bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of heart rate reduction on recurrence after catheter ablation of persistent atrial fibrillation
Authors: Okada M , Inoue K , Tanaka N , Masuda M , Furukawa Y , Hirata A , Egami Y , Watanabe T , Minamiguchi H , Miyoshi M , Sunaga A , Sotomi Y , Dohi T , Shungo H , Sakata Y 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Johnson & Johnson KK

OnBehalf
OCVC Arrhythmia Investigators

Background
Predicting heart rate (HR) after restoration of sinus rhythm (SR) remains one of the challenges when performing catheter ablation (CA) of persistent atrial fibrillation (AF).

Purpose
To evaluate the association between pre-ablation HR during AF and post-ablation HR during SR, and whether the HR reduction is associated with AF recurrence.

Methods
The analysis was performed from the EARNEST-PVI trial, a randomized controlled trial designed to assess a CA strategy for persistent AF, which was conducted in the Osaka region of Japan. After excluding patients with beta-blocker prescription, a total of 216 patients (median age, 67 years; 20% female; 23% long-standing persistent AF) with AF rhythm at baseline and SR at discharge were enrolled in this study. Baseline HR during AF and post-ablation HR during SR was measured on admission and at discharge using the 12-lead electrocardiograms, respectively.

Results
There was a mild correlation between baseline HR (median 82 [interquartile range 72-95] bpm) and post-ablation HR (78 [48-117] bpm) (r = 0.27, p &lt;0.001). Reduction in HR was positively associated with baseline HR (r = 0.79, p &lt;0.001) and was negatively associated with post-ablation HR (r = - 0.37, p &lt;0.001). During the follow-up of 1 year, 56 patients (25.9%) experienced AF recurrence. HR reduction had the higher diagnostic accuracy in predicting AF recurrence than HR at baseline and HR after CA (area under the curve, 0.625; 95% confidence interval, 0.557–0.690; p = 0.003). AF recurrence rate was significantly higher in 141 patients with smaller HR reduction (cut-off, &lt;14bpm) than those with larger HR reduction (31.9% vs. 14.7%, p = 0.009). After adjustment of age, gender, long-standing persistent AF, and CA strategy, HR reduction of &lt;14 bpm was a significant predictor of AF recurrence (hazard ratio, 2.32; 95% confidence interval, 1.20–4.51; p = 0.013).

Conclusions
There was a mild correlation between HR during AF and HR after restoration of SR in patients underwent CA of persistent AF. HR reduction after restoration of SR predicted AF recurrence.
Validation of HAS-BELD scoring system and risk factors of bleeding with warfarin among non-valvular atrial fibrillation patients
Authors: Wachirapraditporn P , Uaprasert N 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objectives
This study aimed to validate different bleeding scoring systems including HAS-BELD score and other scores and risks of bleeding in Thai patients with non-valvular atrial fibrillation (AF).

Background
AF is the most common sustained arrhythmia and associated with an increased risk of embolic stroke. Although warfarin can decrease the risk for thromboembolism, it increases the risk of major bleeding. The use of the bleeding scoring system can predict bleeding risks and guide physicians to decide the benefit and risk ratio before prescribing warfarin to prevent stroke in patients with AF. However, the validation of these scoring systems as well as studies evaluating risk factors associated with bleeding complications in Thai patients are still lacking.

Methods
A retrospective study was conducted in adult patients diagnosed with AF who received warfarin therapy and were followed at hospital during January 2015 to December 2019. Validation of HAS-BELD score, ATRIA score and ORBIT score were determined using the c-index. Individual factors for bleeding were assessed.

Results
From medical record review, 200 patients met inclusion criteria, and 27 patients presented with major bleeding events. HAS-BELD score, ATRIA score and ORBIT score had c-index of 0.790 (95%CI0.651-0.865, p &lt; 0.001), 0.708 (95%CI0.615-0.802, p &lt; 0.001) and 0.752 (95%CI0.651-0.853, p &lt; 0.001), respectively. There were no statistical differences among these scores in predicting the bleeding risk (P = 0.089). Notably, risk factors significantly associated with major bleeding in this population in multivariate analysis were anemia (OR3.28, 95%CI1.15-9.38, p = 0.027), bleeding history (OR5.34, 95%CI1.94-14.71, p = 0.001), concomitant NSAIDs (OR8.94, 95%CI1.48-53.83, p = 0.017) and time in therapeutic range &lt; 60% (OR11.57, 95%CI2.51-53.41, p = 0.002) and were incorporated into the new scoring system, ABC-TTR.

