bluuebunny/crossref_metadata_2025_split huggingface dataset:
Causation of potential drug to drug interactions alerts, alert overrides, and adverse drug events in critical cardiac patients
Authors: Mohamed Ariff A , Nalliah S N , Abdul Hadi H A H , Win N T W , Thoulath M I T , Aktifanus A T J , Mutaya S M M , Yusof A K M 
Published: October 2022

Abstract

Background
Drug-drug interactions (DDIs) leading to adverse drug events (ADEs) are of special interest because they represent preventable medication errors. Preventable ADE can result in errors involving the manifestation of adverse patient outcomes. Given the high complexity of critically ill cardiac patients, it is important to learn how Clinical Drug Decision Support System (CDDSS) affects outcomes in this population and the number of alerts that are likely to be safely suppressed.

Purpose
Identify adverse DDIs that are clinically detected and review the appropriateness of the doctor's actions to the potential DDIs (PDDIs) alert. Study Design: This is a prospective observational study conducted at a critical cardiac care unit (CCU) in a selected tertiary cardiac center for a duration of six months.

Methods
Physicians treating critically ill cardiac patients were presented with PDDIs data which were acquired from two commercially available CDDSS. The relationship between the decision to prescribe and factors hypothesized to affect physicians' decisions was examined.

Results
Evaluation of 709 patient medication profiles were conducted, resulting in 521 assessed patient profiles having had one or more PDDIs with 87% of them being influenced by polypharmacy. Ninety-one patients (17.5%) were associated with one or more adverse DDIs. Of the total 3284 potential DDIs alerts, 95.5% of the alerts were overridden. Preventable ADE as an outcome of inappropriate override has resulted in 83.1%. (236/284) of adverse DDIs. Whereas appropriate overrides as an outcome of clinically irrelevant ADE were 16.9% (48/284).

Conclusion
Poor preventive actions taken by the doctors caused drug-related harm to the patients despite having CDDSS in place. This suggests that CDDSS is an important application to minimize the harm associated with adverse DDIs by alerting physicians of potentially unsafe situations.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): International Medical UniversityNational Heart Institute
Activation of the HeartLogic algorithm on top of heart failure care: a multicenter propensity-matched cohort analysis
Authors: Feijen M , Beles M , Than Y Z , Cordon A , Dupont M , Treskes R W , Caputo M , Mullens W , Van Bokstal K , Auricchio A , Egorova A D , Maes E , Beeres S L M A , Heggermont W A 
Published: October 2022

Abstract

Background
Hospitalization for decompensated heart failure may be prevented by early detection of fluid retention. The multisensory HeartLogic™ algorithm, incorporated in a cardiac implantable electronic device (CIED) aims to detect impending fluid retention and thereby enables timely adjustment of medical therapy. However, it is to be investigated whether HeartLogic™ provides clinical benefit compared to heart failure care with conventional telemonitoring. This analysis investigates the effects of activating HeartLogic™ on top of heart failure care with telemonitoring on the number of episodes with fluid retention and heart failure related hospitalizations.

Methods
Heart failure patients with a CIED were recruited from the outpatient clinics of four European cardiology departments. All patients were included from January 2017 until December 2020, and followed-up for 365 days. Patients with a CIED and an activated HeartLogic™ algorithm were compared to a 1:1 propensity score-based matched control group consisting of patients with CIED on routine telemonitoring. Data of all episodes of (impending) fluid retention with ≥2 signs and symptoms of congestion were included for analyses.

