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Cosentino F, Verma S, Ambery P, Treppendahl MB, van Eickels M, Anker SD, Cecchini M, Fioretto P, Groop PH, Hess D, Khunti K, Lam CSP, Richard-Lordereau I, Lund LH, McGreavy P, Newsome PN, Sattar N, Solomon S, Weidinger F, Zannad F, Zeiher A. Cardiometabolic risk management: insights from a European Society of Cardiology Cardiovascular Round Table. Eur Heart J 2023; 44:4141-4156. [PMID: 37448181 DOI: 10.1093/eurheartj/ehad445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Metabolic comorbidities are common in patients with cardiorenal disease; they can cause atherosclerotic cardiovascular disease (ASCVD), speed progression, and adversely affect prognosis. Common comorbidities are Type 2 diabetes mellitus (T2DM), obesity/overweight, chronic kidney disease (CKD), and chronic liver disease. The cardiovascular system, kidneys, and liver are linked to many of the same risk factors (e.g. dyslipidaemia, hypertension, tobacco use, diabetes, and central/truncal obesity), and shared metabolic and functional abnormalities lead to damage throughout these organs via overlapping pathophysiological pathways. The COVID-19 pandemic has further complicated the management of cardiometabolic diseases. Obesity, T2DM, CKD, and liver disease are associated with increased risk of poor outcomes of COVID-19 infection, and conversely, COVID-19 can lead to worsening of pre-existing ASCVD. The high rates of these comorbidities highlight the need to improve recognition and treatment of ASCVD in patients with obesity, insulin resistance or T2DM, chronic liver diseases, and CKD and equally, to improve recognition and treatment of these diseases in patients with ASCVD. Strategies to prevent and manage cardiometabolic diseases include lifestyle modification, pharmacotherapy, and surgery. There is a need for more programmes at the societal level to encourage a healthy diet and physical activity. Many pharmacotherapies offer mechanism-based approaches that can target multiple pathophysiological pathways across diseases. These include sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, selective mineralocorticoid receptor antagonists, and combined glucose-dependent insulinotropic peptide/glucagon-like peptide-1 receptor agonist. Non-surgical and surgical weight loss strategies can improve cardiometabolic disorders in individuals living with obesity. New biomarkers under investigation may help in the early identification of individuals at risk and reveal new treatment targets.
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Affiliation(s)
- Francesco Cosentino
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Philip Ambery
- Late-stage Development, CVRM, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Michele Cecchini
- Health Division, Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Paola Fioretto
- Department of Medicine, University of Padova, Padova, Italy
| | - Per-Henrik Groop
- Department of Nephrology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Helsinki, Finland
- Department of Diabetes, Monash University, Melbourne, Australia
| | - David Hess
- Department of Physiology and Pharmacology, University of Western Ontario, Robarts Research Institute, London, ON, Canada
- Department of Pharmacology, University of Toronto, Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore
| | | | - Lars H Lund
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Philip N Newsome
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Liver & Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Scott Solomon
- Harvard Medical School, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Franz Weidinger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria
| | - Faiez Zannad
- Université de Lorraine, Inserm Clinical Investigation Center at Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy, Nancy, France
| | - Andreas Zeiher
- Cardio Pulmonary Institute, Goethe University of Frankfurt, Frankfurt, Germany
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McGreavy P. Managing mental well-being and the emotional aspects of cardiovascular disease: views from the patient lounge. Eur Heart J 2023; 44:1291-1292. [PMID: 36370001 DOI: 10.1093/eurheartj/ehac609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, De Hert S, de Laval I, Geisler T, Hinterbuchner L, Ibanez B, Lenarczyk R, Mansmann UR, McGreavy P, Mueller C, Muneretto C, Niessner A, Potpara TS, Ristić A, Sade LE, Schirmer H, Schüpke S, Sillesen H, Skulstad H, Torracca L, Tutarel O, Van Der Meer P, Wojakowski W, Zacharowski K. [2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery Developed by the task force for cardiovascular assessment and management of patients undergoing non-cardiac surgery of the European Society of Cardiology (ESC) Endorsed by the European Society of Anaesthesiology and Intensive Care (ESAIC)]. G Ital Cardiol (Rome) 2023; 24:e1-e102. [PMID: 36645369 DOI: 10.1714/3956.39326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, De Hert S, de Laval I, Geisler T, Hinterbuchner L, Ibanez B, Lenarczyk R, Mansmann UR, McGreavy P, Mueller C, Muneretto C, Niessner A, Potpara TS, Ristić A, Sade LE, Schirmer H, Schüpke S, Sillesen H, Skulstad H, Torracca L, Tutarel O, Van Der Meer P, Wojakowski W, Zacharowski K. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J 2022; 43:3826-3924. [PMID: 36017553 DOI: 10.1093/eurheartj/ehac270] [Citation(s) in RCA: 209] [Impact Index Per Article: 104.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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5