Conclusion
HAS-BELD, ATRIA and ORBIT scores demonstrated diagnostic ability to predict major bleeding events in non-valvular atrial fibrillation patient receiving warfarin. Risk factors associated with bleeding in Thais with AF were identified. Abstract Figure. C-index to predict major bleeding Abstract Figure. The risk factors
Bridging to warfarin with apixaban versus conventional heparin: an open label, pilot, randomized controlled trial
Authors: Dangploy T , Wongvipaporn C 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Queen Sirikit Heart center of the Northeast of Thailand
Background : Despite of non-vitamin K antagonist oral anticoagulants (NOACs) is a preferred oral anticoagulant but in limited-resource country, warfarin still be first line drug. Bridging parenteral anticoagulant with warfarin is required in particular circumstances. Since a NOACs contains rapid onset and steady activity characteristics, then the use of NOACs instead of traditional parenteral anticoagulant to bridging with warfarin is intriguing.
Methods : We conducted an open-label, block of four randomized, pilot study in patients with atrial fibrillation (AF) and thromboembolism who considerably required bridging therapy to apixaban (5 mg orally b.i.d.) or enoxaparin (1 mg/kg subcutaneously every 12 hours) bridging to warfarin. The dose of warfarin was adjusted every 3 to 5 days to achieve the goal of international normalized ratio (INR) between 2 to 3 before stopping the bridging. The primary outcome was bleeding complication classified as the Bleeding Academic Research Consortium (BARC) criteria. The secondary outcome included thromboembolic complication, mean change of hemoglobin (Hb) level during bridging, and cost of anticoagulant.
Results : A total of 37 patients underwent randomization after stratified to AF and thromboembolism groups from 60 patients screened, which 21 assigned to apixaban and 16 to enoxaparin. Six patients were excluded after randomization (1 in apixaban group and 5 in enoxaparin group), the data before the patients were excluded were used in the analysis. The median (interquartile range) bridging duration was 7 (5-10) and 9 (6-14.5) days for apixaban and enoxaparin, respectively. There was null BARC bleeding in apixaban group whereas 3 patients developed BARC 1 bleeding in enoxaparin group (p = 0.058). Thromboembolic complication was not occurred in any group during the bridging. The mean cost of anticoagulant was 833 and 5487 Thai Baht (p = 0.001) and mean change of Hb level was +0.36 and -0.38 g/dl in apixaban and enoxaparin group (p = 0.029), respectively.
Conclusions : Apixaban was as safe, effective, and less expensive than enoxaparin in bridging to warfarin in patients with AF and thromboembolism.
Implantable cardioverter-defibrillators in heart transplant patients: a systematic review and meta-analysis
Authors: Cho K , Lo P , Subbiah R 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Whilst implantable cardioverter-defibrillator (ICD) implantation is beneficial in a select group of patients, heart transplant patients were excluded from landmark clinical trials. Thus, controversy remains about the utility of ICD in high-risk heart transplant patients.

Purpose
To understand the utility, benefits and side-effects of ICD in heart transplant patients.

Methods
Five electronic databases were systematically searched from their inception to August 2021, in order to identify all studies which explored the role of ICD in heart transplant patients. We used a random-effects model for data analysis based on event rates (ER) and 95% confidence interval (CI). Publication bias was assessed using funnel plots and Egger’s regression analysis.