Results
Data of 127 patients with an activated HeartLogic™ algorithm were adequately matched with 127 heart failure patients with a CIED on routine telemonitoring. Median age was 68 [59–75], majority of patients were male (80%), 46% had an ischemic etiology of heart failure. Total follow-up consisted of 254 patient years. During follow up, 77 (61%) individual patients with HeartLogic™ experienced an episode of fluid retention, compared to 85 (67%) induvial patients on routine telemonitoring. Patients with an activated HeartLogic™ algorithm had 1.62±1.78 events of fluid retention per patient year (PPY) compared to 2.61±3.71 events PPY in patients on routine telemonitoring, p&lt;0.01 (Figure 1). Hospitalization for fluid retention occurred in 7 (6%) HeartLogic™ patients (0.06±0.27 hospitalizations PPY) compared to 13 (10%) patients on routine telemonitoring (0.15±0.45 PPY), p=0.07 (Figure 2A). Mean length of hospitalization in days PPY was 0.29±1.46 in patients with HeartLogic™ and 1.59±6.30 in patients on routine telemonitoring, p=0.02 (Figure 2B).

Conclusion
In a real-world multicenter heart failure population, activation of the HeartLogic™ algorithm was associated with a lower number of episodes of fluid retention per patient and a shorter duration of hospitalization for congestive heart failure.

Funding Acknowledgement
Type of funding sources: None.
The effectiveness of a telemedical program for COVID-19 positive high-risk patients in domestic isolation
Authors: Brunelli L , Poelzl L , Hirsch J , Engler C , Naegele F , Egelseer-Bruendl T , Scheffauer T , Rassel C , Schmit C , Nawabi F , Luckner-Hornischer A , Bauer A , Poelzl G 
Published: October 2022

Abstract

Background
For almost two years, the Covid-19 pandemic has posed an enormous challenge to healthcare systems. Recurrent waves of disease brought the health systems to the limit of their resilience.

Purpose
The Tele-Covid telemedicine care program was installed in December 2020 to monitor high-risk patients in home isolation. Close monitoring allows early detection of disease deterioration and timely intensification of therapy, ideally avoiding intensive care. Conversely, if the course of the disease is stable, unnecessary hospitalisation can be avoided, thus reducing the burden on the healthcare system.

Methods
Patient acquisition was performed in collaboration with the local public health service and primary care physicians. Covid-19 positive high-risk patients (age &gt;65 years and/or severe comorbidities) from the greater Innsbruck area were fitted with an ear sensor-based home monitoring system. The ear sensor measures SpO2, respiratory rate, body temperature and heart rate. The monitoring team (25 medical students supervised by 6 physicians) provided continuous monitoring of vital signs (24/7).
After validation of the measurements, the collected parameters were evaluated using a specially developed risk score. If a defined risk score was exceeded, the patient was contacted by telephone. The combination of the clinical condition and the risk score determined the further course of action: (a) wait and see, (b) notify the primary care physician, or (c) refer for inpatient admission.
The program was active from December 2020 to March 2022. In Summer 2021, the program was temporarily paused due to the epidemiological situation.

Results
A total of 132 patients (59.8% women) were monitored. The median age was 74 years (IQR: [67.3–80.8]). 91 patients (68.9%) had at least one relevant comorbidity. During the monitoring period, hospitalisation was required in 20 patients (15.2%), 3 of whom were transferred to the intensive care unit. Of the hospitalised patients, 3 (15%) patients died. During the same monitoring period, the Austrian Ministry of Health reported a mortality rate of 20.5% of all hospitalised patients in Austria aged 70–79 years. Subjectively, the patients felt safe due to close monitoring.

Conclusion
The Tele-Covid program is the successful implementation of a remote monitoring system in a pandemic situation. In the future, a broad application of the program is feasible.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Region of the Tyrol
Clinical relevance of the single-lead ECG of the Apple Watch
Authors: Pepplinkhuizen S , Hoeksema W F , Van Der Stuijt W , Smeding L , Wilde A A M , Knops R E 
Published: October 2022

Abstract

Introduction
The Apple Watch (AW) is one of the first commercially available wearable with built-in electrocardiogram (ECG) electrodes to perform a single-lead ECG to detect atrial fibrillation (AF). The AW ECG application showed to have a high rate of unclassifiable notifications. The interpretation of the single-lead ECG by a physician can possibly reduce the total of unclassifiable notifications and contribute to the overall accuracy to detect AF.

