bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sacubitril/valsartan versus in empagliflozin heart failure with preserved ejection fraction
Authors: Alnsasra H , Tsaban G , Aboalhasan E , El Nasasra A , Azuri J , Hammerman A , Arbel R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Heart failure with preserved ejection fraction (HFpEF) is associated with frequent hospitalizations and an increased risk of death. Empagliflozin was recently reported to reduce the combined risk of cardiovascular death or hospitalization for heart failure (HF) among patients with HFpEF, whereas Sacubitril/Valsartan has shown only marginal significance benefits in these patients. We aimed to compare the value for money of these treatments.

Methods
We compared the annualized Cost Needed to Treat (CNT) to prevent the composite outcome of HF hospitalization and cardiovascular death with Empagliflozin or Sacubitril/Valsartan. The CNT was estimated by multiplying the drug-specific annual cost and the annualized Number Needed-to-Treat (aNNT) which was calculated based on data from the EMPEROR-Preserved and PARAGON -HF trials for Empagliflozin and Sacubitril-Valsartan, respectively. Costs were based on 2021 US prices. We performed scenario analyses to attenuate the differences between the studies’ populations. Subgroup analyses were performed across diabetes status.

Results
The aNNT with Empagliflozin in EMPEROR-Preserved was 61 (95% CI: 41-128) versus 53 (28-∞) with Sacubitril-Valsartan in PARAGON-HF, with an annual cost of 4,797$ versus 6,298 $, respectively. The corresponding CNTs were therefore $292,620 (95% CI: 196,679 - 614,023) for Empagliflozin and $333,834 (95% CI: 176,365 - ∞) for Sacubitril-Valsartan. In diabetic patients, the corresponding CNTs were $254,244 (95% CI: 158,303 - 882,659) for Empagliflozin versus $308,639
(95% CI: 132, 2740 - ∞) for Sacubitril-Valsartan. In non-diabetic patients, the corresponding CNTs were $326,200 (95% CI: 201,476 - 1,443,914) for Empagliflozin versus $333,834 (170,066 - ∞) for Sacubitril-Valsartan.

Conclusion
Empagliflozin provides better value for money than Sacubitril-Valsartan in preventing HF hospitalizations and cardiovascular death among patients with HFpEF. This difference was more pronounced among patients with diabetes.
Benefits of cardiac rehabilitation in cardio-renal patients: a retrospective study of heart failure 578 patients with reduced ejection fraction
Authors: Mroue A , Roueff S , Kovalska O , Iliou MC 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Chronic kidney disease (CKD) is common during the course of heart failure (HF). It is often associated with worse prognosis and complicates the management of these patients. Moreover CKD is accompanied by sarcopenia, which may limit the benefits of cardiac rehabilitation (CR) in the cardio-renal syndrome (CRS).
The aim of this study was to evaluate the effect of CR on the physical capacities according to the stage of CKD assessed by a cardiorespiratory exercise test (CPET) at the beginning and end of the program in patients with reduced ejection fraction (HFrEF).

Methods
This is a retrospective study, conducted from January 2004 to December 2019 on 573 consecutive HFrEF patients, who benefited from a 4-week CR.
Patients were divided into 4 groups according to their GFR (group (G) 1 &gt;= 60; G2: 45-59; G3: 30-44; G4 &lt; 30 ml/min/1.73m². We compared these groups (ANOVA test) and looked with multivariate analysis for factors associated with an improvement in peak VO2 (VO2p).

Results
Of the general population, 38% of patients had a GFR&lt;60ml/min. After CR, there was an improvement in VO2p (15.4 vs 17.8, p=0.00009), SV1 (10.5 vs12.4, p=0.0001), watts (77 vs 93.6, p&lt;0.000), and BNP (688 vs 488, p=0.00002). With decreasing stages of CKD, there was a deterioration in VO2p (16.2, 14.3, 13.6, 13.3), SV1 (10.9, 10.1, 9.3, 9.1), watts (83.4, 69.2, 66.3, 55.2), and an increase BNP levels (570, 885, 771, 1235 pg/ml). The improvement in VO2p, SV1, watts, BNP was statistically significant for all stages of CKD except in group 4 for VO2p (13.3 vs 14.4, p=0.1).
In multivariate analysis factors predicting improvement in VO2p were baseline VO2p and maximal systolic blood pressure.