Results
Eleven studies with 4648 heart transplant patients, 129 of whom received ICD, met the inclusion criteria for the meta-analysis. Studies included two multicentre retrospective cohort studies, four single centre retrospective cohort studies, two case series and three case reports. Of the 129 heart transplant patients with ICD, 74% were men, mean age at ICD implantation was 48.5 years, mean time from transplant to ICD was 99 months, and mean follow-up duration was 40 months.
The indication for ICD implantation was often multifactorial and included severe allograft vasculopathy (40%), the presence of left ventricular systolic dysfunction (37%), documented VT/VF (14%), unexplained syncope (14%), and history of cardiac arrest (13%).
Appropriate ICD therapy for patients occurred as an average event rate of 19% (95% CI 13%-27%) (I2 = 0% p = 0.66), Figure 1. Inappropriate therapy for patients occurred as an average event rate of 9% (95% CI 5%-16%) (I2 = 0% p = 0.96), Figure 2. There was no evidence of publication bias.
In total, nine ICD-related complications were reported including pocket haematoma (n = 1), pocket site infection (n = 2), infection of the ICD system (n = 1), lead displacement (n = 2) and lead fracture (n = 1). Mortality occurred in 28 patients, with heart failure being the leading primary cause of death (n = 10), followed by sepsis (n = 6), arrhythmia (n = 3) and electromechanical disassociation (n = 3).

Conclusion
Heart transplant patients with ICD more often received appropriate than inappropriate ICD shock therapy. The 19% appropriate ICD shock rate suggests a high burden of ventricular arrhythmias in high-risk heart transplant patients. Thus, ICD therapy may be beneficial in a select subset of heart transplant patients, keeping in mind even with appropriate shock therapy, subsequent terminal electromechanical disassociation and arrhythmias may imply ICD are not fully protective against arrhythmic aetiologies of mortality. Abstract Figure 1 Abstract Figure 2
A short and long-term outcomes of heart failure with midrange and preserved ejection fraction; developing countries perspective
Authors: Leesutipornchai T , Puwanant S , Siwamogsatham S , Aekarach A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Hospitalization and mortality are common among patients with heart failure (HF). However, evidence of outcomes in HF patients classified by left ejection fraction (LVEF) is limited, especially in Thailand.

Methods
This is a single center retrospective study of patients who were hospitalized with acute HF from June 2017 to June 2019. The patient was identified by ICD coding and justified by Framingham Criteria. Patients’ characteristics, treatments and outcomes were gathered. The patients were classified by LVEF into reduced ejection fraction (HFrEF; &lt;40%), midrange ejection fraction (HFmrEF; 40-49%) and preserved ejection fraction (HFpEF; ≥50%) groups. In-hospital mortality, length of stay and 1-year all cause death and re-hospitalization were collected. Pearson’s chi-square and one-way ANOVA were used to analyze the data.

Results
A total of 773 patients were screened and 668 patients with known LVEF were enrolled (mean age of 69.2 ± 15.0 years, 49.5% male, mean LVEF of 46.9 ± 19.3%). There were 279, 67, and 322 patients in HFrEF, HFmrEF and HFpEF groups, respectively. The patients with HFpEF were more likely to be female, elderly and less likely to have history of myocardial infarction (p &lt;0.05). Neurohormonal blockages were more commonly prescribed in HFrEF. Overall, the in-hospital and 1-year mortality rate were 5.9% and 22.4%, respectively, which is not different between groups (p = 0.4). Overall, the length of stay was 12 days and not significantly different between groups (11.4 ± 11.3 vs. 13.7 ± 22.4 vs. 12.9 ± 17.8 for HFrEF, HFmrEF and HFpEF; p = 0.4). However, the 30 day-rehospitalization was still significantly higher in HFrEF compare to HFmrEF or HFpEF (31.3 vs. 17.2%, vs.19.9%, p = 0.003).

Conclusion
More than half of patients hospitalized for acute HF had HFpEF. The outcomes were poor regardless of LVEF groups. In this single center study, mortality was higher than that previously reported from developed countries registries. Therefore, awareness of poor outcomes is needed all HF patients regardless of LVEF.
Chronic kidney disease begets heart failure and vice versa; temporal associations between heart failure events in relation to incident chronic kidney disease
Authors: Wu M Z , Teng T H , Tay W T , Ren Q W , Wong P F , Tse H F , Lam S P , Yiu K H 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Diabetes, chronic kidney disease (CKD) and heart failure (HF) are fast-growing causes of morbidity and mortality worldwide. Diabetes is an optimal model to study the inter-play of cardiovascular disease and renal disease.

Purpose
To investigate the association of CKD with HF and its prognosis in a large, population-based cohort of diabetes, in which incident CKD and HF events were ascertained longitudinally.

