bluuebunny/crossref_metadata_2025_split huggingface dataset:
How to screen frailty in outpatients with heart failure: multimodality assessment vs. the Vulnerable Elderly Survey 13 (VES-13) scale
Authors: Roig T , Gonzalez B , Lopez Y , Rivas C , Arderiu A , Pulido A , Crespo E , Velayos P , Diaz V , Altabella M , Bares D , Barcelo E , Domingo M , Lupon J , Bayes-Genis A 
Published: October 2022

Abstract

Background
During two decades we have been screening fragility in outpatients with heart failure (HF) with a multimodality assessment using several geriatric scales, showing that frailty or fragility is frequent in HF patients, even in young patients, and we demonstrated that this identified fragility played an important prognostic role. Frailty is a medical syndrome with multiple causes and contributors that increases outpatients' vulnerability so a minimal stress can cause functional impairment, with a major risk of dependency, even death. Frailty can be reversible or attenuated by interventions. Nowadays several specific scales for fragility or frailty detection are widely available. One of them, the Vulnerable Elderly Survey 13 (VES-13) has scarcely been used in HF.

Purpose
To assess the prevalence of fragility in an outpatient HF Clinic at first visit using both the VES-13 scale and a multimodality assessment that includes Barthel index, OARS scale, Pfeiffer test, and abbreviated Yesavage Geriatric Depression Scale of 4 items (GDS), and compare the two approaches

Methods
Nurses fulfilled the scales with the patients at their first visit. An scoring ≥3 in the VES-13 scale and the presence of one of the predefined criteria in the multimodality assessment (Barthel &lt;90; OARS score &lt;10 in women and &lt;6 in men; Pfeiffer Test score &gt;3±1, depending on educational level; one positive depression response in abbreviated GDS; and age &gt;85 years or nobody to turn to for help) were considered to have fragility for the purpose of the study.

Results
From March 2021 to December 2021, 136 patients were evaluated with the two fragility screening modalities (mean age 68.8±10.8 years, 64% men, 46% from ischaemic aetiology, 65.4%/27.9% in NYHA class II/III, LVEF 39.5% ± 13.4). VES-13 identified 51 (37.5%) patients with fragility, while the multimodality assessment detected 45 (33.6%) patients. Barthel index and depressive symptoms in the GDS were the most altered items (19 and 20 patients respectively) in the multimodality assessment. Concordance between VES-13 and multimodality assessment was 83.8%, but Cohen's Kappa was 0.65, not reaching the suitable level of 0.70.

Conclusions
VES-13 was capable of identifying a higher number of patients with fragility at first visit in the routine screening performed in an outpatient HF clinic, than the multimodality assessment used in the last decades. Follow-up of patients and further analysis will allow evaluating which of these two approaches adds more value for outcomes prediction.

Funding Acknowledgement
Type of funding sources: None.
The effects of illness perceptions on health-related quality of life in patients with atrial fibrillation
Authors: Holmlund L , Hornsten C , Hornsten A , Olsson K , Valham F , Hellstrom Angerud K 
Published: October 2022

Abstract

Background/Introduction
Health-related quality of life (HRQoL) in patients with atrial fibrillation (AF) is lower compared with the general population, healthy controls, and patients with other cardiovascular diseases. Many factors influence HRQoL in patients with AF negatively. Illness perceptions have been shown to be related to HRQoL in a number of diseases, but, the role of the effect of illness perception on HRQoL in patients with AF is lacking.

Purpose
The aim was to explore the relationship between illness perceptions and HRQoL in patients with AF.

Methods
The present study with a cross-sectional design included 167 patients with AF. Patients scheduled for cardioversion at a University hospital in Sweden, filled in self-reported, validated questionnaires. Illness perception was measured with the Revised Illness Perception Questionnaire (IPQ-r) and HRQoL was measured with the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmias (ASTA). The illness perception part of IPQ-r consists of seven dimensions (Timeline acute/chronic, Consequences, Emotional Representations, Personal control, Treatment control, Illness coherence, and Timeline cyclic). Dimensions of the IPQ-R with significant correlations with HRQoL were included in a multiple regression model.