Conclusion
CR is beneficial in HFrEF patients with CKD. CRS should not be a barrier to prescribing CR.
Skeletal muscle mass metrics as factors in the prognosis of heart failure patients
Authors: Uchida S , Kamiya K , Hamazaki N , Nozaki K , Ichikawa T , Yamashita M , Noda T , Maekawa E , Yamaoka-Tojo M , Matsunaga A , Ako J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI Grant

Background
Sarcopenia is a chronic condition that is characterized by the loss of skeletal muscle mass with declining muscle strength and/or performance that occurs gradually with aging. It has been reported that sarcopenia is highly prevalent in patients with heart failure (HF) and is a poor prognostic factor. Therefore, it is important to accurately assess skeletal muscle mass in patients with HF. However, there are no reports that have simultaneously examined different skeletal muscle mass metrics as factors in the prognosis of HF patients.

Purpose
The purpose of this study is to examine if the different skeletal muscle mass metrics are associated with the prognosis of HF patients.

Methods
We examined a total of 869 patients with HF, aged ≥20 years (73 [63, 80] years; 537 males), who were admitted to our hospital and participated in an inpatient cardiac rehabilitation program. We used skeletal muscle mass index (SMI) as measured by bioelectrical impedance analysis (BIA), mid-upper arm circumference (MUAC), arm muscle circumference (AMC), and calf circumference (CC) as metrics of skeletal muscle mass. The primary outcome was all-cause deaths, and secondary outcome was HF readmission. To investigate the association between each skeletal muscle mass metric and prognosis, patients were divided into three groups according to the tertiles of SMI, MUAC, AMC, and CC. In addition, cumulative event rates of survival curves, Gray test, and Fine & Gray test were performed to evaluate the prognostic predictive capability.

Results
Over a median follow-up period of 0.9 years (interquartile 0.4–1.9) years, a total of 80 deaths and 195 HF readmissions occurred in the patients. Cumulative event rates of survival curves and Gray test showed that there was a significant decrease in all-cause mortality and HF readmission in the high MUAC group and high AMC group compared to their respective low groups (P &lt; 0.05). Fine & Gray test after multivariate adjustment showed significantly better prognosis in the high MUAC group and high AMC group compared to their respective low groups (All-cause mortality: high MUAC group, subdistribution hazard ratio [sHR] = 0.42, 95% confidence interval [CI] = 0.20-0.88, P &lt; 0.05; high AMC group, sHR = 0.34, 95%CI = 0.16-0.72 P &lt; 0.05, HF readmission: high MUAC group, sHR = 0.69, 95%CI = 0.47-1.00, P &lt; 0.05; high AMC group, sHR = 0.63, 95%CI = 0.43-0.93, P &lt; 0.05).

Conclusion
Patients with HF who maintained high MUAC and high AMC had a good prognosis. CC and SMI were not associated with the prognosis of HF patients. This suggests the importance of evaluating MUAC and AMC in HF patients.
Inflammation in acute coronary syndrome: prognostic significance
Authors: Monteiro E , Barbosa J , Guimaraes J , Fernandes D , Costa G , Gomes A , Saleiro C , Campos D , Sousa J , Lopes J , Puga L , Teixeira R , Lourenco C , Madeira M , Goncalves L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In patients with acute coronary syndrome (ACS) the acute phase reactant, C-reactive protein (CRP), might be significantly elevated. Several reports suggest that CRP may play a direct pathophysiological role on the development and progression of atherosclerosis, and CRP values correlate with infarct size when measured by magnetic resonance imaging.

Purpose
The aim of the present study was to evaluate the prognostic value of CRP in patients presenting with an ACS.

Methods
Retrospective analysis of 635 consecutively admitted patients due to ACS in a single coronary intensive care unit. CRP levels were measured at admission. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether CRP was an independent predictor of outcome.

Results
In the studied sample, 75% were male. Median age was 69 [interquartile range (IQR) 57–78]. ST-elevation myocardial infarction (STEMI) occurred in 39.6%, non-ST segment elevation myocardial infarction in 44.9% and unstable angina in 15.5% of the patients. Median left ventricular ejection fraction (LVEF) was 48% (IQR 40–55%) and median CRP level at admission 0.7 mg/dL (IQR 0.5–1.9 mg/dL). Regarding important comorbidities and past medical history, 75.9% had hypertension (HTN), 34.0% diabetes, 20.3% chronic kidney disease (CKD), 68.6% dyslipidaemia and 17.3% heart failure (HF). The median follow-up was 34 months (IQR 22–72). In univariate analysis, CRP was significantly associated with all-cause mortality (HR 1.06 per 1 mg/dL increase, 95% CI 1.04–1.08, p&lt;0.001), as was gender, age, LVEF, STEMI and previous history of diabetes, HTN, CKD or HF. In multivariate analysis, CRP remained significantly associated with the primary endpoint (HR 1.02, 95% CI 1.00–1.05, p=0.033), as did age, LVEF and previous history of HF.