Methods
A population-based cohort of patients aged ≥18 years with diabetes, but without CKD, HF or acute kidney injury at baseline was identified from the previously validated territory-wide Clinical Data Analysis Reporting System between 2000 and 2015. Patients were followed up through December 31,2020 for incident CKD and/or HF or all-cause mortality. Multi-state modelling was used to examine the association of the subgroups (with/without CKD or HF).

Results
Among 294,413 patients (mean age: 65 ± 14 years; 49.5% women), new-onset CKD occurred in 51,583, in whom one-fifth (21.3%) had HF. In contrast, among 28,335 patients with new-onset HF, nearly two-fifth (38.7%) had CKD (Figure 1A). Median duration from baseline to incident CKD was shorter than incident HF [8.27 (4.69-11.97) years vs. 8.76 (5.28-12.37) years, p &lt;0.001]. However, median duration for incident event of HF after CKD diagnosis was 2.15 (0.83-4.50) years and 1.73 (0.62-3.87) years for incident CKD after HF diagnosis. The incidence rate of CKD and HF was 20.39 per 1000 person-years and 10.61 per 1000 person-years, respectively.
Presence of CKD was associated with incident HF (odds ratios [OR] 1.27 [95%CI 1.21-1.33]), and HF with incident CKD (OR 1.26 [95%CI 1.18-1.33]). The presence of both CKD and HF (regardless of which comes first) portends higher risk (6 to 8-fold hazards) of all-cause mortality than neither condition (Figure 1B).

Conclusions
Incident HF occurs in one-fifth of patients with new-onset CKD, and CKD occurs in about 40% with new-onset HF. CKD seems to precede HF. More research on the inter-play of these dual conditions is warranted in view of the high mortality risk. Abstract Figure.
Pulmonary artery pulsatility index and hemolysis during Impella support
Authors: Nakamura M , Imamura T , Kinugawa K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Impella-related hemolysis is a well-known complication, which we sometimes experience in the clinical practice depending on various hemodynamic status including right ventricular impairment.

Methods
We enrolled consecutive patients with cardiogenic shock who received Impella support between March 2018 and December 2020. The association between pulmonary artery pulsatility index (PAPi) immediately after Impella insertion and the occurrence of hemolysis was investigated. Hemolytic event was defined as detection of hemoglobinuria and elevated lactate dehydrogenase level over 2.5 folds of upper normal range.

Results
Among 38 patients (median 71 y; men 61%; LVEF 29%) included in this study, hemolysis occurred in 18 patients (47%). Incidence of hemolysis was significantly higher in the low PAPi group (&lt; 1.3) compared with the normal PAPi group (≥ 1.3) (67% vs. 33%, p = 0.0176; Figure 1). The low PAPi (&lt;1.3) was significantly associated with the occurrence of hemolysis with a hazard ratio of 5.71 (95% confidence interval 1.09–29.91, p = 0.0313) adjusted for other clinically significant variables.

Conclusions
In patients with right ventricular impairment with lower PAPi, it might be encouraged to be aware of the risk of hemolysis, maintaining volume status and considering inotropes administration. Abstract Figure.
Role of myocardial performance index as predictor of in-hospital cardiac events in patients with acute myocardial infarction
Authors: Dalimunthe N 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Acute myocardial infarction (AMI) remains the leading cause of morbidity and mortality worldwide. Left ventricular dysfunction is a common consequence of acute coronary events and has important prognostic implications. Myocardial performance index (MPI) is an echocardiographic parameter that represent both left ventricular systolic and diastolic function that might provide substantial information essential to guide management and prognosis after AMI.
Purpose. This study aims to determine the role of MPI as predictor of in-hospital cardiac events after AMI.
Method. Seventy-five patients admitted with AMI were included in this study. Standard echocardiography and MPI calculation were conducted within 24 hours of hospital admission. MPI was calculated as (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. All patients were followed during hospital stay and in-hospital cardiac events were recorded as heart failure, cardiogenic shock and all caused mortality.
Results. Mean MPI values were significantly higher in patients with cardiac events compared with patients without events (0.696 ± 0.564 vs 0.558 ± 0.575; p = 0.016). MPI demonstrates fair discrimination for in-hospital cardiac events (AUC 0.644 95% CI 0.482-0.806).
Conclusion. MPI might have minor role as predictive parameters for in-hospital cardiac events after AMI.
Primary PCI in the very elderly: A study of outcomes in patients aged &gt; 85 years with STEMI
Authors: Jariwala P , Jadhav KARTIK 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Primary percutaneous coronary intervention (PPCI) as management for acute STEMI is a well-established, evidence-based treatment offered across India. Evidence of benefit in the very elderly is sparse. With an aging population, the demand on PPCI services for STEMI in the elderly is likely to increase. Our aim was to establish real life outcomes in patients aged 85 years and older who receive PPCI for acute STEMI.