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Kotecha D, Asselbergs FW, Achenbach S, Anker SD, Atar D, Baigent C, Banerjee A, Beger B, Brobert G, Casadei B, Ceccarelli C, Cowie MR, Crea F, Cronin M, Denaxas S, Derix A, Fitzsimons D, Fredriksson M, Gale CP, Gkoutos GV, Goettsch W, Hemingway H, Ingvar M, Jonas A, Kazmierski R, Løgstrup S, Thomas Lumbers R, Lüscher TF, McGreavy P, Piña IL, Roessig L, Steinbeisser C, Sundgren M, Tyl B, van Thiel G, van Bochove K, Vardas PE, Villanueva T, Vrana M, Weber W, Weidinger F, Windecker S, Wood A, Grobbee DE. CODE-EHR best practice framework for the use of structured electronic healthcare records in clinical research. Eur Heart J 2022; 43:3578-3588. [PMID: 36208161 PMCID: PMC9452067 DOI: 10.1093/eurheartj/ehac426] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
Big data is central to new developments in global clinical science aiming to improve the lives of patients. Technological advances have led to the routine use of structured electronic healthcare records with the potential to address key gaps in clinical evidence. The covid-19 pandemic has demonstrated the potential of big data and related analytics, but also important pitfalls. Verification, validation, and data privacy, as well as the social mandate to undertake research are key challenges. The European Society of Cardiology and the BigData@Heart consortium have brought together a range of international stakeholders, including patient representatives, clinicians, scientists, regulators, journal editors and industry. We propose the CODE-EHR Minimum Standards Framework as a means to improve the design of studies, enhance transparency and develop a roadmap towards more robust and effective utilisation of healthcare data for research purposes.
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Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust and Health Data Research UK Midlands, Birmingham, UK
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ulleval, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
| | | | | | - Barbara Casadei
- Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - Martin R Cowie
- Royal Brompton Hospital, Division of Guy’s St Thomas’ NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine Sciences, King’s College London, London, UK
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- European Heart Journal, Oxford University Press, University of Oxford, Oxford, UK
| | - Maureen Cronin
- Vifor Pharma, Glattbrugg, Switzerland and Ava AG, Zurich, Switzerland
| | - Spiros Denaxas
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, London, UK
- British Heart Foundation Data Science Centre, London, UK
| | | | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland
| | - Martin Fredriksson
- Late Clinical Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Georgios V Gkoutos
- University Hospitals Birmingham NHS Foundation Trust and Health Data Research UK Midlands, Birmingham, UK
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Wim Goettsch
- National Health Care Institute (ZIN), Diemen, Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Harry Hemingway
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Department of Neuroradiology, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Adrian Jonas
- Data and Analytics Group, National Institute for Health and Care Excellence, London, UK
| | - Robert Kazmierski
- Office of Cardiovascular Devices, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - R Thomas Lumbers
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Barts Health NHS Trust and University College London Hospitals NHS Trust
| | - Thomas F Lüscher
- Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Research, Education & Development, Royal Brompton and Harefield Hospitals, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Paul McGreavy
- European Society of Cardiology Patient Forum, European Society of Cardiology, Brussels, Belgium
| | - Ileana L Piña
- Central Michigan University College of Medicine, Midlands, MI, USA
- Centre for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Carl Steinbeisser
- Bayer AG, Leverkusen, Germany
- Steinbeisser Project Management, Munich, Germany
| | - Mats Sundgren
- Data Science AI, Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Benoît Tyl
- Centre for Therapeutic Innovation, Cardiovascular and Metabolic Disease, Institut de Recherches Internationales Servier, Suresnes, France
| | - Ghislaine van Thiel
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Panos E Vardas