Conclusions
In our study, CRP at admission was an independent risk factor for all-cause mortality following an ACS. This finding indicates that inflammation associated with the acute event has a significant impact in the long-term prognosis. More evidence is needed to determine if treating inflammation (and when, in the course of the disease) could result in better outcomes.
The impact of comorbidities on preventive care of patients with myocardial infarction: is there still a gender gap?
Authors: King R , Giedrimiene D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The management of comorbidities is a significant component of preventive care to address the development of cardiovascular disease. Consistent care provided by a primary care physician (PCP) may be important in bridging any gender disparity in patients with comorbidities for the prevention of acute myocardial infarction (AMI).

Purpose
To identify gaps in established care by a PCP between genders and to evaluate the impact of comorbidities in patients who have experienced AMI.

Methods
Data collected for 250 total patients for this retrospective study included gender, PCP documentation, and comorbidities (hypertension, hyperlipidemia, diabetes, chronic kidney disease (CKD), arrhythmia) among patients admitted for an AMI. Data on previous MI, coronary artery bypass graft (CABG), and stent were also collected. 27 patients were excluded due to incomplete documentation.

Results
Out of 223 included patients, 138 (61.9%) were males and 85 (38.1%) were females with 172 (77.1%) having care by a PCP. PCP services have been utilized by 100 (72.5%) males and 72 (84.7%) females, mean age = 64.39 years.
Multiple comorbidities were identified in 191 (85.7%) out of 223 patients, including 156 (81.7%) who have used PCP services and number of comorbidities varied from 1 to 5. Of these patients, 74 (43.0%) had 1-2 comorbidities: males 51 vs 23 females, and 82 patients: 41 males vs 41 females had 3-5 comorbidities that impacted their treatment and preventive care.
Among the most common comorbidities were hypertension - n=165 (74.0%) and hyperlipidemia - n=157 (70.4%). Other comorbidities included diabetes - n=82 (36.8%), CKD - n=42 (18.8%), and previous arrhythmia - n=35 (15.7%). Overall, the utilization of PCP services was between 83-93% in these patients with documented comorbidities.
Gender-based comparison between patients who have utilized PCP services showed that more males were diagnosed with hypertension than females: 78 vs 59, p=0.033; more males with hyperlipidemia: 75 vs 55, p=0.051; no significant difference was noticed in case of diabetes: 36 males vs 38 females (p=0.457), in case of CKD: 22 males vs 17 females (p=0.138), previous MI - 21 males vs 22 females (p=0.381), or previous arrhythmia - 19 males vs 13 females (p=0.805).
The findings regarding previous procedures among those who used PCP services showed that CABG was done for 16 males vs 8 females (p=1.0), coronary stent placement – 25 males vs 21 females (p= 0.196), and significantly more males have received antiplatelet therapy - 61 vs 36 females (p=0.031).

Conclusion
Identification of comorbidities was significantly associated with PCP care utilization in both genders, however more males have been diagnosed with hypertension and other comorbidities. The findings show that timely identification of comorbidities is highly dependent on PCP services and is related to preventive treatment in both genders of patients who experienced AMI.
Acute coronary syndromes hospitalizations and in-hospital outcomes during and after the lockdown of corona virus disease 19 (COVID-19) pandemic outbreak
Authors: Simoni L , Alimehmeti I , Gina M , Ceka A , Tafaj E , Voci A , Panariti A , Xhafa F , Dibra A , Goda A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Multiple studies documented an important reduction of acute coronary syndromes (ACS) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding the ACS admissions and outcomes during the ongoing pandemic after the initial lockdown.

Purpose
We aimed to study the ACS admissions and in-hospital outcomes during and after the COVID-19 lockdown period.

