean age was 73±11 years, 67% were male, prevalence of hypertension and diabetes was 79 and 33% respectively and 7.5% underwent invasive ventilation.
In the propensity score-matched population, cumulative incidence of in-hospital mortality was lower in patients treated with PAC and aspirin vs PAC (15% vs 21%, Log Rank p=0.01, Figure 1). At multivariable analysis in propensity matched population of COVID-19 patients, including age, sex, hypertension, diabetes, kidney failure and invasive ventilation, aspirin treatment was associated with lower risk of in-hospital mortality (HR 0.62, CI 95% 0.42–0.92, p=0.018).

Conclusions
Additional therapy with aspirin over PAC in COVID-19 hospitalized patients was associated with lower mortality risk in a propensity score matched population.

Funding Acknowledgement
Type of funding sources: None.
The role of cardiac magnetic resonance-based feature-tracking strain analysis in the differential diagnosis and prognostic assessment of patients with left ventricular hypertrophy
Authors: Dohy Z , Szabo L , Pozsonyi Z , Csecs I , Toth A , Suhai F I , Czimbalmos C , Szucs A , Kiss A R , Becker D , Merkely B , Vago H 
Published: October 2022

Abstract

Background
Cardiac magnetic resonance (CMR) examinations have an essential role in the diagnosis of myocardial diseases with left ventricular (LV) hypertrophy; however, limited data are available from CMR-based feature-tracking strain analysis in this patient population. The aim of our study was to investigate the differential diagnostic and prognostic importance of feature-tracking strain analysis in patients with LV hypertrophy caused by myocardial disease.

Methods
We investigated 404 patients who underwent CMR examination and were diagnosed with myocardial disease causing LV hypertrophy. Hypertrophic cardiomyopathy (HCM) was detected in 330 patients, cardiac amyloidosis (CA) in 46 patients, Fabry disease (FD) in 12 patients, and endomyocardial fibrosis (EMF) in 16 patients. LV strain analysis was performed with feature-tracking. Global longitudinal (GLS), circumferential (GCS) and radial (GRS) LV strain parameters were measured. Strain values for the six basal, six midventricular, and five apical segments were averaged to obtain regional longitudinal and circumferential strain values (basal LS, midventricular LS, apical LS, basal CS, midventricular CS, apical CS). The apex-to-base regional LS and CS ratios were calculated as apical LS/basal LS and apical CS/basal CS, respectively. To assess global dyssynchrony, mechanical dispersion (MD) was measured. The all-cause mortality of the patients was analyzed.

Results
In the differentiation of CA from HCM, GLS had the highest sensitivity with a cutoff of more than −23%, and basal LS and basal CS had the highest specificity with a cutoff of more than −16% and −38%, respectively (p&lt;0.001). FD patients had the lowest longitudinal and circumferential MD values, meaning that compared to that of other patients with LV hypertrophy, global dyssynchrony is least pronounced in this patient population (p&lt;0.01). EMF patients had impaired global and regional CS and the lowest apex-to-base CS and LS ratios. CA patients had the highest apex-to-base CS and LS ratios, suggestive of apical sparing (p&lt;0.001). CA patients had the worst prognosis; the significant independent predictors of mortality were a diagnosis of CA, the LV stroke volume index and basal LS (p&lt;0.01).

Conclusions
Myocardial diseases with left ventricular hypertrophy have remarkable differences in CMR-based strain characteristics which can be helpful in the differential diagnosis and provides incremental information on adverse outcomes.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Development and Innovation Fund of Hungary, Ministry for Innovation and Technology in Hungary
Short dual antiplatelet therapy duration in high bleeding risk patients undergoing PCI for non-ST-elevation acute coronary syndrome
Authors: Cao D , Valgimigli M , Sartori S , Spirito A , Snyder C , Mehran R 
Published: October 2022

Abstract

Background
Patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remain at increased risk of recurrent ischemic events. An abbreviated dual antiplatelet therapy (DAPT) duration as short as 1 month has been suggested for those at high bleeding risk (HBR). Whether the benefits of 1-month DAPT are preserved in HBR patients presenting with non-ST-elevation ACS (NSTE-ACS) is subject of debate.

Purpose
To assess the impact of NSTE-ACS presentation on the ischemic and bleeding outcomes of HBR patients undergoing PCI with a cobalt-chromium everolimus-eluting stent followed by a 1-month versus 3-month DAPT.

Methods
The XIENCE Short DAPT Program encompasses three prospective, international, single-arm studies evaluating the safety and efficacy of a 1-month (XIENCE 28 USA and Global) or 3-month (XIENCE 90) DAPT duration. The program enrolled HBR patients who had undergone successful XIENCE stent implantation for acute or chronic coronary syndrome (excluding ST-elevation ACS). Event-free subjects discontinued DAPT at 1 or 3 months post-PCI. The primary endpoint was the composite of all-cause death or myocardial infarction (MI), while the key secondary endpoint was Bleeding Academic Research Consortium (BARC) type 2–5 bleeding between 1 and 12 months post-PCI. Ischemic and bleeding events associated with 1-month versus 3-month DAPT were assessed according to clinical presentation using propensity-score (PS) adjustment.