- Hygeia, Mitera, Hospitals Hellenic Health Group, Athens, Greece
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | | | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Diederick E Grobbee
- Department of Epidemiology, University Medical Centre Utrecht, Division Julius Centrum, Utrecht, Netherlands
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Kotecha D, Asselbergs FW, Achenbach S, Anker SD, Atar D, Baigent C, Banerjee A, Beger B, Brobert G, Casadei B, Ceccarelli C, Cowie MR, Crea F, Cronin M, Denaxas S, Derix A, Fitzsimons D, Fredriksson M, Gale CP, Gkoutos GV, Goettsch W, Hemingway H, Ingvar M, Jonas A, Kazmierski R, Løgstrup S, Lumbers RT, Lüscher TF, McGreavy P, Piña IL, Roessig L, Steinbeisser C, Sundgren M, Tyl B, Thiel GV, Bochove KV, Vardas PE, Villanueva T, Vrana M, Weber W, Weidinger F, Windecker S, Wood A, Grobbee DE. CODE-EHR best-practice framework for the use of structured electronic health-care records in clinical research. Lancet Digit Health 2022; 4:e757-e764. [PMID: 36050271 DOI: 10.1016/s2589-7500(22)00151-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Abstract
Big data is important to new developments in global clinical science that aim to improve the lives of patients. Technological advances have led to the regular use of structured electronic health-care records with the potential to address key deficits in clinical evidence that could improve patient care. The COVID-19 pandemic has shown this potential in big data and related analytics but has also revealed important limitations. Data verification, data validation, data privacy, and a mandate from the public to conduct research are important challenges to effective use of routine health-care data. The European Society of Cardiology and the BigData@Heart consortium have brought together a range of international stakeholders, including representation from patients, clinicians, scientists, regulators, journal editors, and industry members. In this Review, we propose the CODE-EHR minimum standards framework to be used by researchers and clinicians to improve the design of studies and enhance transparency of study methods. The CODE-EHR framework aims to develop robust and effective utilisation of health-care data for research purposes.
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Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Department of Cardiology, Division of Heart and Lungs, University of Utrecht, Utrecht, Netherlands.
| | - Folkert W Asselbergs
- Health Data Research UK London, London, UK; Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research, Charité Universitätsmedizin, Berlin, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Colin Baigent
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Health Data Research UK London, London, UK; University College London Hospitals NHS Trust, London, UK
| | | | | | - Barbara Casadei
- Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford, UK
| | | | - Martin R Cowie
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Cardiovascular Medicine Sciences, King's College London, London, UK
| | - Filippo Crea
- European Heart Journal, Oxford University Press, University of Oxford, Oxford, UK; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Maureen Cronin
- Vifor Pharma, Glattbrugg, Switzerland; Ava, Zurich, Switzerland
| | - Spiros Denaxas
- Health Data Research UK London, London, UK; Alan Turing Institute, London, UK; British Heart Foundation Data Science Centre, London, UK
| | | | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland
| | - Martin Fredriksson
- Late Clinical Development, Cardiovascular, Renal and Metabolism, Biopharmaceuticals, AstraZeneca, Gothenburg, Sweden
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wim Goettsch
- University Medical Centre Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, Netherlands; National Health Care Institute, Diemen, Netherlands
| | | | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; Department of Neuroradiology, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Adrian Jonas
- Data and Analytics Group, National Institute for Health and Care Excellence, London, UK
| | - Robert Kazmierski
- Office of Cardiovascular Devices, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - R Thomas Lumbers
- Health Data Research UK London, London, UK; Institute of Health Informatics, Barts Health NHS Trust and University College London Hospitals NHS Trust, London, UK
| | - Thomas F Lüscher
- Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland; Research, Education and Development, Royal Brompton and Harefield Hospitals, London, UK; Faculty of Medicine, Imperial College London, London, UK
| | - Paul McGreavy
- European Society of Cardiology Patient Forum, European Society of Cardiology, Brussels, Belgium
| | - Ileana L Piña
- Centre for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA; College of Medicine, Central Michigan University, Midlands MI, USA
| | | | - Carl Steinbeisser
- Bayer, Leverkusen, Germany; Steinbeisser Project Management, Munich, Germany