Results
The participants consisted of 69.5% men and the mean age for the group was 68,8±10,4. The correlations for the dimensions of illness perception are presented in Table 1. The multiple regression analysis (Table 2) showed that Consequences (p&lt;0,001) and Emotional Representations (p=0,003) were significantly associated with and adversely affected HRQoL. The model explained 35% of the total variance in HRQoL (R2= 0,350, p=0,001).

Conclusion(s)
Emotional representations such as anger, anxiety, depression, and the consequences that patients experience that the condition has on daily life, negatively affect patients with AF. The relationship between illness perception and quality of life, indicates that efforts to change illness perceptions can be useful in improving HRQoL. In addition to information, patients need to be given the opportunity to talk about the disease, about their feelings, and about the consequences that the disease has on daily life. A challenge for healthcare will be to design support for each unique individual based on their illness perceptions.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Forskningslyftet, Umea UniversityStrategic Research Area Health Care Sience (SFO-V)
Using a co-designed, self-delivered, Avatar-based patient discharge education application to improve acute coronary syndrome patient knowledge
Authors: Zhang L , Gallagher R , Du H , Barry T , Foote J , Clark R 
Published: October 2022

Abstract

Background
30-day rehospitalisation following heart event among acute coronary syndrome (ACS) patients remains high and is largely contributed by poor disease-related knowledge and self-management, especially in the disadvantaged patient groups such as those with low education levels and inadequate health literacy. Traditional patient education methods fail to address these issues.

Purpose
This study aimed to test a unique consumer co-designed discharge education application (app) on patients' knowledge and its acceptability.

Methods
ACS patients (unstable angina, non-STEMI or STEMI) were recruited from Royal Adelaide Hospital at South Australia during admission, provided with the app via tablet for one-month self-delivered education. The app has undergone a rigorous development process with the substantial engagement of consumers (Figure 1). App content includes the Heart Foundation Six Steps to Cardiac Recovery including disease-related knowledge, risk factor management, and ACS responses, assessed at baseline, followed by first use at discharge and one month later. Patients and cardiac nurses rated the acceptability of the app.

Results
Among 22 Participants 81.8% were male (n=18), with a mean age of 59.7 (10.3) years, 45.5% (n=10) had not completed high school and nearly a quarter of the participants had marginal or below marginal health literacy. The diagnosis included STEMI (n=16, 72.7%) and non-STEMI (n=5, 22.7%). The majority of participants underwent percutaneous coronary intervention (PCI) (n=21, 95.5%)
Significant improvements were observed for overall coronary artery disease knowledge at one month (p=0.003) and the exercise and nutrition domains at discharge (p=0.029; p&lt;0.001) and one month (p=0.02; p=0.003) (Figure 2). Significant improvements were also observed for ACS knowledge and beliefs at discharge (p=0.008; p=0.038) and one month (p&lt;0.001; p=0.025) when ACS response attitude was also significantly improved at one month (p=0.036). Overall acceptability was high at 7.7/10 (n=22 nurses) and 8.3/10 (patients). The participants described the app as `clear, simple, easy to understand, as well as stimulating and interactive, better than a live person'.

Conclusion
This novel, self-delivered Avatar-based ACS discharge education App has the potential to provide discharge education for ACS patients even for those who have low education levels or inadequate health literacy. Results need to be confirmed in a randomised controlled trial.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The National Heart Foundation Australia
Is there an inter-manufacturer difference in generic clopidogrel response?
Authors: Hall S , Xia Y , Ahmed H , Iskhakov D , Alviar C , Berger J , Keller N , Bangalore S 
Published: October 2022

Abstract

Background
Differences in platelet aggregation response to generic clopidogrel by manufacturer has not been investigated.

Purpose
Compare rates of clopidogrel response among patients receiving medication produced by two different manufacturers after acute coronary syndrome and/or percutaneous coronary intervention.