Results
Out of 3,364 HBR patients (n=1,392 on 1-month DAPT and n=1,972 on 3-month DAPT), 1164 (34.6%) underwent PCI for NSTE-ACS. At 12 months, the risk of death or MI was similar between 1- and 3-month DAPT in patients with (adjHR 1.12, 95% CI 0.73–1.70) and without NSTE-ACS (adjHR 0.92, 95% CI 0.65–1.29; p-interaction = 0.33). Landmark analysis between 1 and 3 months post-PCI showed significant treatment effect modification according to clinical presentation (p-interaction = 0.03) with greater benefit of 1-month DAPT in stable patients. BARC 2–5 bleeding was consistently reduced in both NSTE-ACS (adjHR 0.58, 95% CI 0.38–0.90) and stable patients (adjHR 0.86, 95% CI 0.63–1.18; p-interaction = 0.15).

Conclusions
Among HBR patients undergoing PCI with an everolimus-eluting stent, 1-month compared with 3-month DAPT was associated with similar 1-year risk of ischemic events and reduced bleeding, irrespective of clinical presentation. Between 1 and 3 months post-PCI, however, stable patients seemed to derive greater net benefit from 1-month DAPT compared to those with NSTE-ACS.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott
CYP2C19 loss-of-function alleles and the use of omeprazole or esomeprazole increase the risk of cardiovascular outcomes in patients using clopidogrel – a real-world study
Authors: Ritvos M S , Rasanen M , Hayrynen S , Kiiski J I , Niemi M , Sinisalo J 
Published: October 2022

Abstract

Background
Patients carrying loss-of-function (LOF) variants of CYP2C19 or using the CYP2C19-inhibitors omeprazole or esomeprazole cannot fully bioactivate clopidogrel, and thus are lacking optimal thrombosis prevention. However, clopidogrel is a relevant alternative to ticagrelor due to its lower incidence of hemorrhagic events and lower cost.

Purpose
The purpose of this study was to investigate in a real-life prospective patient cohort how loss-of-function (LOF) CYP2C19 variants and omeprazole or esomeprazole influence the incidence of cardiovascular events (cardiovascular deaths, reinfarction and strokes) in patients using clopidogrel.

Methods
A cohort of prospective patients (N=1972) with acute coronary syndrome (ACS) (N=1302) or symptomatic chronic coronary disease (N=670) were followed for 365 days. Information of purchased prescription drugs, hospital discharge, and death registry was available for all patients. The patients were retrospectively genotyped for the CYP2C19*2, CYP2C19*3, and CYP2C19*8 LOF variants.

Results
A total of 608 (30.8%) patients carried CYP2C19 LOF alleles. During the 365 days follow-up, 252 patients had a recurring ischemic vascular event, either myocardial infarction (N=189), stroke (N=24) or cardiovascular death (N=39). Vascular events were significantly more frequent among carriers of CYP2C19 LOF alleles [14.8% (95% CI 11.7–17.8] than in non-carriers [10.8% (95% CI 9.0–12.6)], p=0.016. Omeprazole or esomeprazole use was similar among the LOF allele carriers and non-carriers, but inclusion of their use in the analysis strengthened the association. Vascular events were significantly more common in a composite group of carriers of CYP2C19 LOF alleles and non-carriers who were using omeprazole or esomeprazole than in non-carriers who were not using omeprazole or esomeprazole 14.8% (95% CI 12.2–17.3) vs 9.9% (95% CI 8.0–11.9) p=0.002. There was a tendency towards lower risk of hemorrhagic complications in carriers of LOF alleles than in non-carriers (p=0.07).

Conclusions
Patients with impaired clopidogrel bioactivation due to loss-of-function CYP2C19 variants or concomitant omeprazole or esomeprazole use are at increased risk of cardiovascular events. For relevant patient care both genetics and concomitant medication should be considered both in everyday patient care and further randomised studies.

Funding Acknowledgement
Type of funding sources: None.
Patents experiences of in-hospital telemetry monitoring
Authors: Holm M , Falun N , Bendz B , Fridlund B , Langorgen J , Norekval T M 
Published: October 2022

Abstract

Background
Telemetry monitoring is a cornerstone of care in in-hospital arrhythmia monitoring. Annually, a large number of patients experience arrhythmias that need to be monitored and treated during hospital stay. However, studies focusing on patients' experiences of telemetry monitoring are scarce.

Purpose
To explore and describe adult patients' experiences of in-hospital monitoring in a non-intensive care unit setting.

Methods
In-depth interviews with an inductive, explorative and descriptive design were performed before hospital discharge at two university hospitals in Norway. Twenty patients were purposefully selected. Inclusion criteria were; monitored for more than 72 hours, with at least one serious arrhythmia registered. A qualitative content analysis according to Graneheim and Lundman was performed revealing categories at a manifest level.