Methods
A retrograde single-center study was conducted. The data for all admissions were collected from March 9th, (first COVID-19 case) until April 30th, the corresponding period of 2020 total lockdown, for three consecutive years from 2019 to 2021. The control period was considered the year 2019 and the study periods were in 2020 (lockdown) and 2021 (ongoing pandemic). ACS admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). Incidence rate ratio (IRR [95%CI]) was used to compare all-ACS and subgroups admissions, and risk ratio (RR [95%CI]) to compare the mortality between each study period with the control one.

Results
Were included 550 ACS patients (pts) during 2019, 321 pts during 2020, and 473 pts during 2021 period. The overall-ACS admissions IRR was significantly lower during 2020 lockdown (0.58 [0.44-0.76]), and not significant during 2021 ongoing pandemic (0.86 [0.62-1.18]). During 2020 lockdown, significant reduction for STEMI and UA, the IRR respectively (0.72 [0.56-0.94]) and (0.42 [0.22-0.76]), and not significant during 2021 respectively (0.87 [0.63-1.21]) and (0.86 [0.51-1.46]) were observed. The reduction in NSTEMI admissions was not significant in both periods.
The overall mortality was, importantly increased during the lockdown period (7.45 vs. 3.4 %), RR=2.16 (1.2-3.89). Meanwhile the 2021 mortality was similar (4.2 vs. 3.4%), RR=1.22 (0.66-2.26).

Conclusions
After the initial reduction of admissions in all-ACS, STEMI and UA during the 2020 lockdown period and the increase of all-ACS mortality, the number of admissions and the mortality returned to a similar range during 2021 despite the ongoing COVID-19 pandemic.
Hyperuricemia in addition to GRACE Score improves risk stratification in acute coronary syndromes
Authors: Devesa Neto VANDA , Pires INÊS , Santos JOÃO , Correia JOANA , Marmelo BRUNO , Cabral COSTA 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Uric acid (UA) is a risk factor for coronary artery disease, and it might be a predictor of outcomes in patients (P) with acute coronary syndromes (ACS). Global Registry of Acute Coronary Events (GRACE) Score is an extensively validated tool for risk stratification in these P. The aim of this study is to evaluate the impact of hyperuricemia (HU) in the prognosis of ACS and compare it with the GRACE Score.

Methods
This study included all P admitted for ACS between 2007 and 2015 in a Cardiology Department. HU was defined as admission UA levels &gt; 6 mg/dL. In-hospital mortality and all-cause mortality at 12 months after discharge were assessed. Chi-square and Mann-Whitney U tests were used for group comparisons; survival analysis used Kaplan-Meier curves and log-rank tests; and subgroup analysis was performed with an unadjusted Cox model.

Results
959 P were included (mean age 67.7±12.8y, 71.1% male). HU occurred in 498 P (51.9%). Its presence was associated with older age (p&lt;0.001); male sex (p=0.034); arterial hypertension (p&lt;0.001); obesity (p=0.006) and chronic kidney disease (p=0.025). At admission, P with HU had higher heart rate (p=0.003); higher Killip-Kimball class (p=0.001); higher plasma concentrations of creatinine (p&lt;0.001), C-reactive protein (p=0.003), blood natriuretic peptide (p=0.010) and triglycerides (p&lt;0.001); and lower high-density lipoprotein cholesterol levels (p&lt;0.001). HU was also associated with conservative treatment of ACS (p=0.005), left main disease (p=0.037) and longer length of hospital stay (p=0.009). Univariate logistic regression analysis showed that HU was a predictor of in-hospital mortality (OR 2.048; 95% CI 1.048-4.005; p=0.036). During the follow-up, P with HU had a significantly decreased survival than P with normal UA levels (Kaplan-Meier x²=8.25; p=0.004). In subgroup analysis, the effect of HU in survival was consistent among P stratified based on gender, age and comorbidities. When P were classified according to serum UA levels and GRACE Score, a progressive decline in survival was found in P without HU and GRACE score≤140, P with HU and GRACE score≤140, P without HU and GRACE score&gt;140, and P with HU and GRACE score&gt;140 (Kaplan-Meier χ²=24.17; p&lt;0.001) - graph 1.