Methods
This was a prospective, non-randomized, single center observational study to evaluate the accuracy and interrater agreement of the single-lead ECG of the AW. Patients scheduled for cardioversion for atrial fibrillation were asked for participation. The AW series 6 was used with WatchiOS 7.2 or 7.3 and ECG algorithm version 2.0. A single-lead ECG was obtained pre-conversion and, when cardioversion was successful, post-conversion. All single-lead ECGs and 12-lead ECGs were adjudicated by two physicians, agreement was reached by consensus. The AW single-lead ECG notification was compared to the physicians “gold-standard” interpretation of the 12-lead ECG. Sensitivity and specificity of the AW single-lead ECG and Kappa coefficient were calculated.

Results
In total, 74 patients were included. Mean age was 67.1±12.3 years and 20.3% were female. In total 65 AF and 64 sinus rhythm (SR) single-lead ECG measurements were obtained. Of these measurements, 27.9% (36/129) showed an unclassifiable notification. The AW ECG notification showed a sensitivity of 93.5% to detect AF and a specificity of 100% to detect SR (K= 0.94). After adjudication of the unclassifiable notifications by two independent physicians 1.6% (2/129) of the measurements remained unclassifiable. When including the by the physicians adjudicated unclassifiable recordings the sensitivity to diagnose AF was 89.2% and the specificity to detect SR was 93.8% (K=0.83). The adjudication of all single-lead ECGs by the two physicians showed a sensitivity of 90.6% to detect AF and specificity of 95.2% to detect SR (K= 0.83) (Table 1). All SR and AF notification by the AW were similarly adjudicated by the two physicians. The kappa coefficient for interrater agreement between both physicians was 0.69 for all single-lead ECGs and 0.58 for unclassifiable notifications specific.

Conclusion
Unclassifiable notifications of the AW can be reduced by physicians interpretation of the single-lead ECG, however the interrater agreement is only moderate. The physicians interpretation of the single-lead ECGs did not increase the accuracy to detect AF and the clinical relevance of the single-lead ECG, in addition to the AW notification, should therefore be questioned.

Funding Acknowledgement
Type of funding sources: None.
Telemedical monitoring and coaching improves survival and hospitalisation rates in heart failure
Authors: Knoll K , Rosner S , Trenkwalder T , Lennerz C , Dittrich D , Kloss C , Doerr M , Schunkert H , Reinhard W 
Published: October 2022

Abstract

Aims
To investigate the effectiveness of a combined telemonitoring and telecoaching programme for chronic heart failure patients at high risk for hospitalisation compared to usual care in a real life setting. The applied telehealth programme consisted of regular individualised telecoaching sessions as well as daily remote telemonitoring of heart failure signs and symptoms.

Methods
Between January 2018 and September 2020, 6,065 heart failure patients were enrolled in a combined telehealth programme and retrospectively compared to a propensity matched usual care group (n=6,065). All participants were members of a statutory health insurance. Median follow-up was 442 days (IQR 309–681). Endpoints were all cause mortality, number and duration of hospitalisations.

Results
After 1 year the combined telecoaching and telemonitoring programme significantly reduced all-cause mortality probability compared to usual care (11.0 vs. 5.8%, p&lt;0.001). The corresponding number-needed to treat to prevent one death in one year was 19.3. In addition, the number of hospitalisations for heart failure (17.9 vs. 21.8 per 100 patient years, p&lt;0.001) and all cause hospitalisations (129.0 vs. 133.2, p=0.015), as well as their duration (2.0 vs. 2.6 days per year p&lt;0.001, and 12.0 vs. 13.4 days per year p&gt;0.001, respectivel y) were significantly lower in the telehealth group than in the usual care group.