| | - Mats Sundgren
- Data Science and Artificial Intelligence, Biopharmaceuticals, AstraZeneca, Gothenburg, Sweden
| | - Benoît Tyl
- Centre for Therapeutic Innovation, Cardiovascular and Metabolic Disease, Institut de Recherches Internationales Servier, Suresnes, France
| | - Ghislaine van Thiel
- Julius Center for Health Sciences and Primary Care, University of Utrecht, Utrecht, Netherlands
| | | | - Panos E Vardas
- Hygeia, Mitera, Hospitals Hellenic Health Group, Athens, Greece; European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | - Wim Weber
- The British Medical Journal, London, UK
| | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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7
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Gencer B, Gale CP, Aktaa S, Halvorsen S, Beska B, Abdelhamid M, Mueller C, Tutarel O, McGreavy P, Schirmer H, Geissler T, Sillesen H, Niessner A, Zacharowski K, Mehilli J, Potpara T. European Society of Cardiology Quality Indicators for the Cardiovascular Preoperative Assessment and Management of patients considered for non-cardiac surgery. Developed in collaboration with the European Society of Anaesthesiology & Intensive Care. Eur Heart J Qual Care Clin Outcomes 2022:qcac057. [PMID: 36069905 DOI: 10.1093/ehjqcco/qcac057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIMS To establish a set of quality indicators (QIs) for the cardiovascular (CV) assessment and management of patients undergoing non-cardiac surgery. METHODS AND RESULTS The Quality Indicator Committee of the European Society of Cardiology (ESC) and European Society of Anaesthesiology & Intensive Care (ESAIC) in collaboration with Task Force members of the 2022 ESC Guidelines on CV assessment and management of patients undergoing non-cardiac surgery followed the ESC methodology for QI development. This included 1) identification, by constructing a conceptual framework of care, of domains of the CV assessment and management of patients with risk factors or established cardiovascular disease (CVD) who are considered for or undergoing non-cardiac surgery, 2) development of candidate QIs following a systematic literature review, 3) selection of the final set of QIs using a modified Delphi method, 4) evaluation of the feasibility of the developed QIs. In total, eight main and nine secondary QIs were selected across six domains: 1) Structural framework (written policy), 2) Patient education and quality of life (CV risk discussion), 3) Peri-operative risk assessment (indication for diagnostic tests), 4) Peri-operative risk mitigation (use of hospital therapies), 5) Follow-up (post-discharge assessment) and 6) Outcomes (major CV events). CONCLUSION We present the 2022 ESC/ESAIC QIs for the CV assessment and management of patients with risk factors or established CVD who are considered for or are undergoing non-cardiac surgery. These indicators are supported by evidence from the literature, underpinned by expert consensus and align with 2022 ESC Guidelines on CV assessment and management of patients undergoing non-cardiac surgery.
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Affiliation(s)
- Baris Gencer
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
- Institute of Primary Health Care (BIHAM), Bern University, Bern, Switzerland
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds Institute for Data Analytics and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Suleman Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds Institute for Data Analytics and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
| | - Ben Beska
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds Institute for Data Analytics and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Magdy Abdelhamid
- Cardiology Department, Faculty of Medicine, Kase Al Ainy, Cairo University, Cairo, Egypt
| | - Christian Mueller
- Cardiovascular Research Institute Basel, University Heart Center, University Hospital Basel, Basel, Switzerland, University of Basel, Basel, Switzerland
| | - Oktay Tutarel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Paul McGreavy
- Patient representatives, European Society of Cardiology (ESC)
| | - Henrik Schirmer
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Tobias Geissler
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Henrik Sillesen
- Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Kai Zacharowski
- Department Anaesthesiology, Intensive Care Medicine & Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Julinda Mehilli
- Department of Cardiology, LMU University Hospital and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, Medizinische Klinik I, Landshut-Achdorf Hospital, Landshut, Germany
| | - Tatjana Potpara
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Serbia
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8