Methods
Data was collected retrospectively on all patients aged 85 years and older who were referred and accepted for PPCI to our centre between 2015 and 2019. This represented 11.2% (N = 572) of all accepted PPCI referrals over the 4-year period.

Results
64 patients proceeded to invasive angiography, of whom 43 patients received PPCI. PPCI was successful in over 95% of cases. Median hospital stay of all patients was 5 days (range 3– 15). 38 patients survived STEMI admission (88.4%). 94% of patients who survived admission were discharged to their own home, and 72% were functionally independent. One-year mortality was 33.7%. Median survival of all patients post-STEMI was 3.45 years.

Conclusions
Advanced age should not be used as an exclusion criterion in isolation for PPCI. Rather, a personalised approach that takes into account all clinically relevant patient factors should be adopted to guide PCI decision-making. Despite relatively long hospital stays and high 1-year mortality, there are still potential good quality life years to be gained following intervention. Our findings therefore suggest that emergency revascularization therapy as first-line treatment for STEMI in the very elderly should be considered routinely
Cost and prescription trends of P2Y12 inhibitors in Australia over the last decade
Authors: Abrahams T , Brown A , Pol D 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Coronary artery disease (CAD) remains one of the leading causes of mortality worldwide and in Australia, and places significant burden on healthcare costs. [1,2] Dual antiplatelet therapy (DAPT) is guideline therapy following acute coronary syndrome (ACS).[3] Novel, potent P2Y12 inhibitors have been developed and studied but it is unclear how this evidence has been incorporated into patient care across the spectrum of P2Y12 prescribers.

Purpose
We sought to describe the prescribing trends, healthcare costs of P2Y12 therapy in Australia over the last decade using real world prescribing data and cost per MACE prevented.

Method
The latest statistical data collected by the Pharmaceutical Benefit Scheme (PBS), Australia was reviewed. PBS codes for coronary indications were selected. Yearly total prescriptions and cost were then compared between all three P2Y12 inhibitors. Linear trend modelling was used to observe general trends over the data collection period. Cost per mace was calculated from major DAPT ACS trials [4,5].

Results
Total yearly P2Y12 scripts have increased 2.5-fold in Australia between 2010 (403,880 scripts) and 2020 (994,826 scripts). Clopidogrel is the most prescribed P2Y12 inhibitor and has been for the last decade, representing 71% of P2Y12 prescriptions in 2020. Ticagrelor represented 26.2% of total prescriptions but accounts for 75% of PBS spending. More than $30 million is spent on ticagrelor yearly with a cost per MACE prevented of $72,637. Prasugrel was the least prescribed agent but was 41% more cost effective than ticagrelor before being removed from the Australian market. Prasugrel has a cost per MACE prevented of $42,993. Without prasugrel available, Clopidogrel scripts have increased 10% and ticagrelor scripts remain stable.

Conclusion
Clopidogrel remains the most prescribed P2Y12 agent in Australia, despite emergence of more potent P2Y12 inhibitors. Ticagrelor is increasingly prescribed but represents a disproportionately large burden of spending. Whilst Prasugrel is the most efficacious, cost effective and a guideline recommended P2Y12 inhibitor after ACS, it represented the minority of scripts before being withdrawn. Rather than use of a potent P2Y12 agent, clinicians are reverting to prescribing clopidogrel. Compared to other countries in the Asia Pacific region with access to prasugrel, Australian patients may be having higher rates of MACE post PCI at a higher cost compared to Ticagrelor. Abstract Figure. Abstract Figure.