Conclusion
In ambulatory heart failure patients at high risk for hospitalisation, a combined telemonitoring and telecoaching programme led to a reduction of heart failure hospitalisations and all-cause mortality compared to standard care.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Health Care Systems GmbH (HCSG), Pullach i. Isartal
Efficacy of controlvit as a complementary strategy in reducing hospitalizations in patients with heart failure. Randomized clinical trial
Authors: Achury D M , Garcia A G , Marino A M , Bohorquez W B , Gonzalez R G 
Published: October 2022

Abstract

Introduction
In patients with heart failure, the main cause of hospital admissions is due to episodes of decompensation, which are associated with an increase in the costs and resources needed for care; they have a negative impact on the quality of life and prognosis of the disease. Therefore, it is necessary to design, evaluate and implement alternatives to achieve efficient follow-up and monitoring, improving adherence to treatment and helping identify decompensation episodes that facilitate their early treatment, so new hospital admissions can be avoided. For this reason, the use of information and communication technologies (apps) is emerging as an excellent strategy for the possibility of improving coverage, real-time monitoring and timeliness of care. ControlVit® is an electronic application that allows permanent, real-time monitoring of biomedical measurements for early detection of complications.

Objective
To determine the efficacy of ControlVit® as a complementary strategy in reducing hospital admissions in patients in a heart failure program.

Methodology
A randomized, placebo-controlled, open-label clinical trial was conducted, (n=140), included patients with heart failure under controlled clinical follow-up in a structured heart failure program, into NYHA FC II–IV, capable of handling smartphones and with permanent internet connectivity. All patients were provided with educational elements, a scale and a blood pressure monitor to enter clinical data and a symptom questionnaire necessary for follow-up. The patients were randomized to 2 groups: intervention: use of ControlVit® vs. placebo, with a 6-month follow-up. The primary outcome was the difference in readmissions for heart failure between the 2 groups. Patients on the waiting list for heart transplantation or use of ventricular assist devices were excluded. All participants signed informed consent and the protocol was approved by the institutional ethics committee.

Results
A total of 140 patients were included in the study (intervention = 71, placebo = 69), with an average age of 66 years, 71% were men, the main etiology of heart failure was ischemic (60%), the main comorbidities were arterial hypertension (44%), dyslipidemia (42%), hypothyroidism (38%), chronic kidney disease (38%), and diabetes mellitus (27%). During follow-up, there were 6 deaths (3 in each group) and 17 readmissions (3 in the intervention group and 14 in the control group). After adjustment for comorbidities, HR 0.72 CI95 (0.52; 0.92), p=0.0325 was found.

Conclusion
In patients with heart failure, ControlVit® is a useful and complementary tool for follow-up, which reduces hospital admissions due to episodes of decompensation.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): German Saldarriega award.Javeriana University
Healthcare utilization and costs associated with a diagnosis of incident atrial fibrillation
Authors: Deshmukh A D , Iglesias M I , Khanna R K , Beaulieu T B 
Published: October 2022

Abstract

Background
Atrial fibrillation (AF) is the most prevalent arrhythmia among adults worldwide and is associated with an increased risk of heart failure, stroke, and death. Prior studies have highlighted the healthcare burden associated with AF; however, contemporary data is lacking. As AF incidence and prevalence continue to increase due to the aging of the population, current estimates are needed for adequate healthcare resource allocation and policy decisions.

Purpose
The purpose of our study was to examine the healthcare utilization and cost burden associated with a diagnosis of incident AF in the United States (US).

Methods
Using the 2017–2020 Optum Clinformatics database, an administrative claims data of commercially insured individuals in the US, adult patients with an incident diagnosis of AF were identified. Adults with AF were matched on demographic and comorbid characteristics to those without AF using a propensity score greedy-matching algorithm with a 1:1 case to control ratio. Outcomes including medical services (inpatient admissions, emergency room [ER] visits, outpatients admissions, other services), utilization (all-cause, cardiovascular [CV]-related), and healthcare costs (sum of all medical services and prescription costs; adjusted for medical inflation and reported in 2021 US $) in the one-year post-incident diagnosis of AF were then compared among the matched cohort. Logistic and general linear modeling assessed healthcare utilization and cost outcomes.