Findings
Patients were 25–83 years (mean 62), and had spent an average of 9 days on telemetry (3–14). Patients were monitored due to primary arrhythmia (9), STEMI (2), syncope (2), TAVI (1), acute heart failure (1), heart transplant (1), GUCH (1) and non-cardiac causes (3). Four main categories were revealed from the analysis. Firstly, patients' experienced to receive limited information related to the purpose and results of the monitoring. Communication with the staff and immediate response to arrhythmias were important factors to feel safe and taken care of during hospital stay. Secondly, patients experienced the monitoring system to be troublesome. The device and the wires attached made it challenging to maintain adequate hygiene. Patients also experienced sleeping problems related to both wires and disturbing alarms, and described pain in the neck due to the weight of the telemetry unit. Thirdly, patients' experienced a restricted range of activity. Patients experienced the restricted radius of movement as a feeling of security, even though patients also described uncomfortable feelings like “wearing an ankle brace”. Fourthly, patients' experienced uncertainty at hospital discharge as the telemetry monitoring was discontinued, especially if they still experienced arrhythmias.

Conclusion
The information provided to patients on telemetry monitoring is poor and there is need for a better system to carry the telemetry in order to ease mobilisation and facilitate good sleep. Patients need to be informed about the results of the telemetry monitoring, to help them to be familiar with their arrhytmia, and increase the experience of security after discharge.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): 1 Department of Health and Social Sciences at Western Norway University of Applied Sciences, Norway2 Department of Heart Disease, Haukeland University Hospital, Norway
Quality of life in patients with heart failure and improved ejection fraction: one year changes and prognostic implication
Authors: Gonzalez B , Zamora E , Rivas C , Pulido A , Crespo E , Velayos P , Diaz V , Altabella M , Bares D , Codina P , Domingo M , Santiago-Vacas E , Cediel G , Lupon J , Bayes-Genis A 
Published: October 2022

Abstract

Background
Inconsistent and controversial results have been reported about the association of quality of life (QoL) and left ventricular ejection fraction (LVEF) in patients with heart failure (HF). The 2021 universal definition of HF specifically describes the criteria for the patients with HF and improved LVEF (HFimpEF): HF with a baseline LVEF ≤40%, a ≥10 point increase from baseline LVEF, and a second measurement of LVEF &gt;40%.

Purpose
1) To assess whether patients with HF and reduced LVEF (HFrEF) at first visit in an outpatient HF Clinic that fulfil the HFimpEF criteria one year later presented a higher improvement in QoL assessed by the Minnesota Living With Heart Failure Questionnaire (MLWHFQ) than those patients that did not fulfil HFimpEF criteria. 2) To assess the prognostic role of QoL on outcomes in HFimpEF patients.

Methods
In a prospective registry of real-life HF outpatients LVEF and QoL evaluated by MLWHFQ were assessed at first visit at the HF Clinic and at one year of follow-up.

Results
From August 2001 to August 2021, baseline and one year LVEF and MLWFQ scores were available in 1040 patients with an initial LVEF ≤40%. Table 1 shows baseline demographic and clinical characteristics of patients. In summary, mean age was 65.2±11.7 years, 75.9% of the patients were men, the main aetiology was ischaemic heart disease (52.9%) and patients were mostly in New York heart Association (NHYA) class II (71.1%) and III (21.6%). Baseline LVEF was 28.5% ± 7.3 and baseline MLWHFQ score was 30.2±19.5. At one year, mean LVEF increased to 38.0±12.2 while MLWHFQ scores improved to 17.4±16.0. There were 361 patients that fulfilled the HFimpEF criteria (34.7%). These patients significantly and markedly improved both LVEF (from 28.7±6.6 to 50.9±7.6, p&lt;0.001) and QoL (from 32.9±20.6 to 16.9±16.0, p&lt;0.001). Although in patients that did not fulfil the criteria of HFimpEF both LVEF (from 28.4±7.6 to 31.1±7.9, p&lt;0.001) and QoL (from 28.7±18.8 to 17.6±15.9, p&lt;0.001) also significantly improved, the improvement in QoL was significantly higher in HFimpEF patients (−16.0±23.8 vs. −11.1±20.3, p=0.001), taking into account that baseline MLWHFQ score was worse in HFimpEF patients (p=0.001). However, at one year QoL was similar when both groups were compared (p=0.50). MLWHFQ score at one year proved to be superior to QoL improvement (using a cut-off of at least 5 points) from the prognostic point of view.

Conclusions
QoL improved both in patients with and without HFimpEF criteria, and QoL perception at one year was similar in both groups, suggesting the influence of other factors other than LVEF in QoL perception. QoL at one year revealed to be superior to QoL changes from baseline from the prognostic point of view.

Funding Acknowledgement
Type of funding sources: None.