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Kotecha D, Asselbergs FW, Achenbach S, Anker SD, Atar D, Baigent C, Banerjee A, Beger B, Brobert G, Casadei B, Ceccarelli C, Cowie MR, Crea F, Cronin M, Denaxas S, Derix A, Fitzsimons D, Fredriksson M, Gale CP, Gkoutos GV, Goettsch W, Hemingway H, Ingvar M, Jonas A, Kazmierski R, Løgstrup S, Lumbers RT, Lüscher TF, McGreavy P, Piña IL, Roessig L, Steinbeisser C, Sundgren M, Tyl B, van Thiel G, van Bochove K, Vardas PE, Villanueva T, Vrana M, Weber W, Weidinger F, Windecker S, Wood A, Grobbee DE. CODE-EHR best practice framework for the use of structured electronic healthcare records in clinical research. BMJ 2022; 378:e069048. [PMID: 36562446 PMCID: PMC9403753 DOI: 10.1136/bmj-2021-069048] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Birmingham, UK
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ulleval, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
| | | | | | - Barbara Casadei
- Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - Martin R Cowie
- Royal Brompton Hospital, Division of Guy's St Thomas' NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine Sciences, King's College London, London, UK
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- European Heart Journal, Oxford University Press, University of Oxford, Oxford, UK
| | - Maureen Cronin
- Vifor Pharma, Glattbrugg, Switzerland and Ava AG, Zurich, Switzerland
| | - Spiros Denaxas
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, London, UK
- British Heart Foundation Data Science Centre, London, UK
| | | | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland
| | - Martin Fredriksson
- Late Clinical Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Georgios V Gkoutos
- University Hospitals Birmingham NHS Foundation Trust and Health Data Research UK Midlands, Birmingham, UK
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Wim Goettsch
- National Health Care Institute (ZIN), Diemen, Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Harry Hemingway
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Department of Neuroradiology, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Adrian Jonas
- Data and Analytics Group, National Institute for Health and Care Excellence, London, UK
| | - Robert Kazmierski
- Office of Cardiovascular Devices, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - R Thomas Lumbers
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Barts Health NHS Trust and University College London Hospitals NHS Trust
| | - Thomas F Lüscher
- Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Faculty of Medicine, Imperial College London, London, UK
| | - Paul McGreavy
- European Society of Cardiology Patient Forum, European Society of Cardiology, Brussels, Belgium
| | - Ileana L Piña
- Central Michigan University College of Medicine, Midlands, MI, USA
- Centre for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Carl Steinbeisser
- Bayer AG, Leverkusen, Germany
- Steinbeisser Project Management, Munich, Germany
| | - Mats Sundgren
- Data Science AI, Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Benoît Tyl
- Centre for Therapeutic Innovation, Cardiovascular and Metabolic Disease, Institut de Recherches Internationales Servier, Suresnes, France
| | - Ghislaine van Thiel
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Panos E Vardas
- Hygeia, Mitera, Hospitals Hellenic Health Group, Athens, Greece
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | | | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Diederick E Grobbee
- Department of Epidemiology, University Medical Centre Utrecht, Division Julius Centrum, Utrecht, Netherlands
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9
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Jensen MT, Treskes RW, Caiani EG, Casado-Arroyo R, Cowie MR, Dilaveris P, Duncker D, Di Rienzo M, Frederix I, De Groot N, Kolh PH, Kemps H, Mamas M, McGreavy P, Neubeck L, Parati G, Platonov PG, Schmidt-Trucksäss A, Schuuring MJ, Simova I, Svennberg E, Verstrael A, Lumens J. ESC working group on e-cardiology position paper: use of commercially available wearable technology for heart rate and activity tracking in primary and secondary cardiovascular prevention-in collaboration with the European Heart Rhythm Association, European Association of Preventive Cardiology, Association of Cardiovascular Nursing and Allied Professionals, Patient Forum, and the Digital Health Committee. Eur Heart J Digit Health 2021; 2:49-59. [PMID: 36711174 PMCID: PMC9753086 DOI: 10.1093/ehjdh/ztab011] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/11/2021] [Accepted: 02/04/2021] [Indexed: 02/01/2023]
Abstract