Methods
This quality improvement project included 515 adult patients receiving clopidogrel for acute coronary syndrome or ischemic heart disease and referred for coronary angiography/percutaneous coronary intervention at a large, public hospital. The project was divided into two phases: 1. retrospective collection of baseline data; 2. two 12-week, prospective phases in which all clopidogrel in the hospital was restricted to a single manufacturer at a time. The primary outcome was clopidogrel response measured by platelet function testing defined as ADP response &lt;40% on light transmission aggregometry between two manufacturer groups. Aspirin response defined as arachidonic acid response &lt;20% was also measured.

Results
Of 515 total patients included in both phases (mean [SD] age, 64.5 [11.4] years; 351 [68.2%] men; 450 [87.4%] ACS), 52% were found to be clopidogrel responders based on results of platelet function testing (Table 1 – select variables). Among 135 patients in the prospective phase, there was a significantly lower proportion of patients who were clopidogrel responders in the Manufacturer 1 group compared to the Manufacturer 2 group (34.8% vs. 55.1%, p=0.03) (Table 2 – select variables). After adjustment for age, sex, BMI, aspirin response, therapeutic hypothermia, LHC indication, clopidogrel loading dose, time between loading dose and lab measurement, and manufacturer, aspirin response (OR [95% CI]: 0.96 [0.95–0.97], p&lt;0.001) and manufacturer (OR [95% CI]: 2.45 [1.18–5.22], p=0.02) were associated with clopidogrel response.

Conclusions
In a large public hospital, we observed that pharmacodynamic response to clopidogrel varied by drug manufacturer. Further investigation and/or regulation is needed to minimize inter-manufacturer variability.

Funding Acknowledgement
Type of funding sources: None.
Incremental prognostic value of stress CMR for cardiovascular risk stratification after a cryptogenic ischemic stroke
Authors: Pezel T , Toupin S , Sanguineti F , Kinnel M , Hovasse T , Unterseeh T , Champagne S , Garot P , Garot J 
Published: October 2022

Abstract

Background
One-third of ischemic strokes are “cryptogenic” without clearly identified etiology. Although coronary artery disease (CAD) is the main cause of death after stroke, the interest of CAD screening in patients with cryptogenic stroke is still debated.

Purpose
The aim of the study was to assess the incremental prognostic value of stress cardiovascular magnetic resonance (CMR) beyond traditional risk factors for predicting cardiovascular events in patients with a prior cryptogenic ischemic stroke.

Methods
Between 2008 and 2021, consecutive patients with prior cryptogenic strokes referred for stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction (MI). Univariable and multivariable Cox regressions were performed to determine the prognostic value of unrecognized MI and silent ischemia.

Results
Of 542 patients (55.2% male, mean age 71.4±8.8 years) who completed the follow-up (median 5.9 years), 66 (12.2%) experienced MACE. Silent ischemia and unrecognized MI were detected in 18% and 17% of patients, respectively. Using Kaplan-Meier analysis, silent ischemia and unrecognized MI were associated with the occurrence of MACE (hazard ratio, HR: 8.43 [95% CI: 5.11–13.9]; HR: 7.87 [95% CI: 4.80–12.9]; respectively, p&lt;0.001). In multivariable analysis, silent ischemia and unrecognized MI were independent predictors of MACE (HR: 8.08 [95% CI: 4.21–15.5]; HR: 6.65 [95% CI: 3.49–12.7]; respectively, p&lt;0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI=0.428; IDI=0.048).

Conclusions
In patients with prior cryptogenic stroke, stress CMR findings have an incremental prognostic value to predict MACE over traditional risk factors.

Funding Acknowledgement
Type of funding sources: None.
The association between fitness measurement and cardiac rehabilitation completion
Authors: Alotaibi J , Doherty P 
Published: October 2022

Abstract

Background
Assessing functional capacity for patients entering a CR programme is strongly recommended by various organisations. Based on the result of this assessment, the intensity of exercise is prescribed, the risk is stratified and by the end of the programme, the effectiveness of the exercise intervention is evaluated [1]. However, despite the recommendations relating to assessing patients' level of functional capacity prior to the programme and following it, less than one -third of CR patients undertook this test [2].