Results
A total of 159,242 matched participants (79,621 AF cases and 79,621 non-AF controls) were identified. Among patients with AF, the mean age was 74 years, and 51% were females. Among the non-AF controls, the mean age was 73 years, and 50% were females. Patients with incident AF had significantly higher all-cause inpatient visits (relative risk [RR] 1.72; 95% confidence interval [CI]: 1.71–1.73), cardiovascular-related inpatient visits (RR 2.42; 95% CI: 2:41–2:44), as well as cardiovascular-related ER visits (RR: 2.36; 95% CI: 2:30–2:42) as compared to non-AF controls in the 1-year following diagnosis (Figure 1). The one-year mean total healthcare costs were $25,006 (95% CI $24,357-$26,912) higher among patients with AF as compared to non-AF controls ($63,031 vs $38,025, p&lt;0.001).

Conclusion
Patients with AF had significantly higher medical services use than non-AF controls. The higher medical services utilization among the AF cohort translated into a considerably higher economic burden in this cohort. Timely management and treatment remain critical in alleviating the significant financial and health burden imposed by AF on patients, payers, and providers.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Johnson and Johnson
Conflicts of interest among authors of the ESC guidelines for the diagnosis and treatment of acute and chronic heart failure between 2012 and 2021
Authors: Schneider B , Stoellberger C 
Published: October 2022

Abstract

Background
In 2011, the Institute of Medicine (IOM) published standards for developing trustworthy clinical practice guidelines recommending that “Whenever possible guideline development group members should not have conflicts of interest (COIs)... Members with COIs should represent not more than a minority of the guideline development group members. The chair or cochair should not be a person with COIs.”

Purpose
Aim of this study was to assess if the standards of the IOM have influenced the development of the heart failure guidelines of the European Society of Cardiology (ESC) published between 2012 and 2021.

Methods
From the ESC homepage, the declarations of COIs of task force members (TFM) and reviewers of the guidelines for the diagnosis and treatment of acute and chronic heart failure from 2012, 2016 and 2021 were retrieved. The number of COIs was assessed for each version of the guideline.

Results
Regarding the 2012 guidelines, 24/26 TFM (92%) indicated any COI (range 1–36). Overall, 249 COIs were reported (10.4±7.3 per member). 20/26 TFM (77%) received direct personal payments (8.0±6.6 COIs per member, range 1–28). The chairperson declared 8 COIs. Among the reviewers, 32/38 (84%) indicated any COI (8.1±5.9 COIs per reviewer, range 1–29).
Regarding the 2016 guidelines, 19/21 TFM (90%) indicated any COI (range 1–35). Overall, 250 COIs were reported (13.2±9.9 per member). 17/21 TFM (81%) received direct personal payments (10.4±7.4 COIs per member, range 1–28). The chairperson declared the second most COIs (n=33) and the co-chairperson the fourth most COIs (n=21). Among the reviewers, 67/87 (77%) indicated any COI (8.1±7.3 COIs per reviewer, range 1–31).
In 2021, 28/31 TFM (90%) indicated any COI (range 2–54). Overall, 391 COIs were reported (13.9±13.8 per member). 23/31 TFM (74%) received direct personal payments (9.7±7.5 COIs per member, range 1–29). The chairperson declared 5 COIs. Among the reviewers, 91/117 (78%) indicated any COI (4.8±4.3 COIs per reviewer, range 1–20).

Conclusion
Despite the recommendations of the IOM, the proportion of TFM and reviewers of the ESC heart failure guidelines with COIs remains high in 2021 (90% and 78%, respectively). Overall, the number of COIs of the TFM have increased from 2012 to 2021, and direct personal payments to the TFM remained at a high level. Since COIs can influence healthcare decision makers and may consciously or unconsciously influence choices made throughout the guideline development process, the ESC should follow the standards of the IOM.

Funding Acknowledgement
Type of funding sources: None.