Commercially available health technologies such as smartphones and smartwatches, activity trackers and eHealth applications, commonly referred to as wearables, are increasingly available and used both in the leisure and healthcare sector for pulse and fitness/activity tracking. The aim of the Position Paper is to identify specific barriers and knowledge gaps for the use of wearables, in particular for heart rate (HR) and activity tracking, in clinical cardiovascular healthcare to support their implementation into clinical care. The widespread use of HR and fitness tracking technologies provides unparalleled opportunities for capturing physiological information from large populations in the community, which has previously only been available in patient populations in the setting of healthcare provision. The availability of low-cost and high-volume physiological data from the community also provides unique challenges. While the number of patients meeting healthcare providers with data from wearables is rapidly growing, there are at present no clinical guidelines on how and when to use data from wearables in primary and secondary prevention. Technical aspects of HR tracking especially during activity need to be further validated. How to analyse, translate, and interpret large datasets of information into clinically applicable recommendations needs further consideration. While the current users of wearable technologies tend to be young, healthy and in the higher sociodemographic strata, wearables could potentially have a greater utility in the elderly and higher-risk population. Wearables may also provide a benefit through increased health awareness, democratization of health data and patient engagement. Use of continuous monitoring may provide opportunities for detection of risk factors and disease development earlier in the causal pathway, which may provide novel applications in both prevention and clinical research. However, wearables may also have potential adverse consequences due to unintended modification of behaviour, uncertain use and interpretation of large physiological data, a possible increase in social inequality due to differential access and technological literacy, challenges with regulatory bodies and privacy issues. In the present position paper, current applications as well as specific barriers and gaps in knowledge are identified and discussed in order to support the implementation of wearable technologies from gadget-ology into clinical cardiology.
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Affiliation(s)
| | - Roderick W Treskes
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Enrico G Caiani
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Via Ponzio 34/5, 20133 Milan, Italy,National Council of Research, Institute of Electronics, Information and Telecomunication Engineering, Milan, Italy
| | - Ruben Casado-Arroyo
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - Martin R Cowie
- Department of Cardiology, Royal Bromptom Hospital, Sydney St, Chelsea, London SW3 6NP, UK
| | - Polychronis Dilaveris
- Department of Cardiology, Hippokration Hospital, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - David Duncker
- Department of Cardiology and Angiology, Hannover Heart Rhythm Center, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Marco Di Rienzo
- Department of Biomedical Technology, IRCCS Fondazione Don Carlo Gnocchi, 20121 Milano, Italy
| | - Ines Frederix
- Department of Cardiology, Jessa Hospital, Salvatorstraat 20, 3500 Hasselt, Belgium,Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegm, Belgium,Faculty of Medicine & Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium,Faculty of Medicine & Health Sciences, Antwerp University, Campus Drie Eiken, Building S, Universiteitsplein 1, 2610 WILRIJK, Antwerp, Belgium
| | - Natasja De Groot
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Philippe H Kolh
- Department of Cardiovascular Surgery, University Hospital Liege, Quai Paul van Hoegaerden 2, 4000 Liege, Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Dominee Theodor Fliednerstraat 1, 5631 BM Eindhoven, The Netherlands,Department of Industrial Design, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Mamas Mamas
- Academic Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Newcastle Rd, Stoke-on-Trent ST4 6QG, UK
| | - Paul McGreavy
- ESC Patient’s Platform, European Society of Cardiology, Sophia Antipolis Cedex, France
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Ct, Edinburgh EH11 4BN, UK
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca & Istituto Auxologico Italiano, IRCCS, Piazza dell'Ateneo Nuovo, 1, 20126 Milano MI, Italy,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Piazzale Brescia 20, Milano, Italy
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University Hosptial, EA-blocket, 221 85 Lund, Sweden
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Mark J Schuuring
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Iana Simova
- Cardiology Clinic, Heart and Brain—University Hospital, One, G. M. Dimitrov Blvd. Sofia 1172, Pleven, Bulgaria
| | - Emma Svennberg
- Department of Cardiology, Karolinska University Hospital, Anna Steckséns gata 41, 171 64 Solna, Stockholm, Sweden,Department of Clinical Sciences Danderyd University Hospital, 171 77 Stockholm, Sweden
| | - Axel Verstrael
- ESC Patient’s Platform, European Society of Cardiology, Sophia Antipolis Cedex, France
| | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Duboisdomein 30, 6229 GT Maastricht, the Netherlands
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