Conclusions
In this study, HU was associated with in-hospital and 12-month follow-up mortality. Its use may allow a better risk stratification in P with ACS, particularly when combined with the most widely used tool, the GRACE score.
Impact of Atrial Fibrillation and/or Flutter on in-Hospital Management and Outcomes in Non-ST Elevation Acute Coronary Syndromes
Authors: Dakhil Z A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation is the most common arrhythmia in patients with acute coronary syndromes, and it is increasing in prevalence considering the aging of populations and the overlap of risk factors. It was reported by earlier studies that atrial fibrillation and/or flutter portend worse prognosis in patients with acute coronary syndromes. Yet there is no data from Iraq regarding impact of these arrhythmias on prognosis of patients with NSTE-ACS.

Purpose
This study aimed to evaluate the impact of pre-existing or new onset atrial fibrillation and/or flutter on in-hospital management and outcomes in an Iraqi cohort of patients with NSTE-ACS.

Methods
Patients with NSTE-ACS were prospectively included. GRACE risk score was calculated by the investigator with subsequent classification into low, intermediate and high GRACE risk class. Then the patients were classified into those who had pre-existing or new onset atrial fibrillation and/or atrial flutter (Patients with AF) group versus those with no atrial fibrillation nor atrial flutter (non-AF group).

Results
N=200, among whom AF was evident in 8.5%. Patients with AF were older (64.47±10.02 vs 58.22±11.79 years, p=0.025), they were females in 35.3% vs 29% in non-AF counterparts, p=0.58. There were no statistical differences between the two groups regarding presence of hypertension, diabetes, prior history of ischemic heart disease (IHD) nor family history of IHD, however, AF group were smokers in 11.8% vs 36.6% in non-AF group, p=0.039. Patients with AF reported dyspnoea at presentation in 47.1% vs 27.9%. Patients with AF were at high GRACE risk class at presentation in 76.5% vs 28.4% in non-AF group, p&lt;0.001. Patients with AF were referred less for catheterisation during index hospitalisation compared to non-AF counterparts (35.3% vs 72.1%, p=0.002). There were no statistical differences between the two groups regarding days to catheterisation nor days of hospitalisation. There were no statistical differences between the two groups regarding developing in-hospital acute heart failure, cardiogenic shock, persistent ischemic chest pain, nor in-hospital ventricular life-threatening arrhythmia (VT, VF or Complete heart block), however, patients with AF developed higher in-hospital stroke (5.9% vs 0.5%, p=0.034) and higher in-hospital death (11.8% vs 1.6%, p=0.011).

Conclusion
Patients with NSTE-ACS and concurrent AF presented at higher risk class at presentation and higher in-hospital stroke and in-hospital death compared to patients with no AF, yet those patients were catheterised less frequently during index hospitalisation. Larger studies are needed to assess the impact of AF on longer term prognosis in the setting of NSTE-ACS. More attention should be paid for this high-risk category of NSTE-ACS patients with more emphasis on following evidence-based guidelines regarding decision and timing of catheterisation in order to improve their outcomes.
The orthostatic hypotension in patients with Stanford type A aortic dissection after surgery
Authors: Funaki T , Kanazawa M , Takahashi S , Seki T , Iguchi A , Kagaya Y , Sato K , Saito H , Kondo M , Miura M , Kawatsu S , Endo H , Oda K , Nakamura A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Orthostatic hypotension (OH) is sometimes observed during cardiac rehabilitation in patients with surgery for aortic dissection. However, little is known about the primary determinant of OH and influence of surgical range on incidence of OH.

Purpose
The aim of this study was to elucidate the incidence of OH in patients with surgery for aortic dissection, and compare it between the patients with ascending aortic replacement surgery (ascending group) and those with ascending aorta and hemiarch or total arch replacement surgery (arch group).

Methods
We analyzed 59 patients who underwent emergent surgery due to Stanford type A aortic dissection from January 2014 to March 2018, and compared the incidence of OH between ascending group (n = 28, age 69.8 ± 11.3 years) and arch group (n = 31, age 64.1 ± 13.0 years).

Results
The incidence of OH in total patients was 30.5%. There were no significant differences in patient characteristics including body tall, body weight, antihypertensive use and progress of rehabilitation between 2 groups. The arch group showed a significant higher incidence of OH as compared with ascending group (arch group: 46.4% vs. ascending group: 16.1%, p = 0.03). Moreover, the patients who occurred OH were significantly taller than those who did not occur OH.

Conclusions
OH was observed in about one third of patients with surgery for aortic dissection and it showed a close relationship with patient’s height and the range repaired by surgical operation. More careful cardiac rehabilitation is needed for tall patients with large area replacement of aorta.