Aims
The aim of this study was to examine the association between whether the patient's fitness is measured at bseline assessment and the completion of their Cardiac Rehabilitation (CR) programme.

Method
A retrospective observational study using data from 102 CR centres from January 2015 to April 2016 was conducted to address this aim. Logistic regression was used to investigate the association and taken into account some factors including age, gender, Body Mass Index (BMI), employment status, total number of comorbidities

Results
Data relating to 31,433 patients (mean age of 65.20±11.80 years, 73% of whom were male) was analysed. Out of the total number of patients, 9,785 (31%) undertook a fitness assessment at baseline. Patients whose fitness was measured were 48% more likely to complete their CR programme compared to those whose fitness was not measured.

Conclusion
Patients are more likely to complete CR if their fitness is measured at baseline which represents one the largest modifiable service-level characteristics reported in CR

Funding Acknowledgement
Type of funding sources: None.
Incremental prognostic value of stress CMR in symptomatic patients with coronary stenosis on CCTA
Authors: Pezel T , Hovasse T , Lefevre T , Sanguineti F , Champagne S , Benamer H , Neylon A , Toupin S , Garot P , Chevalier B , Garot J 
Published: October 2022

Abstract

Background
Noninvasive functional imaging is often performed in patients with obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CCTA). However, the prognostic value of stress cardiovascular magnetic resonance (CMR) is unknown in patients with coronary stenosis of unknown significance on CCTA.

Purpose
To assess the prognostic value of stress CMR in symptomatic patients with obstructive CAD of unknown significance on CCTA.

Methods
Between 2008–2020, consecutive symptomatic patients without known CAD referred for CCTA were screened. Patients with obstructive CAD (at least 1 ≥50% stenosis on CCTA) were further referred for stress CMR and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction.

Results
Of 2,210 patients who completed CMR, 2,038 (46.5% male, mean age 69.8±12.2 years) completed follow-up (median 6.8 [IQR 5.9–9.2] years); 281 experienced a MACE (13.8%). Inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with MACE (HR: 4.51, [95% CI: 3.55–5.74]; and HR: 3.32, [95% CI: 2.55–4.32], respectively; p&lt;0.001). In multivariable Cox regression, number of segments with &gt;70% stenosis, with noncalcified plaques and number of vessels with obstructive CAD were prognosticators (p&lt;0.001). The presence of inducible ischemia and LGE were independent predictors of MACE (HR: 3.97, [95% CI: 3.43–5.13]; HR: 2.30, [95% CI: 1.52–3.33]; p&lt;0.001). After adjustment, stress CMR showed the best improvement in model discrimination and reclassification above traditional risk factors and CCTA (C-statistic improvement: 0.04; NRI=0.421; IDI=0.047).

Conclusions
In symptomatic patients with obstructive CAD of unknown significance on CCTA, stress CMR had incremental prognostic value to predict MACE.

Funding Acknowledgement
Type of funding sources: None.
Can artificial intelligence prediction of successful atrial fibrillation catheter ablation therapy be interpretable?
Authors: Ogbomo-Harmitt S , Muffoletto M , Zeidan A , Qureshi A , King A , Aslanidi O 
Published: October 2022

Abstract

Background
Radiofrequency catheter ablation (RFCA) therapy is the first-line treatment for atrial fibrillation (AF), the most common type of cardiac arrhythmia globally. However, the procedure currently has low success rates in dealing with persistent AF, with a reoccurrence rate of ∼50% post-ablation. Therefore, artificial intelligence (AI), particularly deep learning (DL), has increasingly been applied to improve and optimise treatments for AF. However, AI is limited by its black-box nature. Therefore, a factor hindering the broad clinical application of DL in AF is the lack of assurance that the DL model is using physiological relevant features when making its prediction. In order to provide this assurance, its decision process needs to be interpretable and have biomedical relevance.

Aim
This study aims to explore interpretability in DL prediction of successful ablation therapy for AF and evaluate if pro-arrhythmogenic regions in the left atrium (LA) were used in its decision process.

Methods
LA models with segmented fibrotic tissue were derived from 122 late gadolinium-enhanced magnetic resonance (LGE MR) images of persistent AF patients. To increase the dataset size, an additional 199 synthetic LA tissue models were generated from the LGE MR images. Two ablation strategies were simulated: fibrosis-based ablation (FIBRO) and a rotor-based ablation (ROTOR). RFCA strategy success was determined by its ability to terminate persistent AF in 2s with less than 40% of the tissue ablated [1]. A convolutional neural network (CNN) was developed to predict the success of each RFCA strategy, and gradient weighted class activation maps (GradCAM) were used to assess if the CNN was using locations of pro-arrhythmogenic regions in its decision process on an independent test set of 50 LA tissue models.

Results
For predicting the success of the FIBRO strategy, the CNN model had an AUC (area under the receiver operating characteristic curve) of 0.92±0.02, recall of 0.89±0.03 and precision of 0.82±0.02. For the ROTOR strategy, the AUC was 0.77±0.02, the recall was 0.93±0.04 and the precision was 0.76±0.02. Finally, the independent test set's GradCAM saliency maps showed that 62±25% and 71±13% of ablation lesions (known from the LA model simulations, but unseen by the CNN during training) coincided with informative regions in the saliency maps for the FIBRO and ROTOR strategies, respectively (Figure 1).

Conclusion
The most informative regions of the saliency maps coincided with the successful ablation lesions, suggesting that the DL model was able to identify ablated pro-arrhythmogenic regions by leveraging structural features of LGE MR images. In the future, this technique could provide a clinician with a decision support tool and increase confidence in the AI prediction.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UK Medical Research Council
Neuronal nets and logistic regression analysis provide improved prediction of infective endocarditis compared to the modified Duke Score: a post-hoc analysis of the prospective PRO-ENDOCARDITIS study
Authors: Vogel L , Dykun I , Totzeck M , Rassaf T , Mahabadi A 
Published: October 2022

Abstract

Introduction
The modified Duke score is the currently recommended diagnostic algorithm in suspected infective endocarditis (IE). The categorization in major and minor criteria enables an easy clinical application, but may not optimally utilize individual patient's information. In contrast, detailed statistical evaluation of multiple characteristics using artificial intelligence and logistic regression report improved prediction of various cardiovascular diseases over conventional clinical strategies. We tested the hypothesis that neuronal nets and logistic regression analysis would provide improved prediction of IE as compared to the modified Duke score.

Methods
This post-hoc evaluation of the prospective observational PRO-ENDOCARDITIS study was conducted at the West German Heart and Vascular center between December 2017 and May 2019 and includes 261 patients. Duke criteria and clinical characteristics were prospectively collected. Transesophageal echocardiography (TEE) imaging was evaluated by a blinded cardiologist at a central core-lab. IE as primary endpoint was adjudicated by an independent clinical endpoint committee. The database was divided into a training (70%) and validation cohort (30%). We compared the value of the Duke score, neuronal nets and logistic regression analysis for prediction of the primary endpoint.

Results
The mean age was 60.1±16.1 years, 37.2% were female. In 47 cases, IE was present. The modified Duke score achieved an AUC of 0.863 in the training cohort and 0.913 within the validation cohort. The logistic regression and the neural net exceeded the predictive value in both cohorts (training cohort: 0.992 and 0.986; validation cohort: 0.964, 0.957; for logistic regression and neuronal nets, respectively, Figure 1). Without the use of TEE, the remaining Duke criteria only poorly predicted IE (training cohort: 0.771, 0.951 and 0.938; validation cohort: 0.835, 0.862 and 0.780, for the Duke score, logistic regression and neuronal nets, respectively).

Discussion
Logistic regression analysis and neuronal nets provide improved prediction of IE as compared to the clinically established modified Duke score. Further studies on larger databases are needed to confirm our results and provide algorithms for clinical routine.

Funding Acknowledgement
Type of funding sources: None.